Risk factors for hospital re-presentation among older adults following fragility fractures: Protocol for a systematic review

Background After being discharged from hospital following the acute management of a fragility fracture, older adults may re-present to hospital emergency departments in the post-discharge period. Early re-presentation to hospital, which includes hospital readmissions, and emergency department presentations without admission, may be considered undesirable for individuals, hospital institutions and society. The identification of modifiable risk factors for hospital re-representation following initial fracture management may prove useful for informing policy or practice initiatives that seek to minimise the need for older adults to re-present to hospital early after they have been discharged from their initial inpatient care. The purpose of this systematic review is to identify correlates of hospital re-presentation in older patients who have been discharged from hospital following clinical management of fragility fractures. Methods/Design The review will follow the PRISMA-P reporting guidelines for systematic reviews. Four electronic databases (Pubmed, CINAHL, Embase, and Scopus) will be searched. A suite of search terms will identify peer-reviewed articles that have examined the correlates of hospital re-presentation in older adults (mean age of 65 years or older) who have been discharged from hospital following treatment for fragility fractures. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the quality of the studies. The strength of evidence will be assessed through best evidence synthesis. Clinical and methodological heterogeneity across studies are likely to impede meta-analyses. Discussion The best evidence synthesis will outline correlates of hospital re-presentations in this clinical group. This synthesis will take into account potential risks of bias for each study, while permitting inclusion of findings from a range of quantitative study designs. It is anticipated that findings from the review will be useful in identifying potentially modifiable risk factors that have relevance in policy, practice and research priorities to improve the management of patients with fragility fractures. Systematic Review Registration PROSPERO CRD42015019379

The empire of cancer: Gene patents and cancer voices

In his book, The Emperor of All Maladies, Siddhartha Mukherjee writes a history of cancer — "It is a chronicle of an ancient disease — once a clandestine, 'whispered-about' illness — that has metamorphosed into a lethal shape-shifting entity imbued with such penetrating metaphorical, medical, scientific, and political potency that cancer is often described as the defining plague of our generation." Increasingly, an important theme in the history of cancer is the role of law, particularly in the field of intellectual property law. It is striking that a number of contemporary policy debates over intellectual property and public health have concerned cancer research, diagnosis, and treatment. In the area of access to essential medicines, there has been much debate over Novartis’ patent application in respect of Glivec, a treatment for leukaemia. India’s Supreme Court held that the Swiss company’s patent application violated a safeguard provision in India’s patent law designed to stop evergreening. In the field of tobacco control, the Australian Government introduced plain packaging for tobacco products in order to address the health burdens associated with the tobacco epidemic. This regime was successfully defended in the High Court of Australia. In the area of intellectual property and biotechnology, there have been significant disputes over the Utah biotechnology company Myriad Genetics and its patents in respect of genetic testing for BRCA1 and BRCA2, which are related to breast cancer and ovarian cancer. The Federal Court of Australia handed down a decision on the validity of Myriad Genetics’ patent in respect of genetic testing for BRCA1 in February 2013. The Supreme Court of the United States heard a challenge to the validity of Myriad Genetics’ patents in this area in April 2013, and handed down a judgment in July 2013. Such disputes have involved tensions between intellectual property rights, and public health. This article focuses upon one of these important test cases involving intellectual property, public health, and cancer research. In June 2010, Cancer Voices Australia and Yvonne D’Arcy brought an action in the Federal Court of Australia against the validity of a BRCA1 patent — held by Myriad Genetics Inc, the Centre de Recherche du Chul, the Cancer Institute of Japan and Genetic Technologies Limited. Yvonne D’Arcy — a Brisbane woman who has had treatment for breast cancer — maintained: "I believe that what they are doing is morally and ethically corrupt and that big companies should not control any parts of the human body." She observed: "For my daughter, I've had her have [sic] mammograms, etc, because of me but I would still like her to be able to have the test to see if the mutation gene is in there from me." The applicants made the following arguments: "Genes and the information represented by human gene sequences are products of nature universally present in each individual, and the information content of a human gene sequence is fixed. Genetic variations or mutations are products of nature. The isolation of the BRCA1 gene mutation from the human body constitutes no more than a medical or scientific discovery of a naturally occurring phenomenon and does not give rise to a patentable invention." The applicants also argued that "the alleged invention is not a patentable invention in that, so far as claimed in claims 1–3, it is not a manner of manufacture within the meaning of s 6 of the Statute of Monopolies". The applicants suggested that "the alleged invention is a mere discovery". Moreover, the applicants contended that "the alleged invention of each of claims 1-3 is not a patentable invention because they are claims for biological processes for the generation of human beings". The applicants, though, later dropped the argument that the patent claims related to biological processes for the generation of human beings. In February 2013, Nicholas J of the Federal Court of Australia considered the case brought by Cancer Voices Australia and Yvonne D’Arcy against Myriad Genetics. The judge presented the issues in the case, as follows: "The issue that arises in this case is of considerable importance. It relates to the patentability of genes, or gene sequences, and the practice of 'gene patenting'. Briefly stated, the issue to be decided is whether under the Patents Act 1990 (Cth) a valid patent may be granted for a claim that covers naturally occurring nucleic acid — either deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) — that has been 'isolated'". In this context, the word "isolated" implies that naturally occurring nucleic acid found in the cells of the human body, whether it be DNA or RNA, has been removed from the cellular environment in which it naturally exists and separated from other cellular components also found there. The genes found in the human body are made of nucleic acid. The particular gene with which the patent in suit is concerned (BRCA1) is a human breast and ovarian cancer disposing gene. Various mutations that may be present in this gene have been linked to various forms of cancer including breast cancer and ovarian cancer.' The judge held in this particular case that Myriad Genetics’ patent claims were a "manner of manufacture" under s 6 of the Statute of Monopolies and s 18(1)(a) of the Patents Act 1990 (Cth). The matter is currently under appeal in the Full Court of the Federal Court of Australia. This article interprets the dispute over Myriad Genetics in light of the scholarly work of Nobel Laureate Professor Joseph Stiglitz on inequality. Such work has significant explanatory power in the context of intellectual property and biotechnology. First, Stiglitz has contended that "societal inequality was a result not just of the laws of economics, but also of how we shape the economy — through politics, including through almost every aspect of our legal system". Stiglitz is concerned that "our intellectual property regime … contributes needlessly to the gravest form of inequality." He maintains: "The right to life should not be contingent on the ability to pay." Second, Stiglitz worries that "some of the most iniquitous aspects of inequality creation within our economic system are a result of 'rent-seeking': profits, and inequality, generated by manipulating social or political conditions to get a larger share of the economic pie, rather than increasing the size of that pie". He observes that "the most iniquitous aspect of this wealth appropriation arises when the wealth that goes to the top comes at the expense of the bottom." Third, Stiglitz comments: "When the legal regime governing intellectual property rights is designed poorly, it facilitates rent-seeking" and "the result is that there is actually less innovation and more inequality." He is concerned that intellectual property regimes "create monopoly rents that impede access to health both create inequality and hamper growth more generally." Finally, Stiglitz has recommended: "Government-financed research, foundations, and the prize system … are alternatives, with major advantages, and without the inequality-increasing disadvantages of the current intellectual property rights system.’" This article provides a critical analysis of the Australian litigation and debate surrounding Myriad Genetics’ patents in respect of genetic testing for BRCA1. First, it considers the ruling of Nicholas J in the Federal Court of Australia that Myriad Genetics’ patent was a manner of manufacture as it related to an artificially created state of affairs, and not mere products of nature. Second, it examines the policy debate over gene patents in Australia, and its relevance to the litigation involving Myriad Genetics. Third, it examines comparative law, and contrasts the ruling by Nicholas J in the Federal Court of Australia with developments in the United States, Canada, and the European Union. Fourth, this piece considers the reaction to the decision of Nicholas at first instance in Australia. Fifth, the article assesses the prospects of an appeal to the Full Federal Court of Australia over the Myriad Genetics’ patents. Finally, this article observes that, whatever happens in respect of litigation against Myriad Genetics, there remains controversy over Genetic Technologies Limited. The Melbourne firm has been aggressively licensing and enforcing its related patents on non-coding DNA and genomic mapping.

Now you're talking

Undergraduate medical imaging students at an urban Australian university attend their first clinical placement towards the end of Semester two in their first year. While they often have a great deal of contextual knowledge and targeted theoretical learning prior to their first clinical placement, many of them are unfamiliar with the dynamics of a hospital environment. With the increase in online communication platforms, there was a concern that face-to-face clinical communication skills were becoming a source of anxiety for students, especially prior to their first clinical placements. Given the impact of anxiety on communication, reducing communication-related apprehension was considered a programme priority. A pilot series of scenario-based tutorials was implemented in the general radiography unit for the first year students.

Re-theorizing the “digital divide”: Identifying dimensions of social exclusion in contemporary media technologies

The digital divide is the disparancy in access to information, in the ability to communicate, and in the capacity to make information and communication serve full participation in the information society. Indeed, the conversation about the digital divide has developed over the last decade from a focus on connectivity and access to information and communication technologies, to a conversation that encompasses the ability to use them and to the utility that usage provides (Wei et al., 2011). However, this conversation, while transitioning from technology to the skills of the people that use them and to the fruits of their use is limited in its ability to take into account the social role of information and communication technologies (ICTs). One successful attempt in conceptualizing the social impact of the differences in access to and utilization of digital communication technologies, was developed by van Dijk (2005) whose sequential model for analyzing the divide states that: 1. Categorical inequalities in society produce an unequal distribution of resources; 2. An unequal distribution of resources causes unequal access to digital technologies; 3. Unequal access to digital technologies also depends on the characteristics of these technologies; 4. Unequal access to digital technologies brings about unequal participation in society; 5. Unequal participation in society reinforces categorical inequalities and unequal distributions of resources.” (p. 15) As van Dijk’s model demonstrates, the divide’s impact is the exclusion of individuals from participation. Still left to be defined are the “categorical inequalities,” the “resources,” the “characteristics of digital technologies,” and the different levels of “access” that result in differentiated levels of participation, as these change over time due to the evolving nature of technology and the dynamics of society. And most importantly, the meaning of “participation” in contemporary society needs to be determined as it is differentiated levels of participation that are the result of the divide and the engine of the ever-growing disparities. Our argument is structured in the following manner: We first claim that contemporary digital media differ from the previous generation of ICTs along four dimensions: They offer an abundance of information resources and communication channels when compared to the relative paucity of both in the past; they offer mobility as opposed to the stationary nature of their predecessors; they are interactive in that they provide users with the capability to design their own media environments in contrast to the dictated environs of previous architectures; and, they allow users to communicate utilizing multi forms of mediation, unlike the uniformity of sound or word that limited users in the past. We then submit that involvement in the information society calls for egalitarian access to all four dimensions of the user experience that make contemporary media different from their predecessors and that the ability to experience all four affects the levels in which humans partake in the shaping of society. The model being cyclical, we then discuss how lower levels of participation contribute to the enhancement of social inequalities. Finally, we discuss why participation is needed in order to achieve full membership in the information society and what political philosophy should govern policy solutions targeting the re-inclusion of those digitally excluded.

Hampson type heat-exchanger technology and economic evaluation for LNG re- gasification and power generation At LNG receiving terminals

The system for high utilization of LNG cold energy is proposed by use of process simulator. The proposed design is a closed loop system, and composed by a Hampson type heat exchanger, turbines, pumps and advanced humid air turbine (AHAT) or Gas turbine combined cycle (GTCC). Its heat sources are Boil-off gas and cooling water for AHAT or GTCC. The higher cold exergy recovery to power can be about 38 to 56% as compared to the existing cold power generation of about 20% with a Rankine cycle of a single component. The advantage of the proposed system is to reduce the number of heat exchangers. Furthermore, the environmental impact is minimized because the proposed design is a closed loop system. A life cycle comparative cost is calculated to demonstrate feasibility of the proposed design. The development of the Hampson type exchangers is expected to meet the key functional requirements and will result in much higher LNG cold exergy recovery and the overall system performance i.e. re-gasification. Additionally, the proposed design is expected to provide flexibility to meet different gas pressure suited for the deregulation of energy system in Japan and higher reliability for an integrated boil-off gas system.

Re-thinking ancillary: Australian screen content in education

The use of Australian screen content in Australian schools and universities is undergoing rapid change due to digital and online distribution capacity on the supply side and digital and online affordance embedded in student cultures. This paper examines the ways in which Australian screen content and its distribution are beginning to adapt to educational usage. Issues facing content rights holders, distribution companies and emerging digital platforms reflect broad-based digital disruption patterns. Learning opportunities that can coincide with the growth in uptake of Australian screen content in Australia's education sector are not immune to the challenges posed by emerging digital consumption behaviours and issues of sustainability. At the same time, the growth in the use of digital and online screen content learning resources, under current copyright conditions, poses significant increases in the underlying cost structure for educational interests. This paper examines the innovations occurring in both the supply and the demand sides of Australian screen content and the expanded learning opportunities arising out of emerging digital affordances. Precedents in the UK are explored that demonstrate how stronger connections can be forged between nationally produced film and media content and a national curriculum. While addressing recent issues arising out of the Australian Law Review Commission's inquiry into copyright in the digital economy, the purpose of this discussion is not to assess policy debates about fair use versus fair dealing. What is clear, however, is that independent research is required that draws upon research-based evidence with an aim to better understanding the needs of the education sector against the transformative shifts taking place in digital-based learning materials and their modes of delivery.

Is there evidence to support the use of the angle of peak torque as a marker of hamstring injury and re-injury risk?

Hamstring strain injuries are the predominant injury in many sports, costing athletes and clubs a significant financial and performance burden. Therefore the ability to identify and intervene with individuals who are considered at a high risk of injury is important. One measure which has grown in popularity as an outcome variable following hamstring intervention/prevention studies and rehabilitation is the angle of peak knee flexor torque. This current opinion article will firstly introduce the measure and the processes behind it. Secondly, this article will summarise how the angle of peak knee flexor torque has been suggested to measure hamstring strain injury risk. Finally various limitations will be presented and outlined as to how they may influence the measure. These include the lack of muscle specificity, the common concentric contraction mode of assessment, reliability of the measure, various neural contributions (such as rate of force development and neuromuscular inhibition) as well as the lack of prospective data showing any predictive value in the measure.

Re-valuing construction materials and components through design for disassembly

The construction industry accounts for a significant portion of the material consumption of our industrialised societies. That material consumption comes at an environmental cost, and when buildings and infrastructure projects are demolished and discarded, after their useful lifespan, that environmental cost remains largely unrecovered. The expected operational lifespan of modern buildings has become disturbingly short as buildings are replaced for reasons of changing cultural expectations, style, serviceability, locational obsolescence and economic viability. The same buildings however are not always physically or structurally obsolete; the materials and components within them are very often still completely serviceable. While there is some activity in the area of recycling of selected construction materials, such as steel and concrete, this is almost always in the form of down cycling or reprocessing. Very little of this material and component resource is reuse in a way that more effectively captures its potential. One significant impediment to such reuse is that buildings are not designed in a way that facilitates easy recovery of materials and components; they are designed and built for speed of construction and quick economic returns, with little or no consideration of the longer term consequences of their physical matter. This research project explores the potential for the recovery of materials and components if buildings were designed for such future recovery; a strategy of design for disassembly. This is not a new design philosophy; design for disassembly is well understood in product design and industrial design. There are also some architectural examples of design for disassembly; however these are specialist examples and there is no significant attempt to implement the strategy in the main stream construction industry. This paper presents research into the analysis of the embodied energy in buildings, highlighting its significance in comparison with operational energy. Analysis at material, component, and whole-of-building levels shows the potential benefits of strategically designing buildings for future disassembly to recover this embodied energy. Careful consideration at the early design stage can result in the deconstruction of significant portions of buildings and the recovery of their potential through higher order reuse and upcycling.

A framework for freeway incident modeling and traffic re-routing

This paper proposes an analytical Incident Traffic Management framework for freeway incident modeling and traffic re-routing. The proposed framework incorporates an econometric incident duration model and a traffic re-routing optimization module. The incident duration model is used to estimate the expected duration of the incident and thus determine the planning horizon for the re-routing module. The re-routing module is a CTM-based Single Destination System Optimal Dynamic Traffic Assignment model that generates optimal real-time strategies of re-routing freeway traffic to its adjacent arterial network during incidents. The proposed framework has been applied to a case study network including a freeway and its adjacent arterial network in South East Queensland, Australia. The results from different scenarios of freeway demand and incident blockage extent have been analyzed and advantages of the proposed framework are demonstrated.

MicroRNA regulation of epithelial-to-mesenchymal transition during re-epithelialisation: Assessing an open wound

It is becoming increasing clear that microRNAs contribute to the regulation of many biological processes, including wound healing. After injury, keratinocytes need to undergo what is known as an epithelial-to-mesenchymal transition (EMT) to initiate re-epithelialisation. During this process, keratinocytes reduce their attachment to the underlying matrix, extend membrane protrusions, become motile and migrate over the wound bed, affecting wound closure. MicroRNAs that regulate EMT are aberrantly upregulated in keratinocytes at the edge of non-healing wounds and potentially play a role in the chronicity of these wounds. In vitro and in vivo, downregulation of these microRNAs promotes EMT and migration, facilitating re-epithelialisation in wound models. This review will focus on the role of microRNAs that regulate or have potential to regulate EMT and re-epithelialisation during wound healing

You're hot, then you're cold: Creative industries policy making in Australia

Much compelling evidence has emerged over the last two decades demonstrating the importance of Australia’s creative industries. In 2014, the Australian Bureau of Statistics confirmed that culture is ‘big business’ in this country. Yet despite this, interest by policy makers at all levels of government has been intermittent, at best. This chapter gives a brief history of policy development, and offers a number of reasons for why policy and politics have not focussed more resolutely on Australia’s creative economy. It finishes with a discussion of Australia’s ‘unfinished agenda’, one which demands attention not only by government, but also industry and higher education, if we are to properly meet both the challenges and opportunities before us.

The impact of safety measures on the re-offence and crash rates of drink-driving offenders in Victoria

Alcohol is a major factor in road deaths and serious injuries. In Victoria, between 2008 and 2013, 30% of drivers killed were involved in alcohol-related crashes. From the early 1980s Victoria progressively introduced a series of measures, such as driver licence cancellation and alcohol interlocks, to reduce the level of drink-driving on Victoria's roads. This project tracked drink-driving offenders to measure and understand their re-offence and road trauma involvement levels during and after periods of licensing and driving interventions. The methodology controlled for exposure by aggregating crashes and traffic violations within relevant categories (e.g. licence cancelled/relicensed/relicensing not sought) and calculated as rates 'per thousand person-years'. Inferential statistical techniques were used to compare crash and offence rates between control and treatment groups across three distinct time periods, which coincided with the introduction of new interventions. This paper focuses on the extent to which the Victorian drink-driving measures have been successful in reducing re-offending and road trauma involvement during and after periods of licence interventions. It was found that a licence cancellation/ban is an effective drink-driving countermeasure as it reduced drink-driving offending and drink-driving crashes. Interlocks also had a positive effect on drink-driving offences as they were reduced during the interlock period as well as for the entire intervention period. Possible drink-driving policy implications are briefly discussed.

Re-thinking teacher quality in high-poverty schools in Australia

As is the case globally, Australian schools that serve high-poverty communities most often employ the least experienced, least prepared teachers. Beginning with a discussion of poverty in Australia this chapter draws on 6 years of learnings from Australia's National Exceptional Teachers for Disadvantaged Schools (NETDS) program to examine how social justice can be taught within a mainstream Initial Teacher Education program in an increasingly neoliberal climate where teacher education curriculum around social justice struggles to find a place within the current discourses of quality teaching and its preoccupations with standards, accountability, and high-stakes testing.

Corporate fraud culture: Re-examining the corporate governance and performance relation

We analyse the corporate governance and performance relation, when conditioning on corporate fraud, for fraud firms during 2000 – 2007. Fraud firms are identified as either self- reported fraud events, or subject to regulatory investigation. We use the inverse Mills ratio procedure to account for firms' (unobservable) fraud culture in the dynamic system GMM model of the performance- governance relation. We find that corporate governance is an endogenously determined characteristic that has no causal impact on firm performance when conditioning on fraud. Fraud is a significant regulatory event but its overall economic impact at the firm level is highly variable.

"Re-thinking" the influence of regulatory capture in the development of government regulation

On 30 March 2015 the Australian Federal Government launched its "Re-Think" initiative with the objective of achieving a better tax system which delivers taxes that are lower, simpler and fairer. The discussion paper released as part of the "Re:think" initiative is designed to start a national conversation on tax reform. However, inquiries into Australia's future tax system, subsequent reforms and the introduction of new taxes are nothing new. Unfortunately, recent history also demonstrates that reform initiatives arising from reviews of the Australian tax system are often deemed a failure. The most prominent of these failures in recent times is the Minerals Resource Rent Tax (MRRT), which lasted a mere 16 months before its announced repeal. Using the established theoretic framework of regulatory capture to interpret publically observable data, the purpose of this article is to explain the failure of this arguably sound tax. It concludes that the MRRT legislation itself, through the capture by the mining companies, provided internal subsidization in the form of reduced tax and minimal or no rents. In doing so, it offers an opportunity to understand and learn from past experiences to ensure that recommendations coming out of the Re:think initiative do not suffer the same fate.