Arc flash protection of a low voltage motor control centre

This dissertation seeks to investigate the arc flash hazard incident energy levels throughout the section of the power network that includes the Low Voltage Motor Control Centre (MCC) P6512 at Cristal Pigment Australia’s Kemerton Plant, in Western Australia. It involved researching common industry practice for arc flash hazard studies, and following the requirements set out in the NFPA 70E (2012) and IEEE 1584 (2002) standards. An audit of all associated plant and equipment was carried out. The power network of the plant was modelled, and a short-circuit evaluation conducted. The network’s protection was studied to establish whether it provided the necessary protection/coordination between devices. Finally, with the aid of arc flash analysis calculation software (‘Power Tools for Windows’), the arc flash study was conducted. The result of this research has shown that the most dangerous location within the power network is the wiring (and connections) between the low voltage terminals of the MCC 22kV/415VAC supply transformer and the main Air Circuit Breaker (ACB) of the MCC. This is due to the location and type of the upstream protective device in use (i.e. a 22kV fuse upstream of the HV termination of the transformer). When calculated, the clearing time of this fuse was found to be greater than 14 seconds, by which time life could be lost and irreparable damage would occur. It is recommended that this 22kV fuse should be replaced with a circuit breaker and relay. Calculations showed this could potentially reduce the clearing time to less than 0.75 seconds (an arc flash hazard/risk category of 3). A further recommendation would be to also incorporate an optical arc flash detection system, which could reduce this clearing time even further (to an arc flash hazard/risk category of 1)

Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study

BACKGROUND: In response to the escalating burden of chronic illness in Australia, recent health policies have emphasised the promotion of patient self-management and better preventive care. A notable omission from these policies is the acknowledgment that patients with chronic illness tend to have co-morbid conditions. Our objectives were: to identify the common challenges co-morbidity poses to patients and carers in their experiences of self-management; to detail the views and perceptions of health professionals about these challenges; and to discuss policy options to improve health care for people with co-morbid chronic illness. The method included semistructured interviews and focus groups with 129 purposively sampled participants. Participants were people with Type 2 diabetes, chronic obstructive pulmonary disease and/or chronic heart failure as well as carers and health care professionals. Content analysis of the interview data was conducted using NVivo7 software. RESULTS: Patients and their carers found co-morbidity influenced their capacity to manage chronic illness in three ways. First, co-morbidity created barriers to patients acting on risk factors; second, it complicated the process of recognising the early symptoms of deterioration of each condition, and third, it complicated their capacity to manage medication. CONCLUSION: Findings highlight challenges that patients with multiple chronic conditions face in relation to preventive care and self-management. Future clinical policy initiatives need to move away from single illness orientation toward strategies that meet the needs of people with co-morbid conditions and strengthen their capacity to self-manage. These patients will benefit directly from specialised education and services that cater to the needs of people with clusters of co-morbidities.NHMRC, Australian National University, University of Sydney, Menzies Centre for Health Polic

Public management in the welfare state : managerialism and consumer advocacy in the 1980's

This thesis is about recent developments in the Australian welfare state. The historical focus is on the Federal Labor administration in Australia in the 1980s. It is concerned with questions about the public administration in society with regard to social welfare. This concern covers the internal arrangements of the bureaucracy, its effect on society through its actions, and its interactions with society that influence its operation

Do women in major cities experience better health? A comparison of chronic conditions and their risk factors between women living in major cities and other cities in Indonesia

Background: Inhabitants of rural areas can be tempted to migrate to urban areas for the type and range of facilities available. Although urban inhabitants may benefit from greater access to human and social services, living in a big city can also bring disadvantages to some residents due to changes in social and physical environments. Design: We analysed data from 4,208 women aged 15 years old participating in the fourth wave of the Indonesia Family Life Survey. Chronic condition risk factors systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and tobacco use among women in four major cities in Indonesia (Jakarta, Surabaya, Medan, and Bandung) were compared against other cities. Fractional polynomial regression models were applied to examine the association between living in the major cities and SBP, DBP, BMI, and tobacco use. The models were also adjusted for age, education, employment status, migration status, ethnic groups, and religion. The patterns of SBP, DBP, and BMI were plotted and contrasted between groups of cities. Results: Chronic condition prevalence was higher for women in major cities than in contrasting cities (pB0.005). Living in major cities increased the risk of having higher SBP, DBP, BMI and being a current smoker. Chronic disease risk factors in major cities were evident from younger ages. Conclusions: Women residing in Indonesia’s major cities have a higher risk of developing chronic conditions, starting at younger ages. The findings highlight the challenges inherent in providing long-term healthcare with its associated cost within major Indonesian cities and the importance of chronic disease prevention programmes targeting women at an early ag

Time's up. Descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.This work was funded by the National Health and Medical Research Council ID (402793, 2006)

Stewardship of the Oral Health System in the Australia Capital Territory (ACT)

The study had two main aims: firstly to use the standards developed as part of DrTahani's PhD in order to evaluate the stewardship of the oral health system in the ACT; and secondly, to see if the standards, initially developed for the task of evaluating oral health stewardship in a middle income nation (Iran), had face validity and use value in the evaluation of the oral health system in a high income province (the ACT). The present report mostly focusses on the first aim

A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

BACKGROUND The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. METHOD We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. RESULTS Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. CONCLUSIONS In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case.he Serious and Continuing Illnesses Policy and Practice Study (SCIPPS) is a National Health and Medical Council of Australia (NHMRC) funded program (no: 402793) conducted at the University of Sydney and The Australian National University and administered by the Menzies Centre for Health Policy

Development and internal validation of the Edmonton Obesity Staging System-2 Risk screening Tool (EOSS-2 Risk Tool) for weight-related health complications : a case-control study in a representative sample of Australian adults with overweight and obesity

Objective Excess weight and related health complications remain under diagnosed and poorly treated in general practice. We aimed to develop and validate a brief screening tool for determining the presence of unknown clinically significant weight-related health complications for potential application in general practice. Design We considered 14 self-reported candidate predictors of clinically significant weight-related health complications according to the Edmonton Obesity Staging System (EOSS score of ≥2) and developed models using multivariate logistic regression across training and test data sets. The final model was chosen based on the area under the receiver operating characteristic curve and the Hosmer-Lemeshow statistic; and validated using sensitivity, specificity and positive predictive value. Setting and participants We analysed cross-sectional data from the Australian Health Survey 2011–2013 sample aged between 18 and 65 years (n=7518) with at least overweight and obesity. Results An EOSS≥2 classification was present in 78% of the sample. Of 14 candidate risk factors, 6 (family history of diabetes, hypertension, high sugar in blood/urine, high cholesterol and self-reported bodily pain and disability) were automatically included based on definitional or obvious correlational criteria. Three variables were retained in the final multivariate model (age, self-assessed health and history of depression/anxiety). The EOSS-2 Risk Tool (index test) classified 89% of those at ‘extremely high risk’ (≥25 points), 67% of those at ‘very high risk’ (7–24 points) and 42% of those at ‘high risk’ (<7 points) of meeting diagnostic criteria for EOSS≥2 (reference). Conclusion The EOSS-2 Risk Tool is a simple, safe and accurate screening tool for diagnostic criteria for clinically significant weight-related complications for potential application in general practice. Research to determine the feasibility and applicability of the EOSS-2 Risk Tool for improving weight management approaches in general practice is warranted

Modifying bananas: From transgenics to organics?

Bananas are one of the top ten world food crops. Unlike most other major food crops, bananas are difficult to genetically improve. The challenge is that nearly all banana cultivars and landraces are triploids, with high levels of male and female infertility. There are a number of international conventional breeding programs and many of these are developing new cultivars. However, it is virtually impossible to backcross bananas, thus excluding the possibility of introgressing new traits into a current cultivar. The alternative strategy is to “modify” the cultivar itself. We have been developing the capacity to modify Cavendish bananas and other cultivars for both disease resistance and enhanced fruit quality. Initially, we were using transgenes; genes that were derived from species outside of the Musa or banana genus. However, we have recently incorporated two banana genes (cisgenes) into Cavendish; one to enhance the level of pro-vitamin A and the other to increase the resistance to Panama disease. Modified Cavendish with these cisgenes have been employed in a field trial. Almost certainly, the next advance will be to edit the Cavendish genome, to generate the desired traits. As these banana cultivars are essentially sterile, transgene flow and the outcrossing of modified genes into wild Musa species. are highly unlikely and virtually impossible in other triploid cultivars. Therefore, genetic changes in bananas may be compatible with organic farming

Self-Management: Parkinson’s as a Chronic Condition

Setting Parkinson’s is cited as a chronic disease which is a “disease… of long duration and generally slow progression”. The burden of chronic, neurodegenerative diseases, including Parkinson’s, is a growing problem worldwide, and it is necessary to find ways to support People Living with Parkinson’s (PlwP) and their carers world-wide. Objective This poster presents the results of a systematic review of the existing literature relating to selfmanagement in PlwP. Methods The Cochrane Database of Systematic Reviews, PsycINFO, CINAHL and Embase were used to identify evidence such as randomised controlled trials and original literature, as well as evidence-based guidelines, evidence-based review articles and meta-analysis relevant to the topics reviewed. 3532 studies were found in total, of which 49 were appropriate for review. Selection was based on quality of evidence and relevance to the topic (table 1). Five studies were judged as meeting the inclusion criteria and included in the initial review. Data was extracted, summarised, coded and critiqued. Findings Five studies provided evidence related to the effectiveness of self-management. Four of the studies demonstrated beneficial impact but one study showed negative impact, namely worsening in fatigue scores. Emerging Themes Experience of illness: Three areas emerged from the evidence as particularly impacting on selfmanagement. Pain and fatigue was an area that was improved by CDSMP involvement. Deterioration and acceptance of loss of physical and mental function was a large issue for people living with the fluctuating nature of the disorder. Depression was positively impacted by the CDSMP, with increased sense of self-efficacy and reduced stress levels. Ways of coping: Relaxation was a key theme throughout the literature, which responded positively to mindfulness exercises. Self-tailoring was shown to be highly beneficial to participants, and was a particular focus for the young onset PlwP. Use of Health Services: Many of the studies found no impact on health service use, with only one finding any reduction in emergency room visits. It was noted that the participants had appropriate use of health services at baseline but developed better collaborative relationships with their healthcare teams. Self Efficacy: Self-efficacy was measured in the majority of studies and found to be worthwhile in most, with benefits sustained for one year. Overall Self-management improves self-efficacy, despite the progressive, fluctuating nature of Parkinson’s. It is limited by the health systems in which it is attempted, requiring a collaborative, flexible approach from Health Professionals. In the medical model, this becomes a source of frustration and conflict. Additionally, younger PlwP seem to have a higher desire to engage in self-management and collaborative medicine, requiring increased access and responsiveness from the services they are engaged with, a flexibility that is not possible in the current model of care. Conclusion Self-management is a valuable tool in the overall management for PlwP. Self-management also requires that the health system be accessible, reactive and collaborative, rather than a medical model system focussed on acute issues, and that healthcare professionals acknowledge the PlwP as someone knowledgeable about their condition and able to play an expert role in their own care. Many healthcare professionals would require support and education around this manner of working. A Parkinson's Disease Nurse Specialist is wellplaced to oversee and contribute a supervisory role for healthcare staff and PlwP as an element of a larger overall service for people living with the conditio