Conservation of urban historic districts in China : present models of integration and utilization of historic resources and challenges for authenticity

Chinese urban historic districts retain abundant urban traditional features, local characteristics and historic architecture. They not only gather and display urban cultural heritage but extend and develop urban historic culture and social traditions. In 1964 the “Venice Charter” expanded the concept and scope of historical and cultural heritage conservation from individual building heritage, historical sites comprising heritage buildings and historical environments to whole historic districts. At the same time, authenticity was adopted as a principle of heritage conservation. In 1994 the Nara Document on Authenticity confirmed that authenticity is of great importance to the conservation of cultural heritage. In 2003, “The Hoi An Declaration on Conservation of Historic Districts of Asia” reinforced the significance, integrity and authenticity of historic district conservation. In China, with the accelerated urbanization process and improved living conditions of urban residents, the unique values and historic and cultural heritage of historic districts is being destroyed. Considerable historic and cultural heritage has been reconstructed, leading to the loss of authenticity of these historic districts. This paper provides an overview of the Chinese situation. It highlights the problems and demonstrates a clear need to protect the authenticity of these historic districts. Authenticty is evaluated against various Chinese conservation of historic districts having regard to international experience and methods. As a result, it will be demonstrated that conservation modes of authenticity of urban historic districts in China and historic resources should be employed to ensure: 1) the restoration and conservation of historic architecture; 2) the preservation and renovation of old spaces and structures; 3) the integration and coordination of historic and new buildings; and the 4) the continuation and succession of historic culture and local tradition.

Web health portal to enhance patient safety in Australian healthcare systems

The use of a web Health Portal can be employed not only for reducing health costs but also to view patient's latest medical information (e.g. clinical tests, pathology and radiology results, discharge summaries, prescription renewals, referrals, appointments) in real-time and carry out physician messaging to enhance the information exchanged, managed and shared in the Australian healthcare sector. The Health Portal connects all stakeholders (such as patients and their families, health professionals, care providers, and health regulators) to establish coordination, collaboration and a shared care approach between them to improve overall patient care safety. The paper outlines a Health Portal model for designing a real-time health prevention system. An application of the architecture is described in the area of web Health Portal.

A framework for the design of privacy preserving pervasive healthcare

Privacy is an important aspect of pervasive and ubiquitous computing systems, and, in particular, pervasive healthcare. With reference to previous approaches on developing privacy sensitive pervasive healthcare applications, we detail a framework for the design of such systems that aims to minimise the impact of privacy on such systems. In reviewing previous approaches, we extract and combine common elements in order to unify the approaches and create a more formal methodology for designing privacy mechanisms in pervasive healthcare applications. In doing so we also consider the manner in which ubiquitous technologies impact on privacy and methods for reducing this impact. We demonstrate how the framework can be applied by using examples from the previous approaches. In addressing privacy issues, the framework aims to remove a large obstacle to deployment of pervasive healthcare systems, acceptance of the technology.

A theoretical framework of entrepreneurship and innovation in healthcare organisations

This paper examines the role of entrepreneurship and innovation in the context of healthcare management by offering a number of research propositions. In recent years, hospitals have attracted ever growing commentary about rising costs and the need for improving information technology systems. Whilst there have been some service innovations introduced from other industries, particularly the manufacturing industry, there have been few service innovations originating from the healthcare sector. In the healthcare sector, there are a number of service innovations, which are discussed in this paper in terms of their relevance to managerial roles of hospital staff members. In addition, this paper examines the role of entrepreneurial managers in determining innovative technology behaviour in healthcare organisations. Literature from innovation management, corporate intrapreneurship and healthcare management is used to explain the findings of this paper and future areas of research are also proposed.

Cross-sectional analysis of association between socioeconomic status and utilization of primary total hip joint replacements 2006-7 : Australian orthopaedic association national joint replacement registry

Background The utilization of total hip replacement (THR) surgery is rapidly increasing, however few data examine whether these procedures are associated with socioeconomic status (SES) within Australia. This study examined primary THR across SES for both genders for the Barwon Statistical Division (BSD) of Victoria, Australia.

Methods Using the Australian Orthopaedic Association National Joint Replacement Registry data for 2006–7, primary THR with a diagnosis of osteoarthritis (OA) among residents of the BSD was ascertained. The Index of Relative Socioeconomic Disadvantage was used to measure SES; determined by matching residential addresses with Australian Bureau of Statistics census data. The data were categorised into quintiles; quintile 1 indicating the most disadvantaged. Age- and sex-specific rates of primary THR per 1,000 person years were reported for 10-year age bands using the total population at risk.

Results Females accounted for 46.9% of the 642 primary THR performed during 2006–7. THR utilization per 1,000 person years was 1.9 for males and 1.5 for females. The highest utilization of primary THR was observed in those aged 70–79 years (males 6.1, and females 5.4 per 1,000 person years). Overall, the U-shaped pattern of THR across SES gave the appearance of bimodality for both males and females, whereby rates were greater for both the most disadvantaged and least disadvantaged groups.

Conclusions Further work on a larger scale is required to determine whether relationships between SES and THR utilization for the diagnosis of OA is attributable to lifestyle factors related to SES, or alternatively reflects geographic and health system biases. Identifying contributing factors associated with SES may enhance resource planning and enable more effective and focussed preventive strategies for hip OA.

Patient and business rules extraction and formalisation using SVN and SBVR for automated healthcare

This paper describes advances in automated health service selection and composition in the Ambient Assisted Living (AAL) domain. We apply a Service Value Network (SVN) approach to automatically match medical practice recommendations to health services based on sensor readings in a home care context. Medical practice recommendations are extracted from National Health and Medical Research Council (NHMRC) guidelines. Service networks are derived from Medicare Benefits Schedule (MBS) listings. Service provider rules are further formalised using Semantics of Business Vocabulary and Business Rules (SBVR), which allows business participants to identify and define machine-readable rules. We demonstrate our work by applying an SVN composition process to patient profiles in the context of Type 2 Diabetes Management.

Feedback reporting of survey data to healthcare aides

Background

This project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides’ (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed.

Methods
A convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews.

Results
One hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs’ opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating.

Conclusions
This study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.

Unsupervised DRG upcoding detection in healthcare databases

Diagnosis Related Group (DRG) upcoding is an anomaly in healthcare data that costs hundreds of millions of dollars in many developed countries. DRG upcoding is typically detected through resource intensive auditing. As supervised modeling of DRG upcoding is severely constrained by scope and timeliness of past audit data, we propose in this paper an unsupervised algorithm to filter data for potential identification of DRG upcoding. The algorithm has been applied to a hip replacement/revision dataset and a heart-attack dataset. The results are consistent with the assumptions held by domain experts.

Visualising a state-wide patient data collection : a case study to expand the audience for healthcare data

This paper describes the application of existing and novel adaptations of visualisation techniques to routinely collected health data. The aim of this case study is to examine the capacity for visualisation approaches to quickly and e ectively inform clinical, policy, and scal decision making to improve healthcare provision. We demonstrate the use of interactive graphics, fluctuation plots, mosaic plots, time plots, heatmaps, and disease maps to visualise patient admission, transfer, in-hospital mortality, morbidity coding, execution of diagnosis and treatment guidelines, and the temporal and spatial variations of diseases. The relative e ectiveness of these techniques and associated challenges are discussed.

Is chemotherapy dose intensity adequate in breast cancer management in the Australian healthcare setting: a retrospective analysis

Aim
To determine the adequacy of chemotherapy received dose intensity (RDI) in breast cancer treatment in a general population and to identify factors that influence RDI.

Methods
A retrospective analysis of breast cancer patients who commenced a course of i.v. chemotherapy in 2008 was undertaken. Data were collected on patient and tumor characteristics, chemotherapy regimen, dose (including delays, reductions and the reasons for these), granulocyte colony-stimulating factor (G-CSF) use and febrile neutropenia incidence. RDI was calculated using the planned and actual dose received and time taken. A level of ≥85% RDI was considered acceptable for treatment given with curative intent.

Results
In all, 131 patients (aged 28 to 77 years) received chemotherapy in adjuvant (n = 76, 58%), neoadjuvant (n = 11, 8%) and metastatic settings (n = 44, 34%). RDI did not reach 85% for 12% adjuvant, 36% neoadjuvant and 34% metastatic cases (χ2 = 10.55, P = 0.005). Overall, 43% of patients received G-CSF.

Conclusion
Acceptable chemotherapy RDI was delivered for most patients in the adjuvant setting but not in the neoadjuvant setting. G-CSF treatment contributed to the optimization of dose intensity in the adjuvant setting only. Dose intensity in the metastatic setting was considered satisfactory where quality of life is the primary focus. Other factors can be modified to improve RDI.

Primary healthcare costs associated with sleep problems up to age 7 years: Australian population-based study

This article studies Australian 0-7-year olds with and without sleep problems and compares the type and costs to government of non-hospital healthcare services and prescription medication in each year of age and  the cumulative costs according to persistence of the sleep problem.