Evidence of disagreement between patient-perceived change and conventional longitudinal evaluation of change in health-related quality of life among older adults

Objective: To identify agreement levels between conventional longitudinal evaluation of change (post–pre) and patient-perceived change (post–then test) in health-related quality of life. Design: A prospective cohort investigation with two assessment points (baseline and six-month follow-up) was implemented. Setting: Community rehabilitation setting. Subjects: Frail older adults accessing community-based rehabilitation services. Intervention: Nil as part of this investigation. Main measures: Conventional longitudinal change in health-related quality of life was considered the difference between standard EQ-5D assessments completed at baseline and follow-up. To evaluate patient-perceived change a ‘then test’ was also completed at the follow-up assessment. This required participants to report (from their current perspective) how they believe their health-related quality of life was at baseline (using the EQ-5D). Patient-perceived change was considered the difference between ‘then test’ and standard follow-up EQ-5D assessments. Results: The mean (SD) age of participants was 78.8 (7.3). Of the 70 participants 62 (89%) of data sets were complete and included in analysis. Agreement between conventional (post–pre) and patient-perceived (post–then test) change was low to moderate (EQ-5D utility intraclass correlation coefficient (ICC)¼0.41, EQ-5D visual analogue scale (VAS) ICC¼0.21). Neither approach inferred greater change than the other (utility P¼0.925, VAS P¼0.506). Mean (95% confidence interval (CI)) conventional change in EQ-5D utility and VAS were 0.140 (0.045,0.236) and 8.8 (3.3,14.3) respectively, while patient-perceived change was 0.147 (0.055,0.238) and 6.4 (1.7,11.1) respectively. Conclusions: Substantial disagreement exists between conventional longitudinal evaluation of change in health-related quality of life and patient-perceived change in health-related quality of life (as measured using a then test) within individuals.

Dark humour invigorates familiar fables ; a review

THEATRE: Grimm Tales. By Carol Ann Duffy and Tim Supple. Queensland Theatre Company, Brisbane. November 16. QUEENSLAND Theatre Company concludes its season with Grimm Tales, Carol Ann Duffy and Tim Supple's adaptation of classic cautionary tales as set down by the Brothers Grimm in the 19th century. This programming decision is clearly designed to present fun family entertainment as Christmas approaches. In Grimm Tales, well-known stories such as Hansel and Gretel, Snow White and Rumpelstiltskin pack a little more punch than in your standard picture book. Duffy and Supple's play is by no means the sort of poetic, postmodern or politicised adaptation of the fairytale we see from writers such as Angela Carter, and it is not intended to be subversive or to question the social and gender assumptions that underpin the tales. Start of sidebar. Skip to end of sidebar. End of sidebar. Return to start of sidebar. Rather, a return to the grislier original incarnations of the tales - the wicked stepsisters who lop off parts of their feet to fit the slipper and win the prince, or the hare so confused by the hedgehog's stratagem to make him think he is losing the race, he runs himself to death - has a comic effect. In this production, directed by Michael Futcher, heightened performances from some of Brisbane's best comic and physical actors, live music and an open, acknowledged relationship with the audience establish the atmosphere for the piece. While the production is a little sombre and slow to start with the first tale, Hansel and Gretel, the knowingness and almost slapstick quality with which the cast plays out the gruesome, scatological or silly moments in the other tales are well pitched to carry the comedy. The action is supported by a fantastic set by Greg Clarke of wooden planked walls, stairs and walkways which, with the help of David Walter's lighting design, is transformed into forests, ballrooms and castles as the cast moves up, over and under it. The overall highlight is probably the cast Futcher has brought together. Established QTC actors Eugene Gilfedder, Lucas Stibbard and Scott Witt, and emerging QTC actor Melanie Zanetti, join Liz Buchanan, Dan Crestani and Emma Pursey, all well known for their independent work in Brisbane but making their mainstage debut for the QTC. Every one of them metamorphoses with ease from character to character, human to animal, and central player to support. There is nothing particularly new in Grimm Tales, and it doesn't try to do anything more (or, indeed, less) than entertain, but skilful direction and a strong cast ensure it succeeds on those terms.

Physical function and health-related quality of life of older adults undergoing hospital rehabilitation : how strong is the association?

The purpose of this research is to report preliminary empirical evidence regarding the association between common physical performance measures and health-related quality of life (HRQoL) of hospitalized older adults recovering from illness and injury. Frequently, these patients do not return to premorbid levels of independence and physical ability. Rehabilitation for this population often focuses on improving physical functioning and mobility with the intention of maximizing their HRQoL for discharge and thereafter. For this reason, longitudinal use of physical performance measures as an indicator of improvement in physical functioning (and thus HRQoL) is common. Although this is a logical approach, there have been mixed results from previous investigations into the association between common measures of physical function and HRQoL amongst other adult patient populations.1,2 There has been no previous investigation reporting the association between HRQoL and a variety of common physical performance measures in hospitalized older adults.

Informational city

Many cities worldwide face the prospect of major transformation as the world moves towards a global information order. In this new era, urban economies are being radically altered by dynamic processes of economic and spatial restructuring. The result is the creation of ‘informational cities’ or its new and more popular name, ‘knowledge cities’. For the last two centuries, social production had been primarily understood and shaped by neo-classical economic thought that recognized only three factors of production: land, labor and capital. Knowledge, education, and intellectual capacity were secondary, if not incidental, factors. Human capital was assumed to be either embedded in labor or just one of numerous categories of capital. In the last decades, it has become apparent that knowledge is sufficiently important to deserve recognition as a fourth factor of production. Knowledge and information and the social and technological settings for their production and communication are now seen as keys to development and economic prosperity. The rise of knowledge-based opportunity has, in many cases, been accompanied by a concomitant decline in traditional industrial activity. The replacement of physical commodity production by more abstract forms of production (e.g. information, ideas, and knowledge) has, however paradoxically, reinforced the importance of central places and led to the formation of knowledge cities. Knowledge is produced, marketed and exchanged mainly in cities. Therefore, knowledge cities aim to assist decision-makers in making their cities compatible with the knowledge economy and thus able to compete with other cities. Knowledge cities enable their citizens to foster knowledge creation, knowledge exchange and innovation. They also encourage the continuous creation, sharing, evaluation, renewal and update of knowledge. To compete nationally and internationally, cities need knowledge infrastructures (e.g. universities, research and development institutes); a concentration of well-educated people; technological, mainly electronic, infrastructure; and connections to the global economy (e.g. international companies and finance institutions for trade and investment). Moreover, they must possess the people and things necessary for the production of knowledge and, as importantly, function as breeding grounds for talent and innovation. The economy of a knowledge city creates high value-added products using research, technology, and brainpower. Private and the public sectors value knowledge, spend money on its discovery and dissemination and, ultimately, harness it to create goods and services. Although many cities call themselves knowledge cities, currently, only a few cities around the world (e.g., Barcelona, Delft, Dublin, Montreal, Munich, and Stockholm) have earned that label. Many other cities aspire to the status of knowledge city through urban development programs that target knowledge-based urban development. Examples include Copenhagen, Dubai, Manchester, Melbourne, Monterrey, Singapore, and Shanghai. Knowledge-Based Urban Development To date, the development of most knowledge cities has proceeded organically as a dependent and derivative effect of global market forces. Urban and regional planning has responded slowly, and sometimes not at all, to the challenges and the opportunities of the knowledge city. That is changing, however. Knowledge-based urban development potentially brings both economic prosperity and a sustainable socio-spatial order. Its goal is to produce and circulate abstract work. The globalization of the world in the last decades of the twentieth century was a dialectical process. On one hand, as the tyranny of distance was eroded, economic networks of production and consumption were constituted at a global scale. At the same time, spatial proximity remained as important as ever, if not more so, for knowledge-based urban development. Mediated by information and communication technology, personal contact, and the medium of tacit knowledge, organizational and institutional interactions are still closely associated with spatial proximity. The clustering of knowledge production is essential for fostering innovation and wealth creation. The social benefits of knowledge-based urban development extend beyond aggregate economic growth. On the one hand is the possibility of a particularly resilient form of urban development secured in a network of connections anchored at local, national, and global coordinates. On the other hand, quality of place and life, defined by the level of public service (e.g. health and education) and by the conservation and development of the cultural, aesthetic and ecological values give cities their character and attract or repel the creative class of knowledge workers, is a prerequisite for successful knowledge-based urban development. The goal is a secure economy in a human setting: in short, smart growth or sustainable urban development.

Planning online : a community-based interactive decision-making model

The first use of computing technologies and the development of land use models in order to support decision-making processes in urban planning date back to as early as mid 20th century. The main thrust of computing applications in urban planning is their contribution to sound decision-making and planning practices. During the last couple of decades many new computing tools and technologies, including geospatial technologies, are designed to enhance planners' capability in dealing with complex urban environments and planning for prosperous and healthy communities. This chapter, therefore, examines the role of information technologies, particularly internet-based geographic information systems, as decision support systems to aid public participatory planning. The chapter discusses challenges and opportunities for the use of internet-based mapping application and tools in collaborative decision-making, and introduces a prototype internet-based geographic information system that is developed to integrate public-oriented interactive decision mechanisms into urban planning practice. This system, referred as the 'Community-based Internet GIS' model, incorporates advanced information technologies, distance learning, sustainable urban development principles and community involvement techniques in decision-making processes, and piloted in Shibuya, Tokyo, Japan.

Managing ubiquitous eco cities (管理信息全方位生态城市)

Efficient and effective urban management systems for Ubiquitous Eco Cities require having intelligent and integrated management mechanisms. This integration includes bringing together economic, socio-cultural and urban development with a well orchestrated, transparent and open decision making mechanism and necessary infrastructure and technologies. In the Ubiquitous Eco Cities, telecommunication technologies plan an important role in monitoring and managing activities over wired, wireless and fibre-optic networks. particularly technology convergence creates new ways in which the information and telecommunication technologies are used and formed the back bone or urban management systems. The research paper reports and introduces recent approaches on urban management systems, such as intelligent urban management systems, that are suitable for Ubiquitous Eco Cities.

Sustainability : driver for decision making in infrastructure

With the growing importance of sustainability assessment in the construction industry, many green building rating schemes have been adopted in the building sector of Australia. However, there is an abnormal delay in the similar adoption in the infrastructure sector. This prolonged delay in practice poses a challenge in mapping the project objectives with sustainability outcomes. Responding to the challenge of sustainable development in infrastructure, it is critical to create a set of decision indicators for sustainability in infrastructure, which to be used in conjunction with the emerging infrastructure sustainability assessment framework of the Australian Green Infrastructure Council. The various literature sources confirm the lack of correlation between sustainability and infrastructure. This theoretical missing link signifies the crucial validation of the interrelationship and interdependency in sustainability, decision making and infrastructure. This validation is vital for the development of decision indicators for sustainability in infrastructure. Admittedly, underpinned by the serious socio-environmental vulnerability, the traditional focus on economic emphasis in infrastructure development needs to be drifted towards the appropriate decisions for sustainability enhancing the positive social and environmental outcomes. Moreover, the research findings suggest sustainability being observed as powerful socio-political and influential socio-environmental driver in deciding the infrastructure needs and its development. These newly developed sustainability decision indicators create the impetus for change leading to sustainability in infrastructure by integrating the societal cares, environmental concerns into the holistic financial consideration. Radically, this development seeks to transform principles into actions for infrastructure sustainability. Lastly, the thesis concludes with knowledge contribution in five significant areas and future research opportunities. The consolidated research outcomes suggest that the development of decision indicators has demonstrated sustainability as a pivotal driver for decision making in infrastructure.

Preparing quality teachers : making learning visible

Teacher quality is recognised as a lynchpin for education reforms internationally, and both Federal and State governments in Australia have turned their attention to teacher education institutions: the starting point for preparing quality teachers. Changes to policy and shifts in expectations impact on Faculties of Education, despite the fact that little is known about what makes a quality teacher preparation program effective. New accountability measures, mandated Professional Standards, and proposals to test all graduates before registration, mean that teacher preparation programs need capacity for flexibility and responsiveness. The risk is that undergraduate degree programs can become ‘patchwork quilts’ with traces of the old and new stitched together, sometimes at the expense of coherence and integrity. This paper provides a roadmap used by one large Faculty of Education in Queensland for reforming and reconceptualising the curriculum for a 4-year undergraduate program, in response to new demands from government and the professional bodies.

Indigeneity and the judicial decision to imprison : a study of Western Australia’s higher courts

Internationally, sentencing research has largely neglected the impact of Indigeneity on sentencing outcomes. Using data from Western Australia’s higher courts for the years 2003–05, we investigate the direct and interactive effects of Indigenous status on the judicial decision to imprison. Unlike prior research on race/ethnicity in which minority offenders are often found to be more harshly treated by sentencing courts, we find that Indigenous status has no direct effect on the decision to imprison,after adjusting for other sentencing factors (especially past and current criminality).However, there are sub-group differences: Indigenous males are more likely to receive a prison sentence compared to non-Indigenous females. We draw on the focal concerns perspective of judicial decision making in interpreting our findings.

Clinical indicators of quality for Australian residential aged care facilities : establishing reliability, validity, and quality thresholds

Background: In response to the need for more comprehensive quality assessment within Australian residential aged care facilities, the Clinical Care Indicator (CCI) Tool was developed to collect outcome data as a means of making inferences about quality. A national trial of its effectiveness and a Brisbane-based trial of its use within the quality improvement context determined the CCI Tool represented a potentially valuable addition to the Australian aged care system. This document describes the next phase in the CCI Tool.s development; the aims of which were to establish validity and reliability of the CCI Tool, and to develop quality indicator thresholds (benchmarks) for use in Australia. The CCI Tool is now known as the ResCareQA (Residential Care Quality Assessment). Methods: The study aims were achieved through a combination of quantitative data analysis, and expert panel consultations using modified Delphi process. The expert panel consisted of experienced aged care clinicians, managers, and academics; they were initially consulted to determine face and content validity of the ResCareQA, and later to develop thresholds of quality. To analyse its psychometric properties, ResCareQA forms were completed for all residents (N=498) of nine aged care facilities throughout Queensland. Kappa statistics were used to assess inter-rater and test-retest reliability, and Cronbach.s alpha coefficient calculated to determine internal consistency. For concurrent validity, equivalent items on the ResCareQA and the Resident Classification Scales (RCS) were compared using Spearman.s rank order correlations, while discriminative validity was assessed using known-groups technique, comparing ResCareQA results between groups with differing care needs, as well as between male and female residents. Rank-ordered facility results for each clinical care indicator (CCI) were circulated to the panel; upper and lower thresholds for each CCI were nominated by panel members and refined through a Delphi process. These thresholds indicate excellent care at one extreme and questionable care at the other. Results: Minor modifications were made to the assessment, and it was renamed the ResCareQA. Agreement on its content was reached after two Delphi rounds; the final version contains 24 questions across four domains, enabling generation of 36 CCIs. Both test-retest and inter-rater reliability were sound with median kappa values of 0.74 (test-retest) and 0.91 (inter-rater); internal consistency was not as strong, with a Chronbach.s alpha of 0.46. Because the ResCareQA does not provide a single combined score, comparisons for concurrent validity were made with the RCS on an item by item basis, with most resultant correlations being quite low. Discriminative validity analyses, however, revealed highly significant differences in total number of CCIs between high care and low care groups (t199=10.77, p=0.000), while the differences between male and female residents were not significant (t414=0.56, p=0.58). Clinical outcomes varied both within and between facilities; agreed upper and lower thresholds were finalised after three Delphi rounds. Conclusions: The ResCareQA provides a comprehensive, easily administered means of monitoring quality in residential aged care facilities that can be reliably used on multiple occasions. The relatively modest internal consistency score was likely due to the multi-factorial nature of quality, and the absence of an aggregate result for the assessment. Measurement of concurrent validity proved difficult in the absence of a gold standard, but the sound discriminative validity results suggest that the ResCareQA has acceptable validity and could be confidently used as an indication of care quality within Australian residential aged care facilities. The thresholds, while preliminary due to small sample size, enable users to make judgements about quality within and between facilities. Thus it is recommended the ResCareQA be adopted for wider use.

Variability of input parameters related to pollutants build-up in stormwater quality modelling

The variability of input parameters is the most important source of overall model uncertainty. Therefore, an in-depth understanding of the variability is essential for uncertainty analysis of stormwater quality model outputs. This paper presents the outcomes of a research study which investigated the variability of pollutants build-up characteristics on road surfaces in residential, commercial and industrial land uses. It was found that build-up characteristics vary highly even within the same land use. Additionally, industrial land use showed relatively higher variability of maximum build-up, build-up rate and particle size distribution, whilst the commercial land use displayed a relatively higher variability of pollutant-solid ratio. Among the various build-up parameters analysed, D50 (volume-median-diameter) displayed the relatively highest variability for all three land uses.

Establishing a quality franchise relationship in Taiwan : Investigating relationships between relationship quality, loyalty and cooperation

Franchised convenience stores successfully operate throughout Taiwan, but the convenience store market is approaching saturation point. Creating a cooperative long-term franchising relationship between franchisors and franchisees is essential to maintain the proportion of convenience stores...

Subtropical design in South East Queensland : a handbook for planners, developers and decision makers

Subtropical Design in South East Queensland provides a direct link between climatic design, applied urban design and sustainable planning policy. The role that character and identity of a place plays in achieving environmental sustainability is explained. Values of local distinctiveness to do with climate, landscape and culture are identified and the environmental, social and economic benefits of applying subtropical design principles to planning are described. The handbook provides planners and urban designers with an understanding of how subtropical design principles apply within the different contexts of urban planning including the entire spectrum of urban scales from the regional scale, to the city, neighbourhood, street, individual building or site. Twelve interactive principles, and interrelated strategies, drawn predominantly from the body of knowledge of landscape architecture, architectural science and urban design are described in detail in text, and richly illustrated with diagrams and photographs.

Why teaching about Asia matters in higher education

I commence this opinion piece with specific reference to the Gillard Government's decision to cut funding for the Australian Learning and Teaching Council (ALTC)in 2011. I then consider impact of this decision on quality teaching in higher education with specific reference to Studies of Asia. In particular, I reflect on the teaching of Asian languages and cultures in Australia since the 1970 Auchmuty report, and conclude that despite the efforts of policy makers, not much has really changed. In doing so, I emphasise the importance of quality teaching in higher education for inspiring students to challenge their cultural assumptions and to prompt them to develop new views of the world.

Analysis of the build-up of semi and non volatile organic compounds on urban roads

Vehicular traffic in urban areas may adversely affect urban water quality through the build-up of traffic generated semi and non volatile organic compounds (SVOCs and NVOCs) on road surfaces. The characterisation of the build-up processes is the key to developing mitigation measures for the removal of such pollutants from urban stormwater. An in-depth analysis of the build-up of SVOCs and NVOCs was undertaken in the Gold Coast region in Australia. Principal Component Analysis (PCA) and Multicriteria Decision tools such as PROMETHEE and GAIA were employed to understand the SVOC and NVOC build-up under combined traffic scenarios of low, moderate, and high traffic in different land uses. It was found that congestion in the commercial areas and use of lubricants and motor oils in the industrial areas were the main sources of SVOCs and NVOCs on urban roads, respectively. The contribution from residential areas to the build-up of such pollutants was hardly noticeable. It was also revealed through this investigation that the target SVOCs and NVOCs were mainly attached to particulate fractions of 75 to 300 µm whilst the redistribution of coarse fractions due to vehicle activity mainly occurred in the >300 µm size range. Lastly, under combined traffic scenario, moderate traffic with average daily traffic ranging from 2300 to 5900 and average congestion of 0.47 was found to dominate SVOC and NVOC build-up on roads.