Assessment of wilderness quality using the analytic hierarchy process

Wilderness is a unique environmental resource that provides a multitude of use and non-use benefits. The use and management of wilderness depend on the assessment of wilderness quality. Current wilderness assessment in Australia is based on two broad criteria, the remoteness and naturalness of the wilderness, determined using geographic information systems. This paper discusses a complementary assessment method using the Analytic Hierarchy Process (AHP). The AHP can be used to incorporate additional criteria, such as social and cultural criteria, to improve the quality of wilderness assessment. It provides a flexible and compatible method for large-scale wilderness assessments with multiple criteria. The weighting factors for the different criteria can be obtained from expert panels and focus groups.

Students' evaluations of teaching quality and their unit online activity : an empirical investigation

This paper reports on an investigation of the relationship between students’ level of online activity in units in a business faculty and their evaluations of teaching quality in these units. The analysis was conducted using student evaluation data from 2004 to 2007 together with data for student online activity for one semester. We compare on-campus and off-campus students and undergraduate and postgraduate students. The results indicate that students’ evaluations of units have improved on all surveyed criteria during the five years. We also show that for some cohorts student online activity is associated with greater satisfaction with teaching. The paper concludes by considering the implications of these findings for further research and teaching practice.

Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis?

Background: Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis (OA). The most well-known is the disease-specific Stanford Arthritis Self-Management Program (ASMP). While Australian and international clinical guidelines promote the concept of self-management for OA, there is currently little evidence to support the use of the ASMP. Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability. However, previous studies have had methodological shortcomings including the use of outcome measures which do not accurately reflect program goals. Additionally, limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored.

Methods/design: This study is a randomised controlled trial to determine the efficacy (in terms of Health-Related Quality of Life and self-management skills) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.

Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practices within 2 private hospital settings in Victoria, Australia. Participants must be 18 years or over, fluent in English and able to attend ASMP sessions. Exclusion criteria include cognitive dysfunction, previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement.

Eligible, consenting participants will be randomised to an intervention group (who receive the ASMP and an arthritis self-management book) or a control group (who receive the book only). Follow-up will be at 6 weeks, 3 months and 12 months using standardised self-report measures. The primary outcome is Health-Related Quality of Life at 12 months, measured using the Assessment of Quality of Life instrument. Secondary outcome measures include the Health Education Impact Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (pain subscale and total scores), Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool. Cost-utility analyses will be undertaken using administrative records and self-report data. A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP.

Discussion: Using an innovative design combining both quantitative and qualitative components, this project will provide high quality data to facilitate evidence-based recommendations regarding the ASMP.

Quality of reporting of randomized clinical trials in abstracts of the 2005 annual meeting of the American College of Rheumatology.

Objective: To determine the quality of abstracts reporting randomized clinical trials (RCT) at the 2005 Annual Scientific Meeting of the American College of Rheumatology.

Methods: All 2005 abstracts including late-breaking abstracts were assessed. An abstract was deemed to be reporting an RCT if it indicated that participants were randomized in the title or body of the abstract. RCT were excluded if they included only pharmacokinetic data. The CONSORT checklist was applied and relevant data extracted. We defined manufacturer support as acknowledgment of industry support or industry employee as co-author.

Results: Of 2146 abstracts, 143 (6.7%) reported RCT. Of these, 78.3% were drug trials, and 63.6% indicated manufacturer support. Only 30.8% of abstracts used "randomized" in the title, 44.1% did not explicitly state whether blinding was undertaken, and only 7.0% clearly stated who was blinded. Thirty percent of studies did not give an explicit definition of eligibility criteria of participants. While 84.6% explicitly described the experimental intervention, only 37.1% explicitly described the comparator intervention. Only 21% explicitly stated that an intention to treat analysis was performed. Baseline demographic and clinical characteristics were reported in 48.3%. While most abstracts reported summary results for each treatment group, only 35.7% reported effect size with its precision.

Conclusion: The quality of reporting is suboptimal in many RCT abstracts. Abstracts reporting RCT would benefit from a structured approach that ensures more detailed reporting of eligibility criteria, active and comparator interventions, flow of participants, and adequate summary and precision of results.

Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry

Objective: To compare the quality and funding source of studies concluding a negative economic impact of smoke-free policies in the hospitality industry to studies concluding no such negative impact.

Data sources: Researchers sought all studies produced before 31 August 2002. Articles published in scientific journals were located with Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, PsychInfo, Econlit, and Healthstar. Unpublished studies were located from tobacco company websites and through internet searches.

Study selection: 97 studies that made statements about economic impact were included. 93% of the studies located met the selection criteria as determined by consensus between multiple reviewers.

Data extraction: Findings and characteristics of studies (apart from funding source) were classified independently by two researchers. A third assessor blind to both the objective of the present study and to funding source also classified each study.

Data synthesis: In studies concluding a negative impact, the odds of using a subjective outcome measure was 4.0 times (95% confidence interval (CI) 1.4 to 9.6; p = 0.007) and the odds of not being peer reviewed was 20 times (95% CI 2.6 to 166.7; p = 0.004) that of studies concluding no such negative impact. All of the studies concluding a negative impact were supported by the tobacco industry. 94% of the tobacco industry supported studies concluded a negative economic impact compared to none of the non-industry supported studies.

Conclusion: All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment. Policymakers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact.

Electronic commerce publications and the implications for research quality output in Australia

Australian universities and academics will soon see a major change in the way research is reported and funded. It is expected that by 2008, according to the most recent timetable (Bishop 2006), the Research Quality Framework (RQF) will be implemented. The result of the announcement has been an increased activity within universities focusing on the proposed criteria. The proposed RQF will seek to have research assessed according to quality and impact. Part of both quality and impact relates to where research is published. For academics it will be increasingly important to target high quality journals if the research is to be rated as high quality. The question this raises for Information Systems academics is where do we publish for maximum impact? The Information Systems (IS) field is diverse with researchers working in many areas and a publication outlet for one area may not be relevant for another. One area where many Australian IS researchers have focused their research interest is the field of electronic commerce (e-commerce). The research reported in this paper identified the publication outlets that would be regarded as amongst the highest quality for researchers wishing to publish e-commerce research. The authors analysed e-commerce research papers by Australian researchers published in the period 2000 to 2005. The results describe where Australian researchers are publishing in this field. The paper also provides guidance to those working in the e-commerce field on which journals and conferences to target to ensure their work rates highly in terms of the RQF.

The impact of hypoglycemia on quality of life in type 2 diabetes : a systematic review.

Hypoglycemia is the commonest and most serious side-effect of insulin treatment for Type 1 diabetes (T1DM). The prevalence of hypoglycemia is lower in insulin-treated Type 2 diabetes (T2DM) than in T1DM but the prevalence increases with duration of insulin therapy and increasingly resembles T1DM. As hypoglycemia has not been widely recognised to affect people with T2DM, its impact on quality of life (QoL) has received little attention.

A systematic literature review was performed to identify empirical papers published in English since 1966 reporting the effect of hypoglycemia on any patient-reported outcomes (PROs), including QoL, in T2DM. Despite our specific interest in QoL, the inclusion criteria were defined broadly to encompass a range of self-assessed psychosocial outcomes, including generic and diabetes-specific QoL, emotional well-being and health utilities. Studies were excluded in which the impact of hypoglycemia was confounded by treatment effects. Our search included: MEDLINE, PsycINFO, CINAHL. Abstracts were screened independently by two investigators.

Of 2,469 abstracts, Thirty-one met the inclusion criteria and were subjected to data extraction and analysis. These comprised four controlled trials and twenty-seven others (including cross-sectional and health utility studies). The results indicate associations between the experience of hypoglycemia and a range of adverse PROs, including impaired QoL and well-being, higher levels of anxiety, depression and anger and loss of health utility. Fear of hypoglycemia was also associated with compensatory lifestyle limitations and changes.

Publications suggest that QoL and other psychosocial outcomes are impaired by the experience and/or fear of hypoglycemia in T2DM, however, very few studies have directly investigated this phenomenon to date. Interpretation of the evidence is hampered by inconsistent or inadequate definitions and measurement of both hypoglycemia and QoL outcomes, by confounding of the impact of hypoglycemia and by treatment factors. Targeted research using appropriate study design is needed to quantify and qualify the true impact of hypoglycemia on QoL in people with T2DM.

Efficient management of drinking water distribution systems through the application of water quality modeling

The quality of drinking water generally degrades when it is delivered through a distribution system due to the decay of disinfectant, which subsequently allows the re-growth of microorganisms in the distribution system. A model that describes the changes that occur in the water quality in distribution system is needed to determine whether to enhance the treatment processes or to improve the distribution system so that microbiological criteria are met. This paper describes how chlorine decay kinetics are modeled and the model output is used in finding the elements that are contributing to the consumption of chlorine at the treatment plant other than the water itself; this allows better control of chlorine dosing at the treatment plant, which in tum will reduce the formation of disinfectant by-products. In addition, the model will accurately predict the decay due to the organic/inorganic and nitrogenous compounds that are remaining in the water at any point in the distribution system, which will indicate the status of the distribution system with respect to its chlorine consumption. Further, if re-chlorination is introduced in the distribution system downstream of the treatment plant, the model will predict the chlorine decay due to the slow reacting organic and nitrogenous compounds accurately.

Rapid water quality characterization for chlorine demand and THM formation in drinking waters

The quality of drinking water generally deteriorates when it is delivered through a distribution system due to the decay of disinfectant, which subsequently allows the re-growth of microorganisms in the distribution system in addition to the formation of trihalomethane (THM). Therefore, a model which describes the changes that occur in the water quality in the distribution system is needed to determine whether to enhance the treatment processes or to improve the distribution system so that microbiological criteria are met. In this paper the chlorine decay kinetics and THM formation in treated water is modeled considering the reaction of chlorine with fast and slow reacting organic and nitrogenous compounds which are present in that water. The treated water was also passed through three types of resins to fractionate very hydrophobic acids (VHA), slightly hydrophobic acids (SHA), hydrophilic charged (CHA) and hydrophilic neutral (NEU) compounds which are present in the water. Chlorine decay tests were conducted on the effluents emerging from the resins to evaluate the chlorine demand and THM formation potential of those organic fractions. The model shows that the CHA presented in the waters has a very high THM formation potential (around 62% of the THM produced). VHA, NEU and CHA contributed to chlorine demand in the water.

Sustainable retrofit potential in lower quality office stock in the central business district

Given the relationship between energy consumption, greenhouse gas emissions and climate change, the built environment has significant potential to lessen overall emissions. With around half of all greenhouse gas emissions attributed to the built environment; it has a significant role to play in mitigating global warming. With large percentages of office stock structurally vacant in some city centres and only 1 or 2% of new buildings added to the total stock each year; the scope for reductions lay with adaptation of existing buildings. The stock with the highest levels of vacancy and obsolescence offers the highest potential of all.

Many cities are now aiming to become carbon neutral. Successful retrofit demands that social, technological, environmental, economic and legislative criteria are addressed. Buildings have to meet user and community needs. City centres comprise a range of different type of office stock with regards to age, size, location, height, tenure and quality. All buildings present challenges and opportunities with regards to retrofit and sustainability and integrating retrofit measures that reduce energy, water and resource consumption.

Using a selection of low grade office buildings to develop retrofit profiles, this paper addresses the questions; (a) what is the nature of retrofits in relation to low quality office building stock in the Central Business District (CBD) and, (b) what is the extent and scope for sustainable retrofits to low quality office buildings. Using Melbourne CBD retrofit events of low quality office buildings were analysed between 1998 and 2008 to identify the scope and extent for integrating sustainability into retrofits projects.

Six sigma approach to improve quality in E-services : an empirical study in Jordan

In the last two decades, Six Sigma approach has found its success in manufacturing sectors. The relevance of Six Sigma methodologies in service sector has been realised more recently. This paper investigates the application of Six Sigma approach to improve quality in electronic services (e-services) as more and more countries are adopting e-services as a means of providing services to their community and people through the Web. In particular, this paper presents a case study about the use of Six Sigma model to measure the customer satisfaction and quality levels achieved in e-services that were recently launched by public sector organisations in a developing country, such as Jordan. An empirical study consisting of 280 participating customers of Jordan‘s e-services is conducted and the problems are identified through the DMAIC phases of Six Sigma. The service quality levels are measured and analysed using six main criteria, namely, Website Design, Reliability, Responsiveness, Personalization, Information Quality, and System Quality. The overall result of the study indicating a 74% customer satisfaction with a Six Sigma level of 2.12 has enabled the Greater Amman Municipality to identify the usability issues associated with their e-services offered by public sector organisations and to take the leads from the results of the study to improve customer satisfaction. The aim of the paper is not only to implement Six Sigma as a measurement-based strategy for improving e-customer service quality in a newly launched e-service programme, but also to help widen its scope in investigating other service dimensions and perform comparative studies in other developing countries as future research.

Impact of depression treatment on mental and physical health-related quality of life of cardiac patients : a meta-analysis

PURPOSE: To conduct a meta-analysis evaluating the effectiveness of depression treatment on mental and physical health-related quality of life (HRQOL) of cardiac patients.

METHODS: Studies were identified using medical, health, psychiatry, psychology, and social sciences databases. Inclusion criteria were (1) 1 or more control conditions, (2) random assignment to condition after admission for myocardial infarction (MI)/acute coronary syndrome, after recording positive results on a depression screener, (3) documentation of depression symptoms at baseline, (4) depression management as a component of the rehabilitation/intervention, (5) validated measure of HRQOL as an outcome, at minimum 6-month followup. For meta-analysis, mental and physical HRQOL were the end points studied, using standardized mean differences for continuous outcome measures, with 95% confidence intervals. Heterogeneity was explored by calculating I2 statistic.

RESULTS: Five randomized controlled trials included in the analysis represented 2105 participants (1058 intervention vs 1047 comparator). Compared with a comparator group at 6 months, a test for overall effect demonstrated statistically significant improvements in mental HRQOL in favor of the intervention (standardized mean differences = −0.29 [−0.38 to −0.20], [P < .00001]; I2 = 0%). Depression treatment had a modest yet significant impact on physical HRQOL (standardized mean differences = −0.14 [−0.24 to −0.04] [P = .009]; I2 = 15%).

CONCLUSION: While the impact of post-MI depression interventions on physical HRQOL is modest, treatment can improve mental HRQOL in a significant way. Future research is required to develop and evaluate a program that can achieve vital improvements in overall HRQOL, and potentially cardiovascular outcomes, of cardiac patients.

The quality of dietary intake methodology and reporting in child and adolescent obesity intervention trials : a systematic review

Assessing dietary intake is important in evaluating childhood obesity intervention effectiveness. The purpose of this review was to evaluate the dietary intake methods and reporting in intervention studies that included a dietary component to treat overweight or obese children. A systematic review of studies published in the English language, between 1985 and August 2010 in health databases. The search identified 2,295 papers, of which 335 were retrieved and 31 met the inclusion criteria. Twenty-three studies reported energy intake as an outcome measure, 20 reported macronutrient intakes and 10 studies reported food intake outcomes. The most common dietary method employed was the food diary (n = 13), followed by 24-h recall (n = 5), food frequency questionnaire (FFQ) (n = 4) and dietary questionnaire (n = 4). The quality of the dietary intake methods reporting was rated as ‘poor’ in 15 studies (52%) and only 3 were rated as ‘excellent’. The reporting quality of FFQs tended to be higher than food diaries/recalls. Deficiencies in the quality of dietary intake methods reporting in child obesity studies were identified. Use of a dietary intake methods reporting checklist is recommended. This will enable the quality of dietary intake results to be evaluated, and an increased ability to replicate study methodology by other researchers.

Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

Quantifying the profile and progression of impairments, activity, participation, and quality of life in people with Parkinson disease : protocol for a prospective cohort study

Background Despite the finding that Parkinson disease (PD) occurs in more than one in every 1000 people older than 60 years, there have been few attempts to quantify how deficits in impairments, activity, participation, and quality of life progress in this debilitating condition. It is unclear which tools are most appropriate for measuring change over time in PD.
Methods and design This protocol describes a prospective analysis of changes in impairments, activity, participation, and quality of life over a 12 month period together with an economic analysis of costs associated with PD. One-hundred participants will be included, provided they have idiopathic PD rated I-IV on the modified Hoehn & Yahr (1967) scale and fulfil the inclusion criteria. The study aims to determine which clinical and economic measures best quantify the natural history and progression of PD in a sample of people receiving services from the Victorian Comprehensive Parkinson's Program, Australia. When the data become available, the results will be expressed as baseline scores and changes over 3 months and 12 months for impairment, activity, participation, and quality of life together with a cost analysis.
Discussion This study has the potential to identify baseline characteristics of PD for different Hoehn & Yahr stages, to determine the influence of disease duration on performance, and to calculate the costs associated with idiopathic PD. Valid clinical and economic measures for quantifying the natural history and progression of PD will also be identified.