Australia’s position on medicines policy in international forums: Intellectual property protection and public health

Universal access to affordable medicines, which are safe, efficacious and of high quality, and which are appropriately used, depends on national legislation that is in turn constrained by a range of international agreements. This regulatory configuration also affects the profitability of the pharmaceutical industry, domestic and international. Tensions and contradictions between industry profitability and public health objectives relate to access, innovation and regulation.

Changes in corticomotor excitability and inhibition after exercise are influenced by hand dominance and motor demand

Previous studies on handedness have often reported functional asymmetries in corticomotor excitability (CME) associated with voluntary movement. Recently, we have shown that the degree of post-exercise corticomotor depression (PED) and increase in short-interval cortical inhibition (SICI) after a repetitive finger movement task was less when the task was performed at a maximal voluntary rate (MVR) than when it was performed at a submaximal sustainable rate (SR). In the current study, we have compared the time course of PED and SICI in the dominant (DOM) and nondominant (NDOM) hands after an MVR and SR finger movement task to determine the influence of hand dominance and task demand. We tracked motor-evoked potential (MEP) amplitude from the first dorsal interosseous muscle of the DOM and NDOM hand for 20 min after a 10-s index finger flexion-extension task at MVR and SR. For all hand-task combinations, we report a period of PED and increased SICI lasting for up to 8 min. We find that the least demanding task, one that involved index finger movement of the DOM hand at SR, was associated with the greatest change in PED and SICI from baseline (63.6±5.7% and 79±2%, P<0.001, PED and SICI, respectively), whereas the most demanding task (MVR of the NDOM hand) was associated with the least change from baseline (PED: 88.1±3.6%, SICI: 103±2%; P<0.001). Our findings indicate that the changes in CME and inhibition associated with repetitive finger movement are influenced both by handedness and the degree of demand of the motor task and are inversely related to task demand, being smallest for an MVR task of the NDOM hand and greatest for an SR task of the DOM hand. The findings provide additional evidence for differences in neuronal processing between the dominant and nondominant hemispheres in motor control.

Nurse-led titration of angiotensin converting enzyme inhibitors, beta-adrenergic blocking agents, and angiotensin receptor blockers for people with heart failure with reduced ejection fraction

BACKGROUND: Heart failure is associated with high mortality and hospital readmissions. Beta-adrenergic blocking agents, angiotensin converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) can improve survival and reduce hospital readmissions and are recommended as first-line therapy in the treatment of heart failure. Evidence has also shown that there is a dose-dependent relationship of these medications with patient outcomes. Despite this evidence, primary care physicians are reluctant to up-titrate these medications. New strategies aimed at facilitating this up-titration are warranted. Nurse-led titration (NLT) is one such strategy. OBJECTIVES: To assess the effects of NLT of beta-adrenergic blocking agents, ACEIs, and ARBs in patients with heart failure with reduced ejection fraction (HFrEF) in terms of safety and patient outcomes. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL Issue 11 of 12, 19/12/2014), MEDLINE OVID (1946 to November week 3 2014), and EMBASE Classic and EMBASE OVID (1947 to 2014 week 50). We also searched reference lists of relevant primary studies, systematic reviews, clinical trial registries, and unpublished theses sources. We used no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing NLT of beta-adrenergic blocking agents, ACEIs, and/or ARBs comparing the optimisation of these medications by a nurse to optimisation by another health professional in patients with HFrEF. DATA COLLECTION AND ANALYSIS: Two review authors (AD & JC) independently assessed studies for eligibility and risk of bias. We contacted primary authors if we required additional information. We examined quality of evidence using the GRADE rating tool for RCTs. We analysed extracted data by risk ratio (RR) with 95% confidence interval (CI) for dichotomous data to measure effect sizes of intervention group compared with usual-care group. Meta-analyses used the fixed-effect Mantel-Haenszel method. We assessed heterogeneity between studies by Chi(2) and I(2). MAIN RESULTS: We included seven studies (1684 participants) in the review. One study enrolled participants from a residential care facility, and the other six studies from primary care and outpatient clinics. All-cause hospital admission data was available in four studies (556 participants). Participants in the NLT group experienced a lower rate of all-cause hospital admissions (RR 0.80, 95% CI 0.72 to 0.88, high-quality evidence) and fewer hospital admissions related to heart failure (RR 0.51, 95% CI 0.36 to 0.72, moderate-quality evidence) compared to the usual-care group. Six studies (902 participants) examined all-cause mortality. All-cause mortality was also lower in the NLT group (RR 0.66, 95% CI 0.48 to 0.92, moderate-quality evidence) compared to usual care. Approximately 27 deaths could be avoided for every 1000 people receiving NLT of beta-adrenergic blocking agents, ACEIs, and ARBs. Only three studies (370 participants) reported outcomes on all-cause and heart failure-related event-free survival. Participants in the NLT group were more likely to remain event free compared to participants in the usual-care group (RR 0.60, 95% CI 0.46 to 0.77, moderate-quality evidence). Five studies (966 participants) reported on the number of participants reaching target dose of beta-adrenergic blocking agents. This was also higher in the NLT group compared to usual care (RR 1.99, 95% CI 1.61 to 2.47, low-quality evidence). However, there was a substantial degree of heterogeneity in this pooled analysis. We rated the risk of bias in these studies as high mainly due to a lack of clarity regarding incomplete outcome data, lack of reporting on adverse events associated with the intervention, and the inability to blind participants and personnel. Participants in the NLT group reached maximal dose of beta-adrenergic blocking agents in half the time compared with participants in usual care. Two studies reported on adverse events; one of these studies stated there were no adverse events, and the other study found one adverse event but did not specify the type or severity of the adverse event. AUTHORS' CONCLUSIONS: Participants in the NLT group experienced fewer hospital admissions for any cause and an increase in survival and number of participants reaching target dose within a shorter time period. However, the quality of evidence regarding the proportion of participants reaching target dose was low and should be interpreted with caution. We found high-quality evidence supporting NLT as one strategy that may improve the optimisation of beta-adrenergic blocking agents resulting in a reduction in hospital admissions. Despite evidence of a dose-dependent relationship of beta-adrenergic blocking agents, ACEIs, and ARBs with improving outcomes in patients with HFrEF, the translation of this evidence into clinical practice is poor. NLT is one strategy that facilitates the implementation of this evidence into practice.

Modeling intelligent agents for web-based information gathering

The recent emergence of intelligent agent technology and advances in information gathering have been the important steps forward in efficiently managing and using the vast amount of information now available on the Web to make informed decisions. There are, however, still many problems that need to be overcome in the information gathering research arena to enable the delivery of relevant information required by end users. Good decisions cannot be made without sufficient, timely, and correct information. Traditionally it is said that knowledge is power, however, nowadays sufficient, timely, and correct information is power. So gathering relevant information to meet user information needs is the crucial step for making good decisions. The ideal goal of information gathering is to obtain only the information that users need (no more and no less). However, the volume of information available, diversity formats of information, uncertainties of information, and distributed locations of information (e.g. World Wide Web) hinder the process of gathering the right information to meet the user needs. Specifically, two fundamental issues in regard to efficiency of information gathering are mismatch and overload. The mismatch means some information that meets user needs has not been gathered (or missed out), whereas, the overload means some gathered information is not what users need. Traditional information retrieval has been developed well in the past twenty years. The introduction of the Web has changed people's perceptions of information retrieval. Usually, the task of information retrieval is considered to have the function of leading the user to those documents that are relevant to his/her information needs. The similar function in information retrieval is to filter out the irrelevant documents (or called information filtering). Research into traditional information retrieval has provided many retrieval models and techniques to represent documents and queries. Nowadays, information is becoming highly distributed, and increasingly difficult to gather. On the other hand, people have found a lot of uncertainties that are contained in the user information needs. These motivate the need for research in agent-based information gathering. Agent-based information systems arise at this moment. In these kinds of systems, intelligent agents will get commitments from their users and act on the users behalf to gather the required information. They can easily retrieve the relevant information from highly distributed uncertain environments because of their merits of intelligent, autonomy and distribution. The current research for agent-based information gathering systems is divided into single agent gathering systems, and multi-agent gathering systems. In both research areas, there are still open problems to be solved so that agent-based information gathering systems can retrieve the uncertain information more effectively from the highly distributed environments. The aim of this thesis is to research the theoretical framework for intelligent agents to gather information from the Web. This research integrates the areas of information retrieval and intelligent agents. The specific research areas in this thesis are the development of an information filtering model for single agent systems, and the development of a dynamic belief model for information fusion for multi-agent systems. The research results are also supported by the construction of real information gathering agents (e.g., Job Agent) for the Internet to help users to gather useful information stored in Web sites. In such a framework, information gathering agents have abilities to describe (or learn) the user information needs, and act like users to retrieve, filter, and/or fuse the information. A rough set based information filtering model is developed to address the problem of overload. The new approach allows users to describe their information needs on user concept spaces rather than on document spaces, and it views a user information need as a rough set over the document space. The rough set decision theory is used to classify new documents into three regions: positive region, boundary region, and negative region. Two experiments are presented to verify this model, and it shows that the rough set based model provides an efficient approach to the overload problem. In this research, a dynamic belief model for information fusion in multi-agent environments is also developed. This model has a polynomial time complexity, and it has been proven that the fusion results are belief (mass) functions. By using this model, a collection fusion algorithm for information gathering agents is presented. The difficult problem for this research is the case where collections may be used by more than one agent. This algorithm, however, uses the technique of cooperation between agents, and provides a solution for this difficult problem in distributed information retrieval systems. This thesis presents the solutions to the theoretical problems in agent-based information gathering systems, including information filtering models, agent belief modeling, and collection fusions. It also presents solutions to some of the technical problems in agent-based information systems, such as document classification, the architecture for agent-based information gathering systems, and the decision in multiple agent environments. Such kinds of information gathering agents will gather relevant information from highly distributed uncertain environments.

Quality of life in restless legs syndrome: A systematic review of clinical trials and a critical review of instruments

Restless legs syndrome (RLS) is a neurological movement disorder characterized by sensory symptoms and motor disturbances. While the underlying cause remains unknown, it is suggested that 20–25% of people with RLS are affected seriously enough to require pharmacological treatment. Dopamine agonists (DAs) are the most common treatment and act by increasing the low levels of dopamine to which RLS is often attributed. A growing literature highlights the debilitating and distressing nature of this condition from the patient's perspective. While sleep problems are most commonly reported, the impact of RLS on quality of life (QOL) is wide ranging, affecting relationships with partners, sex life, family life, social life, leisure activities, friendships, everyday activities, concentration, travel, career/work, sleep, and health.

We conducted a systematic review of clinical trials in which DAs have been evaluated in terms of RLS-specific QOL, i.e. their impact on the QOL of people with RLS, and critically reviewed the development history and measurement properties of RLS-specific QOL instruments.

A systematic search using terms synonymous with RLS, DAs and QOL was conducted using Scopus software, which includes MEDLINE, PsycINFO, EMBASE, and CINAHL. Our search covered publications from 2000 (prior to which RLS-specific QOL measures did not exist) to August 2009. Trials were included in our review if they evaluated DAs for the treatment of adults with RLS and reported evaluation using an RLS-specific QOL measure. We also ran citation searches to identify papers reporting the development history and measurement properties of the identified RLS-specific QOL instruments.

Three measures of RLS-specific QOL have been developed in recent years and are reviewed here: the Restless Legs Syndrome Quality of Life (RLSQOL) questionnaire, the Restless Legs Syndrome Quality of Life Instrument (RLS-QLI), and the Quality of Life Restless Legs Syndrome (QOL-RLS) measure. Critical review indicates that each has limitations (particularly in terms of published developmental history and content validity). Eleven trials of DAs were identified that included assessment of RLS-specific QOL (nine using the RLSQOL and two using the QOL-RLS). In all studies, significant improvements in RLS-specific QOL were observed, although these were mostly short term (12 weeks) and large placebo effects were also noted.

In people with RLS, the use of DAs has been shown to improve RLS-specific QOL. Longer-term, large-scale studies may be needed to confirm these findings and demonstrate statistically significant improvements in RLS-specific QOL at lower doses. Further development of the RLS-specific QOL measures is needed to ensure that the full impact of RLS (and the full benefit of new treatments) on aspects of life identified as important to individuals is captured in future studies.

Discussing sex at work can be a costly business: Translating the science, language and law behind M v A & U (2007) QADT 8...

On 16 March 2007, in the matter of M v A & U [2007] QADT 8, the Anti-Discrimination Tribunal of Queensland found that a complaint of discrimination in the supply of goods and services had been made out by the complainant on two grounds: her female sex and lawful sexual activity. The decision would have been quite unremarkable except that ‘M’, as the complainant was known for the purposes of the hearing, is a woman of difference, one who had unusually arrived at her legal female state by completing the sex reassignment process now more commonly described as ‘sex affirmation’.

This article seeks to elaborate on the language and law of transsexualism used by the Tribunal. Its aim is to enhance practitioners’ understanding of the legal and social issues peculiar to those who affirm a sex opposite that first assigned to them so that those practitioners may better interpret the law to their clients. As the instant decision shows, the failure by an employer to take reasonable steps to avoid infringing the Anti-Discrimination Act 1991 (Qld), either on its own part or by the actions of its employees, can prove a costly business indeed.

The author offers a brief synopsis of the current medical viewpoint regarding transsexualism and reviews recent Australian legal developments in the jurisprudence. She reminds practitioners that the Anti-Discrimination Act 1991 (Qld) has since been further strengthened by the inclusion of ‘gender identity’ as a protected attribute, and concludes by proposing the existence of a heightened duty on the part of practitioners to ensure business clients are aware of the full extent of their legal obligations to not discriminate against employees or clients.

Perceived characteristics and pedagogical efficacy of animated conversational agents

We investigated college students' perceptions of a diverse sample of animated conversational agents. We also examined the pedagogical efficacy of those agents. We found that people perceive differences among the agents on several dimensions, such as likeability, and that the agents differ in pedagogical efficacy. However, none of the characteristics that we measured accounted for differences in pedagogical efficacy across the agents. We discuss implications for the field of agent studies with pmiicular emphasis on the creation of pedagogically effective conversational agents and suggest directions for future research.

Australian property law: cases, materials and analysis

"CONTENTS: Concepts of Property; Possession and Title; Fixtures, Encroachment and Boundaries; Adverse Possession; The Doctrine of Tenure and Estates; Leases; Native Title; Equitable Interests; Priority Rules; The Torrens System; Unregistered Interests; Easements; Covenants; Mortgages; Co-ownership."--Provided by publisher.

Conceptualising, conducting and disseminating research for the 'public'

Drawing upon one research project Home-School-Community Partnerships for Enhancing Children's Numeracy Development we examine, critically, some problems entailed in the processes of conceptualizing the subjects and objects of inquiry, conducting field work with subjects (as knowing agents) and interpreting and disseminating the knowledge gained. Addressing these issues, in practice, has entailed some necessary consideration of fundamental tensions centred around the professional power-knowledge of teachers and a dominant cultural discourse that situates numeracy learning in the school.

A theoretical model (based upon Engeström's Activity Theory) was used to specify and analyse various types of partnerships within a network of mutually interconnected activities to support children's learning (Bloome et al., 2000; Engeström, 1999). By decentering the school, within this model, we have been led to a closer analysis of the concept of 'partnership' and of the social construction of parental and community involvement in children's numeracy development. One of the most problematic aspects of partnerships evident in our research is the way in which the term 'numeracy' is understood by different stakeholders. Awareness of this has shaped the conduct and dissemination of our research and ultimately enabled us to identify critical issues for further inquiry.

Crime rates, male youth unemployment and real income in Australia: evidence from Granger causality tests

This article applies Granger causality tests to examine the relationship between seven different categories of property crime and violent crime against the person, male youth unemployment and real male average weekly earnings in Australia from 1964 to 2001 within a cointegration and vector error correction framework. It is found that fraud, homicide and motor vehicle theft are cointegrated with male youth unemployment and real male average weekly earnings. However, there is no evidence of a long-run relationship between either break and enter, robbery, serious assault or stealing with male youth unemployment and real male average weekly earnings.

Succession and Indigenous Australians : addressing Indigenous customary law notions of 'property' and 'kinship' in a succession law context

The purpose of this article is to critically evaluate the existing capacity of Indigenous people to exercise succession rights against their estate. This article begins with a discussion of the sources of the general succession laws in Australia, noting that they have derived from UK law, where the common law notions of property, property rights and family, including the expectational right to succeed to property, are all important factors. These common law notions do not easily fit within the spectrum of Indigenous customary law. Generally, many Indigenous Australians will die without executing a valid will (ie, they die intestate) and it is here that this article undertakes an examination of the general intestacy laws in all Australian jurisdictions noting the inadequacy of the provisions to recognise Indigenous persons’ spiritual and cultural obligations to property, land or otherwise, together with a failure to distinguish extended Indigenous kinship relationships under Indigenous customary law. It is argued that Indigenous people who die intestate should be supported by a flexible and adaptive intestacy framework, responsive to the full customary and cultural responsibilities of the deceased, thus promoting an organic and developmental approach to succession entitlements.

Sui generis protection for plant varieties and traditional agricultural knowledge : the example of India

Explores the sui generis protection of intellectual property, particularly patents, in biotechnology and traditional agricultural knowledge under Indian law. Focuses on the impact of amendments to the Patents Act 1970 and of the Plant Variety Protection and Farmers' Rights Act 2001 and Biological Diversity Act 2002.

Change implementers’ resistance : considering power and resistance in IT implementation projects

Resistance is normally characterized as a set of behaviours located in and belonging to change recipients. Such behaviours are seen to thwart the legitimate aims of both change strategists and the change agents who implement systems and the associated organisational change on the strategists' behalf. However, results from our case study research indicate that resistance can be a property not only of change recipients’ behaviour, but also of change agents and change strategists. The resistance behaviours identified included the failure to follow a prescribed corporate method and template, a refusal to help or listen, a refusal to fix known problems, the display of an adversarial, confrontational, and/or condescending attitude, subversiveness, a poor work ethic, and a refusal to meet requests. This paper argues for a revised conceptualization of resistance as a behaviour that can be demonstrated by any IT project stakeholders, that cannot be divorced from considerations of power in the IT project context.