Australian Public Research Articles

Treatment of pemphigus in Australia: Aligning current practises with global recommendations.

Pemphigus encompasses of a group of rare, and often severe, intraepidermal bullous dermatoses that are mediated by autoantibodies that act against adhesion proteins of the desmosome. The current international consensus is that the use of intravenous CD20 inhibitors should be first-line in the management of moderate-to-severe cases of pemphigus, however Australia is yet to adopt this. Systemic corticosteroids, combined with conventional corticosteroid-sparing immunosuppressive agents such as azathioprine, mycophenolate mofetil, cyclosporin and methotrexate is still recommended as first-line therapy in Australia despite overwhelming evidence that combining rituximab with a rapid corticosteroid tapering regime is more effective in the treatment of moderate-to-severe pemphigus, and leads to fewer severe adverse effects. We propose a therapeutic approach that echoes the international consensus and recommend that rituximab, an anti-CD20 monoclonal antibody, be listed in the formularies of Australian Public Hospitals and on the Pharmaceutical Benefits Schemefor use in moderate to severe pemphigus.

Effects of a Mindfulness App on Employee Stress in an Australian Public Sector Workforce: Randomized Controlled Trial.

BackgroundWorkplace-based mindfulness programs have good evidence for improving employee stress and mental health outcomes, but less is known about their effects on productivity and citizenship behaviors. Most of the available evidence is derived from studies of mindfulness programs that use class-based approaches. Mindfulness apps can increase access to training, but whether self-directed app use is sufficient to realize benefits equivalent to class-based mindfulness programs is unknown.ObjectiveWe assessed the effectiveness of a mindfulness app, both with and without supporting classes, for reducing employees’ perceived stress. Changes in mindfulness, mental health, quality of life, perceptions of job demand, control and support, productivity indicators, organizational citizenship, and mindful behaviors at work were also investigated.MethodsTasmanian State Service employees were invited by the Tasmanian Training Consortium to a 3-arm randomized controlled trial investigating the effects of a mindfulness app on stress. The app used in the Smiling Mind Workplace Program formed the basis of the intervention. The app includes lessons, activities, and guided meditations, and is supported by 4 instructional emails delivered over 8 weeks. Engagement with the app for 10-20 minutes, 5 days a week, was recommended. Reported data were collected at baseline (time point 0), 3 months from baseline (time point 1 [T1]), and at 6-month follow-up (time point 2). At time point 0, participants could nominate a work-based observer to answer surveys about participants’ behaviors. Eligible participants (n=211) were randomly assigned to self-guided app use plus four 1-hour classes (app+classes: 70/211, 33.2%), self-guided app use (app-only: 71/211, 33.6%), or waitlist control (WLC; 70/211, 33.2%). Linear mixed effects models were used to assess changes in the active groups compared with the WLC at T1 and for a head-to-head comparison of the app+classes and app-only groups at follow-up.ResultsApp use time was considerably lower than recommended (app+classes: 120/343 minutes; app-only: 45/343 minutes). Compared with the WLC at T1, no significant change in perceived stress was observed in either active group. However, the app+classes group reported lower psychological distress (β=−1.77, SE 0.75; P=.02; Cohen d=–0.21) and higher mindfulness (β=.31, SE 0.12; P=.01; Cohen d=0.19). These effects were retained in the app+classes group at 6 months. No significant changes were observed for the app-only group or for other outcomes. There were no significant changes in observer measures at T1, but by time point 2, the app+classes participants were more noticeably mindful and altruistic at work than app-only participants.ConclusionsIncluding classes in the training protocol appears to have motivated engagement and led to benefits, whereas self-guided app use did not realize any significant results. Effect sizes were smaller and less consistent than meta-estimates for class-based mindfulness training.Trial RegistrationAustralian New Zealand Clinical Trials Register ACTRN12617001386325; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372942&isReview

Serving Their Communities: An Analysis of Australian Public Library Mission Statements

To understand the roles that Australian public libraries are aiming to play in their communities, mission statements from a sample of fifty public library networks were extracted from their corporate documents and subjected to both quantitative and qualitative content analysis. The five broader roles most commonly articulated were to facilitate learning and discovery, to increase social connectedness, to provide spaces and places, to provide access to information and resources, and to facilitate inclusion and celebrate diversity. Overall, the mission of Australian public libraries focuses more on learning and community building than on their traditional function of information access provision.

Australian Public Universities Vice-Chancellor Salaries and Workforce Casualisation: Ethical Tension?

International online peer-reviewed open-access journal offers a possibility for the international community of professionals working in the fields of regional and rural development or tourism to exchange their ideas and research results or practical achievements as it publishes results of both theoretical and applied research in these fields.

Australian Public Perspectives on Genomic Data Storage and Sharing: Benefits, Concerns and Access Preferences

Australian Public Perspectives on Genomic Data Storage and Sharing: Benefits, Concerns and Access Preferences

Balancing Impartiality and Free Speech: An Empirical Study of ‘On the Ground’ Experiences of Australian Public Servants

Balancing Impartiality and Free Speech: An Empirical Study of ‘On the Ground’ Experiences of Australian Public Servants

Rates of Low-Value Service in Australian Public Hospitals and the Association With Patient Insurance Status

Low-value services have limited or no benefit to patients. Rates of low-value service in public hospitals may vary by patient insurance status, given that there may be different financial incentives for treatment of privately insured patients. To assess the variation in rates of 5 low-value services performed in Australian public hospitals according to patient funding status (ie, private or public). This retrospective cross-sectional study analyzed New South Wales public hospital data from January 2013 to June 2018. Patients included in the sample were over age 18 years and eligible to receive low-value services based on diagnoses and concomitant procedures. Data analysis was conducted from June to December 2020. Hospital-specific rates of low-value knee arthroscopic debridement, vertebroplasty for osteoporotic spinal fractures, hyperbaric oxygen therapy, oophorectomy with hysterectomy, and laparoscopic uterine nerve ablation for chronic pelvic pain were measured. For each measure, rates within each public hospital were compared by patient funding status descriptively and using multilevel models. A total of 219 862 inpatients were included in analysis from 58 public hospitals across the 5 measures. A total of 38 365 (22 904 [59.7%] women; 12 448 [32.4%] aged 71-80 years) were eligible for knee arthroscopic debridement for osteoarthritis; 2520 (1924 [76.3%] women; 662 [26.3%] aged 71-80 years), vertebroplasty for osteoporotic spinal fractures; 162 285 (82 046 [50.6%] women; 28 255 [17.4%] aged 61-70 years), hyperbaric oxygen therapy; 15 916 (7126 [44.8%] aged 41-50 years), oophorectomy with hysterectomy; and 776 (327 [42.1%] aged 18-30 years), uterine nerve ablation for chronic pelvic pain. Overall rates of low-value services varied considerably between measures, with the lowest rate for hyperbaric oxygen therapy (0.3 procedures per 1000 inpatients [47 of 158 220 eligible inpatients]) and the highest for vertebroplasty (30.8 procedures per 1000 eligible patients [77 of 2501 eligible inpatients]). There was significant variation in rates between hospitals, with a few outlying hospitals (ie, <10), particularly for knee arthroscopy (range from 1.8 to 21.0 per 1000 eligible patients) and vertebroplasty (range from 13.1 to 70.4 per 1000 eligible patients), with higher numerical rates of low-value services among patients with private insurance than for those without. However, there was no association overall between patient insurance status and low-value services. Overall differences in rates among those with and without private insurance by individual procedure type were not statistically significant. There was significant variation in rates of low-value services in public hospitals. While there was no overall association between private insurance and rate of low-value services, private insurance may be associated with low-value service rates in some hospitals. Further exploration of factors specific to local hospitals and practices are needed to reduce this unnecessary care.

Achieving career satisfaction through fostering innovation: lessons from the engineering profession in the Australian public sector

AbstractThis paper proposes a novel approach that integrates the capability of empirical validation of structural equation modelling (SEM) and the prediction ability of Bayesian networks (BN). The Hybrid SEM–BN approach was used as a decision support framework to examine the interplay between salient organisational constructs and their ability to influence engineers’ career satisfaction in the Australian Public Service (APS). The results emphasise that the ambidextrous culture for innovation was the most important factor that needed to be implemented in their organisation. Managerial implications are recommended for senior managers on how they can implement innovation culture to increase workplace innovation, which could, in turn, help reduce the turnover rate of engineers employed in the APS.

Innovation Hubs in Australian Public Universities: An Appraisal of Their Public Value Claims

ABSTRACT The past decade has witnessed an increased presence of innovation hubs in Australian public universities. This has occurred against a backdrop of public universities, as public institutions, being expected to create value for their host nation. However, the types of public value that such hubs are aiming to create is not altogether clear. Using the theoretical prism of a priori public value, this study examines how the innovation hubs of Australian public universities are proposing to create public value. After establishing a working definition of ‘innovation hub’ in the context of public universities, a thematic analysis of their websites was undertaken to examine how they are positioning themselves with regard to realizing public value. Such an analysis assists with establishing what types of public value they allude to online, and sheds light on how Australian public universities are using innovation hubs to differentiate themselves in an increasingly crowded innovation landscape.

Sepsis epidemiology in Australian Public Hospitals, a nationwide longitudinal study (2013-2018)

Introduction: Sepsis is a life-threatening condition that contributes considerably to the global burden of disease in the population. This study aimed to determine the incidence and mortality of sepsis in Australian public hospitals and to investigate variations in sepsis incidence and mortality.Methods: Patients admitted to 739 Australian public hospitals from 2013-14 to 2017-18 were included in this study. Sepsis patients were identified based on the recorded diagnosis codes. Age standardised sepsis incidence and mortality rates were calculated. Generalised estimating equations were applied to examine changes in mortality rates over time.Results: Among 23,827,061 hospitalisations, 437,354 (1.8%) had a coded diagnosis of sepsis and 12.0% of these sepsis patients (n=52,297) died in hospital, which was 11 times higher than non-sepsis patients (1.1%). Overall age standardised sepsis incidence was 1,162.8 cases/100,000 population. Despite the increase in sepsis incidence over the study period, sepsis mortality rates remained relatively stable after adjusting for relevant risk factors and hospital clustering. The youngest patients experienced the highest sepsis incidence rate. Those living in very remote areas were hospitalised for sepsis at around 1.7 times the rate as those living in major cities. The sepsis incidence rate among Indigenous people was also 1.7 times higher than among other Australians.Conclusion: This is the first national study on hospitalisations and in-hospital deaths associated with sepsis across all Australian public hospitals. Despite an increase in awareness and clinical initiatives related to sepsis, it remains a significant health problem that affects certain groups in the population more than others. Introduction: Sepsis is a life-threatening condition that contributes considerably to the global burden of disease in the population. This study aimed to determine the incidence and mortality of sepsis in Australian public hospitals and to investigate variations in sepsis incidence and mortality. Methods: Patients admitted to 739 Australian public hospitals from 2013-14 to 2017-18 were included in this study. Sepsis patients were identified based on the recorded diagnosis codes. Age standardised sepsis incidence and mortality rates were calculated. Generalised estimating equations were applied to examine changes in mortality rates over time. Results: Among 23,827,061 hospitalisations, 437,354 (1.8%) had a coded diagnosis of sepsis and 12.0% of these sepsis patients (n=52,297) died in hospital, which was 11 times higher than non-sepsis patients (1.1%). Overall age standardised sepsis incidence was 1,162.8 cases/100,000 population. Despite the increase in sepsis incidence over the study period, sepsis mortality rates remained relatively stable after adjusting for relevant risk factors and hospital clustering. The youngest patients experienced the highest sepsis incidence rate. Those living in very remote areas were hospitalised for sepsis at around 1.7 times the rate as those living in major cities. The sepsis incidence rate among Indigenous people was also 1.7 times higher than among other Australians. Conclusion: This is the first national study on hospitalisations and in-hospital deaths associated with sepsis across all Australian public hospitals. Despite an increase in awareness and clinical initiatives related to sepsis, it remains a significant health problem that affects certain groups in the population more than others.

Suresh Narayanan Comment on Wage Differentials in Malaysia: Public Employment, Gender, and Ethnicity

Suresh Narayanan Comment on Wage Differentials in Malaysia: Public Employment, Gender, and Ethnicity

Should Digital Contact Tracing Technologies be used to Control COVID-19? Perspectives from an Australian Public Deliberation.

Mobile phone-based applications (apps) can promote faster targeted actions to control COVID-19. However, digital contact tracing systems raise concerns about data security, system effectiveness, and their potential to normalise privacy-invasive surveillance technologies. In the absence of mandates, public uptake depends on the acceptability and perceived legitimacy of using technologies that log interactions between individuals to build public health capacity. We report on six online deliberative workshops convened in New South Wales to consider the appropriateness of using the COVIDSafe app to enhance Australian contact tracing systems. All groups took the position (by majority) that the protections enacted in the app design and supporting legislation were appropriate. This support is contingent on several system attributes including: the voluntariness of the COVIDSafe app; that the system relies on proximity rather than location tracking; and, that data access is restricted to local public health practitioners undertaking contact tracing. Despite sustained scepticism in media coverage, there was an underlying willingness to trust Australian governing institutions such that in principle acceptance of the new contact tracing technology was easy to obtain. However, tensions between the need to prove system effectiveness through operational transparency and requirements for privacy protections could be limiting public uptake. Our study shows that informed citizens are willing to trade their privacy for common goods such as COVID-19 suppression. But low case numbers and cautionary public discourses can make trustworthiness difficult to establish because some will only do so when it can be demonstrated that the benefits justify the costs to individuals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10728-021-00441-1.

Fear of missing out? Linking workplace changes and presenteeism

AbstractWhy do employees continue to work during illness? So‐called presenteeism behaviour is a topic of great managerial and societal importance as it is connected to a series of negative individual and organisational outcomes. A growing body of research points to the importance of workplace factors in shaping employee stress and uncertainty and, ultimately, presenteeism behaviour. Curiously though, the impact of workplace changes on presenteeism behaviour has not been examined, even though the potential stress‐inducing effects of such change are well‐recognised. Building on a data set from the Australian Public Service, we examine how workplace changes are related to presenteeism behaviour. Our findings show that workplace changes generally provoke presenteeism behaviour. Specifically, cutback‐related changes appear to cause presenteeism. This finding is relevant in times when many organisations are confronted with major budget cuts.Brief summaryThis article explores the link between working during illness, or presenteeism behaviour, and workplace changes. Presenteeism behaviour is a topic of great managerial and societal importance as it is connected to a series of negative individual and organisational outcomes. A growing body of research points to the importance of workplace factors in shaping employee stress and uncertainty and, ultimately, presenteeism behaviour. Curiously though, the impact of workplace changes on presenteeism behaviour has not been examined, even though the potential stress‐inducing effects of such change are well‐recognised. Building on a data set from the Australian Public Service, we examine how workplace changes are related to presenteeism behaviour. Our findings show that workplace changes generally provoke presenteeism behaviour. Specifically, cutback‐related changes appear to cause presenteeism. This finding is relevant in times when many organisations are confronted with major budget cuts. Employees who experience workplace changes are more likely to go to work sick. Decreased staffing (cutback‐related change) is the main driver of presenteeism behaviour. Presenteeism is higher among employees working harder and longer hours – that is performing overtime, likely for the purpose of meeting high job demands. Fairness of pay reduces the likelihood of presenteeism. The findings suggest that although change itself is unavoidable and even necessary for organisations adapting to external demands, the potentially negative effects of change may be mitigated by appropriate change management and structures.

'Waiting with Bated Breath'

'Waiting with Bated Breath'

A stakeholder perspective on public sector innovation: Linking the target groups of innovations to the inclusion of stakeholder ideas

Public sector innovation scholarship has not yet systematically explored how the target context (or output phase) of innovations impacts the early phases of innovation processes. This study theorizes and tests whether innovating organizations are more sensitive to ideas from particular stakeholder groups depending on the target group of said innovation. Using a large-scale dataset from the Australian Public Service, the results show that innovations with external target groups are more likely to be built on ideas from external stakeholders (compared with internal stakeholders) and—within the group of internal stakeholders—on ideas from managers (compared with non-managerial employees). Practical and scholarly implications are discussed.Points for practitioners: Innovations benefit from the inclusion of internal and external stakeholder ideas, both substantively (appropriate knowledge leads to better end products) and symbolically (innovations need to be deemed legitimate, and receive support from the actors that will be primarily impacted by the innovation). Innovating organizations need to be aware of the perceptions of the stakeholders affected by the innovation, and properly sense, capture and translate the ideas of those stakeholders in the innovation process.

Evaluation of Research Capacity and Culture of Health Professionals Working with Women, Children and Families at an Australian Public Hospital: A Cross Sectional Observational Study.

BackgroundThere is limited evidence for use of the Research Capacity and Culture tool across multidisciplinary health professionals. We explored using the Research Capacity and Culture tool among multidisciplinary health professionals at an Australian secondary hospital.MethodsA cross-sectional observational study where online and paper-based surveys of the Research Capacity and Culture tool were disseminated between November 2020 and January 2021. Descriptive analyses of demographic variables and Likert scale items were summarized using median and inter-quartile ranges. Differences between organization, team and individual domains were checked using a Friedman test. Post-hoc Wilcoxon signed rank tests determined specific differences between domains.ResultsSeventy-six multidisciplinary health professionals (female, 89.3%) reported overall perceptions of research success/skills highest in the organization (median 6), followed by the team (median 5) and individual domains (median 3.5). Only 21.3% agreed that research activities were a part of their role description. Mean scores across professions were highest for Medicine (5.47), Midwifery (4.52), Nursing (4.47) and Allied Health (3.56), respectively, for the team domain. Individual domain scores across all professions were below 50%. Commonly reported barriers to research were “lack of time for research,” “other work roles taking priority” and “a lack of skill.” “Developing skills” was the most common personal motivator.ConclusionMultidisciplinary health professionals reported the highest overall perception of research success/skills in the organization domain. Medical health professionals perceived research success/skills highest compared to nursing, midwifery and allied health professionals.

Challenges for Public Sector Organisations in Cloud Adoption: A Case Study of South Australian Public Sector Agency

This research explores critical aspects of procurement of ICT cloud services for South Australian public sector organisations with the case of South Australia Police (SAPOL) for evaluation. SAPOL as one of the state government agencies at the time is initiating this transition to the cloud environment. This exploratory research takes place when this public sector agency is doing its due diligence to ensure a successful implementation. In this study the researcher started off with surfacing the challenges in this journey for a public sector organisation before the actual journey commenced. SAPOL being a public sector organisation operates differently from private enterprises and has certain constraints and limitations that pose additional challenges for the organisation to transition towards the cloud. Interview with the CIO of the organisation responsible for the cloud migration initiative was organised. After detailed literature review, an interview questionnaire was prepared in accordance with the subject of interest. The information gathered in the interviews was recorded for detailed analysis. This paper contains a detailed report on the information analysed highlighting fourteen important challenges faced by the organisation in this cloud migration journey.

An exploration of public libraries as dementia friendly places

Dementia can be a lonely, stigmatising and isolating illness. People living with dementia and their carers want to remain connected with their local communities and feel safe, welcome and valued. A growing community awareness of dementia has borne the concept of dementia friendliness and dementia friendly communities.Core features of dementia friendly communities are supportive, inclusive, welcoming and safe environments. Public libraries are widely valued as safe, accessible and welcoming community assets and in this sense are well placed to be part of dementia friendly communities. This study has sought to understand how publiclibraries contribute to Australian dementia friendly communities. A mixed methods approach with a sequential exploratory design was employed to answer two distinct questions: firstly, how are individual needs of patrons living with dementia and their carers being met; and second, is there alignment between dementia friendly public libraries and the ALIA Framework for Australian Public Libraries. From a review of international and Australian literature, features of dementia friendly public libraries were codified along two facets—services and enabling environments.&#x0D; This study found that dementia friendly public libraries offered a suite of services and enabling environments that benefit people living with dementia and their carers. Collectively, they enable social capital and contribute to personal development and wellbeing, informed and connected citizens, and ultimately stronger more inclusive communities—achieving five of the six ALIA outcome measures. Public libraries located in dementia friendly communities provided similar benefits, although some inconsistencies were evident with a shift to age-friendliness. Dementia friendliness is a reflective movement and public libraries in dementia friendly communities must continue to respond to the needs of that community. There was an absence of strategic planning by the public libraries assessed to provide for such need, and thus targeted, collaborative planning could be considered to enhance dementia friendliness and inclusivity.

The Impact of Coronavirus on Australian Public Sector Employees

The COVID-19 pandemic has affected the lives of billions of people around the world in many ways. This study aims to examine how the lockdowns implemented in Australia have affected public sector employees working from their homes as well as examining if the level of trust between managers and their employees has changed. A qualitative research study was conducted with 60 Australian public sector employees. The findings indicate that teamwork and individual learning outcomes were altered. This research contributes to the body of knowledge surrounding the mechanisms used to cope with the changes and the effects on employee productivity.

Fear and Greed: Australian Public Opinion Towards China's Rise*

The gradual transformation of Australia's relationship with Asia over the past half century has been accompanied by major shifts in public opinion. These changes have been prompted by numerous changes in the social composition of the electorate, by globalisation which has brought many foreign firms to Australia, and by the political elite's changing approach to engagement with Asia. There is, however, considerable elite anxiety concerning the economic and military rise of China, and these concerns are expressed in public debate and attitudes. Using opinion surveys collected over half a century, the first part of this article examines the trends emerging from debates over Australia's economic and political relationship with China. In the second part, we use the 2018 and 2020 Lowy Polls to explain who changed their views of China and why. The results suggest that the dramatic shift in attitudes towards China between 2018 and 2020 was mainly driven by concerns about foreign influence in Australian politics. Overall, public opinion towards China has become more polarised, between economic opportunity on the one hand and fear of an authoritarian neighbour on the other.