Leg Clubs - Beyond the ulcers : case studies based on participatory action research

Based on Participatory Action Research (PAR), the case studies in this paper examine the psychosocial benefits and outcomes for clients of community based Leg Clubs. The Leg Club model was developed in the United Kingdom (UK) to address the issue of social isolation and non-compliance to leg ulcer treatment. Principles underpinning the Leg Club are based on the Participatory Action Framework (PAR) where the input and involvement of participants is central. This study identifies the strengths of the Leg Club in enabling and empowering people to improve the social context in which they function. In addition it highlights the potential of expanding operations that are normally clinically based (particularly in relation to chronic conditions) but transferable to community settings in order that that they become “agents of change” for addressing such issues as social isolation and the accompanying challenges that these present, including no-compliance to treatment.

Everyone's problem but nobody's job : staff perceptions and explanations for poor nutritional intake in older medical patients

Aim: Up to 60% of older medical patients are malnourished with further decline during hospital stay. There is limited evidence for effective nutrition intervention. Staff focus groups were conducted to improve understanding of potential contextual and cultural barriers to feeding older adults in hospital. Methods: Three focus groups involved 22 staff working on the acute medical wards of a large tertiary teaching hospital. Staff disciplines were nursing, dietetics, speech pathology, occupational therapy, physiotherapy, pharmacy. A semistructured topic guide was used by the same facilitator to prompt discussions on hospital nutrition care including barriers. Focus groups were tape-recorded, transcribed and analysed thematically. Results: All staff recognised malnutrition to be an important problem in older patients during hospital stay and identified patient-level barriers to nutrition care such as non-compliance to feeding plans and hospital-level barriers including nursing staff shortages. Differences between disciplines revealed a lack of a coordinated approach, including poor knowledge of nutrition care processes, poor interdisciplinary communication, and a lack of a sense of shared responsibility/coordinated approach to nutrition care. All staff talked about competing activities at meal times and felt disempowered to prioritise nutrition in the acute medical setting. Staff agreed education and ‘extra hands’ would address most barriers but did not consider organisational change. Conclusions: Redesigning the model of care to reprioritise meal-time activities and redefine multidisciplinary roles and responsibilities would support coordinated nutrition care. However, effectiveness may also depend on hospitalwide leadership and support to empower staff and increase accountability within a team-led approach.

Full circle on costs

This article considers the implications of the decision in Paroz v Clifford Gouldson Lawyers [2012] QDC 151, which examined provisions of the Legal Profession Act 2007 (Qld) dealing with costs disclosure and assessment, and also considered associated provisions of the Uniform Civil Procedure Rules 1999 (Qld).

Offsetting methane emissions : an alternative to emission equivalence metrics

It is widely recognised that defining trade-offs between greenhouse gas emissions using ‘emission equivalence’ based on global warming potentials (GWPs) referenced to carbon dioxide produces anomalous results when applied to methane. The short atmospheric lifetime of methane, compared to the timescales of CO2 uptake, leads to the greenhouse warming depending strongly on the temporal pattern of emission substitution. We argue that a more appropriate way to consider the relationship between the warming effects of methane and carbon dioxide is to define a ‘mixed metric’ that compares ongoing methane emissions (or reductions) to one-off emissions (or reductions) of carbon dioxide. Quantifying this approach, we propose that a one-off sequestration of 1 t of carbon would offset an ongoing methane emission in the range 0.90–1.05 kg CH4 per year. We present an example of how our approach would apply to rangeland cattle production, and consider the broader context of mitigation of climate change, noting the reverse trade-off would raise significant challenges in managing the risk of non-compliance. Our analysis is consistent with other approaches to addressing the criticisms of GWP-based emission equivalence, but provides a simpler and more robust approach while still achieving close equivalence of climate mitigation outcomes ranging over decadal to multi-century timescales.

Pleading - self-incrimination and penalty privileges

In Anderson v Australian Securities and Investments Commission [2012] QCA 301 the Queensland Court of Appeal allowed an appeal from the decision of the primary judge (ASIC v Managed Investments Ltd No 3 [2012] QSC 74. The Court of Appeal was satisfied that the defendants’ non-compliance with the pleading rules in the Uniform Civil Procedure Rules 1999 (Qld) was justified by the claims to privilege against self-incrimination or exposure to a penalty.

Decision making under pressure : a behavioural economics perspective

This research investigates the decision making process of individuals from revealed preferences in extreme environments or life-and-death situations, from a behavioral economics perspective. The empirical analysis of revealed behavioral preferences shows how the individual decision making process can deviate from the standard self-interested or “homo economicus” model in non-standard situations. The environments examined include: elite athletes in FIFA World and Euro Cups; climbing on Everest and the Himalaya; communication during 9/11 and risk seeking after the 2011 Brisbane floods. The results reveal that the interaction of culture and environment has a significant impact on the decision process, as social behaviors and institutions are intimately intertwined, which govern the processes of human behavior and interaction. Additionally, that risk attitudes are not set and that immediate environmental factors can induce a significant shift in an individuals risk seeking behaviors.

Is the two hour recommended maximum driving time appropriate for both healthy older and treated obstructive sleep apnoea drivers?

Objectives The UK Department for Transport recommends taking a break from driving every 2 h. This study investigated: (i) if a 2 h drive time on a monotonous road is appropriate for OSA patients treated with CPAP, compared with healthy age matched controls, (ii) the impact of a night’s sleep restriction (with CPAP) and (iii) what happens if these patients miss one nights’ CPAP treatment. Methods About 19 healthy men aged 52–74 y (m = 66.2 y) and 19 OSA participants aged 50–75 y (m = 64.4 y) drove an interactive car simulator under monotonous motorway conditions for 2 h on two afternoons, in a counterbalanced design; (1) following a normal night’s sleep (8 h). (2) following a restricted night’s sleep (5 h), with normal CPAP use (3) following a night without CPAP treatment. (n = 11) Lane drifting incidents, indicative of falling asleep, were recorded for up to 2 h depending on competence to continue driving. Results Normal sleep: Controls drove for an average of 95.9 min (s.d. 37 min) and treated OSA drivers for 89.6 min (s.d. 29 min) without incident. 63.2% of controls and 42.1% of OSA drivers successfully completed the drive without an incident. Sleep restriction: 47.4% of controls and 26.3% OSA drivers finished without incident. Overall: controls drove for an average of 89.5 min (s.d. 39 min) and treated OSA drivers 65 min (s.d. 42 min) without incident. The effect of condition was significant [F(1.36) = 9.237, P < 0.05, eta2 = 0.204]. Stopping CPAP: 18.2% of drivers successfully completed the drive. Overall, participants drove for an average of 50.1 min (s.d. 38 min) without incident. The effect of condition was significant [F(2) = 8.8, P < 0.05, eta2 = 0.468]. Conclusion 52.6% of all drivers were able to complete a 2 hour drive under monotonous conditions after a full night’s sleep. Sleep restriction significantly affected both control and OSA drivers. We find evidence that treated OSA drivers are more impaired by sleep restriction than healthy control, as they were less able to sustain safely the 2 h drive without incidents. OSA drivers should be aware that non-compliance with CPAP can significantly impair driving performance. It may be appropriate to recommend older drivers take a break from driving every 90 min especially when undertaking a monotonous drive, as was the case here.

Continuous positive air pressure treatment for obstructive sleep apnoea patients : effects on sleep quality and quantity as measured by actigraphy

Objectives Actigraphy can reliably assess sleep in healthy adults and be used to estimate total sleep time in suspected obstructive sleep apnoea (OSA) patients. We compared sleep quality for Continuous Positive Air Pressure (CPAP) treated OSA patients and controls, evaluating the impact of stopping CPAP for one night. Methods 11 men, aged 51–75 years (m = 65.6 years), compliant CPAP users, treated for 1–19 years (m = 7.8 years) wore Cambridge Neurotechnology Ltd actiwatches for one night while using CPAP and for one night sleeping without CPAP. A control group of 11 healthy men, aged 63–74 years (m = 64.1 years) slept normally whilst wearing an actiwatch. Subsequent daytime sleepiness was recorded using Karolinska sleepiness scores (KSS). Results Actimetry showed no significant differences between actual sleep time, sleep efficiency, sleep disturbance index or number of wake bouts when comparing OSA participants using CPAP, with controls; there was no difference in subsequent daytime sleepiness, control KSS = 4.21, OSA KSS = 4.17. Without CPAP there was no significant difference in sleep length or sleep onset latency compared with using CPAP, but there was a significant impact on sleep quality as shown by: increased sleep disturbance index from 7.9 to 13.8 [t(10) = 3.510, P < 0.05], decreased percent of actual sleep from 92.05% to 86.15% [t(10) = 3.51, P < 0.05], decreased sleep efficiency from 86.6% to 81% [t(10) = 2.204, P < 0.05] and increased number of wake bouts from 29 to 42.5 [t(10) = 3.877, P < 0.05]. Daytime sleepiness became significantly worse increasing from KSS 4.17 to 6.27 [t(10) = )4.96, P < 0.05]. Conclusion There was no disparity in sleep quality or KSS scores between CPAP treated OSA patients and healthy controls of a similar age. Treated OSA patients obtained quality sleep with no elevated day time sleepiness. However, cessation of treatment for one night caused sleep quality to deteriorate despite a comparable sleep time; the deterioration in sleep quality could explain the increase in daytime sleepiness. OSA patients need to know that even short-term noncompliance with CPAP treatment significantly impairs sleep quality, leading to excessive sleepiness during monotonous tasks such as driving. Actigraphy successfully identified nights of non-compliance in treated OSA patients; but did not differentiate between the sleep of CPAP treated OSA patients and healthy controls.

Water Quality Indices from Unbalanced Spatio-Temporal Monitoring Designs

This chapter investigates a variety of water quality assessment tools for reservoirs with balanced/unbalanced monitoring designs and focuses on providing informative water quality assessments to ensure decision-makers are able to make risk-informed management decisions about reservoir health. In particular, two water quality assessment methods are described: non-compliance (probability of the number of times the indicator exceeds the recommended guideline) and amplitude (degree of departure from the guideline). Strengths and weaknesses of current and alternative water quality methods will be discussed. The proposed methodology is particularly applicable to unbalanced designs with/without missing values and reflects the general conditions and is not swayed too heavily by the occasional extreme value (very high or very low quality). To investigate the issues in greater detail, we use as a case study, a reservoir within South-East Queensland (SEQ), Australia. The purpose here is to obtain an annual score that reflected the overall water quality, temporally, spatially and across water quality indicators for each reservoir.

Airport security screeners expertise and implications for interface design

This paper describes research investigating expertise and the types of knowledge used by airport security screeners. It applies a multi method approach incorporating eye tracking, concurrent verbal protocol and interviews. Results show that novice and expert security screeners primarily access perceptual knowledge and experience little difficulty during routine situations. During non-routine situations however, experience was found to be a determining factor for effective interactions and problem solving. Experts were found to use strategic knowledge and demonstrated structured use of interface functions integrated into efficient problem solving sequences. Comparatively, novices experienced more knowledge limitations and uncertainty resulting in interaction breakdowns. These breakdowns were characterised by trial and error interaction sequences. This research suggests that the quality of knowledge security screeners have access to has implications on visual and physical interface interactions and their integration into problem solving sequences. Implications and recommendations for the design of interfaces used in the airport security screening context are discussed. The motivations of recommendations are to improve the integration of interactions into problem solving sequences, encourage development of problem scheme knowledge and to support the skills and knowledge of the personnel that interact with security screening systems.

Small firms and health and safety harmonisation : potential regulatory effects of a dominant narrative

Small firms are popularly viewed as resistant to complying with regulation. Harmonisation of Australia’s state-based work health and safety regimes is a significant regulatory change. In this article, we consider the likely responses of small firms to work health and safety harmonisation and argue that a range of choices are open to small firm owner-managers. These choices are shaped by individuals’ world views and are influenced by elements in the firms’ context. A significant element is the public narrative of work health and safety harmonisation, which can be understood by using discourse and sense-making concepts. Our analysis of small firm owner-manager choices takes into account small firms’ embeddedness in their regulatory context and the influence on organisational decision-making of the narrative of work health and safety harmonisation. The dominant narrative is arguably silent on the benefits of the work health and safety regulatory change and therefore the response of small firms is likely to be avoidance or minimalism. Non-compliance could be the result due to poor awareness of opportunities arising from this regulatory change.

License scheme : an optimal waste management policy under asymmetric information

A system requiring a waste management license from an enforcement agency has been introduced in many countries. A license system is usually coupled with fines, a manifest, and a disposal tax. However, these policy devices have not been integrated into an optimal policy. In this paper we derive an optimal waste management policy by using those policy devices. Waste management policies are met with three difficult problems: asymmetric information, the heterogeneity of waste management firms, and non-compliance by waste management firms and waste disposers. The optimal policy in this paper overcomes all three problems.

Government procurement contracts and minimum labour standards enforcement: Rhetoric, duplication and distraction?

Government contracts for services typically include terms requiring contractors to comply with minimum labour standards laws. Procurement contract clauses specify reporting procedures and sanctions for non-compliance, implying that government contracting agencies will monitor and enforce minimum labour standards within contract performance management. In this article, the case of school cleaners employed under New South Wales government contracts between 2010 and 2011 is the vehicle for exploring the effectiveness of these protective clauses. We find that the inclusion of these protective clauses in procurement contracts is unnecessary in the Australian context, and any expectations that government contracting agencies will monitor and enforce labour standards are misleading. At best, the clauses are rhetoric, and at worst, they are a distraction for parties with enforcement powers.

Making smart decisions : key steps towards a typology for emergency communication during natural hazards

Governments, authorities, and organisations dedicate significant resources to encourage communities to prepare for and respond to natural hazards such as cyclones, earthquakes, floods, and bushfires. However, recent events, media attention, and ongoing academic research continue to highlight cases of non-compliance including swift water rescues. Individuals who fail to comply with instructions issued during natural hazards significantly impede the emergency response because they divert resources to compliance-enforcement and risk the lives of emergency service workers who may be required to assist them. An initial investigation of the field suggests several assumptions or practices that influence emergency management policy, communication strategy, and community behaviours during natural hazards: 1) that community members will comply with instructions issued by governments and agencies that represent the most authoritative voice, 2) that communication campaigns are shaped by intuition rather than evidence-based approaches (Wood et al., 2012), and 3) that emergency communication is linear and directional. This extended abstract represents the first stage of a collaborative research project that integrates industry and cross-disciplinary perspectives to provide evidence-based approaches for emergency and risk communication during the response and recovery phases of a natural hazard. Specifically, this abstract focuses on the approach taken and key elements that will form the development of a typology of compliance-gaining messages during the response phase of natural hazards, which will be the focus of the conference presentation.

Audit committee effectiveness : informal processes and behavioural effects

Purpose This paper seeks to investigate the conditions and processes affecting the operation and potential effectiveness of audit committees (ACs), with particular focus on the interaction between the AC, individuals from financial reporting and internal audit functions and the external auditors. Design/methodology/approach A case study approach is employed, based on direct engagement with participants in AC activities, including the AC chair, external auditors, internal auditors, and senior management. Findings The authors find that informal networks between AC participants condition the impact of the AC and that the most significant effects of the AC on governance outcomes occur outside the formal structures and processes. An AC has pervasive behavioural effects within the organization and may be used as a threat, an ally and an arbiter in bringing solutions to issues and conflicts. ACs are used in organizational politics, communication processes and power plays and also affect interpretations of events and cultural values. Research limitations/implications Further research on AC and governance processes is needed to develop better understanding of effectiveness. Longitudinal studies, focusing on the organizational and institutional context of AC operations, can examine how historical events in an organization and significant changes in the regulatory environment affect current structures and processes. Originality/value The case analysis highlights a number of significant factors which are not fully recognised either in theorizing the governance role of ACs or in the development of policy and regulations concerning ACs but which impinge on their governance contribution. They include the importance of informal processes around the AC; its influence on power relations between organizational participants; the relevance of the historical development of governance in an organization; and the possibility that the AC’s impact on governance may be greatest in non-routine situations.