Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

From efficiency to effectiveness :a new management model of social inclusion

This paper challenges the tendency in the contemporary management literature to conceptualize management within a micro-framework that focuses on short-term efficiency and privatized economic gain. Based on a literature review of social-relation theories, we propose a new management model of social inclusion for general management across contexts with a particular concern for profit-for organizations. The model conceptualizes management within a systemic societal framework where its effectiveness is demonstrated for society, organizations, groups and individuals.  We suggest that management based on the collectivistic values of shared humanity and social inclusion (not only organization) is expected to reduce management-led systematic marginalization in the workplace and social whole. For the purpose of this paper, we define management as “mutually interdependent activities that add value to individuals’, groups’, organizations’ and societal wellbeing by ensuring social inclusion at each of these dimensions.” We term this management process ‘Management Process of Social Inclusion’ as it extends management perspectives to not only organizational effectiveness but societal effectiveness. The paper concludes by proposing several propositions and implications for future research.

The complexity of social practice : understanding inertia and change in maternity care organizations

Beyond the limited efficiency and economy goals of neoliberal health policy lies the promise of genuine health services reform. In maternity care in particular, recent policy developments have sought to make the management of birth more ‘women-centred and family-friendly’. Interprofessional collaboration and greater consumer participation in policy and decision-making are key means to achieve this goal, but changing the entrenched system of medicalised birth remains difficult. Recent social contestation of maternity care has destabilised but not eradicated pervasive medical hegemony. Further reform requires analysis both of institutionalised patterns of power, and attention to the fluidity and situated knowledge shaping organisational and professional practices. Accordingly, this paper outlines a framework with which to explore the multi-layered social processes involved in implementing organisational and cultural change in maternity care. Analysis of social interventions in health systems, we suggest, can be advanced by drawing on strands from critical organization studies, complexity and critical discourse theories and social practice approaches.

Parsimonious and efficient assessment of health-related quality of life in osteoarthritis research: validation of the Assessment of Quality of Life (AQoL) instrument

Background: The Assessment of Quality of Life (AQoL) utility instrument was psychometrically developed for the general population. This study aimed to explore its potential as an osteoarthritis (OA) outcome measure.

Methods: WOMAC, Lequesne index, SF-36, Visual analogue scales and the AQoL were administered to 222 people with OA. The ability of each questionnaire to detect differences between groups was based on (i) self-rated health (SRH) and, (ii) differences between people on an orthopedic waiting list (WL) vs people with OA in the community (C). Comparisons included effect size, relative efficiency and receiver operator characteristic curves.

Results: All instruments detected differences between groups; however no one instrument exhibited superior efficiency. The AQoL demonstrated strong psychometric properties.

Conclusion: The AQoL has equivalent performance to comparator questionnaires commonly used in OA research and would be a useful adjunct to well-established disease specific scales. The AQoL has important advantages; brevity (12 items), facilitates comparisons between disease groups, and delivers a utility score that can be used in health economic evaluations.

Office buildings and the environment : the increasing role of facility managers

The Australian commercial stock emits 12% of all greenhouse gas emissions however the commercial property market has some inherent barriers to sustainability (DSE, 2005). A substantial proportion of the stock is owned by institutional investors who are unconvinced by the need to improve their stock and pass on running costs to tenants (Callender & Key, 1997). The links between the built environment and sustainability issues such as fossil fuel consumption and climate change is clear. In developed countries buildings contribute around half of all carbon dioxide emissions and offer considerable scope for a significant contribution to sustainability through ecologically aware design and increased energy efficiency (BRE, 1996). As capital values are not greatly affected by sustainability, owners react by doing little or nothing and the effect is to limit sustainability-related investment and undermine efforts to deliver sustainability in the sector. Facility managers are in an influential position to help address sustainability issues via an increased awareness of energy efficiency and CO2 emissions.

Even though the efficiency of buildings is primarily focused on new stock, with an existing churn replacement rate of approximately 2-3% the existing stock must be improved if urban built environment greenhouse gas emissions are to be reduced – clearly the management of existing stock must therefore contribute to substantial savings in energy use. Much of the property and surveying research has previously adopted an illustrative case study approach advocating the benefits of ESD and energy efficiency in existing buildings. This research adopts a radically different approach and profiles the entire office stock of a global CBD, namely Melbourne, which is seeking to become a carbon neutral city by 2020 (City of Melbourne, 2003). The research also employs scenario forecasting to model future changes to the stock over a fifteen year period. This paper sets out the rationale for the research and establishes the methodological approach adopted by the research team. The results provides a unique insight into the variations between different building types and grades of office buildings, which in turn will allow facility managers to gain a better understanding of where gains in energy efficiency can be made.

Cultural diversity in the Australian classroom and the experience of Arab-Muslim students

Table of Contents : Preface Introduction 1. Building the Australia-India Relationship- Bruce Bennett 2. Plural Cultures, Monolithic Structures- Kapila Vatsyayan 3. The Homogenised Other: Cultural Diversity and Social Inequality- Alan Mayne 4. Deliberative Democracy and Modern Pluralism- Subrata Mukherjee 5. ‘A long and winding road’. From Cultural Homogeneity to a Multicultural Society: An Analysis of Inclusion and Exclusion in Australia- David Roberts 6. Limits of Multiculturalism in a Liberal Polity: Need for a Shared Identity-Sushila Ramaswamy 7. “Australia is a Multicultural Community –you’ll feel at home”:Cultural Diversity and the Promotion of Australia Internationally- Andrew Hassam 8. Accommodation of Cultural Diversity in India: Reflections on Past and Present- Abdulrahim P. Vijapur 9. Gandhian Ideas on Cultural Diversity and Unity in India- Sailaja Gullapalli 10. Multiculturalism: Australian and Indian Approach-Sonu Trivedi 11. Post Colonial Formation, Paradigm Consolidation and Economic Marginalization- S. Ram Vemuri 12. Dalits and Indigenous Australians: Affirmative Actions and Existing Realities- Swaraj Basu 13. Exploring a Critical Tradition in Communications Research: A Cultural Discourse- Amita Singh 14. Education and Empowerment: Dalits and the Demand for Modern Education in Colonial India- Shashi Bhushan Upadhyay 15. Recent Developments in Indian Migration to Australia (with Special Reference to Academics)- Graeme Hugo and Gouranga Lal Dasvarma 16. Cultural Diversity in the Australian Classroom and the Experience of Arab-Muslim Students- Sally Percival Wood 17. Working Australia Efficiency and Equity- Liz Hall 18. North-East India’s Cultural Diversity: Trends of Unrest and Marginalization- Sudhir Jacob George 19. Socio-economic Inequities of Tribal Communities in India- Priti Singh 20. Reinventing Australian Identity-D. Gopal 21. Identity and Rights of the Diaspora in the Post-colonial Era- R. Narayanan 22. Understanding Cultural Diversity: Reflections from the Americas- Satya R. Pattnayak Contributors Index

Anycast services and its applications

Anycast in next generation Internet Protocol is a hot topic in the research of computer networks. It has promising potentials and also many challenges, such as architecture, routing, Quality-of-Service, anycast in ad hoc networks, application-layer anycast, etc. In this thesis, we tackle some important topics among them. The thesis at first presents an introduction about anycast, followed by the related work. Then, as our major contributions, a number of challenging issues are addressed in the following chapters. We tackled the anycast routing problem by proposing a requirement based probing algorithm at application layer for anycast routing. Compared with the existing periodical based probing routing algorithm, the proposed routing algorithm improves the performance in terms of delay. We addressed the reliable service problem by the design of a twin server model for the anycast servers, providing a transparent and reliable service for all anycast queries. We addressed the load balance problem of anycast servers by proposing new job deviation strategies, to provide a similar Quality-of-Service to all clients of anycast servers. We applied the mesh routing methodology in the anycast routing in ad hoc networking environment, which provides a reliable routing service and uses much less network resources. We combined the anycast protocol and the multicast protocol to provide a bidirectional service, and applied the service to Web-based database applications, achieving a better query efficiency and data synchronization. Finally, we proposed a new Internet based service, minicast, as the combination of the anycast and multicast protocols. Such a service has potential applications in information retrieval, parallel computing, cache queries, etc. We show that the minicast service consumes less network resources while providing the same services. The last chapter of the thesis presents the conclusions and discusses the future work.

Structural and functional properties of human multidrug resistance protein 1 (MRP1/ABCC1)

Multidrug ABC transporters such as P-glycoprotein (P-gp/MDR1/ABCB1) and multidrug resistance protein 1 (MRP1/ABCC1) play an important role in the extrusion of drugs from the cell and their overexpression can be a cause of failure of anticancer and antimicrobial chemotherapy. Recently, the mouse P-gp/Abcb1a structure has been determined and this has significantly enhanced our understanding of the structure-activity relationship (SAR) of mammalian ABC transporters. This paper highlights our current knowledge on the structural and functional properties and the SAR of human MRP1/ABCC1. Although the crystal structure of MRP1/ABCC1 has yet to be resolved, the current topological model of MRP1/ABCC1 contains two transmembrane domains (TMD1 and TMD2) each followed by a nucleotide binding domain (NBD) plus a third NH2-terminal TMD0. MRP1/ABCC1 is expressed in the liver, kidney, intestine, brain and other tissues. MRP1/ABCC1 transports a structurally diverse array of important endogenous substances (e.g. leukotrienes and estrogen conjugates) and xenobiotics and their metabolites, including various conjugates, anticancer drugs, heavy metals, organic anions and lipids. Cells that highly express MRP1/ABCC1 confer resistance to a variety of natural product anticancer drugs such as vinca alkaloids (e.g. vincristine), anthracyclines (e.g. etoposide) and epipodophyllotoxins (e.g. doxorubicin and mitoxantrone). MRP1/ABCC1 is associated with tumor resistance which is often caused by an increased efflux and decreased intracellular accumulation of natural product anticancer drugs and other anticancer agents. However, most compounds that efficiently reverse P-gp/ABCB1-mediated multidrug resistance have only low affinity for MRP1/ABCC1 and there are only a few effective and relatively specific MRP1/ABCC1 inhibitors available. A number of site-directed mutagenesis studies, biophysical and photolabeling studies, SAR and QSAR, molecular docking and homology modeling studies have documented the role of multiple residues in determining the substrate specificity and inhibitor selectivity of MRP1/ABCC1. Most of these residues are located in the TMs of TMD1 and TMD2, in particular TMs 4, 6, 7, 8, 10, 11, 14, 16, and 17, or in close proximity to the membrane/cytosol interface of MRP1/ABCC1. The exact transporting mechanism of MRP1/ABCC1 is unclear. MRP1/ABCC1 and other multidrug transporters are front-line mediators of drug resistance in cancers and represent important therapeutic targets in future chemotherapy. The crystal structure of human MRP1/ABCC1 is expected to be resolved in the near future and this will provide an insight into the SAR of MRP1/ABCC1 and allow for rational design of anticancer drugs and potent and selective MRP1/ABCC1 inhibitors.

Energy-efficient management of data center resources for cloud computing : a vision, architectural elements, and open challenges

Cloud computing is offering utility-oriented IT services to users worldwide. Based on a pay-as-you-go model, it enables hosting of pervasive applications from consumer, scientific, and business domains. However, data centers hosting Cloud applications consume huge amounts of energy, contributing to high operational costs and carbon footprints to the environment. Therefore, we need Green Cloud computing solutions that can not only save energy for the environment but also reduce operational costs. This paper presents vision, challenges, and architectural elements for energy-efficient management of Cloud computing environments. We focus on the development of dynamic resource provisioning and allocation algorithms that consider the synergy between various data center infrastructures (i.e., the hardware, power units, cooling and software), and holistically work to boost data center energy efficiency and performance. In particular, this paper proposes (a) architectural principles for energy-efficient management of Clouds; (b) energy-efficient resource allocation policies and scheduling algorithms considering quality-of-service expectations, and devices power usage characteristics; and (c) a novel software technology for energy-efficient management of Clouds. We have validated our approach by conducting a set of rigorous performance evaluation study using the CloudSim toolkit. The results demonstrate that Cloud computing model has immense potential as it offers significant performance gains as regards to response time and cost saving under dynamic workload scenarios.

Optimising e-mail communication : the impact of seminar-and computer-based training

Employees continue to report multifarious e-mail concerns ('e-mail defects') including ambiguous unclear messages, e-mail overload, security and privacy issues, and e-mail interruptions. These defects have an effect on employee efficiency and effectiveness. This paper explores the importance of identifying e-mail defects and the effectiveness of training employees in efficient use of e-mail at four UK organisations, using Seminar-Based Training (SBT) and Computer-Based Training (CBT) delivery modes. The findings suggest that SBT has a diminishing impact over a very short period of time, but a combined approach of SBT and CBT is more effective and provides better results.

The roles, responsibilities and development needs of quality managers in Britain and Australia

This paper compares and contrasts the career experiences and development needs of 334 British quality managers compared with Australian quality managers based on two Australian surveys. The quality managers in both countries brought wide functional experience to their roles, with many coming in particular from production and operations and general management. In their current roles major sources of job satisfaction for managers in both countries were improving efficiency and problem solving, whereas aspects of employee relations was a source of least satisfaction. Both groups of quality managers utilised a very limited range of quality tools, the most popular being brainstorming, control charts and Pareto analysis, with virtually no mention of more sophisticated tools like Six sigma, which is in stark contrast to American managers. Also British and Australian managers showed little awareness in terms of their development needs for a broader background in quality, which could disadvantage their companies in global markets.

Spectral element modelling of wave propagation with boundary and structural discontinuity reflections

Spectral element method is very efficient in modelling high-frequency stress wave propagation because it works in the frequency domain. It does not need to use very fine meshes in order to capture high frequency wave energy as the time domain methods do, such as finite element method. However, the conventional spectral element method requires a throw-off element to be added to the structural boundaries to act as a conduit for energy to transmit out of the system. This makes the method difficult to model wave reflection at boundaries. To overcome this limitation, imaginary spectral elements are proposed in this study, which are combined with the real structural elements to model wave reflections at structural boundaries. The efficiency and accuracy of this proposed approach is verified by comparing the numerical simulation results with measured results of one dimensional stress wave propagation in a steel bar. The method is also applied to model wave propagation in a steel bar with not only boundary reflection, but also reflections from single and multiple cracks. The reflection and transmission coefficients, which are obtained from the discrete spring model, are adopted to quantify the discontinuities. Experimental tests of wave propagation in a steel bar with one crack of different depths are also carried out. Numerical simulations and experimental results show that the proposed method is effective and reliable in modelling wave propagation in one-dimensional waveguides with reflections from boundary and structural discontinuities. The proposed method can be applied to effectively model stress wave propagation for structural damage detection.

Recognition of polyadenylation sites in yeast pre-mRNAs by cleavage and polyadenylation factor

Recognition of poly(A) sites in yeast pre-mRNAs is poorly understood. Employing an in vitro cleavage system with cleavage and polyadenylation factor (CPF) and cleavage factor IA we show that the efficiency and positioning elements are dispensable for poly(A)-site recognition within a short CYC1 substrate in vitro. Instead, U-rich elements immediately upstream and downstream of the poly(A) site mediate cleavage-site recognition within CYC1 and ADH1 pre-mRNAs. These elements act in concert with the poly(A) site to produce multiple recognition sites for the processing machinery, since combinations of mutations within these elements were most effective in cleavage inhibition. Intriguingly, introduction of a U-rich element downstream of the GAL7 poly(A) site strongly enhanced cleavage, underscoring the importance of downstream sequences in general. RNA- binding analyses demonstrate that cleavage depends on the recognition of the poly(A)-site region by CPF. Consistent with in vitro results, mutation of sequences upstream and downstream of the poly(A) site affected 3'-end formation in vivo. A model for yeast pre-mRNA cleavage-site recognition outlines an unanticipated high conservation of yeast and mammalian 3'-end processing mechanisms.

Earliest Wuchiapingian (Lopingian, Late Permian) brachiopods in southern Hunan, South China : implications for the Pre-Lopingian crisis and onset of Lopingian recovery / radiation

The uppermost 5-15 m of the Douling Formation in the southern Hunan area. South China, yields a diverse fauna comprised of ammonoids, bivalves, and brachiopods. The brachiopods reported in this paper consist of 51 species in 34 genera and are dominated by the Lopingian (Late Permian) species associated with a few species persisting from the underlying Maokouan (Late Guadalupian). This fauna is of earliest Wuchiapingian in age as precisely constrained by the associated conodont Clarkina postbitteri postbitteri and the Guadalupian-type ammonoid fauna of the Roadoceras-Doulingoceras Zone in the brachiopod horizon. The discovery of the Lopingian species-dominated brachiopod fauna in the earliest Wuchiapingian in southern Hunan suggests a much less pronounced effect of the pre-Lopingian crisis (end-Guadalupian mass extinction) than the end-Changhsingian mass extinction in terms of brachiopods, a contemporaneous onset of the Lopingian recovery/radiation during the pre-Lopingian crisis period, and taxonomic selectivity of the pre-Lopingian crisis in terms of different fossil groups. New taxa are Echinauris doulingensis n. sp., Pararigbyella quadrilobata n. gen. and n. sp. and P. doulingensis n. gen. and n. sp.

Application of novel technologies in water reclamation, reuse and recycle

Water reuse has become an integral element of the "total water resources planning and management" along with the other elements such as water conservation, water use efficiency and management of the allocation of existing water sources. Researchers are working actively on the following aspects of water reuse: identification and characterization of different wastewaters that could be reclaimed, development of treatment technologies and effluent standards, quantification of potential gains due to recycling and risk management. The wastewaters that can be reclaimed are domestic and industrial wastewaters, grey water, black water, stormwater and rain water and their potential reuse lies in agriculture, aquaculture, industries, non-potable use in residential and community fronts and indirect and direct potable use. The treatment of wastewater ranges from secondary treatment to advanced treatment, which produces different "Classes" of reclaimed water. This paper evaluates the current status of the research on the above-mentioned important aspects of water reuse with relevant case studies and the future demand for reuse water. The direction in which the future-reuse schemes should be formulated so that they are safe, environmentally sustainable and cost effective are also discussed.