University of the Sunshine Coast
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Understanding work-as-done in the ED: New approaches to addressing the challenges of patient flow
No full textBackground: Patient flow through the emergency department (ED) is a key hospital performance measure, determined by factors including the volume of patients arriving to be seen, the time taken to assess and treat patients, and availability of beds in hospital wards. To develop strategies to improve patient flow, we need to better understand work-as-done in the ED, including the constraints that bound potential solutions. Objectives: Using Cognitive Work Analysis (CWA) and Functional Resonance Analysis Method (FRAM), the study aimed to develop an in-depth understanding of patient flow problems within the ED and identify potential sustainable patient flow interventions. Methods: Publicly available documents (e.g., policies, guidelines), and 263 h of observations in a tertiary public hospital ED were reviewed, thematically analysed and modelled. Results: CWA and FRAM models identified differences between work-as-imagined in the ED compared with work-as-done. Analyses identified workplace constraints, potential modifications (e.g., multiple communication pathways) and impediments (e.g., IT system speed and maintenance practices) to maintain safe and timely care. Areas for process improvement include communication, administration, equipment and stakeholder engagement. Conclusions: A comprehensive, systematic and contextual description of the ED system was developed for the first time, illustrating the complexity and resilience of an ED with multiple measures, functions, capabilities and physical resource limitations. Using the CWA and FRAM, improvement recommendations can be generated that take into account the contextual information of the wider system. These findings have significant implications for designing interventions to align work-as-imagined and work-as-done in ED to support and improve patient safety
The Effect of Sea Cucumber Extract (Holothuria scabra) on the Proliferation of Human Placenta Derived Mesenchymal Stromal Cells
No full textBackground: The sea cucumber, Holothuria scabra, is an economically important aquatic species. They have received considerable attention because of their self-regeneration ability. They may contain numerous growth factors necessary to drive the proliferation and differentiation of stem cells for tissue maintenance. The knowledge of regenerative process, including the factors that regulate this process, may provide a new treatment option for degenerative diseases in human.
Objective: The present study focused on the effects of sea cucumber extract (H. scabra) on the proliferation of mesenchymal stromal cells (MSCs) derived from human placenta.
Materials and Methods: The H. scabra crude protein extracts were prepared from the body wall (BW) and viscera (VI) using 0.1 M phosphate buffer saline (PBS) and 0.1M acetic acid buffers. MSCs were isolated from the human placenta using enzyme digestion. The effects of H. scabra extracts on cytotoxicity and MSC proliferation were evaluated using MTT assay and cell counting, respectively.
Results: The SDS-PAGE showed abundance of proteins in the BW and VI extracts using 0.1M PBS buffer. Less abundant proteins were observed in the tissues extract using 0.1M acetic acid buffer. However, proteins with molecular weight of ~38 kDa and ~17 kDa were highly detected in BW. The H. scabra protein extracts at low doses did not show any toxicity to PL-MSCs, moreover they could increase the cell number at the range of 0.01 μg/ml to 25 μg/ml. The treatment of 0.1 and 1 μg/ml of H. scabra extracts increased the proliferative rate of MSCs when compared with control.
Conclusion: These results obtained an in vitro proliferative potency of the H. scabra extracts on MSCs derived from human placenta. While further studies are required, this finding has provided the evidence that the sea cucumber extracts could be potentially used to induce in vitro MSC proliferation
Upscaling Collaborative Crisis Management: A Comparison of Wildfire Responder Networks in Canada and Sweden
No full textOne recurrent challenge during major crises and emergencies is how to effectively scale up the response. This involves efforts to expand the number of organizations involved to ensure access to resources, coordination of information and decisions, and joint actions to minimize costs and risks and to restore order. At the same time, upscaling requires difficult decisions about the timing and proper design of crisis responder organizations. In addition, it is generally challenging to orchestrate collaboration among diverse actors from different organizations with different cultures, missions, and experiences. This chapter demonstrates the dynamics of upscaling during two major wildfires in Canada (Fort McMurray, 2016) and Sweden (Västmanland, 2014). We detail the course of events leading up to the activation of joint crisis response organizations and shed light on the formal process of upscaling, how upscaling played out in practice, and how actors perceived performance. The comparison between the two cases demonstrates that although crisis management in Canada and Sweden is organized in different ways, similar challenges emerged in relation to upscaling. We find that differences in perceptions of the situation and divergent beliefs about the sufficiency of local capacities lead to different understandings of the necessity and timing of upscaling
Palliative care in the context of immune and targeted therapies: A qualitative study of bereaved carers’ experiences in metastatic melanoma
No full textBackground: Immune and targeted therapies continue to transform treatment outcomes for those with metastatic melanoma. However, the role of palliative care within this treatment paradigm is not well understood.
Aim: To explore bereaved carers’ experiences of immune and targeted therapy treatment options towards end of life for patients with metastatic melanoma.
Design: An interpretive, qualitative study using a social constructivist framework was utilised. Interviews were recorded, transcribed and analysed using grounded theory methods.
Setting/participants: Participants (n = 20) were bereaved carers of patients who had received some form of immune and/or targeted therapy at one of three Australian metropolitan melanoma treatment centres.
Results: Carers struggled to reconcile the positive discourse around the success of immune and targeted therapies in achieving long-term disease control, and the underlying uncertainty in predicting individual responses to therapy. Expectations that immune and targeted therapies necessarily provide longer-term survival were evident. Difficulty in prognostication due to clinical uncertainty and a desire to maintain hope resulted in lack of preparedness for treatment failure and end of life.
Conclusion: Immune and targeted therapies have resulted in increased prognostic challenges. There is a need to engage, educate and support patients and carers to prepare and plan amid these challenges. Educational initiatives must focus on improving communication between patients, carers and clinicians; the differences between palliative and end-of-life care; and increased competency of clinicians in having goals-of-care discussions. Clinicians must recognise and communicate the benefit of collaborative palliative care to meet patient and family needs holistically and comprehensively
The influence of current food and nutrition trends on dietitians' perceptions of the healthiness of packaged food
No full textOBJECTIVE: To investigate the influence of current food and nutrition trends on dietitians' perceptions of the healthiness of packaged foods.
DESIGN: This observational study used a cross-sectional survey. Participants rated (strongly disagree to strongly agree) the extent to which a range of factors, independent of the energy, nutrient and ingredient content, influenced their perceptions of the healthiness of packaged foods. Two open-ended questions allowed for participants to list additional items they considered important.
SETTING: Online survey.
PARTICIPANTS: Australian dietitians (n 117).
RESULTS: The greatest consensus was a positive influence of the fit within the core food groups and presence of seasonal ingredients, and a negative influence of an increasing number of additives. Mixed opinions were obtained for GM ingredients, locally sourced ingredients, labelling of animal welfare and organic certification. Nutritional indicators received a split where almost half of participants disagreed/strongly disagreed that they positively influenced their perception of healthiness. Content analysis of open-ended responses (n 53, 45 %) revealed four broad categories as important in considering healthiness: 'a whole food approach', 'marketing and labelling', 'product information' and 'context of diet'. A small number of responses (count of 6, 5 %) reported that packaging, advertising and features such as celebrity endorsement were a negative influence.
CONCLUSIONS: Dietitians have a broad concept of the healthiness of packaged foods, which incorporates elements of food safety, wholeness of the ingredients and marketing. Providing unified messages to the consumer can help to build the public perception of dietitians as experts in nutrition advice and counselling
Auditory Event-Related Potentials in Individuals with Subjective and Mild Cognitive Impairment
No full textNo abstract available
Above-ground biomass recovery following logging and thinning over 46 years in an Australian tropical forest
No full textManaged tropical forests are a globally important carbon pool, but the effects of logging and thinning intensities on long-term biomass dynamics are poorly known. We investigated the demographic mechanisms of above-ground biomass recovery over 48 years in an Australian tropical forest following four silvicultural treatments: selective logging only as a control and selective logging followed by low-, medium- and high-intensity thinning. Initial biomass recovery rates following thinning were poor predictors of the long-term changes. Initial biomass recovery from 1969 to 1973 was slow and was largely concentrated on an increase in the biomass of residual stems. From 1973 to 1997, above ground biomass (AGB) increased almost linearly, with a similar slope for all sites. From 1997 to 2015, the rate of biomass accumulation slowed, especially for the L treatment. All thinning treatments stimulated more recruitment and regrowth of non-harvested remaining trees compared to the untreated control. Biomass at both the low and medium intensity treatments has almost fully recovered to within 98% and 97% of pre-logging biomass levels respectively. The predicted times of complete above-ground biomass recovery for the logging only and high intensity treatments are 55 and 77 years respectively. The slower biomass recovery at the logging only site was largely due to increased mortality in the last measurement period. The slower recovery of the high intensity site was due to a combination of a higher initial reduction in biomass from thinning and the increased mortality in the last measurement period. The high mortality rates in the most recent measurement period are likely due to the impacts of two cyclones that impacted the study site. Our results suggest that sustainable cutting cycles in this site need to be at least 50 years, which is much longer that many of the cutting cycles currently used in tropical forest management
Franchisee Advisory Councils and Justice: franchisees finding their voice
No full textNo abstract available
Breathing Room
No full textThis chapter is a collective autoethnography that reveals the messiness and fractured identities of (non)mothers and (non)researchers in and out of academic contexts. Luce Irigaray’s writing on breath, interiority and autonomy brings together the reflections. In Between East and West, Irigaray (2002) has learnt “the importance of breathing in order to survive, to cure certain ills, and to attain detachment and autonomy” (p. 10). She explores “a sexuation of breathing” as a woman “by practicing, by listening (to myself), by reading, by awakening myself” (2002, p. 10). Collectively, the stories in this chapter reveal living with and letting go of the demands of academia and the complexities of caring for selves and others
(Re)Claiming Our Soulful Intuitive Lives: Initiating Wildish Energy into the Academy Through Story, Dreaming and Connecting with Mother Earth
No full textAcademia is narrowly focused on finite games and never-ending pursuits of competing, achieving and proving one’s worth. In this chapter, the authors ponder the risk of serving the function of academia’s patriarchal structures. They seek to move beyond lamenting and engage in containment to assert their intuition and attend to their wild, infinite and instinctual natures. In this chapter, the authors tap into their power as women and engage in writing/not-writing to support their wild, receptive and embodied ways of knowing and sensing. They bundle together their stories and dreaming and engage in processes of calling, bearing witness and responding to each other. This freedom in writing becomes a resource for listening, for ‘doing academia differently’ and for clarifying what is most important to them