Inequitable provision of optimal services for patients with chronic heart failure : a national geo-mapping study

Objective : To compare the location and accessibility of current Australian chronic heart failure (CHF) management programs and general practice services with the probable distribution of the population with CHF. Design and setting : Data on the prevalence and distribution of the CHF population throughout Australia, and the locations of CHF management programs and general practice services from 1 January 2004 to 31 December 2005 were analysed using geographic information systems (GIS) technology. Outcome measures : Distance of populations with CHF to CHF management programs and general practice services. Results : The highest prevalence of CHF (20.3–79.8 per 1000 population) occurred in areas with high concentrations of people over 65 years of age and in areas with higher proportions of Indigenous people. Five thousand CHF patients (8%) discharged from hospital in 2004–2005 were managed in one of the 62 identified CHF management programs. There were no CHF management programs in the Northern Territory or Tasmania. Only four CHF management programs were located outside major cities, with a total case load of 80 patients (0.7%). The mean distance from any Australian population centre to the nearest CHF management program was 332 km (median, 163 km; range, 0.15–3246 km). In rural areas, where the burden of CHF management falls upon general practitioners, the mean distance to general practice services was 37 km (median, 20 km; range, 0–656 km). Conclusion : There is an inequity in the provision of CHF management programs to rural Australians.

Directed search, coordination failure, and seller profits: an experimental comparison of posted pricing with single and multiple prices

We experimentally examine posted pricing and directed search. In one treatment, capacity-constrained sellers post fixed prices, which buyers observe before choosing whom to visit. In the other, firms post both “single-buyer” (applied when one buyer visits) and “multibuyer” (when multiple buyers visit) prices. We find, based on a 2 × 2 (two buyers and two sellers) market and a follow-up experiment with 3 and 2 × 3 markets, that multibuyer prices can be lower than single-buyer prices or prices in the one-price treatment. Also, allowing the multibuyer price does not affect seller profits and increases market frictions.

Hospital readmission among older adults with congestive heart failure

Older adults with congestive heart failure [CHF] are likely to experience multiple readmissions to hospital. There have been several studies conducted on hospital readmissions; however, generalising the findings is problematic due to the use of variable definitions of what constitutes a readmission. This paper addresses the absence of Australian research comparing groups of older patients with CHF who are readmitted to hospital with those who are not readmitted. It also adopts one of the more frequently used definitions of readmission to aid in future comparability of research. Using a comparative cohort design, a multivariate logistic regression model was used to compare readmitted patients with non-readmitted patients and identify risk factors associated with readmission. Significant risk factors identified were male gender, numerous diagnoses, lengths of stay of 3 days or longer and admission from acute, subacute or aged care facilities. The increased likelihood of readmission among patients from acute, subacute and aged care services warrants further investigation.

Cycling time to failure is better maintained by cold than contrast or thermoneutral lower-body water immersion in normothermia

Purpose
To examine the effects of four commonly used recovery treatments applied between two bouts of intense endurance cycling on the performance of the second bout in normothermia (~21 °C).

Methods
Nine trained men completed two submaximal exhaustive cycling bouts (Ex1 and Ex2: 5 min at ~50 % V˙O2 peak, followed by 5 min at ~60 % V˙O2 peak and then ~80 % V˙O2 peak to failure) separated by 30 min of (a) cold water immersion at 15 °C (C15), (b) contrast water therapy alternating 2.5 min at 8 °C and 2.5 min at 40 °C (CT), (c) thermoneutral water immersion at 34 °C (T34) and (d) cycling at ~40 % V˙O2 peak (AR).

Results
Exercise performance, cardiovascular and metabolic responses during Ex1 were similar among all trials. However, time to failure (~80 % V˙O2 peak bout) during Ex2 was significantly (P < 0.05) longer in C15 (18.0 ± 1.6) than in CT (14.5 ± 1.5), T34 (12.4 ± 1.4) and AR (10.6 ± 1.0); and it was also longer (P < 0.05) in CT than AR. Core temperature and heart rate were significantly (P < 0.05) lower during the initial ~15 min of Ex2 during C15 compared with all other conditions but they reached similar levels at the end of Ex2.

Conclusions
A 30 min period of C15 was more beneficial in maintaining intense submaximal cycling performance than CT, T34 and AR; and CT was also more beneficial than T34 and AR. These effects were not mediated by the effect of water immersion per se, but by the continuous (C15) or intermittent (CT) temperature stimulus (cold) applied throughout the recovery.

Failure to thrive: mid-career women in higher education

Gender underrepresentation in higher education (HE) is a persistent global phenomenon. The purpose of this research was to re-examine it through symbolic interactionism (SI). Eight women aspiring to leadership were invited to participate in semi structured interviews after attending a leadership programme specifically designed to enhance their prospects. Analysis indicated ambiguities and contradictions surround notions of leadership, as well as opportunities for leadership. This was evidenced by their appraisal of the existing leadership, speculations regarding their leadership capacity, how the participants position themselves and are positioned in their workplace. Actively “paying it forward” was seen as facilitating promotion, and line managers’ familiarity with the work undertaken by aspirants. Formal leadership training was advocated rather than experiential processes.