'Online' geriatric assessment procedure for older adults referred for geriatric assessment during an acute care episode for consideration of reliability of triage decisions

Background Comprehensive geriatric assessment has been shown to improve patient outcomes, but the geriatricians who deliver it are in short-supply. A web-based method of comprehensive geriatric assessment has been developed with the potential to improve access to specialist geriatric expertise. The current study aims to test the reliability and safety of comprehensive geriatric assessment performed “online” in making geriatric triage decisions. It will also explore the accuracy of the procedure in identifying common geriatric syndromes, and its cost relative to conventional “live” consultations. Methods/Design The study population will consist of 270 acutely hospitalized patients referred for geriatric consultation at three sites. Paired assessments (live and online) will be conducted by independent, blinded geriatricians and the level of agreement examined. This will be compared with the level of agreement between two independent, blinded geriatricians each consulting with the patient in person (i.e. “live”). Agreement between the triage decision from live-live assessments and between the triage decision from live-online assessments will be calculated using kappa statistics. Agreement between the online and live detection of common geriatric syndromes will also be assessed using kappa statistics. Resource use data will be collected for online and live-live assessments to allow comparison between the two procedures. Discussion If the online approach is found to be less precise than live assessment, further analysis will seek to identify patient subgroups where disagreement is more likely. This may enable a protocol to be developed that avoids unsafe clinical decisions at a distance. Trial registration Trial registration number: ACTRN12611000936921

An analysis of tax expenditure versus direct expenditure

Each financial year concessions, benefits and incentives are delivered to taxpayers via the tax system. These concessions, benefits and incentives, referred to as tax expenditure, differ from direct expenditure because of the recurring fiscal impact without regular scrutiny through the federal budget process. There are approximately 270 different tax expenditures existing within the current tax regime with total measured tax expenditures in the 2005-06 financial year estimated to be around $42.1 billion, increasing to $52.7 billion by 2009-10. Each year, new tax expenditures are introduced, while existing tax expenditures are modified and deleted. In recognition of some of the problems associated with tax expenditure, a Tax Expenditure Statement, as required by the Charter of Budget Honesty Act 1988, is produced annually by the Australian Federal Treasury. The Statement details the various expenditures and measures in the form of concessions, benefits and incentives provided to taxpayers by the Australian Government and calculates the tax expenditure in terms of revenue forgone. A similar approach to reporting tax expenditure, with such a report being a legal requirement, is followed by most OECD countries. The current Tax Expenditure Statement lists 270 tax expenditures and where it is able to, reports on the estimated pecuniary value of those expenditures. Apart from the annual Tax Expenditure Statement, there is very little other scrutiny of Australia’s Federal tax expenditure program. While there has been various academic analysis of tax expenditure in Australia, when compared to the North American literature, it is suggested that the Australian literature is still in its infancy. In fact, one academic author who has contributed to tax expenditure analysis recently noted that there is ‘remarkably little secondary literature which deals at any length with tax expenditures in the Australian context.’ Given this perceived gap in the secondary literature, this paper examines fundamental concept of tax expenditure and considers the role it plays in to the current tax regime as a whole, along with the effects of the introduction of new tax expenditures. In doing so, tax expenditure is contrasted with direct expenditure. An analysis of tax expenditure versus direct expenditure is already a sophisticated and comprehensive body of work stemming from the US over the last three decades. As such, the title of this paper is rather misleading. However, given the lack of analysis in Australia, it is appropriate that this paper undertakes a consideration of tax expenditure versus direct expenditure in an Australian context. Given this proposition, rather than purport to undertake a comprehensive analysis of tax expenditure which has already been done, this paper discusses the substantive considerations of any such analysis to enable further investigation into the tax expenditure regime both as a whole and into individual tax expenditure initiatives. While none of the propositions in this paper are new in a ‘tax expenditure analysis’ sense, this debate is a relatively new contribution to the Australian literature on the tax policy. Before the issues relating to tax expenditure can be determined, it is necessary to consider what is meant by ‘tax expenditure’. As such, part two if this paper defines ‘tax expenditure’. Part three determines the framework in which tax expenditure can be analysed. It is suggested that an analysis of tax expenditure must be evaluated within the framework of the design criteria of an income tax system with the key features of equity, efficiency, and simplicity. Tax expenditure analysis can then be applied to deviations from the ideal tax base. Once it is established what is meant by tax expenditure and the framework for evaluation is determined, it is possible to establish the substantive issues to be evaluated. This paper suggests that there are four broad areas worthy of investigation; economic efficiency, administrative efficiency, whether tax expenditure initiatives achieve their policy intent, and the impact on stakeholders. Given these areas of investigation, part four of this paper considers the issues relating to the economic efficiency of the tax expenditure regime, in particular, the effect on resource allocation, incentives for taxpayer behaviour and distortions created by tax expenditures. Part five examines the notion of administrative efficiency in light of the fact that most tax expenditures could simply be delivered as direct expenditures. Part six explores the notion of policy intent and considers the two questions that need to be asked; whether any tax expenditure initiative reaches its target group and whether the financial incentives are appropriate. Part seven examines the impact on stakeholders. Finally, part eight considers the future of tax expenditure analysis in Australia.

Pass the scissors : consumers close in on the fashion industry

The fashion ecosystem is at boiling point as consumers turn up the heat in all areas of the fashion value, trend and supply chain. While traditionally fashion has been a monologue from designer brand to consumer, new technology and the virtual world has given consumers a voice to engage brands in a conversation to express evolving needs, ideas and feedback. Product customisation is no longer innovative. Successful brands are including customers in the design process and holding conversations ‘with’ them to improve product, manufacturing, sales, distribution, marketing and sustainable business practices. Co-creation and crowd sourcing are integral to any successful business model and designers and manufacturers are supplying the technology or tools for these creative, active, participatory ‘prosumers’. With this collaboration however, there arises a worrying trend for fashion professionals. The ‘design it yourself’, ‘indiepreneur’ who with the combination of technology, the internet, excess manufacturing capacity, crowd funding and the idea of sharing the creative integrity of a product (‘copyleft’ not copyright) is challenging the notion that the fashion supply chain is complex. The passive ‘consumer’ no longer exists. Fashion designers now share the stage with ‘amateur’ creators who are disrupting every activity they touch, while being motivated by profit as well as a quest for originality and innovation. This paper examines the effects this ‘consumer’ engagement is having on traditional fashion models and the fashion supply chain. Crowd sourcing, crowd funding, co-creating, design it yourself, global sourcing, the virtual supply chain, social media, online shopping, group buying, consumer to consumer marketing and retail, and branding the ‘individual’ are indicative of the new consumer-driven fashion models. Consumers now drive the fashion industry - from setting trends, through to creating, producing, selling and marketing product. They can turn up the heat at any time _ and any point _ in the fashion supply chain. They are raising the temperature at each and every stage of the chain, decreasing or eliminating the processes involved: decreasing the risk of fashion obsolescence, quantities for manufacture, complexity of distribution and the consumption of product; eliminating certain stages altogether and limiting the brand as custodians of marketing. Some brands are discovering a new ‘enemy’ – the very people they are trying to sell to. Keywords: fashion supply chain, virtual world, consumer, ‘prosumers’, co-creation, fashion designers

Analytical and numerical solutions of the space and time fractional bloch-torrey equation

Fractional order dynamics in physics, particularly when applied to diffusion, leads to an extension of the concept of Brown-ian motion through a generalization of the Gaussian probability function to what is termed anomalous diffusion. As MRI is applied with increasing temporal and spatial resolution, the spin dynamics are being examined more closely; such examinations extend our knowledge of biological materials through a detailed analysis of relaxation time distribution and water diffusion heterogeneity. Here the dynamic models become more complex as they attempt to correlate new data with a multiplicity of tissue compartments where processes are often anisotropic. Anomalous diffusion in the human brain using fractional order calculus has been investigated. Recently, a new diffusion model was proposed by solving the Bloch-Torrey equation using fractional order calculus with respect to time and space (see R.L. Magin et al., J. Magnetic Resonance, 190 (2008) 255-270). However effective numerical methods and supporting error analyses for the fractional Bloch-Torrey equation are still limited. In this paper, the space and time fractional Bloch-Torrey equation (ST-FBTE) is considered. The time and space derivatives in the ST-FBTE are replaced by the Caputo and the sequential Riesz fractional derivatives, respectively. Firstly, we derive an analytical solution for the ST-FBTE with initial and boundary conditions on a finite domain. Secondly, we propose an implicit numerical method (INM) for the ST-FBTE, and the stability and convergence of the INM are investigated. We prove that the implicit numerical method for the ST-FBTE is unconditionally stable and convergent. Finally, we present some numerical results that support our theoretical analysis.

The impact of temperature on years of life lost in Brisbane, Australia

Temperature is an important determinant of health. A better knowledge of how temperature affects population health is important not only to the scientific community, but also to the decision-makers who develop and implement early warning systems and intervention strategies to mitigate the health effects of extreme temperatures. The temperature–health relationship is also of growing interest as climate change is projected to shift the overall temperature distribution higher. Previous studies have examined the relative risks of temperature-related mortality, but the absolute measure of years of life lost is also useful as it combines the number of deaths with life expectancy. Here we use years of life lost to provide a novel measure of the impact of temperature on mortality in Brisbane, Australia. We also project the future temperature-related years of life lost attributable to climate change. We show that the association between temperature and years of life lost is U-shaped, with increased years of life lost for cold and hot temperatures. The temperature-related years of life lost will worsen greatly if future climate change goes beyond a 2 �C increase and without any adaptation to higher temperatures. This study highlights that public health adaptation to climate change is necessary.

Not all older adults have insight into their driving abilities : evidence from an on-road assessment and implications for policy

Purpose To compare self-reported driving ability with objective measures of on-road driving performance in a large cohort of older drivers. Methods 270 community-living adults aged 70 – 88 years recruited via the electoral roll completed a standardized assessment of on-road driving performance and questionnaires determining perceptions of their own driving ability, confidence and driving difficulties. Retrospective self-reported crash data over the previous five years were recorded. Results Participants reported difficulty with only selected driving situations, including driving into the sun, in unfamiliar areas, in wet conditions, and at night or dusk. The majority of participants rated their own driving as good to excellent. Of the 47 (17%) of drivers who were rated as potentially unsafe to drive, 66% rated their own driving as good to excellent. Drivers who made critical errors, where the driving instructor had to take control of the vehicle, had no lower self-rating of driving ability then the rest of the group. The discrepancy in self-perceptions of driving and participants’ safety rating on the on-road assessment was significantly associated with self-reported retrospective crash rates, where those drivers who displayed greater overconfidence in their own driving were significantly more likely to report a crash. Conclusions This study demonstrates that older drivers with the greatest mismatch between actual and self-rated driving ability pose the greatest risk to road safety. Therefore licensing authorities should not assume that when older individuals’ driving abilities begin to decline they will necessarily be aware of these changes and adopt appropriate compensatory driving behaviours; rather, it is essential that evidence-based assessments are adopted.

Regulating virtual environments

Online gaming environments feature a number of challenging regulatory issues; a diverse player base, uneven power relationship, and lack of real dispute resolution mechanisms. By conducting an ethnographic study of the online environment Eve Online, and using as a comparative the offshore gaming industry, I consider how we might look to regulate, and resolve disputes within, online gaming environments. In doing so, I adopted a novel approach to the study of online gaming environments - that of norms - which gave significance not only to the terms of service dictated by platform providers and their legal advisors, but also to the social and ludic limitations and affordances players constructed themselves. Finally, through an account of the evolution of regulatory mechanisms and dispute resolution in the offshore gambling industry, I consider how an environment which features much in common with online gaming environments overcame a number of these challenges within the last 10-15 years, and what lessons might be taken from those experiences and applied to contemporary online gaming environments.

Service convenience and social servicescape : retail vs hedonic setting

Purpose – While there have been numerous studies on the antecedents and consequences of service quality, there has been little investigation of the moderators of service quality. The purpose of this study is to demonstrate the effects of two moderators: service convenience and the social servicescape. The moderating effects are tested in two service settings: retail and hedonic (concert). Design/methodology/approach – A survey of 270 customers at kitchen display showrooms and 320 concert-goers was undertaken. The results were analysed using regression analysis. Findings – The results show support for ten of the 12 hypotheses. Service convenience moderated the relationships between perceived service quality and its three sub-dimensions (interaction, environment, and outcome quality), differently in different settings (retail vs hedonic). This supports the authors' general argument that the outcome dimension tends to be more important to customers in a retail setting, while interaction and environment quality dimensions tend to be more important in hedonic service consumption. Practical implications – These findings suggest that managers need to use different service management tactics in retail and hedonic service settings. Specifically managers in retail settings need to pay more attention to service convenience to achieve service quality and managers in hedonic settings should concentrate on the social servicescape. Originality/value – This paper is the first to test the moderating factors of service convenience and social servicescape on service quality.

A method for measuring the creative potential of computer games

This paper describes a method for measuring the creative potential of computer games. The research approach applies a behavioral and verbal protocol to analyze the factors that influence the creative processes used by people as they play computer games from the puzzle genre. Creative potential is measured by examining task motivation and domain-relevant and creativity-relevant skills. This paper focuses on the reliability of the factors used for measurement, determining those factors that are more strongly related to creativity. The findings show that creative potential may be determined by examining the relationship between skills required and the effect of intrinsic motivation within game play activities.

A practical signal processing approach for condition monitoring of low speed machinery using Peak-Hold-Down-Sample algorithm

A simple and effective down-sample algorithm, Peak-Hold-Down-Sample (PHDS) algorithm is developed in this paper to enable a rapid and efficient data transfer in remote condition monitoring applications. The algorithm is particularly useful for high frequency Condition Monitoring (CM) techniques, and for low speed machine applications since the combination of the high sampling frequency and low rotating speed will generally lead to large unwieldy data size. The effectiveness of the algorithm was evaluated and tested on four sets of data in the study. One set of the data was extracted from the condition monitoring signal of a practical industry application. Another set of data was acquired from a low speed machine test rig in the laboratory. The other two sets of data were computer simulated bearing defect signals having either a single or multiple bearing defects. The results disclose that the PHDS algorithm can substantially reduce the size of data while preserving the critical bearing defect information for all the data sets used in this work even when a large down-sample ratio was used (i.e., 500 times down-sampled). In contrast, the down-sample process using existing normal down-sample technique in signal processing eliminates the useful and critical information such as bearing defect frequencies in a signal when the same down-sample ratio was employed. Noise and artificial frequency components were also induced by the normal down-sample technique, thus limits its usefulness for machine condition monitoring applications.

Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma : a meta-analysis and systematic review of the literature

Objectives: To investigate the efficacy of progestin treatment to achieve pathological complete response (pCR) in patients with complex atypical endometrial hyperplasia (CAH) or early endometrial adenocarcinoma (EC). Methods: A systematic search identified 3245 potentially relevant citations. Studies containing less than ten eligible CAH or EC patients in either oral or intrauterine treatment arm were excluded. Only information from patients receiving six or more months of treatment and not receiving other treatments was included. Weighted proportions of patients achieving pCR were calculated using R software. Results: Twelve studies met the selection criteria. Eleven studies reported treatment of patients with oral (219 patients, 117 with CAH, 102 with grade 1 Stage I EC) and one reported treatment of patients with intrauterine progestin (11 patients with grade 1 Stage IEC). Overall, 74% (95% confidence interval [CI] 65-81%) of patients with CAH and 72% (95% CI 62-80%) of patients with grade 1 Stage I EC achieved a pCR to oral progestin. Disease progression while on oral treatment was reported for 6/219 (2.7%), and relapse after initial complete response for 32/159 (20.1%) patients. The weighted mean pCR rate of patients with grade 1 Stage I EC treated with intrauterine progestin from one prospective pilot study and an unpublished retrospective case series from the Queensland Centre of Gynaecologic Oncology (QCGC) was 68% (95% CI 45- 86%). Conclusions: There is a lack of high quality evidence for the efficacy of progestin in CAH or EC. The available evidence however suggests that treatment with oral or intrauterine progestin is similarly effective. The risk of progression during treatment is small but longer follow-up is required. Evidence from prospective controlled clinical trials is warranted to establish how the efficacy of progestin for the treatment of CAH and EC can be improved further.

An index of best practice performance reporting for Malaysian local authorities

Abstract Purpose – The purpose of this paper is to identify stakeholders’ expectations of information to be conveyed in local authorities’ annual reports and to develop an index of best practice performance reporting. Design/methodology/approach – The paper describes the development of a disclosure index emphasizing the public interest aspect of reporting and the need to provide relevant and meaningful information to stakeholders. The index was crafted from a public accountability perspective and based on the expectations of stakeholders as reconciled and validated by a Delphi panel of experts. Findings – The wide scope of information that was dentified as being important for disclosure by local authorities is consistent with the public accountability paradigm which requires the reporting of comprehensive information (both financial and non financial), about the condition, performance, activities and progress of the entity. Originality/value – The research posits a model of best practice performance reporting for Malaysian, and other, local authorities to meet the need for greater accountability by these entities.

Understanding Indigenous Australian women's social and emotional wellbeing and wellness through yarning : the Indigenous Women's Wellness Program

This paper explores Indigenous Australian women’s understanding of wellness, through the lens of social and emotional wellbeing. The authors use a “yarning” approach to explore how wellness is important to Indigenous women who live in North Brisbane (Australia). They discuss the benefits of yarning and its strength as a methodology for conducting research and building activism within Indigenous Australian communities. They argue that, for Indigenous Australian women, wellness is linked to a sense of wholeness and strongly related to the feeling of connection that women get from meeting together and having time for women’s business. They describe the way that their research project developed into a community summit focused on Indigenous women’s wellness.