Spatial and temporal definition of Ochlerotatus camptorhynchus (Thomson) (Diptera: Culicidae) in the Gippsland Lakes system of eastern Victoria

The confirmed vector of Ross River virus, Ochlerotatus camptorhynchus (Thomson), is the dominant mosquito species inhabiting saline marshes in coastal Victoria. This paper re-examines previously published data on Oc. camptorhynchus, plus additional data collected since that time, and provides greater spatial and temporal definition of Oc. camptorhynchus numbers at seven sites across the Gippsland Lakes system of eastern Victoria. A total of 357 672 Oc. camptorhynchus was captured from 1188 trap-nights across the seven trap sites during trapping seasons from 1990 to 2001. The  dominance of Oc. camptorhynchus across the seven sites averaged 75%, with significant differences in mean abundance of Oc. camptorhynchus found between all trap sites. Significant differences in monthly abundance of Oc. camptorhynchus were observed for Wellington Shire. Increase in populations of Oc. camptorhynchus was associated with increases in rainfall at all trap sites, higher minimum temperatures at two of the seven trap sites, and wind speed at one trap site. Prioritisation of mosquito control may be applied based on spatial and temporal factors according to the findings of this study.

A systemic approach to the database marketing process

The role of database marketing (DBM) has become increasingly important for organisations that have large databases of information on customers with whom they deal directly. At the same time, DBM models used in practice have increased in sophistication. This paper examines a systemic view of DBM and the role of analytical techniques within DBM. It extends existing process models to develop a systemic model that encompasses the increased complexity of DBM in practice. The systemic model provides a framework to integrate data mining, experimental design and prioritisation decisions. This paper goes on to identify opportunities for research in DBM, including DBM process models used in practice, the use of evolutionary operations techniques in DBM, prioritisation decisions, and the factors that surround the uptake of DBM.

Taking environmental water requirements and climate change into account in the designation and management of protected areas for floodplain ecosystems

In 2005, the Victorian government asked the Victorian Environmental Assessment Council (VEAC) to 1) identify and evaluate the extent, condition, values, management, resources and uses of riverine red gum forests and associated fauna, wetlands, floodplain ecosystems and vegetation communities in northern Victoria; and 2) make recommendations relating to the conservation, protection and ecological sustainable use of public land. The design of a comprehensive, adequate and representative (CAR) reserve system was a key part of the recommendations made by VEAC. In order to assist in the decision-making for environmental water allocation for protected areas and other public land, a process for identifying flood-dependent natural values on the Victorian floodplains of the River Murray and its tributaries was developed.

Although some areas such as the Barmah forest are very well known, there have been few comprehensive inventories of important natural values along the Murray floodplains. For this project, VEAC sought out and compiled data on flood requirements (natural flood frequency, critical interval between floods, minimum duration of floods) for all flood-dependent ecological vegetation classes (EVCs) and threatened species along the Goulburn, Ovens, King and Murray Rivers in Victoria. The project did not include the Kerang Lakes and floodplains of the Avoca, Loddon and Campaspe Rivers. 186 threatened species and 110 EVCs (covering 224,247 ha) were identified as flood-dependent and therefore at risk from insufficient flooding.

Past environmental water allocations have targeted a variety of different natural assets (e.g. stressed red gum trees, colonial nesting waterbirds, various fish species), but consideration of the water requirements of the full suite of floodplain ecosystems and significant species has been limited. By considering the water requirements of the full range of natural assets, the effectiveness of water delivery for biodiversity can be maximised. This approach highlights the species and ecosystems most in need of water and builds on the icon sites approach to view the Murray floodplains as an interconnected system. This project also identified for the first time the flood-frequency and duration requirements for the full suite of floodplain ecosystems and significant species.

This project is the most comprehensive identification of water requirements for natural values on the floodplain to date, and is able to be used immediately to guide prioritisation of environmental watering. As more information on floodplain EVCs and species becomes available, the water requirements and distribution of values can be refined by ecologists and land and water managers. That is, the project is intended as the start of an adaptive process allowing for the incorporation of monitoring and feedback over time. The project makes it possible to transparently and easily communicate the extent to which manipulated or natural flows benefit various natural values. Quantitative and visual outputs such as maps will enable environmental managers and the public to easily see which values do and do not receive water (see http://www.veac.vic.gov.au/riverredgumfinal.htm for further details).

The influence of various aspects of enjoyment on participation in leisure time physical activity

This study examines the direct and indirect influence of various aspects of enjoyment, including activity enjoyment, enjoyment conceptualised as physical/environmental, and enjoyment conceptualised as social interaction, on regular participation in leisure-time physical activity (LTPA). The study was cross-sectional and used self-report questionnaires to collect data from a random sample of 250 people aged 19-87 years living in an Australian city. Questionnaires included demographic items and scales to measure enjoyment of LTPA, prioritisation of LTPA and regularity of participation in LTPA. The findings suggest that the influence of enjoyment on participation in LTPA is complex. Aspects of enjoyment have varying levels of influence on participation in LTPA and this influence is indirect through preference for LTPA, life priority of LTPA and making time for LTPA. Policies, programs and strategies by government and practitioners that aim to increase participation in LTPA should primarily aim to enhance activity enjoyment, rather than focusing on other aspects of participation. Theoretically, this study suggests that enjoyment is a multidimensional concept and that enjoyment is a part of a larger decision-making process influencing participation in LTPA.

Victorian index of estuary condition : recommended themes and measures

Deakin University was engaged by the Department of Sustainability and Environment to develop an Index of Estuary Condition (IEC) for evaluating the environmental condition of Victorian estuaries. The Index will ultimately complement the existing Index of Stream Condition (ISC) by providing a consistent statewide assessment of the environmental condition of estuaries. This will better enable:

• Estuarine condition to be reported at regional, state and national levels.

• Prioritisation of resource allocation.

• Strategic evaluation of management interventions in estuaries.

Workshops involving participants with expertise in a variety of disciplines were convened to integrate learnings from assessment programs currently being developed interstate and overseas. This report synthesises and builds on the output from those workshops which:

• Identified key components (themes) of estuaries that contribute to estuarine condition.

• Contributed to development of a broad conceptual model for Victorian estuaries

• Identified possible measures of each theme

In keeping with the sub-indices of the ISC, six themes were identified for use in the IEC: Physical form, Hydrology, Water quality, Sediment, Flora and Fauna. Several measures within each theme are recommended to assess estuary condition.

Implementation of particular measures in the IEC partly depends on the investment required to both collect and interpret the required data. With regard to data collection, each measure was assessed according to whether there is an established sampling procedure, how frequently data need to be collected and the level of expertise required for collection and processing. For interpreting the data, measures were scored on whether baseline condition is established and whether descriptions and scores are developed which reflect the extent of deviation from that condition. These scores were used to indicate which measures are feasible to implement immediately and which require further investigation.

A trial of the recommended IEC measures in a selection of estuaries is recommended as it would provide an opportunity to test the measures and their suitability for application statewide. It is suggested that the trial is conducted in estuaries subject to various levels of threats within each of the four estuary classes described by Barton et al. (2008)

Borderline personality disorder - an overview for emergency clinicians

The diagnosis of borderline personality disorder frequently underlies self-harm and suicidal presentations to the emergency department. Borderline pathology combined with high levels of comorbidity, stigma, and treatment uncertainty, increase the challenges of caring for someone with this diagnosis in an emergency setting. Attributes such as black-and-white thinking and splitting may compromise an already precarious situation. The maintenance of safety requires prioritisation and necessitates a practical and respectful approach, which avoids notions of attention-seeking behaviour. Clinical assessment should distinguish between self-harm and suicide attempts where possible and take into account acute on chronic risk. The emergency clinician will need to consider the degree of containment required in the emergency department and is encouraged to maintain transparency and honesty with the client regarding treatment decisions. If hospitalisation needs to be considered, clinicians should take into account immediate therapeutic benefit versus the counter-therapeutic risk of dependency and regression. Overall, it is reasonable for clinicians to aim for clients to return to their pre-crisis level of functioning, and beneficial for clinicians to approach this client group with therapeutic optimism.

Significance of environment in the assessment of sustainable development : the case for South West Victoria

The assessment of sustainable development is often based on the three pillars of sustainability model or triple bottom line using a set of indicators that evaluate the social, economic and environmental systems. It is thought that by measuring the performance of each system information can be gained about the sustainability of the whole system. However, this represents a disconnect between sustainability theory and the practice of sustainability evaluation as there is no attempt to evaluate if this assumption is true. During the development of a sustainability assessment framework for south west Victoria, Australia, it has become evident that this approach to sustainability assessment does not provide an accurate evaluation of system sustainability. Throughout this project, from stakeholder prioritisation of indicators to final multiple criteria analysis of sustainability, the environmental indicators were found to be the most important for the region’s sustainability. As a consequence, the assessment produced shows that in south west Victoria, sustainability is largely determined by the condition of the environment. This finding highlights the current disconnection between theory and the reality of sustainability. Thus, we discuss a framework for sustainability assessment that attempts to re-connect theory to practice.

Improving the communication between care providers of individuals who may require joint replacement surgery (JRS) a framework for referral

Aims & rationale/Objectives : The objective of the project was to specify the information required in referrals to public hospital orthopaedic outpatient departments in order to streamline the care and prioritisation of individuals who may require JRS. It was envisaged that an evidence-based GP-Orthopaedic derived referral system would assist in ensuring that the right person accessed the right care at the right time.

Methods : In collaboration with the RACGP and the Commonwealth Department of Health and Ageing, a national stakeholder working group was convened. A scoping document was prepared with input from key stakeholders. A review of primary research was undertaken as well as a review of relevant guidelines. Information on the implementation and evaluation of similar programs in Australia and overseas also informed the referral specification.

Principal findings : The initial scoping processes with key stakeholders provided clear information on core components of the referral. These were the use of standardised and respected assessment tools to determine the severity of arthritis, fitness for surgery and willingness of affected individuals to undergo surgery.

Discussion : About 20,000 JRS occur each year in public hospitals which emanate from 5 to 10 fold number of referrals. Arthritis and musculoskeletal diseases are a national health priority area reflecting the high burden of disease associated with these conditions. Various initiatives are being undertaken to address the quality of life of affected individuals. This project has revealed areas of potential improvement in the communication between care providers of individuals who may need JRS.

Implications : The project will result in the development of a standard referral form and guidelines to assist referring practitioners to communicate more effectively with the multidisciplinary care team, in particular orthopaedic care providers. The guidelines will be piloted in a large rural setting.

Does traditional security risk assessment have a future in information security?

The current information security standards still advocate the use of risk assessment in the prioritisation of security investments. However, prior research on the use of risk assessment methodologies in organisational security has shown that the use of the traditional monolithic risk assessment process described in the current risk management standard is simply not practical at the organisational level. This paper first examines the problems in performing a systematic risk assessment and then discusses the limitations of a traditional risk assessment. To address these limitations, this paper proposes splitting up the current monolithic risk assessment process. The result is an information security assessment framework that puts greater emphasis on situational awareness and allows for better decision making on the prioritization of security investments.

Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

Analysing stakeholder-associated risks in green buildings : a social network analysis method

In the research of risk associated with developing energy and water efficient green buildings, previous studies had mainly focused on "what the risks are and how the risks may impact on project objectives", which were from an inward looking self-perspective and treated the risks in isolation from one another. While intensive research efforts have been dedicated to risk identification, assessment, classification, prioritisation and mitigation, a research gap exists, that is previous studies had ignored the fact that most risks are interrelated and associated with internal or external project stakeholders. To remedy the gap, this current research developed and presented a SNA (Social Network Analysis) based stakeholder-associated risk analysis method to assess risks in green buildings and the interactions between the risks. A case study has been conducted to demonstrate and validate this method. This research contributes to the development of a new theory to model the interdependent and interactive relationships of risks by using SNA as a methodology. This research should broaden project managers' awareness of the influential risks in green building and enhance their ability to perceive, understand, assess, and mitigate the risks in an effective and efficient way, thereby achieving higher performance in strategic risk management and stakeholder communication in green building development.

Estimating the proportion of metabolic health outcomes attributable to obesity: a cross-sectional exploration of body mass index and waist circumference combinations

BACKGROUND: Recent evidence suggests that a substantial subgroup of the population who have a high-risk waist circumference (WC) do not have an obese body mass index (BMI). This study aimed to explore whether including those with a non-obese BMI but high risk WC as 'obese' improves prediction of adiposity-related metabolic outcomes.

METHODS: Eleven thousand, two hundred forty-seven participants were recruited. Height, weight and WC were measured. Ten thousand, six hundred fifty-nine participants with complete data were included. Adiposity categories were defined as: BMI(N)/WC(N), BMI(N)/WC(O), BMI(O)/WC(N), and BMI(O)/WC(O) (N = non-obese and O = obese). Population attributable fraction, area under the receiver operating characteristic curve (AUC), and odds ratios (OR) were calculated.

RESULTS: Participants were on average 48 years old and 50 % were men. The proportions of BMI(N)/WC(N), BMI(N)/WC(O), BMI(O)/WC(N) and BMI(O)/WC(O) were 68, 12, 2 and 18 %, respectively. A lower proportion of diabetes was attributable to obesity defined using BMI alone compared to BMI and WC combined (32 % vs 47 %). AUC for diabetes was also lower when obesity was defined using BMI alone (0.62 vs 0.66). Similar results were observed for all outcomes. The odds for hypertension, dyslipidaemia, diabetes and CVD were increased for those with BMI(N)/WC(O) (OR range 1.8-2.7) and BMI(O)/WC(O) (OR 1.9-4.9) compared to those with BMI(N)/WC(N).

CONCLUSIONS: Current population monitoring, assessing obesity by BMI only, misses a proportion of the population who are at increased health risk through excess adiposity. Improved identification of those at increased health risk needs to be considered for better prioritisation of policy and resources.