Obesity in pregnancy : outcomes and economics

Maternal obesity is an important aspect of reproductive care. It is the commonest risk factor for maternal mortality in developed countries and is also associated with a wide spectrum of adverse pregnancy outcomes. Maternal obesity may have longer-term implications for the health of the mother and infant, which in turn will have economic implications. Efforts to prevent, manage and treat obesity in pregnancy will be costly, but may pay dividends from reduced future economic costs, and subsequent improvements to maternal and infant health. Decision-makers working in this area of health services should understand whether the problem can be reduced, at what cost; and then, what cost savings and health benefits will accrue in the future from a reduction of the problem.

Semantic and context-based retrieval of digital cultural objects [Published in Chinese]

Cultural objects are increasingly generated and stored in digital form, yet effective methods for their indexing and retrieval still remain an important area of research. The main problem arises from the disconnection between the content-based indexing approach used by computer scientists and the description-based approach used by information scientists. There is also a lack of representational schemes that allow the alignment of the semantics and context with keywords and low-level features that can be automatically extracted from the content of these cultural objects. This paper presents an integrated approach to address these problems, taking advantage of both computer science and information science approaches. We firstly discuss the requirements from a number of perspectives: users, content providers, content managers and technical systems. We then present an overview of our system architecture and describe various techniques which underlie the major components of the system. These include: automatic object category detection; user-driven tagging; metadata transform and augmentation, and an expression language for digital cultural objects. In addition, we discuss our experience on testing and evaluating some existing collections, analyse the difficulties encountered and propose ways to address these problems.

Are country and cultural values interchangeable? : a case example using occupational stress and coping

Cross-cultural research in occupational stress and coping has produced a wealth of knowledge. Although advancement has been made, there are still problems to be solved. One of these problems is the confusion generated in the literature by researchers claiming nation or country as representing cultural values, and the use of the two terms interchangeably. It remains unclear whether this practice is correct. The present paper reported on this by using 511 full time employees from Australia, Singapore and Sri Lanka to study occupational stress and coping. Results revealed that cultural value paradigm (i.e., Individualism-Collectivism) was distributed across the three nations, such that over 60% of participants across the three nations were either high or low in both I-C paradigms. The findings also indicated that the relationship between cultural value paradigm and country impacted on stress and coping differently. The study shows that significant differences exist within country, as well as between countries, such that any attempt to equate ‘culture’ with ‘country’ becomes problematic. Therefore, these findings establish that country or nation was not the same as culture values and could not be used interchangeably.

Creating cultural change in education : A proposal for a continuum for evaluating the effectiveness of sustainable schools implementation strategies in Australia

Networks are increasingly recognised as advantageous when creating and embedding cultural change within organisations. This paper explores andproblematises ideas around networks for education for sustainability (EfS), Australian Sustainable Schools Initiative (AuSSI), a national, whole-school approach to EfS. In three Australian states - New South Wales, Victoria and Queensland – AuSSI has been implemented in different ways. In examining the use of products, facilitators and networks to embed initiatives such as AuSSI in Australian schools, we propose a “continuum of cultural change strategies” as a framework for thinking about each of these approaches to creating organisational and cultural change for sustainability. We anticipate that such a framework may assist where choices need to be made in relation to the kinds of capacity building processes that might best achieve “deep and wide” change within schools hoping to engender significant cultural change.

Project culture in the Chinese construction industry : perceptions of contractors

In recent years culture has become one of the most studied topics in project management research. Some studies have investigated the influence of culture at different levels – such as national culture, industry culture, organisational culture and professional culture. As a project-based industry, the construction industry needs to have more insight concerning cultural issues at the project level and their influence on the performance of construction projects. Few studies, however, have focused on culture at the project level. This paper uses a questionnaire survey to determine the perceptions of Chinese contractors about the impact of project culture on the performance of local construction projects. This is augmented by a series of in-depth interviews with senior executive managers in the industry. The findings indicate that specific project culture does contribute significantly towards project outcomes. In particular, goal orientation and flexibility, as two dimensions of project culture, have a negative statistical correlation with perceived satisfaction of the process, commercial success, future business opportunities, lessons learnt from the project, satisfaction with the relationships, and overall performance. This paper also indicates that the affordability of developing an appropriate project culture is a major concern for industry practitioners.

From 'sympathetic' to 'dialogic' imagination : cultural study in the foreign language classroom

This chapter reports on a critical literacy approach to developing intercultural competence in an EFL/ESL classroom: an approach which uses a form of 'connective analysis' between linguacultures leading to productive exploration of the interstices between cultures.

Setting hospital infection control policy : a decision-making framework incorporating health economics and healthcare epidemiology

Background: Reducing rates of healthcare acquired infection has been identified by the Australian Commission on Safety and Quality in Health Care as a national priority. One of the goals is the prevention of central venous catheter-related bloodstream infection (CR-BSI). At least 3,500 cases of CR-BSI occur annually in Australian hospitals, resulting in unnecessary deaths and costs to the healthcare system between $25.7 and $95.3 million. Two approaches to preventing these infections have been proposed: use of antimicrobial catheters (A-CVCs); or a catheter care and management ‘bundle’. Given finite healthcare budgets, decisions about the optimal infection control policy require consideration of the effectiveness and value for money of each approach. Objectives: The aim of this research is to use a rational economic framework to inform efficient infection control policy relating to the prevention of CR-BSI in the intensive care unit. It addresses three questions relating to decision-making in this area: 1. Is additional investment in activities aimed at preventing CR-BSI an efficient use of healthcare resources? 2. What is the optimal infection control strategy from amongst the two major approaches that have been proposed to prevent CR-BSI? 3. What uncertainty is there in this decision and can a research agenda to improve decision-making in this area be identified? Methods: A decision analytic model-based economic evaluation was undertaken to identify an efficient approach to preventing CR-BSI in Queensland Health intensive care units. A Markov model was developed in conjunction with a panel of clinical experts which described the epidemiology and prognosis of CR-BSI. The model was parameterised using data systematically identified from the published literature and extracted from routine databases. The quality of data used in the model and its validity to clinical experts and sensitivity to modelling assumptions was assessed. Two separate economic evaluations were conducted. The first evaluation compared all commercially available A-CVCs alongside uncoated catheters to identify which was cost-effective for routine use. The uncertainty in this decision was estimated along with the value of collecting further information to inform the decision. The second evaluation compared the use of A-CVCs to a catheter care bundle. We were unable to estimate the cost of the bundle because it is unclear what the full resource requirements are for its implementation, and what the value of these would be in an Australian context. As such we undertook a threshold analysis to identify the cost and effectiveness thresholds at which a hypothetical bundle would dominate the use of A-CVCs under various clinical scenarios. Results: In the first evaluation of A-CVCs, the findings from the baseline analysis, in which uncertainty is not considered, show that the use of any of the four A-CVCs will result in health gains accompanied by cost-savings. The MR catheters dominate the baseline analysis generating 1.64 QALYs and cost-savings of $130,289 per 1.000 catheters. With uncertainty, and based on current information, the MR catheters remain the optimal decision and return the highest average net monetary benefits ($948 per catheter) relative to all other catheter types. This conclusion was robust to all scenarios tested, however, the probability of error in this conclusion is high, 62% in the baseline scenario. Using a value of $40,000 per QALY, the expected value of perfect information associated with this decision is $7.3 million. An analysis of the expected value of perfect information for individual parameters suggests that it may be worthwhile for future research to focus on providing better estimates of the mortality attributable to CR-BSI and the effectiveness of both SPC and CH/SSD (int/ext) catheters. In the second evaluation of the catheter care bundle relative to A-CVCs, the results which do not consider uncertainty indicate that a bundle must achieve a relative risk of CR-BSI of at least 0.45 to be cost-effective relative to MR catheters. If the bundle can reduce rates of infection from 2.5% to effectively zero, it is cost-effective relative to MR catheters if national implementation costs are less than $2.6 million ($56,610 per ICU). If the bundle can achieve a relative risk of 0.34 (comparable to that reported in the literature) it is cost-effective, relative to MR catheters, if costs over an 18 month period are below $613,795 nationally ($13,343 per ICU). Once uncertainty in the decision is considered, the cost threshold for the bundle increases to $2.2 million. Therefore, if each of the 46 Level III ICUs could implement an 18 month catheter care bundle for less than $47,826 each, this approach would be cost effective relative to A-CVCs. However, the uncertainty is substantial and the probability of error in concluding that the bundle is the cost-effective approach at a cost of $2.2 million is 89%. Conclusions: This work highlights that infection control to prevent CR-BSI is an efficient use of healthcare resources in the Australian context. If there is no further investment in infection control, an opportunity cost is incurred, which is the potential for a more efficient healthcare system. Minocycline/rifampicin catheters are the optimal choice of antimicrobial catheter for routine use in Australian Level III ICUs, however, if a catheter care bundle implemented in Australia was as effective as those used in the large studies in the United States it would be preferred over the catheters if it was able to be implemented for less than $47,826 per Level III ICU. Uncertainty is very high in this decision and arises from multiple sources. There are likely greater costs to this uncertainty for A-CVCs, which may carry hidden costs, than there are for a catheter care bundle, which is more likely to provide indirect benefits to clinical practice and patient safety. Research into the mortality attributable to CR-BSI, the effectiveness of SPC and CH/SSD (int/ext) catheters and the cost and effectiveness of a catheter care bundle in Australia should be prioritised to reduce uncertainty in this decision. This thesis provides the economic evidence to inform one area of infection control, but there are many other infection control decisions for which information about the cost-effectiveness of competing interventions does not exist. This work highlights some of the challenges and benefits to generating and using economic evidence for infection control decision-making and provides support for commissioning more research into the cost-effectiveness of infection control.

Closing the cultural distance gap: managing value-based knowledge in MNC by using MEP

Today more than ever, generating and managing knowledge is an essential source of competitive advantage for every organization, and particularly for Multinational corporations (MNC). However, despite the undisputed agreement about the importance of creating and managing knowledge, there are still a large number of corporations that act unethically or illegally. Clearly, there is a lack of attention in gaining more knowledge about the management of ethical knowledge in organizations. This paper refers to value-based knowledge, as the process of recognise and manage those values that stand at the heart of decision-making and action in organizations. In order to support MNCs in implementing value-based knowledge process, the managerial ethical profile (MEP) has been presented as a valuable tool to facilitate knowledge management process at both the intra-organizational network level and at the inter-organizational network level.

Internationalising the curriculum : attending to cultural diversity in teaching and learning across three faculties at QUT

This was a two-year project focusing on internationalising the curriculum within the context of the QUT Graduate Capabilities and teaching and learning issues within three Faculties. It was based on the assumption that there is an increased need for social and cultural responsiveness in curriculum that intersects local, national and global contexts and priorities. The Internationalising the Curriculum Project sought to challenge and support staff (academic and general) and students to engage with complex concepts of identity, values, awareness and sensitivity as they relate to internationalising the curriculum. The project took a case study approach to planning, implementation and evaluation in a way that complements and enhances platforms developed and emerging from the Indigenous Perspectives and cultural diversity projects already underway in Education, Creative Industries and QUT, Carseldine.