Costs and advance directives at the end of life: a case of the ‘Coaching Older Adults and Carers to have their preferences Heard (COACH)’ trial

BACKGROUND: Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs).

METHODS: Study participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs.

RESULTS: The trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs.

CONCLUSION: For our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people.

Characterization of apolipoprotein E genetic variations in Taiwanese: assocation with coronary heart disease and plasma lipid levels

Apolipoprotein E (apoE, protein; APOE, gene) is important in lipoprotein metabolism. Three isoforms, apoE2 (Cys112 Cys158), apoE3 (Cys112 Arg158), and apoE4 (Arg112 Arg158), are present in the general population. This report investigates the frequency distribution of apoE isoforms and the association of APOE genotypes with plasma lipid profile and coronary heart disease (CHD) in a population of Taiwan. ApoE isoforms were determined genetically by polymerase chain reaction and HhaI restriction enzyme digestion in control and coronary heart disease (CHD) patients. Plasma lipid and lipoprotein concentrations were also determined. The control group exhibited frequencies of 84.6% APOE3, 7.9% APOE4, 7.5% APOE2, 70.6% APOE3E3, 14.4% APOE3E4, 13.6% APOE2E3, and 1.4% APOE2E4. Comparable frequencies were observed in the CHD group. In both APOE2 carrier and APOE3E3 groups, the CHD patients expressed abnormal lipid profiles while the control group expressed normal lipid profiles. The APOE4 carriers, however, expressed abnormal lipid profiles in both normal control and CHD groups. Extremely high apoE levels in the hypertriglyceridemic group (TG > 400 mg/dL) seemed to be undesirable and were often observed in CHD patients

Behavioural effects of tourism on oceanic common dolphins, Delphinus sp., in New Zealand: the effects of Markov analysis variations and current tour operator compliance with regulations

Common dolphins, Delphinus sp., are one of the marine mammal species tourism operations in New Zealand focus on. While effects of cetacean-watching activities have previously been examined in coastal regions in New Zealand, this study is the first to investigate effects of commercial tourism and recreational vessels on common dolphins in an open oceanic habitat. Observations from both an independent research vessel and aboard commercial tour vessels operating off the central and east coast Bay of Plenty, North Island, New Zealand were used to assess dolphin behaviour and record the level of compliance by permitted commercial tour operators and private recreational vessels with New Zealand regulations. Dolphin behaviour was assessed using two different approaches to Markov chain analysis in order to examine variation of responses of dolphins to vessels. Results showed that, regardless of the variance in Markov methods, dolphin foraging behaviour was significantly altered by boat interactions. Dolphins spent less time foraging during interactions and took significantly longer to return to foraging once disrupted by vessel presence. This research raises concerns about the potential disruption to feeding, a biologically critical behaviour. This may be particularly important in an open oceanic habitat, where prey resources are typically widely dispersed and unpredictable in abundance. Furthermore, because tourism in this region focuses on common dolphins transiting between adjacent coastal locations, the potential for cumulative effects could exacerbate the local effects demonstrated in this study. While the overall level of compliance by commercial operators was relatively high, non-compliance to the regulations was observed with time restriction, number or speed of vessels interacting with dolphins not being respected. Additionally, prohibited swimming with calves did occur. The effects shown in this study should be carefully considered within conservation management plans, in order to reduce the risk of detrimental effects on common dolphins within the region.

Reducing yarn hairiness with a modified yarn path in worsted ring spinning

The spinning geometry of a ring frame plays an important role, and the twist triangle is the critical region in ring spinning. Changes in the spinning geometry may affect yarn properties. This paper examines the idea of ring spinning with a "diagonal" yarn path, and the effect of such a path on yam properties, particularly hairiness. Both "left diagonal" and "right diagonal" yam arrangements are tried on a 24-spindle Cognetex FLC worsted ring frame. The hairiness results obtained from the Zweigle hairiness meter show that the right diagonal yam path produces yams of lower hairiness than the conventional ring spun yarn in almost all the hair length groups. Yam evenness and tenacity are not as sensitive to the change in yarn path. The mean spindle speed at break is also tested, and there is some deterioration in spinning efficiency with the right diagonal yarn path, particularly at higher spinning speeds. Results from this study may help explain variations in yarns spun on poorly aligned ring frames.

Modeling the tensile behavior of fibers with geometrical and structural irregularities

Virtually all fibers exhibit some dimensional and structural irregularities. These include the conventional textile fibers, the high-performance brittle fibers and even the newly developed nano-fibers. In recent years, we have systematically examined the effect of fiber dimensional irregularities on the mechanical behavior of the irregular fibers. This paper extends our research to include the combined effect of dimensional and structural irregularities, using the finite element method (FEM). The dimensional irregularities are represented by sine waves with a 30 % magnitude of diameter variation while the structural irregularities are represented by longitudinal and horizontal cavities distributed within the fiber structure. The results indicate that fiber geometrical or dimensional variations have a marked influence on the tensile properties of the fiber. It affects not only the values of the breaking load and extension, but also the shape of the load-extension curves. The fiber structural irregularities simulated in this study appear to have little effect on the shape of the load-extension curves.

Evaluating the robustness of objective pilling classification with the two-dimensional discrete wavelet transform

Previously, we proposed a new method of frequency domain analysis based on the two-dimensional discrete wavelet transform to objectively measure pilling intensity in sample fabric images. We have further evaluated this method, and our results indicate that it is robust to small horizontal and/or vertical translations and to significant variations in the brightness of the image under analysis, and is sensitive to rotation and to dilation of the image. These results suggest that as long as precautions are taken to ensure fabric test samples are imaged under consistent conditions of weave/knit pattern alignment (rotation) and apparent interyarn pitch (dilation), the method will yield repeatable results.

Are age-related variations in breeding performance greatest when food availability is limited?

Age-related improvements in reproductive performance in seabirds have been well documented, and may be explained by improvements in foraging efficiency or increased experience and reproductive effort with age. The interactive effects of parental age and food supply on reproductive performance, however, remain poorly understood. A widespread mass mortality of pilchards Sardinops sagax in southern Australian waters in 1998 provided a unique opportunity to investigate the effects of a sudden reduction in the availability of amajor prey species on Australasian gannets Morus serrator, an important local marine predator. Age-related differences in the breeding performance of gannets were evident in 1 year of reduced pilchard availability; when food was not limited, both young and experienced parents were equally capable of rearing chicks and had similar levels of breeding success. These data clearly demonstrate the interactive effects of parental age and food supply on breeding performance and suggest that such differences only become apparent when conditions become more stressful.

Can the use of foreign currency derivatives explain variations in foreign exchange exposure? Evidence from Australian companies

We investigate the role of foreign currency derivatives (FCD) in alleviating foreign exchange rate exposure of Australian firms. While there is some evidence that the use of FCD reduces the level of ex-post short-term exposure, such an effect is absent with regard to the degree of foreign operations. Our results support the view that FCDs are used to hedge existing exchange rate exposures and that Australian firms, generally, are extensively exposed to currency fluctuations in the long run. While monthly exposure appears to be a function of a firm's size and financial hedging, exchange rate exposure of shorter horizons (1 and 3 months) appears to be negatively related to a firm's price earnings ratio (proxying growth opportunities)—thereby supporting the ‘underinvestment’ hypothesis. Further, the exposure of longer horizons (12 and 24 months) is positively related to a firm's liquidity, supporting the view that liquidity is a substitute for hedging.

Analysis of stamping production data with view towards quality management

A quality analysis trial was undertaken at Ford Geelong Stamping Plant on a press line that was fitted with standard press sensors to measure press and binder force over the stamping cycle for each panel. The quality of randomly sampled panels was measured by obtaining the panel thicknesses at five points, for 135 panels in total. These points were chosen such that they exhibited different forming modes. This paper analyses the input force data and the output quality data from the trial to determine any potential relationships. The analysis of the production data was performed using statistical correlation techniques to determine initial potential relationships between input and output variables. An Active Shape Model was used to extract features when identifying the major sources of variation within the input data. However, the initial analysis of the data elicited no direct relationship between the input variables measured and the panel thicknesses. This result is significant as the data collected is from a standard sensor configuration found in many press lines through-out the world. The reason for the lack of a direct relationship is believed to come from the lack of sensitivity in the force measurements which are not able to identify small changes in the process, whereas gross geometric variations have in previous studies shown an obvious relationship with changes in the force press profile. This means that existing force sensors require augmentation by additional sensors if a detailed automatic quality control system for the press lines based on input sensors alone.

Inclusion and accountability: communications research with consumers with disabilities

Over the past two decades there has been an increasing focus on doing research with and for consumers rather than on consumers. Research that is collaborative and inclusive has been called for by people with disabilities. People with disabilities are a group of telecommunications consumers who are disadvantaged because of social barriers and access issues with equipment, services and information. In this paper, the benefits and challenges of collaborative (e.g. participatory, participatory action, emancipatory) research with these consumers and the processes that can facilitate inclusive and accountable research outcomes are addressed. Throughout the paper, four questions will be explored: Who determines which research issues are explored and the methods that are used? What is the level of consumer involvement in the research process? How can academics and government ensure that consumer-focused research is inclusive and participatory? How, and to whom, should research results be made available?

In the first part of the paper, the perspectives on consumer research by people with disabilities are presented. Respect for and appreciation of consumers' views underpins the philosophical stance needed by researchers and funding bodies before serious engagement in empowering, person-centred research can be successful.

In the second part of the paper, there is a focus on defining the features of collaborative research approaches. Participatory research, participatory action research, and emancipatory research are variations that incorporate differing levels of consumer involvement. Each of these, however, embrace shifts in philosophy and methods away from more traditional 'scientific' research. Such changes result in a greater sense of inclusion and project ownership by consumers.

The third part of the paper addresses some of the issues associated with collaborative research for consumers with disabilities, for academic researchers, and for government funding bodies. Differing understandings of the social nature of disablement influence attitudes toward consumer involvement and are demonstrated in the choice of research questions, project aims, and the methodologies used. Differing agendas are reflected in reactions to the traditional project requirements and processes of government, the preferred research methodologies of researchers, and the perceived accountability of researchers or government for the dissemination and sharing of research results. The challenges to successful engagement with consumers in collaborative research have been identified in the literature and a number of strategies recommended (Barnes, 2003; Clear, 1999; Mercer, 2002; Oliver, 1992, 1997; Zarb, 1997). Application of inclusive strategies by researchers and funding bodies is essential for positive change and inclusive, empowering outcomes.

The paper concludes with a case study of a DCITA-funded research project. The project is evaluated using participatory/emancipatory research criteria modified from Zarb (1992) and addresses consumer, researcher, and funding body participation. The four questions used in the discussion of the paper are applied to this particular project. In addition, the benefits and learnings from the project will be compared with the outcomes desired by consumers who espouse collaborative research approaches.

Evaluating a measure of content quality for accounting narratives (with an empirical application to narratives from Australia, Hong Kong, and the United States)

This paper evaluates a texture-based approach developed by Sydserff and Weetman (1999), to examine corporate annual report narratives. This is achieved by using the texture index to evaluate information content (which includes readability) in accounting narratives. Specifically, we examine the letter to shareholders of reports from Australia, Hong Kong and the United States.

We suggest a texture-based evaluation provides a robust measure of narrative quality due to the incorporation of readability and content analysis. The ability to measure content quality assists in promoting accountability, with the aim of improving usefulness of corporate
information and disclosures, and greater investor confidence in capital markets.

This paper also investigates these exploratory results to consider variations in quality between different countries. Considerable differences were found between the countries with Hong Kong reports generally superior. These tentative findings provide a small contribution to the comparative annual report literature and the emerging area of narrative evaluation.

At home on the road? Can drivers' relationships with their cars be associated with territoriality?

The current research explores the relationship between people and their cars within the framework of Altman's theory of human territoriality. It further develops the research of Sandqvist by examining the descriptions given by people with differing ownership and uses of their cars and exploring the congruence between these and the characteristics used to describe human territories. Thirteen focus groups were held with young drivers between the ages of 18 and 25 years, drivers over the age of 25 who are parents of pre-license age children, drivers over the age of 25 who do not regularly transport children, and drivers of work vehicles. Analyses of discussions revealed that drivers’ descriptions of the relationship with their car could be matched with Brown and Altman's descriptions of territory types. However, variations existed both between and within individuals as to the application of the labels ‘primary’, ‘secondary’ and ‘public’ territory to the car. Implications for the understanding of road user behaviour and the further development of theory on the car as a place or an object in terms of territoriality are discussed.

Seasonal variations of lipid content and composition in perna viridis

The total lipid content, composition of main lipid classes, composition of sterols and composition of fatty acids in the main glycerolipids of Perna viridis were analyzed through four seasons using TLC-FID and GLC. Mussel samples were collected during different seasons between 2003 and 2004 from Shengsi Island, Zhejiang Province, China and stored frozen prior to freeze-drying and lipid extraction. Ten grams of dried mussel powder of each season were analyzed. Total lipid content ranged from 14.5 g/100 g in spring month to 7.8 g/100 g dried mussel powder in autumn month. The predominant lipid in spring month was triacylglycerol (TAG), however, in the other three seasons the phospholipids (PL) was the main lipid class. The most abundant fatty acid in TAG, PL and phosphatidylcholine (PC) was 16:0, with the summer samples having the highest proportion (24-30% of total fatty acid) and winter the lowest (14-22%). In phosphatidylethanolamine (PE), the spring samples had the highest proportions of 16:0. The predominant polyunsaturated fatty acids (PUFA) were 22:6n-3 and 20:5n-3 in TAG, PL, PE and PC (25-40%). The proportions of 22:6n-3 and 20:5n-3 were higher in spring than in other seasons in PL and PE. There were nine sterols identified, with cholesterol being the predominant sterol, and other main ones were desmostersol/brassicasterol and 24-methylenecholesterol. Proportions of other fatty acids in different lipid fractions and the sterol compositions as well also varied seasonally. There were subject to the seasonal variations. Differences in lipid content and composition, fatty acid composition in different lipid fractions may be caused by multiple factors such as lifecycle, sex, variation of plankton in different seasons and temperature, which could influence physiological activities and metabolism.

Diameter variations of irregular fibers under different tensions

The cross-section area of animal fibers varies along the fiber length, and this geometrical irregularity has a major impact on the mechanical properties of those fibers. In practice fibers are often subjected to tensile stresses during processing and application, which may change fiber cross-section area. It is thus necessary to examine geometrical irregularity of fibers under tension. In this study, scoured animal fibers were subjected to different tensile loading using a Single Fiber Analyzer (SIFAN) instrument. The 3D images of the fiber specimens were first constructed, and then along-fiber diameter irregularities of the specimens were analyzed for different levels of tensile loading. The changes in effective fineness of the fiber specimens were also discussed. The results indicate that for the wool fibers examined, there is considerable discrepancy in the fiber diameter results obtained from the commonly used single scan along fiber length and that from multiple scans at different rotational angles, and that the diameter variation along fiber length increases as fiber tension increases. The results also show that when diameter reduction treatments are applied to wool by stretching, the reduced average fiber diameter is associated with an increase in both within-fiber and between-fiber diameter variations. So in terms of effective fineness, the change is much smaller than the difference between the average diameters of the parent and treated wool. These results have significant implications for improving the accuracy of fiber diameter measurement and evaluation.

Educational enrolment of students with a disability in New South Wales and Victoria

The extent to which legislation and special education policy have impacted on the nature of the educational enrolment of students with a disability in Australia has not been clearly addressed. Although there are no detailed and systematic national data on the enrolment of students with a disability in inclusive settings, special classes and special schools in Australia, some broad trends are apparent. The legislative background to these trends is discussed. As might be expected, there are variations in the nature of the educational enrolment of students with a disability across the states and territories of Australia. Enrolment trends in the two most populous states, New South Wales and Victoria, are examined and discussed within the context of their respective special education policies, disability discrimination legislation, and educational precedent.