Quality-based benefit design in health insurance : the impact of a product benefit design change on the utilisation of oral health services by members of a private health insurance fund in regional and rural New South Wales, Australia

Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

The legality of tissue transplants for the benefit of family members in the UK and Australia : implications for saviour siblings

The ethics of creating ‘saviour siblings’ for the benefit of another has received much attention, but little consideration has been given to the legal position of those saviours born who may be asked to provide tissue for transplantation to another during childhood. This article examines the ethical issues surrounding minor donation as well as the existing legal framework in the UK and Australia that regulates minors providing tissue for the benefit of another. Against this background the position of minor saviours, who are called upon to donate bone marrow or peripheral blood stem cells, is examined. This analysis suggests that the law does not provide sufficient protection for minor saviours who are called upon to donate to another. It is argued that specific ethical obligations are owed to saviours—that ought to be reflected in the law—in order to protect them from exploitation while they remain minors.

Investigating the influences on attendance and intention to rejoin with inaugural members of a new football team

This study investigated the effects of factors like member satisfaction and social rituals on desirable outcomes such as attendance, intention to rejoin and merchandise sales. This study focuses on the inaugural members of a new team in Australia’s A-League to gain insight into how loyalty develops amongst fans of new sporting organisations. The results show the importance to sports marketers of satisfying members and building ritual behaviour, as both are correlated with all of the positive outcomes investigated here.

Members abroad - Australia - Brisbane and the Gold Coast

Brisbane's sub-tropical climate, vegetation and urban history as a British settlement, endow the region with many characteristics that are familiar in KwaZulu-Natal. Brisbane settlement, firstly as a penal conlony to accommodate the hardiest criminals dispatched from Sydney, was established in 1825 on a wide river, several kilometers upstream from Moreton Bay with the Pacific Ocean beyond. The penal colony was short lived and was soon opened up to free settlement in 1842. The growth of the fledgling town was characterized by brick warehouse and service buildings to the port that was established on its riverbanks, resembling those of the old Point Road area in Durban. Government and administration buildings heralded Brisbane as the captial city of the State of Queensland, annexed from New South Wales in 1859. Morphological studies reveal that Brisbane had reached its first zenith around 1930 as a commerical city of four and five storey buildings. The urban form remained stagnant until the post-1960's building boom and the developments from this period on, consolidated land amalgamations largely ignoring the urban characteristics of the established city. Public space was poorly observed, resulting in a city that had turned its back on the river. It is only in recent times that the currency of good urban design, under the custodial direction of the City Council, has fostered a re-engagemed urban realm that, enabled by the recent building boom, has delivered high quality urban environments

Members abroad - Australia : Paul Sanders

I have been an academic since joining the University of Natal in 1998 and, following a period as a visiting lecturer in Brisbane in 2001, I joined the staff at QUT on an ongoing basis in 2003. I was appointed as Architecture Co-ordinator in 2006, and this role involves the leadership of the architectur discipline of 17 full time academics. I am currently enrolled in a PhD course in the field of urban morphology. This research proposes a theory on the relevance of mapping the evolutionary aspects of historical urban form to develop a measure for evaluating architecural elements and deriving parameters for new buildings. My participation in a QUT design team contributed to a recent successful invited competition bid for an Urban Transit Centre in Hangzhou, China. The Centre will include retail, business, entertainment, residential and service components at the heart of the Binjiang district on the 11.5ha core area with 32ha surrounding urban design precinct. The project has received the approval to commence and is to be implemented over the next three years!

Members abroad - Australia : Lindy Osborne

When I arrived in Queensland's capital in 1996, Brisbane was commonly referred to as an 'overgrown country town'. This might have been an acceptable description in the 1990s, but it cannot be applied any longer. Brisbane, affectionaly referred to by the locals as Bris-Vegas, has now come of age. Following Sydney and Melbourne, Brisbane is the third most populous city in Australia with a population of approximately two million. Interestingly, the 2006 Census showed that 22 per cent of Brisbane's population was born overseas, the three main countries of birth being the UK, New Zealand and South Africa. Brisbane City is centred on its most dominant environmental element, the Brisbane River, which effectively carves Brisbane into two areas - the Northside and the Southside. The 2001 addition of Cox Rayner's Goodwill Pedestrian and Cycle Bridge signified Brisbane's acceptance and affectionate embrace of its River resulting in a long overdue linage between Brisbane's North and South. It connects the City's key precincts - the Northside CBD through Queensland University of Technology (QUT), across Brisbane River, to the recreational precinct of the Southside Southbank Parklands. The Southside cultural precinct of Southbank is the home to Queensland's Art Gallery, Performing Arts Complex, State Library and Museum -each of which were designed by Brisbane Stalwart Architect Robin Gibson, in the 1970s and '80s. The CBD component of the Brisbane River is flanked by a number of Institutional Facilities, including the campuses of QUT, Griffith University and the Southbank Education and Training Precinct (SETP), which combine to form a cross-river educational precinct. The past decade has born witness to a city which has keenly supported emerging architects in addition to the more entrenched stalwarts of the profession, resulting in a youthful, relaxed and unpretentious sub-tropical city. Viva Bris-Vegas!

Kallikrein-related peptidase 4 activation of protease-activated receptor family members and association with prostate cancer

Two areas of particular importance in prostate cancer progression are primary tumour development and metastasis. These processes involve a number of physiological events, the mediators of which are still being discovered and characterised. Serine proteases have been shown to play a major role in cancer invasion and metastasis. The recently discovered phenomenon of their activation of a receptor family known as the protease activated receptors (PARs) has extended their physiological role to that of signaling molecule. Several serine proteases are expressed by malignant prostate cancer cells, including members of the kallikreinrelated peptidase (KLK) serine protease family, and increasingly these are being shown to be associated with prostate cancer progression. KLK4 is highly expressed in the prostate and expression levels increase during prostate cancer progression. Critically, recent studies have implicated KLK4 in processes associated with cancer. For example, the ectopic over-expression of KLK4 in prostate cancer cell lines results in an increased ability of these cells to form colonies, proliferate and migrate. In addition, it has been demonstrated that KLK4 is a potential mediator of cellular interactions between prostate cancer cells and osteoblasts (bone forming cells). The ability of KLK4 to influence cellular behaviour is believed to be through the selective cleavage of specific substrates. Identification of relevant in vivo substrates of KLK4 is critical to understanding the pathophysiological roles of this enzyme. Significantly, recent reports have demonstrated that several members of the KLK family are able to activate PARs. The PARs are relatively new members of the seven transmembrane domain containing G protein coupled receptor (GPCR) family. PARs are activated through proteolytic cleavage of their N-terminus by serine proteases, the resulting nascent N-terminal binds intramolecularly to initiate receptor activation. PARs are involved in a number of patho-physiological processes, including vascular repair and inflammation, and a growing body of evidence suggests roles in cancer. While expression of PAR family members has been documented in several types of cancers, including prostate, the role of these GPCRs in prostate cancer development and progression is yet to be examined. Interestingly, several studies have suggested potential roles in cellular invasion through the induction of cytoskeletal reorganisation and expression of basement membrane-degrading enzymes. Accordingly, this program of research focussed on the activation of the PARs by the prostate cancer associated enzyme KLK4, cellular processing of activated PARs and the expression pattern of receptor and agonist in prostate cancer. For these studies KLK4 was purified from the conditioned media of stably transfected Sf9 insect cells expressing a construct containing the complete human KLK4 coding sequence in frame with a V5 epitope and poly-histidine encoding sequences. The first aspect of this study was the further characterisation of this recombinant zymogen form of KLK4. The recombinant KLK4 zymogen was demonstrated to be activatable by the metalloendopeptidase thermolysin and amino terminal sequencing indicated that thermolysin activated KLK4 had the predicted N-terminus of mature active KLK4 (31IINED). Critically, removal of the pro-region successfully generated a catalytically active enzyme, with comparable activity to a previously published recombinant KLK4 produced from S2 insect cells. The second aspect of this study was the activation of the PARs by KLK4 and the initiation of signal transduction. This study demonstrated that KLK4 can activate PAR-1 and PAR-2 to mobilise intracellular Ca2+, but failed to activate PAR-4. Further, KLK4 activated PAR-1 and PAR-2 over distinct concentration ranges, with KLK4 activation and mobilisation of Ca2+ demonstrating higher efficacy through PAR-2. Thus, the remainder of this study focussed on PAR-2. KLK4 was demonstrated to directly cleave a synthetic peptide that mimicked the PAR-2 Nterminal activation sequence. Further, KLK4 mediated Ca2+ mobilisation through PAR-2 was accompanied by the initiation of the extra-cellular regulated kinase (ERK) cascade. The specificity of intracellular signaling mediated through PAR-2 by KLK4 activation was demonstrated by siRNA mediated protein depletion, with a reduction in PAR-2 protein levels correlating to a reduction in KLK4 mediated Ca2+mobilisation and ERK phosphorylation. The third aspect of this study examined cellular processing of KLK4 activated PAR- 2 in a prostate cancer cell line. PAR-2 was demonstrated to be expressed by five prostate derived cell lines including the prostate cancer cell line PC-3. It was also demonstrated by flow cytometry and confocal microscopy analyses that activation of PC-3 cell surface PAR-2 by KLK4 leads to internalisation of this receptor in a time dependent manner. Critically, in vivo relevance of the interaction between KLK4 and PAR-2 was established by the observation of the co-expression of receptor and agonist in primary prostate cancer and prostate cancer bone lesion samples by immunohistochemical analysis. Based on the results of this study a number of exciting future studies have been proposed, including, delineating differences in KLK4 cellular signaling via PAR-1 and PAR-2 and the role of PAR-1 and PAR-2 activation by KLK4 in prostate cancer cells and bone cells in prostate cancer progression.

Distortional buckling tests of cold-formed steel compression members at elevated temperatures

In recent times, light gauge cold-formed steel sections have been used extensively since they have a very high strength to weight ratio compared with thicker hot-rolled steel sections. However, they are susceptible to various buckling modes including a distortional mode and hence show complex behaviour under fire conditions. Therefore a research project based on detailed experimental studies was undertaken to investigate the distortional buckling behaviour of light gauge cold-formed steel compression members under simulated fire conditions. More than 150 axial compression tests were undertaken at uniform ambient and elevated temperatures. Two types of cross sections were selected with nominal thicknesses of 0.60, 0.80, and 0.95 mm. Both low (G250) and high (G550) strength steels were used. Distortional buckling tests were conducted at six different temperatures in the range of 20 to 800°C. The ultimate loads of compression members subject to distortional buckling were then used to review the adequacy of the current design rules at ambient and elevated temperatures. This paper presents the details of this experimental study and the results.

Safety climate and relational conflict in the eyes of team members : examining the role of need for closure

This study was aimed at examining the safety climate and relational conflict within teams at the individual level. A sample of 372 respondents, divided into 50 teams, was used to test our hypothesis. It was proposed - and discovered - that team members’ individual differences in need for closure mitigated the negative relationship between perceptions of team safety climate and team relational conflict. The implications of our findings and the study’s limitations are discussed.

Lateral distortional buckling design rules for back to back LiteSteel beams

A new cold-formed steel beam, known as the LiteSteel Beam (LSB), has the potential to transform the low-rise building industry. The new beam is effectively a channel section with two rectangular hollow flanges and a slender web, and is manufactured using a simultaneous cold-forming and electric resistance welding process. Research into the flexural behaviour of single LSB members showed that the LSBs are susceptible to lateral distortional buckling effects and their moment capacities are significantly reduced for intermediate spans. Build-up LSB sections are expected to improve their flexural capacity and to enhance their applications. They are also likely to mitigate the detrimental effects of lateral distortional buckling observed with single LSB members of intermediate spans. However, the behaviour of build up beams is not well understood. Currently available design rules were found to be inadequate to predict the member moment capacities of back to back LSBs. Therefore a research project based on both experimental and numerical studies was undertaken to investigate the flexural behaviour of back to back LSBs with various longitudinal connection spacings under a uniform moment. New design rules were developed using the moment capacity data obtained using finite element analyses and experimental tests. This paper presents the details of the development of design rules for the back to back LSB sections.

Axial shortening in reinforced concrete members using vibration characteristics - Part 1 - Theory

Differential axial shortening in vertical members of reinforced concrete high-rise buildings occurs due to shrinkage, creep and elastic shortening, which are time dependent effects of concrete. This has to be quantified in order to make adequate provisions and mitigate its adverse effects. This paper presents a novel procedure for quantifying the axial shortening of vertical members using the variations in vibration characteristics of the structure, in lieu of using gauges which can pose problems in use during and after the construction. This procedure is based on the changes in the modal flexiblity matrix which is expressed as a function of the mode shapes and the reciprocal of the natural frequencies. This paper will present the development of this novel procedure.

Axial shortening in reinforced concrete members using vibration characteristics - part 2 - Application

Controlling differential axial shortening in vertical load bearing concrete elements is a major concern for new generation tall buildings with complex geometries and mechanisms. Quantification of axial shortening using gauges to verify the pre-estimated numerical values used at the design stage is a well established method. This method makes adequate provision to mitigate the adverse effects during the construction. However, this method is becoming increasingly unusable due to its drawbacks. This highlights the need a novel method to quantify the axial shortening using ambient measurements. This paper will first brief introduce the method and then illustrate its application to a high-rise building with two outrigger and belt systems. Moreover, this procedure can be used as a health or performance monitoring tool of the building structure, both during and after construction.

Influence of axial deformation of structural members on vibration characteristics

The vibration characteristics of structural members are significantly influenced by the axial loads and hence axial deformation of the member. Numerous methods have been developed to quantify the axial loads in individual structural members using their natural frequencies. However, the findings of these methods cannot be applied to individual members in a structural framing system as the natural frequency is a global parameter for the entire framing system. This paper proposes an innovative method which uses the modal flexibility parameter to quantify axial deformations in load bearing elements of structural framing systems. The proposed method is illustrated through examples and results highlight that the method can be used to quantify the axial deformations of Individual elements of structural framing systems.

Positioning refugee students as intellectual class members

This chapter looks at the 'smart links' and 'smart paths' created by some English as a second language (ESL) teachers to enable refugee students with little, no or severely interrupted schooling to participate in class after re-settlement in the West. Data are drawn from an interview study conducted in an intensive English language school for adolescents and three mainstream high schools. Findings show how teachers who rejected deficit discourses enabled student participation in the intellectual work of the classroom. The Bourdieusian concept of capital is used to describe teacher competence for diverse classrooms in a world of student mobility and unequal educational access.