Implementation of a better choice healthy food and drink supply strategy for staff and visitors in government owned health facilities in Queensland, Australia

Objective The present paper reports on a quality improvement activity examining implementation of A Better Choice Healthy Food and Drink Supply Strategy for Queensland Health Facilities (A Better Choice). A Better Choice is a policy to increase supply and promotion of healthy foods and drinks and decrease supply and promotion of energy-dense, nutrient-poor choices in all food supply areas including food outlets, staff dining rooms, vending machines, tea trolleys, coffee carts, leased premises, catering, fundraising, promotion and advertising. Design An online survey targeted 278 facility managers to collect self-reported quantitative and qualitative data. Telephone interviews were sought concurrently with the twenty-five A Better Choice district contact officers to gather qualitative information. Setting Public sector-owned and -operated health facilities in Queensland, Australia. Subjects One hundred and thirty-four facility managers and twenty-four district contact officers participated with response rates of 48·2 % and 96·0 %, respectively. Results Of facility managers, 78·4 % reported implementation of more than half of the A Better Choice requirements including 24·6 % who reported full strategy implementation. Reported implementation was highest in food outlets, staff dining rooms, tea trolleys, coffee carts, internal catering and drink vending machines. Reported implementation was more problematic in snack vending machines, external catering, leased premises and fundraising. Conclusions Despite methodological challenges, the study suggests that policy approaches to improve the food and drink supply can be implemented successfully in public-sector health facilities, although results can be limited in some areas. A Better Choice may provide a model for improving food supply in other health and workplace settings.

Open problem: Shifting experts on easy data

A number of online algorithms have been developed that have small additional loss (regret) compared to the best “shifting expert”. In this model, there is a set of experts and the comparator is the best partition of the trial sequence into a small number of segments, where the expert of smallest loss is chosen in each segment. The regret is typically defined for worst-case data / loss sequences. There has been a recent surge of interest in online algorithms that combine good worst-case guarantees with much improved performance on easy data. A practically relevant class of easy data is the case when the loss of each expert is iid and the best and second best experts have a gap between their mean loss. In the full information setting, the FlipFlop algorithm by De Rooij et al. (2014) combines the best of the iid optimal Follow-The-Leader (FL) and the worst-case-safe Hedge algorithms, whereas in the bandit information case SAO by Bubeck and Slivkins (2012) competes with the iid optimal UCB and the worst-case-safe EXP3. We ask the same question for the shifting expert problem. First, we ask what are the simple and efficient algorithms for the shifting experts problem when the loss sequence in each segment is iid with respect to a fixed but unknown distribution. Second, we ask how to efficiently unite the performance of such algorithms on easy data with worst-case robustness. A particular intriguing open problem is the case when the comparator shifts within a small subset of experts from a large set under the assumption that the losses in each segment are iid.

Marginal costs of hospital-acquired conditions : information for priority-setting for patient safety programmes and research

Objective: To estimate the relative inpatient costs of hospital-acquired conditions. Methods: Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian ‘condition-onset' flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n = 1,699,997) treated in Australian public hospitals in Victoria (2005/06) and Queensland (2006/07). Results: The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU$21,827 to the cost of an episode, followed by MRSA (AU$19,881) and enterocolitis due to Clostridium difficile (AU$19,743). Aggregate costs to the system, however, were highest for septicaemia (AU$41.4 million), complications of cardiac and vascular implants other than septicaemia (AU$28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU$27.8 million) and UTI (AU$24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. Conclusions: Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on ‘indicators’ of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.

The Figmentum Project: appropriating information and communication technologies to animate our urban fabric

This paper explores how we may design located information and communication technologies (ICTs) to foster community sentiment. It focuses explicitly on possibilities for ICTs to create new modalities of place through exploring key factors such as shared experiences, shared knowledge and shared authorship. To contextualise this discussion in a real world setting, this paper presents FIGMENTUM, a situated generative art application that was developed for and installed in a new urban development. FIGMENTUM is a non-authoritative, non-service based application that aims to trigger emotional and representational place-based communities. Out of this practice-led research comes a theory and a process for designing creative place-based ICT’s to animate our urban communities.

Strong designated verifier signature in a multi-user setting

The security of strong designated verifier (SDV) signature schemes has thus far been analyzed only in a two-user setting. We observe that security in a two-user setting does not necessarily imply the same in a multi-user setting for SDV signatures. Moreover, we show that existing security notions do not adequately model the security of SDV signatures even in a two-user setting. We then propose revised notions of security in a multi-user setting and show that no existing scheme satisfies these notions. A new SDV signature scheme is then presented and proven secure under the revised notions in the standard model. For the purpose of constructing the SDV signature scheme, we propose a one-pass key establishment protocol in the standard model, which is of independent interest in itself.

The use of online counselling within an Australian secondary school setting: a practitioner’s viewpoint

This paper proposes that the provision of online counselling services for young people accessed through their local school website has the potential to assist students with mental health issues as well as increasing their help seeking behaviours. It stems from the work of the authors who trialled an online counselling service within one Australian secondary school. In Australia, online counselling with the adult population is now an accepted part of the provision of mental health services. Online provision of mental health information for young people is also well accepted. However, online counselling for young people is provided by only a few community organisations such as Kids Help Line within Australia. School based counselling services which are integral to most secondary schools in Australia, seem slow to provide this service in spite of initial interest and enthusiasm by individual school counsellors. This discussion is the product of reflection on the potential benefits of this trial with a consideration of relevant research of the issues raised. It highlights the need for further research into the use of computer mediated communication in the provision of counselling within a school setting.

Community information literacy : developing an Australian research agenda

The majority of information literacy (IL) research has been con ducted within the confi nes of educational or workplace settings. Little to no research has explored IL in community contexts. This paper will consider the current state of IL research within the community setting. The paper uses three re cent IL studies as a vehicle for developing an Australian com munity IL research agenda. Three observations are made about community information literacy (CIL) and CIL research: (i) it is multi- and inter-disciplinary; (ii) it has a learning lens; and (iii) it has a pluralistic approach. The CIL research agenda should be seen as practical and real – it is about real people, doing real things in real life contexts. To achieve this we must bring to gether a research community that is ready to cross boundar ies and forge relationships with other groups. In addition a coherent and structured research agenda should be established.

Rough set-based reasoning and pattern mining for information filtering

An information filtering (IF) system monitors an incoming document stream to find the documents that match the information needs specified by the user profiles. To learn to use the user profiles effectively is one of the most challenging tasks when developing an IF system. With the document selection criteria better defined based on the users’ needs, filtering large streams of information can be more efficient and effective. To learn the user profiles, term-based approaches have been widely used in the IF community because of their simplicity and directness. Term-based approaches are relatively well established. However, these approaches have problems when dealing with polysemy and synonymy, which often lead to an information overload problem. Recently, pattern-based approaches (or Pattern Taxonomy Models (PTM) [160]) have been proposed for IF by the data mining community. These approaches are better at capturing sematic information and have shown encouraging results for improving the effectiveness of the IF system. On the other hand, pattern discovery from large data streams is not computationally efficient. Also, these approaches had to deal with low frequency pattern issues. The measures used by the data mining technique (for example, “support” and “confidences”) to learn the profile have turned out to be not suitable for filtering. They can lead to a mismatch problem. This thesis uses the rough set-based reasoning (term-based) and pattern mining approach as a unified framework for information filtering to overcome the aforementioned problems. This system consists of two stages - topic filtering and pattern mining stages. The topic filtering stage is intended to minimize information overloading by filtering out the most likely irrelevant information based on the user profiles. A novel user-profiles learning method and a theoretical model of the threshold setting have been developed by using rough set decision theory. The second stage (pattern mining) aims at solving the problem of the information mismatch. This stage is precision-oriented. A new document-ranking function has been derived by exploiting the patterns in the pattern taxonomy. The most likely relevant documents were assigned higher scores by the ranking function. Because there is a relatively small amount of documents left after the first stage, the computational cost is markedly reduced; at the same time, pattern discoveries yield more accurate results. The overall performance of the system was improved significantly. The new two-stage information filtering model has been evaluated by extensive experiments. Tests were based on the well-known IR bench-marking processes, using the latest version of the Reuters dataset, namely, the Reuters Corpus Volume 1 (RCV1). The performance of the new two-stage model was compared with both the term-based and data mining-based IF models. The results demonstrate that the proposed information filtering system outperforms significantly the other IF systems, such as the traditional Rocchio IF model, the state-of-the-art term-based models, including the BM25, Support Vector Machines (SVM), and Pattern Taxonomy Model (PTM).

A 5 year review of information requests to QISU

The Queensland Injury Surveillance Unit (QISU) has been collecting and analysing injury data in Queensland since 1988. QISU data is collected from participating emergency departments (EDs) in urban, rural and remote areas of Queensland. Using this data, QISU produces several injury bulletins per year on selected topics, providing a picture of Queensland injury, and setting this in the context of relevant local, national and international research and policy. These bulletins are used by numerous government and non-government groups to inform injury prevention and practice throughout the state. QISU bulletins are also used by local and state media to inform the general public of injury risk and prevention strategies. In addition to producing the bulletins, QISU regularly responds to requests for information from a variety of sources. These requests often require additional analysis of QISU data to tailor the response to the needs of the end user. This edition of the bulletin reviews 5 years of information requests to QISU.

Setting hospital infection control policy : a decision-making framework incorporating health economics and healthcare epidemiology

Background: Reducing rates of healthcare acquired infection has been identified by the Australian Commission on Safety and Quality in Health Care as a national priority. One of the goals is the prevention of central venous catheter-related bloodstream infection (CR-BSI). At least 3,500 cases of CR-BSI occur annually in Australian hospitals, resulting in unnecessary deaths and costs to the healthcare system between $25.7 and $95.3 million. Two approaches to preventing these infections have been proposed: use of antimicrobial catheters (A-CVCs); or a catheter care and management ‘bundle’. Given finite healthcare budgets, decisions about the optimal infection control policy require consideration of the effectiveness and value for money of each approach. Objectives: The aim of this research is to use a rational economic framework to inform efficient infection control policy relating to the prevention of CR-BSI in the intensive care unit. It addresses three questions relating to decision-making in this area: 1. Is additional investment in activities aimed at preventing CR-BSI an efficient use of healthcare resources? 2. What is the optimal infection control strategy from amongst the two major approaches that have been proposed to prevent CR-BSI? 3. What uncertainty is there in this decision and can a research agenda to improve decision-making in this area be identified? Methods: A decision analytic model-based economic evaluation was undertaken to identify an efficient approach to preventing CR-BSI in Queensland Health intensive care units. A Markov model was developed in conjunction with a panel of clinical experts which described the epidemiology and prognosis of CR-BSI. The model was parameterised using data systematically identified from the published literature and extracted from routine databases. The quality of data used in the model and its validity to clinical experts and sensitivity to modelling assumptions was assessed. Two separate economic evaluations were conducted. The first evaluation compared all commercially available A-CVCs alongside uncoated catheters to identify which was cost-effective for routine use. The uncertainty in this decision was estimated along with the value of collecting further information to inform the decision. The second evaluation compared the use of A-CVCs to a catheter care bundle. We were unable to estimate the cost of the bundle because it is unclear what the full resource requirements are for its implementation, and what the value of these would be in an Australian context. As such we undertook a threshold analysis to identify the cost and effectiveness thresholds at which a hypothetical bundle would dominate the use of A-CVCs under various clinical scenarios. Results: In the first evaluation of A-CVCs, the findings from the baseline analysis, in which uncertainty is not considered, show that the use of any of the four A-CVCs will result in health gains accompanied by cost-savings. The MR catheters dominate the baseline analysis generating 1.64 QALYs and cost-savings of $130,289 per 1.000 catheters. With uncertainty, and based on current information, the MR catheters remain the optimal decision and return the highest average net monetary benefits ($948 per catheter) relative to all other catheter types. This conclusion was robust to all scenarios tested, however, the probability of error in this conclusion is high, 62% in the baseline scenario. Using a value of $40,000 per QALY, the expected value of perfect information associated with this decision is $7.3 million. An analysis of the expected value of perfect information for individual parameters suggests that it may be worthwhile for future research to focus on providing better estimates of the mortality attributable to CR-BSI and the effectiveness of both SPC and CH/SSD (int/ext) catheters. In the second evaluation of the catheter care bundle relative to A-CVCs, the results which do not consider uncertainty indicate that a bundle must achieve a relative risk of CR-BSI of at least 0.45 to be cost-effective relative to MR catheters. If the bundle can reduce rates of infection from 2.5% to effectively zero, it is cost-effective relative to MR catheters if national implementation costs are less than $2.6 million ($56,610 per ICU). If the bundle can achieve a relative risk of 0.34 (comparable to that reported in the literature) it is cost-effective, relative to MR catheters, if costs over an 18 month period are below $613,795 nationally ($13,343 per ICU). Once uncertainty in the decision is considered, the cost threshold for the bundle increases to $2.2 million. Therefore, if each of the 46 Level III ICUs could implement an 18 month catheter care bundle for less than $47,826 each, this approach would be cost effective relative to A-CVCs. However, the uncertainty is substantial and the probability of error in concluding that the bundle is the cost-effective approach at a cost of $2.2 million is 89%. Conclusions: This work highlights that infection control to prevent CR-BSI is an efficient use of healthcare resources in the Australian context. If there is no further investment in infection control, an opportunity cost is incurred, which is the potential for a more efficient healthcare system. Minocycline/rifampicin catheters are the optimal choice of antimicrobial catheter for routine use in Australian Level III ICUs, however, if a catheter care bundle implemented in Australia was as effective as those used in the large studies in the United States it would be preferred over the catheters if it was able to be implemented for less than $47,826 per Level III ICU. Uncertainty is very high in this decision and arises from multiple sources. There are likely greater costs to this uncertainty for A-CVCs, which may carry hidden costs, than there are for a catheter care bundle, which is more likely to provide indirect benefits to clinical practice and patient safety. Research into the mortality attributable to CR-BSI, the effectiveness of SPC and CH/SSD (int/ext) catheters and the cost and effectiveness of a catheter care bundle in Australia should be prioritised to reduce uncertainty in this decision. This thesis provides the economic evidence to inform one area of infection control, but there are many other infection control decisions for which information about the cost-effectiveness of competing interventions does not exist. This work highlights some of the challenges and benefits to generating and using economic evidence for infection control decision-making and provides support for commissioning more research into the cost-effectiveness of infection control.

The impact of Health Information Technology (I-HIT) scale : the Australian results

One of role of the nurse in the clinical setting is that of coordinating communication across the healthcare team. On a daily basis nurses interact with the person receiving care, their family members, and multiple care providers thus placing the nurse in the central position with access to a vast array of information on the person. Through this nurses have historically functioned as “information repositories”. With the advent of Health Information Technology (HIT) tools there is a potential that HIT could impact interdisciplinary communication, practice efficiency and effectiveness, relationships and workflow in acute care settings \[1]\[3]. In 2005, the HIMSS Nursing Informatics Community developed the IHITScale to measure the impact of HIT on the nursing role and interdisciplinary communication in USA hospitals. In 2007, nursing informatics colleagues from Australia, Finland, Ireland, New Zealand, Scotland and the USA formed a research collaborative to validate the IHIT in six additional countries. This paper will discuss the background, methodology, results and implications from the Australian IHIT survey of over 1100 nurses. The results are currently being analyzed and will be presented at the conference.

Rethinking health planning : a framework for organising information to underpin collaborative health planning

The field of collaborative health planning faces significant challenges created by the narrow focus of the available information, the absence of a framework to organise that information and the lack of systems to make information accessible and guide decision-making. These challenges have been magnified by the rise of the ‘healthy communities movement’, as a result of which, there have been more frequent calls for localised, collaborative and evidence-driven health related decision-making. This paper discusses the role of decision support systems as a mechanism to facilitate collaborative health decision-making. The paper presents a potential information management framework to underpin a health decision support system and describes the participatory process that is currently being used to create an online tool for health planners using geographic information systems. The need for a comprehensive information management framework to guide the process of planning for healthy communities has been emphasised. The paper also underlines the critical importance of the proposed framework not only in forcing planners to engage with the entire range of health determinants, but also in providing sufficient flexibility to allow exploration of the local setting-based determinants of health.

Accounting information systems in a centrally planned economy : the case of the General Company for Pipelines (GCP)

The paper has a twofold purpose. First it highlights the importance of accounting information in the economic development of developing countries, with a particular focus on the nation of Libya. Secondly, using the case of Libya's General Company for Pipelines (GCP), it demonstrates that the use of accounting information to achieve economic development goals is determined to a large extent by the political/ideological setting in which it is generated. The study is based on a literature review and archival research, reinforced by a qualitative case study comprised of interviews, attendance at meetings and a study of internal documents. A study of The General Company for Pipelines (GCP) revealed that frequent politically driven changes in the structure and number of popular congresses and committees severely limited the use of accounting information, relegating it to a formal role. In consequence, accounting information had litle effect on stimulating economic development in Libya. This study focuses on one case study which does limit generalisability. However, it also suggests fruitful research areas considering the historic factors which have determined the accounting role in developing and planned economies. By providing insights about social factors which have determined the use of accounting in a planned economy, this study has implications for similar economies as they move towards a more globalised mode of operations which enhance the role of accounting in meeting economic development needs. If devleoping countries are to harness the potential of accounting aid in the achievement of their development plans, the social and political setting in which accounting has been conducted needs to be understood.

Compliance with international financial reporting standards (IFRS) and the value relevance of accounting information in emerging stock markets : evidence from Kuwait

Since the 1960s, the value relevance of accounting information has been an important topic in accounting research. The value relevance research provides evidence as to whether accounting numbers relate to corporate value in a predicted manner (Beaver, 2002). Such research is not only important for investors but also provides useful insights into accounting reporting effectiveness for standard setters and other users. Both the quality of accounting standards used and the effectiveness associated with implementing these standards are fundamental prerequisites for high value relevance (Hellstrom, 2006). However, while the literature comprehensively documents the value relevance of accounting information in developed markets, little attention has been given to emerging markets where the quality of accounting standards and their enforcement are questionable. Moreover, there is currently no known research that explores the association between level of compliance with International Financial Reporting Standards (IFRS) and the value relevance of accounting information. Motivated by the lack of research on the value relevance of accounting information in emerging markets and the unique institutional setting in Kuwait, this study has three objectives. First, it investigates the extent of compliance with IFRS with respect to firms listed on the Kuwait Stock Exchange (KSE). Second, it examines the value relevance of accounting information produced by KSE-listed firms over the 1995 to 2006 period. The third objective links the first two and explores the association between the level of compliance with IFRS and the value relevance of accounting information to market participants. Since it is among the first countries to adopt IFRS, Kuwait provides an ideal setting in which to explore these objectives. In addition, the Kuwaiti accounting environment provides an interesting regulatory context in which each KSE-listed firm is required to appoint at least two external auditors from separate auditing firms. Based on the research objectives, five research questions (RQs) are addressed. RQ1 and RQ2 aim to determine the extent to which KSE-listed firms comply with IFRS and factors contributing to variations in compliance levels. These factors include firm attributes (firm age, leverage, size, profitability, liquidity), the number of brand name (Big-4) auditing firms auditing a firm’s financial statements, and industry categorization. RQ3 and RQ4 address the value relevance of IFRS-based financial statements to investors. RQ5 addresses whether the level of compliance with IFRS contributes to the value relevance of accounting information provided to investors. Based on the potential improvement in value relevance from adopting and complying with IFRS, it is predicted that the higher the level of compliance with IFRS, the greater the value relevance of book values and earnings. The research design of the study consists of two parts. First, in accordance with prior disclosure research, the level of compliance with mandatory IFRS is examined using a disclosure index. Second, the value relevance of financial statement information, specifically, earnings and book value, is examined empirically using two valuation models: price and returns models. The combined empirical evidence that results from the application of both models provides comprehensive insights into value relevance of accounting information in an emerging market setting. Consistent with expectations, the results show the average level of compliance with IFRS mandatory disclosures for all KSE-listed firms in 2006 was 72.6 percent; thus, indicating KSE-listed firms generally did not fully comply with all requirements. Significant variations in the extent of compliance are observed among firms and across accounting standards. As predicted, older, highly leveraged, larger, and profitable KSE-listed firms are more likely to comply with IFRS required disclosures. Interestingly, significant differences in the level of compliance are observed across the three possible auditor combinations of two Big-4, two non-Big 4, and mixed audit firm types. The results for the price and returns models provide evidence that earnings and book values are significant factors in the valuation of KSE-listed firms during the 1995 to 2006 period. However, the results show that the value relevance of earnings and book values decreased significantly during that period, suggesting that investors rely less on financial statements, possibly due to the increase in the available non-financial statement sources. Notwithstanding this decline, a significant association is observed between the level of compliance with IFRS and the value relevance of earnings and book value to KSE investors. The findings make several important contributions. First, they raise concerns about the effectiveness of the regulatory body that oversees compliance with IFRS in Kuwait. Second, they challenge the effectiveness of the two-auditor requirement in promoting compliance with regulations as well as the associated cost-benefit of this requirement for firms. Third, they provide the first known empirical evidence linking the level of IFRS compliance with the value relevance of financial statement information. Finally, the findings are relevant for standard setters and for their current review of KSE regulations. In particular, they highlight the importance of establishing and maintaining adequate monitoring and enforcement mechanisms to ensure compliance with accounting standards. In addition, the finding that stricter compliance with IFRS improves the value relevance of accounting information highlights the importance of full compliance with IFRS and not just mere adoption.