Built environment education and research : making connections

This conference is a landmark gathering of those from around the world concerned with the future of Built environment education and Research. It takes place at a time of great change and opportunity. Around the world the long-standing principles of what, how and who we teach for graduate entry into Built environment professions, is increasingly under review. The need for research and the way in which it is funded, conducted and knowledge shared is also under increasing pressure. Both changes are being triggered by a fast changing and increasingly challenging competitive environment for education and research. Competition for the highest quality of graduate entrants in the right numbers is becoming more intense. Competition between Universities, as funding for education and research comes under ever close scrutiny, is intensifying and we are all being forced to look for more effective and exciting ways of recruting, retaining, enhancing and maximising the achievement of our students and of our staff in their research activities. Competition amongst employees in industry is becoming more intense as professional employers increasingly recognise that people and knowledge are their key strategic resources. Universities are increasingly looking to partnerships with industry, the professions and other Universities to further improve their eduacation, research and innovation activities. These challenges are unfolding at a time of accelerating development in information technologies and systems and in our understanding of principles of knowledge management and pedagogical advancement. This environment presents both opportunities and threats to the world of education.

The implication of a term of good faith in commercial leases

Much has been written in the past decade on the subject of the implication of a term of good faith in contracts in Australia, particularly since the judgment Priestley JA in Renard Constructions (ME) Pty Ltd v Minister for Public Works (1992) 26 NSWLR 234. Except for an early article by Rachael Mulheron, 'Good Faith and Commercial Leases: New Opportunities for the Tenant' (1996) 4 APLJ 223, very little else has been written with respect to the possible application of the doctrine to the commercial leases.With the advent of two later New South Wales Supreme Court decisions Alcatel Australia Ltd v Scarcella (1998) 44 NSWLR 349 and, more recently, Advance Fitness v Bondi Diggers [1999] NSWSC 264, the question of the application of the doctrine in the commercial leasing context has been examined. This article briefly considers the nature and substance of the doctrine against the background of the relationship of lessor and lessee and examines in some depth the Australian decisions on commercial leases where it has been sought, unsuccessfully, to apply the doctrine. The article concludes by suggesting that as a standard commercial lease usually covers the field of agreement between lessor and lessee and as a lessee has a high degree of statutory protection derived from equitable principles, there may be little room for the operation of the doctrine in this legal environment.

The implication of a term of good faith in commercial leases — A brief response

By way of response to Professor Duncan's article,1 this article examines the theoretical basis for the implication of contractual terms, particularly the implication of a term at law. In this regard the recent decision of Barrett J in Overlook v Foxtel [2002] NSWSC 17 is considered, to the extent that it provides guidance concerning the implication of an obligation of good faith in the context of a commercial contract. A number of observations are made which may be considered likely to have application to the relationship of commercial landlord and tenant. The conclusion reached is that although the commercial landlord and tenant contractual relationship is highly regulated, this may not deny a remedy to a tenant who is the victim of a landlord's 'bad faith'. Finally, the article concludes by considering the extent to which it may be possible to contractually exclude the implied obligation of good faith.

The S.T.A.B. Trial - Standardised Testing of Artificial Blood. A comparative study of various products that may be used as artificial blood for high fidelity simulation training in the critical care setting

Aim: In the current climate of medical education, there is an ever-increasing demand for and emphasis on simulation as both a teaching and training tool. The objective of our study was to compare the realism and practicality of a number of artificial blood products that could be used for high-fidelity simulation. Method: A literature and internet search was performed and 15 artificial blood products were identified from a variety of sources. One product was excluded due to its potential toxicity risks. Five observers, blinded to the products, performed two assessments on each product using an evaluation tool with 14 predefined criteria including color, consistency, clotting, and staining potential to manikin skin and clothing. Each criterion was rated using a five-point Likert scale. The products were left for 24 hours, both refrigerated and at room temperature, and then reassessed. Statistical analysis was performed to identify the most suitable products, and both inter- and intra-rater variability were examined. Results: Three products scored consistently well with all five assessors, with one product in particular scoring well in almost every criterion. This highest-rated product had a mean rating of 3.6 of 5.0 (95% posterior Interval 3.4-3.7). Inter-rater variability was minor with average ratings varying from 3.0 to 3.4 between the highest and lowest scorer. Intrarater variability was negligible with good agreement between first and second rating as per weighted kappa scores (K = 0.67). Conclusion: The most realistic and practical form of artificial blood identified was a commercial product called KD151 Flowing Blood Syrup. It was found to be not only realistic in appearance but practical in terms of storage and stain removal.

Inter-agency working : good intentions and interaction dynamics

This paper explores inter-agency working and examines the implications of inter-agency operations for delivering multi-domain service outcomes. Cross-agency collaborative approaches to service delivery are suggested to provide the vehicle for achieving integrated service and policy goals. However, it is argued these need to be crafted ‘fit’ for purpose’ and may not be the requisite approach for all joint purposes. Moreover, some commentators suggest that the optimism about these partnership arrangements and cross-agency actions to resolve complex multi-dimensional problems may be misplaced and propose that further research into the actual rather than desired consequences of these arrangements may find that, at times, partnership working creates negative effects. While collaboration and partnerships are often framed as the way to achieve real breakthroughs in service delivery across agencies, there remain key challenges to interagency working. As more and insistent calls for agencies and other community actors to work together in resolving complex social problems are heeded, the implications of working across organizational boundaries need to be further investigated. This paper investigates cases of inter-agency programmes to understand the dimensions and limitations of inter-agency working. The paper concludes by offering a framework for better inter-agency working that has applicability across all sectors.

Impeding good governance implementation in Indonesian regional government : the effect of a bureaucratic generation gap

The implementation of ‘good governance’ in Indonesia’s regional government sector became a central tenet in governance research following the introduction of the national code for governance in 2006. The code was originally drafted in 1999 as a response to the Asian financial crises and many cases of unearthed corruption, collusion, and nepotism. It was reviewed in 2001 and again in 2006 to incorporate relevant political, economical, and social developments. Even though the national code exists along with many regional government decrees on good governance, the extent of implementation of the tenets of good governance in Indonesia’s regional government is still questioned. Previous research on good governance implementation in Indonesian regional government (Mardiasmo, Barnes and Sakurai, 2008) identified differences in the nature and depth of implementation between various Indonesian regional governments. This paper analyses and extends this recent work and explores key factors that may impede the implementation and sustained application of governance practices across regional settings. The bureaucratic culture of Indonesian regional government is one that has been shaped for over approximately 30 years, in particular during that of the Soeharto regime. Previous research on this regime suggests a bureaucratic culture with a mix of positive and negative aspects. On one hand Soeharto’s regime resulted in strong development growth and strong economic fundamentals, resulting in Indonesia being recognised as one of the Asian economic tigers prior to the 1997 Asian financial crises. The financial crises however revealed a bureaucratic culture that was rife with corruption, collusion, and nepotism. Although subsequent Indonesian governments have been committed to eradicating entrenched practices it seems apparent that the culture is ingrained within the bureaucracy and eradication of it will take time. Informants from regional government agree with this observation, as they identify good governance as an innovative mechanism and to implement it will mean a deviation from the “old ways.” Thus there is a need for a “changed” mind set in order to implement sustained governance practices. Such an exercise has proven to be challenging so far, as there is “hidden” resistance from within the bureaucracy to change its ways. The inertia of such bureaucratic cultures forms a tension against the opportunity for the implementation of good governance. From this context an emergent finding is the existence of a ‘bureaucratic generation gap’ as an impeding variable to enhanced and more efficient implementation of governance systems. It was found that after the Asian financial crises the Indonesian government (both at national and regional level) drew upon a wider human resources pool to fill government positions – including entrants from academia, the private sector, international institutions, foreign nationals and new graduates. It suggested that this change in human capital within government is at the core of this ‘inter-generational divide.’ This divergence is exemplified, at one extreme, by [older] bureaucrats who have been in-position for long periods of time serving during the extended Soeharto regime. The “new” bureaucrats have only sat in their positions since the end of Asian financial crisis and did not serve during Soeharto’s regime. It is argued that the existence of this generation gap and associated aspects of organisational culture have significantly impeded modernising governance practices across regional Indonesia. This paper examines the experiences of government employees in five Indonesian regions: Solok, Padang, Gorontalo, Bali, and Jakarta. Each regional government is examined using a mixed methodology comprising of on-site observation, document analysis, and iterative semi-structured interviewing. Drawing from the experiences of five regional governments in implementing good governance this paper seeks to better understand the causal contexts of variable implementation governance practices and to suggest enhancements to the development of policies for sustainable inter-generational change in governance practice across regional government settings.

Good times and philanthropy : giving by Australia's affluent

This report draws upon the latest research to examine giving trends by affluent individuals in Australia and how these compare with overseas counterparts. It is driven by several factors. Giving by individuals matters enormously to the nonprofit sector, far exceeding business donations. Whether the richest of the population gives commensurate with their wealth is a question worth asking.

The relationship between deformity correction and clinical outcomes after thoracoscopic scoliosis surgery

Surgical treatment of scoliosis is quantitatively assessed in the clinic using radiographic measures of deformity correction, as well as the rib hump, but it is important to understand the extent to which these quantitative measures correlate with self-reported improvements in patients’ quality of life following surgery. The purpose of this prospective study was to evaluate the relationship between clinical outcomes of thoracoscopic anterior scoliosis surgery and deformity correction using the Scoliosis Research Society questionnaire (SRS-24). Patients undergoing thoracoscopic anterior scoliosis correction report good SRS scores which are comparable to those reported in previous studies for both open and thoracoscopic scoliosis correction procedures. Major Cobb correction is a significant predictor of patient satisfaction when comparing subgroups of patients with the highest and lowest major curve corrections.

Understanding rural and remote schools, and facilitating school-community relationships

Rural and remote schools make up a significant portion of Australian schools. Although there are rural schools that exceed 500 students, the Australian Bureau of Statistics (ABS) (2008) reports that 2,188 Australian primary schools have enrolment numbers less than 100. Rural schools need a supply of good teachers; however many universities involved in teacher education are located in city areas. For example, Queensland University of Technology is city-based, generating the highest number of early career teachers for Queensland including teachers for rural schools. Given the number of graduates and the number of rural schools, it seems likely that early career teachers will have opportunities for teaching in these settings, which also means living within a rural community. This chapter will discuss the nature of teaching in rural and remote schools, the challenges, the rewards and the importance of working closely with the local community. It is hoped that by understanding rural and remote schools, early career teachers can make informed decisions that will influence their future career prospects.

On-road ultrafine particle concentration in the M5 East road tunnel, Sydney, Australia

The human health effects following exposure to ultrafine (<100nm) particles (UFPs) produced by fuel combustion, while not completely understood, are generally regarded as detrimental. Road tunnels have emerged as locations where maximum exposure to these particles may occur for the vehicle occupants using them. This study aimed to quantify and investigate the determinants of UFP concentrations in the 4km twin-bore (eastbound and westbound) M5 East tunnel in Sydney, Australia. Sampling was undertaken using a condensation particle counter (CPC) mounted in a vehicle traversing both tunnel bores at various times of day from May through July, 2006. Supplementary measurements were conducted in February, 2008. Over three hundred transects of the tunnel were performed, and these were distributed evenly between the bores. Additional comparative measurements were conducted on a mixed route comprising major roads and shorter tunnels, all within Sydney. Individual trip average UFP concentrations in the M5 East tunnel bores ranged from 5.53 × 104 p cm-3 to 5.95 × 106 p cm-3. Data were sorted by hour of capture, and hourly median trip average (HMA) UFP concentrations ranged from 7.81 × 104 p cm-3 to 1.73 × 106 p cm-3. Hourly median UFP concentrations measured on the mixed route were between 3.71 × 104 p cm-3 and 1.55 × 105 p cm-3. Hourly heavy diesel vehicle (HDV) traffic volume was a very good determinant of UFP concentration in the eastbound tunnel bore (R2 = 0.87), but much less so in the westbound bore (R2 = 0.26). In both bores, the volume of passenger vehicles (i.e. unleaded gasoline-powered vehicles) was a significantly poorer determinant of particle concentration. When compared with similar studies reported previously, the measurements described here were among the highest recorded concentrations, which further highlights the contribution road tunnels may make to the overall UFP exposure of vehicle occupants.

The family attitude scale : reliability and validity of a new scale for measuring the emotional climate of families

Research on outcomes from psychiatric disorders has highlighted the importance of expressed emotion (EE), but its cost-effective measurement remains a challenge. This article describes development of the Family Attitude Scale (FAS), a 30-item instrument that can be completed by any informant. Its psychometric characteristics are reported in parents of undergraduate students and in 70 families with a schizophrenic member. The total FAS had high internal consistency in all samples, and reports of angry behaviour in FAS items showed acceptable inter-rater agreement. The FAS was associated with the reported anger, anger expression and anxiety of respondents. Substantial associations between the parents' FAS and the anger and anger expression of students was also observed. Parents of schizophrenic patients had higher FAS scores than parents of students, and the FAS was higher if disorder duration was longer or patient functioning was poorer. Hostility, high criticism and low warmth on the Camberwell Family Interview (CFI) were associated with a more negative FAS. The highest FAS in the family was a good predictor of a highly critical environment on the CFI. The FAS is a reliable and valid indicator of relationship stress and expressed anger that has wide applicability.

Exercise and lymphoedema : Is it good or bad?

Being physically active during and following treatment for breast cancer has been associated with a range of benefits including improved fitness and function, body composition and immune function and reductions in stress, depression and anxiety, as well as the number and severity of treatment-related side-effects such as nausea, fatigue and pain, all of which contribute to improvements in quality of life. There is also emerging evidence linking active lifestyles with improved survival. Therefore, there is little doubt that participating in regular exercise following breast cancer is ‘good’. Unfortunately, research investigating the role of exercise for women considered at high-risk of lymphoedema or who have developed lymphedema following breast cancer is lacking. For fear of initiating or exacerbating lymphoedema, these women have traditionally been cautioned rather than encouraged to be regularly active. However, recent preliminary findings suggest that being inactive may increase risk of developing lymphedema, and that for those with lymphoedema, participation in an exercise program does not exacerbate the condition. This presentation will address what we know about the role of exercise following a breast cancer diagnosis and will provide some practical recommendations about becoming and staying regularly active following breast cancer, for those with and without lymphoedema.

Good clinical endpoints with denosumab in osteoporosis and cancer

Background: Bone loss associated with low oestrogen levels in postmenopausal women, and with androgen deprivation therapy in men with hormone-sensitive prostate cancer, result in an increased incidence of fractures. Denosumab has been shown to increase bone mineral density in these two conditions. Objectives/methods: The objective of this evaluation is to review the clinical trials that have studied clinical endpoints in these conditions. Results: FREEDOM (Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months) was an International Phase III clinical trial that measured the clinical endpoints with denosumab in postmenopausal women with osteoporosis. At 36 months, new vertebral fractures had occurred in 7.2% of subjects in the placebo group and this was lowered to 2.3% of subjects treated with denosumab. HALT (Denosumab Hormone Ablation Bone Loss Trial) studied the clinical endpoints in men with non-metastatic prostate cancer receiving androgen-deprivation therapy. The incidence of vertebral fractures was significantly lower in the denosumab group (1.5%) than in the placebo group (3.9%). The incidence of adverse effects with denosumab in both clinical trials was low. Conclusions: Denosumab reduces the incidence of fractures in postmenopausal women with osteoporosis and in men with non-metastatic prostate cancer receiving androgen-deprivation therapy. Denosumab is well tolerated.

Cost effectiveness of antimicrobial catheters in the intensive care unit : Addressing uncertainty in the decision

Introduction: Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost-effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncertainty amongst clinicians over which, if any, antimicrobial-coated central venous catheters to use. We re-evaluated the cost-effectiveness of all commercially available antimicrobialcoated central venous catheters for prevention of catheter-related bloodstream infection in adult intensive care unit (ICU) patients. Methods: We used a Markov decision model to compare the cost-effectiveness of antimicrobial-coated central venous catheters relative to uncoated catheters. Four catheter types were evaluated; minocycline and rifampicin (MR)-coated catheters; silver, platinum and carbon (SPC)-impregnated catheters; and two chlorhexidine and silver sulfadiazine-coated catheters, one coated on the external surface (CH/SSD (ext)) and the other coated on both surfaces (CH/SSD (int/ext)). The incremental cost per qualityadjusted life-year gained and the expected net monetary benefits were estimated for each. Uncertainty arising from data estimates, data quality and heterogeneity was explored in sensitivity analyses. Results: The baseline analysis, with no consideration of uncertainty, indicated all four types of antimicrobial-coated central venous catheters were cost-saving relative to uncoated catheters. Minocycline and rifampicin-coated catheters prevented 15 infections per 1,000 catheters and generated the greatest health benefits, 1.6 quality-adjusted life-years, and cost-savings, AUD $130,289. After considering uncertainty in the current evidence, the minocycline and rifampicin-coated catheters returned the highest incremental monetary net benefits of $948 per catheter; but there was a 62% probability of error in this conclusion. Although the minocycline and rifampicin-coated catheters had the highest monetary net benefits across multiple scenarios, the decision was always associated with high uncertainty. Conclusions: Current evidence suggests that the cost-effectiveness of using antimicrobial-coated central venous catheters within the ICU is highly uncertain. Policies to prevent catheter-related bloodstream infection amongst ICU patients should consider the cost-effectiveness of competing interventions in the light of this uncertainty. Decision makers would do well to consider the current gaps in knowledge and the complexity of producing good quality evidence in this area.