Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Little is known about any variations in resource use and costs of care between stroke subtypes, especially nonhospital costs. The purpose of this study was to describe the patterns of resource use and to estimate the first-year and lifetime costs for stroke subtypes.

Methods-: A cost-of-illness model was used to estimate the total first-year costs and lifetime costs of stroke subtypes for all strokes (subarachnoid hemorrhages excluded) that occurred in Australia during 1997. For each subtype, average cost per case during the first year and the present value of average cost per case over a lifetime were calculated. Resource use data obtained in the North East Melbourne Stroke Incidence Study (NEMESIS) were used.

Results-: The present value of total lifetime costs for all strokes was Aus $1.3 billion (US $985 million). Total lifetime costs were greatest for ischemic stroke (72%; Aus $936.8 million; US $709.7 million), followed by intracerebral hemorrhage (26%; Aus $334.5 million; US $253.4 million) and unclassified stroke (2%; Aus $30 million; US $22.7 million). The average cost per case during the first year was greatest for total anterior circulation infarction (Aus $28 266). Over a lifetime, the present value of average costs was greatest for intracerebral hemorrhage (Aus $73 542), followed by total anterior circulation infarction (Aus $53 020), partial anterior circulation infarction (Aus $50 692), posterior circulation infarction (Aus $37 270), lacunar infarction (Aus $34 470), and unclassified stroke (Aus $12 031).

Conclusions-: First-year and lifetime costs vary considerably between stroke subtypes. Variation in average length of total hospital stay is the main explanation for differences in first-year costs.

Informal care for stroke survivors. Results from the North East Melbourne stroke incidence study (NEMESIS)

Background and Purpose-: Informal caregivers play an important role in the lives of stroke patients, but the cost of providing this care has not been estimated. The purpose of this study was to determine the nature and amount of informal care provided to stroke patients and to estimate the economic cost of that care.

Methods-: The primary caregivers of stroke patients registered in the North East Melbourne Stroke Incidence Study (NEMESIS) were interviewed at 3, 6, and 12 months after stroke, and the nature and amount of informal care provided were documented. The opportunity and replacement costs of informal care for all first-ever-in-a-lifetime strokes (excluding subarachnoid hemorrhages) that occurred in 1997 in Australia were estimated.

Results-: Among 3-month stroke survivors, 74% required assistance with activities of daily living and received informal care from family or friends. Two thirds of primary caregivers were women, and most primary caregivers (>90%) provided care during family or leisure time. Total first-year caregiver time costs for all first-ever-in-a-lifetime strokes were estimated to be A$21.7 million (opportunity cost approach) or A$42.5 million (replacement cost approach), and the present values of lifetime caregiver time costs were estimated to be A$171.4 million (opportunity cost approach) or A$331.8 million (replacement cost approach).

Conclusions-: Informal care for stroke survivors represents a significant hidden cost to Australian society. Because our community is rapidly aging, this informal care burden may increase significantly in the future.

Cost of stroke in Australia from a societal perspective: results from the north east Melbourne stroke incidence study (NEMESIS)

Background and Purpose—— Accurate information about resource use and costs of stroke is necessary for informed health service planning. The purpose of this study was to determine the patterns of resource use among stroke patients and to estimate the total costs (direct service use and indirect production losses) of stroke (excluding SAH) in Australia for 1997.

Methods—— An incidence-based cost-of-illness model was developed, incorporating data obtained from the North East Melbourne Stroke Incidence Study (NEMESIS). The costs of stroke during the first year after stroke and the present value of total lifetime costs of stroke were estimated.

Results—— The total first-year costs of all first-ever-in-a lifetime strokes (SAH excluded) that occurred in Australia during 1997 were estimated to be A$555 million (US$420 million), and the present value of lifetime costs was estimated to be A$1.3 billion (US$985 million). The average cost per case during the first 12 months and over a lifetime was A$18 956 (US$14 361) and A$44 428 (US$33 658), respectively. The most important categories of cost during the first year were acute hospitalization (A$154 million), inpatient rehabilitation (A$150 million), and nursing home care (A$63 million). The present value of lifetime indirect costs was estimated to be A$34 million.

Conclusions—— Similar to other studies, hospital and nursing home costs contributed most to the total cost of stroke (excluding SAH) in Australia. Inpatient rehabilitation accounts for {approx}27% of total first-year costs. Given the magnitude of these costs, investigation of the cost-effectiveness of rehabilitation services should become a priority in this community.

Isn't sport taxing? The taxation of sports professionals post-Agassi

In Agassi v Robinson (Her Majestyʹs Inspector of Taxes), a majority of the House of Lords found that payments under two sponsorship contracts between a company owned and controlled by Mr Andre Agassi, (Agassi Enterprises Inc) and Nike Inc and Head Sport AG were assessable under UK tax law. This was so despite (i) none of the parties to the contracts was resident, nor domiciled, in the United Kingdom and (ii) none of the payer companies conducted business, directly or indirectly, through branches/agencies in the United Kingdom. The article considers whether the Australian Taxation Office could similarly assess non‐resident sports‐persons, like Mr Agassi, personally, and/or entities they control, on payments made under sponsorship agreements with a company such as Nike Inc. While the preferable view is that such payments are not sourced in Australia, Australian source rules are so ill defined that there is some basis for asserting such payments are sourced in Australia.

Observations of the ecological impacts of Sambar Cervus unicolor in East Gippsland, Victoria, with reference to destruction of rainforest communities

Damage caused by Sambar, particularly browsing, antler rubbing and physical removal of particular plant species, is resulting in serious ecological consequences. Threatening processes instigated or maintained by Sambar include: loss of individual taxa, altered vegetation structure and massive
widespread removal and prevention of regeneration, which is now resulting in the loss of plant communities in some areas. These observations are particularly disturbing, as it is apparent that Sambar are yet to reach their full ecological and population potential in south-eastern Australia. The destruction documented ill this article is now so widespread and so severe that in places it represents an ecological disaster for specific plant and animal species, ecological vegetation classes and floristic communities. We strongly recommend that Sambar in particular, and feral deer in general. should no longer be protected under the Wildlife Act 1975 so that control methods can be devised and implemented. It now appears that such measures will he essential for the long-term survival of some fragile plant species and communities in Victoria. (Title: Victorian Naturalist 122(4) 2005, 189-200

Business ethics and accounting students : Australia, South Asia and East Asia

Recent corporate collapses around the world show that there are no national boundaries for these occurrences. Australian corporate collapses including HIH Insurance, One.Tel, Ansett Australia and Harris Scarfe have raised public expectations of investigation of the causes of collapses (Mirshekary, Yaftian & Cross, 2005). The main reason for the collapse of HIH was mismanagement, with an emphasis more on the directors’ personal qualities such as integrity, honesty and morality rather than tougher legislation and rules. Accounting students are our future business leaders. The teaching of ethics in the classroom to multicultural groups of students provides an opportunity to facilitate the sharing of knowledge, and to increase interaction and debate around different approaches to ethics among students from different countries.
This study uses previous literature to explain the attitudes of accounting students towards academic and business/accounting ethics at an Australian university which is a multi-campus institution undertaking programs and activities at regional, national, international levels and by distance education.
This study reports the results of cross-cultural investigations of students’ ethical perceptions on moral values, academic and accounting/business vignettes, given that all students share the same learning opportunities, knowledge of ethics and interaction with their peers and lecturers. The results indicate no significant differences in responses between the students from Australia, South Asia and East Asia.

A second-order blind equalization method robust to ill-conditioned SIMO FIR channels

This paper deals with blind equalization of single-input-multiple-output (SIMO) finite-impulse-response (FIR) channels driven by i.i.d. signal, by exploiting the second-order statistics (SOS) of the channel outputs. Usually, SOS-based blind equalization is carried out via two stages. In Stage 1, the SIMO FIR channel is estimated using a blind identification method, such as the recently developed truncated transfer matrix (TTM) method. In Stage 2, an equalizer is derived from the estimate of the channel to recover the source signal. However, this type of two-stage approach does not give satisfactory blind equalization result if the channel is ill-conditioned, which is often encountered in practical applications. In this paper, we first show that the TTM method does not work in some situations. Then, we propose a novel SOS-based blind equalization method which can directly estimate the equalizer without knowing the channel impulse responses. The proposed method can obtain the desired equalizer even in the case that the channel is ill-conditioned. The performance of our method is illustrated by numerical simulations and compared with four benchmark methods. © 2014 Elsevier Inc.

Seduction and demise in East Berlin: Digital prototype for an immersive opera

‘Seduction and Demise in East Berlin – a digital prototype for an immersive opera’ is a reflective case study of how digital technologies can be successfully applied to facilitate dynamic mediated partnerships and collaborations resulting in cutting-edge industry standard outcomes in the fields of design, performance and digital media. The ongoing use of online interaction throughout the development of the prototype facilitated a grammar of participation, collaboration and output between third year tertiary design students from Deakin University and independent Opera Company the Beggars Opera Co-Operative (BegOpCoOp), resulting in the achievement of positive professional outcomes for both project partners. Through this process, students at Deakin University Visual Communication Design department developed a normative working model that enabled a swift engagement with and response to the creative and strategic challenges that come with applying contemporary design practice in a current industry context. BegOpCop, as the industry partner, were able to use the digital collaborative process as a springboard to interrogate and innovate their own practice as producers of contemporary operatic repertoire and to develop exciting new digital and design-savvy creative collateral with which to seek further production partners, taking them to the next professional level as a growing arts organisation.