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.

Educating for digital futures : what the learning strategies of digital content professionals can teach higher education

Beginning in the second half of the 20th century, ICTs transformed many societies from industrial societies in which manufacturing was the central focus, into knowledge societies in which dealing effectively with data and information has become a central element of work (Anderson, 2008). To meet the needs of the knowledge society, universities must reinvent their structures and processes, their curricula and pedagogic practices. In addition to this, of course higher education is itself subject to the sweeping influence of ICTs. But what might effective higher education look like in the 21st century? In designing higher education systems and learning experiences which are responsive to the learning needs of the future and exploit the possibilities offered by ICTs, we can learn much from the existing professional development strategies of people who are already successful in 21st century fields, such as digital media. In this study, I ask: (1) what are the learning challenges faced by digital media professionals in the 21st century? (2) what are the various roles of formal and informal education in their professional learning strategies at present? (3) how do they prefer to acquire needed capabilities? In-depth interviews were undertaken with successful Australian digital media professionals working in micro businesses and SMEs to answer these questions. The strongest thematic grouping that emerged from the interviews related to the need for continual learning and relearning because of the sheer rate of change in the digital media industries. Four dialectical relationships became apparent from the interviewees’ commentaries around the learning imperatives arising out of the immense and continual changes occurring in the digital content industries: (1) currency vs best practice (2) diversification vs specialisation of products and services (3) creative outputs vs commercial outcomes (4) more learning opportunities vs less opportunity to learn. These findings point to the importance of ‘learning how to learn’ as a 21st century capability. The interviewees were ambivalent about university courses as preparation for professional life in their fields. Higher education was described by several interviewees as having relatively little value-add beyond what one described as “really expensive credentialling services.” For all interviewees in this study, informal learning strategies were the preferred methods of acquiring the majority of knowledge and skills, both for ongoing and initial professional development. Informal learning has no ‘curriculum’ per se, and tends to be opportunistic, unstructured, pedagogically agile and far more self-directed than formal learning (Eraut, 2004). In an industry impacted by constant change, informal learning is clearly both essential and ubiquitous. Inspired by the professional development strategies of the digital media professionals in this study, I propose a 21st century model of the university as a broad, open learning ecology, which also includes industry, professionals, users, and university researchers. If created and managed appropriately, the university learning network becomes the conduit and knowledge integrator for the latest research and industry trends, which students and professionals alike can access as needed.

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.

A novel real time pricing scheme for demand response in residential distribution systems

Price based technique is one way to handle increase in peak demand and deal with voltage violations in residential distribution systems. This paper proposes an improved real time pricing scheme for residential customers with demand response option. Smart meters and in-home display units are used to broadcast the price and appropriate load adjustment signals. Customers are given an opportunity to respond to the signals and adjust the loads. This scheme helps distribution companies to deal with overloading problems and voltage issues in a more efficient way. Also, variations in wholesale electricity prices are passed on to electricity customers to take collective measure to reduce network peak demand. It is ensured that both customers and utility are benefitted by this scheme.

Purification of particles of subterranean clover red leaf virus using an industrial-grade cellulase

Particles of two isolates of subterranean clover red leaf virus were purified by a method in which infected plant tissue was digested with an industrial-grade cellulase, Celluclast® 2.0 L type X. The yields of virus particles using this enzyme were comparable with those obtained using either of two laboratory-grade cellulases, Cellulase type 1 (Sigma) and Driselase®. However, the specific infectivity or aphid transmissibility of the particles purified using Celluclast® was 10-100 times greater than those of preparations obtained using laboratory-grade cellulases or no enzyme. The main advantage of using Celluclast® is that at present in Australia its cost is only ca. 1% of laboratory-grade cellulases.

Practical Modbus flooding attack and detection

The Modicon Communication Bus (Modbus) protocol is one of the most commonly used protocols in industrial control systems. Modbus was not designed to provide security. This paper confirms that the Modbus protocol is vulnerable to flooding attacks. These attacks involve injection of commands that result in disrupting the normal operation of the control system. This paper describes a set of experiments that shows that an anomaly-based change detection algorithm and signature-based Snort threshold module are capable of detecting Modbus flooding attacks. In comparing these intrusion detection techniques, we find that the signature-based detection requires a carefully selected threshold value, and that the anomaly-based change detection algorithm may have a short delay before detecting the attacks depending on the parameters used. In addition, we also generate a network traffic dataset of flooding attacks on the Modbus control system protocol.

The power of hands-on exercises in SCADA cyber security education

For decades Supervisory Control and Data Acquisition (SCADA) and Industrial Control Systems (ICS) have used computers to monitor and control physical processes in many critical industries, including electricity generation, gas pipelines, water distribution, waste treatment, communications and transportation. Increasingly these systems are interconnected with corporate networks via the Internet, making them vulnerable and exposed to the same risks as those experiencing cyber-attacks on a conventional network. Very often SCADA networks services are viewed as a specialty subject, more relevant to engineers than standard IT personnel. Educators from two Australian universities have recognised these cultural issues and highlighted the gap between specialists with SCADA systems engineering skills and the specialists in network security with IT background. This paper describes a learning approach designed to help students to bridge this gap, gain theoretical knowledge of SCADA systems' vulnerabilities to cyber-attacks via experiential learning and acquire practical skills through actively participating in hands-on exercises.