Affordable housing solutions : affordable housing providers’ perspective

Accessibility to housing for low to moderate income groups in Australia has experienced a severe decline since 2002. On the supply side, the public sector has been reducing its commitment to the direct provision of public housing. Despite strong demand for affordable housing, limited supply has been generated by non-government housing providers. This paper identifies and discusses some current affordable housing solutions which have been developed by non-government housing providers to ameliorate the problem. This study utilises case studies generated from nineteen housing providers during in-depth interviews in South East Queensland in 2007-2008. The case studies are classified into four categories which relate to the nature of their product: affordable rental housing, mixed housing, affordable housing for people with special needs and low cost home ownership. Each category is discussed on the basis of the characteristics typical of that organisation of housing provider, their partnership arrangements and main target market. In addition, the special design and facilities required for people with special needs which include high care accommodation and aged care are highlighted. Finally, this study recommends offering a continuum of solutions to affordable housing for low income people by means of a rent-to-buy scheme.

Affordable housing solutions : affordable housing providers’ perspective

Accessibility to housing for low to moderate income groups in Australia has been experiencing a severe decline since 2002. On the supply side, the public sector has been reducing its commitment to the direct provision of public housing. Despite strong demand for affordable housing, limited supply has been generated by nongovernment housing providers. This paper identifies and discusses some current affordable housing solutions to ameliorate the problem which have been developed by non-government housing providers. This study utilises case studies generated from nineteen housing providers during indepth interviews in South East Queensland in 2007-2008. The case studies are classified into four categories which relate to the nature of their product: affordable rental housing, mixed housing, affordable housing for people with special needs and low cost home ownership. Each category is discussed on the basis of the characteristics typical of that organisation of housing provider, their partnership arrangements and main target market. In addition, the special design and facilities required for people with special needs which include high care accommodation and aged care are highlighted. Finally, this study recommends offering a continuum of solutions to affordable housing for low income people by means of a rent-to-buy scheme.

Corneal sensitivity as an ophthalmic marker of diabetic neuropathy

Purpose. The objective of this study was to explore the discriminative capacity of non-contact corneal esthesiometry (NCCE) when compared with the neuropathy disability score (NDS) score—a validated, standard method of diagnosing clinically significant diabetic neuropathy. Methods. Eighty-one participants with type 2 diabetes, no history of ocular disease, trauma, or surgery and no history of systemic disease that may affect the cornea were enrolled. Participants were ineligible if there was history of neuropathy due to non-diabetic cause or current diabetic foot ulcer or infection. Corneal sensitivity threshold was measured on the eye of dominant hand side at a distance of 10 mm from the center of the cornea using a stimulus duration of 0.9 s. The NDS was measured producing a score ranging from 0 to 10. To determine the optimal cutoff point of corneal sensitivity that identified the presence of neuropathy (diagnosed by NDS), the Youden index and “closest-to-(0,1)” criteria were used. Results. The receiver-operator characteristic curve for NCCE for the presence of neuropathy (NDS ≥3) had an area under the curve of 0.73 (p = 0.001) and, for the presence of moderate neuropathy (NDS ≥6), area of 0.71 (p = 0.003). By using the Youden index, for an NDS ≥3, the sensitivity of NCCE was 70% and specificity was 75%, and a corneal sensitivity threshold of 0.66 mbar or higher indicated the presence of neuropathy. When NDS ≥6 (indicating risk of foot ulceration) was applied, the sensitivity was 52% with a specificity of 85%. Conclusions. NCCE is a sensitive test for the diagnosis of minimal and more advanced diabetic neuropathy and may serve as a useful surrogate marker for diabetic and perhaps other neuropathies.

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.

The regulation of insurance intermediaries in the Australian financial services market

The insurance industry discharges a critical role in the Australian economy and is a significant part of the Australian financial services market. The industry relies upon intermediaries, the principal types being brokers and agents, to promote, arrange and distribute their products and services in the market. The pivotal role that they play in this context and sensitivities associated with the consumer oriented products, such as house and contents insurance, has ensured close regulatory attention. Of particular importance was the passage of the Insurance (Agents and Brokers) Act 1984 (Cth), a comprehensive attempt to address the responsibilities of intermediaries as well as particular problem areas associated with the handling of money. However, with the introduction of financial services and market reform early in the new millennium this insurance intermediary specific regulatory approach was abandoned in favour of a market-wide strategy; that is, market reform was based upon across-the-board licensing, disclosure, conduct and fairness standards, and all financial products and services are now regulated at a generic level under Ch 7 of the Corporations Act 2001 (Cth). This article briefly explores the categories of insurance intermediaries and the relevant distinctions between them but focuses mainly upon the regulatory context in which they operate. This context transcends a strictly legal framework as the regulatory body, the Australian Securities and Investments Commission (ASIC), has sought to inform and guide the market through Policy Statements and Regulatory Guides. The usefulness of these guides as an adjunct to the legislation in explaining the scope and operation of regulatory framework is examined. In addition, the article looks at the self-regulatory and dispute resolution practices in this area and their impact. In conclusion an assessment of this across-the-board regulatory regime is advanced.

Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project) : study protocol

Background: An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. ---------- Methods/Design: A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned.---------- Discussion: Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally.

European advanced driver training programs : reasons for optimism

Post license advanced driver training programs in the US and early programs in Europe have often failed to accomplish their stated objectives because, it is suspected, that drivers gain self perceived driving skills that exceed their true skills—leading to increased post training crashes. The consensus from the evaluation of countless advanced driver training programs is that these programs are a detriment to safety, especially for novice, young, male drivers. Some European countries including Sweden, Finland, Austria, Luxembourg, and Norway, have continued to refine these programs, with an entirely new training philosophy emerging around 1990. These ‘post-renewal’ programs have shown considerable promise, despite various data quality and availability concerns. These programs share in common a focus on teaching drivers about self assessment and anticipation of risk, as opposed to teaching drivers how to master driving at the limits of tire adhesion. The programs focus on factors such as self actualization and driving discipline, rather than low level mastery of skills. Drivers are meant to depart these renewed programs with a more realistic assessment of their driving abilities. These renewed programs require considerable specialized and costly infrastructure including dedicated driver training facilities with driving modules engineered specifically for advanced driver training and highly structured curricula. They are conspicuously missing from both the US road safety toolbox and academic literature. Given the considerable road safety concerns associated with US novice male drivers in particular, these programs warrant further attention. This paper reviews the predominant features and empirical evidence surrounding post licensing advanced driver training programs focused on novice drivers. A clear articulation of differences between the renewed and current US advanced driver training programs is provided. While the individual quantitative evaluations range from marginally to significantly effective in reducing novice driver crash risk, they have been criticized for evaluation deficiencies ranging from small sample sizes to confounding variables to lack of exposure metrics. Collectively, however, the programs sited in the paper suggest at least a marginally positive effect that needs to be validated with further studies. If additional well controlled studies can validate these programs, a pilot program in the US should be considered.

Sustainability and mandatory disclosure in Queensland : an assessment of the impact on home buyer patterns

Sustainability Declarations were introduced by the Queensland State Government on 1 January 2010 as a compulsory measure for all dwelling sales. The purpose of this policy decision was to improve the relevance of sustainability in the home ownership decision making process. This paper assesses the initial impact of this initiative over its first year in operation. In partnership with the Real Estate Institute of Queensland, real estate agents and salespeople in Queensland were surveyed to determine what impact the Sustainability Declaration has had on home buyer decision making. The level of compliance by the real estate industry was also reviewed. These preliminary findings indicate a high level of compliance from the real estate industry, however results confirm that sustainability is yet to become a criterion of relevance to the majority of home buyers in Queensland. The Sustainability Declarations are a first step in raising awareness in home owners of the importance of sustainability in housing. Further monitoring of this impact will be carried out over time.

QoS-oriented resource allocation and scheduling of multiple composite Web services in a hybrid cloud using a random-key genetic algorithm

In cloud computing resource allocation and scheduling of multiple composite web services is an important challenge. This is especially so in a hybrid cloud where there may be some free resources available from private clouds but some fee-paying resources from public clouds. Meeting this challenge involves two classical computational problems. One is assigning resources to each of the tasks in the composite web service. The other is scheduling the allocated resources when each resource may be used by more than one task and may be needed at different points of time. In addition, we must consider Quality-of-Service issues, such as execution time and running costs. Existing approaches to resource allocation and scheduling in public clouds and grid computing are not applicable to this new problem. This paper presents a random-key genetic algorithm that solves new resource allocation and scheduling problem. Experimental results demonstrate the effectiveness and scalability of the algorithm.

Nursing and Midwifery Services Strategic Directions, 2011-2015

This document presents the newly updated strategic directions for strengthening nursing and midwifery services (SDNM) for the period 2011–2015. Complementing and building on the 2002–2008 SDNM, it seeks to provide policymakers, practitioners and other stakeholders at every level with a flexible framework for broad-based, collaborative action to enhance the capacity of nurses and midwives to contribute to: * universal coverage * people-centred health care * policies affecting their practice and working conditions, and the * scaling up of national health systems to meet global goals and targets. The SDNM for 2011–2015 draws on several key World Health Assembly resolutions, and are underpinned by the associated global policy recommendations and codes of practice. (1,2) After two years of extensive research and consultation, a SDNM task force was developed, and a consensus on a range of specific activities revolving around 13 objectives in five interrelated key results areas (KRAs), was achieved: n health system and service strengthening n policy and practice * education, training and career development * workforce management and * partnership. Stakeholders, although free to prioritize certain parts of the framework to meet their own particular needs, are encouraged to adhere to the cornerstone of collaborative action, namely the common goal enshrined in the core SDNM 2011–2015 vision statement: improved health outcomes for individuals, families and communities through the provision of competent, culturally sensitive, evidence-based nursing and midwifery services.

Beyond sanctions : is there a need to treat first-time offenders?

Aims: Driving Under the Influence (DUI) enforcement can be a broad screening mechanism for alcohol and other drug problems. The current response to DUI is focused on using mechanical means to prevent inebriated persons from driving, with little attention the underlying substance abuse problems. ---------- Methods: This is a secondary analysis of an administrative dataset of over 345,000 individuals who entered Texas substance abuse treatment between 2005 and 2008. Of these, 36,372 were either on DUI probation, referred to treatment by probation, or had a DUI arrest in the past year. The DUI offenders were compared on demographic characteristics, substance use patterns, and levels of impairment with those who were not DUI offenders and first DUI offenders were compared with those with more than one past-year offense. T tests and chi square tests were used to determine significance. ---------- Results: DUI offenders were more likely to be employed, to have a problem with alcohol, to report more past-year arrests for any offense, to be older, and to have used alcohol and drugs longer than the non-DUI clients who reported higher ASI scores and were more likely to use daily. Those with one past-year DUI arrest were more likely to have problems with drugs other than alcohol and were less impaired than those with two or more arrests based on their ASI scores and daily use. Non-DUI clients reported higher levels of mood disorders than DUIs but there was no difference in their diagnosis of anxiety. Similar findings were found between those with one or multiple DUI arrests. ----------Conclusion: Although first-time DUIs were not as impaired as non-DUI clients, their levels of impairment were sufficient to cause treatment. Screening and brief intervention at arrest for all DUI offenders and treatment in combination with abstinence monitoring could decrease future recidivism.

Trends in impaired driving in Australia in 2010 : a status report

This paper reviews the status of alcohol, drugs and traffic safety in Australia, with particular emphasis on developments in the period 2008-2010. Australian jurisdictions have made impressive improvements in road safety since the early 1970s. Enforcement and public education campaigns that specifically target drink driving have been successful, with resultant long-term reduction in alcohol-related fatalities. There is a high level of community disapproval of drink driving and strong support for countermeasures. Many best-practice countermeasures targeting impaired driving are in place, including general prevention/ deterrence programs such as random breath testing (RBT), random roadside drug testing legal alcohol limits, responsible service of alcohol programs, public education and advertising campaigns and designated driver programs, and offender management programs such as driver licensing penalties and fines, alcohol ignition interlocks and vehicle impoundment for high risk drink drivers, and offender education programs. There continue to be enhancements occurring, particularly in the areas of drug-impaired driving and offender management, but also in addressing the fundamental policy and legislative framework to address impaired driving (e.g., a current national debate about lowering the permissible blood alcohol for all drivers from 0.05 to 0.02 or 0.00 gm/100 ml BAC). However, there are major challenges that may be impacting on programs targeting impaired driving, including the rapid development of a binge drinking culture among young Australians, the extension of trading hours of licensed premises, continued problems with secondary supply of alcohol to minors, and increases in the marketing of alcopops and ready-to-drink spirit-based beverages. This paper addresses the question: Are impaired driving countermeasures in Australia continuing to achieve reductions in road traumas and rates of offending, or are they plateauing? If they are plateauing, is this due to declining effectiveness of countermeasures or the need to ‘hold the line’ against societal influences encouraging impaired driving?

Should we be concerned about alcohol in bicycle crashes?

This paper sets out to examine from published literature and crash data analyses whether alcohol in bicycle crashes is an issue about which we should be concerned. It discusses factors that have the potential to increase the number of bicycle crashes in which alcohol is involved (such growth in the size and diversity of the cyclist population, and balance and coordination demands) and factors which may reduce the importance of alcohol in bicycle crashes (such as time of data factors and child riders). It also examines data availability issues that contribute to difficulties in determining the true magnitude of the issue. Methods: This paper reviews previous research and reports analyses of data from Queensland, Australia, that examine the role of alcohol in Police-reported road crashes. In Queensland it is an offence to ride a bicycle or drive a motor vehicle with a BAC exceeding 0.05% (or lower for novice and professional drivers). Results: In the five years 2003-2007, alcohol was reported as involved in 165 bicycle crashes (4%). The bicycle rider was coded as “under the influence” or “over the prescribed BAC limit” in 15 were single unit crashes (12%). In multi-vehicle bicycle crashes, alcohol involvement was reported for 16 cyclists (0.4%) and 110 operators of other vehicles (3%). Additional analyses including characteristics of the cyclist crashes involving alcohol and the importance of missing data will be discussed in the paper. Conclusion: The increase in participation in cycling and the vulnerability of cyclists to injuries support the need to examine the role of alcohol in bicycle crashes. Current data suggest that alcohol on the part of the vehicle driver is a larger concern than alcohol on the part of the cyclist, but improvements in data collection are needed before more precise conclusions can be drawn.

Preface : sustainable urban and regional infrastructure development : technologies, applications and management

The concept of ‘sustainability’ has been pushed to the forefront of policy-making and politics as the world wakes up to the impacts of climate change and the effects of the modern urban lifestyle. Climate change has emerged to be one of the biggest challenges faced by our planet today, threatening both built and natural systems with long term consequences which may be irreversible. While there is a vast literature in the market on sustainable cities and urban development, there is currently none that bring together the vital issues of urban and regional development, and the planning, management and implementation of sustainable infrastructure. Large scale infrastructure plays an important part in modern society by not only promoting economic growth, but also by acting as a key indicator for it. More importantly, it supplies municipal/local amenity and services: water, electricity, social and communication facilities, waste removal, transport of people and goods, as well as numerous other services. For the most part, infrastructure has been built by teams lead by engineers who are more concerned about functionality than the concept of sustainability. However, it has been widely stated that current practices and lifestyle cannot continue if we are to leave a healthy living planet to not only the next generation, but also to the generations beyond. Therefore, in order to be sustainable, there are drastic measures that need to be taken. Current single purpose and design infrastructures that are open looped are not sustainable; they are too resource intensive, consume too much energy and support the consumption of natural resources at a rate that will exhaust their supply. Because of this, it is vital that modern society, policy-makers, developers, engineers and planners become pioneers in introducing and incorporating sustainable features into urban and regional infrastructure.

Information dependencies between architects and services engineers for early design evaluation : a framework for an energy design tool for architects

Effective strategies for the design of effi cient and environmentally sensitive buildings require a close collaboration between architects and engineers in the design of the building shell and environmental control systems at the outset of projects. However, it is often not practical for engineers to be involved early on in the design process. It is therefore essential that architects be able to perform preliminary energy analyses to evaluate their proposed designs prior to the major building characteristics becoming fi xed. Subsequently, a need exists for a simplifi ed energy design tool for architects. This paper discusses the limitations of existing analysis software in supporting early design explorations and proposes a framework for the development of a tool that provides decision support by permitting architects to quickly assess the performance of design alternatives.