Cost-effectiveness of a central venous catheter care bundle

Background: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. ---------- Methods and Findings: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds.---------- Conclusions: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared to invest resources in infection control to see efficiency improvements.

Facilitating needs based cancer care for people with a chronic disease : evaluation of an intervention using a multi-centre interrupted time series design

Background: Palliative care should be provided according to the individual needs of the patient, caregiver and family, so that the type and level of care provided, as well as the setting in which it is delivered, are dependent on the complexity and severity of individual needs, rather than prognosis or diagnosis. This paper presents a study designed to assess the feasibility and efficacy of an intervention to assist in the allocation of palliative care resources according to need, within the context of a population of people with advanced cancer. ---------- Methods/design: People with advanced cancer and their caregivers completed bi-monthly telephone interviews over a period of up to 18 months to assess unmet needs, anxiety and depression, quality of life, satisfaction with care and service utilisation. The intervention, introduced after at least two baseline phone interviews, involved a) training medical, nursing and allied health professionals at each recruitment site on the use of the Palliative Care Needs Assessment Guidelines and the Needs Assessment Tool: Progressive Disease - Cancer (NAT: PD-C); b) health professionals completing the NAT: PD-C with participating patients approximately monthly for the rest of the study period. Changes in outcomes will be compared pre-and post-intervention.---------- Discussion: The study will determine whether the routine, systematic and regular use of the Guidelines and NAT: PD-C in a range of clinical settings is a feasible and effective strategy for facilitating the timely provision of needs based care.

A comparative knowledge-based urban development analysis : Vancouver, Melbourne and Manchester vs. Boston

Purpose - The purpose of this paper is to introduce a knowledge-based urban development assessment framework, which has been constructed in order to evaluate and assist in the (re)formulation of local and regional policy frameworks and applications necessary in knowledge city transformations. Design/methodology/approach - The research reported in this paper follows a methodological approach that includes a thorough review of the literature, development of an assessment framework in order to inform policy-making by accurately evaluating knowledge-based development levels of cities, and application of this framework in a comparative study - Boston, Vancouver, Melbourne and Manchester. Originality/value - The paper, with its assessment framework, demonstrates an innovative way of examining the knowledge-based development capacity of cities by scrutinising their economic, socio-cultural, enviro-urban and institutional development mechanisms and capabilities. Practical implications - The paper introduces a framework developed to assess the knowledge-based development levels of cities; presents some of the generic indicators used to evaluate knowledge-based development performance of cities; demonstrates how a city can benchmark its development level against that of other cities, and; provides insights for achieving a more sustainable and knowledge-based development.

Sustainable urban infrastructure management : integration of urban computer modelling

Purpose - This paper seeks to examine the complex relationships between urban planning, infrastructure management, sustainable urban development, and to illustrate why there is an urgent need for local governments to develop a robust planning support system which integrates with advance urban computer modelling tools to facilitate better infrastructure management and improve knowledge sharing between the community, urban planners, engineers and decision makers. Design/methodology/approach - The methods used in this paper includes literature review and practical project case observations. Originality/value - This paper provides an insight of how the Brisbane's planning support system established by Brisbane City Council has significantly improved the effectiveness of urban planning, infrastructure management and community engagement through better knowledge management processes. Practical implications - This paper presents a practical framework for setting up a functional planning support system within local government. The integration of the Brisbane Urban Growth model, Virtual Brisbane and the Brisbane Economic Activity Monitoring (BEAM) database have proven initially successful to provide a dynamic platform to assist elected officials, planners and engineers to understand the limitations of the local environment, its urban systems and the planning implications on a city. With the Brisbane's planning support system, planners and decision makers are able to provide better planning outcomes, policy and infrastructure that adequately address the local needs and achieve sustainable spatial forms.

The Early Prevention of Obesity in CHildren (EPOCH) collaboration : an individual patient data prospective meta-analysis

Background: Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori. Methods/Design: The Early Prevention of Obesity in CHildren (EPOCH) Collaboration was formed in 2009. The main objective of the EPOCH Collaboration is to determine if early intervention for childhood obesity impacts on body mass index (BMI) z scores at age 18-24 months. Additional research questions will focus on whether early intervention has an impact on children’s dietary quality, TV viewing time, duration of breastfeeding and parenting styles. This protocol includes the hypotheses, inclusion criteria and outcome measures to be used in the IPD PMA. The sample size of the combined dataset at final outcome assessment (approximately 1800 infants) will allow greater precision when exploring differences in the effect of early intervention with respect to pre-specified participant- and intervention-level characteristics. Discussion: Finalisation of the data collection procedures and analysis plans will be complete by the end of 2010. Data collection and analysis will occur during 2011-2012 and results should be available by 2013. Trial registration number: ACTRN12610000789066

What will the Apple iPad deliver for newspapers?

The launch of the Apple iPad in January 2010 was one of the most anticipated and publicised launched of a new technological device in recent history. Positioning itself as between a smart phone and a PC, but with the attributes of both, Apple have sought to develop a new market niche with the iPad for tablet PC devices, and early signs are that market expectations are being met.. The iPad’s launch was potentially fortuitous for the newspaper industry worldwide, as it offered the potential to address its two recurring problems: the slow but inexorable decline of print media circulation, and the inability to satisfactorily monetise online readerships. As a result, the Apple iPad has benefited from an enormous amount of free publicity in newspapers, as they develop their own applications (apps) for the device. This paper reports on findings from work undertaken through Smart Services CRC into potential take-up and likely uses of the iPad, and their implications for the news media industry. It reports on focus group analysis undertaken in the mid-2010 using “customer job mapping” methodologies, that draw attention to current gaps in user behaviour in terms of available devices, in order to anticipate possibilities beyond the current “three screens” of PC, mobile phone and television.

The Guardian reportage of the UK MP expenses scandal: a case study of computational journalism

The Guardian reportage of the United Kingdom Member of Parliament (MP) expenses scandal of 2009 used crowdsourcing and computational journalism techniques. Computational journalism can be broadly defined as the application of computer science techniques to the activities of journalism. Its foundation lies in computer assisted reporting techniques and its importance is increasing due to the: (a) increasing availability of large scale government datasets for scrutiny; (b) declining cost, increasing power and ease of use of data mining and filtering software; and Web 2.0; and (c) explosion of online public engagement and opinion.. This paper provides a case study of the Guardian MP expenses scandal reportage and reveals some key challenges and opportunities for digital journalism. It finds journalists may increasingly take an active role in understanding, interpreting, verifying and reporting clues or conclusions that arise from the interrogations of datasets (computational journalism). Secondly a distinction should be made between information reportage and computational journalism in the digital realm, just as a distinction might be made between citizen reporting and citizen journalism. Thirdly, an opportunity exists for online news providers to take a ‘curatorial’ role, selecting and making easily available the best data sources for readers to use (information reportage). These activities have always been fundamental to journalism, however the way in which they are undertaken may change. Findings from this paper may suggest opportunities and challenges for the implementation of computational journalism techniques in practice by digital Australian media providers, and further areas of research.

Evaluation of accessibility for knowledge-based cities

Purpose: The purpose of the paper is to develop a framework for evaluation of accessibility for knowledge based cities. ----- ----- Design/methodology/approach: This approach notifies common mistakes and problems in accessibility assessment for knowledge cities. ----- ----- Originality/value: Accessibility plays a key role in transport sustainability and recognizes the crucial links between transport and sustainable goals like air quality, environmental resource consumption & social equity. In knowledge cities, accessibility has significant effects on quality of life and social equity by improving the mobility of people and goods. Accessibility also influences patterns of growth and economic health by providing access to land. Accessibility is not only one of the components of knowledge cities but also affects other elements of knowledge cities directly or indirectly. ----- ----- Practical implications: The outcomes of the application will be helpful for developing particular methodologies for evaluating knowledge cities. On other words, this methodology attempts to develop an assessment procedure for examining accessibility of knowledge-based cities.

Where money and meanings meet : theorizing the emergence of new values in media and education

Recent developments in technology, globalization, and consumer activism have challenged the "broadcasting model" of natonally bounded, vertically integrated, monopolistic, expert-paradigm media industries, dedicated to supplying leisure entertainment to more or less passive consumers. Instead, attention has turned to globally traded formats, social network markets, consumer-created content, multiplatform "publication," and a semiotic long tail where niche representations can be as valuable as blockbusters. Such chenges are just as much a challenge to education as they are to business models. And education, both formal and informal, is a dynamic agent in these processes, participation, and creative content require a rethink of "studies" just as much as of "media."

Media Economics

A concise introduction to the key ideas and issues in the study of media economics, drawing on a broad range of case studies - from Amazon and Twitter, to Apple and Netflix - to illustrate how economic paradigms are not just theories, but provide important practical insights into how the media operates today. Understanding the economic paradigms at work in media industries and markets is vitally important for the analysis of the media system as a whole. The changing dynamics of media production, distribution and consumption are stretching the capacity of established economic paradigms. In addition to succinct accounts of neo-classical and critical political economics, the text offers fresh perspectives for understanding media drawn from two 'heterodox' approaches: institutional economics and evolutionary economics. Applying these paradigms to vital topics and case studies, Media Economics stresses the value – and limits – of contending economic approaches in understanding how the media operates today. It is essential reading for all students of Media and Communication Studies, and also those from Economics, Policy Studies, Business Studies and Marketing backgrounds who are studying the media. Table of Contents: 1. Media Economics: The Mainstream Approach 2. Critical Political Economy of the Media 3. Institutional Economics 4. Evolutionary Economics 5. Case Studies and Conclusions

Early relational reasoning and the novice programmer : swapping as the “hello world” of relational reasoning

We report on a longitudinal research study of the development of novice programmers in their first semester of programming. In the third week, almost half of our sample of students could not answer an explain-in-plain-English question, for code consisting of just three assignment statements, which swapped the values in two variables. We regard code that swaps the values of two variables as the simplest case of where a programming student can manifest a SOLO relational response. Our results demonstrate that the problems many students face with understanding code can begin very early, on relatively trivial code. However, using traditional programming exercises, these problems often go undetected until late in the semester. New approaches are required to detect and fix these problems earlier.

Spatial distribution of suicide in Queensland, Australia

Background: There has been a lack of investigation into the spatial distribution and clustering of suicide in Australia, where the population density is lower than many countries and varies dramatically among urban, rural and remote areas. This study aims to examine the spatial distribution of suicide at a Local Governmental Area (LGA) level and identify the LGAs with a high relative risk of suicide in Queensland, Australia, using geographical information system (GIS) techniques.---------- Methods: Data on suicide and demographic variables in each LGA between 1999 and 2003 were acquired from the Australian Bureau of Statistics. An age standardised mortality (ASM) rate for suicide was calculated at the LGA level. GIS techniques were used to examine the geographical difference of suicide across different areas.---------- Results: Far north and north-eastern Queensland (i.e., Cook and Mornington Shires) had the highest suicide incidence in both genders, while the south-western areas (i.e., Barcoo and Bauhinia Shires) had the lowest incidence in both genders. In different age groups (≤24 years, 25 to 44 years, 45 to 64 years, and ≥65 years), ASM rates of suicide varied with gender at the LGA level. Mornington and six other LGAs with low socioeconomic status in the upper Southeast had significant spatial clusters of high suicide risk.---------- Conclusions: There was a notable difference in ASM rates of suicide at the LGA level in Queensland. Some LGAs had significant spatial clusters of high suicide risk. The determinants of the geographical difference of suicide should be addressed in future research.

4-Carbamoylpiperidinium 5-nitrosalicylate

In the structure of the title compound, C6H13N2O+ C7H4NO5-, the isonipecotamide cations and the 5-nitrosalicylate anions form hydrogen-bonded chain substructures through head-to-tail piperidinium N---H...O(carboxyl) hydrogen bonds and through centrosymmetric cyclic head-to-head amide-amide hydrogen-bonding associations [graph set R2/2(8)]. These chains are cross linked by amide N---H...O~carboxyl~ and piperidinium N-H...O(nitro) associations to give a two-dimensional sheet structure.

rac-Ammonium cis-2-carboxycyclohexane-1-carboxylate

In the structure of the title compound, cis NH4+ C8H11O4-, the carboxylic acid and carboxyl groups of the cation adopt C-C-C-O torsion angles of 174.9(2) and -145.4(2)deg. respecticely with the alicyclic ring. The ammonium H atoms of the cations give a total of five hydrogen-bonding associations with carboxyl O-atom acceptors of the anion which, together with a carboxylic acid O-H...O(carboxyl) interaction give two-dimensional sheet structures which lie in the (101) planes in the unit cell.

catena-Poly[[[diaquacobalt(II)]-mu-(3,5-dinitro-2-oxidobenzoato)-kappa3O1,O2:O1'-[tetraaquacobalt(II)]-mu-(3,5-dinitro-2-oxidobenzoato)-kappa3-O1:O1',O2] dihydrate]

In the structure of polymeric title compound, {[Co2(C7H2N2O7)2(H2O)6] . 2H2O}n from the reaction of 3,5-dinitrosalicylic acid with cobalt(II) acetate, both slightly distorted octahedral Co(II) centres have crystallographic inversion symmetry. The coordination sphere about one Co centre comprises four O donors from two bidentate chelate O(phenolate), O(carboxyl) and bridging dianionic ligands and two water molecules [Co-O range, 2.0249(11)-2.1386(14)A] while that about the second Co centre has four water molecules and two bridging carboxyl O donor atoms [Co-O range, 2.0690(14)-2.1364(11)A]. The coordinated water molecules as well as the water molecules of solvation give water-water and water-carboxyl hydrogen-bonding interactions in the three-dimensional framework structure.