Cost-effectiveness of a central venous catheter care bundle

Background: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. ---------- Methods and Findings: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds.---------- Conclusions: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared to invest resources in infection control to see efficiency improvements.

Legislative proposals to codify directors' liability for insolvent trading in Hong Kong : a 10-year journey

Hong Kong is a modern global city with a reputation for well-regulated financial markets, but for years, the government had been trying to enact laws on corporate rescue procedures with relatively little success. It is under the pretext of the Global Financial Crisis, the threat of a future economic meltdown gave the Hong Kong government the impetus to revisit this issue. This third attempt to codify statutory obligations on directors’ liability for insolvent trading has been criticised for either setting the standards too high or low for directors trading whilst insolvent. There is also some reservation given the beliefs and values of directors in Chinese family-owned and controlled companies. These companies would most likely trade out the difficult times. Nevertheless, this does not negate from the fact that the enactment of corporate rescue procedures in Hong Kong in 2010 is a momentous achievement for the Hong Kong government.

Estimating the cost of health care–associated infections : mind your p’s and q’s

Monetary valuations of the economic cost of health care–associated infections (HAIs) are important for decision making and should be estimated accurately. Erroneously high estimates of costs, designed to jolt decision makers into action, may do more harm than good in the struggle to attract funding for infection control. Expectations among policy makers might be raised, and then they are disappointed when the reduction in the number of HAIs does not yield the anticipated cost saving. For this article, we critically review the field and discuss 3 questions. Why measure the cost of an HAI? What outcome should be used to measure the cost of an HAI? What is the best method for making this measurement? The aim is to encourage researchers to collect and then disseminate information that accurately guides decisions about the economic value of expanding or changing current infection control activities.

Comparing cost uplift in infrastructure delivery methods : a case based approach

The alliance project delivery method is used for approximately one third of all Australian government infrastructure projects representing $8-$10 billion per annum. Despite its widespread use, little is known about the differences between estimated project cost and actual cost over the project lifecycle. This paper presents the findings of research into 14 Australian government alliance case studies investigating the observed cost uplift over each project’s lifecycle. I find that significant cost uplift is likely and that this uplift is greater than that afflicting traditional delivery methods. Furthermore, most of the cost uplift occurs at a different place in the project lifecycle, namely between Business Case and Contractual Commitment.

Integrating the resource-based view and transaction cost economics in immigrant business performance

This paper presents a new integrated framework that integrates the resource-based view and transaction cost economics to explain the phenomenon of immigrant entrepreneurship. We extend the existing literature on immigrant entrepreneurship by identifying different types of ethnic network resources and demonstrating how these resources interact with transaction costs in the context of Chinese immigrants. Thus, our study contributes to the literature by providing a theoretical framework which identifies mechanisms immigrant entrepreneurs use to strategically deploy resources to minimize costs and maximize performance outcomes.

Mental harm, rescuers and the Civil Liability Act 2002 (NSW)

At common law, a duty of care may be owed to a claimant who suffers nervous shock or pure mental harm due to witnessing, or hearing about, physical injury caused to another due to a defendant’s negligence. “Pure mental harm” is the ‘impairment of a person’s mental condition’ that is not suffered as a consequence of any other kind of personal injury to them. However, as many accidents have the potential to create a wide circle of mental suffering to bystanders, family members or others not physically injured themselves, it has traditionally been ‘thought impolitic that everybody so affected should be able to recover damages from the tortfeasor.’ ‘To allow such extended recovery would stretch liability too far.’ Nevertheless, whilst adopting a restrictive approach to liability, the common law courts have recognised that a defendant might owe a duty in relation to the pure mental harm suffered by one who foreseeably attends an accident scene to rescue another from a situation created by the defendant’s negligence.

Energy and cost savings from pipe insulation on domestic, pumped storage (split), solar water heating systems in Australia and New Zealand

Appropriate pipe insulation on domestic, pumped storage (split), solar water heating systems forms an integral part of energy conservation measures of well engineered systems. However, its importance over the life of the system is often overlooked. This study outlines the findings of computer modelling to quantify the energy and cost savings by using pipe insulation between the collector and storage tank. System sizes of 270 Litre storage tank, together with either selectively surfaced, flat plate collectors (4m2 area), or 30 evacuated tube collectors, were used. Insulation thicknesses of 13mm and 15mm, pipe runs both ways of 10, 15 and 20 metres and both electric and gas boosting of systems were all considered. The TRNSYS program was used to model the system performance at a representative city in each of the 6 climate zones for Australia and New Zealand, according to AS/NZS4234 – Heat Water Systems – Calculation of energy consumption and the ORER RECs calculation method. The results show:  Energy savings from pipe insulation are very significant, even in mild climates such as Rockhampton. Across all climates zones, savings ranged from 0.16 to 3.5GJ per system per year, or about 2 to 23 percent of the annual load.  There is very little advantage in increasing the insulation thickness from 13 to 15mm. For electricity at 19c/kWh and gas at 2 c/MJ, cost savings of between $27 and $100 per year are achieved across the climate zones. Both energy and cost savings would increase in colder climates with increased system size, solar contribution and water temperatures.  The pipe insulation substantially improves the solar contribution (or fraction) and Renewable Energy Certificates (RECs), as well as giving small savings in circulating pump running costs in milder climates. Solar contribution increased by up to 23 percent points and RECs by over 7 in some cases.  The study highlights the need to install and maintain the integrity of appropriate pipe insulation on solar water heaters over their life time in Australia and New Zealand.

Leg Clubs® : a clinically and cost-effective approach to lower limb management

Leg ulcers affect 55000-90000 people, predominantly aged over 65, in the UK at any one time. Traditional care, delivered in people’s homes by district nurses or in GP clinics, is costly and often not effective, with slow healing rates and a high incidence of recurrence. A social model of leg ulcer clinics developed by the author has been shown to improve healing and reduce recurrence within a highly cost-effective framework that delivers genuine patient empowerment, public health education and social outreach. This paper outlines the rationale for the Leg Club, its clinical and social impact, and the infrastructure behind it. It also considers the challenges to establishing and running a Leg Club.

Towards the adoption of low-cost rail level crossing warning devices in regional areas of Australia : a review of current technologies and reliability issues

This paper discusses major obstacles for the adoption of low cost level crossing warning devices (LCLCWDs) in Australia and reviews those trialed in Australia and internationally. The argument for the use of LCLCWDs is that for a given investment, more passive level crossings can be treated, therefore increasing safety benefits across the rail network. This approach, in theory, reduces risk across the network by utilizing a combination of low-cost and conventional level crossing interventions, similar to what is done in the road environment. This paper concludes that in order to determine if this approach can produce better safety outcomes than the current approach, involving the incremental upgrade of level crossings with conventional interventions, it is necessary to perform rigorous risk assessments and cost-benefit analyses of LCLCWDs. Further research is also needed to determine how best to differentiate less reliable LCCLWDs from conventional warning devices through the use of different warning signs and signals. This paper presents a strategy for progressing research and development of LCLCWDs and details how the Cooperative Research Centre (CRC) for Rail Innovation is fulfilling this strategy through the current and future affordable level crossing projects.

Standardisation and patent ambush : potential liability under Australian competition law

This article examines the problem of patent ambush in standard setting, where patent owners are sometimes able to capture industry standards in order to secure monopoly power and windfall profits. Because standardisation generally introduces high switching costs, patent ambush can impose significant costs on downstream manufacturers and consumers and drastically reduce the efficiency gains of standardisation.This article considers how Australian competition law is likely to apply to patent ambush both in the development of a standard (through misrepresenting the existence of an essential patent) and after a standard is implemented (through refusing to license an essential patented technology either at all or on reasonable and non-discriminatory (RAND) terms). This article suggests that non-disclosure of patent interests is unlikely to restrained by Part IV of the Trade Practices Act (TPA), and refusals to license are only likely to be restrained if the refusal involves leveraging or exclusive dealing. By contrast, Standard Setting Organisations (SSOs) which seek to limit this behaviour through private ordering may face considerable scrutiny under the new cartel provisions of the TPA. This article concludes that SSOs may be best advised to implement administrative measures to prevent patent hold-up, such as reviewing which patents are essential for the implementation of a standard, asking patent holders to make their licence conditions public to promote transparency, and establishing forums where patent licensees can complain about licence terms that they consider to be unreasonable or discriminatory. Additionally, the ACCC may play a role in authorising SSO policies that could otherwise breach the new cartel provisions, but which have the practical effect of promoting competition in the standards setting environment.

Information sharing with key suppliers : a transaction cost theory perspective

Purpose: The purpose of this paper is to explain variations in discretionary information shared between buyers and key suppliers. The paper also aims to examine how the extent of information shared affects buyers’ performance in terms of resource usage, output, and flexibility. ----- ----- Design/methodology/approach: The data for the paper comprise 221 Finnish and Swedish non-service companies obtained through a mail survey. The hypothesized relationships were tested using partial least squares modelling with reflective and formative constructs.----- ----- Findings: The results of the study suggest that (environmental and demand) uncertainty and interdependency can to some degree explain the extent of information shared between a buyer and key supplier. Furthermore, information sharing improves buyers’ performance with respect to resource usage, output, and flexibility.----- ----- Research limitations/implications: A limitation to the paper relates to the data, which only included buyers.Abetter approach would have been to collect data from both, buyers and key suppliers. Practical implications – Companies face a wide range of supply chain solutions that enable and encourage collaboration across organizations. This paper suggests a more selective and balanced approach toward adopting the solutions offered as the benefits are contingent on a number of factors such as uncertainty. Also, the risks of information sharing are far too high for a one size fits all approach.----- ----- Originality/value: The paper illustrates the applicability of transaction cost theory to the contemporary era of e-commerce. With this finding, transaction cost economics can provide a valuable lens with which to view and interpret interorganizational information sharing, a topic that has received much attention in the recent years.

Security analysis and enhancement of one-way hash based low-cost authentication protocol (OHLCAP)

Choi et al. recently proposed an efficient RFID authentication protocol for a ubiquitous computing environment, OHLCAP(One-Way Hash based Low-Cost Authentication Protocol). However, this paper reveals that the protocol has several security weaknesses : 1) traceability based on the leakage of counter information, 2) vulnerability to an impersonation attack by maliciously updating a random number, and 3) traceability based on a physically-attacked tag. Finally, a security enhanced group-based authentication protocol is presented.

Encroachment: what cost a pool with ocean views?

In Shadbolt v Wise [2002] QSC 348 the applicants were seeking relief under s184 of the Property Law Act 1974 (Qld) in respect of an encroachment that they constructed on land belonging to the adjacent owner. The encroachment in question consisted of slightly less than one half of an elaborate pool and pool enclosure (the area of the encroachment being approximately 108 square metres). The land upon which the encroachment was situated was elevated with distant ocean views.

Open content licensing of public sector information and the risk of tortious liability for Australian Governments

There has been an increasing interest by governments worldwide in the potential benefits of open access to public sector information (PSI). However, an important question remains: can a government incur tortious liability for incorrect information released online under an open content licence? This paper argues that the release of PSI online for free under an open content licence, specifically a Creative Commons licence, is within the bounds of an acceptable level of risk to government, especially where users are informed of the limitations of the data and appropriate information management policies and principles are in place to ensure accountability for data quality and accuracy.