Effects of affective and anxiety disorders on outcome in problem gamblers attending routine cognitive-behavioural treatment in South Australia

This study evaluated the influence of 12-month affective and anxiety disorders on treatment outcomes for adult problem gamblers in routine cognitive–behavioural therapy. A cohort study at a state-wide gambling therapy service in South Australia. Primary outcome measure was rated by participants using victorian gambling screen (VGS) ‘harm to self’ sub-scale with validated cut score 21? (score range 0–60) indicative of problem gambling behaviour. Secondary outcome measure was Work and Social Adjustment Scale (WSAS). Independent variable was severity of affective and anxiety disorders based on Kessler 10 scale. We used propensity score adjusted random-effects models to estimate treatment outcomes for sub-populations of individuals from baseline to 12 month follow-up. Between July, 2010 and December, 2012, 380 participants were eligible for inclusion in the final analysis. Mean age was 44.1 (SD = 13.6) years and 211 (56 %) were males. At baseline, 353 (92.9 %) were diagnosed with a gambling disorder using VGS. For exposure, 175 (46 %) had a very high probability of a 12-month affective or anxiety disorder, 103 (27 %) in the high range and 102 (27 %) in the low to moderate range. For the main analysis, individuals experienced similar clinically significant reductions (improvement) in gambling related outcomes across time (p\0.001). Individuals with co-varying patterns of problem gambling and 12 month affective and anxiety disorders who present to a gambling help service for treatment in metropolitan South Australia

Chronic condition management and self-management in Aboriginal communities in South Australia : outcomes of a longitudinal study

OBJECTIVES: This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. METHODS: The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. RESULTS: Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. CONCLUSIONS: The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs.

Is client-centred care planning for chronic disease sustainable? Experience from rural South Australia

This qualitative evaluation of a chronic disease self-management project in rural South Australia considers the sustainability of client-centred care planning under current organisational and funding arrangements. The study involved consultation with a range of five stakeholder types over two stages (40 in the beginning stage and 39 in the middle stage) about their satisfaction with the care planning and self-management approach used in the project. All stakeholder types valued the client-centred approach because they perceived that clients were better able to accept and deal with the long-term management of their condition. However, this required that care planning should deal with a wider range of issues than just medical management, and so it took longer, which raised its sustainability in general practice under the current funding through the national health insurance programme (Medicare). The study concludes that sustainability may be addressed through further research into the role of and funding for peer-led self-management groups and the employment of care planners in organisational settings that are conducive to a client-centred approach.

The impact of coordinated care : Eyre region, South Australia 1997-1999

The SA HealthPlus Coordinated Care Trial in the Eyre Region began in fortuitous circumstances. First, it coincided with the completion of the Eyre Regional Health Service (ERHS) needs assessment in 1996, which highlighted outstanding health service needs and community concerns in relation to health care across the region. Second, although conceived as a formal trial, using standard research techniques, scientific processes and formal control groups to test significant differences between intervention and control groups, the trial did not conform strictly to the rules of social science or pure science and became more an exercise in action research. More significantly still, the Eyre Region became involved in the process, not so much as a way of proving a concept (the SA Health Plus hypotheses around utilisation, funding and health outcomes), but as a way of creating opportunities for change in the regional health system. If nothing else, the region stood to benefit from the implementation of the trial and involvement in the trial process. The present paper outlines the impact of the Eyre Coordinated Care Trial, not in terms of hypotheses and data analysis, but in terms of the impact of the trial processes on systems change and the evolution of an outcome-based health system. Such a system has the potential to deliver improved health outcomes to communities within existing financial resources and make much more effective use of resources by integrating care delivery and encouraging collaboration between health providers. In addition, the success of the change process in Eyre also supports the notion that change is not necessarily predicated upon scientific processes and research outcomes alone, but also upon the human and social structures associated with such endeavours. This perspective also contributes to the debate about the nature and role of science in the advancement of knowledge.

The politics of public sector change: trends in health and education sector change in South Australia

BACKGROUND: As the changes underpinning the Coordinated Care Trials in South Australia have become more apparent, similarities have emerged between the rationalisation of public schooling in the mid 1980s and the transformation of public health in the 1990s.

OBJECTIVE: This article aims to discuss the evolution of health services in South Australia and help us answer the question of how best to manage our public and private health infrastructure in a changing economic and social context.

DISCUSSION: Both strategies in education and health share common elements of cost cutting, attempts at improving efficiencies, a flirting with the private sector and the attendant risk of reduced quality of services to the public. This situation in both sectors is indicative of a shift in public policy and a growth in the belief that private management of public sector infrastructure can help resolve the funding crises around our education and health systems.

Early recognition of ipilimumab-related autoimmune hypophysitis in patients with metastatic melanoma: case studies and recommendations for management

Ipilimumab is a human anti-CTLA-4 monoclonal antibody recently approved for the treatment of advanced melanoma. Stimulation of T-cell activity unmasks antitumor activity, but can cause immune-related adverse events. Autoimmune hypophysitis is of particular importance because its presentation can be subtle but life threatening. We present two cases where early recognition of ipilimumab-related autoimmune hypophysitis led to timely intervention and low subsequent morbidity, without compromise of antitumor effects. We provide recommendations for detection and management of this potentially life-threatening complication of ipilimumab.

Industry case study: rapid prototype of mountain bike frame section

The purpose of this study is to detail a virtual and physical prototyping process to overcome a design constraint in the mountain bike industry. Through a series of techniques, 3D scanning, developing detailed CAD models, then through additive manufacturing processes, a solution wasdeveloped. The challenge in the industry is the constant geometrical changes of components; the trend has been that bike cranks are becoming narrower due to biomechanical factors and tyres are becoming wider due to rider preferences and increased grip. This change in geometry results in metal tubes that can no longer be deformed without exceeding the minimum bend radius for the material. As such exceeding the minimum bend radius will induce early performance failure and geometrical (aesthetic) defects. The solution is an additivemanufactured part that can be substituted into the process without disrupting the entire conventional build process of a customised bike build.

Managing intragroup conflicts in construction project teams : case studies in Sri Lanka

Conflict is intrinsic to individuals, teams and organisations. Due to the unique and complex nature with various parties, conflict is inevitable in most construction projects. According to the general management literature, three distinct types of intragroup conflicts can be identified: task, process and relationship conflicts. However, very little consideration has been given in the literature addressing the three types individually in a construction project team setting. Therefore, this study has explored the existence of types of intragroup conflicts and their management in this context. This research was approached through case studies of six construction projects, which were operating under the traditional procurement method in Sri Lanka. Semi-structured interviews were conducted with three distinct participants from each team. The findings revealed that both process and relationship conflicts offer disruptive effects to construction projects and teams, while task conflicts offer positive effects when they exist at low levels. Based on the most critical sources identified within the cases, suggestions are offered here to construction project team managers on how to manage intergroup conflicts proactively. Since the research is based on six case studies on traditional procurement arrangement in Sri Lanka, further research is required to generalise the findings across different contexts.

Developing family businesses through ongoing learning: case studies of Chinese urban and rural family businesses under market-oriented reforms

This study advances organisational learning research by exploring how and why learning patterns differ between different family businesses at different layers of China’s marketoriented transformation. The focus is the locational difference, namely the separate urban and rural environments and outcomes. Combining case studies and in-depth interviews, the study investigated how family businesses interact with their institutional environment and consequently build learning patterns. Learning initiatives undertaken by relevant and motivated family members are found to reflect a dynamic process involving personal learning, business growth, and business innovation. Family conflicts and business growth were also found to impact learning in family businesses. Implications for organisational learning are discussed at the end of the paper.

Country brand and stakeholder engagement: Case study of Australia unlimited

The thesis presents a comprehensive conceptual framework of stakeholder brand engagement with a place brand identity. The framework comprises of typology of stakeholder brand engagement in place branding context as well as drivers, inhibitors, manifestations and outcomes of such engagement.

Continuous product innovation : learning behaviours and knowledge management

The research reported in this paper considers Product Innovation from a broader perspective than that of the isolated NPD (New Product Development) project commonly discussed in the literature. In this perspective, Product Innovation is a continuous and cross-functional process involving the sharing and transfer of knowledge within the many steps of the innovation process, and the integration of a growing number of different competencies inside and outside the organisational boundaries. This paper examines two in-depth case studies that were carried out to establish if and how learning occurred within companies developing new products. Based on a model developed as part of a joint Euro-Australian research project, the way in which the selected companies share and transfer knowledge and learning experiences during their product innovation processes have been examined and analysed. This model uses a number of interrelated variables including performance, behaviours and levers to stimulate improvement, contingencies, and learning/innovation capabilities to describe the learning and knowledge transfer in product innovation processes within the case studies. This paper discusses some of the skills the research has identified that managers need to enable their companies to gain a competitive advantage through improved product innovation. The ongoing research has developed, tested and disseminated a computer-based methodology to assess organisational knowledge capture and transfer in the new product development process. The research is part of the Euro-Australian co-operation project known as CIMA (Continuous Improvement and Product Innovation Management).

Cost and time overruns in commercial construction projects : an Australian study

Cost and schedule are two of most important performance indicators of construction projects. Cost escalation and time overruns are typically associated with poor management practices. Cost overruns and delays have huge impacts on construction projects in relation to the costs of a project, the reputation of the parties involved, and the satisfaction of the final product. Therefore, it is imperative to understand the causes of cost and time overruns so that mitigation measures can be set in place. A group of industry professionals in South Australia were surveyed on their perceptions of the factors contributing towards the cost and time overruns in commercial construction projects. The results showed that timeliness of decision making is ranked as the top factor contributing towards delays whereas problems with design is perceived as most influential to the cost overruns. In addition, the questionnaire survey found that different parties, i.e. clients, contractors and consultants have different perceptions on the impacts of these factors. Similarly, the structural frame stage was considered the most critical stage for controlling the time and cost performance during the construction process. Implications are discussed.

Multiple criteria sustainability modelling: case study on school buildings

This paper describes development of a computer-based tool for sustainability modelling using multiple criteria, and preliminary conclusions from doctoral research being undertaken into the relationship between key sustainability indicators. The model used in both cases produces a sustainability index with an accept/reject threshold of one that has the potential to completely replace traditional net present value methods. Minimum performance benchmarks are prescribed and must be observed - often by trading off performance across the full criteria set. Sustainability is shown to be capable of objective (numeric)· analysis for new projects, existing facilities, or indeed any product or asset. A combination of investor-centred and community-centred motivations can also be explored in the model. Known as SINDEX, the tool has industry-wide application, both locally and abroad, and represents a paradigm shift in project evaluation techniques. Furthermore, its multi-discipline considerations underscore the importance of a team approach to sustainability modelling and the need for people to work more closely together when dealing with complex problems. The results of twenty case studies of actual high schools constructed and operated in New South Wales (Australia) are also presented and the relationships between the key sustainability indicators are explored and interpreted.