Palliative care and other physicians’ knowledge, attitudes and practice relating to the law on withholding/withdrawing life-sustaining treatment: Survey results

Background: To effectively care for people who are terminally ill, including those without decision-making capacity, palliative care physicians must know and understand the legal standing of Advance Care Planning (ACP) in their jurisdiction of practice. This includes the use of advance directives/living wills (ADs) and substitute decision-makers (SDMs) who can legally consent to or refuse treatment if there is no valid AD. Aim: The study aimed to investigate the knowledge, attitudes and practices of medical specialists most often involved in end-of-life care in relation to the law on withholding/ withdrawing life-sustaining treatment (WWLST) from adults without decision-making capacity. Design/participants: A pre-piloted survey was posted to specialists in palliative, emergency, geriatric, renal and respiratory medicine, intensive care and medical oncology in three Australian States. Surveys were analysed using SPSS20 and SAS 9.3. Results: The overall response rate was 32% (867/2702); 52% from palliative care specialists. Palliative Care specialists and Geriatricians had significantly more positive attitudes towards the law (χ242 = 94.352; p < 0.001) and higher levels of knowledge about the WWLST law (χ27 = 30.033; p < 0.001), than did the other specialists, while still having critical gaps in their knowledge. Conclusions: A high level of knowledge of the law is essential to ensure that patients’ wishes and decisions, expressed through ACP, are respected to the maximum extent possible within the law, thereby according with the principles and philosophy of palliative care. It is also essential to protect health professionals from legal action resulting from unauthorised provision or removal of treatment.

Regulating unilateral supermarket misconduct as customer/acquirer of goods and services

Supermarkets in Australia may have substantial market power as buyers in wholesale markets for grocery products. They may also have substantial bargaining power in negotiating contracts with their suppliers of grocery products. The Competition and Consumer Act 2010 (Cth) (CCA) regulates misconduct by supermarkets as customer/acquirers in three ways. First, s 46(1) of the CCA prohibits the ‘taking advantage’ of buyer power for the purpose of damaging a competitor, preventing entry or deterring or preventing competitive conduct. Secondly, s 21 of the ACL prohibits unconscionable conduct in business–to–business transactions. Thirdly, Pt IVB of the CCA provides for the promulgation of mandatory and voluntary industry codes of conduct. Since 1 July 2015 the conduct of supermarkets as customer/acquirers has been regulated by the Food and Grocery Industry Code of Conduct. This article examines these three different approaches. It considers them against the background of the misconduct at issue in ACCC v Coles Supermarkets Australia Pty Ltd which the ACCC chose to litigate as an unconscionable conduct case, rather than a misuse of market power case. The article also considers the strengths and weaknesses of each of the three approaches and concludes that while the three approaches address different problems there is scope for overlap and all three should be retained for compete coverage.

Medicines information sources and services for consumers : A special focus on the Internet and people with depression

The range of consumer health and medicines information sources has diversified along with the increased use of the Internet. This has led to a drive to develop medicines information services and to better incorporate the Internet and e-mail into routine practice in health care and in community pharmacies. To support the development of such services more information is needed about the use of online information by consumers, particularly of those who may be the most likely to use and to benefit from the new sources and modes of medicines communication. This study explored the role and utilization of the Internet-based medicines information and information services in the context of a wider network of information sources accessible to the public in Finland. The overall aim was to gather information to develop better and more accessible sources of information for consumers and services to better meet the needs of consumers. Special focus was on the needs and information behavior among people with depression and using antidepressant medicines. This study applied both qualitative and quantitative methods. Consumer medicines information needs and sources were identified by analyzing the utilization of the University Pharmacy operated national drug information call center (Study I) and surveying Finnish adults (n=2348) use of the different medicines information sources (Study II). The utilization of the Internet as a source of antidepressant information among people with depression was explored by focus group discussions among people with depression and with current or past use of the antidepressant(s) (n=29, Studies III & IV). Pharmacy response to the needs of consumers in term of providing e-mail counseling was assessed by conducting a virtual pseudo customer study among the Finnish community pharmacies (n=161, Study V). Physicians and pharmacists were the primary sources of medicines information. People with mental disorders were more frequent users of telephone- and Internet-based medicines information sources and patient information leaflets than people without mental disorders. These sources were used to complement rather than replace information provided face-to-face by health professionals. People with depression used the Internet to seek facts about antidepressants, to share experiences with peers, and for the curiosity. They described that the access to online drug information was empowering. Some people reported lacking the skills necessary to assess the quality of online information. E-mail medication counseling services provided by community pharmacies were rare and varied in quality. Study results suggest that rather than discouraging the use of the Internet, health professionals should direct patients to use accurate and reliable sources of online medicines information. Health care providers, including community pharmacies should also seek to develop new ways of communicating information about medicines with consumers. This study determined that people with depression and using antidepressants need services enabling interactive communication not only with health care professionals, but also with peers. Further research should be focused on developing medicines information service facilitating communication among different patient and consumer groups.

Fox management in south-eastern Australia: management strategies and cost-efficiencies

The European red fox is one of Australia´s most devastating vertebrate affecting both biodiversity and agricultural production. Fox management strategies rely heavily on poisoning using baits impregnated with sodium fluoroacetate (1080). Factors such as the ability of foxes to locate bait, palatability and toxicity of bait, pattern and density of bait distribution, and cost/benefits of specific use patterns all affect the overall efficiency of management programs. It is essential to examine and refine all such factors to manage the damaging impacts of this pest species. This book examines the problems associated with management of the fox in south-eastern Australia, highlights deficiencies in ´best-practice´ baiting techniques, and provides recommendations to improve current management strategies and guide future research.

Towards responsible native fish stocking: identifying management concerns and appropriate research methodologies

A major outcome of this project has been the identification and prioritisation of the major management issues related to the ecological impacts of fish stocking and the elucidation of appropriate research methodologies that can be used to investigate these issues. This information is paramount to development of the relevant research projects that will lead to stocking activities aligned with world’s best practice, a requisite for ecologically sustainable recreational freshwater fisheries. In order to quantify the major management issues allied to the sustainability of freshwater fish stocking, stakeholders from around Australia were identified and sent a questionnaire to determine which particular issues they regarded as important. These stakeholders included fisheries managers or researchers from Federal, Territory and State jurisdictions although others, including representatives from environment and conservation agencies and peak recreational fishing and stocking groups were also invited to give their opinions. The survey was completed in late 2007 and the results analysed to give a prioritized list of key management issues relating to the impacts of native fish stocking activities. In the analysis, issues which received high priority rankings were flagged as potential topics for discussion at a future expert workshop. Identified high priority issues fell into the following core areas: marking techniques, genetics, population dynamics, introduction of pathogens and exotic biological material and ecological, biological and conservation issues. The next planned outcome, determination of the most appropriate methodologies to address these core issues in research projects, was addressed through the outputs of an expert workshop held in early 2008. Participants at this workshop agreed on a range of methodologies for addressing priority sustainability issues and decided under what circumstances that these methodologies should be employed.

Improving decisions for invasive species management: Reformulation and extensions of the Panetta-Lawes eradication graph

Aim: Effective decisions for managing invasive species depend on feedback about the progress of eradication efforts. Panetta & Lawes. developed the eradograph, an intuitive graphical tool that summarizes the temporal trajectories of delimitation and extirpation to support decision-making. We correct and extend the tool, which was affected by incompatibilities in the units used to measure these features that made the axes impossible to interpret biologically. Location: Victoria, New South Wales and Queensland, Australia. Methods: Panetta and Lawes' approach represented delimitation with estimates of the changes in the area known to be infested and extirpation with changes in the mean time since the last detection. We retain the original structure but propose different metrics that improve biological interpretability. We illustrate the methods with a hypothetical example and real examples of invasion and treatment of branched broomrape (Orobanche ramosa L.) and the guava rust complex (Puccinia psidii (Winter 1884)) in Australia. Results: These examples illustrate the potential of the tool to guide decisions about the effectiveness of search and control activities. Main conclusions: The eradograph is a graphical data summary tool that provides insight into the progress of eradication. Our correction and extension of the tool make it easier to interpret and provide managers with better decision support. © 2013 John Wiley & Sons Ltd.

Literature, tourism and the city: Writing and cultural change

Today national and regional tourism organizations look to sophisticated cultural tourism programs to enhance the visitor experience for tourists of their particular city. Yet research indicates that a challenge exists in designing and implementing programs that take full advantage of a city’s historical and emergent literary cultures. In this paper we offer critical insights into how literary cultural heritage can foster the development of an integrated and dynamic approach and provide the experience sought by local and global tourists. International exemplars are cited together with an analysis of the Australian city of Brisbane that describes itself as a ‘new world city.’ The findings of our research show that programs that harness diverse literary cultures, rather than adhering to a single literary representation, are better equipped to build identity and thus extend cultural tourism potential.

Current Debates on Classifying Diversity Management: Review and a Proposal

This paper discusses various theoretical approaches to diversity management, analysing their similarities and differences. I start with a review of certain previously presented classifications, and then proceed to describing the different approaches in more detail. In this paper, I propose that the various viewpoints can be categorized into three groups: 1) practitioner/consultant approach, 2) mainstream approach, and 3) critical approaches. Although there are differences within these groups, in particular regarding the critical approaches, these differences appear less significant than those between the groups. Those representing the first group are mainly interested in how to get most out of a diverse workforce, while those in the second group focus on the effects of diversity on performance or work group functioning. While some of the mainstream writers can be rather critical towards earlier research, they hardly ever discuss or even recognize the wide ranging criticism put forward by critical scholars. The critical researchers, then, remain a rather scattered group who do not always share much more than a conviction that the mainstream research keeps missing highly significant issues. Nonetheless, in order to increase our understanding of how different persons can and do work together, more dialogue is required between the varying standpoints.

Non-industrial private forest landowners’ choices of timber management strategies and potential allowable cut.

In the study, the potential allowable cut in the district of Pohjois-Savo - based on the non-industrial private forest landowners' (NIPF) choices of timber management strategies - was clarified. Alternative timber management strategies were generated, and the choices and factors affecting the choices of timber management strategies by NIPF landowners were studied. The choices of timber management strategies were solved by maximizing the utility functions of the NIPF landowners. The parameters of the utility functions were estimated using the Analytic Hierarchy Process (AHP). The level of the potential allowable cut was compared to the cutting budgets based on the 7th and 8th National Forest Inventories (NFI7 and NFI8), to the combining of private forestry plans, and to the realized drain from non-industrial private forests. The potential allowable cut was calculated using the same MELA system as has been used in the calculation of the national cutting budget. The data consisted of the NIPF holdings (from the TASO planning system) that had been inventoried compartmentwise and had forestry plans made during the years 1984-1992. The NIPF landowners' choices of timber management strategies were clarified by a two-phase mail inquiry. The most preferred strategy obtained was "sustainability" (chosen by 62 % of landowners). The second in order of preference was "finance" (17 %) and the third was "saving" (11 %). "No cuttings", and "maximum cuttings" were the least preferred (9 % and 1 %, resp.). The factors promoting the choices of strategies with intensive cuttings were a) "farmer as forest owner" and "owning fields", b) "increase in the size of the forest holding", c) agriculture and forestry orientation in production, d) "decreasing short term stumpage earning expectations", e) "increasing intensity of future cuttings", and f) "choice of forest taxation system based on site productivity". The potential allowable cut defined in the study was 20 % higher than the average of the realized drain during the years 1988-1993, which in turn, was at the same level as the cutting budget based on the combining of forestry plans in eastern Finland. Respectively, the potential allowable cut defined in the study was 12 % lower than the NFI8-based greatest sustained allowable cut for the 1990s. Using the method presented in this study, timber management strategies can be clarified for non-industrial private forest landowners in different parts of Finland. Based on the choices of timber managemet strategies, regular cutting budgets can be calculated more realistically than before.

Orientational disorder and other aspects of C70 and C60-C70 films deposited on single-crystal substrates

C-70 films deposited on highly oriented pyrolytic graphite (HOPG), Ag(110), Ag(111) and Pt(110) substrates have been investigated by scanning tunnelling microscopy. Interesting observations on novel molecular arrangements, as well as orientational disorder, are presented. Solid solutions of C-60 and C-70 show interesting packing of these molecules when deposited on HOPG.

Context dependency of rewards and services in an Indian ant-plant interaction: southern sites favour the mutualism between plants and ants

Protection-based ant-plant mutualisms may vary in strength due to differences in ant rewards, abundance of protective ants and herbivory pressure. We investigated geographical and temporal variation in host plant traits and herbivory pressure at five sites spanning the distribution range of the myrmecophyte Humboldtia brunonis (Fabaceae) in the Indian Western Ghats. Southern siteshad, onaverage, 2.4 times greater abundance of domatia-bearing individuals, 1.6 times greater extrafloral nectary numbers per leaf, 1.2 times larger extrafloral nectary sizes, 2.2 times greater extrafloral nectar (EFN) volumes and a two-fold increase in total amino acid and total sugar concentrations in EFN compared with northern sites. Astrong protection-based mutualismwith ants occurred at only one southern site where herbivory was highest, suggesting that investments in attracting ants correlate with anti-herbivore benefits gained from the presence of protective ants. Our results confirm a temporally stable north-south gradient in myrmecophytic traits in this ant-plant as several of these traits were re-sampled after a 5-y interval. However, the chemical composition of EFN varied at both spatial and short-term temporal scales suggesting that only repeated measurements of rewards such as EFN can reveal the real spectrum of trait variation in an ant-plant mutualistic system.