Cholesterol-lowering management of stroke : inconsistencies of evidence and practice

Cholesterol-lowering treatment by statins is an important and costly issue; however, its role in stroke has not been well documented. The aim of the present study was to review literature and current practice regarding cholesterol-lowering treatment for stroke patients. A literature review was conducted on lipids in stroke and their management with both statins and diet, including the cost-effectiveness of medical nutrition therapy. Qualifying criteria and prescription procedures of the Pharmaceutical Benefits Scheme (PBS) were also reviewed. Data on lipid levels and statin prescriptions were analysed for 468 patients admitted to a stroke unit. The literature shows that management with both medication and diet can be effective, especially when combined; however, 60% of patients with an ischaemic event had fasting total cholesterol measures ≥4 mmol/L (n = 231), with only 52% prescribed statins on discharge (n = 120). Hypercholesterolaemia is an underdiagnosed and undertreated risk factor within the stroke population. It appears that the PBS has not kept pace with advances in the evidence in terms of statin use in the stroke population, and review is needed. The present review should address the qualifying criteria for the stroke population and recommendations on referral to dietitians for dietary advice. Cholesterol-lowering treatment for both stroke patients and the wider population is an area that needs awareness raising and review by the PBS, medical practitioners and dietitians. The role of dietary and pharmacological treatments needs to be clearly defined, including adjunct therapy, and the cost-effectiveness of medical nutrition therapy realised.

Technology strategy : findings from adoption and adaptation of Japanese manufacturing management (JMM) to ASEAN and Australasian automotive manufacturers

The purpose of this study is to demonstrate the appropriateness of “Japanese Manufacturing Management” (JMM) strategies in the Asian, ASEAN and Australasian automotive sectors. Secondly, the study assessed JMM as a prompt, effective and efficient global manufacturing management practice for automotive manufacturing companies to learn; benchmark for best practice; acquire product and process innovation, and enhance their capabilities and capacities. In this study, the philosophies, systems and tools that have been adopted in various automotive manufacturing assembly plants and their tier 1 suppliers in the three Regions were examined. A number of top to middle managers in these companies were located in Thailand, Indonesia, Malaysia, Singapore, Philippines, Viet Nam, and Australia and were interviewed by using a qualitative methodology. The results confirmed that the six pillars of JMM (culture change, quality at shop floor, consensus, incremental continual improvement, benchmarking, and backward-forward integration) are key enablers to success in adopting JMM in both automotive and other manufacturing sectors in the three Regions. The analysis and on-site interviews identified a number of recommendations that were validated by the automotive manufacturing company’s managers as the most functional JMM strategies.

Ubiquitous infrastructure : urban infrastructure planning and management experience of Korea

Urban infrastructure development in Korea has recently shifted from an old paradigm of conventional infrastructure planning to a new paradigm of intelligent infrastructure provision. This new paradigm, so called ubiquitous infrastructure, is based on a combination of urban infrastructure, information and communication technologies and digital networks. Ubiquitous infrastructure basically refers to an urban infrastructure where any citizen could access any infrastructure and services via any electronic device regardless of time and location. This paper introduces this new paradigm of intellectual infrastructure planning and its design schemes. The paper also examines the ubiquitous infrastructure development in Korea and discusses the positive effects of ubiquitous infrastructure on sustainable urban development.

Controlled flexibility and lifecycle management of business processes through extensibility

Vendors provide reference process models as consolidated, off-the-shelf solutions to capture best practices in a given industry domain. Customers can then adapt these models to suit their specific requirements. Traditional process flexibility approaches facilitate this operation, but do not fully address it as they do not sufficiently take controlled change guided by vendors' reference models into account. This tension between the customer's freedom of adapting reference models, and the ability to incorporate with relatively low effort vendor-initiated reference model changes, thus needs to be carefully balanced. This paper introduces process extensibility as a new paradigm for customizing reference processes and managing their evolution over time. Process extensibility mandates a clear recognition of the different responsibilities and interests of reference model vendors and consumers, and is concerned with keeping the effort of customer-side reference model adaptations low while allowing sufficient room for model change.

Student success : the identification and support of first year university students at risk of attrition

The engagement behaviour of 1,524 student-enrolments (“students”) in five first year units was monitored and 608 (39.9%) were classified as “at risk” using the criterion of not submitting or failing their first assignment. Of these, 327 (53.8%) were successfully contacted (i.e., spoken to by phone) and provided with advice and/or referral to learning and personal support services while the remaining 281 (46.2%) could not be contacted. Nine hundred and sixteen students (60.1%) were classified as “not at risk.” Overall, the at risk group who were contacted achieved significantly higher end-of-semester final grades than, and persisted (completed the unit) at more than twice the rate of, the at risk group who were not contacted. There were variations among the units which were explained by the timing of the first assignment, specific teaching-learning processes and the structure of the curriculum. Implications for curriculum design and supporting first year students within a personal, social and academic framework are discussed.

The future of cognitive and behavioral therapies in the prevention and early management of psychosis : opportunities and risks

Behavioral and cognitive interventions for people with psychosis have a long and distinguished history, although the evidence for their application to young people remains limited. We anticipate that the next decades will show substantial research into psychological intervention for this population. Important targets will include the management of environmental stressors, reduction of substance misuse, and promotion of early treatment. Psychological management of positive symptoms, depression, and suicidal behavior will continue to be critical objectives. Important secondary prevention goals will be the retention of cognitive functioning, vocational options, social skills, and social network support, including appropriate family support. We expect primary prevention to include both universal programs and interventions for adolescents at particularly high risk. Technical innovations will include increasing use of Internet-based intervention and behavior cueing devices. Pressures for intervention brevity will continue, as will problems with the systematic delivery of effective procedures.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.

Can Risk Management boost the supply of Affordable Housing Development and Management?

A shortage of affordable housing is a major problem in Australia today. This is mainly due to the limited supply of affordable housing that is provided by the non-government housing sector. Some private housing developers see the provision of affordable housing for lower income people as a high risk investment which offers a lower return than broader market-based housing. The scarcity of suitable land, a limited government ‘subsidy’, and increasing housing costs have not provided sufficient development incentives to encourage their investment despite the existing high demand for affordable housing. This study analyses the risk management process conducted by some private and not-for-profit housing providers in South East Queensland, and draws conclusions about the relationship between risk assessments/responses and past experiences. In-depth interviews of selected non-government housing providers have been conducted to facilitate an understanding of their approach to risk assessment/response in developing and in managing affordable housing projects. These developers use an informal risk management process as part of their normal business process in accordance with industry standards. A simple qualitative matrix has been used to analyse probability and impacts using a qualitative scale - low, medium and high. For housing providers who have considered investing in affordable housing but have not yet implemented any such projects, affordable housing development is seen as an opportunity that needs to be approached with caution. The risks associated with such projects and the levels of acceptance of these are not consistently identified by current housing providers. Many interviewees agree that the recognition of financial risk and the fear of community rejection of such housing projects have restrained them from committing to such investment projects. This study suggests that implementing improvements to the risk mitigation and management framework may assist in promoting the supply of affordable housing by non-government providers.

Developing leadership and management capability for the future of an industry

The importance of having effective managers in an organisation who possess both management and leadership abilities is rarely questioned. However, should we be taking this a step further and looking to the challenge of leadership within an industry sector? The rail industry in Australia faces a challenging future: an aging workforce, geographical spread, privatisation and corporatisation, plus particular issues of industry image and culture. This paper reports the findings of an exploratory study into the current approaches to leadership and management development in the Australian rail industry. It discusses critical issues facing the sector and outlines some theoretical approaches to addressing these issues.

The effects of sensing and seizing of market opportunities and reconfiguring activities on the organisational resource base

This study has important implications for marketing theory and practice. In an era of turbulent market environments, the organisational ability to sense and seize market opportunities and to reconfigure the resource base accordingly, has significant effects on performance. This paper uses a dynamic capability framework to explain more explicitly the intricacies of the relationship between sensing and seizing of market opportunities and reconfiguring the resource base (i.e. dynamic capabilities) and the resource base. We investigate how the attributes of dynamic capability deployment, timing, frequency and speed, influence the resource base. We test the proposed framework using survey data from 228 large organisations. Findings show that the timing and frequency of dynamic capability deployment have significant effects on the resource base.

Conceptualisation and facilitation of SOA governance

As organisations strive to improve their capabilities in the areas of Service Management and Service-oriented Architectures (SOA), SOA Governance is becoming an increasingly important success factor. However, the concept of SOA Governance is complex and not well-understood, and the adoption of an adequate SOA Governance approach in an organisation can be difficult. Tools that support SOA Governance mostly have a technical bias and rarely address organisational aspects. In this paper, we contribute to the field by specifying a conceptual meta model for SOA Governance that integrates the structure of major IT and SOA Governance frameworks into one consolidated view. By presenting this conceptualisation and a corresponding prototypical implementation of a tool that supports SOA Governance maturity assessment, reference framework exploration and company-specific tailoring of SOA Governance, we provide insights into the first step of a Design Science research project, i.e. the development of an important IT artefact.