A pilot randomised control trial of general practitioner and exercise physiologist interventions to reduce primary cardiovascular risk in overweight patients [Abstract]

Aims & Rationale/Objectives: With the knowledge that overweight is a major public health concern in Australia, that a multidisciplinary team approach to the management of lifestyle-related conditions is supported, and that the Australian Government recently recognised the role of the exercise physiologist (EP) in reducing the health burden of disease by their inclusion for reimbursement under the Medicare Plus scheme, this study sought to undertake a pilot RCT to compare GP and EP interventions to reduce primary cardiovascular risk in the overweight general practice population. Methods and Measures: Overweight patients recruited by a convenience sample of GPs were randomised into one of three arms: the control group, or the GP or EP intervention group (in which patients received either five GP or five EP consultations over 24 weeks). Patients had baseline, 12- and 24-week measures of body composition and cardio-respiratory fitness, and completed baseline and end-of-study surveys, fasting lipids and glucose. GPs and EPs completed an end-of-study survey. Results:Sixty-seven patients attended the baseline assessment. Overall retention rate was 67%. Patients were generally satisfied with the effectiveness of the interventions and their weight reduction. Favourable trends in BMI, weight, glucose and exercise levels for GP and EP intervention groups and in physical activity levels for all groups Conclusions: This study supports the feasibility of a RCT of GP and EP interventions for decreasing primary cardiovascular risk in the overweight general practice population.

Open standards-based system integration for asset management decision support

Over the last decade, system integration has grown in popularity as it allows organisations to streamline business processes. Traditionally, system integration has been conducted through point-to-point solutions – as a new integration scenario requirement arises, a custom solution is built between the relevant systems. Bus-based solutions are now preferred, whereby all systems communicate via an intermediary system such as an enterprise service bus, using a common data exchange model. This research investigates the use of a common data exchange model based on open standards, specifically MIMOSA OSA-EAI, for asset management system integration. A case study is conducted that involves the integration of processes between a SCADA, maintenance decision support and work management system. A diverse number of software platforms are employed in developing the final solution, all tied together through MIMOSA OSA-EAI-based XML web services. The lessons learned from the exercise are presented throughout the paper.

Power management and power flow control with back-to-back converters in a utility connected microgrid

This paper proposes a method for power flow control between utility and microgrid through back-to-back converters, which facilitates desired real and reactive power flow between utility and microgrid. In the proposed control strategy, the system can run in two different modes depending on the power requirement in the microgrid. In mode-1, specified amount of real and reactive power are shared between the utility and the microgrid through the back-to-back converters. Mode-2 is invoked when the power that can be supplied by the DGs in the microgrid reaches its maximum limit. In such a case, the rest of the power demand of the microgrid has to be supplied by the utility. An arrangement between DGs in the microgrid is proposed to achieve load sharing in both grid connected and islanded modes. The back-to-back converters also provide total frequency isolation between the utility and the microgrid. It is shown that the voltage or frequency fluctuation in the utility side has no impact on voltage or power in microgrid side. Proper relay-breaker operation coordination is proposed during fault along with the blocking of the back-to-back converters for seamless resynchronization. Both impedance and motor type loads are considered to verify the system stability. The impact of dc side voltage fluctuation of the DGs and DG tripping on power sharing is also investigated. The efficacy of the proposed control ar-rangement has been validated through simulation for various operating conditions. The model of the microgrid power system is simulated in PSCAD.

Performance Research in Rangeland Communities

In 2003, Bill Dunstone, John McCallum and Paul Makeham began a collaboration with researchers at the Centre for the Management of Arid Environments (CMAE) in Kalgoorlie, Western Australia. CMAE researchers are keen to develop 'people-oriented' strategies for implementing agricultural extension initiatives in their region. Traditional hierarchies of knowledge-transfer have impeded the 'connectedness' between community and researchers that gives meaning and relevance to useful practice (Ison and Russell, 2000). Our aim is to establish a partnership between the Live Events Research Network (LERN) and CMAE, investigating ways to link creative, performance-based research and practice with the scientific methodologies associated with natural resources management. This accords with recent work undertaken by Deborah Mills and Paul Brown, showing how community cultural development strategies enhance the implementation of policy concerned with community wellbeing. Mills and Brown 'adopted a concept of wellbeing which builds on a social and environmental view of health', and considered such themes as ecological sustainability, rural economic revitalisation, community strengthening, health and wellbeing (Mills, 2003). We propose that rangeland communities can creatively manage some of the challenges confronting them through performance-based projects which: - activate the stories through which a community enacts its sense of place; - facilitate live events in which the community enacts ownership of its culture and identity; - directly involve the community in the formulation of research issues

Evaluation of aerial remote sensing techniques for vegetation management in power line corridors

The following paper presents an evaluation of airborne sensors for use in vegetation management in powerline corridors. Three integral stages in the management process are addressed including, the detection of trees, relative positioning with respect to the nearest powerline and vegetation height estimation. Image data, including multi-spectral and high resolution, are analyzed along with LiDAR data captured from fixed wing aircraft. Ground truth data is then used to establish the accuracy and reliability of each sensor thus providing a quantitative comparison of sensor options. Tree detection was achieved through crown delineation using a Pulse-Coupled Neural Network (PCNN) and morphologic reconstruction applied to multi-spectral imagery. Through testing it was shown to achieve a detection rate of 96%, while the accuracy in segmenting groups of trees and single trees correctly was shown to be 75%. Relative positioning using LiDAR achieved a RMSE of 1.4m and 2.1m for cross track distance and along track position respectively, while Direct Georeferencing achieved RMSE of 3.1m in both instances. The estimation of pole and tree heights measured with LiDAR had a RMSE of 0.4m and 0.9m respectively, while Stereo Matching achieved 1.5m and 2.9m. Overall a small number of poles were missed with detection rates of 98% and 95% for LiDAR and Stereo Matching.

Examining the role of human resource management in continuous improvement

The objective of this paper is to take a first step in developing a theoretical framework describing the role of HRM in successful CI, based on the current literature from both fields. To this end, elements from the CI Maturity Model and a framework depicting the role of HRM in innovation serve as a foundation for examining how specific bundles of HRM practices utilised during different phases of the CI implementation process may contribute to sustained organisational and enhanced operational performance. The primary contribution of this paper is theoretical; however, the framework has practical value in that it suggests important relationships between HRM practices and behaviours necessary for successful CI. A preliminary test of the framework in an empirical setting is summarised at the conclusion of this paper, where a number of possible research avenues are also suggested.

The intra-aortic balloon pump in heart failure management : implications for nursing practice

Management of acute heart failure is an important consideration in critical care. Mechanical support of the failing heart is crucial for improving health outcomes. The most common Australasian application of intraaortic balloon counterpulsation (IABP) is in the setting of cardiogenic shock. High end users of IABP (>37/annum) demonstrate significantly lower mortality for cardiogenic shock managed with IABP (p <0.001) in contrast to hospitals which employ limited IABP (<4/annum). This underscores the importance of proficiency in managing patient receiving IABP support. Nurses play a crucial role in carding for patients with acute heart failure. This paper summarises care considerations for management of the IABP.

The diversity management approach to equal employment opportunity in Australian organisations

This article assesses the 'Managing Diversity' (MD) approach in Australia, examining its drivers, discussing its relationship to legislation designed to promote equity, and examining it as a set of management practices. It has been plausibly argued, on efficiency grounds, that responsibility for achieving equality objectives must be shifted to organisations as this links contextual conditions to organisational processes. However, even where there is some prescription and guidance such as that provided by Australian Equal Employment Opportunity (EEO) legislation targeted specifically to women employees, both practice and outcomes are variable. This is even more the case with MD where there are no guiding principles or legislative support. The article examines the best practice EEO and MD programs of Australian organisations to demonstrate the approaches and programs that are being developed at the workplace and to highlight the limitations of the 'business case' approach underlying such programs.

Improving quality management system implementation in Indonesian construction firms : a research project

This paper has two main sections, the first of which presents a summarized review of the literature concerning previous studies on the implementation of ISO 9000 quality management systems (QMSs) both in global construction companies as well as in Indonesian construction firms, and the perceived correlation between organisational culture and QMS practices in the construction sector. The first section of the paper contributes to the development of the second section, which presents details of the research project being undertaken. Based on the fundamental questions that led to the development of the main research objectives, suitable research methods have been developed in order to meet these objectives. Primary data will be collected by use of a mixed methods approach, i.e., questionnaire surveys and focus group discussions/interviews in order to obtain opinions from respondents drawn from targeted ISO construction firms. Most of the data expected to be obtained will be in future be analyzed using statistical software then the findings will be discussed in order to ultimately develop a culture-based QMS framework.

Risk management in the Lusoponte concession : a case study of the two bridges in Lisbon, Portugal

The case study of Lusoponte illustrates the concession awarded by the Portuguese Government to finance, design, build and operate two bridges over the Tagus in Lisbon, Portugal. It includes an overview of the project's background and an analysis of the main risk categories stating both the actual risks encountered and the mitigation measures adopted. Throughout the project a great attention was given to whole life cycle costs, and gains in efficiency and cost control. Among the lessons that can be learned from both the public and private sector is that a complete risk management analysis must include not only the technical factors but also a realistic assessment of environmental and social risks. These were the risks that were somewhat overseen and that caused the main problems to the project's development.

Manufacturing management programs : are developing economies bridging the strategic gap?

Over the past decade there have been a large number of significant innovations in manufacturing which have resulted in more flexible and cost efficient methods and higher quality products, as manufacturers have set about upgrading their processes, systems and performance. This study compares the use of technologies and improvement programs between OECD and Non-OECD countries, and also between small and large firms, and examines differences in the use and outcomes across the economies and different sized firms. The empirical analysis provides an opportunity to test whether the ‘capabilities’ or strengths of a firm can be linked to these activities and examines if developing economies are using technology or management programs such as quality management and business process re-engineering to catch up to manufacturers in developed economies. The analysis utilises data from the second International Manufacturing Strategy Survey (IMSS), which encompasses 703 firms in 23 countries.

The relationship between HRM practices and service behaviour in South African service organizations

This paper reports on findings from research conducted in South African service organizations that frontline employees' perceptions of HRM practices have a direct influence on their service behaviour. Specific HRM practices have more impact than others and this was attributed to the influence of external factors such as the socio-political situation and national culture and to internal factors linked to the way managers implemented the HRM practices in the organization. Organizational commitment was found to play a mediating role in the relationship between frontline employees' perceptions of HRM and their service behaviour.

Quality issues for the National Bowel Cancer Screening Program (NBCSP)

Purpose: This two-part research project was undertaken as part of the planning process by Queensland Health (QH), Cancer Screening Services Unit (CSSU), Queensland Bowel Cancer Screening Program (QBCSP), in partnership with the National Bowel Cancer Screening Program (NBCSP), to prepare for the implementation of the NBCSP in public sector colonoscopy services in QLD in late 2006. There was no prior information available on the quality of colonoscopy services in Queensland (QLD) and no prior studies that assessed the quality of colonoscopy training in Australia. Furthermore, the NBCSP was introduced without extra funding for colonoscopy service improvement or provision for increases in colonoscopic capacity resulting from the introduction of the NBCSP. The main purpose of the research was to record baseline data on colonoscopy referral and practice in QLD and current training in colonoscopy Australia-wide. It was undertaken from a quality improvement perspective. Implementation of the NBCSP requires that all aspects of the screening pathway, in particular colonoscopy services for the assessment of positive Faecal Occult Blood Tests (FOBTs), will be effective, efficient, equitable and evidence-based. This study examined two important aspects of the continuous quality improvement framework for the NBCSP as they relate to colonoscopy services: (1) evidence-based practice, and (2) quality of colonoscopy training. The Principal Investigator was employed as Senior Project Officer (Training) in the QBCSP during the conduct of this research project. Recommendations from this research have been used to inform the development and implementation of quality improvement initiatives for provision of colonoscopy in the NBCSP, its QLD counterpart the QBCSP and colonoscopy services in QLD, in general. Methods – Part 1 Chart audit of evidence-based practice: The research was undertaken in two parts from 2005-2007. The first part of this research comprised a retrospective chart audit of 1484 colonoscopy records (some 13% of all colonoscopies conducted in public sector facilities in the year 2005) in three QLD colonoscopy services. Whilst some 70% of colonoscopies are currently conducted in the private sector, only public sector colonoscopy facilities provided colonoscopies under the NBCSP. The aim of this study was to compare colonoscopy referral and practice with explicit criteria derived from the National Health & Medical Research Council (NHMRC) (1999) Clinical Practice Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer, and describe the nature of variance with the guidelines. Symptomatic presentations were the most common indication for colonoscopy (60.9%). These comprised per rectal bleeding (31.0%), change of bowel habit (22.1%), abdominal pain (19.6%), iron deficiency anaemia (16.2%), inflammatory bowel disease (8.9%) and other symptoms (11.4%). Surveillance and follow-up colonoscopies accounted for approximately one-third of the remaining colonoscopy workload across sites. Gastroenterologists (GEs) performed relatively more colonoscopies per annum (59.9%) compared to general surgeons (GS) (24.1%), colorectal surgeons (CRS) (9.4%) and general physicians (GPs) (6.5%). Guideline compliance varied with the designation of the colonoscopist. Compliance was lower for CRS (62.9%) compared to GPs (76.0%), GEs (75.0%), GSs (70.9%, p<0.05). Compliance with guideline recommendations for colonoscopic surveillance for family history of colorectal cancer (23.9%), polyps (37.0%) and a past history of bowel cancer (42.7%), was by comparison significantly lower than for symptomatic presentations (94.4%), (p<0.001). Variation with guideline recommendations occurred more frequently for polyp surveillance (earlier than guidelines recommend, 47.9%) and follow-up for past history of bowel cancer (later than recommended, 61.7%, p<0.001). Bowel cancer cases detected at colonoscopy comprised 3.6% of all audited colonoscopies. Incomplete colonoscopies occurred in 4.3% of audited colonoscopies and were more common among women (76.6%). For all colonoscopies audited, the rate of incomplete colonoscopies for GEs was 1.6% (CI 0.9-2.6), GPs 2.0% (CI 0.6-7.2), GS 7.0% (CI 4.8-10.1) and CRS 16.4% (CI 11.2-23.5). 18.6% (n=55) of patients with a documented family history of bowel cancer had colonoscopy performed against guidelines recommendations (for general (category 1) population risk, for reasons of patient request or family history of polyps, rather than for high risk status for colorectal cancer). In general, family history was inadequately documented and subsequently applied to colonoscopy referral and practice. Methods - Part 2 Surveys of quality of colonoscopy training: The second part of the research consisted of Australia-wide anonymous, self-completed surveys of colonoscopy trainers and their trainees to ascertain their opinions on the current apprenticeship model of colonoscopy in Australia and to identify any training needs. Overall, 127 surveys were received from colonoscopy trainers (estimated response rate 30.2%). Approximately 50% of trainers agreed and 27% disagreed that current numbers of training places were adequate to maintain a skilled colonoscopy workforce in preparation for the NBCSP. Approximately 70% of trainers also supported UK-style colonoscopy training within dedicated accredited training centres using a variety of training approaches including simulation. A collaborative approach with the private sector was seen as beneficial by 65% of trainers. Non-gastroenterologists (non-GEs) were more likely than GEs to be of the opinion that simulators are beneficial for colonoscopy training (χ2-test = 5.55, P = 0.026). Approximately 60% of trainers considered that the current requirements for recognition of training in colonoscopy could be insufficient for trainees to gain competence and 80% of those indicated that ≥ 200 colonoscopies were needed. GEs (73.4%) were more likely than non-GEs (36.2%) to be of the opinion that the Conjoint Committee standard is insufficient to gain competence in colonoscopy (χ2-test = 16.97, P = 0.0001). The majority of trainers did not support training either nurses (73%) or GPs in colonoscopy (71%). Only 81 (estimated response rate 17.9%) surveys were received from GS trainees (72.1%), GE trainees (26.3%) and GP trainees (1.2%). The majority were males (75.9%), with a median age 32 years and who had trained in New South Wales (41.0%) or Victoria (30%). Overall, two-thirds (60.8%) of trainees indicated that they deemed the Conjoint Committee standard sufficient to gain competency in colonoscopy. Between specialties, 75.4% of GS trainees indicated that the Conjoint Committee standard for recognition of colonoscopy was sufficient to gain competence in colonoscopy compared to only 38.5% of GE trainees. Measures of competency assessed and recorded by trainees in logbooks centred mainly on caecal intubation (94.7-100%), complications (78.9-100%) and withdrawal time (51-76.2%). Trainees described limited access to colonoscopy training lists due to the time inefficiency of the apprenticeship model and perceived monopolisation of these by GEs and their trainees. Improvements to the current training model suggested by trainees included: more use of simulation, training tools, a United Kingdom (UK)-style training course, concentration on quality indicators, increased access to training lists, accreditation of trainers and interdisciplinary colonoscopy training. Implications for the NBCSP/QBCSP: The introduction of the NBCSP/QBCSP necessitates higher quality colonoscopy services if it is to achieve its ultimate goal of decreasing the incidence of morbidity and mortality associated with bowel cancer in Australia. This will be achieved under a new paradigm for colonoscopy training and implementation of evidence-based practice across the screening pathway and specifically targeting areas highlighted in this thesis. Recommendations for improvement of NBCSP/QBCSP effectiveness and efficiency include the following: 1. Implementation of NBCSP and QBCSP health promotion activities that target men, in particular, to increase FOBT screening uptake. 2. Improved colonoscopy training for trainees and refresher courses or retraining for existing proceduralists to improve completion rates (especially for female NBCSP/QBCSP participants), and polyp and adenoma detection and removal, including newer techniques to detect flat and depressed lesions. 3. Introduction of colonoscopy training initiatives for trainees that are aligned with NBCSP/QBCSP colonoscopy quality indicators, including measurement of training outcomes using objective quality indicators such as caecal intubation, withdrawal time, and adenoma detection rate. 4. Introduction of standardised, interdisciplinary colonoscopy training to reduce apparent differences between specialties with regard to compliance with guideline recommendations, completion rates, and quality of polypectomy. 5. Improved quality of colonoscopy training by adoption of a UK-style training program with centres of excellence, incorporating newer, more objective assessment methods, use of a variety of training tools such as simulation and rotations of trainees between metropolitan, rural, and public and private sector training facilities. 6. Incorporation of NHMRC guidelines into colonoscopy information systems to improve documentation, provide guideline recommendations at the point of care, use of gastroenterology nurse coordinators to facilitate compliance with guidelines and provision of guideline-based colonoscopy referral letters for GPs. 7. Provision of information and education about the NBCSP/QBCSP, bowel cancer risk factors, including family history and polyp surveillance guidelines, for participants, GPs and proceduralists. 8. Improved referral of NBCSP/QBCSP participants found to have a high-risk family history of bowel cancer to appropriate genetics services.