Barriers experienced by Asians in accessing injury-related services and compensations

Introduction: The Accident Compensation Corporation (ACC) administers New Zealand’s (NZ) accident compensation scheme. Asians in NZ are apparently under-serviced by ACC and may be experiencing barriers to accessing services. This study identifies barriers that Asians in NZ face in accessing ACC’s injury-related services and compensations.

Methods: By utilising a qualitative research design, 113 Chinese, Korean, Indian, and South East Asian participants residing in Auckland, NZ were recruited through maximum variation and purposive snowball sampling. Data were gathered during 2006 through 22 individual in-depth interviews and 14 focus group discussions based on semi-structured interview schedules. Interviewees included Asian general practitioners, traditional health providers, users and non-users of injury-related services, case managers and Asian community leaders. Data were analysed using a general inductive approach.

Findings: Results show that personal/cultural characteristics such as age, gender, English language competence, injury-related language competence, differing Asian worldviews, and consequent help-seeking behaviours act as barriers to accessing services and entitlements. This is exacerbated by logistical and environmental factors such as cost, transport, time, inadequate interpretation and translation services, as well as institutional barriers such as lack of information about services, culturally inappropriate services, discriminatory attitudes and employment risks.

Conclusion: It is evident that Asians living in NZ are experiencing several cultural, environmental and institutional barriers to accessing ACC services. There is clearly a need for more culturally relevant information and injury-related services if Asian immigrants’ use of such services and entitlements is to be increased.

Linking future ecosystem services and future human well-being

Ecosystem services are necessary, yet not sufficient for human well-being (however defined). Insufficient access to the ecosystem provisioning service of food is a particularly important factor in the loss of human well-being, but all ecosystem services contribute in some way to well-being. Although perhaps long obvious to ecologists, the links between ecosystems and aspects of human well-being, including health, have been less well understood among the social science community. This situation may now be starting to change, thanks in part to the Millennium Ecosystem Assessment (MA). Causality between ecosystem services and well-being is bidirectional; it is increasingly clear that functioning societies can protect or enhance ecosystem services, and accordingly, that societies with impaired well-being (best documented in the case of chronic diseases such as malaria and HIV/AIDS) can also experience a related decline in ecosystem services.

The future state of human well-being and of ecosystem services is more than the co-evolution of these two fundamental elements. Human well-being also depends, critically, upon the human institutions that govern relationships between human individuals and groups, and also between humans and ecosystem services.

The scenarios working group of the MA found that human well-being is highest in the Global Orchestration scenario, which assumes the fastest evolution of beneficial institutions, and is lowest in the Order from Strength scenario. Human well-being was found to be intermediate in the other two scenarios (Adapting Mosaic and Techno-Garden) even though these scenarios share a much greater recognition of the importance of ecosystem services to human well-being.

A new modelling approach to simulate preferential flow and transport in water repellent media: parameter sensitivity, and effects on crop growth and solute leaching

A modified version of the popular agrohydrological model SWAP has been used to evaluate modelling of soil water flow and crop growth at field situations in which water repellency causes preferential flow. The parameter sensitivity in such situations has been studied. Three options to model soil water flow within SWAP are described and compared: uniform flow, the classical mobile-immobile concept, and a recent concept accounting for the dynamics of finger development resulting from unstable infiltration. Data collected from a severely water-repellent affected soil located in Australia were used to compare and evaluate the usefulness of the modelling options for the agricultural management of such soils.

The study shows that an assumption of uniform flow in a water-repellent soil profile leads to an underestimation of groundwater recharge and an overestimation of plant transpiration and crop production. The new concept of modelling taking finger dynamics into account provides greater flexibility and can more accurately model the observed effects of preferential flow compared with the classical mobile–immobile concept. The parameter analysis indicates that the most important factor defining the presence and extremity of preferential flow is the critical soil water content.

Comparison of the modelling results with the Australian field data showed that without the use of a preferential flow module, the effects of the clay amendments to the soil were insufficiently reproduced in the dry matter production results. This means that the physical characteristics of the soil alone are not sufficient to explain the measured increase in production on clay amended soils. However, modelling with the module accounting for finger dynamics indicated that the preferential flow in water repellent soils that had not been treated with clay caused water stress for the crops, which would explain the decrease in production.

Metabolism and transport of oxazphosphorines and the clinical implications

The oxazaphosphorines including cyclophosphamide (CPA), ifosfamide (IFO), and trofosfamide represent an important group of therapeutic agents due to their substantial antitumor and immuno-modulating activity. CPA is widely used as an anticancer drug, an immunosuppressant, and for the mobilization of hematopoetic progenitor cells from the bone marrow into peripheral blood prior to bone marrow transplantation for aplastic anemia, leukemia, and other malignancies. New oxazaphosphorines derivatives have been developed in an attempt to improve selectivity and response with reduced toxicity. These derivatives include mafosfamide (NSC 345842), glufosfamide (D19575, β-D-glucosylisophosphoramide mustard), NSC 612567 (aldophosphamide perhydrothiazine), and NSC 613060 (aldophosphamide thiazolidine). This review highlights the metabolism and transport of these oxazaphosphorines (mainly CPA and IFO, as these two oxazaphosphorine drugs are the most widely used alkylating agents) and the clinical implications. Both CPA and IFO are prodrugs that require activation by hepatic cytochrome P450 (CYP)-catalyzed 4-hydroxylation, yielding cytotoxic nitrogen mustards capable of reacting with DNA molecules to form crosslinks and lead to cell apoptosis and/or necrosis. Such prodrug activation can be enhanced within tumor cells by the CYP-based gene directed-enzyme prodrug therapy (GDEPT) approach. However, those newly synthesized oxazaphosphorine derivatives such as glufosfamide, NSC 612567 and NSC 613060, do not need hepatic activation. They are activated through other enzymatic and/or non-enzymatic pathways. For example, both NSC 612567 and NSC 613060 can be activated by plain phosphodiesterase (PDEs) in plasma and other tissues or by the high-affinity nuclear 3'-5' exonucleases associated with DNA polymerases, such as DNA polymerases and ε. The alternative CYP-catalyzed inactivation pathway by N-dechloroethylation generates the neurotoxic and nephrotoxic byproduct chloroacetaldehyde (CAA). Various aldehyde dehydrogenases (ALDHs) and glutathione S-transferases (GSTs) are involved in the detoxification of oxazaphosphorine metabolites. The metabolism of oxazaphosphorines is auto-inducible, with the activation of the orphan nuclear receptor pregnane X receptor (PXR) being the major mechanism. Oxazaphosphorine metabolism is affected by a number of factors associated with the drugs (e.g., dosage, route of administration, chirality, and drug combination) and patients (e.g., age, gender, renal and hepatic function). Several drug transporters, such as breast cancer resistance protein (BCRP), multidrug resistance associated proteins (MRP1, MRP2, and MRP4) are involved in the active uptake and efflux of parental oxazaphosphorines, their cytotoxic mustards and conjugates in hepatocytes and tumor cells. Oxazaphosphorine metabolism and transport have a major impact on pharmacokinetic variability, pharmacokinetic-pharmacodynamic relationship, toxicity, resistance, and drug interactions since the drug-metabolizing enzymes and drug transporters involved are key determinants of the pharmacokinetics and pharmacodynamics of oxazaphosphorines. A better understanding of the factors that affect the metabolism and transport of oxazaphosphorines is important for their optional use in cancer chemotherapy.

Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

Accounting services and SMEs : an Australian study

Background: The observance of regulation has become a fundamental part of life for the conduct of business around the world. Governments and their duly appointed designates, acting in the interest of the collective public, have relied on regulation to moderate economic and social behaviour through the imposition and enforcement of rules. While it can be commonly accepted that such a prescriptive framework may be necessary for the achievement of desired economic and social outcomes, regulation does impose costs on society and on individual firms. These costs, which can include the costs for government departments to administer, the cost for firms to comply, and the multitude of indirect costs such as lost innovation and productivity or their interrelated opportunity costs, have received ample attention.

Accountants are key advisers to all businesses on all aspects of doing business, including regulation. As such, it is appropriate that ACCA has sponsored this study, which explores the regulatory issues facing SMEs and the critical role that accountants and other organisations play in helping SMEs be aware of, comply with and generally manage effectively the regulations that apply to their business.

ACCA has consistently argued for a balanced view to be taken on regulation, recognising that certain rules are necessary for the fair development of business and for employees’ rights. Yet at the same time, ACCA recognises that SMEs are likely to be disproportionately burdened by regulatory requirements and, as a consequence, it actively campaigns for fairness in regulation, recognising the issue as a significant factor in the success, productivity and growth of small businesses.

Overview: This study complements similar research commissioned by ACCA in the United Kingdom and Canada (Blackburn et al. 2006), with the aim of helping to provide a more international picture of the effects of regulation on adviceseeking by SMEs and how accountants can help SMEs meet their regulatory obligations.

The research commenced in November 2006 and was conducted over the Australian summer period 2006/7, among SMEs and accounting practices, as follows:

* telephone survey among 250 SMEs
* postal survey among 130 accounting practitioner firms.

Key findings: The SME section of this study revealed the following points.

* Most SMEs (between 70% and 80%), agreed that the regulations under review were reasonable, however there were significantly high levels of concern regarding:
* the number of regulations affecting their business (80%)
* staying up to date with changing regulations (80%)
* complexity of regulation or the ease of understanding regulations (77%)
* inequity, or the cost of regulation in proportion to the business (66%)
* duplication, or being required to provide the same information to more than one government department (55%).
* External accountants were the most common source of advice, being used by 72% of SMEs; this was followed by federal government agencies,    62%; trade or industry bodies, 61%; and a lawyer or solicitor, 53%.
* Highest levels of satisfaction with the advice provided were recorded for lawyers/solicitors (94%), banks (91%) and external accountants (90%).
* Overall, 80% of SMEs who had used accountants rated their service as excellent or good. Thirty per cent gave accountants an excellent rating.
* Accountants rated particularly well on the following attributes:
* the potential for a long-term relationship with the business (81% excellent/good)
* technical understanding of the regulatory requirements that apply to the business (79%)
* ability to meet the needs of the business (77%)
* understanding of the business of the SME and its operations (73%).

The survey of accounting practitioners produced the following information.
* The results indicate that SME firms with fewer than 10 employees are the main source of revenue for the respondent accounting practitioners.
* Virtually all accountants provide regulatory advice, primarily in the areas of taxation (particularly Goods and Services Tax, GST), and Do-It-      Yourself (DIY) superannuation requirements. These services provided the accountants with their largest business growth in the two years before the time of the survey.

Seventy-nine per cent of accountants referred their SME clients to external professional advisers. Their comments indicate (see Appendix 4) that some accountants consider their role to be as convenors or advisers for their SME clients. Importantly, according to the accountants, SME firms with fewer than 10 employees did not update their knowledge of regulatory requirements; they relied on their accountant for the right advice. The main types of external adviser to whom accountants referred their SME clients were lawyers and financial planners.

* Accountants expressed their concern regarding the complexity and amount of regulations affecting their SME clients.
* The accountants also stated that they would like to provide additional advice to their SME clients.
 
Confidence intervals – SME survey:  The survey sample size was 250 SMEs from the total of 1.2 million Australian SMEs. Any estimate of proportions agreeing or disagreeing with particular statements must be considered with respect to the margin of possible statistical error. Owing to the small sample size, generalising the results from this study to a wider population of SMEs may be constrained.

A 95% confidence interval of the sample mean for the following estimates based on a percentage agreement of 75% to a proposition with a sample size of 250 would be from 69.5% to 80.5%. The 95% confidence interval for estimates of any other value will diverge slightly in magnitude from the numbers given.

In general then we can be highly confident that the actual sample mean will be within approximately ± 5% of the figure given, with a survey of this size. Confidence intervals – acounting practitioner survey IBISWorld estimates reveal a figure of 9,222 accounting practices in Australia as at June 2006 (IBISWorld 2007). The sample size of 133 accounting practitioners gives a 95% confidence limit that the results reported from the mail-out survey are within the ± 5% confidence interval of the reported values.

Conclusions:  This report describes the results of two parallel surveys undertaken on the impact of business regulation on small and medium-sized enterprises in Australia and on the perceptions of accounting firms about the ways in which the regulatory impact on the SME sector drove their business.

The survey of SMEs provides empirical support for many of the concerns raised with the Regulation Taskforce, which reported to the Australian government in 2006. Many businesses are concerned about the volume and complexity of government legislation as it applies to their business. They are concerned that they are unable to keep up with new legislation and that there is apparent duplication of reporting requirements across the various tiers of government.

The survey of accountants revealed that accounting firms derive a significant proportion of their revenue from SMEs. While the SMEs are concerned with regulatory changes, the accountants surveyed reported that the major growth areas in their businesses were in what could be seen as traditional accounting areas of tax and superannuation. Some SMEs sought advice on areas such as employment law, environmental regulation and health and safety but it appears that many accountants refer their clients to specialists in these areas. Recent changes to the laws regarding financial planning in Australia may lead to changes in the market for financial advice in Australia, with many accountants apparently regarding this as a key driver of future business opportunities.

The surveys were conducted using a similar instrument to similar surveys conducted in the UK and Canada and reported in Blackburn et al. (2006). Comparisons of the Australian survey results with those from the UK and Canada seem to support the perception that Australian business is not over-regulated, but the SME sector is concerned with the volume and complexity of regulation. This suggests that the SME sector wants to see improvements to Australia’s regulatory regime as a result of the work of the Regulation Taskforce undertaken in 2005/6. In its response to the work of the Taskforce the government agreed with 158 of the 178 specific recommendations of the Taskforce. This now needs to be followed through at all levels of government.

Accountants in all three countries understand their SME clients’ concerns with the burden of regulation and they are prepared to advise their clients where appropriate or refer them to specialist advisers. Most business growth for accountants has come from the taxation area. Very few accountants in the UK or Australia specialise in providing advice in the areas of environmental regulation or health and safety regulation.

International comparisons show that in all three countries accountants are generally highly regarded by SMEs for their professionalism and competence. The major area of client concern is the value for money offered by the accountant’s service. In an era of rapidly shifting professional and technical boundaries, accountants need to be more strongly attuned to levels of client satisfaction. Lawyers, financial planners and a plethora of specialist advisers operate in the business services market and if they have an opportunity to take business from accountants by competing on price they may well do so. This suggests a stronger role for professional accounting bodies in monitoring the broader business services market for opportunities and threats on behalf of their membership.

"Tell us something new!" : the response of planning and transport professionals to public health guidance on the built environment and physical activity

A large proportion of non-communicable disease can be attributed to modifiable risk factors such as poor nutrition and physical inactivity. We present data on planning and transport practitioners' perceptions and responses to government public health guidance aimed at modifying environmental factors to promote physical activity. This study was informed by questions on the role of evidence-based guidance, the views of professionals towards the guidance, the links between guidance and existing legislation and policy and the practicality of guidelines. A key informant 'snowball' sampling technique was used to recruit participants from the main professional planning organisations across England. Seventy-six people were interviewed in eight focus groups. We found that evidence-based public health guidance is a new voice in urban and town planning, although much of the advice is already reflected by the 'accepted wisdom' of these professions. Evidence-based health guidance could be a powerful driver affecting planning practice, but other legislated planning guidance may take priority for planning and transport professionals.

UnitingCare West Outreach Services and the Good Lives Model of offender rehabiliation

UnitingCare West is a not-for-profit community services organisation committed to achieving justice, hope and opportunity for all, and works to support and empower in particular those most in need in the WA community. Through its program Outreach Services, it delivers a specialist re-entry service for sex offenders and men serving life and indeterminate sentences. The program has recently been reviewed by Dr Andrew Day from the Centre for Offender Reintegration, Deakin University with input from Dr Tony Ward, University of Victoria, Wellington, New Zealand. In this paper we describe the aims of the review, the process and findings and our ongoing work in developing a rationale for the service that is underpinned by the Good Lives Model (GLM) of offender rehabilitation. More generally, the presentation will seek to understand the needs of offenders who re-enter the community following long-term imprisonment in relation to those areas of need identified in the GLM.

Anycast services and its applications

Anycast in next generation Internet Protocol is a hot topic in the research of computer networks. It has promising potentials and also many challenges, such as architecture, routing, Quality-of-Service, anycast in ad hoc networks, application-layer anycast, etc. In this thesis, we tackle some important topics among them. The thesis at first presents an introduction about anycast, followed by the related work. Then, as our major contributions, a number of challenging issues are addressed in the following chapters. We tackled the anycast routing problem by proposing a requirement based probing algorithm at application layer for anycast routing. Compared with the existing periodical based probing routing algorithm, the proposed routing algorithm improves the performance in terms of delay. We addressed the reliable service problem by the design of a twin server model for the anycast servers, providing a transparent and reliable service for all anycast queries. We addressed the load balance problem of anycast servers by proposing new job deviation strategies, to provide a similar Quality-of-Service to all clients of anycast servers. We applied the mesh routing methodology in the anycast routing in ad hoc networking environment, which provides a reliable routing service and uses much less network resources. We combined the anycast protocol and the multicast protocol to provide a bidirectional service, and applied the service to Web-based database applications, achieving a better query efficiency and data synchronization. Finally, we proposed a new Internet based service, minicast, as the combination of the anycast and multicast protocols. Such a service has potential applications in information retrieval, parallel computing, cache queries, etc. We show that the minicast service consumes less network resources while providing the same services. The last chapter of the thesis presents the conclusions and discusses the future work.

Cross-cultural adaptation of a tobacco questionnaire for Punjabi, Cantonese, Urdu and Sylheti speakers: qualitative research for better clinical practice, cessation services and research.Â

Objective : To develop cross‐culturally valid and comparable questionnaires for use in clinical practice, tobacco cessation services and multiethnic surveys on tobacco use.
Methods : Key questions in Urdu, Cantonese, Punjabi and Sylheti on tobacco use were compiled from the best existing surveys. Additional items were translated by bilingual coworkers. In one‐to‐one and group consultations, lay members of the Pakistani, Chinese, Indian Sikh and Bangladeshi communities assessed the appropriateness of questions. Questionnaires were developed and field tested. Cross‐cultural comparability was judged in a discussion between the researchers and coworkers, and questionnaires were finalised. Questionnaires in Cantonese (written and verbal forms differ) and Sylheti (no script in contemporary use) were written as spoken to avoid spot translations by interviewers.
Results : The Chinese did not use bidis, hookahs or smokeless tobacco, so these topics were excluded for them. It was unacceptable for Punjabi Sikhs to use tobacco. For the Urdu speakers and Sylheti speakers there was no outright taboo, particularly for men, but it was not encouraged. Use of paan was common among women and men. Many changes to existing questions were necessary to enhance cultural and linguistic appropriateness—for example, using less formal language, or rephrasing to clarify meaning. Questions were modified to ensure comparability across languages, including English.
Conclusion : Using theoretically recommended approaches, a tobacco‐related questionnaire with face and content validity was constructed for Urdu, Punjabi, Cantonese and Sylheti speakers, paving the way for practitioners to collect more valid data to underpin services, for sounder research and ultimately better tobacco control. The methods and lessons are applicable internationally.

Structure and transport properties in an N,N-substituted pyrrolidinium tetrafluoroborate plastic crystal system

The structure and transport of N-propyl-N-methylpyrrolidinium tetrafluoroborate (P₁₃BF₄) has been investigated over a wide temperature range in consequence to exhibiting properties suitable for potential solid-state superionic electrolyte applications. Prior to melting, the organic salt, P₁₃BF₄, transforms into a plastic crystal phase. Intrinsic conductivity in this solid, phase I (45–65 °C), is comparable to that in the melt (_~10⁻³ S cm⁻¹). Ionic motion and transport properties were investigated by ¹H and ¹¹B nuclear magnetic resonance (NMR) spectroscopy. Pressure-induced plastic flow in this system may accommodate volume changes in device application and to this extent, X-ray diffraction (XRD) has been used. Scanning electron microscopy (SEM) revealed complex surface morphology and lattice imperfections associated with the strong orientational disorder of the plastic state.