Heterogeneity of heart failure management programs in Australia

Background: Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes.
Objective: To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure.
Method: Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003.
Results: All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24–147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs.
Conclusion: Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.

Quantifying effects of soil heterogeneity on groundwater pollution at four sites in the USA

Four sites located in the north-eastern region of the United States of America have been chosen to investigate the impacts of soil heterogeneity in the transport of solutes (bromide and chloride) through the vadose zone (the zone in the soil that lies below the root zone and above the permanent saturated groundwater). A recently proposed mathematical model based on the cumulative beta distribution has been deployed to compare and contrast the regions' heterogeneity from multiple sample percolation experiments. Significant differences in patterns of solute leaching were observed even over a small spatial scale, indicating that traditional sampling methods for solute transport, for example the gravity pan or suction Iysimeters, or more recent inventions such as the multiple sample percolation systems may not be effective in estimating solute fluxes in soils when a significant degree of soil heterogeneity is present. Consequently, ignoring soil heterogeneity in solute transport studies will likely result in under- or overprediction of leached fluxes and potentially lead to serious pollution of soils and/or groundwater. The cumulative beta distribution technique is found to be a versatile and simple technique of gaining valuable information regarding soil heterogeneity effects on solute transport. It is also an excellent tool for guiding future decisions of experimental designs particularly in regard to the number of samples within one site and the number of sampling locations between sites required to obtain a representative estimate of field solute or drainage flux.

Occurrence of small mammals in a fragmented landscape: the role of vegetation heterogeneity

Most studies of habitat use by small mammals rely on data from trapping grids. Such studies pertain to habitat use by individuals, which may not reflect population-level requirements. To meet the challenge of landscape change, it is important to understand habitat use by populations across large geographic areas. We surveyed small mammals in 48 forest remnants across a 300 km2 study area, to investigate the influence of vegetation heterogeneity on regional distributions. Information-theoretic techniques were used to evaluate models of vegetation associations. Richness of native mammals was influenced by vegetation condition: disturbed sites supported fewer species. Models for individual species showed the agile antechinus, Antechinus agilis, to prefer structurally diverse forest vegetation, the long-nosed potoroo, Potorous tridactylus, to favour mesic shrub communities, the bush rat, Rattus fuscipes, to prefer complex low cover regardless of composition, the swamp rat, Rattus lutreolus, to favour reduced canopy cover, and the house mouse, Mus domesticus, to prefer disturbed vegetation. To satisfy the needs of all native species, a mosaic of natural vegetation is required. Degradation and simplification of forest vegetation have detrimental consequences. These results highlight the need to consider habitat quality, together with more traditional biogeographic variables, when investigating factors influencing patch occupancy by native fauna in modified landscapes.

Analysis of multi-cluster computing systems with processor heterogeneity

This paper addresses the problem of performance modeling of heterogeneous multi-cluster computing systems. We present an analytical model that can be employed to explore the effectiveness of different design approaches so that one can have an intelligent choice during design and evaluation of a cost effective large-scale heterogeneous distributed computing system. The proposed model considers stochastic quantities as well as processor heterogeneity of the target system. The analysis is based on a parametric fat-tree network, the m-port n-tree, and a deterministic routing algorithm. The correctness of the proposed model is validated through comprehensive simulation of different types of clusters.

Heterogeneity in service delivery and inequity in access are common characteristics of chronic heart failure management programs

Background: The prevalence of heart failure in Australia is similar to that of Europe. In Australia, chronic heart failure management programs (CHF-MPs) have become part of standard care for patients with Chronic Heart Failure (CHF). However, heterogeneity among programs is common which can result in variable patient outcomes.

Method: A national survey was undertaken of 59 post-discharge CHF-MPs identified from within the Australian health care system. Two had ceased operating and one centre declined to participate in the study. A 33-item investigator-developed questionnaire, examining the characteristics and interventions used within each CHF-MP, was sent to the remaining 56 CHF-MPs. A response rate of 100% was achieved.

Results: Our survey revealed a disproportional distribution of CHF-MPs across the Australian continent: the State of Victoria had 3.6 CHF-MPs/million population, New South Wales had 3.7 CHF-MPs/million population, Queensland had 1 program/million population, South Australia had 0.3 CHF-MPs/million population and Western Australia had 1 program/million population.Overall, 8000 postdischarge CHF pts (median: 126; IQR: 26-260) were managed via CHF-MPs. Approximately 40,000 CHF pts are discharged from metropolitan institutions nationally, this represents only 22% of the potential caseload for these cost-effective CHF-MPs. Only 8% of these programs were located within rural regions. The majority of CHF-MPs were located within an acute metropolitan hospital (52%) and 36% were community based (all associated with a hospital). Heterogeneity of CHF-MPs in applied models of care was evident with 75% of CHF-MPs offering CHF outpatient clinics and 77% conducting home visits. Of the programs offering home visits 78% were funded by regional government (p<0.048). There were no nurse-led CHF outpatient clinics. A hybrid approach to CHF-MPs was common with many CHF-MPs comprising an outpatient clinic, home visits and inpatient visits. Various medications were titrated by nurses in 43% of CHF-MPs. In the programs that allowed nurses to titrate medications 79% were located in an acute hospital (p<0.011).

Conclusion: Variability of service availability is of concern within the context of universal coverage. In addition, heterogeneity between programs and the diversity in models of care delivery highlights the inconsistency and questions the quality of health related outcomes. We are currently analysing health outcome data from the 1015 patients managed in these CHF-MPs to describe the relationship between quality of care and health outcomes.

Birds in agricultural mosaics : the influence of landscape pattern and countryside heterogeneity

Agricultural environments are critical to the conservation of biota throughout the world. Efforts to identify key influences on the conservation status of fauna in such environments have taken complementary approaches. Many studies have focused on the role of remnant or seminatural vegetation and emphasized the influence on biota of spatial patterns in the landscape. Others have recognized that many species use diverse ‘‘countryside’’ elements within farmland, and emphasize the benefits of landscape heterogeneity for conservation. Here, we investigated the effect of independent measures of both the spatial pattern (extent and configuration) and heterogeneity of elements (i.e., land uses/vegetation types) on bird occurrence in farm-scale agricultural mosaics in southeastern Australia. Birds were sampled in all types of elements in 27 mosaics (each 1 3 1 km) selected to incorporate variation in cover of native vegetation and the number of different element types in the mosaic. We used an information-theoretic approach to identify the mosaic properties that most strongly influenced bird species richness. Subgroups of birds based on habitat requirements responded most strongly to the extent of preferred elements in mosaics. Woodland birds were richer in mosaics with higher cover of native vegetation while open-tolerant species responded to the extent of scattered trees. In contrast, for total species richness, mosaic heterogeneity (richness of element types) and landscape context (cover of native vegetation in surrounding area) had the greatest influence. These results showed that up to 76% of landscape-level variation in richness of bird groups is attributable to mosaic properties directly amenable to management by landowners. Key implications include (1) conservation goals for farm landscapes must be carefully defined because the richness of different faunal components is influenced by different mosaic properties; (2) the extent of native vegetation is a critical influence in agricultural environments because it drives the farmscale richness of woodland birds and has a broader context effect on total bird richness in mosaics; (3) land-use practices that enhance the heterogeneity of farmland mosaics are beneficial for native birds; and (4) the cumulative effect of even small elements in farm mosaics contribute to the structural properties of entire landscapes.

Do reproductive tactics vary with habitat heterogeneity in the intertidal sea anemone Actinia tenebrosa?

Cnidarians display a diverse range of reproductive tactics including sexual and asexual modes of reproduction. Although few studies have looked for intraspecific variation in reproductive tactics, flexible expression of such life-history traits may be favoured in species that occupy a range of habitats. We tested this in the sea anemone Actinia tenebrosa by comparing cycles of reproductive activity and the mode of production of brooded larvae in local populations occupying boulder fields and stable rock platforms. We determined the mode of production of broods from eight rock platforms (separated by up to 1600 km) and two boulder shores on the south east coast of Australia using a combination of allozyme data and four newly characterised microsatellite markers.

We determined seasonal patterns of brooding and gonad development by monthly dissection of 15–30 adults from each of two boulder fields and two stable platforms. Previous genetic studies have shown that populations of A. tenebrosa on rock platforms can be highly clonal, whereas anemones on more heterogeneous boulder habitats display levels of genotypic diversity similar to that expected for sexual reproduction. We genotyped a total of 221 juveniles from 37 brooding adults including 11 broods and 80 juveniles from boulder shores. We did not detect any evidence of sexual production of broods. All brooded juveniles displayed identical multi-locus genotypes to their brood parent irrespective of habitat of origin or location, including 28 broods (200 juveniles) that were heterozygous at one or more locus. Similarly, we found that temporal patterns of gonad formation and brooding were consistent across habitats and locations. We detected 346 mature males, 234 non-reproductive or immature individuals, and no mature females within a total of 580 dissected individuals. These data suggest that the reproductive tactics of A. tenebrosa are essentially fixed and that variation in the genotypic diversity of populations may reflect variation in factors such as the input of sexually derived planktonically dispersed recruits or post-settlement processes. However, the apparent lack of females paradoxically implies that sexual reproduction, and hence recruitment, must be rare or no longer possible within some populations, and highlights the need for long-term studies of these populations.

Resource heterogeneity for stream detritivores

Invertebrate animals in headwater streams depend upon leaves, wood and bark for both food and living space. This project demonstrated the strength of that dependence where the patchiness in habitat is influenced at the smallest spatial scales by the movement of sediments, and at the largest by agricultural clearing.

Landscape pattern, countryside heterogeneity and bird conservation in agricultural environments

This study confirms the valuable contribution that agricultural landscapes make to bird conservation in Australia. While native vegetation is critical to conservation efforts, careful management of production land-use types may provide additional benefits. Results show that productive farm enterprises can make real contributions to the success of broader conservation goals.

Investigation of population heterogeneity of diet use among middle-aged Australians

The purpose of the study was to determine patterns of diet use among middle-aged Australian men and women and the relationships between these different usage patterns and demographic characteristics, health status and health habits. A cross-sectional mail survey was conducted among a random sample of 2975 people aged 40–71 years in Victoria, Australia. A total of 1031 usable questionnaires were obtained which included information about the use of diets (e.g. low-fat and low-salt) during the past 3 months along with demographic information, health status and health habits. Based on the responses about the use of thirteen diets for both sexes, latent class analysis was employed to identify the optimal number of use of diets and the assignment of participants to particular groups. Three types of diet uses were identified and provisionally named: diet use, selected diet use and non-diet use. This classification was associated with demographics, health status and health habits, and these associations differed between men and women. The findings suggest that nutrition education programmes should be tailored to the different needs of the diet use groups.

Firm heterogeneity and calendar anomalies

While the calendar anomalies and financial market relationship is one of the oldest relationships in financial economics, we treat this relationship differently by addressing two unknown issues: (a) Do calendar anomalies have a heterogeneous effect on firm returns and firm volatility depending on the sectoral location of firms? and (b) Do calendar anomalies affect firm returns and firm volatility differently depending on firm size? Unlike the assumption in this literature that firms are homogeneous, we show that they are in fact heterogeneous. Using 560 firms listed on the New York Stock Exchange (NYSE) over the period 5 January 2000 to 31 December 2008, we find fresh results, previously undocumented in this literature. We find evidence of calendar anomalies affecting returns and return volatility of firms differently depending on their sectoral locations and size.

Identification of surface heterogeneity effects in cyclic voltammograms derived from analysis of an individually addressable gold array electrode

Voltammetric behavior at gold electrodes in aqueous media is known to be strongly dependent on electrode polishing and history. In this study, an electrode array consisting of 100 nominally identical and individually addressable gold disks electrodes, each with a radius of 127 µm, has been fabricated. The ability to analyze both individual electrode and total array performance enables microscopic aspects of the overall voltammetric response arising from variable levels of inhomogeneity in each electrode to be identified. The array configuration was initially employed with the reversible and hence relatively surface insensitive [Ru(NH₃)₆]^3+/2+ reaction and then with the more highly surface sensitive quasi-reversible [Fe(CN)₆]^3−/4− process. In both these cases, the reactants and products are solution soluble and, at a scan rate of 50 mV s⁻¹, each electrode in the array is assumed to behave independently, since no evidence of overlapping of the diffusion layers was detected. As would be expected, the variability of the individual electrodesʼ responses was significantly larger than found for the summed electrode behavior. In the case of cytochrome c voltammetry at a 4,4′-dipyridyl disulfide modified electrode, a far greater dependence on electrode history and electrode heterogeneity was detected. In this case, voltammograms derived from individual electrodes in the gold array electrode exhibit shape variations ranging from peak to sigmoidal. However, again the total response was always found to be well-defined. This voltammetry is consistent with a microscopic model of heterogeneity where some parts of each chemically modified electrode surface are electroactive while other parts are less active. The findings are consistent with the common existence of electrode heterogeneity in cyclic voltammetric responses at gold electrodes, that are normally difficult to detect, but fundamentally important, as electrode nonuniformity can give rise to subtle forms of kinetic and other forms of dispersion.