Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia

Summary
In 2007, Medicare Australia revised reimbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged ≥70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low.

Introduction
On April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged ≥70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division.

Methods
Proportions of DXA referrals 2003–2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged ≥70 years referred to the major public health service provider for DXA clinical purposes (n = 6,096; 21 % men).

Results
DXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p < 0.001). For 2003–2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007–2010 were 1:2.3 to 1:3.4. Referral ratios <2007:≥2007 were 1:1.7 for men aged 70–79 years (p < 0.001), 1:1.2 for men aged 80–84 years (p = 0.06), and 1:1.3 for men 85+ years (p = 0.16). For women, the ratios <2007:≥2007 were 1:2.1 (70–79 years), 1.1.5 (80–84 years), and 1:1.4 (85+ years) (all p < 0.001).

Conclusions
DXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007–2010 vs. 2003–2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.

The impact of column connection on band broadening in very high pressure liquid chromatography

A series of experiments was conducted to evaluate the degree of band broadening in very high pressure LC due to column connections. Different column manufacturers use slightly different designs for their column fittings. If the same column connections are repeatedly used to attach columns of different origins, different void volumes form between capillary tubes and column inlets. An Agilent Ultra Low Dispersion Kit (tubing id 75 μm) was installed on an Agilent Infinity 1290 ultra HPLC and used to connect successively an Agilent, a Phenomenex, and a Waters column. A series of uracil (unretained) samples were injected and eluted at a wide range of flow rates with a water/acetonitrile mixture as eluent. In order to determine the variance contribution from column connections as accurately as possible a nonretained probe compound was selected because the variance contribution from the column is the smallest for analytes, which have very low k values. Yet, this effect still has an impact on the resolution for moderately retained compounds (k > 2) for narrow-bore columns packed with fine particles, since variance contributions are additive for linear chromatographic systems. Each injection was replicated five times under the same experimental conditions. Then NanoViper column connections (tubing id 75 μm) were used and the same injections were made. This system was designed to minimize connection void volumes for any column. Band variances were calculated as the second central moment of elution peaks and used to assess the degree of band broadening due to the column connections. Band broadening may increase from 3.8 to 53.9% when conventional metal ferrules were used to join columns to connection sites. The results show that the variance contribution from improper connections can generate as much as 60.5% of the total variance observed. This demonstrates that column connections can play a larger role than the column packing with respect to band dispersion.

The impact of knowledge and attitudes on access to eye-care services in Cambodia

Purpose: To investigate how knowledge and attitudes influence the access to eye-care services in Takeo Province, Cambodia.

Design: A cross-sectional survey (n=600).

Methods: 30 villages were randomly selected. Groups included: >50 years, 30–49 years, and parents with children <5 years. A newly developed Knowledge, Attitude and Practice in Eye Health (KAP-EH) questionnaire about knowledge and treatment of eye diseases, practices and attitudes to accessing services was used to interview respondents. Descriptive analysis, including Chi square and logistic regression tested for associations with sub-groups of gender, age group, education and self-reported type of disability.

Results: The proportion of respondents who reported having knowledge of specific eye conditions ranged from 97% for eye injury, to 8% for diabetic eye disease. While 509 (85%) people reported knowledge of cataract, 47% did not know how cataract was treated and only 19% listed surgery. The older group (66.5%) were least informed about cataract (p= 0.001) compared to other groups, and were least likely to believe that some blindness could be prevented (p < 0.001). Women (55%) were more likely than men (46%) (p=0 .003) to report that a child with blindness could attend school, as did people without a disability compared to those with a disability (58% vs 34%) (p < 0.001).

Conclusions: The knowledge about cataract and refractive error and what to do to resolve the problems was low among this population and this study suggests that poor knowledge of eye diseases might contribute to the occurrence of un-operated cataract and uncorrected refractive error.

Impact of carbon material on RF MEMS switch

Carbon materials such as Graphene and carbon nano tube promise a new generation of RF NEMS devices that bring many advantages due to their very high performances such as low mass, high Young's modulus and electrical conductivity. In this paper, the properties of Graphene for RF M/NEMS applications are briefly described. We compare the mechanical behaviour of Graphene switches with metallic RF MEMS switches such as Aluminium and Gold. The analytical study and simulation results show that the actuation voltage of Al and Au switches is high (35 V) whereas the actuation voltage for the Graphene switch is low (7.7 V). Also, the switching time of Graphene switch is 3.5 ns while the switching time for metallic switches is approximately 17μs.

Uni has a different language … to the real world: demystifying academic culture and discourse for students from low socioeconomic backgrounds

The Australian government has set ambitious targets for increased higher-education participation of people from low socioeconomic backgrounds. There is, thus, a pressing need to explore how best to empower these students with what they require to progress and succeed at university. The paper draws on a literature review and qualitative data from a national study in which 89 students from low socioeconomic backgrounds and 26 staff were interviewed. The paper argues that demystifying academic culture and discourses for these students is a key step institutions and staff can take in assisting students from low socioeconomic backgrounds to progress and succeed at university. A recurring theme to emerge from both the literature and interviews with students and staff was that teaching the discourse empowers and enables students to learn, has a positive impact on their sense of belonging and ultimately helps them succeed in higher education.

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

Background
Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.

Methods
Searches of major electronic databases identified articles published from 1993–2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.

Results
Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m2 to -0.54 kg/m2 for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3–5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.

Conclusion
There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.

Smart-phone obesity prevention trial for adolescent boys in low-income communities: the ATLAS RCT

The goal of this study was to evaluate the impact of the Active Teen Leaders Avoiding Screen-time (ATLAS) intervention for adolescent boys, an obesity prevention intervention using smartphone technology.

Experimental and simulation study of the impact of increased photovoltaic integration with the grid

The abundance, availability, and climate-friendly characteristics of solar photovoltaic (PV) energy encourage nations around the globe to adopt it to assist in overcoming global warming as well as build a sustainable society for the future. The intermittent nature of solar energy generation and the associated power electronic inverters with connected consumer loads creates a number of potential challenges in integrating large-scale PV into the grid that affects power quality of the distribution networks. This paper investigates the impacts of varying PV integration into the grid through experimental and simulation studies. Initially, several experiments were conducted with varying PV penetration and load conditions using the Renewable Energy Integration Facility at CSIRO, Newcastle, Australia. Later, a simulation model was developed that mimics the experimental facility used at CSIRO to investigate the adverse impacts on integrating large-scale PV into the grid using the power system simulation software PSS Sincal. Experimental and simulation analyses clearly indicate that integration of PV into the grid causes power quality issues such as voltage instability, harmonic injection, and low power factor into the networks and the level of these impacts increases with the increase of PV penetration. © 2014 AIP Publishing LLC.

Gambling participation and problem gambling severity in a stratified random survey : Findings from the second social and economic impact study of gambling in Tasmania

Demographic characteristics associated with gambling participation and problem gambling severity were investigated in a stratified random survey in Tasmania, Australia. Computer-assisted telephone interviews were conducted in March 2011 resulting in a representative sample of 4,303 Tasmanian residents aged 18 years or older. Overall, 64.8 % of Tasmanian adults reported participating in some form of gambling in the previous 12 months. The most common forms of gambling were lotteries (46.5 %), keno (24.3 %), instant scratch tickets (24.3 %), and electronic gaming machines (20.5 %). Gambling severity rates were estimated at non-gambling (34.8 %), non-problem gambling (57.4 %), low risk gambling (5.3 %), moderate risk (1.8 %), and problem gambling (.7 %). Compared to Tasmanian gamblers as a whole significantly higher annual participation rates were reported by couples with no children, those in full time paid employment, and people who did not complete secondary school. Compared to Tasmanian gamblers as a whole significantly higher gambling frequencies were reported by males, people aged 65 or older, and people who were on pensions or were unable to work. Compared to Tasmanian gamblers as a whole significantly higher gambling expenditure was reported by males. The highest average expenditure was for horse and greyhound racing ($AUD 1,556), double the next highest gambling activity electronic gaming machines ($AUD 767). Compared to Tasmanian gamblers as a whole problem gamblers were significantly younger, in paid employment, reported lower incomes, and were born in Australia. Although gambling participation rates appear to be falling, problem gambling severity rates remain stable. These changes appear to reflect a maturing gambling market and the need for population specific harm minimisation strategies. © 2014 Springer Science+Business Media New York.

The effect of simulated thermomechanical processing on the transformation behavior and microstructure of a low-carbon Mo-Nb linepipe steel

The present work investigates the transformation behavior of a low-carbon Mo-Nb linepipe steel and the corresponding transformation product microstructures using deformation dilatometry. The continuous cooling transformation (CCT) diagrams have been constructed for both the fully recrystallized austenite and that deformed in uniaxial compression at 1148 K (875 °C) to a strain of 0.5 for cooling rates ranging from 0.1 to about 100 K/s. The obtained microstructures have been studied in detail using electron backscattered diffraction complemented by transmission electron microscopy. Heavy deformation of the parent austenite has caused a significant expansion of the polygonal ferrite transformation field in the CCT diagram, as well as a shift in the non-equilibrium ferrite transformation fields toward higher cooling rates. Furthermore, the austenite deformation has resulted in a pronounced refinement in both the effective grain (sheaf/packet) size and substructure unit size of the non-equilibrium ferrite microstructures. The optimum microstructure expected to display an excellent balance between strength and toughness is a mix of quasi-polygonal ferrite and granular bainite (often termed “acicular ferrite”) produced from the heavily deformed austenite within a processing window covering the cooling rates from about 10 to about 100 K/s.

The effect of low cycle fatigue, ratcheting and mean stress relaxation on stress-strain response and microstructural development in a dual phase steel

This study examines the cyclic plastic deformation behavior and microstructural development of a dual phase steel in both symmetric and asymmetric cycling in strain and stress control modes. The low-cycle fatigue (LCF) and mean stress relaxation (MSR) tests show very similar fatigue lifetimes. However, fatigue lifetimes reduce and prominent accumulation of directional strain was observed in ratcheting. A microstructural analysis has revealed that the type of cyclic test carried out has a noticeable impact on the substructural development, and this has been correlated with differences in accumulated tensile strain. Electron backscatter diffraction investigation has shown larger in-grain misorientation for ratcheting specimen in comparison with LCF and MSR specimens. The orientation of ferrite grains was found to have very little effect on their substructural development, and strain localization commonly occurred in the ferrite at the ferrite/martensite interface.

Money laundering and terror financing risk management of low risk financial products and services in South Africa

When the South African anti-money laundering regulations were drafted in 2002, the Minister of Finance made an exemption to protect so-called mass market banking services products for the poor against negative compliance impact by the new system. This exemption, known as Exemption 17, relaxes the requirement to identify and verify a client’s residential address. Exemption 17 was amended in 2004 to facilitate the launch of a basic bank account, the Mzansi account. This account has proved to be hugely popular. According to the FinScope 2007 survey 10% of South African adults claimed to hold a Mzansi account.

Low back pain in microgravity and bed rest studies

BACKGROUND: The prevalence of low back pain (LBP) for astronauts in space (68%) is higher than the 1-mo prevalence for the general population on Earth (39%). It is unclear whether differences occur between healthy subjects and astronauts with a history of LBP. Knowledge of this issue is important to assess whether a history of LBP could have an operational impact. METHODS: We evaluated LBP prospectively during short duration spaceflight (15 d; N=20) and compared this with similar data collected during two bed rest studies (N=40). Astronauts completed a questionnaire 5-10 d preflight, during each flight day, and 5-10 d postflight. RESULTS: All astronauts with a history of LBP also developed LBP in flight. These astronauts reported a significantly longer duration of LBP and a different pain location. LBP was most often experienced in the central area of the lower back during spaceflight with an incidence of 70% and a mean pain level of 3 (on a scale of 0-10). Pain resolved within 10 d of flight. No neurological signs were present. The most frequently reported countermeasure was assuming a "knees to chest (fetal tuck) position" combined with stretching. Greater LBP intensity was reported in spaceflight than bed rest with a trend indicating a greater number of days of pain during spaceflight. DISCUSSION: The current study represents a prospective study of LBP in spaceflight. The results indicate that LBP is self-limiting in spaceflight and should not pose an operational risk. Prior LBP on Earth appears to be a risk factor for LBP in spaceflight.

The impact of mandatory versus voluntary auditor switches on stock liquidity: some Korean evidence

Using Korean listed firms subject to the auditor "designation rule", this paper shows that (1) firms that switch auditors exhibit lower stock liquidity than firms that do not switch auditors, and (2) the negative liquidity effect of auditor switches is concentrated in firms that switch to low-quality auditors. Meanwhile, firms that switch auditors under the auditor designation system do not exhibit lower stock liquidity, consistent with audit designation mitigating the concerns about audit quality deterioration around auditor changes. Furthermore, we find that foreign ownership has a mitigating impact on the negative relation between auditor switches and stock liquidity, suggesting that investors are less concerned about auditor switches when an alternative monitoring mechanism exists.

Mental health following acquisition of disability in adulthood-the impact of wealth

BACKGROUND: Acquisition of a disability in adulthood has been associated with a reduction in mental health. We tested the hypothesis that low wealth prior to disability acquisition is associated with a greater deterioration in mental health than for people with high wealth. METHODS: We assess whether level of wealth prior to disability acquisition modifies this association using 12 waves of data (2001-2012) from the Household, Income and Labour Dynamics in Australia survey-a population-based cohort study of working-age Australians. Eligible participants reported at least two consecutive waves of disability preceded by at least two consecutive waves without disability (1977 participants, 13,518 observations). Fixed-effects linear regression was conducted with a product term between wealth prior to disability (in tertiles) and disability acquisition with the mental health component score of the SF-36 as the outcome. RESULTS: In models adjusted for time-varying confounders, there was evidence of negative effect measure modification by prior wealth of the association between disability acquisition and mental health (interaction term for lowest wealth tertile: -2.2 points, 95% CI -3.1 points, -1.2, p<0.001); low wealth was associated with a greater decline in mental health following disability acquisition (-3.3 points, 95% CI -4.0, -2.5) than high wealth (-1.1 points, 95% CI -1.7, -0.5). CONCLUSION: The findings suggest that low wealth prior to disability acquisition in adulthood results in a greater deterioration in mental health than among those with high wealth.