The Australian prehospital pandemic risk perception study and an examination of new public health roles in pandemic response for ambulance services

This report is one of a series of products resulting from a National Health and Medical Research Council (NHMRC) Urgent Research Grant – Pandemic Influenza [No 409973]. The research targeted two key aspects of planning and preparedness for a human influenza pandemic, namely:

Nutritional risk of cancer patients receiving chemotherapy in the ambulatory care setting : a prospective study

Background Cancer itself can alter the metabolic and physiologic of the body's nutritional needs. As a result, some patients experience some degree of weight loss before the start of the treatment. Aim The aim of the study was to determine at which chemotherapy treatment cycle patients with cancer begin to exhibit signs and symptoms of malnutrition. Methods A prospective descriptive correlational design was used to assess the nutritional risk of 111 patients with cancer receiving chemotherapy in the ambulatory setting. The data were collected by using a nutritional screening tool. Findings The prevalence of malnutrition risk was 45% in patients undergoing the first cycle of chemotherapy. Patients who received the first three cycles of chemotherapy were 2.62 times more likely to develop malnutrition than those who received seven or more cycles. The risk of developing malnutrition varies depending on the type of cancer, the types of chemotherapy regime, the number of chemotherapy cycles, body mass index and the stage of cancer. Conclusion The study found about half of the patients had developed signs and symptoms of nutritional risk at cycle one. Hence, nutritional support may be required even before the start of chemotherapy.

Expert Opinion: Serious Concerns regarding Western Australian Planning Commission (WAPC) Draft Policy 3.7 “Planning for Bushfire Risk Management” and associated Guidelines (May 2014)

10 page document containing expert assessment of shortcomings of Western Australian State Planning Policy SPP3.7- Planning for Bushfire Risk Management. Document produced on behalf of QUT and submitted to and published by the WAPC as part of their public consultation process for their draft policy.

Institutional investors, risk/performance and corporate governance

Modern portfolio theory suggests that investors minimize risk for a given level of expected return by carefully choosing the proportions of various assets. This study sets out to determine the role of the institutional investor in monitoring risk and firm performance. Using a sample of Australian firms from 2006 to 2008, our empirical study shows a positive association between firm-specific risk, risk-management policy, and performance for firms with increasing institutional shareholdings. The study also finds that the significance of this association depends on the institutional investor's ability to influence management, which in turn depends on the size of ownership and whether the investee firm does not have potential business dealings with the investor. We also find that when firms are financially distressed, institutional investors engage in promoting short-term performance or exit rather than support long-term value creation. The results are robust while controlling the potential for endogeneity and using sensitivity tests to control for variants of performance and risk. These findings add to the growing body of literature examining institutional ownership and the importance of understanding the role of risk-management in the risk and return relation.

Working the iceberg : a staffroom morality play

This play comes from a research project about how teachers understand and sustain their work in challenging secondary school classrooms. The research asked “How DO teachers work in these classrooms?” not “How SHOULD they?” In the play you meet three teachers who speak candidly about their principles, priorities and vulnerabilities to a pre-service teacher as they move between classes and staffroom. These are real people, real quotes and real feelings taken from real interview data, not idealised guidelines for ‘best practice’. Rather than templates for practice, the play offers a variety of models, issues and food for thought to discuss in teacher education programs. The project was interested in the moral dynamics of classrooms created under the Council of Australian Governments’ 2009 Compact with Young Australians, a policy move that required students to be ‘earning or learning till 17’ across all Australian states. By removing the unemployment benefit for this age group, and tying school attendance to family welfare entitlements, these policies effectively raised the minimum school-leaving age. The risk in this well-intended policy move is that a lack of suitable job opportunities will keep young people at school longer than they want to be there. The effects of this ‘earning or learning’ policy will impact some communities, schools and classrooms much harder than others. The title uses the metaphor of an iceberg to refer to the complex community-school relations that lie below classroom interactions. The idea of a morality play in the play’s title refers back to a medieval form of popular play that used characters to instruct the audience in virtues and values. In the same way, this play seeks to bring to the surface and embody the different moral principles that can inform teacher’s work. The research involved classroom ethnographies of classes for 16 to 17 years olds in non-academic pathways. Eight different teacher/ class combinations were sampled across 2 high schools, 2 TAFE colleges and I hybrid TAFE/school program in three towns experiencing chronic youth unemployment. Their timetabled lessons were observed across 3 to 4 weeks and the teachers and some students were interviewed in each site. The project was funded by an ARC Discovery Early Career Award, 2012-214.

Male and female, cyclist and driver perceptions of crash risk in critical road situations

Male and Female, Cyclist and Driver Perceptions of Crash Risk in Critical Road Situations. Governments are promoting cycling but many Australians, particularly women, do not ride because they perceive it to be too risky. This research compared the risks perceived by female and male, cyclists and drivers in specific on-road situations, accounting for factors such as travel patterns and experience, perceived skill, and risk taking behaviours. Compared to their male counterparts, female cyclists and drivers gave similarly elevated perceptions of risk. These differences are not completely accounted for by cycling patterns or perceptions of skill. Thus, these gender differences are not specific to cycling, but may reflect wider differences in risk perception.

Development of health risk-based metrics for defining a heatwave : a time series study in Brisbane, Australia

Background: This study attempted to develop health risk-based metrics for defining a heatwave in Brisbane, Australia. Methods: Poisson generalised additive model was performed to assess the impact of heatwaves on mortality and emergency hospital admissions (EHAs) in Brisbane. Results: In general, the higher the intensity and the longer the duration of a heatwave, the greater the health impacts. There was no apparent difference in EHAs risk during different periods of a warm season. However, there was a greater risk of mortality in the second half of a warm season than that in the first half. While elderly (>75 years)were particularly vulnerable to both the EHA and mortality effects of a heatwave, the risk for EHAs also significantly increased for two other age groups (0-64 years and 65-74 years) during severe heatwaves. Different patterns between cardiorespiratory mortality and EHAs were observed. Based on these findings, we propose the use of a teiered heat warning system based on the health risk of heatwave. Conclusions: Health risk-based metrics are a useful tool for the development of local heatwave definitions. thsi tool may have significant implications for the assessment of heatwave-related health consequences and development of heatwave response plans and implementation strategies.

Sustainability of public health interventions to reduce the risk of dioxin exposure at severe dioxin hot spots in Vietnam

Severe dioxin contamination at Bien Hoa and Da Nang airbases, Vietnam is of international concern. Public Health risk reduction programs were implemented in Bien Hoa in 2007-2009 and in Da Nang in 2009-2011. In 2009 and 2011 we reported the encouraging results of these interventions in improving the knowledge, attitude and practices (KAP) of local residents in reducing the dioxin exposure risk through foods. In 2013 we revisited these dioxin hot spots, aimed to evaluate whether the results of the intervention were maintained and to identify factors affecting the sustainability of the programs. To assess this, 16 in-depth interviews, six focus group discussions, and pre and post intervention KAP surveys were undertaken. 800 respondents from six intervention wards and 200 respondents from Buu Long Ward (the control site) were randomly selected to participate in the surveys. The results showed that as of 2013, the programs were rated as "moderately sustained" with a score of 3.3 out of 5.0 (cut off points 2.5 to <3.5) for Bien Hoa, and "well sustained" with a score of 3.8 out of 5.0 (cut off points 3.5 to <4.5) for Da Nang. Most formal intervention program activities had ceased and dioxin risk communication activities were no longer integrated into local routine health education programs. However, the main outcomes were maintained and were better than that in the control ward. Migration, lack of official guidance from City People's Committees and local authorities as well as the politically sensitive nature of dioxin issues were the main challenges for the sustainability of the programs.

An ERP-client benefit-oriented maintenance taxonomy

The worldwide installed base of enterprise resource planning (ERP) systems has increased rapidly over the past 10 years now comprising tens of thousands of installations in large- and medium-sized organizations and millions of licensed users. Similar to traditional information systems (IS), ERP systems must be maintained and upgraded. It is therefore not surprising that ERP maintenance activities have become the largest budget provision in the IS departments of many ERP-using organizations. Yet, there has been limited study of ERP maintenance activities. Are they simply instances of traditional software maintenance activities to which traditional software maintenance research findings can be generalized? Or are they fundamentally different, such that new research, specific to ERP maintenance, is required to help alleviate the ERP maintenance burden? This paper reports a case study of a large organization that implemented ERP (an SAP system) more than three years ago. From the case study and data collected, we observe the following distinctions of ERP maintenance: (1) the ERP-using organization, in addition to addressing internally originated change-requests, also implements maintenance introduced by the vendor; (2) requests for user-support concerning the ERP system behavior, function and training constitute a main part of ERP maintenance activity; and (3) similar to the in-house software environment, enhancement is the major maintenance activity in the ERP environment, encompassing almost 64% of the total change-request effort. In light of these and other findings, we ultimately: (1) propose a clear and precise definition of ERP maintenance; (2) conclude that ERP maintenance cannot be sufficiently described by existing software maintenance taxonomies; and (3) propose a benefits-oriented taxonomy, that better represents ERP maintenance activities. Three salient dimensions (for characterizing requests) incorporated in the proposed ERP maintenance taxonomy are: (1) who is the maintenance source? (2) why is it important to service the request? and (3) what––whether there is any impact of implementing the request on the installed module(s)?

Speaking too soon : the sabotage of bail reform in New South Wales

Within just over one month of coming into operation in May 2014, the new Bail Act 2013 (NSW), a product of long-term law reform consideration, was reviewed and then amended after talk-back radio ‘shock jock’ and tabloid newspaper outcry over three cases. This article examines the media triggers, the main arguments of the review conducted by former New South Wales (NSW) Attorney General John Hatzistergos, and the amendments, with our analysis of the judicial interpretation of the Act thus far providing relevant background. We argue that the amendments are premature, unnecessary, create complexity and confusion, and, quite possibly, will have unintended consequences: in short, they are a mess. The whole process of reversal is an example of law and order politics driven by the shock jocks and tabloid media, the views of which, are based on fundamental misconceptions of the purpose of bail and its place in the criminal process, resulting in a conflation of accusation, guilt and punishment. Other consequences of the review and amendments process recognised in this article include the denigration of judicial expertise and lack of concern with evidence and process; the disproportionate influence of the shock jocks, tabloids and Police Association of NSW on policy formation; the practice of using retired politicians to produce ‘quick fix’ reviews; and the political failure to understand and defend fundamental legal principles that benefit us all and are central to the maintenance of a democratic society and the rule of law. The article concludes with some discussion of ways in which media and political debate might be conducted to produce more balanced outcomes.

‘Only a pawn in their game’ : crime, risk and politics in the case of Robert Fardon

In 2003 Robert Fardon was the first prisoner to be detained under the Dangerous Prisoners (Sexual Offenders) Act 2003 (Qld), the first of the new generation preventive detention laws enacted in Australia and directed at keeping sex offenders in prison or under supervision beyond the expiry of their sentences where a court decides, on the basis of psychiatric assessments, that unconditional release would create an unacceptable risk to the community. A careful examination of Fardon’s case shows the extent to which the administration of the regime was from the outset governed by politics and political calculation rather than the logic of risk management and community protection. In 2003 Robert Fardon was the first person detained under the Dangerous Prisoners (Sexual Offenders) Act 2003 (Qld) (hereafter DPSOA), a newly enacted Queensland law aimed at the preventive detention of sex offenders. It was the first of a new generation of such laws introduced in Australia, now also in force in NSW, Western Australia and Victoria. The laws have been widely criticized by lawyers, academics and others (Keyzer and McSherry 2009; Edgely 2007). In this article I want to focus on the details of how the Queensland law was administered in Fardon’s case, he being perhaps the most well-known prisoner detained under such laws and certainly the longest held. It will show, I hope, that seemingly abstract rule of law principles invoked by other critics are not simply abstract: they afford a crucial practical safeguard against the corruption of criminal justice in which the ends both of community protection and of justice give way to opportunistic exploitation of ‘the mythic resonance of crime and punishment for electoral purposes’ (Scheingold 1998: 888).

Risk factors for delayed healing in venous leg ulcers : a review of the literature

Background Chronic leg ulcers, remaining unhealed after 4–6 weeks, affect 1-3% of the population, with treatment costly and health service resource intensive. Venous disease contributes to approximately 70% of all chronic leg ulcers and these ulcers are often associated with pain, reduced mobility and a decreased quality of life. Despite evidence-based care, 30% of these ulcers are unlikely to heal within a 24-week period and therefore the recognition and identification of risk factors for delayed healing of venous leg ulcers would be beneficial. Aim To review the available evidence on risk factors for delayed healing of venous leg ulcers. Methods: A review of the literature in regard to risk factors for delayed healing in venous leg ulcers was conducted from January 2000 to December 2013. Evidence was sourced through searches of relevant databases and websites for resources addressing risk factors for delayed healing in venous leg ulcers specifically. Results Twenty-seven studies, of mostly low-level evidence (Level III and IV), identified risk factors associated with delayed healing. Risk factors that were consistently identified included: larger ulcer area, longer ulcer duration, a previous history of ulceration, venous abnormalities and lack of high compression. Additional potential predictors with inconsistent or varying evidence to support their influence on delayed healing of venous leg ulcers included decreased mobility and/or ankle range of movement, poor nutrition and increased age. Discussion Findings from this review indicate that a number of physiological risk factors are asso- ciated with delayed healing in venous leg ulcers and that social and/or psychological risk factors should also be considered and examined further. Conclusion The findings from this review can assist health professionals to identify prognostic indicators or risk factors significantly associated with delayed healing in venous leg ulcers. This will facilitate realistic outcome planning and inform implementation of appropriate early strategies to promote healing.

Out-of-pocket expenditures for hospital care in Iran : who is at risk of incurring catastrophic payments?

Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian—regardless of their employment status—can better protect households from catastrophic health spending.