BMI and healthcare cost impact of eliminating tax subsidy for advertising unhealthy food to youth

INTRODUCTION: Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years. METHODS: We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. RESULTS: We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years. CONCLUSIONS: Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.

Brutalism, metabolism and its American parallel : encounters in Skopje and in the architecture of Georgi Konstantinovski

Abstract Massive, raw concrete structures – the likes of the Telecommunications Building (1972–81) by Janko Konstantinov; the campus of Ss. Cyril and Methodius University (1974) by Marko Musˇicˇ; the National Hydraulic Institute (1972) by Krsto Todorovski; and the Bank Complex (1970) by R. Lalovik and O. Papesˇ – have led to the production of an enduring monumental presence and helped inspire Skopje’s title as the “Brutalist capital of the world”. These works followed Kenzo Tange’s introduction of Japanese Metabolism to Skopje through his role in the 1965 United Nations sponsored reconstruction competition. The unique position of a Non-Aligned Yugoslavia staged and facilitated architectural and professional exchange during the Cold War. Each trajectory and manifestation illustrates the complex picture of international architectural exchange and local production. Skopje and its numerous Brutalist edifices is an elucidative story, because it represents a meeting point between Brutalism, Metabolism and its American parallel. This article discusses, in particular, the Skopje Archive Building (1966) and the “Goce Delcˇev” Student Dormitory (1969) – two buildings designed by the architect Georgi Konstantinovski, realised on his return from a Masters program at Yale University and employment within I. M. Pei’s New York office. Their architecture illustrates the simultaneous preoccupations of leading architects at the time in regaining a conceptual ground made explicit through a complete and apprehensible image. From this particular position, the article explores the question of ethics and aesthetics central to Banham’s outline of the “New Brutalism”.

Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes

Background : The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual.

Methods : Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15–24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge.

Findings : Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts.

Interpretation : Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis service showed significant improvement in key service outcomes. Further analysis is needed to determine cost savings and effects on psychosocial outcomes. Targeting intensive case management services to high-risk patients with unmet needs should reduce the distress associated with pathways to care for patients, their families, and the community.

People with dementia and the hospital environment: the view of patients and family carers

Background

A metropolitan geriatric evaluation and management (GEM) facility in Australia was undergoing expansion, and consideration for the needs of individuals with dementia and their family carers was identified as important in planning the new facility. Existing literature revealed that people in hospital value privacy, minimal noise, family amenities and homeliness, but these findings did not consider the perspectives of the person with dementia specifically.

Aim

The aim was to elicit the perspectives of current inpatients with dementia, and their family carers, about the environment/design features that they believe are necessary for people with dementia, and their family carers.

Method and design

This qualitative study utilised in-depth semi-structured interviews to obtain information from current inpatients with dementia and their family carers.

Results

Participants described how the care received was more important than the physical environment; however, participants also valued homeliness, privacy for the patient and for conversations, a shared space without a television and a connection to the outside. Participants described how accommodating carers, providing quiet spaces and appropriate amenities were also important.

Conclusions

While participants valued care over the physical surroundings, they also offered valuable information about their experience in the ward environment. Despite cognitive difficulties, people with dementia were able to provide useful information about the environment within which they were being cared.

Implications for practice

Consumer opinions about hospital design/environment should be considered as an important source of data. Privacy and personal space for people with dementia and their family carers, a connection with the outside environment , and the needs of carers and visitors are all important considerations when designing healthcare environments.

Building G20 outreach: The role of transnational policy networks in sustaining effective and legitimate summitry

G20 outreach processes, in the form of the Think 20, Labour 20, Business 20, and Civil 20, Youth 20, and Women 20, are a formal attempt by G20 leaders to engage various social sectors with G20 policymaking. This essay contends that G20 outreach processes are best understood as transnational policy networks, which are involved in widening the field of policy communication and deliberation. The importance of these transnational policy networks rest upon their role in developing and disseminating G20 policy priorities and principles; and are an attempt to enhance the legitimacy and influence of the G20 and its policy proposals.

"We agree that, in order to strengthen its ability to build and sustain the political consensus needed to respond to challenges, the G20 must remain efficient, transparent and accountable. To achieve this, we decide to … pursue consistent and effective engagement with non-members, regional and international organisations, including the United Nations, and other actors, and we welcome their contribution to our work as appropriate. We also encourage engagement with civil society.G20 Cannes Summit Final Declaration 2011 (G20 2011)"

The difficulty in balancing the effectiveness and representativeness of the Group of Twenty (G20) has led to sustained questions about its legitimacy (Cooper 2010; Rudd 2011; Cooper and Pouliot 2015). Consequently, while leaders have long sought external advice about the agendas of Group of Seven (G7) summits since 1975, and about the G20 finance ministers and central bank governors’ meetings (G20 FM/CBG) since 1999, there has been intensification, elaboration, and institutionalization of transnational networks of policymakers with respect to the G20 in recent years. These networks are especially evident in the form of the G20 working groups and G20 outreach processes involved in the G20 FM/CBG and the G20 leaders’ forum created in 2008.

G20 working groups include transgovernmental groups of government officials and outside experts within a specific policy area who are charged with preparing material for G20 deliberations. G20 outreach processes are a recent and more formal attempt by G20 leaders to engage various social sectors with the policymaking activity of the G20 and were first considered by the G20 membership in 2010 with a more formal engagement with business interests. This led to the formal development of G20 outreach groups in 2013 in the form of the Think 20 (think tanks), Labour 20, Business 20, Civil 20 and Youth 20, which include representatives from these sectors. In 2015, a Women 20 outreach group was also added. These outreach processes are best understood as transnational policy networks which have been built to support the G20’s capacity to be effective and legitimate.

This essay focuses on G20 outreach processes and examines why and how the G20 has sought to augment its intergovernmental summitry and transgovernmental working groups with transnational policy networks, purposely involving a range of societal interests. Transnational policy networks demonstrate the existence of policymaking practices which include the policy influence of experts and advocates outside government. These networks also indicate the ways in which governments, International Governmental Organizations (IGOs) and summits like the G20 engage society, or where elements of society engage themselves with the policymaking process (Stone 2008). These networks intersect with the intergovernmental activities of leaders and key diplomats, and overlap with the transgovernmental relationships of various levels of government bureaucrats (Baker 2009). One of the principle features of transnational policy networks is the way they create and channel the communication of political ideas and priorities. However, it is important to keep in the mind the purpose and power of actors involved in the network and consider who has the discretion and motivation to create the network in the first instance. As the G20 members stated in 2012, the aspiration for outreach is founded upon an intent to strengthen the G20’s capacity “to build and sustain the political consensus”. Consequently, it is important to consider how the development of transnational policy networks in the form of G20 outreach processes are able to sustain the effectiveness and legitimacy of the G20.

This essay contends that G20 outreach processes are best understood as transnational policy networks. These networks have been built to widen the field of policy communication and deliberation. Furthermore, these outreach processes and networks are an attempt to enhance the legitimacy and influence of the G20 and its policy proposals. While there is no doubt that outreach practices are “ad hoc responses to the widespread charge that the G20 reproduces the politics of exclusion in global governance” (Cooper and Pouliot 2015, 347), these practices have the potential to improve both the effectiveness and legitimacy of the G20. The G20 possesses uncertain legitimacy and members of the G20 demonstrate an awareness of this and a corresponding willingness to actively develop various political practices to support the capacity and legitimacy of the G20.

However, G20 outreach also enables the G20 to place some limit upon the policy narratives and ideas that develop within these policy networks. The G20 is liable to be misunderstood without examining the activity of these transnational networks because the G20 is fundamentally a deliberative policy forum rather than a negotiating forum of binding regulations. Transnational policy networks have the potential to scrutinize and amplify relevant policy ideas and thereby enhance the legitimacy of the G20 and strengthen the capacity of the G20 to address an array of global economic and social problems. However, while some narrative control is important to amplify the G20 agenda, too much narrative control will undermine its legitimacy and capacity to develop broad-based responses to global problems. This essay explores the formation of these transnational policy networks by first outlining the evolution of the purpose and configuration of the G20, then it considers the ways G20 outreach processes constitute transnational policy networks and why they have been established, and lastly, analyses how these networks operate to enhance the legitimacy and effectiveness of the G20.

Financial model for investment recovery period in electronic health records implementations

Technology usage for better healthcare delivery is being emphasised in the USA and other advanced nations. Electronic health records (EHR) are being widely seen as improving operational efficiency and reducing medication errors in clinic practices and hospitals. Further, hospitals and clinics stand to gain incentives from the federal government if they implement EHRs and demonstrate meaningful use of EHRs. While numerous other aspects of HER implementations is found in literature, financial models have not been well studied. Before implementing EHR, one must take into consideration investment recovery period considering the costs, savings and possible tax incentives. In this paper, we develop financial model for computing investment recovery period in EHR implementations assuming constant patient visits. We further develop required growth rate formula if investments need to be recovered in fixed number of years. The model is illustrated with numerical example.

Cash flow sensitivities and the allocation of internal cash flow

We study how firms allocate cash flow by estimating the cash-flow sensitivities of various uses of cash flow.We decompose cash flow into a transitory and a permanent component and focus on the allocation of the transitory component, which by construction contains little information about future growth opportunities. We find that more financially constrained firms allocate more transitory cash flow to cash savings and direct less toward investmentthan do less constrained firms, consistent with constrained firms accumulating liquidity to buffer against future financial constraints. We also illustrate several methodological advantages of our approach over alternative methods in previous studies

Making difference count: a demographic study of overseas born teachers

This article reports on the findings of a demographic study which is part of an Australian Research Council funded case study. It seeks to better understand the experiences and challenges facing teachers who are overseas born and educated non-native speakers of English. The investigation has been carried out in Victorian government metropolitan, regional city and rural secondary schools. A statewide survey has provided data about this previously `invisible' population of teachers, their demographic location, their qualifications, backgrounds and the nature of their teaching experiences. The findings raise a number of concerns in relation to overseas born teachers of ethnic difference in rural schools where cultural and professional isolation may be of particular concern. We explore some of the implications for teacher education in the light of increasing numbers of overseas born students entering teacher education courses.

The political economy of maritime industry non-reform in interwar Australia: the establishment of the Maritime Services Board of New South Wales

From the First World War Australian port administration came under criticism from exporters, shipping companies and the Commonwealth government, all of whom argued that port authorities charges imposed an excessive burden on exporters. They sought the replacement of public port authorities by trusts representative of business interests. The campaign for port administration reform also diverted farmers from criticism of shipping freights and to secure their acquiescence in anti-competitive practices in the shipping industry. The formation of the Australian Overseas Transport Association in 1929 was the culmination of this campaign. Elite conservative political support for such anti-competitive practices reflected a belief that competitive capitalism was inherently unstable. The Scullin Labor of 1929-31 government abandoned Labor's earlier hostility to shipping companies to support cartelisation. Conservative state governments, in a more competitive electoral position than their federal counterparts and under greater financial pressure, deflected business calls for port administration reform. Business groups expected the NSW conservative government elected in 1932 to reform port administration towards a representative model, but the Maritime Services Board established in 1935 merely rationalised existing administrative structures. In the 1980s international economic instability legitimated the project of microeconomic reform, particularly in the maritime sector, but in the interwar period a different balance of capital, labour and the state meant that economic isolationism rather than integration was the policy outcome.

How employees remain happy: explaining a paradox

This paper draws on subjective quality of life theory to explain findings from three studies of quality of work life. The studies were conducted with 346 regional process workers, metropolitan employment officers and nurses, The results support the adoption of the theory of homeostasis as an explanation for findings on subjective wellbeing at work surveys. This research goes some way in explaining the paradox that perceived job and work satisfaction remain stable over time, while working conditions may vary widely

Justice in Medicare : recent changes to the public health care system

This article sets out and examines a number of changes proposed by the Commonwealth Government to the Australian Medicare system as part of the 2003-2004 and 2004-2005 federal budgets, and the 2004 federal election campaign. In assessing the suitability of these reforms, the idea of justice is discussed. Health, as a basic good, is argued to be a matter of distributional and rectificatory justice. A number of popular material principles of justice are also examined and shown to be unsuited as sole determinants of health care resource allocation decisions. In light of this, various problems with the reforms are identified and improvements suggested.

Comfort letters- a fresh look?

The topic of “comfort letters” is an ongoing debate in Australia. There are arguments for and against enforceability of comfort letters, yet little has been said about how the “law” can be reformed. In support of enforceability, this article provides a comparative perspective on the American and Australian models and suggests that certain principles from the former could be adopted in Australia to eliminate the inconsistency in the treatment of comfort letter cases. The article also analyses Gate Gourmet and Lasalle Bank, two recent cases from Australia and the United States, respectively.

To choose or not to choose: exploring Australians` views about internet banking

This paper explores Australian domestic customers' choices with regard to Internet banking, examining why it is taken up by some Australians and not others. The constructivist conceptual framework and the grounded nature of the method enabled in-depth exploration of key issues not undertaken before by the mainly positivist studies. The purposeful sample of 32 participants was selected to represent the major categories of people relevant to the research. Everett Rogers' famous analysis of 'diffusion of innovations' was one theoretical framework used to illuminate the findings; the other was digital divide factors in relation to banking choices. The findings include 1) that the major motivation for people to adopt Internet banking is convenience, closely linked to time savings and ease of accessibility, as well as confidence and skill in Internet use; and 2) that, at the time of the study, digital divide factors were playing an important part in banking choices.

Solar versus fossil fuels : A net energy analysis of domestic solar hot water systems in Australia

It is commonly assumed that solar hot water systems save energy and reduce greenhouse gas emissions compared to conventional electric and gas hot water systems. Very rarely has the life-cycle energy requirements (including the embodied energy of manufacture) of solar hot water systems been analysed. The extent to which solar hot water systems can save energy compared to conventional electric or gas hot water systems can be shown through a comparative net energy analysis. This method determines the ‘energy payback period’, including consideration of the difference in operational energy savings and energy embodied in the devices relative to a base case. Dr Robert Crawford, Deakin University, Australia presents the results of a net energy analysis that compared solar and conventional hot water systems for a southern (Melbourne) and a northern (Brisbane) Australian climate.

An urgent challenge: new training opportunities for junior medical officers

There will be a massive increase in the number of medical school graduates over the next 5–10 years — there were 1287 Australian resident graduates in 2004, and there will be more than 3000 by the middle of the next decade.

A workshop held during the 11th National Prevocational Medical Education Forum explored ways to provide the additional prevocational training posts that will be required.

Four possible sites for additional training posts were discussed:
         • expansion of public hospital training posts;
         • general practice;
         • private hospitals; and
         • other sites, including private rooms and community placements.

Current accreditation procedures will need to be amended to accommodate more interns.

There will be limited access to prevocational training posts for non-resident (full-fee-paying) graduates and international medical graduates.

There is an urgent need for postgraduate medical councils, state health departments, the federal government, and medical boards to work together to identify, develop and accredit new training posts.