Ethics and advance care planning in a culturally diverse society

Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds. An important aim of this article is to redress this oversight.

Building social capital in groups : facilitating skill development for natural resource management

Analysis of the experiences of four farmer groups set up to learn how to jointly manage local natural resource issues shows that the groups are going though two simultaneous processes. One builds technical competency in natural resource management and the other is the underpinning social process that allows the groups to make decisions and work collectively, which builds social capital. Natural resource management practitioners and farmers are practical people. They are likely to be more comfortable with a process that develops monitoring tools and benchmarks for natural resource management than a process of group development and social capital formation. Yet the two are intrinsically linked. This paper reflects on and analyses the experience of establishing and working with farmer groups as they go through a process of identifying environmental issues, setting and monitoring environmental benchmarks and identifying and implementing sustainable farming practices to meet the benchmarks.

Two questions emerged from the analysis. First, how do the four groups compare to other measures of effective natural resource management groups? Second, what are the characteristics of the groups that make them more or less effective and what has occurred in the groups (either before or during this project) to make them more or less effective? Social capital emerges as a key determinant of group effectiveness. Social capital is most effective when it comprises a balance of bonding and bridging networks, and includes shared values in relation to the purpose of the group.

Policy makers and extension workers need to understand the link between the two simultaneous processes occurring as people come together in groups to define and implement best practice at a local level, and how to use knowledge of social processes when designing the more concrete process of developing and implementing best practice monitoring and benchmarking with groups. An understanding of how people build social capital as they work in groups will assist with designing and facilitating group projects in a range of contexts, not only natural resource management.

"Tell us something new!" : the response of planning and transport professionals to public health guidance on the built environment and physical activity

A large proportion of non-communicable disease can be attributed to modifiable risk factors such as poor nutrition and physical inactivity. We present data on planning and transport practitioners' perceptions and responses to government public health guidance aimed at modifying environmental factors to promote physical activity. This study was informed by questions on the role of evidence-based guidance, the views of professionals towards the guidance, the links between guidance and existing legislation and policy and the practicality of guidelines. A key informant 'snowball' sampling technique was used to recruit participants from the main professional planning organisations across England. Seventy-six people were interviewed in eight focus groups. We found that evidence-based public health guidance is a new voice in urban and town planning, although much of the advice is already reflected by the 'accepted wisdom' of these professions. Evidence-based health guidance could be a powerful driver affecting planning practice, but other legislated planning guidance may take priority for planning and transport professionals.

Staff perceptions of the implementation of enterprise resource planning systems in three Australian universities

This chapter reports a study that examined the staff perceptions of the implementation of an Enterprise Resource Planning system (ERPs) in three Australian universities. The literature on issues impacting on effective Enterprise Resource Planning (ERP) implementations identified a number of issues that translate from the corporate sector to the higher education sector and included a number that require particular focus in this sector. Case study methodology is used to examine the staff perceptions of the management of ERP implementations in three Australian universities in the process of implementing ERP systems. The study was conducted in two phases. The first phase of the study obtained data through a series of focus groups at one university and, combined with an analysis of the relevant literature served as a framework for the development of the research process in the second phase of the study. This phase involved in depth interviews with staff that enabled the researcher to undertake a more detailed exploration of the staff perceptions of influences affecting ERP system implementations at three Australian universities. This chapter reports that staff perceptions of the process of ERP implementations are central to their efficacious implementations in Australian universities. Staff perceptions demonstrate that particular consideration of organisational influences related to their context and the perceptions of the users of the systems must be factored into the planning for ERP implementations in Universities.

The resident assessment instrument-minimum data set 2.0 quality indicators : a systematic review

Background
The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs).

Methods
We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included.

Results
The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n=13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others.

Conclusion
Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.

Sweet talking to ethnic customers : a field experiment on the links between entrepreneurial business planning, cultural sensitivity and sales growth

The purpose of this study was to test whether calculated inclusion of cultural sensitivity in a selected entrepreneurial business planning (EBP) process could increase sales growth in a test market and to explore the implications of a positive answer for the theory and practice of entrepreneurial business planning. Execution of a pretest-posttest control group experimental design measured and compared the implemented effectiveness of a planned entrepreneurial initiative based on cultural sensitivity. Though small in scale and limited in focus, the initiative qualified as an example of entrepreneurial business planning (EBP) and could be used to apply, test and extend aspects of the developing theory in this field of entrepreneurship research. Since the initiative was planned to overcome a culturally-defined impediment to business growth, it also offered opportunity to explore the specific importance of cultural variables in the context of EBP.

A planned sales-promotion was offered to a control group (receiving information in English) and a treatment group (who received the information in the language of ethnic origin). The sixty subjects had been chosen at random from a population of route-trade retailers of defined ethnic origins (Greek, Lebanese and Chinese) and randomly assigned to control and treatment groups. Monthly sales averages of the promoted product were measured before and after treatment. A Chi Square test was used to evaluate the relative proportion of the control and treatment groups who accepted the promotional offer. A two sample t-test procedure and complementary non-parametric Mann-Whitney test were performed to compare the mean sales-performance change of the two groups. Analysis showed that there was a significant increase in mean sales when the planned entrepreneurial initiative was communicated in the relevant language of origin.

The experimental results have specific practical relevance to revitalising the deteriorating route-trade segment of the Australian confectionery market through increasing the sales growth of wholesalers who are prepared to act entrepreneurially and include cultural sensitivity as an element in planning and implementation. By introducing cultural sensitivity as a necessary extension of a plan’s communications role, the results also have general theoretical implications for the developing paradigm of entrepreneurial business planning.

Stakeholder involvement and interplay in coastal zone management and marine protected area planning

Most of Australia’s coastline and marine waters are crown ‘land’ and can be accessed by the public. As a result, many different users and stakeholder groups have an interest in coastal and marine planning and management decisions. As a way of analysing stakeholder involvement and interplay in coastal zone management and marine protected area (MPA) development in Australia, three case studies are presented to dissect the issues and explore common themes. The three themes are 1) Stakeholder involvement in implementing the oceans policy, 2) Stakeholder involvement in marine protected area network identification and 3) Stakeholder involvement in coastal land issues.

Identifying co-regulating microrna groups

Background: Current miRNA target prediction tools have the common problem that their false positive rate is high. This renders identification of co-regulating groups of miRNAs and target genes unreliable. In this study, we describe a procedure to identify highly probable co-regulating miRNAs and the corresponding co-regulated gene groups. Our procedure involves a sequence of statistical tests: (1) identify genes that are highly probable miRNA targets; (2) determine for each such gene, the minimum number of miRNAs that co-regulate it with high probability; (3) find, for each such gene, the combination of the determined minimum size of miRNAs that co-regulate it with the lowest p-value; and (4) discover for each such combination of miRNAs, the group of genes that are co-regulated by these miRNAs with the lowest p-value computed based on GO term annotations of the genes.
Results: Our method identifies 4, 3 and 2-term miRNA groups that co-regulate gene groups of size at least 3 in human. Our result suggests some interesting hypothesis on the functional role of several miRNAs through a "guilt by association" reasoning. For example, miR-130, miR-19 and miR-101 are known neurodegenerative diseases associated miRNAs. Our 3-term miRNA table shows that miR-130/19/101 form a co-regulating group of rank 22 (p-value =1.16 × 10^-2). Since miR-144 is co-regulating with miR-130, miR-19 and miR-101 of rank 4 (p-value = 1.16 × 10^-2) in our 4-term miRNA table, this suggests hsa-miR-144 may be neurodegenerative diseases related miRNA. Conclusions: This work identifies highly probable co-regulating miRNAs, which are refined from the prediction by computational tools using (1) signal-to-noise ratio to get high accurate regulating miRNAs for every gene, and (2) Gene Ontology to obtain functional related co-regulating miRNA groups. Our result has partly been supported by biological experiments. Based on prediction by TargetScanS, we found highly probable target gene groups in the Supplementary Information. This result might help biologists to find small set of miRNAs for genes of interest rather than huge amount of miRNA set.

MAAGs: the next generation. A study of the development of medical audit advisory groups and the arrangements for supporting clinical audit in primary care

Background: MAAGs have, historically, been disparate organisations with a lack of central direction, albeit with the same goal: to develop and support the performance of audit in primary care. This goal has been (and is being) achieved in a number of ways all over the country. In the last two years, MAAGs have witnessed many changes in primary care and are adapting themselves to suit these new arrangements at a local level.

Aim: To formalise our knowledge of where MAAGs are going, how they are getting there and the support they are receiving.

Method: A postal questionnaire to the 104 MAAGs in England and Wales, addressing 6 main issues of relevance to the development of MAAGs and the support they are receiving.

Results: At least two MAAGs have dissolved, leaving a possible total of 102 still in existence. Of these, 76 (74.5%) responded to the survey. The composition of the MAAG committee has changed dramatically since the inception of MAAGs in 1990, and staffing levels appear to have risen substantially. MAAGs appear to be more adequately funded by their health authorities than has previously been reported and many are actively seeking additional sources of funding. There is still large variation in levels of MAAG funding. Furthermore, funding is unrelated to the number of GPs or practices served. Security for MAAG staff appears to have been addressed in many areas, with 84% of MAAGs having at least one member of staff on a permanent employment contract. Many MAAGs are developing rolling programmes in an attempt to eliminate the short-sighted approach to the development of clinical audit that has existed since MAAGs were first set up.

Conclusion: Many MAAGs (with the obvious exception of those that have been dissolved) appear to be thriving without central direction or initiative. It is now evident that we were a little hasty in our concerns for the future of MAAGs beyond April 1996. It would seem that many organisations have taken the situation which arose two years ago as an opportunity to grow and develop in ways that may not have been possible within the confines of the Health Circular.

Back to basics : empirical support for the importance of release planning in reducing sex offender recidivism

This article reports findings from a series of empirical studies investigating whether poor release planning might contribute to sex offender recidivism. A coding protocol was developed to measure the comprehensiveness of release planning which included items relating to accommodation, employment, pro-social support, community based treatment, and the Good Lives Model (T. Ward & C.A. Stewart, 2003) secondary goods. The protocol was retrospectively applied to groups of recidivist and non recidivist child molesters, matched on static risk level and time since release. As predicted, overall release planning was significantly poorer for recidivists compared to non recidivists. The accommodation, employment, and social support items combined to best predict recidivism, with predictive accuracy comparable to that obtained using static risk models. Results highlighted the importance of release planning in efforts to reduce sex offender recidivism. Implications for policy makers and community members are briefly discussed.

Assessment of community reintegration planning for sex offenders

Poor planning for reintegrating child molesters from prison to the community is a likely risk factor for sexual recidivism. The quality of reintegration planning was retrospectively measured for groups of recidivist (n = 30) and nonrecidivist (n = 30) child molesters who were individually matched on static risk level and time since release. Recidivists had significantly poorer reintegration planning scores than nonrecidivists, consistent with a previous study by the authors. Data from both studies were combined (total N = 141), and survival analyses showed that poor reintegration planning predicted an increased rate of recidivism. Accommodation, employment, and social support planning combined to predict recidivism, with predictive validity comparable to static risk models (area under the curve = .71). Summing these items yielded a scale of reintegration planning quality that differentiated well between recidivists and nonrecidivists and may have practical utility for risk assessment as an adjunct to static models.

The quality of community reintegration planning for child molesters : effects on sexual recidivism

Research on the causal factors underlying sex offender recidivism has not considered the success or failure of the reintegration process by which the offender rejoins the community after prison. The authors developed a coding protocol to measure the quality and comprehensiveness of reintegration planning for sex offenders. The protocol was retrospectively applied to groups of recidivists and nonrecidivists who were matched on static risk level and follow-up time. The protocol demonstrated adequate reliability. Compared to nonrecidivists, recidivists had significantly lower scores relating to accommodation, employment, and the Good Lives Model secondary goods, as well as lower total reintegration plan scores. ANCOVAs showed that when IQ and level of sexual deviance were controlled for, accommodation (a place to live) was significantly related to sexual recidivism and the Good Lives Model—secondary goods was significantly related to any recidivism. These results suggest that poor reintegration planning may be a risk factor for recidivism.

Solving the median shortest path problem in the planning and design of urban transportation networks using a vector labeling algorithm

This paper proposes an alternative algorithm to solve the median shortest path problem (MSPP) in the planning and design of urban transportation networks. The proposed vector labeling algorithm is based on the labeling of each node in terms of a multiple and conflicting vector of objectives which deletes cyclic, infeasible and extreme-dominated paths in the criteria space imposing cyclic break (CB), path cost constraint (PCC) and access cost parameter (ACP) respectively. The output of the algorithm is a set of Pareto optimal paths (POP) with an objective vector from predetermined origin to destination nodes. Thus, this paper formulates an algorithm to identify a non-inferior solution set of POP based on a non-dominated set of objective vectors that leaves the ultimate decision to decision-makers. A numerical experiment is conducted using an artificial transportation network in order to validate and compare results. Sensitivity analysis has shown that the proposed algorithm is more efficient and advantageous over existing solutions in terms of computing execution time and memory space used.

Type 2 diabetes prevalence varies by socio-economic status within and between migrant groups: analysis and implications for Australia

Background:
Ethnic diversity is increasing through migration in many developed countries. Evidence indicates that type 2 diabetes mellitus (T2DM) prevalence varies by ethnicity and socio- economic status (SES), and that in many settings, migrants experience a disproportionate burden of disease compared with locally-born groups. Given Australia’s multicultural demography, we sought to identify groups at high risk of T2DM in Victoria, Australia.

Paradigm shift to enhanced water supply planning through augmented grids, scarcity pricing and adaptive factory water : a system dynamics approach

This paper details a system dynamics model developed to simulate proposed changes to water governance through the integration of supply, demand and asset management processes. To effectively accomplish this, interconnected feedback loops in tariff structures, demand levels and financing capacity are included in the model design, representing the first comprehensive life-cycle modelling of potable water systems. A number of scenarios were applied to Australia's populated South-east Queensland region, demonstrating that introducing temporary drought pricing (i.e. progressive water prices set inverse with availability), in conjunction with supply augmentation through rain-independent sources, is capable of efficiently providing water security in the future. Modelling demonstrated that this alternative tariff structure reduced demand in scarcity periods thereby preserving supply, whilst revenues are maintained to build new water supply infrastructure. In addition to exploring alternative tariffs, the potential benefits of using adaptive pressure-retarded osmosis desalination plants for both potable water and power generation was explored. This operation of these plants for power production, when they would otherwise be idle, shows promise in reducing their net energy and carbon footprints. Stakeholders in industry, government and academia were engaged in model development and validation. The constructed model displays how water resource systems can be reorganised to cope with systemic change and uncertainty.