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.

Privacy concerns and purchase of travel product online

The travel and tourism industry has come to rely heavily on information and communication technologies to facilitate relations with consumers. Compiling consumer data profiles has become easier and it is widely thought that consumers place great importance on how that data is handled by firms. Lack of trust may cause consumers to have privacy concerns and may, in turn, have an adverse impact on consumers’ willingness to purchase online. Three specific aspects of privacy that have received attention from researchers are unauthorized use of secondary data, invasion of privacy, and errors. A survey study was undertaken to examine the effects of these factors on both prior purchase of travel products via the Internet and future purchase probability. Surprisingly, no significant relationships were found to indicate that such privacy concerns affect online purchase behavior within the travel industry. Implications for managers are discussed.

Risk management and high reliability : a case study of Australian airport management

This thesis investigated risk management and organisational reliability in airports from the perspective of complex sociotechnical systems (CSSs). Two research studies were undertaken, the first focusing on the processes by which disruptive events occur, are detected and responded to; the second exploring the presence of organisational reliability traits within airports. A key result of the studies was the development of new approach: the Critical Incident Disturbance Process model that detailed a means to understand and analyse how disruptions in complex CSSs might be influenced by vulnerability reduction and enhanced risk management. Further, this thesis identified and defined the concept of 'compartmentalised reliability' in complex sociotechnical systems, extending existing knowledge of high reliability theory.

A conceptual analysis of strategic capability development within product innovation projects

Strategic capability development refers to the renewal of the organisational capabilities which are sources of competitive advantage. The aim of this paper is to examine how strategic capability and competitive advantage build up over time. Recent literature points to the integration of dynamic capability and ambidexterity perspectives in explaining organisational capability development. Literature analysis reveals the role of knowledge integration and product innovation in integrating dynamic capability and ambidexterity. However, little attention has yet been paid to knowledge integration within innovation projects as a context for capability development. Accordingly, this paper aims to develop a conceptual framework for strategic capability development focusing on the role of knowledge integration within product innovation projects. This framework contributes to identifying and emphasising the role of micro processes in capability renewal which in turn enhances our understanding of strategic capability development.

Developing a transdisciplinary approach to improve urban traffic congestion based on Product Ecosystem theory

Product Ecosystem theory is an emerging theory that shows that disruptive “game changing” innovation is only possible when the entire ecosystem is considered. When environmental variables change faster than products or services can adapt, disruptive innovation is required to keep pace. This has many parallels with natural ecosystems where species that cannot keep up with changes to the environment will struggle or become extinct. In this case the environment is the city, the environmental pressures are pollution and congestion, the product is the car and the product ecosystem is comprised of roads, bridges, traffic lights, legislation, refuelling facilities etc. Each one of these components is the responsibility of a different organisation and so any change that affects the whole ecosystem requires a transdisciplinary approach. As a simple example, cars that communicate wirelessly with traffic lights are only of value if wireless-enabled traffic lights exist and vice versa. Cars that drive themselves are technically possible but legislation in most places doesn’t allow their use. According to innovation theory, incremental innovation tends to chase ever diminishing returns and becomes increasingly unable to tackle the “big issues.” Eventually “game changing” disruptive innovation comes along and solves the “big issues” and/or provides new opportunities. Seen through this lens, the environmental pressures of urban traffic congestion and pollution are the “big issues.” It can be argued that the design of cars and the other components of the product ecosystem follow an incremental innovation approach. That is why the “big issues” remain unresolved. This paper explores the problems of pollution and congestion in urban environments from a Product Ecosystem perspective. From this a strategy will be proposed for a transdisciplinary approach to develop and implement solutions.

Measuring reliability and validity of the ActiGraph GT3X accelerometer for children with cerebral palsy : a feasibility study

PURPOSE The purposes of this study were to: 1) establish inter-instrument reliability between left and right hip accelerometer placement; 2) examine procedural reliability of a walking protocol used to measure physical activity (PA), and; 3) confirm concurrent validity of accelerometers in measuring PA intensity as compared to the gold standard of oxygen consumption measured by indirect calorimetry. METHODS Eight children (mean age: 11.9; SD: 3.2, 75% male) with CP (GMFCS levels I-III) wore ActiGraph GT3X accelerometers on each hip and the Cosmed K4b^{2} portable indirect calorimeter during two measurement sessions in which they performed the six minute walk test (6MWT) at three self-selected speeds (comfortable/slow, brisk, fast). Oxygen consumption (VO2) and accelerometer step and activity count data were recorded. RESULTS Inter-instrument reliability of ActiGraph GT3X accelerometers placed on left and right hips was excellent (ICC=0.96-0.99, CI_{95}: 0.81-0.99). Reproducibility of the protocol was good/excellent (ICC=0.75-0.95, CI_{95}: 0.75-0.98). Concurrent validity of accelerometer count data and VO2 was fair/good (rho=0.67, p< 0.001). The correlation between step count and VO2 was not significant (rho=0.29, p=0.2). CONCLUSION This preliminary research suggests that ActiGraph GT3X accelerometers are reliable and valid devices to monitor PA during walking in children with CP and may be appropriate in rehabilitation research and clinical practice. ActiGraph GTX3 step counts were not valid for this sample and further research is warranted.

Identifying product families using data mining techniques in manufacturing paradigm

Identifying product families has been considered as an effective way to accommodate the increasing product varieties across the diverse market niches. In this paper, we propose a novel framework to identifying product families by using a similarity measure for a common product design data BOM (Bill of Materials) based on data mining techniques such as frequent mining and clus-tering. For calculating the similarity between BOMs, a novel Extended Augmented Adjacency Matrix (EAAM) representation is introduced that consists of information not only of the content and topology but also of the fre-quent structural dependency among the various parts of a product design. These EAAM representations of BOMs are compared to calculate the similarity between products and used as a clustering input to group the product fami-lies. When applied on a real-life manufacturing data, the proposed framework outperforms a current baseline that uses orthogonal Procrustes for grouping product families.

Audit pricing and product differentiation in small private firms : evidence from Thailand

Purpose – There is limited evidence on how differences in economic environments affect the demand for and supply of auditing. Research on audit pricing has mainly focused on large client markets in developed economies; in contrast, the purpose of this paper is to focus on the small client segment in the emerging economy of Thailand which offers a choice between auditors of two different qualities. Design/methodology/approach – This paper is based on a random stratified sample of small clients in Thailand qualifying for audit exemption. The final sample consists of 1,950 firm-year observations for 2002-2006. Findings – The authors find evidence of product differentiation in the small client market, suggesting that small firms view certified public accountants as superior and pay a premium for their services. The authors also find that audit fees have a positive significant association with leverage, metropolitan location and client size. Audit risk and audit opinion are not, however, significantly associated with audit fees. Furthermore, the authors find no evidence that clients whose financial year ends in the auditors’ busy period pay significantly higher audit fees, and auditors engage in low-balling on initial engagements to attract audit clients. Research limitations/implications – The research shows the importance of exploring actual decisions regarding audit practice and audit pricing in different institutional and organizational settings. Originality/value – The paper extends the literature from developed economies and large/listed market setting to the emerging economy and small client market setting. As far as the authors are aware, this is the first paper to examine audit pricing in the small client market in an emerging economy.

Book review - Richard Goldberg, Medicinal Product Liability and Regulation (Hart Publishing, Oxford, 2013) 214pp

In December 2013, settlement was reached between approximately 100 Australian and New Zealand Thalidomide victims and the company which had acted as the Australian distributor of the infamous drug, thus putting to rest the possibility of litigation. Around the same time, Thalidomide victims in the United Kingdom (UK) launched a similar bid for compensation against the manufacturer and distributor. It is clear that despite a lengthy amount of time having passed ever since the thalidomide disaster commenced in 1962, the controversy over compensation continues. Indeed, the author of Medicinal Product Liability and Regulation (published before the announcement of the British legal claim), Professor Goldberg, notes that claims for resulting birth defects continue to emerge right into the present day. His prescient insight into the contemporary relevance of compensation for pharmaceutical injuries thus makes Medicinal Product Liability and Regulation a very relevant addition to the small body of scholarship that is available on this rather specific and complex issue.

Reliability in the Parameterization of the Functional Reach Test in Elderly Stroke Patients: A Pilot Study

BACKGROUND: Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. OBJECTIVES: To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. DESIGN: Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient's back (lumbar and trunk). PARTICIPANTS: Five subjects over 65 who suffer from a stroke. MEASUREMENTS: FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. RESULTS: FRT measure is  12.75±2.06 cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT's reliability was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject, respectively. CONCLUSION: The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke.

Impact of PV units in LV feeders on distribution system reliability

Re-supplying loads on outage through cross-connect from adjacent feeders in a distribution system may cause voltage drop and hence require load shedding. However, the surplus PV generated in some of the LV feeders can prevent load shedding, and improve reliability. In order to measure these effects, this paper proposes the application of Direct Load Flow method[1] in reliability evaluation of distribution systems with PV units. As part of this study, seasonal impacts on load consumption together with surplus PV output power injection to higher voltage networks are also considered. New indices are proposed to measure yearly expected energy export, from LV to MV and from MV to higher voltage network.

Dynamics of industry architecture and firm’s capability development : role of knowledge integration within product innovation

Aligned with the decline of Marshalian view of industry as constituting homogeneous set of firms, the new perspective is emerging by concentrating more on dynamics of sectors as the building block of industrial changes. Based on new assumptions, much of the action in terms of strategy, technology, and knowledge development does not happen either among firms within a stable industry, or through the growth or decline of certain sectors compared to others. Instead, the action happens in terms of the definition, redefinition, drawing, and redrawing of the very nature of these sectors. Technology does not progress and develop within a sector; rather it shapes (and is shaped by) the encompassing architecture of multiple sectors.