Hot Summers and Heart Failure: Seasonal Variations in Morbidity and Mortality in Australian Heart Failure Patients (1994-2005)

Background There are minimal reports of seasonal variations in chronic heart failure (CHF)-related morbidity and mortality beyond the northern hemisphere. Aims and methods We examined potential seasonal variations with respect to morbidity and all-cause mortality over more than a decade in a cohort of 2961 patients with CHF from a tertiary referral hospital in South Australia subject to mild winters and hot summers. Results Seasonal variation across all event-types was observed. CHF-related morbidity peaked in winter (July) and was lowest in summer (February): 70 (95% CI: 65 to 76) vs. 33 (95% CI: 30 to 37) admissions/1000 at risk (p<0.005). All-cause admissions (113 (95% CI: 107 to 120) vs. 73 (95% CI 68 to 79) admissions/1000 at risk, p<0.001) and concurrent respiratory disease (21% vs. 12%,p<0.001) were consistently higher in winter. 2010 patients died, mortality was highest in August relative to February: 23 (95% CI: 20 to 27) vs. 12 (95% CI: 10 to 15) deaths per 1000 at risk, p<0.001. Those aged 75 years or older were most at risk of seasonal variations in morbidity and mortality. Conclusion Seasonal variations in CHF-related morbidity and mortality occur in the hot climate of South Australia, suggesting that relative (rather than absolute) changes in temperature drive this global phenomenon.

Rural and Urban Differentials in Primary Care Management of Chronic Heart Failure: New Data from the CASE Study

Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

Using complex network metrics to predict the persistence of metapopulations with asymmetric connectivity patterns

Almost all metapopulation modelling assumes that connectivity between patches is only a function of distance, and is therefore symmetric. However, connectivity will not depend only on the distance between the patches, as some paths are easy to traverse, while others are difficult. When colonising organisms interact with the heterogeneous landscape between patches, connectivity patterns will invariably be asymmetric. There have been few attempts to theoretically assess the effects of asymmetric connectivity patterns on the dynamics of metapopulations. In this paper, we use the framework of complex networks to investigate whether metapopulation dynamics can be determined by directly analysing the asymmetric connectivity patterns that link the patches. Our analyses focus on “patch occupancy” metapopulation models, which only consider whether a patch is occupied or not. We propose three easily calculated network metrics: the “asymmetry” and “average path strength” of the connectivity pattern, and the “centrality” of each patch. Together, these metrics can be used to predict the length of time a metapopulation is expected to persist, and the relative contribution of each patch to a metapopulation’s viability. Our results clearly demonstrate the negative effect that asymmetry has on metapopulation persistence. Complex network analyses represent a useful new tool for understanding the dynamics of species existing in fragmented landscapes, particularly those existing in large metapopulations.

Using participatory action research in a community-based initiative addressing complex mental health needs

Objective: This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community. Method: Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions. Results: Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources. Conclusions: The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.

Planning of distribution networks for medium voltage and low voltage

Determination of the placement and rating of transformers and feeders are the main objective of the basic distribution network planning. The bus voltage and the feeder current are two constraints which should be maintained within their standard range. The distribution network planning is hardened when the planning area is located far from the sources of power generation and the infrastructure. This is mainly as a consequence of the voltage drop, line loss and system reliability. Long distance to supply loads causes a significant amount of voltage drop across the distribution lines. Capacitors and Voltage Regulators (VRs) can be installed to decrease the voltage drop. This long distance also increases the probability of occurrence of a failure. This high probability leads the network reliability to be low. Cross-Connections (CC) and Distributed Generators (DGs) are devices which can be employed for improving system reliability. Another main factor which should be considered in planning of distribution networks (in both rural and urban areas) is load growth. For supporting this factor, transformers and feeders are conventionally upgraded which applies a large cost. Installation of DGs and capacitors in a distribution network can alleviate this issue while the other benefits are gained. In this research, a comprehensive planning is presented for the distribution networks. Since the distribution network is composed of low and medium voltage networks, both are included in this procedure. However, the main focus of this research is on the medium voltage network planning. The main objective is to minimize the investment cost, the line loss, and the reliability indices for a study timeframe and to support load growth. The investment cost is related to the distribution network elements such as the transformers, feeders, capacitors, VRs, CCs, and DGs. The voltage drop and the feeder current as the constraints are maintained within their standard range. In addition to minimizing the reliability and line loss costs, the planned network should support a continual growth of loads, which is an essential concern in planning distribution networks. In this thesis, a novel segmentation-based strategy is proposed for including this factor. Using this strategy, the computation time is significantly reduced compared with the exhaustive search method as the accuracy is still acceptable. In addition to being applicable for considering the load growth, this strategy is appropriate for inclusion of practical load characteristic (dynamic), as demonstrated in this thesis. The allocation and sizing problem has a discrete nature with several local minima. This highlights the importance of selecting a proper optimization method. Modified discrete particle swarm optimization as a heuristic method is introduced in this research to solve this complex planning problem. Discrete nonlinear programming and genetic algorithm as an analytical and a heuristic method respectively are also applied to this problem to evaluate the proposed optimization method.

The contribution of leadership attributes to large scale, complex project success

Mismanagement of large-scale, complex projects has resulted in spectacular failures, cost overruns, time blowouts, and stakeholder dissatisfaction. We focus discussion on the interaction of key management and leadership attributes which facilitate leaders’ adaptive behaviors. These behaviors should in turn influence adaptive team member behavior, stakeholder engagement and successful project outcomes, outputs and impacts. An understanding of this type of management will benefit from a perspective based in managerial and organizational cognition. The research question we explore is whether successful leaders of large-scale complex projects have an internal process leading to a display of administrative, adaptive, and enabling behaviors that foster adaptive processes and enabling behaviors within their teams and with external stakeholders. At the core of the model we propose interactions of key attributes, namely cognitive flexibility, affect, and emotional intelligence. The result of these cognitive-affective attribute interactions is leadership leading to enhanced likelihood of complex project success.

Re-thinking how we plan to address technically complex problems : drawing on planning theory to guide practice in revision of land use plans in coastal high hazard zones

Queensland's new State Planning Policy for Coastal Protection, released in March and approved in April 2011 as part of the Queensland Coastal Plan, stipulates that local governments prepare and implement adaptation strategies for built up areas projected to be subject to coastal hazards between present day and 2100. Urban localities within the delineated coastal high hazard zone (as determined by models incorporating a 0.8 meter rise in sea level and a 10% increase in the maximum cyclone activity) will be required to re-evaluate their plans to accommodate growth, revising land use plans to minimise impacts of anticipated erosion and flooding on developed areas and infrastructure. While implementation of such strategies would aid in avoidance or minimisation of risk exposure, communities are likely to face significant challenges in such implementation, especially as development in Queensland is so intensely focussed upon its coasts with these new policies directing development away from highly desirable waterfront land. This paper examines models of planning theory to understand how we plan when faced with technically complex problems towards formulation of a framework for evaluating and improving practice.