How costs change with infection prevention efforts

Purpose of review: To describe articles since January 2013 that include information on how costs change with infection prevention efforts. Recent findings: Three articles described only the costs imposed by nosocomial infection and so provided limited information about whether or not infection prevention efforts should be changed. One article was found that described the costs of supplying alcohol-based hand run in low-income countries. Eight articles showed the extra costs and cost savings from changing infection prevention programmes and discussed the health benefits. All concluded that the changes are economically worthwhile. There was a systematic review of the costs of methicillin-resistant Staphylococcus aureus control programmes and a methods article for how to make cost estimates for infection prevention programmes. Summary: The balance has shifted away from studies that report the high cost of nosocomial infections toward articles that address the value for money of infection prevention. This is good as simply showing a disease is high cost does not inform decisions to reduce it. More research, done well, on the costs of implementation, cost savings and change to health benefits in this area needs to be done as many gaps exist in our knowledge.

Marginal costs of hospital-acquired conditions : information for priority-setting for patient safety programmes and research

Objective: To estimate the relative inpatient costs of hospital-acquired conditions. Methods: Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian ‘condition-onset' flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n = 1,699,997) treated in Australian public hospitals in Victoria (2005/06) and Queensland (2006/07). Results: The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU$21,827 to the cost of an episode, followed by MRSA (AU$19,881) and enterocolitis due to Clostridium difficile (AU$19,743). Aggregate costs to the system, however, were highest for septicaemia (AU$41.4 million), complications of cardiac and vascular implants other than septicaemia (AU$28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU$27.8 million) and UTI (AU$24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. Conclusions: Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on ‘indicators’ of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.

Accounting for management costs in sensitivity analyses of matrix population models

Traditional sensitivity and elasticity analyses of matrix population models have been used to inform management decisions, but they ignore the economic costs of manipulating vital rates. For example, the growth rate of a population is often most sensitive to changes in adult survival rate, but this does not mean that increasing that rate is the best option for managing the population because it may be much more expensive than other options. To explore how managers should optimize their manipulation of vital rates, we incorporated the cost of changing those rates into matrix population models. We derived analytic expressions for locations in parameter space where managers should shift between management of fecundity and survival, for the balance between fecundity and survival management at those boundaries, and for the allocation of management resources to sustain that optimal balance. For simple matrices, the optimal budget allocation can often be expressed as simple functions of vital rates and the relative costs of changing them. We applied our method to management of the Helmeted Honeyeater (Lichenostomus melanops cassidix; an endangered Australian bird) and the koala (Phascolarctos cinereus) as examples. Our method showed that cost-efficient management of the Helmeted Honeyeater should focus on increasing fecundity via nest protection, whereas optimal koala management should focus on manipulating both fecundity and survival simultaneously. These findings are contrary to the cost-negligent recommendations of elasticity analysis, which would suggest focusing on managing survival in both cases. A further investigation of Helmeted Honeyeater management options, based on an individual-based model incorporating density dependence, spatial structure, and environmental stochasticity, confirmed that fecundity management was the most cost-effective strategy. Our results demonstrate that decisions that ignore economic factors will reduce management efficiency. ©2006 Society for Conservation Biology.

Costs and benefits of ivory-billed woodpecker re-discovery

Several years ago, the purported re-discovery of the ivory-billed woodpecker (Campephilus principalis) in eastern Arkansas generated lively discussion in renowned scientific journals. The debate concerned both the central question of whether the bird videotaped in April 2004 really was an ivorybilled woodpecker (eg Fitzpatrick et al. 2005; Sibley et al. 2006) and the controversy around the resulting species recovery plan and its costs (McKelvey et al. 2008; Dalton 2010): was $14 million pointlessly spent?

Depression in Working Adults: Comparing the Costs and Health Outcomes of Working When Ill

Objective Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill (“presenteeism”) amongst employed Australians reporting lifetime major depression. Methods Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar). Results Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. Conclusions Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.

Book Review: "Below the Line: Producers and Production Studies in the New Television Economy by Vicki Mayer", Duke University Press, 2012

Vicki Mayer’s book is unusual in that, despite its title, it is not about television producers at all, or at least not in the sense that scholars and the television industry itself have traditionally understood the role. Rather than referring to those in creative, managerial or financial control, or those with substantial intellectual input into a program, Mayer uses the term in a deliberately broad sense to mean, essentially, anyone ‘whose labor, however small, contributes to [television] production’ (179).

Working as one: A road map to disaster resilience for Australia

Natural disasters cause widespread disruption, costing the Australian economy $6.3 billion per year, and those costs are projected to rise incrementally to $23 billion by 2050. With more frequent natural disasters with greater consequences, Australian communities need the ability to prepare and plan for them, absorb and recover from them, and adapt more successfully to their effects. Enhancing Australian resilience will allow us to better anticipate disasters and assist in planning to reduce losses, rather than just waiting for the next king hit and paying for it afterwards. Given the scale of devastation, governments have been quick to pick up the pieces when major natural disasters hit. But this approach (‘The government will give you taxpayers’ money regardless of what you did to help yourself, and we’ll help you rebuild in the same risky area.’) has created a culture of dependence. This is unsustainable and costly. In 2008, ASPI published Taking a punch: building a more resilient Australia. That report emphasised the importance of strong leadership and coordination in disaster resilience policymaking, as well as the value of volunteers and family and individual preparation, in managing the effects of major disasters. This report offers a roadmap for enhancing Australia’s disaster resilience, building on the 2011 National Strategy for Disaster Resilience. It includes a snapshot of relevant issues and current resilience efforts in Australia, outlining key challenges and opportunities. The report sets out 11 recommendations to help guide Australia towards increasing national resilience, from individuals and local communities through to state and federal agencies.

Creative industries and the wider economy

Researchers have argued that the creative industries have significant effects on the wider economy, with early agendas focused on urban regeneration, job creation, and economic value-added. Later work extended to new firm creation, the growth of new markets, and regional clustering and development. This chapter reviews the evolution of thinking on classifying the creative industries as a ‘sector’, or group of sectors, and outlines contributions on economic ‘spillovers’ regarding knowledge, innovation, and graduate talent. Work on creative clusters has highlighted the widespread adoption of forms of organization and contracting developed in such clusters. Later work by the authors has contributed a ‘creative trident’ model, and shifted focus to employment and the position of creative workers in the economy, showing that there are more creatives working outside the creative industries than within them. The chapter reflects on the specific role of design and the relationship between the creative industries and innovation.

Proceedings of the 3rd International Subtropical Cities Conference 2011 Subtropical Cities: Subtropical Urbanism -Beyond Climate Change

Climate has been, throughout modern history, a primary attribute for attracting residents to the “Sunshine States” of Florida (USA) and Queensland (Australia). The first major group of settlers capitalized on the winter growing season to support a year-­‐round agricultural economy. As these economies developed, the climate attracted tourism and retirement industries. Yet as Florida and Queensland have blossomed under beneficial climates, the stresses acting on the natural environment are exacting a toll. Southeast Florida and eastern Queensland are among the most vulnerable coastal metropolitan areas in the world. In these places the certainty of sea level rise is measurable with impacts, empirically observable, that will continue to increase regardless of any climate change mitigation.1 The cities of the subtropics share a series of paradoxes relating to climate, resources, environment, and culture. As the subtropical climate entices new residents and visitors there are increasing costs associated with urban infrastructure and the ravages of violent weather. The carefree lifestyle of subtropical cities is increasingly dependent on scarce water and energy resources and the flow of tangible goods that support a trade economy. The natural environment is no longer exploitable as the survival of the human environment is contingent upon the ability of natural ecosystems to absorb the impact of human actions. The quality of subtropical living is challenged by the mounting pressures of population growth and rapid urbanization yet urban form and contemporary building design fail to take advantage of the subtropical zone’s natural attributes of abundant sunshine, cooling breezes and warm temperatures. Yet, by building a global network of local knowledge, subtropical cities like Brisbane, the City of Gold Coast and Fort Lauderdale, are confidently leading the way with innovative and inventive solutions for building resiliency and adaptation to climate change. The Centre for Subtropical Design at Queensland University of Technology organized the first international Subtropical Cities conference in Brisbane, Australia, where the “fault-­‐lines” of subtropical cities at breaking points were revealed. The second conference, held in 2008, shed a more optimistic light with the theme "From fault-­‐lines to sight-­‐lines -­‐ subtropical urbanism in 20-­‐20" highlighting the leadership exemplified in the vitality of small and large works from around the subtropical world. Yet beyond these isolated local actions the need for more cooperation and collaboration was identified as the key to moving beyond the problems of the present and foreseeable future. The spirit of leadership and collaboration has taken on new force, as two institutions from opposite sides of the globe joined together to host the 3rd international conference Subtropical Cities 2011 -­‐ Subtropical Urbanism: Beyond Climate Change. The collaboration between Florida Atlantic University and the Queensland University of Technology to host this conference, for the first time in the United States, forges a new direction in international cooperative research to address urban design solutions that support sustainable behaviours, resiliency and adaptation to sea level rise, green house gas (GHG) reduction, and climate change research in the areas of architecture and urban design, planning, and public policy. With southeast Queensland and southern Florida as contributors to this global effort among subtropical urban regions that share similar challenges, opportunities, and vulnerabilities our mutual aim is to advance the development and application of local knowledge to the global problems we share. The conference attracted over 150 participants from four continents. Presentations by authors were organized into three sub-­‐themes: Cultural/Place Identity, Environment and Ecology, and Social Economics. Each of the 22 papers presented underwent a double-­‐blind peer review by a panel of international experts among the disciplines and research areas represented. The Centre for Subtropical Design at the Queensland University of Technology is leading Australia in innovative environmental design with a multi-­‐disciplinary focus on creating places that are ‘at home’ in the warm humid subtropics. The Broward Community Design Collaborative at Florida Atlantic University's College for Design and Social Inquiry has built an interdisciplinary collaboration that is unique in the United States among the units of Architecture, Urban and Regional Planning, Social Work, Public Administration, together with the College of Engineering and Computer Science, the College of Science, and the Center for Environmental Studies, to engage in funded action research through design inquiry to solve the problems of development for urban resiliency and environmental sustainment. As we move beyond debates about climate change -­‐ now acting upon us -­‐ the subtropical urban regions of the world will continue to convene to demonstrate the power of local knowledge against global forces, thereby inspiring us as we work toward everyday engagement and action that can make our cities more livable, equitable, and green.

Public private partnership infrastructure delivery: Benefits and costs for society

This research provides additional knowledge on the benefits and costs to society, in particular of road transport procured through Public-Private Partnership (PPP) arrangements. Currently, the public sector comparator (PSC) and cost-benefit analysis (CBA) used to evaluate and measure the benefits and costs of PPP are limited in their capacity to predict and forecast long-term events. PPP is attractive to governments due to the non-upfront payment, perceived value for money, and risk allocation and transfer to the private investor. However, public sector remains the guarantor, and under-writer of the private investor's loan from financial institutions and other voluntary risks which are unlimited to future compensatory claims. The new knowledge from this research is the introduction of a framework capable of evaluating, and measuring the associated PPP benefits, as well as the costs, effects, and impacts to society which are protracted and sporadic by nature.

Hospital infection control units: Staffing, costs, and priorities

Background: This article describes infection prevention and control professionals’ (ICPs’) staffing levels, patient outcomes, and costs associated with the provision of infection prevention and control services in Australian hospitals. A secondary objective was to determine the priorities for infection control units. Methods: A cross-sectional study design was used. Infection control units in Australian public and private hospitals completed a Web-based anonymous survey. Data collected included details about the respondent; hospital demographics; details and services of the infection control unit; and a description of infection prevention and control-related outputs, patient outcomes, and infection control priorities. Results: Forty-nine surveys were undertaken, accounting for 152 Australian hospitals. The mean number of ICPs was 0.66 per 100 overnight beds (95% confidence interval, 0.55-0.77). Privately funded hospitals have significantly fewer ICPs per 100 overnight beds compared with publicly funded hospitals (P < .01). Staffing costs for nursing staff in infection control units in this study totaled $16,364,392 (mean, $380,566). Infection control units managing smaller hospitals (<270 beds) identified the need for increased access to infectious diseases or microbiology support. Conclusion: This study provides valuable information to support future decisions by funders, hospital administrators, and ICPs on service delivery models for infection prevention and control. Further, it is the first to provide estimates of the resourcing and cost of staffing infection control in hospitals at a national level. Copyright

A theoretical framework for reducing tendering costs in the procurement of infrastructure projects

Purpose of this paper One way in which the tendering process can be further improved is by reviewing and clarifying the high costs that participants face during the course of the tendering phase. The study aims to provide project teams working in construction tender preparation a clear picture of what to expect when tendering for infrastructure projects. Design/methodology/approach Firstly, a review of current literature on tendering in infrastructure projects is conducted to identify the associated costs affecting traditional and PPP procurements as well as the potential measures contributing to tendering cost-reduction. A theoretical framework and its corresponding research hypotheses, which are based on the literature reviewed, are then proposed. An industry-wide questionnaire survey is currently under design to solicit industry practitioners’ views on tendering costs and the associated tendering cost-reduction measures. The data collected in the survey will subject to statistical analysis to test the proposed research hypotheses, which will be reported in a forthcoming paper. Findings and value The direct and indirect costs in public-private procurement have been identified and have been categorised into internal and external costs arising from working on tender submissions. A theoretical framework, mainly composed of five mechanisms of cost reduction, has been proposed and will be tested in a forthcoming industry-wide questionnaire survey. Originality/value of paper The findings are expected to lead to a transparent tendering process in infrastructure procurement, in which there is increased engagement from the private sector as well as an increase in competitive tendering.

Preparing engineering graduates for the knowledge economy through blended delivery of mathematics

Contemporary higher education institutions are making significant efforts to develop cohesive, meaningful and effective learning experiences for Science, Technology, Engineering and Mathematics (STEM) curricula to prepare graduates for challenges in the modern knowledge economy, thus enhancing their employability (Carnevale et al, 2011). This can inspire innovative redesign of learning experiences embedded in technology-enhanced educational environments and the development of research-informed, pedagogically reliable strategies fostering interactions between various agents of the learning-teaching process. This paper reports on the results of a project aimed at enhancing students’ learning experiences by redesigning a large, first year mathematics unit for Engineering students at a large metropolitan public university. Within the project, the current study investigates the effectiveness of selected, technology-mediated pedagogical approaches used over three semesters. Grounded in user-centred instructional design, the pedagogical approaches explored the opportunities for learning created by designing an environment containing technological, social and educational affordances. A qualitative analysis of mixed-type questionnaires distributed to students indicated important inter-relations between participants’ frames of references of the learning-teaching process and stressed the importance (and difficulty) of creating appropriate functional context. Conclusions drawn from this study may inform instructional design for blended delivery of STEM-focused programs that endeavor to enhance students’ employability by educating work-ready graduates.

Someone else's boom but always our bust: Australia as a derivative economy, implications for regions

This paper examines the socio-economic impact of mineral and agricultural resource extraction on local communities and explores policy options for addressing them. An emphasis on the marketisation of services together with tight fiscal control has reinforced decline in many country communities in Australia and elsewhere. However, the introduction by the European Union of Regional Policy which emphasises ‘smart specialisation’ can enhance greatly the capacity of local people to generate decent livelihoods. For this to have real effect, the innovative state has to enable partnerships between communities, researchers and industry. For countries like Australia, this would be a substantive policy shift.

Regulating ride-sharing in the peer economy

The rise of the peer economy poses complex new regulatory challenges for policy-makers. The peer economy, typified by services like Uber and AirBnB, promises substantial productivity gains through the more efficient use of existing resources and a marked reduction in regulatory overheads. These services are rapidly disrupting existing established markets, but the regulatory trade-offs they present are difficult to evaluate. In this paper, we examine the peer economy through the context of ride-sharing and the ongoing struggle over regulatory legitimacy between the taxi industry and new entrants Uber and Lyft. We first sketch the outlines of ride-sharing as a complex regulatory problem, showing how questions of efficiency are necessarily bound up in questions about levels of service, controls over pricing, and different approaches to setting, upholding, and enforcing standards. We outline the need for data-driven policy to understand the way that algorithmic systems work and what effects these might have in the medium to long term on measures of service quality, safety, labour relations, and equality. Finally, we discuss how the competition for legitimacy is not primarily being fought on utilitarian grounds, but is instead carried out within the context of a heated ideological battle between different conceptions of the role of the state and private firms as regulators. We ultimately argue that the key to understanding these regulatory challenges is to develop better conceptual models of the governance of complex systems by private actors and the available methods the state has of influencing their actions. These struggles are not, as is often thought, struggles between regulated and unregulated systems. The key to understanding these regulatory challenges is to better understand the important regulatory work carried out by powerful, centralised private firms – both the incumbents of existing markets and the disruptive network operators in the peer-economy.