Submission to the New Zealand Parliamentary Inquiry : New Zealand Convention Centre Bill 2013

The Bill outlines the overarching purpose of the NZICC Agreement ‘to provide economic benefits to New Zealanders’. It is really a form of PPP (Public Private Partnership) where the beneficiaries are said to be the Crown and SkyCity but the real payment comes from the losses of the (mainly) community members who will gamble on the expanded facilities outlined in the Agreement. The Howeth International Convention and Exhibition Centre study (2009) established a clear business case for an international convention centre; with an optimistic benefit-cost ratio of 1.433 (which translates into a benefit to the economy of $1.433
for ever $1 spent). Aside from the short-term stimulus to jobs of the construction phase, a convention centre with capacity for 1000 delegates would create about 800 new jobs and attract up to 35 additional conferences of between 150 and 2500 delegates per year (an additional 22,000 additional international visitors and more than 200,000 extra visitor days, worth approximately $85.4 million in tourism-related expenditure per year15. It is therefore questionable as to why this venture needs to be captured by gambling interests, which will also dictate the location. This points to the efficacy of a non-casino provider being able to tender for establishment of an International Convention Centre that could be run profitably without being part of the for-profit model based on expanded gambling machines/revenue.

Comparing mortality outcomes of major burns and toxic epidermal necrolysis in a tertiary burns centre

 Introduction
Our aim was to provide descriptive information to burn clinicians, who have extensive experience treating major burns and determining prognosis, as to whether significant differences in mortality exist between major burns injuries and the comparatively less common toxic epidermal necrolysis for a given age and total body surface area percentage.

Methods
Retrospective data was analyzed of all deceased patients admitted to the Victorian Adult Burns Service in Melbourne, Australia over a period of 10 years with greater than 30% total body surface area burned or greater than 30% total body surface area epidermal detachment in the case of toxic epidermal necrolysis. Retrospective data was also collected on all patients, survivors and deceased, with toxic epidermal necrolysis and these patients were matched with burns patients by age and % total body surface area burned. Comparisons in outcomes were performed with mortality being the primary variable of interest.

Results
Toxic epidermal necrolysis patients that died were older (median: 68.5 vs 57 yrs; P = 0.04), had a longer length of hospital stay (36.5 vs 0.8 days; P = 0.001) and significantly longer periods of mechanical ventilation (1404 vs 14.5 h; P = 0.011) than major burns patients that died. When toxic epidermal necrolysis patients were matched to major burns patients by age and total body surface area burned, there were no significant differences between the two groups with respect to mortality.

Conclusion
Palliative care approaches are more frequently administered at the time of presentation for major burns patients in comparison to toxic epidermal necrolysis patients. This may be due to a perception that if toxic epidermal necrolysis patients can survive their initial systemic injury, they are likely to survive, as opposed to major burns patients who often undergo extensive surgery and for whom other factors should be taken into account in the context of end-of-life decision making.

Mortality and use of the auxiliary score in extensive toxic epidermal necrolysis patients admitted to an adult burns referral centre

 Background: Toxic epidermal necrolysis (TEN) is a rare but fatal condition characterised by cutaneous exfoliation of the dermoepidermal layer and mucosal surfaces. Extensive TEN with epidermal detachment >30% of the total body surface area has been associated with a high mortality. Objective: This study aims to evaluate factors associated with mortality in extensive TEN. In the absence of data to qualify scoring systems such as SCORTEN, this study also aims to evaluate the use of the auxiliary score as a tool for calculating expected mortality. Methods: A retrospective chart review of all patients presenting to our burns service with extensive TEN was undertaken. Application and evaluation of the auxiliary score was also undertaken for this patient population. Results: In extensive TEN, age and delay in admission to a burns centre were factors associated with mortality. Applying the auxiliary score to our patient population, there were no significant differences between expected mortality and observed mortality. Conclusion: Mortality was associated with age and delay in definitive treatment in extensive TEN. Whilst SCORTEN is the gold standard prognostic tool for patients with TEN, in the absence of SCORTEN values, the auxiliary score provides an alternative scoring system to evaluate expected mortality.

The Harbour outdoors: Investigating how children and educators engage with the outdoor learning space at the Harbour Family and Children's Centre

The aim of the research was to carry out an in-depth case study of the outdoor space at a purposively designed outdoor learning space in a demonstration childcare program in an Australian city. The design of the outdoor space emphasises natural elements and sustainability, while the program uses an indoor/outdoor approach with multi-age sharing of the space. The report included staff, management and researcher perspectives on how the outdoor space worked for children and staff, and provided findings that could inform the ongoing professional processes of reflection on the learning environment at the centre. In addition, the researchers also sought the views of the original designers of the outdoor space, and od centre management at the time when outdoor space was being designed and built. The researchers considered that their perspectives, along with those of current management and staff, could assist in addressing questions of long-term sustainability and practicality in the design of outdoor spaces in childcare centres.

Child physical activity levels and associations with modifiable characteristics in centre-based childcare

Objective: To describe children's physical activity levels during childcare and associations with modifiable characteristics. Methods: A cross-sectional study of 328 preschool children (43% girls; age 3-5 years) and 145 staff from 20 long day care centres in the Hunter Region of NSW, Australia. Pedometers assessed child physical activity levels. Centre characteristics and staff attitudes and behaviours towards children's physical activity were assessed using surveys, interviews and observational audit. Results were analysed using descriptive statistics and linear regression. Results: Over the measurement period, average step count of children was 15.8 (SD=6.8) steps/minute. Four-year-olds had the highest step counts (16.4, SD=7.1, p=0.03) with no differences by sex. Step counts were significantly higher in centres that had a written physical activity policy (+3.8 steps/minute, p=0.03) and where staff led structured physical activity (+3.7 steps/minute, p<0.001) and joined in active play (+2.9 steps/minute, p=0.06). Conclusions: Written physical activity policy, structured staff-led physical activity and staff joining in active play were associated with higher levels of physical activity. Implications: Childcare physical activity interventions should consider including strategies to encourage written physical activity policies and support structured staff led physical activities.

Has carotid artery stenting found its place? A 10-year regional centre perspective

The post-Carotid Revascularization Endarterectomy versus Stenting Trial era has seen a dramatic decline in the practice of carotid artery stenting (CAS). A retrospective review of prospectively collected CAS outcomes over a 10-year period by a single operator was undertaken to determine if this change in practice is justified and to identify the place of carotid stenting in current practice.

The role of general and specific stressors in the health and well-being of call centre operators

The call centre industry has developed a reputation for generating a highly stressful work environment with high absenteeism and turnover rates. Research has identified role ambiguity, role conflict, role overload, and work-family conflict as common stressors in other settings. Call centre research has additionally identified performance monitoring, job design and job opportunities as call centre specific stressors.OBJECTIVE AND METHODS: This study investigated the impact of the identified stressors on burnout, somatic symptomology, and turnover intent among 126 call centre representatives (CCRs) from 11 call centres in metropolitan Melbourne, Australia.

The interior of our memories: a history of Melbourne's Jewish holocaust centre

The Interior of Our Memories describes the development of the Centre within global Holocaust memorial activity, both during the Holocaust and in the following decades when many survivors made new lives for themselves in Melbourne. The story begins, not in March 1984 when it first opened its doors, but during the Holocaust, when survivors began gathering documents. The book provides a history of the Centre’s early days and examines its transformation from a collection of photos, documents and material objects into the modern, educationally focused organisation it is today. The book situates the Jewish Holocaust Centre within a broader context, exploring issues of memory, testimony, the role of the museum within contemporary society, and what we can learn from one of the worst tragedies in human history.

Evolving epidemiology of injecting drug use-associated infective endocarditis: a regional centre experience

INTRODUCTION AND AIMS: Injecting drug use (IDU) is a major risk factor for infective endocarditis (IE). An understanding of the epidemiology of IE and IDU is vital for delivery of health care for this disease. Our aim was to examine the rates of IDU-associated IE (IDU-IE) in a single centre over the last 12 years. DESIGN AND METHODS: Retrospective analysis of two cohorts of consecutive patients (n = 226) admitted with IE from 2002 to 2013. Numbers of cases and rates of IE were compared between two cohorts (2002-2006 and 2009-2013). Rate ratios were calculated using Poisson distributions. Poisson regression was used to examine relationship over time. RESULTS: One hundred thirty cases of endocarditis were seen in the first observation period (6 IDU-IE) and 96 in the second observation period (15 IDU-IE). The estimated incidence rate of IE had fallen from 10.1 to 6.45 per 100, 000 person-years [rate ratio 0.64, 95% confidence interval (CI) 0.48, 0.85]. In contrast, the estimated incidence rate of IDU-E has risen from 0.48 to 0.79 per 100, 000 person-years (rate ratio 1.65, 95% CI 0.59, 4.57). Incidence rate regression suggests that the number of IDU-IE cases is expected to increase by a factor of 1.25 (95%CI 1.09-1.44) for each increase of 1 year. DISCUSSION AND CONCLUSIONS: Over the last decade, there has been a decrease in incidence rate and total number of cases of IE but a rise in rate and number of cases of IDU-IE. This may indicate increasing IDU or increased rates of endocarditis in intravenous drug users in this region. This finding may inform health-care planning in the area.