A ‘cost-per-wear’ model based on contact lens replacement frequency

Purpose: The aim was to construct and advise on the use of a cost-per-wear model based on contact lens replacement frequency, to form an equitable basis for cost comparison. ---------- Methods: The annual cost of professional fees, contact lenses and solutions when wearing daily, two-weekly and monthly replacement contact lenses is determined in the context of the Australian market for spherical, toric and multifocal prescription types. This annual cost is divided by the number of times lenses are worn per year, resulting in a ‘cost-per-wear’. The model is presented graphically as the cost-per-wear versus the number of times lenses are worn each week for daily replacement and reusable (two-weekly and monthly replacement) lenses.---------- Results: The cost-per-wear for two-weekly and monthly replacement spherical lenses is almost identical but decreases with increasing frequency of wear. The cost-per-wear of daily replacement spherical lenses is lower than for reusable spherical lenses, when worn from one to four days per week but higher when worn six or seven days per week. The point at which the cost-per-wear is virtually the same for all three spherical lens replacement frequencies (approximately AUD$3.00) is five days of lens wear per week. A similar but upwardly displaced (higher cost) pattern is observed for toric lenses, with the cross-over point occurring between three and four days of wear per week (AUD$4.80). Multifocal lenses have the highest price, with cross-over points for daily versus two-weekly replacement lenses at between four and five days of wear per week (AUD$5.00) and for daily versus monthly replacement lenses at three days per week (AUD$5.50).---------- Conclusions: This cost-per-wear model can be used to assist practitioners and patients in making an informed decision in relation to the cost of contact lens wear as one of many considerations that must be taken into account when deciding on the most suitable lens replacement modality.

Implementing value management as a decision-making tool in the design stages of design and build construction projects : a methodology for improved cost optimization

Value Management (VM) has been proven to provide a structured framework, together with other supporting tools and techniques, that facilitate effective decision-making in many types of projects, thus achieving ‘best value’ for clients. One of the major success factors of VM in achieving better project objectives for clients is through the provision of beneficial input by multi-disciplinary team members being involved in critical decision-making discussions during the early stage of construction projects. This paper describes a doctoral research proposal based on the application of VM in design and build construction projects, especially focusing on the design stage. The research aims to study the effects of implementing VM in design and build construction projects, in particular how well the methodology addresses issues related to cost overruns resulting from poor coordination and overlooking of critical constructability issues amongst team members in construction projects in Malaysia. It is proposed that through contractors’ early involvement during the design stage, combined with the use of the VM methodology, particularly as a decision-making tool, better optimization of construction cost can be achieved, thus promoting more efficient and effective constructability. The main methods used in this research involve a thorough literature study, semi-structured interviews, and a survey of major stakeholders, a detailed case study and a VM workshop and focus group discussions involving construction professionals in order to explore and possibly develop a framework and a specific methodology for the facilitating successful application of VM within design and build construction projects.

Evaluation of risk factors leading to cost overrun in delivery of highway construction projects

Accurate owner budget estimates are critical to the initial decision-to-build process for highway construction projects. However, transportation projects have historically experienced significant construction cost overruns from the time the decision to build has been taken by the owner. This paper addresses the problem of why highway projects overrun their predicted costs. It identifies the owner risk variables that contribute to significant cost overrun and then uses factor analysis, expert elicitation, and the nominal group technique to establish groups of importance ranked owner risks. Stepwise multivariate regression analysis is also used to investigate any correlation of the percentage of cost overrun with risks, together with attributes such as highway project type, indexed cost, geographics location, and project delivery method. The research results indicate a correlation between the reciprocal of project budgets size and percentage cost overrun. This can be useful for owners in determining more realistic decision-to-build highway budget estimates by taking into account the economies of scale associated with larger projects.

Implications for the design of a digital stethoscope for anaesthetic preadmission consultations

Background This research addresses the development of a digital stethoscope for use with a telehealth communications network to allow doctors to examine patients remotely (a digital telehealth stethoscope). A telehealth stethoscope would allow remote auscultation of patients who do not live near a major hospital. Travelling from remote areas to major hospitals is expensive for patients and a telehealth stethoscope could result in significant cost savings. Using a stethoscope requires great skill. To design a telehealth stethoscope that meets doctors’ expectations, the use of existing stethoscopes in clinical contexts must be examined. Method Observations were conducted of 30 anaesthetic preadmission consultations. The observations were video- taped. Interaction between doctor, patient and non-human elements in the consultation were “coded” to transform the video into data. The data were analysed to reveal essential aspects of the interactions. Results The analysis has shown that the doctor controls the interaction during auscultation. The conduct of auscultation draws heavily on the doctor’s tacit knowledge, allowing the doctor to treat the acoustic stethoscope as infrastructure – that is, the stethoscope sinks into the background and becomes completely transparent in use. Conclusion Two important, and related, implications for the design of a telehealth stethoscope have arisen from this research. First, as a telehealth stethoscope will be a shared device, doctors will not be able to make use of their existing expertise in using their own stethoscopes. Very simply, a telehealth stethoscope will sound different to a doctor’s own stethoscope. Second, the collaborative interaction required to use a telehealth stethoscope will have to be invented and refined. A telehealth stethoscope will need to be carefully designed to address these issues and result in successful use. This research challenges the concept of a telehealth stethoscope by raising questions about the ease and confidence with which doctors could use such a device.

Preliminary modelling outcomes : calculation of holding costs in greenfield residential development

Many of the costs associated with greenfield residential development are apparent and tangible. For example, regulatory fees, government taxes, acquisition costs, selling fees, commissions and others are all relatively easily identified since they represent actual costs incurred at a given point in time. However, identification of holding costs are not always immediately evident since by contrast they characteristically lack visibility. One reason for this is that, for the most part, they are typically assessed over time in an ever-changing environment. In addition, wide variations exist in development pipeline components: they are typically represented from anywhere between a two and over sixteen years time period - even if located within the same geographical region. Determination of the starting and end points, with regards holding cost computation, can also prove problematic. Furthermore, the choice between application of prevailing inflation, or interest rates, or a combination of both over time, adds further complexity. Although research is emerging in these areas, a review of the literature reveals attempts to identify holding cost components are limited. Their quantification (in terms of relative weight or proportionate cost to a development project) is even less apparent; in fact, the computation and methodology behind the calculation of holding costs varies widely and in some instances completely ignored. In addition, it may be demonstrated that ambiguities exists in terms of the inclusion of various elements of holding costs and assessment of their relative contribution. Yet their impact on housing affordability is widely acknowledged to be profound, with their quantification potentially maximising the opportunities for delivering affordable housing. This paper seeks to build on earlier investigations into those elements related to holding costs, providing theoretical modelling of the size of their impact - specifically on the end user. At this point the research is reliant upon quantitative data sets, however additional qualitative analysis (not included here) will be relevant to account for certain variations between expectations and actual outcomes achieved by developers. Although this research stops short of cross-referencing with a regional or international comparison study, an improved understanding of the relationship between holding costs, regulatory charges, and housing affordability results.

Elements of public asset management framework for local governments in developing countries

There is a widespread recognition to the need of better manage municipal property in most cities in the world. Structural problems across regional, state, and territorial governments that have legal powers to own and maintain real property are similar, regardless of the level of development of each country. Start from a very basic level of property inventory records. The need for better manage to the local government owned property is the result of widespread decentralisation initiatives that often have devolved huge property portfolios from central to local governments almost “overnight”. At the same time municipal or regional governments were and continue to be unprepared to deal with multiple issues related to the role of property owners and managers. The lack of discussion of public asset management especially the elements that should be incorporated in the framework creates an important challenge to study the discipline of public asset management further. The aim of this paper is to study the practices of public asset management in developed countries, especially the elements of public asset management framework, and its transferability to developing countries. A case study was selected and conducted to achieve this aim. They involved interviews and a focus group. The study found that in public asset management framework, proper asset identification, public asset needs analysis, asset life cycle and performance measurements are an important element that should be incorporated in the framework. Those elements are transferable and applicable to developing countries’ local governments. Finally, findings from this study provide useful input for the local government policy makers, scholars and asset management practitioners to establish a public asset management framework toward more efficient and effective local governments in managing their assets as well as increasing public services quality.

Low-cost hardware speech enhancement for improved speech recognition in automotive environments

Voice recognition is one of the key enablers to reduce driver distraction as in-vehicle systems become more and more complex. With the integration of voice recognition in vehicles, safety and usability are improved as the driver’s eyes and hands are not required to operate system controls. Whilst speaker independent voice recognition is well developed, performance in high noise environments (e.g. vehicles) is still limited. La Trobe University and Queensland University of Technology have developed a low-cost hardware-based speech enhancement system for automotive environments based on spectral subtraction and delay–sum beamforming techniques. The enhancement algorithms have been optimised using authentic Australian English collected under typical driving conditions. Performance tests conducted using speech data collected under variety of vehicle noise conditions demonstrate a word recognition rate improvement in the order of 10% or more under the noisiest conditions. Currently developed to a proof of concept stage there is potential for even greater performance improvement.

Crash risk estimation and assessment tool

Currently in Australia, there are no decision support tools for traffic and transport engineers to assess the crash risk potential of proposed road projects at design level. A selection of equivalent tools already exists for traffic performance assessment, e.g. aaSIDRA or VISSIM. The Urban Crash Risk Assessment Tool (UCRAT) was developed for VicRoads by ARRB Group to promote methodical identification of future crash risks arising from proposed road infrastructure, where safety cannot be evaluated based on past crash history. The tool will assist practitioners with key design decisions to arrive at the safest and the most cost -optimal design options. This paper details the development and application of UCRAT software. This professional tool may be used to calculate an expected mean number of casualty crashes for an intersection, a road link or defined road network consisting of a number of such elements. The mean number of crashes provides a measure of risk associated with the proposed functional design and allows evaluation of alternative options. The tool is based on historical data for existing road infrastructure in metropolitan Melbourne and takes into account the influence of key design features, traffic volumes, road function and the speed environment. Crash prediction modelling and risk assessment approaches were combined to develop its unique algorithms. The tool has application in such projects as road access proposals associated with land use developments, public transport integration projects and new road corridor upgrade proposals.

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.

A model of organisational leadership development informing succession development : elements and practices

It is noted from observations of Compton (2009), Richards (2008), Taylor and Bennett (2002), and others that succession leadership planning and development fails to receive adequate attention in the corporate sector (see Byham 2002; Richards 2008; Wellins and Byham 2001). This paper acknowledges a marked paucity of systematic succession leadership development in education organisations. The need would seem to be compounded at a time when substantial attrition in the leadership ranks is expected over the next five years, reflecting widespread workforce demographics (Busine and Watt 2005; Jacobzone, Cambois, Chaplain, and Robine 1998; Taylor and Bennett 2002). The Lantern model has been developed in response to a perceived need to offer an integrated, systematic approach to organisational and succession leadership development. The model offers an organising framework for considering succession leadership development in a strategic, integrated way. The concept is based on organisational development and leadership literature which sees leadership development not as a series of 'tacked on' activities but as an organic 'whole of organisation' approach fostering the relevant knowledge, skills and understandings which support and 'grow' leaders as the organisation goes about its business. This paper explores how such an ideal might happen, and it suggests that pursuing such an ideal is timely. The leadership baton is set to shift at an accelerated rate in universities, as for organisations broadly, owing to age-related attrition. Moreover, given the increased complexity and demands of the leadership remit in the education leadership environment, it would seem particularly opportune to explore a framework concentrating on engendering a positive, connected organisational climate capable of growing strategic leadership strength from within. Eight core elements of the model, derived from the literature and practice research, are explored. The Lantern model purports to 'cover the bases' of succession leadership development, with particular reference to the education environment. The model is next described

Strategic entrepreneurship in New Zealand's state-owned enterprises : underlying elements and financial implications

The concept of strategic entrepreneurship has received increased attention over the past ten yeras. Viewed as the intersection of entrepreneurship and strategy this field of research is populated by conceptual studies which focus mainly on the nature and perceived benefits of strategic entrepreneurship. Similarly the study of entrepreneurship in a public sector context has gained increasing support in recent years but also remains underexplored. To address these gaps this thesis considers : what are the underlying elements and financial implications of strategic entrepreneurship in New Zealand's state-owned enterprises, New Zealand's SOE sector comprising 17 government-owned,commercially focused organisations, is considered to be a prime subject for this research. Well known for their implementation of new public management, many New Zealand SOEs have also been publicly recognised as both innovative and entrepreneurial. The research question is addressed by first developing a preliminary framework of strategic entrepreneurship from literature on entrepreneurhsip and strategy. The framework is then examined in the context of case studies on activity.

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.

The promise of computational journalism.

There are at least four key challenges in the online news environment that computational journalism may address. Firstly, news providers operate in a rapidly evolving environment and larger businesses are typically slower to adapt to market innovations. News consumption patterns have changed and news providers need to find new ways to capture and retain digital users. Meanwhile, declining financial performance has led to cost cuts in mass market newspapers. Finally investigative reporting is typically slow, high cost and may be tedious, and yet is valuable to the reputation of a news provider. Computational journalism involves the application of software and technologies to the activities of journalism, and it draws from the fields of computer science, social science and communications. New technologies may enhance the traditional aims of journalism, or may require “a new breed of people who are midway between technologists and journalists” (Irfan Essa in Mecklin 2009: 3). Historically referred to as ‘computer assisted reporting’, the use of software in online reportage is increasingly valuable due to three factors: larger datasets are becoming publicly available; software is becoming sophisticated and ubiquitous; and the developing Australian digital economy. This paper introduces key elements of computational journalism – it describes why it is needed; what it involves; benefits and challenges; and provides a case study and examples. Computational techniques can quickly provide a solid factual basis for original investigative journalism and may increase interaction with readers, when correctly used. It is a major opportunity to enhance the delivery of original investigative journalism, which ultimately may attract and retain readers online.

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.