Palliative care phase : inter-rater reliability and acceptability in a national study

Background: The concept of palliative care consisting of five distinct, clinically meaningful, phases (stable, unstable, deteriorating, terminal and bereavement) was developed in Australia about 20 years ago and is used routinely for communicating clinical status, care planning, quality improvement and funding. Aim: To test the reliability and acceptability of revised definitions of Palliative Care Phase. Design: Multi-centre cross-sectional study involving pairs of clinicians independently rating patients according to revised definitions of Palliative Care Phase. Setting/participants: Clinicians from 10 Australian palliative care services, including 9 inpatient units and 1 mixed inpatient/community-based service. Results: A total of 102 nursing and medical clinicians participated, undertaking 595 paired assessments of 410 patients, of which 90.7% occurred within 2 h. Clinicians rated 54.8% of patients in the stable phase, 15.8% in the unstable phase, 20.8% in the deteriorating phase and 8.7% in the terminal phase. Overall agreement between clinicians’ rating of Palliative Care Phase was substantial (kappa = 0.67; 95% confidence interval = 0.61–0.70). A moderate level of inter-rater reliability was apparent across all participating sites. The results indicated that Palliative Care Phase was an acceptable measure, with no significant difficulties assigning patients to a Palliative Care Phase and a good fit between assessment of phase and the definition of that phase. The most difficult phase to distinguish from other phases was the deteriorating phase. Conclusion: Policy makers, funders and clinicians can be confident that Palliative Care Phase is a reliable and acceptable measure that can be used for care planning, quality improvement and funding purposes.

What Next? Future Directions for R&D Investment

Professor Peter Barrett at the 2013 CIB World Building Congress1 (WBC13) presented a timely context for the future of research and development (R&D) investment in the global construction industry (Barrett, 2013). He called for a shift in the focus from lessons learned and doing things better to what is the right thing to do and developing a new paradigm for achieving this. This shift requires empathy with industry and users; a desire to generate and transmit knowledge; an opportunity to study deeply and over the long term; and with an objective stance towards fJositive and negative findings. This shift includes the creation of sta11dards for the holistic impact of spaces through exemplary pilot projects creating evidence for policy makers and clients (Barrett, 2013)...

Understanding causal relationships between the built and social environment, health and associated behaviours and risk factors

Introduction: Built environment interventions designed to reduce non-communicable diseases and health inequity, complement urban planning agendas focused on creating more ‘liveable’, compact, pedestrian-friendly, less automobile dependent and more socially inclusive cities.However, what constitutes a ‘liveable’ community is not well defined. Moreover, there appears to be a gap between the concept and delivery of ‘liveable’ communities. The recently funded NHMRC Centre of Research Excellence (CRE) in Healthy Liveable Communities established in early 2014, has defined ‘liveability’ from a social determinants of health perspective. Using purpose-designed multilevel longitudinal data sets, it addresses five themes that address key evidence-base gaps for building healthy and liveable communities. The CRE in Healthy Liveable Communities seeks to generate and exchange new knowledge about: 1) measurement of policy-relevant built environment features associated with leading non-communicable disease risk factors (physical activity, obesity) and health outcomes (cardiovascular disease, diabetes) and mental health; 2) causal relationships and thresholds for built environment interventions using data from longitudinal studies and natural experiments; 3) thresholds for built environment interventions; 4) economic benefits of built environment interventions designed to influence health and wellbeing outcomes; and 5) factors, tools, and interventions that facilitate the translation of research into policy and practice. This evidence is critical to inform future policy and practice in health, land use, and transport planning. Moreover, to ensure policy-relevance and facilitate research translation, the CRE in Healthy Liveable Communities builds upon ongoing, and has established new, multi-sector collaborations with national and state policy-makers and practitioners. The symposium will commence with a brief introduction to embed the research within an Australian health and urban planning context, as well as providing an overall outline of the CRE in Healthy Liveable Communities, its structure and team. Next, an overview of the five research themes will be presented. Following these presentations, the Discussant will consider the implications of the research and opportunities for translation and knowledge exchange. Theme 2 will establish whether and to what extent the neighbourhood environment (built and social) is causally related to physical and mental health and associated behaviours and risk factors. In particular, research conducted as part of this theme will use data from large-scale, longitudinal-multilevel studies (HABITAT, RESIDE, AusDiab) to examine relationships that meet causality criteria via statistical methods such as longitudinal mixed-effect and fixed-effect models, multilevel and structural equation models; analyse data on residential preferences to investigate confounding due to neighbourhood self-selection and to use measurement and analysis tools such as propensity score matching and ‘within-person’ change modelling to address confounding; analyse data about individual-level factors that might confound, mediate or modify relationships between the neighbourhood environment and health and well-being (e.g., psychosocial factors, knowledge, perceptions, attitudes, functional status), and; analyse data on both objective neighbourhood characteristics and residents’ perceptions of these objective features to more accurately assess the relative contribution of objective and perceptual factors to outcomes such as health and well-being, physical activity, active transport, obesity, and sedentary behaviour. At the completion of the Theme 2, we will have demonstrated and applied statistical methods appropriate for determining causality and generated evidence about causal relationships between the neighbourhood environment, health, and related outcomes. This will provide planners and policy makers with a more robust (valid and reliable) basis on which to design healthy communities.

Regulating supply-chains to address the occupational health and safety problems associated with precarious employment: The case of home-based clothing workers in Australia

Over the past 20 years the labour market, workforce and work organisation of most if not all industrialised countries have been significantly refashioned by the increased use of more flexible work arrangements, variously labelled as precarious employment or contingent work. There is now a substantial and growing body of international evidence that many of these arrangements are associated with a significant deterioration in occupational health and safety (OHS), using a range of measures such as injury rates, disease, hazard exposures and work-related stress. Moreover, there is an emerging body of evidence that these arrangements pose particular problems for conventional regulatory regimes. Recognition of these problems has aroused the concern of policy makers - especially in Europe, North America and Australia - and a number of responses have been adopted in terms of modifying legislation, producing new guidance material and codes of practice and revised enforcement practices. This article describes one such in itiative in Australia with regard to home-based clothing workers. The regulatory strategy developed in one Australian jurisdiction (and now being ‘exported’ into others) seeks to counter this process via contractual tracking mechanisms to follow the work, tie in liability and shift overarching legal responsibility to the top of the supply chain. The process also entails the integration of minimum standards relating to wages, hours and working conditions; OHS and access to workers’ compensation. While home-based clothing manufacture represents a very old type of ‘flexible’ work arrangement, it is one that regulators have found especially difficult to address. Further, the elaborate multi-tiered subcont racting and diffuse work locations found in this industry are also characteristic of newer forms of contingent work in other industries (such as some telework) and the regulatory challenges they pose (such as the tendency of elaborate supply chains to attenuate and fracture statutory responsibilities, at least in terms of the attitudes and behaviour of those involved).

Bribery and corruption in Australian local councils

This paper explores concerns about corruptio and bribery in Australian local government and provides guidance for policy-makers on how to control bribery and corruption. Lack of regulation is a major reason why local councils are not taking appropriate anti-corruption or bribery measures. The author urgers regulators to impose radical and mandatory requirements, especially reporting requirements, on local councils. Australia should also look to other countries for successful measures to curb bribery and corruption.

eHealth and the modern society

The integration of Information and Communication Technologies (ICT) into healthcare processes “eHealth” is driving enormous change in healthcare delivery and productivity. The transformations empower patients and present opportunities for new synergies between healthcare professionals, clinical decision makers, policy makers and educators. Technologies that are directly driving changes include Tele-medicine, Electronic health records (EHR), Standards to ensure computer systems inter-operate, Decision support systems, Data mining and easy access to medical information. This workshop provides an introduction to key informatics initiatives in eHealth using real examples and suggests how applications can be applied to modern society.

Financial literacy and superannuation investment decision-making in a choice environment : an exploratory study

This thesis examines superannuation fund members' level of financial literacy and its association with investment choice decisions in the setting of the mandatory superannuation system in Australia. It also investigates a range of contextual and socio-demographic factors in explaining financial literacy and investment choice. The empirical analysis shows that while most survey respondents displayed high levels of self-rated and general financial literacy, fewer scored as well in relation to more advanced literacy regarding superannuation investment options. The findings of this study have important implications for policy-makers and the superannuation industry in educating and engaging with fund members.

Telecommunications Impacts on the Structure and Organisation of Male Sex Work

(Sub)Urban Sexscapes brings together a collection of theoretically-informed and empirically rich case studies highlighting the contemporary and historical geographies and regulation of the commercial sex industry. Contributions in this edited volume examine the spatial and regulatory contours of the sex industry from a range of disciplinary perspectives—urban planning, urban geography, urban sociology, and, cultural and media studies—and geographical contexts—Australia, the UK, US and North Africa. In overall terms, (Sub)urban Sexscapes highlights the mainstreaming of commercial sex premises—sex shops, brothels, strip clubs and queer spaces—and products—sex toys, erotic literature and pornography—now being commonplace in night time economy spaces, the high street, suburban shopping centres and the home. In addition, the aesthetics of commercial and alternative sexual practices—BDSM and pornography—permeate the (sub)urban landscape via billboards, newspapers and magazines, television, music videos and the Internet. The role of sex, sexuality and commercialized sex, in contributing to the general character of our cities cannot be ignored. In short, there is a need for policy-makers to be realistic about the historical, contemporary and future presence of the sex industry. Ultimately, the regulation of the sex industry should be informed by evidence as opposed to moral panics.

Narrative and multimodality in English language arts curricula : a tale of two nations

In this policy column within this special edition on "The Arts in Language Arts", we critique the current place of multimodality and narratives in research and curriculum policy. This is a vital issue of significance for literacy educators, researchers, and policy makers because the narrative texts that circulate in our everyday lives are multimodal, tied to the ever-broadening range of narratives forms in digital sites of display. Here, we critically evaluate the place of multimodality and narratives in the language arts or English curriculum policies of two nations, the USA and Australia. In particular, we highlight the silence on multimodality within the Common Core State Standards, USA, and the contrasting centrality of multimodality in the National Curriculum: English, Australia.

Resolving the conflicts of sustainable world heritage landscapes in cities : fully open or limited access for visitors?

World Heritage Landscapes (WHLs) are receiving increased attention from researchers, urban planners, managers, and policy makers and many heritage values and resources are becoming irreversibly lost. This phenomenon is especially prominent for WHLs located in cities, where greater development opportunities are involved. Decision making for sustainable urban landscape planning, conservation and management of WHLs often takes place from an economic perspective, especially in developing countries. This, together with the uncertain source of funding to cover WHL operating and maintenance costs, has resulted in many urban managers seeking private sector funding either in the form of visitor access fees or leasing part of the site for high-rental facilities such as five star hotels, clubs and expensive restaurants. For the former, this can result in low-income urban citizens being unable to afford the access fees and hence contradicting the principle of equal access for all; while, for the latter, the principle of open access for all is equally violated. To resolve this conflict, a game model is developed to determine how urban managers should allocate WHL spaces to maximize the combination of economic, social and ecological benefits and cultural values. A case study is provided of the Hangzhou's West Lake Scenic Area, a WHL located at the centre of Hangzhou city, in which several high-rental facilities have recently been closed down by the local authorities due to charges of elitism and misuse of public funds by government officials. The result shows that the best solution is to lease a small space with high rents and leave the remainder of the site to the public. This solution is likely to be applicable only in cities with a strong economy.

Informal interactions between audit committees and internal audit functions : exploratory evidence and directions for future research

Purpose – This paper aims to recognise the importance of informal processes within corporate governance and complement existing research in this area by investigating factors associated with the existence of informal interactions between audit committees and internal audit functions and in providing directions for future research. Design/methodology/approach – To examine the existence and drivers of informal interactions between audit committees and internal audit functions, this paper relies on a questionnaire survey of chief audit executives (CAEs) in the UK from listed and non-listed, as well as financial and non-financial, companies. While prior qualitative research suggests that informal interactions do take place, most of the evidence is based on particular organisational setting or on a very small range of interviews. The use of a questionnaire enabled the examination of the existence of internal interactions across a relatively larger number of entities. Findings – The paper finds evidence of audit committees and internal audit functions engaging in informal interactions in addition to formal pre-scheduled regular meetings. Informal interactions complement formal meetings with the audit committee and as such represent additional opportunities for the audit committees to monitor internal audit functions. Audit committees’ informal interactions are significantly and positively associated with audit committee independence, audit chair’s knowledge and experience, and internal audit quality. Originality/value – The results demonstrate the importance of the background of the audit committee chair for the effectiveness of the governance process. This is possibly the first paper to examine the relationship between audit committee quality and internal audit, on the existence and driver of informal interactions. Policy makers should recognize that in addition to formal mechanisms, informal processes, such as communication outside of formal pre-scheduled meetings, play a significant role in corporate governance.

What Costs Accountability? Financial Accountability, Mission and Fundraising in Nonprofits

Although greater calls for accountability have been articulated by academics, policy makers and donors in the recent years, a stream of thought has been questioning where the giving of an account should stop. In conveying the limits to the giving of an account (Messner, 2009) and associated transparency (Roberts, 2009), critical accounting scholars have also pointed to as yet unresolved contradictions intrinsic to accountability (McKernan, 2012), especially when it comes to be operationalised (Joannides, 2012). The impact of accountability's discharging on nonprofits' strategy or operations has to date been underexplored (Dhanni & Connelly, 2012; Tucker & Parker, 2013). Accordingly, this chapter seeks to contribute to this body of literature on the consequences of accountability on fundraising strategies in nonprofits, questioning whether accountability practice may hamper the effectiveness of the nonprofit sector by restraining the fundraising profession. Our chapter seeks to fill a dual theoretical gap. Firstly, only a number of publications have investigated the interplay between accountability and the making of organisational strategy (Parker, 2002, 2003b, 2011, 2012, 2013; Tucker & Parker, 2013). Therefore, we seek to fill a theoretical gap as to the impact of accountability on the conduct of straegic operations. By questioning whether accountability hampers fundraising strategy in non-profits we are also contributing to the literature balancing accountability and the mission. In this literature, it appears that money and the mission are often conflictual, financial managers being often seen by mission advocates as guardians shielding organisational resources (Chiapello, 1993, 1998; Lightbody, 2000, 2003). Another approach shows that making nonprofits accountable to capital and multiple stakeholders (donors, public authorities) leaders to changes in organisational culture (O'Dwyer & Unerman, 2007; Unerman & Bennett, 2004; Underman & O'Dwyer, 2006a, 2006b, 2008). By examining a small number of cases we show how accountability practices result in fundraising adapting and adjusting under such external pressures and constraints. We also show accountability systems may have a direct impact on the conduct of strategic operations, which might hamper mission conduct.

Psychological determinants of motorcycle helmet use among young adults in Cambodia

Cambodian accident statistics show that motivating motorcyclists to make proper use of a safety helmet is a top priority for road safety policy makers. Yet, currently there is no insight whatsoever in the psychological precursors of helmet use in Cambodia. As such, it remains unclear which variables to target by interventions aimed at promoting the use of safety helmets. Therefore, this study adopted a socio-cognitive perspective towards the examination of helmet use in a sample of Cambodian young adults (N = 344). Two theoretical models, i.e., Health Belief Model and Theory of Planned Behaviour were combined and further complemented with two norm-related variables, i.e., descriptive- and personal norm. Based on the results, two important conclusions can be drawn. Firstly, the sample investigated in this study is clearly favourably disposed towards the use of helmets while riding. Secondly, in decreasing order, helmet use behaviour was found to be determined by the following five key-determinants: perceived behavioural control over a specific set of inhibiting situational factors (i.e., mostly when driving short distances, at night, or when dressed up to go out), perceived behavioural control in general, perceived susceptibility, personal norm, and behavioural intentions. Policy makers are recommended to reevaluate their current behavioural change methods for young adults being favourably disposed towards the use of safety helmets. Rather than focussing on motivation-oriented methods, there is a need for strategies that (1) stimulate the translation of good intentions into the desirable behaviour and (2) encourage young adults not to relapse in case they are exposed to risk facilitating circumstances. These implications will be discussed more in detail.

Competitive advantage through safety compliance : smaller firm responses to changes in the Australian occupational health and safety regulatory context

Smaller firms are often viewed as resistant to regulation due to cost burdens. However, evidence indicates that for some compliance is beneficial under certain conditions. Drawing on data on attitudes and responses of smaller firm owner-managers to changes in Australia’s harmonising work health and safety context we report on smaller firms’ responses to these changes. Despite uncertainty due to incomplete harmonisation, many owner-managers viewed safety compliance as important and necessary to do business. Those with negative views still linked positive safety performance to business outcomes. We categorise smaller firms’ responses and in this sample most are Positive Responders. We suggest ways forward for policy-makers to support smaller firms in complying with occupational health and safety regulation.

Bridging the gap: Exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.