Patient costs during tuberculosis treatment in Bangladesh and Tanzania: the potential of shorter regimens

OBJECTIVE: To estimate the costs incurred by patients during the intensive and continuation phases of the current 6-month tuberculosis (TB) regimen in Bangladesh and Tanzania, and thus identify potential benefits to patients of a shorter, 4-month treatment regimen. DESIGN: The validated Stop TB patient cost questionnaire was adapted and used in interviews with 190 patients in the continuation phase of treatment with current regimens. RESULTS: In both countries, overall patient costs were lower during 2 months of the continuation phase (US$74 in Tanzania and US$56 in Bangladesh) than during the 2 months of the intensive phase of treatment (US$150 and US$111, respectively). However, continuation phase patient costs still represented 89% and 77% of the 2-month average national income in the respective countries. Direct travel costs in some settings were kept low by local delivery system features such as community treatment observation. Lost productivity and costs for supplementary foods remained significant. CONCLUSIONS: Although it is not a straightforward exercise to determine the exact magnitude of likely savings, a shorter regimen would reduce out-of-pocket expenses incurred by patients in the most recent 2 months of the continuation phase and allow an earlier return to productive activities. © 2014 The Union.

Strategies for the implementation of continuing professional development for SMEs in construction

The Victorian government (in Australia) intends to mandate that all registered building practitioners (RBP) undertake a minimum level of Continuing Professional Development (CPD) as part of the registration process. The introduction of CPD increases the travel costs for construction practitioners; due to the necessity to undertake a minimum level of training. This places an increased burden on construction companies' especially small regional-based firms that are not in a position of financial strength. This research is based on study of training needs of 73 construction companies in Victoria, Australia. The results show that training costs are being unequally weighted towards small regional-based firms; suggesting that the location of the company is a major contributing factor to their ability to meet registration requirements. Regional companies have comparatively high costs for training compared to metropolitan-based firms. Company location is a limiting factor that impacts on the ability of regional firms to implement training programs. This research investigates the notion that increasing registration requirements will improve outcomes for all participants.

Testing optimal foraging theory models on benthic divers

Empirical testing of optimal foraging models on diving air-breathing animals is limited due to difficulties in quantifying the prey field through direct observations. Here we used accelerometers to detect rapid head movements during prey encounter events (PEE) of free-ranging benthic-divers, Australian fur seals, Arctocephalus pusillus doriferus. PEE signals from accelerometer data were validated by simultaneous video data. We then used PEEs as a measure of patch quality to test several optimal foraging model predictions. Seals had longer bottom durations in unfruitful dives (no PEE) than those with some foraging success (PEE. ≥. 1). However, when examined in greater detail, seals had longer bottom durations in dives with more PEEs, but shorter bottom durations in bouts (sequences of dives) with more PEEs. Our results suggest that seals were generally maximizing bottom durations in all foraging dives, characteristic of benthic divers. However, successful foraging dives might be more energetically costly (e.g. digestive costs), thus resulting in shorter bottom durations at the larger scale of bouts. Our study provides a case study of how the foraging behaviour of a central place forager foraging in a fairly homogeneous environment, with relatively high travel costs, may deviate from current foraging models under different situations. Future foraging models should aim to integrate other aspects (e.g. diet) of the foraging process for more accurate predictions.

Estimating the economic value of Mount Buffalo National Park with the travel cost and contingent valuation models

The Mount Buffalo National Park is the oldest national park in Victoria, Australia. There has been a rapid increase in the number of visitors to the park during the last decade and park management has been a concern, especially in the light of declining budgetary allocations and potential damage due to the increased visitor numbers. Policy options to increase park revenue remain unclear because of a lack of information on demand parameters and user costs. This study estimates the economic value of the park using the travel cost method (TCM) and the contingent valuation method (CVM). The TCM gives higher consumer surplus (CS) than the CVM. The CS shows that the economic value of the park is high and that there are opportunities to introduce innovative fee schemes to enhance its revenue. Present entry fee systems do not capture the economic value of the park.

Why do Australians, New Zealanders and Americans travel to Fiji? Evidence from cointegration, unit roots and parameter stability tests

The aim of this study was to estimate the demand for Fiji’s tourism from its three main source markets—Australia, New Zealand, and the US—using the bounds testing approach to cointegration. Our main finding was that visitor arrivals to Fiji and its key determinants are cointegrated over the 1970–2000 period. We then used the autoregressive distributed lag model to estimate short-run and long-run elasticities and found that income in origin countries, transport costs, and prices were significant determinants of Fiji’s tourism demand. We also found that coups negatively impact visitor arrivals from all markets. In testing for parameter stability, we established that the series were integrated of order one in the presence of a structural break. We then used the Hansen test for parameter stability and found that the parameters of our long-run model are stable over time.

Travel undertaken by women accessing private Victorian pregnancy termination services

Objective: To investigate the extent and cost of travel undertaken by women accessing Victorian termination of pregnancy services.

Design, setting and participants: This was a multi-centre, cross-sectional observational study of women receiving privately funded pregnancy termination services, conducted between November 2002 and June 2003 at eight major pregnancy termination service providers in Victoria.

Main outcome measures: Distance travelled, money and time expended undertaking travel, and reasons women chose particular clinics.

Results: Of the 1,244 Australian resident respondents who resided in Victoria, 9.3% travelled more than 100 km to access services. Teenagers were 2.5 times more likely than other respondents to travel further than 100 kilometres (km) (18.2% compared with 7.8%, OR=2.5, 95% CI 1.5-4.2, p<0.001). Women originated from all Australian States and Territories except South Australia and 13.7% were from Statistical Divisions other than Melbourne. More than one-third of respondents (41.3%) chose their clinic because they were referred by a doctor or general practitioner.

Conclusion: Many pregnancy termination patients face substantial and immediate costs beyond the service fee, as well as the diffculties associated with poor continuity of care and signifcant time away from home. Patients and service providers should be consulted further to determine appropriate clinical services, support services and subsidy schemes for the sizeable proportion of patients who undertake long-distance travel to access pregnancy termination services.

Employer benefits and costs of employing a person with a disability

This paper is based on results of a national study in Australia. Questionnaires were completed by 643 employers, each of whom had employed a person with a disability between 1996-1998. Employers rated the importance of several factors relevant to decisions to hire and retain a person with a disability. Individual factors were rated most important, with grooming/hygiene and work-performance factors rated highest. Management factors and cost factors were rated moderately important. Social factors were rated least important. Analyses of variance were conducted, identifying several employer differences in ratings. The paper discusses employer values as well as the need to include employers in a partnership approach.

Estimating quality costs in an automotive stamping plant through the use of simulation

The pressures of modern manufacturing require that the quality-cost benefits are determined when evaluating new procedures or alternative operating policies. Traditionally, cost reports and other quality metrics have been used for this purpose. However, the interactions between the main quality cost drivers cannot be understood at the superficial level and the effect that a new process or an alternative operating policy may have on quality costs is difficult to determine. An alternative to the traditional costing methods is simulation. The current work uses simulation to evaluate quality costs in an automotive stamping plant where the quality control is determined by operator inspection of their own work. Self-inspection quality control provides instantaneous feedback of quality problems, allowing for quick rectification. However, the difficult nature of surface finish inspection of automotive panels can create inspection and control errors. A simulation model was developed to investigate the cost effects of inspection and control errors and it was found that inspection error had a significant effect in increasing total quality cost, with the magnitude of this increase dependent on the level of control. Further, the simulation found that the lowest cost quality control policy was that which allowed a number of defective panels to accumulate before resetting the press-line.

Estimating demolition costs for single residential buildings

With the increasing stock of aging structures, building
demolition is becoming achallenging research field from
the perspective of management. As the converse of
construction, management of demolition puts forward some
new management themes or adds some new contents
even though the same issues are faced in construction
management. This research aims to develop a quantitative
approach to estimate the costs of a demolition project. A
cost analysis method is presented to systematically break
down the cost components involved in the demolition of
a structure. Due to the lack of robust research in theory
and systematic summary in practice to date, the economic
performances of demolition will be studied through acase
study, and the majority of parameters are derived from
actual experiences in practice. The proposed demolition cost
estimation method is applied to the actual form of building
elimination (Scenario 1), and further comparison is carried
out with two other elimination methods, which are the newly
developed deconstruction (Scenario 2) and mechanical
demolition (Scenario 3). Deconstruction is found to be the
most profitable in this particular instance, and is closely
followed by the actual form.

Access and attitude of rural allied health professionals to CPD and training

Continuing professional development (CPD) activities for allied health professionals are becoming mandatory as a means for professionals to maintain accreditation or skills. To access CPD activities, rural allied health professionals have the added costs of travel, accommodation and information technology access. It is assumed that health professionals in rural areas want access to training and CPD. In 2003, a survey of allied health professionals was carried out in Southwest Victoria, Australia, with the aim of identifying access and attitudes to CPD. Results showed that allied health professionals in Southwest Victoria were highly qualified, wished to access CPD more than four times a year and were prepared to spend a mean rate of $1000 (1300) per annum on CPD activities.

Cyberfraud & identity theft: the hidden costs of business process outsourcing

Offshore business process outsourcing involves additional risks, according to Anne Rouse and David Watson. Here they outline some of these with strategies for their management.

The metabolic and cognitive energy costs of stabilising a high-energy interlimb coordination task

Kinematic (relative phase error), metabolic (oxygen consumption, heart rate) and attentional (baseline and cycling reaction times) variables were measured while participants practised a high energy-demanding, intrinsically unstable 90° relative phase coordination pattern on independent bicycle ergometers. The variables were found to be strongly inter-correlated, suggesting a link between emerging performance stability with practice and minimal metabolic and attentional cost. The effects of practice of 90° relative phase coordination on the performance of in-phase (0°-phase) and antiphase (180°-phase) coordination were investigated by measuring the relative phase attractor layouts and recording the metabolic and attentional cost of the three coordination patterns before and after practice. The attentional variables did not differ significantly between coordination patterns and did not change with practice. Before practice, the coordination performance was most accurate and stable for in-phase cycling, with antiphase next and 90°-phase the poorest. However, metabolic cost was lower for antiphase than either in-phase or 90°-phase cycling, and the pre-practice attractor layout deviated from that predicted on the basis of dynamic stability as an attractor state, revealing an attraction to antiphase cycling. After practice of 90°-phase cycling, in-phase cycling remained the most accurate and stable, with 90°-phase next and antiphase the poorest, but antiphase retained the lowest metabolic energy cost. The attractor layout had changed, with new attractors formed at the practised 90°-phase pattern and its symmetrical partner of 270°-phase. Considering both the pre- and post-practice results, attractors were formed at either a low metabolic energy cost but less stable (antiphase) pattern or at a more stable but higher metabolic energy cost (90°-phase) pattern, but in neither case at the most stable and accurate (in-phase) pattern. The results suggest that energetic factors affect coordination dynamics and that coordination modes lower in metabolic energy expenditure may compete with dynamically stable modes.

Can you seek security for costs in international arbitration in Australia

International arbitrations can be conducted under either federal or State legislation in Australia. In both cases complexities arise in the resolution of procedural questions, such as whether security for costs can be granted. There is scant Australian case law on such issues. This article considers whether an arbitral tribunal or a court has the power [*2] to order security for costs in an international arbitration in Australia. After analysing Australia's international arbitration laws and discussing New Zealand and House of Lords' authority, it is argued that unless the parties have specifically empowered the arbitral tribunal to order security for costs, only the relevant court has that power, and even that is uncertain.