Substance-induced psychosis : a diagnostic conundrum

Objective: To critically examine the DSM-IV-TR criteria for Substance-Induced Psychotic Disorder (SIPD). Data sources: Leading electronic databases (such as Medline, Pubmed) were searched for the years 1992 through 2007, using combinations of the following key search terms: substance abuse/dependence, alcohol, marijuana, cannabis, methamphetamine, crack, cocaine, amphetamine, ecstasy, ketamine, phencyclidine, LSD, mental health, drug-induced psychosis, substance-induced psychosis, psychosis, schizophrenia. References identified from bibliographies of pertinent articles and books in the field were also collected and reviewed. Data extraction: Only research studies or case reports series that presented data on populations diagnosed with SIPD using clinical or structured diagnostic interviews published in English were used to assess the validity of the current SIPD criteria. Data synthesis: We identified 49 articles that presented clinical data on SIPD. The majority of these publications were case reports, with only 18 articles specifically focusing on delineating the clinical characteristics or outcomes of individuals diagnosed with SIPD. While several large studies have recently been conducted to assess the stability of SIPD, there is a dearth of research rigorously examining the validity of DSM-IV diagnostic criteria across substances. Conclusions: There remains a striking paucity of information on the outcome, treatment and best practice for substance-associated psychotic episodes. Further work is clearly required before the advent of DSM-V. We propose an alternative, broader classification that better reflects the current evidence base, inferring association rather than causation.

An accessible method for teaching doctors about death certification

The World Health Organization recommends that data on mortality in its member countries are collected utilising the Medical Certificate of Cause of Death published in the instruction volume of the ICD-10. However, investment in health information processes necessary to promote the use of this certificate and improve mortality information is lacking in many countries. An appeal for support to make improvements has been launched through the Health Metrics Network’s MOVE-IT strategy (Monitoring of Vital Events – Information Technology) [World Health Organization, 2011]. Despite this international spotlight on the need for capture of mortality data and in the use of the ICD-10 to code the data reported on such certificates, there is little cohesion in the way that certifiers of deaths receive instruction in how to complete the death certificate, which is the main source document for mortality statistics. Complete and accurate documentation of the immediate, underlying and contributory causes of death of the decedent on the death certificate is a requirement to produce standardised statistical information and to the ability to produce cause-specific mortality statistics that can be compared between populations and across time. This paper reports on a research project conducted to determine the efficacy and accessibility of the certification module of the WHO’s newly-developed web based training tool for coders and certifiers of deaths. Involving a population of medical students from the Fiji School of Medicine and a pre and post research design, the study entailed completion of death certificates based on vignettes before and after access to the training tool. The ability of the participants to complete the death certificates and analysis of the completeness and specificity of the ICD-10 coding of the reported causes of death were used to measure the effect of the students’ learning from the training tool. The quality of death certificate completion was assessed using a Quality Index before and after the participants accessed the training tool. In addition, the views of the participants about accessibility and use of the training tool were elicited using a supplementary questionnaire. The results of the study demonstrated improvement in the ability of the participants to complete death certificates completely and accurately according to best practice. The training tool was viewed very positively and its implementation in the curriculum for medical students was encouraged. Participants also recommended that interactive discussions to examine the certification exercises would be an advantage.

A model of organizational innovation implementation effectiveness in small to medium firms

The present study aims to validate the current best-practice model of implementation effectiveness in small and mid-size businesses. Data from 135 organizations largely confirm the original model across various types of innovation. In addition, we extended this work by highlighting the importance of human resources in implementation effectiveness and the consequences of innovation effectiveness on future adoption attitudes. We found that the availability of skilled employees was positively related to implementation effectiveness. Furthermore, organizations that perceived a high level of benefits from implemented innovations were likely to have a positive attitude towards future innovation adoption. The implications of our improvements to the original model of implementation effectiveness are discussed.

Analysis of productive performance of crop and animal production systems : an integrated analytical framework

This article presents a two-stage analytical framework that integrates ecological crop (animal) growth and economic frontier production models to analyse the productive efficiency of crop (animal) production systems. The ecological crop (animal) growth model estimates "potential" output levels given the genetic characteristics of crops (animals) and the physical conditions of locations where the crops (animals) are grown (reared). The economic frontier production model estimates "best practice" production levels, taking into account economic, institutional and social factors that cause farm and spatial heterogeneity. In the first stage, both ecological crop growth and economic frontier production models are estimated to calculate three measures of productive efficiency: (1) technical efficiency, as the ratio of actual to "best practice" output levels; (2) agronomic efficiency, as the ratio of actual to "potential" output levels; and (3) agro-economic efficiency, as the ratio of "best practice" to "potential" output levels. Also in the first stage, the economic frontier production model identifies factors that determine technical efficiency. In the second stage, agro-economic efficiency is analysed econometrically in relation to economic, institutional and social factors that cause farm and spatial heterogeneity. The proposed framework has several important advantages in comparison with existing proposals. Firstly, it allows the systematic incorporation of all physical, economic, institutional and social factors that cause farm and spatial heterogeneity in analysing the productive performance of crop and animal production systems. Secondly, the location-specific physical factors are not modelled symmetrically as other economic inputs of production. Thirdly, climate change and technological advancements in crop and animal sciences can be modelled in a "forward-looking" manner. Fourthly, knowledge in agronomy and data from experimental studies can be utilised for socio-economic policy analysis. The proposed framework can be easily applied in empirical studies due to the current availability of ecological crop (animal) growth models, farm or secondary data, and econometric software packages. The article highlights several directions of empirical studies that researchers may pursue in the future.

Contributions of knowledge-based foundations of universities in knowledge city formation : a Malaysian case study

Purpose – In the 21st Century, as knowledge, technology and education are widely accepted to play key roles in the local economic development, the importance of making space and place for knowledge production is, therefore, on the rise resulting many city administrations and urban policy-makers worldwide restructuring their cities to become highly competitive and creative. Consequently, this has led to a new type of city form, knowledge city, and a new approach in their development, knowledge-based urban development. In this context, knowledge-based foundations of universities are regarded as one of the key elements for knowledge-based urban development and knowledge city formation due to their ability to provide a strong platform for knowledge generation, marketing and transfer. This paper aims to investigate the role and importance of universities and their knowledge-based foundations in the context of developing countries, particularly in Malaysia, in building prosperous knowledge cities of the era of the knowledge economy. Design/Methodology/Approach – The main methodological techniques employed in this research includes: a thorough review of the literature on the role of universities in spatial and socio-economic development of cities; a best practice analysis and policy review of urban and regional development policies targeting to use of university clusters in leveraging knowledge-based development, and; a case study in Malaysia with a review of various policy documents and strategic plans of the local universities and local and state authorities, interviews with key actors, and a trend analysis of local socio-economic and spatial changes. Originality/Value – This paper reports the findings of a pioneering research on examining the role and impact of universities and their knowledge-based foundations, in the context of Malaysia, in building knowledge cities of the era of the knowledge economy. By undertaking a case study investigation in Bandar Seri Iskandar, which is a newly emerging Malaysian knowledge city, located in Perak, Malaysia, the paper sheds light on an important issue of the 21st Century of how universities contribute to the knowledge-based development of cities. Practical Implications – Universities with their rich knowledge-based foundations are increasingly being recognised as knowledge hubs, exercising a strong influence in the intellectual vitality of the city where they are embedded. This paper reveals that universities, in joint action with business and society at large, are necessary prerequisites for constructing and maintaining knowledge societies and, therefore, building prosperous knowledge cities. In light of the literature and case findings, the paper sheds light on the contribution of knowledge-based foundations of universities in knowledge city formation and provides generic recommendations for cities and regions seeking knowledge city transformation.

Motivational Interviewing (MINT) improves Continuous Positive Airway Pressure (CPAP) acceptance and adherence : a randomised controlled trial

Objective: Adherence to Continuous Positive Airway Pressure Therapy (CPAP) for Obstructive Sleep Apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (MINT) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with a new diagnosis of OSA. Method: 106 Australian adults (69% male) with a new diagnosis of obstructive sleep apnoea and clinical recommendation for CPAP treatment were recruited from a tertiary sleep disorders centre. Participants were randomly assigned to receive either three sessions of a motivational interviewing intervention ‘MINT’ (n=53; mean age=55.4 years), or no intervention ‘Control’ (n=53; mean age=57.74). The primary outcome was the difference between the groups in objective CPAP adherence at 1 month, 2 months, 3 months and 12 months follow-up. Results: Fifty (94%) participants in the MINT group and 50 (94%) of participants in the control group met all inclusion and exclusion criteria and were included in the primary analysis. The hours of CPAP use per night in the MINT group at 3 months was 4.63 hours and 3.16 hours in the control group (p=0.005). This represents almost 50% better adherence in the MINT group relative to the control group. Patients in the MINT group were substantially more likely to accept CPAP treatment. Conclusions: MINT is a brief, manualized, effective intervention which improves CPAP acceptance and objective adherence rates as compared to standard care alone.

A Research Framework for Investigating Public Private Partnerships (PPP) in Hong Kong

PPP is a general term covering all contracted relationships between the public and private sectors to produce a public asset or to deliver a public service. Its major advantage lies in utilising resources from the private sector to alleviate some of the financial burdens of the government. The Asian financial turmoil in the late 1990s has imposed enormous pressure on the budget of the Hong Kong Special Administrative Region (HKSAR) Government. With a continuous outcry for better public services due to the rapid development of Hong Kong, alternative financing models need to be sought to ensure sustainability. Hong Kong has the advantage of being the international gateway to Mainland China, and with this benefit has attracted overseas enterprises to base their offices in Hong Kong for the Asian market. Obviously the private sector has much to contribute. The HKSAR Government has realised the benefits of using PPP in Hong Kong as well as the success achieved overseas. But a more thorough research is needed to develop the most suitable practice of PPP in terms of project nature, project complexity, project type and project scale under which PPP is most appropriate for Hong Kong. This paper provides an initial report of a research project being funded by the Research Grants Council (RGC) of the HKSAR. The project aims to evaluate the benefits and risks of PPP adopted in Australia and the United Kingdom, and from these previous experiences to develop a best practice framework for implementing PPP in Hong Kong. It firstly reports on the status of PPP development trend and the hands-on experiences which have been drawn in these countries. Qualitative and quantitative research methods applied in conducting the research are discussed. The likely impacts of the study are highlighted. It is believed that the construction industry and the government would benefit a lot as a result of this study, and further procurement and project financing options would be opened up for delivering better future public service.

Teaching and Learning in Maritime Security: A Literature Review

With the rise in attacks and attempted attacks on marine‐based critical infrastructure, maritime security is an issue of increasing importance worldwide. However, there are three significant shortfalls in the efforts to overcome potential threats to maritime security: the need for greater understanding of whether current standards of best practice are truly successful in combating and reducing the risks of terrorism and other security issues, the absence of a collective maritime security best practice framework and the need for improved access to maritime security specific graduate and postgraduate (long) courses. This paper presents an overview of existing international, regional national standards of best practice and shows that literature concerning the measurement and/ or success of standards is virtually non‐existent. In addition, despite the importance of maritime workers to ensuring the safety of marine based critical infrastructure, a similar review of available Australian education courses shows a considerable lack of availability of maritime security‐specific courses other than short courses that cover only basic security matters. We argue that the absence of an Australian best practice framework informed by evaluation of current policy responses – particularly in the post 9/11 environment – leaves Australia vulnerable to maritime security threats. As this paper shows, the reality is that despite the security measures put in place post 9/11, there is still considerable work to be done to ensure Australia is equipped to overcome the threats posed to maritime security.

The subtropical row house charrette

Current urban development in South East Queensland (SEQ) is impacted by a number of factors: growth and sprawl eroding subtropical character and identity; changing demographics and housing needs; lack of developable land; rising transport costs; diminishing fresh water supply; high energy consumption; and generic building designs which ignore local climate, landscape and lifestyle conditions. The Subtropical Row House project sought to research ‘best practice’ planning and design for contemporary and future needs for urban development in SEQ, and stimulate higher-density housing responses that achieve sustainable, low-energy and low water outcomes and support subtropical character and identity by developing a workable new typology for homes that the local market can adopt. The methodology was that of charrette, an established methodology in architecture and design. Four leading Queensland architectural firms were invited to form multidisciplinary creative teams. During the two-day charrette, the teams visited a selected greenfield site, defined the problems and issues, developed ideas and solutions, and benchmarked performance of designs using the Australian Green Building Council’s Pilot Green Star Multi-Unit residential tool. Each of the four resulting designs simultaneously express a positive relationship with climate and place by demonstrating: suitability for the subtropical climate; flexibility for a diversity of households; integrated building/site/vegetation strategies; market appeal to occupants and developers; affordability in operation; constructability by ‘domestic’ builders; and reduced energy, water and wastage. The project was awarded a Regional Commendation by the Australian Institute of Architects.

Managing innovative change within organisations and project team environments

In an attempt to enhance the efficiency, productivity and competitiveness of today’s Architectural, Engineering, and Contractor (AEC) industry, this paper summarises the current status of an ongoing PhD research investigation in developing a sustainable AEC industry specific best-practice ‘Innovation-driven Change Framework’—more specifically a summation of the ‘fourth interrelated dynamic’ (culture). Leveraging off the outcomes of a two year industry and government supported Cooperative Research Centre for Construction Innovation (CRCCI) research project, as well as referring to recent internationally renowned case studies and related literature investigations, this research investigation includes further identifying, processing, analysing and categorizing various culture change methods, models, frameworks and processes utilized within the AEC and other industry sectors, and incorporating these findings in developing an AEC industry-specific ‘Innovation-driven Change Framework’

Commentary on Spence et al. : "Problem solving programme implemented by teachers may prevent depression in the short term, but longer term benefits are unclear"

This is a methodologically exemplary trial of a population based (universal) approach to preventing depression in young people. The programme used teachers in a classroom setting to deliver cognitive behavioural problem solving skills to a cohort of students. We have little knowledge about “best practice” to prevent depression in adolescence. Classroom-based universal approaches appear to offer advantages in recruitment rates and lack of stigmatisation over approaches that target specific groups of at risk students. Earlier research on a universal school-based approach to preventing depression in adolescents showed promise, but employed mental health professionals to teach cognitive behavioural coping skills in small groups.1 Using such an approach routinely would be economically unsustainable. Spence’s trial, with teachers as facilitators, therefore represents a “real world” intervention that could be routinely disseminated.

Powering innovation through tax concessions : the changing research and development tax incentives

The changing R&D Tax Concession has been touted as the biggest reform to business innovation policy in over a decade. But, is it a changing tax for changing times? This paper addresses this question and further asks ‘what’s tax got to do with it?’. To answer this question, the paper argues that rather than substantive tax reform, the proposed measures simply alter the criteria and means by which companies become eligible for a Federal Government subsidy for qualifying R&D activity. It further argues that when considered as part of the broader innovation agenda, the R&D Tax Concession should be evaluated as a government spending program in the same way as any direct spending on innovation. When this is done, the tax regime is arguably only the administrative policy instrument by which the subsidy is delivered. However, it is proposed that this may not be best practice to distribute those funds fairly, efficiently, and without distortion, while at the same time maintaining adequate government control and accountability. Finally, in answering the question of ‘what’s tax got to do with it?’ the paper concludes that the answer is ‘very little’.

Productivity, technical and efficiency change in Singapore’s services sector, 2005 to 2008

The current study was motivated by statements made by the Economic Strategies Committee that Singapore’s recent productivity levels in services were well below countries such as the US, Japan and Hong Kong. Massive employment of foreign workers was cited as the reason for poor productivity levels. To shed more light on Singapore’s falling productivity, a nonparametric Malmquist productivity index was employed which provides measures of productivity change, technical change and efficiency change. The findings reveal that growth in Total Factor Productivity (TFP) was attributed to technical change with no improvement in efficiency change. Such results suggest that gains from TFP were input-driven rather than from a ‘best-practice’ approach such as improvements in operations or better resource allocation.

Third sector partnerships : opportunities and risks

The establishment by the Prime Minister of the Community Business Partnerships Board along with recent taxation reform has drawn attention to corporate philanthropy in Australia. Definitions and models are needed as each of the potential partners – government, corporations and nonprofit organisations – attempts to come to grips with opportunities. The intending partners will need to determine their responsibilities and desired outcomes so that they may work effectively towards mutually beneficial working relationships. Performance indicators need to be determined, benchmarks developed and best practice promoted. A dearth of research exists in this area (Burch, 1998; Industry Commission Report, 1995; Lyons & Hocking, 1998). More exhaustive research, collection and analysis of appropriate data will aid the process. This particular research indicates a lack of understanding between corporations and nonprofit organisations. There are risks inherent in the proposed partnerships, such as inability to reach agreement, potential for increased costs, and failure to deliver by one of the partners. This paper assesses opportunities and risks, suggests topics for high level debate, and indicates models for the development of partnerships.

A Bias in ML Estimates of Branch Lengths in the Presence of Multiple Signals

Sequence data often have competing signals that are detected by network programs or Lento plots. Such data can be formed by generating sequences on more than one tree, and combining the results, a mixture model. We report that with such mixture models, the estimates of edge (branch) lengths from maximum likelihood (ML) methods that assume a single tree are biased. Based on the observed number of competing signals in real data, such a bias of ML is expected to occur frequently. Because network methods can recover competing signals more accurately, there is a need for ML methods allowing a network. A fundamental problem is that mixture models can have more parameters than can be recovered from the data, so that some mixtures are not, in principle, identifiable. We recommend that network programs be incorporated into best practice analysis, along with ML and Bayesian trees.