Building Healthy Communities : GP Network, Medicare Local and Primary Health Care in the Wheatbelt Region of Western Australia

• Government reports consistently recognise the importance of Primary Health Care to an efficient health system. Barriers identified in Australia’s Primary Health Care include workforce pressures, increase rate of chronic disease, and equitable access to Primary Health Care services. • General Practitioners (GPs) are the key to the successful delivery of Primary Health Care especially in rural and remote regions such as the Wheatbelt region in Western Australia (WA). • The Wheatbelt region of WA is vast: some 72,500 residents spread across 150,000km2 in 43 Local Government Authorities catchments. Majority of the Wheatbelt residents live in small towns. There is a higher reported rates of chronic disease, more at risk of chronic diseases and less utilisation of Primary Health Care services in this region. • General practice patients in the Wheatbelt are among those most in need of Primary Health Care services. • Wheatbelt GP Network (the “Network”) was established in 1998. It is a key health service delivery stakeholder in the Wheatbelt. • The Network has responded to the health needs of the community by creating a mobile Allied Health Team that works closely with GPs and is adaptive to ensure priority needs are met. • The Medicare Local model introduced by the Australian Government in 2011 aimed to improve the delivery of Primary Health Care services by improved health planning and coordinating service delivery. • Little if any recognition has been given to the outstanding work that many Divisions of General Practice have done in improving the delivery of Primary Health Care services such as the Network. • The Network has continued to support GPs and general practices and created a complementary system that integrated general practice with the work of an Allied Health Team. Its program mix is extensive. • The Network has consistently delivered on-required contract outputs and has a fifteen (15) years history of operating successfully in a large geographical area comprising in the main smaller communities that cannot support the traditional health services model. • The complexity of supporting International Medical Graduates in the region requires special attention. • The introduction of the Medicare Local in the South West of WA and their intention to take over the delivery of health services, thus effectively shutting the Network will have catastrophic consequences and cannot be supported economically. • The Network proposes to create a new model, built on its past work that increases the delivery of Primary Health Care services through its current Allied Health Team. • The proposal uses the Wheatbelt GP Super Clinic currently under construction in Northam, part of the Network and funded by the Australian Government is a key to the proposed new model. • Wheatbelt GP Super Clinic is different from existing models of GP Super Clinics around Australia which focus predominately on co-location of services. Wheatbelt GP Super Clinic utilises a hub and spoke model of service outreach to small rural towns to ensure equitable Primary Health Care coverage and continuum of care in a financially responsible and viable manner. In particular, the Wheatbelt GP Super Clinic recognises the importance of Allied Health Professionals and will involve them in a collaborative model with rural general practice. • The proposed model advocated by the Network aims to substitute the South West WA Medicare Local direct service delivery proposed for the Wheatbelt. The Network’s proposed model is to expand on the current hub and spoke model of Primary Health Care delivery to otherwise small unviable Wheatbelt towns. A flexible and adaptive skill mix of Allied Health Professionals, Nurse Practitioners and GPs ensure equitable access to service. Expanded scope of practices are utilised to reduce duplication of service and concentration of services in major towns. This involves a partnership approach. • If the proposed model not funded, the Network and the Wheatbelt region will stand to lose 16 Allied Health Professionals and defeats the purpose of Australian Government current funding for the construction of the Wheatbelt GP Super Clinic. • The Network has considered how its model can best be funded. It proposes a re-allocation of funds made available to the South West WA Medicare Local. • This submission argues that the proposal for the South West WA Medicare Local to take over the service delivery of Primary Health Care services in the Wheatbelt makes no economic sense when an existing agency (the Network) has the infrastructure in place, is experienced in working in this geographical area that has special needs and is capable to expand its programs to meet demand.

Effect of dangling chains on the structure and physical properties of a tightly crosslinked poly(ethylene glycol) network

Major imperfections in crosslinked polymers include loose or dangling chain ends that lower the crosslink d., thereby reducing elastic recovery and increasing the solvent swelling. These imperfections are hard to detect, quantify and control when the network is initiated by free radical reactions. As an alternative approach, the sol-​gel synthesis of a model poly(ethylene glycol) (PEG-​2000) network is described using controlled amts. of bis- and mono-​triethoxy silyl Pr urethane PEG precursors to give silsesquioxane (SSQ, R-​SiO1.5) structures as crosslink junctions with a controlled no. of dangling chains. The effect of the no. of dangling chains on the structure and connectivity of the dried SSQ networks has been detd. by step-​crystn. differential scanning calorimetry. The role that micelle formation plays in controlling the sol-​gel PEG network connectivity has been studied by dynamic light scattering of the bis- and mono-​triethoxy silyl precursors and the networks have been characterized by 29Si solid state NMR, sol fraction and swelling measurements. These show that the dangling chains will increase the mesh size and water uptake. Compared to other end-​linked PEG hydrogels, the SSQ-​crosslinked networks show a low sol fraction and high connectivity, which reduces solvent swelling, degree of crystallinity and the crystal transition temp. The increased degree of freedom in segment movement on the addn. of dangling chains in the SSQ-​crosslinked network facilitates the packing process in crystn. of the dry network and, in the hydrogel, helps to accommodate more water mols. before reaching equil.

Much ado about nothing? Tracing the progress of innovations borne on enterprise social network sites

Enterprise social networks are organizationally bounded online platforms for users to interact with another and maintain interpersonal relationships. The allure of these technologies is often seen in intra-organizational communication, collaboration and innovation. How these technologies actually support organizational innovation efforts remains unclear. A specific challenge is whether digital content on these platforms converts to actual innovation development efforts. In this study we set out to examine innovation-centric content flows on enterprise social networking platforms, and advance a conceptual model that seeks to explain which innovation conveyed in the digital content will traverse from the digital platform into regular processes. We describe important constructs of our model and offer strategies for the operationalization of the constructs. We conclude with an outlook to our ongoing empirical study that will explore and validate the key propositions of our model, and we sketch some potential implications for industry and academia.

Enhancing enterprise social network use : a control theory study

Organizations employ Enterprise Social Networks (ESNs) (e.g., Yammer) expecting better intra-organizational communication, effective knowledge sharing and, in general, greater collaboration. Despite their similarities with Public Social Networks (PSNs) (e.g., Twitter), ESNs are struggling to gain credence with employees. This paper is part of a larger research project that investigates mechanisms to enhance employees’ engagement in the ESNs. Through the lens of Control Theory, this paper reports preliminary findings of a pilot case study aimed to propose formal and informal mechanisms that impact employees’ intrinsic and extrinsic motivations to encourage their use of ESNs. The study results highlight (i) the need to better understand employees’ extrinsic and intrinsic motivations to use Social Networks, and (ii) that unlike a PSN which acts as a hedonic system, an ESN acts as a utilitarian system, highlighting the importance of supporting intrinsic motivations in its implementation.

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) : overview and key principles

Non-communicable diseases (NCDs) dominate disease burdens globally and poor nutrition increasingly contributes to this global burden. Comprehensive monitoring of food environments, and evaluation of the impact of public and private sector policies on food environments is needed to strengthen accountability systems to reduce NCDs. The International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) is a global network of public-interest organizations and researchers that aims to monitor, benchmark and support public and private sector actions to create healthy food environments and reduce obesity, NCDs and their related inequalities. The INFORMAS framework includes two ‘process’ modules, that monitor the policies and actions of the public and private sectors, seven ‘impact’ modules that monitor the key characteristics of food environments and three ‘outcome’ modules that monitor dietary quality, risk factors and NCD morbidity and mortality. Monitoring frameworks and indicators have been developed for 10 modules to provide consistency, but allowing for stepwise approaches (‘minimal’, ‘expanded’, ‘optimal’) to data collection and analysis. INFORMAS data will enable benchmarking of food environments between countries, and monitoring of progress over time within countries. Through monitoring and benchmarking, INFORMAS will strengthen the accountability systems needed to help reduce the burden of obesity, NCDs and their related inequalities.

Pulse-coupled neural network performance for real-time identification of vegetation during forced landing

Safety concerns in the operation of autonomous aerial systems require safe-landing protocols be followed during situations where the a mission should be aborted due to mechanical or other failure. On-board cameras provide information that can be used in the determination of potential landing sites, which are continually updated and ranked to prevent injury and minimize damage. Pulse Coupled Neural Networks have been used for the detection of features in images that assist in the classification of vegetation and can be used to minimize damage to the aerial vehicle. However, a significant drawback in the use of PCNNs is that they are computationally expensive and have been more suited to off-line applications on conventional computing architectures. As heterogeneous computing architectures are becoming more common, an OpenCL implementation of a PCNN feature generator is presented and its performance is compared across OpenCL kernels designed for CPU, GPU and FPGA platforms. This comparison examines the compute times required for network convergence under a variety of images obtained during unmanned aerial vehicle trials to determine the plausibility for real-time feature detection.

A rural health education, training and research network

The purpose of the Rural Health Education, Training and Research Network is to support the education and training of rural health practitioners and research in rural health through the optimum use of appropriate information and communication technologies to link and inform all individuals and organisation involved in the teaching, planning and delivery of health care in rural and remote Queensland. The health care of people in rural areas has the potential to be enhanced, through providing the rural and remote health professionals in Queensland with the same access to educational and training opportunities as their metropolitan colleagues. This consultative, coordinated approach should be cost-effective through both increasing awareness and utilisation of existing and developing networks, and through more efficient and rational use of both the basic and sophisticated technologies which support them. Technological hardware, expertise and infrastructure are already in place in Queensland to support a Rural Health Education, Training and Research Network, but are not being used to their potential, more often due to a lack of awareness of their existence and utility than to their perceived costs. Development of the network has commenced through seeding funds provided by Queensland Health. Future expansion will ensure access by health professionals to existing networks within Queensland. This paper explores the issues and implications of a network for rural health professionals in Queensland and potentially throughout Australia, with a specific focus on the implications for rural and isolated health professional.

Measuring global economic interdependence : a hierarchical network approach

This paper investigates the business cycle co-movement across countries and regions since 1950 as a measure for quantifying the economic interdependence in the ongoing globalisation process. Our methodological approach is based on analysis of a correlation matrix and the networks it contains. Such an approach summarises the interaction and interdependence of all elements, and it represents a more accurate measure of the global interdependence involved in an economic system. Our results show (1) the dynamics of interdependence has been driven more by synchronisation in regional growth patterns than by the synchronisation of the world economy, and (2) world crisis periods dramatically increase the global co-movement in the world economy.

Australian Diabetes Foot Network : practical guideline on the provision of footwear for people with diabetes

Trauma, in the form of pressure and/or friction from footwear, is a common cause of foot ulceration in people with diabetes. These practical recommendations regarding the provision of footwear for people with diabetes were agreed upon following review of existing position statements and clinical guidelines. The aim of this process was not to re-invent existing guidelines but to provide practical guidance for health professionals on how they can best deliver these recommendations within the Australian health system. Where information was lacking or inconsistent, a consensus was reached following discussion by all authors. Appropriately prescribed footwear, used alone or in conjunction with custom-made foot orthoses, can reduce pedal pressures and reduce the risk of foot ulceration. It is important for all health professionals involved in the care of people with diabetes to both assess and make recommendations on the footwear needs of their clients or to refer to health professionals with such skills and knowledge. Individuals with more complex footwear needs (for example those who require custom-made medical grade footwear and orthoses) should be referred to health professionals with experience in the prescription of these modalities and who are able to provide appropriate and timely follow-up. Where financial disadvantage is a barrier to individuals acquiring appropriate footwear, health care professionals should be aware of state and territory based equipment funding schemes that can provide financial assistance. Aboriginal and Torres Strait Islanders and people living in rural and remote areas are likely to have limited access to a broad range of footwear. Provision of appropriate footwear to people with diabetes in these communities needs be addressed as part of a comprehensive national strategy to reduce the burden of diabetes and its complications on the health system.

Brisbane Macroscopic Fundamental Diagram : empirical findings on network partitioning and incident detection

The Macroscopic Fundamental Diagram (MFD) relates space-mean density and flow, and the existence with dynamic features was confirmed in congested urban network in downtown Yokohama with real data set. Since the MFD represents the area-wide network traffic performances, studies on perimeter control strategies and an area traffic state estimation utilizing the MFD concept has been reported. However, limited works have been reported on real world example from signalised arterial network. This paper fuses data from multiple sources (Bluetooth, Loops and Signals) and develops a framework for the development of the MFD for Brisbane, Australia. Existence of the MFD in Brisbane arterial network is confirmed. Different MFDs (from whole network and several sub regions) are evaluated to discover the spatial partitioning in network performance representation. The findings confirmed the usefulness of appropriate network partitioning for traffic monitoring and incident detections. The discussion addressed future research directions

Health and guardianship law : the decision of X v the Sydney Children's Hospitals Network [2013] NSWCA 320 : mature minors and the refusal of blood products

This recent decision of the New South Wales Court of Appeal considers the scope of the parens patriae jurisdiction in cases where the jurisdiction is invoked for the protection of a Gillick competent minor. As outlined below, in certain circumstances the law recognises that mature minors are able to make their own decisions concerning medical treatment. However, there have been a number of Commonwealth decisions which have addressed the issue of whether mature minors are able to refuse medical procedures in circumstances where refusal will result in the minor dying. Ultimately, this case confirms that the minor does not necessarily have a right to make autonomous decisions; the minor’s right to exercise his or her autonomous decision only exists when such decision accords with what is deemed to be in his or her best interests.

Effects of wireless sensor network uncertainties on output-only modal-based damage identification

The use of Wireless Sensor Networks (WSNs) for Structural Health Monitoring (SHM) has become a promising approach due to many advantages such as low cost, fast and flexible deployment. However, inherent technical issues such as data synchronization error and data loss have prevented these distinct systems from being extensively used. Recently, several SHM-oriented WSNs have been proposed and believed to be able to overcome a large number of technical uncertainties. Nevertheless, there is limited research examining effects of uncertainties of generic WSN platform and verifying the capability of SHM-oriented WSNs, particularly on demanding SHM applications like modal analysis and damage identification of real civil structures. This article first reviews the major technical uncertainties of both generic and SHM-oriented WSN platforms and efforts of SHM research community to cope with them. Then, effects of the most inherent WSN uncertainty on the first level of a common Output-only Modal-based Damage Identification (OMDI) approach are intensively investigated. Experimental accelerations collected by a wired sensory system on a benchmark civil structure are initially used as clean data before being contaminated with different levels of data pollutants to simulate practical uncertainties in both WSN platforms. Statistical analyses are comprehensively employed in order to uncover the distribution pattern of the uncertainty influence on the OMDI approach. The result of this research shows that uncertainties of generic WSNs can cause serious impact for level 1 OMDI methods utilizing mode shapes. It also proves that SHM-WSN can substantially lessen the impact and obtain truly structural information without having used costly computation solutions.

Building adaptable agent-based models – application to the electricity distribution network

Agent-based modelling (ABM), like other modelling techniques, is used to answer specific questions from real world systems that could otherwise be expensive or impractical. Its recent gain in popularity can be attributed to some degree to its capacity to use information at a fine level of detail of the system, both geographically and temporally, and generate information at a higher level, where emerging patterns can be observed. This technique is data-intensive, as explicit data at a fine level of detail is used and it is computer-intensive as many interactions between agents, which can learn and have a goal, are required. With the growing availability of data and the increase in computer power, these concerns are however fading. Nonetheless, being able to update or extend the model as more information becomes available can become problematic, because of the tight coupling of the agents and their dependence on the data, especially when modelling very large systems. One large system to which ABM is currently applied is the electricity distribution where thousands of agents representing the network and the consumers’ behaviours are interacting with one another. A framework that aims at answering a range of questions regarding the potential evolution of the grid has been developed and is presented here. It uses agent-based modelling to represent the engineering infrastructure of the distribution network and has been built with flexibility and extensibility in mind. What distinguishes the method presented here from the usual ABMs is that this ABM has been developed in a compositional manner. This encompasses not only the software tool, which core is named MODAM (MODular Agent-based Model) but the model itself. Using such approach enables the model to be extended as more information becomes available or modified as the electricity system evolves, leading to an adaptable model. Two well-known modularity principles in the software engineering domain are information hiding and separation of concerns. These principles were used to develop the agent-based model on top of OSGi and Eclipse plugins which have good support for modularity. Information regarding the model entities was separated into a) assets which describe the entities’ physical characteristics, and b) agents which describe their behaviour according to their goal and previous learning experiences. This approach diverges from the traditional approach where both aspects are often conflated. It has many advantages in terms of reusability of one or the other aspect for different purposes as well as composability when building simulations. For example, the way an asset is used on a network can greatly vary while its physical characteristics are the same – this is the case for two identical battery systems which usage will vary depending on the purpose of their installation. While any battery can be described by its physical properties (e.g. capacity, lifetime, and depth of discharge), its behaviour will vary depending on who is using it and what their aim is. The model is populated using data describing both aspects (physical characteristics and behaviour) and can be updated as required depending on what simulation is to be run. For example, data can be used to describe the environment to which the agents respond to – e.g. weather for solar panels, or to describe the assets and their relation to one another – e.g. the network assets. Finally, when running a simulation, MODAM calls on its module manager that coordinates the different plugins, automates the creation of the assets and agents using factories, and schedules their execution which can be done sequentially or in parallel for faster execution. Building agent-based models in this way has proven fast when adding new complex behaviours, as well as new types of assets. Simulations have been run to understand the potential impact of changes on the network in terms of assets (e.g. installation of decentralised generators) or behaviours (e.g. response to different management aims). While this platform has been developed within the context of a project focussing on the electricity domain, the core of the software, MODAM, can be extended to other domains such as transport which is part of future work with the addition of electric vehicles.

Modelling for the electricity distribution network

Global awareness for cleaner and renewable energy is transforming the electricity sector at many levels. New technologies are being increasingly integrated into the electricity grid at high, medium and low voltage levels, new taxes on carbon emissions are being introduced and individuals can now produce electricity, mainly through rooftop photovoltaic (PV) systems. While leading to improvements, these changes also introduce challenges, and a question that often rises is ‘how can we manage this constantly evolving grid?’ The Queensland Government and Ergon Energy, one of the two Queensland distribution companies, have partnered with some Australian and German universities on a project to answer this question in a holistic manner. The project investigates the impact the integration of renewables and other new technologies has on the physical structure of the grid, and how this evolving system can be managed in a sustainable and economical manner. To aid understanding of what the future might bring, a software platform has been developed that integrates two modelling techniques: agent-based modelling (ABM) to capture the characteristics of the different system units accurately and dynamically, and particle swarm optimization (PSO) to find the most economical mix of network extension and integration of distributed generation over long periods of time. Using data from Ergon Energy, two types of networks (3 phase, and Single Wired Earth Return or SWER) have been modelled; three-phase networks are usually used in dense networks such as urban areas, while SWER networks are widely used in rural Queensland. Simulations can be performed on these networks to identify the required upgrades, following a three-step process: a) what is already in place and how it performs under current and future loads, b) what can be done to manage it and plan the future grid and c) how these upgrades/new installations will perform over time. The number of small-scale distributed generators, e.g. PV and battery, is now sufficient (and expected to increase) to impact the operation of the grid, which in turn needs to be considered by the distribution network manager when planning for upgrades and/or installations to stay within regulatory limits. Different scenarios can be simulated, with different levels of distributed generation, in-place as well as expected, so that a large number of options can be assessed (Step a). Once the location, sizing and timing of assets upgrade and/or installation are found using optimisation techniques (Step b), it is possible to assess the adequacy of their daily performance using agent-based modelling (Step c). One distinguishing feature of this software is that it is possible to analyse a whole area at once, while still having a tailored solution for each of the sub-areas. To illustrate this, using the impact of battery and PV can have on the two types of networks mentioned above, three design conditions can be identified (amongst others): · Urban conditions o Feeders that have a low take-up of solar generators, may benefit from adding solar panels o Feeders that need voltage support at specific times, may be assisted by installing batteries · Rural conditions - SWER network o Feeders that need voltage support as well as peak lopping may benefit from both battery and solar panel installations. This small example demonstrates that no single solution can be applied across all three areas, and there is a need to be selective in which one is applied to each branch of the network. This is currently the function of the engineer who can define various scenarios against a configuration, test them and iterate towards an appropriate solution. Future work will focus on increasing the level of automation in identifying areas where particular solutions are applicable.