Implications of comorbidity for clinical practice

In the past, people with comorbidity have often received inadequate care. The ethical principle of equal access to quality services has important implications for agencies, when combined with knowledge about comorbidity and its management, and about diffusion of innovations across organizations. Comorbidity is common, and often has profound impacts on individuals and families. Tobacco smoking in particular is endemic and affects morbidity, mortality, and functioning. This implies that screening for co-occurring problems should be routine, and that a boutique comorbidity service is impractical. Large numbers mean that universal screening and intervention must be capable of large-scale implementation. Since multiple, closely linked problems are often present, treatments should address these multiple issues, and closely interrelated problems will require well-integrated treatment. Involvement of a single health agency is typically needed. Numbers and severity of problems can blind practitioners and patients to strengths and unaffected areas; these should be assessed and fostered. Better policies and practices for co-occurring disorders will require organizational change. Co-occurring disorders must become core business for organizations and practitioners, so that effective comorbidity practice is rewarded, required skills are present or taught, cues to use the practices are provided, and a culture supporting their application is established.

An evaluation of the Australian ‘reconceptualising early mathematics learning’ project : key findings and implications

The Pattern and Structure Mathematics Awareness Project (PASMAP) has investigated the development of patterning and early algebraic reasoning among 4 to 8 year olds over a series of related studies. We assert that an awareness of mathematical pattern and structure (AMPS) enables mathematical thinking and simple forms of generalization from an early age. This paper provides an overview of key findings of the Reconceptualizing Early Mathematics Learning empirical evaluation study involving 316 Kindergarten students from 4 schools. The study found highly significant differences on PASA scores for PASMAP students. Analysis of structural development showed increased levels for the PASMAP students; those categorised as low ability developed improved structural responses over a short period of time.

Volcanic architecture and chemostratigraphy within the Kalkarindji Continental Flood Basalt Province, Northern Territory : implications for eruption style from multiple fissure eruptions

This thesis was the first to define individual lava flow chemical variation and a detailed definition of the Kalkarindji Continental Flood Basalt Province, a lesser known province of the Phanerozoic eon. This thesis conducted an intensive field study that yielded numerous samples for petrography and chemical analyses as well as the generation of a detailed map of a portion of the Kalkarindji province.

Understanding the implications of digital interactions on the design of public urban spaces

This study investigated the impact of digital networked social interactions on the design of public urban spaces. Urban informatics, social media, ubiquitous computing, and mobile technology offer great potential to urban planning, as tools of communication, community engagement, and placemaking. The study considers the function of public spaces as 'third places,' that is, social places that are familiar, comfortable, social and meaningful for everyday life outside the home and work. Libraries were chosen as the study's focus. The study produced findings and insights at the intersection of urban planning (place), cultural geography and urban sociology (people), and information communication technology (technology) – the triad of urban informatics.

Cloud computing adoption in Australia : the benefits, risks and implications for accounting

The purpose of this paper is to empirically examine the state of cloud computing adoption in Australia. I specifically focus on the drivers, risks, and benefits of cloud computing from the perspective of IT experts and forensic accountants. I use thematic analysis of interview data to answer the research questions of the study. The findings suggest that cloud computing is increasingly gaining foothold in many sectors due to its advantages such as flexibility and the speed of deployment. However, security remains an issue and therefore its adoption is likely to be selective and phased. Of particular concern are the involvement of third parties and foreign jurisdictions, which in the event of damage may complicate litigation and forensic investigations. This is one of the first empirical studies that reports on cloud computing adoption and experiences in Australia.

Intraurban rail access : policy implications of five revealed perspectives from a Q-sorting exercise in three Australian cities

This project advances the current understanding of intraurban rail passengers and their travel experiences to help rail industry leaders tailor policy approaches to fit specific, relevant segments of their target population. Using a Q-sorting technique and cluster analysis, preliminary research identified five perspectives occurring in a small sample of rail passengers who varied in their frequency and location of rail travel as well as certain sociodemographic characteristics. Revealed perspectives (named to capture the gist of their content) included "Rail travel is about the destination, not the journey"; "Despite challenges, public transport is still the best option"; "Rail travel is fine"; "Rail travel? So far, so good"; and "Bad taste for rail travel." This paper discusses each of the perspectives in detail and considers them in relation to tailored policy implications. An overarching finding from this study is that improving railway travel access requires attention to physical, psychological, financial, and social facets of accessibility. For example, designing waiting areas to be more socially functional and comfortable has the potential to increase ridership by addressing social forms of access, decreasing perceived wait times, and making time at the station feel like time well spent. Even at this preliminary stage, the Q-sorting technique promises to provide a valuable, holistic, albeit fine-grained, analysis of passenger attitudes and experiences that will assist industry efforts in increasing ridership.

The Implications of Activity Based Funding for Emergency Departments : A Comprehensive Literature Review

Executive Summary Emergency Departments (EDs) locally, nationally and internationally are becoming increasingly busy. Within this context, it can be challenging to deliver a health service that is safe, of high quality and cost-effective. Whilst various models are described within the literature that aim to measure ED ‘work’ or ‘activity’, they are often not linked to a measure of costs to provide such activity. It is important for hospital and ED managers to understand and apply this link so that optimal staffing and financial resourcing can be justifiably sought. This research is timely given that Australia has moved towards a national Activity Based Funding (ABF) model for ED activity. ABF is believed to increase transparency of care and fairness (i.e. equal work receives equal pay). ABF involves a person-, performance- or activity-based payment system, and thus a move away from historical “block payment” models that do not incentivise efficiency and quality. The aim of the Statewide Workforce and Activity-Based Funding Modelling Project in Queensland Emergency Departments (SWAMPED) is to identify and describe best practice Emergency Department (ED) workforce models within the current context of ED funding that operates under an ABF model. The study is comprised of five distinct phases. This monograph (Phase 1) comprises a systematic review of the literature that was completed in June 2013. The remaining phases include a detailed survey of Queensland hospital EDs’ resource levels, activity and operational models of care, development of new resource models, development of a user-friendly modelling interface for ED mangers, and production of a final report that identifies policy implications. The anticipated deliverable outcome of this research is the development of an ABF based Emergency Workforce Modelling Tool that will enable ED managers to profile both their workforce and operational models of care. Additionally, the tool will assist with the ability to more accurately inform adequate staffing numbers required in the future, inform planning of expected expenditures and be used for standardisation and benchmarking across similar EDs. Summary of the Findings Within the remit of this review of the literature, the main findings include: 1. EDs are becoming busier and more congested Rising demand, barriers to ED throughput and transitions of care all contribute to ED congestion. In addition requests by organisational managers and the community require continued broadening of the scope of services required of the ED and further increases in demand. As the population live longer with more lifestyle diseases their propensity to require ED care continues to grow. 2. Various models of care within EDs exist Models often vary to account for site specific characteritics to suit staffing profile, ED geographical location (e.g. metropolitan or rural site), and patient demographic profile (e.g. paediatrics, older persons, ethnicity). Existing and new models implemented within EDs often depend on the target outcome requiring change. Generally this is focussed on addressing issues at the input, throughput or output areas of the ED. Even with models targeting similar demographic or illness, the structure and process elements underpinning the model can vary, which can impact on outcomes and variance to the patient and carer experience between and within EDs. Major models of care to manage throughput inefficiencies include: A. Workforce Models of Care focus on the appropriate level of staffing for a given workload to provide prompt, timely and clinically effective patient care within an emergency care setting. The studies reviewed suggest that the early involvement of senior medical decision maker and/or specialised nursing roles such as Emergency Nurse Practitioners and Clinical Initiatives Nurse, primary contact or extended scope Allied Health Practitioners can facilitate patient flow and improve key indicators such as length of stay and reducing the number of those who did not wait to be seen amongst others. B. Operational Models of Care within EDs focus on mechanisms for streaming (e.g. fast-tracking) or otherwise grouping patient care based on acuity and complexity to assist with minimising any throughput inefficiencies. While studies support the positive impact of these models in general, it appears that they are most effective when they are adequately resourced. 3. Various methods of measuring ED activity exist Measuring ED activity requires careful consideration of models of care and staffing profile. Measuring activity requires the ability to account for factors including: patient census, acuity, LOS, intensity of intervention, department skill-mix plus an adjustment for non-patient care time. 4. Gaps in the literature Continued ED growth calls for new and innovative care delivery models that are safe, clinically effective and cost effective. New roles and stand-alone service delivery models are often evaluated in isolation without considering the global and economic impact on staffing profiles. Whilst various models of accounting for and measuring health care activity exist, costing studies and cost effectiveness studies are lacking for EDs making accurate and reliable assessments of care models difficult. There is a necessity to further understand, refine and account for measures of ED complexity that define a workload upon which resources and appropriate staffing determinations can be made into the future. There is also a need for continued monitoring and comprehensive evaluation of newly implemented workforce modelling tools. This research acknowledges those gaps and aims to: • Undertake a comprehensive and integrated whole of department workforce profiling exercise relative to resources in the context of ABF. • Inform workforce requirements based on traditional quantitative markers (e.g. volume and acuity) combined with qualitative elements of ED models of care; • Develop a comprehensive and validated workforce calculation tool that can be used to better inform or at least guide workforce requirements in a more transparent manner.

Cyber crime and its implications to the Pacific

Introduction Cybercrime consists of any criminal action or behaviour that is committed through the use of Information Technology. Common examples of such activities include cyber hacking, identity theft, cracking, spamming, social engineering, data tampering, online fraud, programming attacks, etc. The pervasive use of the internet clearly indicates that the impacts of cybercrime is far reaching and any one, may it be a person or an entity can be a victim of cybercriminal activities. Recently in the US, eight members of a global cybercrime ring were charged in one of the biggest ever bank heists. The cybercrime gang allegedly stole US$45 million by hacking into credit card processing firms and withdrawing money from ATMs in 27 countries (Jessica et al. 2013). An extreme example, the above case highlights how IT is changing the way crimes are being committed. No longer do criminals use masks, guns and get-a-way cars, criminals are able to commit crimes in the comfort of their homes, millions of miles from the scene of the crime and can access significant sums of money that can financially cripple organisations. The world is taking notice of this growing threat and organisations in the Pacific must also be proactive in tackling this emerging issue.

Toll-like receptor and pro-inflammatory cytokine expression during prolonged hyperinsulinaemia in horses : implications for laminitis

Equine laminitis, a disease of the lamellar structure of the horse’s hoof, can be incited by numerous factors that include inflammatory and metabolic aetiologies. However, the role of inflammation in hyperinsulinaemic laminitis has not been adequately defined. Tolllike receptor (TLR) activation results in up-regulation of inflammatory pathways and the release of pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-�), and may be a pathogenic factor in laminitis. The aim of this study was to determine whether TLR4 expression and subsequent pro-inflammatory cytokine production is increased in lamellae and skeletal muscle during equine hyperinsulinaemia. Standardbred horses were treated with either a prolonged, euglycaemic hyperinsulinaemic clamp (p-EHC) or a prolonged, glucose infusion (p-GI), which induced marked and moderate hyperinsulinaemia, respectively. Age-matched control horses were treated simultaneously with a balanced electrolyte solution. Treated horses developed clinical (p-EHC) or subclinical (p-GI) laminitis, whereas controls did not. Skeletal muscle and lamellar protein extracts were analysed by Western blotting for TLR4, IL-6, TNF-� and suppressor of cytokine signalling 3 (SOCS3) expression. Lamellar protein expression of TLR4 and TNF-�, but not IL-6, was increased by the p-EHC, compared to control horses. A significant positive correlation was found between lamellar TLR4 and SOCS3. Skeletal muscle protein expression of TLR4 signalling parameters did not differ between control and p-EHC-treated horses. Similarly, the p-GI did not result in up-regulation of lamellar protein expression of any parameter. The results suggest that insulin-sensitive tissues may not accurately reflect lamellar pathology during hyperinsulinaemia. While TLR4 is present in the lamellae, its activation appears unlikely to contribute significantly to the developmental pathogenesis of hyperinsulinaemic laminitis. However, inflammation may have a role to play in the later stages (e.g., repair or remodelling) of the disease.

The creativity imperative : implications for education research

Arguing for the importance of understanding the conditions under which certain forms of the social subject become visible and viable, this chapter conceptualises the current educational focus on ‘creativity’ as a technology of governmentality that has arisen from the perceived need for governing authorities to manage and responsibilise populations for the pervasive uncertainties of the global economy. With reference to the document, Tough Choices or Tough Times, a publication of the National Center on Education and the Economy in the United States, we show how creativity has been reframed as a programmable capacity of the modern student, citizen and worker primarily because it is considered an indispensible source of enterprise and innovation. Education and family life are an integral part of this bio-politics and the ongoing ‘economisation’ of social life. Our concern is that this reductionist understanding of creativity precludes other transgressive and culturally enriching creativities that represent the infinite range of subjectivities associated with imaginative human capacity and activity. It is vital therefore that educational research renders this historical process transparent and opens spaces for more socially inclusive, sustainable and productive ways of being such as those indicated by the three respondees.

Social Media Analytics : Ein interdisziplinärer Ansatz und seine Implikationen für die Wirtschaftsinformatik [Social Media Analytics - An Interdisciplinary Approach and Its Implications for Information Systems]

Social Media Analytics ist ein neuer Forschungsbereich, in dem interdisziplinäre Methoden kombiniert, erweitert und angepasst werden, um Social-Media-Daten auszuwerten. Neben der Beantwortung von Forschungsfragen ist es ebenfalls ein Ziel, Architekturentwürfe für die Entwicklung neuer Informationssysteme und Anwendungen bereitzustellen, die auf sozialen Medien basieren. Der Beitrag stellt die wichtigsten Aspekte des Bereichs Social Media Analytics vor und verweist auf die Notwendigkeit einer fächerübergreifenden Forschungsagenda, für deren Erstellung und Bearbeitung der Wirtschaftsinformatik eine wichtige Rolle zukommt.

Social media analytics: an interdisciplinary approach and its implications for information systems

Social Media Analytics is an emerging interdisciplinary research field that aims on combining, extending, and adapting methods for analysis of social media data. On the one hand it can support IS and other research disciplines to answer their research questions and on the other hand it helps to provide architectural designs as well as solution frameworks for new social media-based applications and information systems. The authors suggest that IS should contribute to this field and help to develop and process an interdisciplinary research agenda.

Dynamics of affordances and implications for design

Affordance is an important concept in HCI. There are various interpretations of affordances but it has been difficult to use this concept for design purposes. Often the treatment of affordances in the current HCI literature has been as a one-to-one relationship between a user and an artefact. According to our views, affordance is a dynamic, always emerging relationship between a human and his environment. We believe that the social and cultural contexts within which an artefact is situated affect the way in which the artefact is used. Using a Structuration Theory approach, we argue that affordances need also be treated at a much broader level, encompassing social and cultural aspects. We suggest that affordances should be seen at three levels: single user, organizational (or work group) and societal. Focusing on the organizational level affordances, we provide details of several important factors that affect the emergence of affordances.

Insect mitochondrial genomics : implications for evolution and phylogeny

The mitochondrial (mt) genome is, to date, the most extensively studied genomic system in insects, outnumbering nuclear genomes tenfold and representing all orders versus very few. Phylogenomic analysis methods have been tested extensively, identifying compositional bias and rate variation, both within and between lineages, as the principal issues confronting accurate analyses. Major studies at both inter- and intraordinal levels have contributed to our understanding of phylogenetic relationships within many groups. Genome rearrangements are an additional data type for defining relationships, with rearrangement synapomorphies identified across multiple orders and at many different taxonomic levels. Hymenoptera and Psocodea have greatly elevated rates of rearrangement offering both opportunities and pitfalls for identifying rearrangement synapomorphies in each group. Finally, insects are model systems for studying aberrant mt genomes, including truncated tRNAs and multichromosomal genomes. Greater integration of nuclear and mt genomic studies is necessary to further our understanding of insect genomic evolution.