Hot Summers and Heart Failure: Seasonal Variations in Morbidity and Mortality in Australian Heart Failure Patients (1994-2005)

Background There are minimal reports of seasonal variations in chronic heart failure (CHF)-related morbidity and mortality beyond the northern hemisphere. Aims and methods We examined potential seasonal variations with respect to morbidity and all-cause mortality over more than a decade in a cohort of 2961 patients with CHF from a tertiary referral hospital in South Australia subject to mild winters and hot summers. Results Seasonal variation across all event-types was observed. CHF-related morbidity peaked in winter (July) and was lowest in summer (February): 70 (95% CI: 65 to 76) vs. 33 (95% CI: 30 to 37) admissions/1000 at risk (p<0.005). All-cause admissions (113 (95% CI: 107 to 120) vs. 73 (95% CI 68 to 79) admissions/1000 at risk, p<0.001) and concurrent respiratory disease (21% vs. 12%,p<0.001) were consistently higher in winter. 2010 patients died, mortality was highest in August relative to February: 23 (95% CI: 20 to 27) vs. 12 (95% CI: 10 to 15) deaths per 1000 at risk, p<0.001. Those aged 75 years or older were most at risk of seasonal variations in morbidity and mortality. Conclusion Seasonal variations in CHF-related morbidity and mortality occur in the hot climate of South Australia, suggesting that relative (rather than absolute) changes in temperature drive this global phenomenon.

Rural and Urban Differentials in Primary Care Management of Chronic Heart Failure: New Data from the CASE Study

Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

Bricolage as a path to innovation for resource constrained new firms

Evidence suggests that both start-up and young firms (henceforth: new firms) – despite typically being resource-constrained – are sometimes able to innovate (Katila & Shane 2005). Such firms are seldom able to invest in expensive innovation processes, which suggests that they may rely on other pathways to innovation. In this paper, we test arguments that “bricolage,” defined as making do by applying combinations of the resources at hand to new problems and opportunities, provides a pathway to innovation for new firms. Our results suggest that variations in bricolage behaviors can provide an explanation of innovation under resource constraints by new firms.

Managerial cognition and reputation : does communication about firms’ intangibles affect performance?

Corporate reputation is viewed as fundamental to firm performance, growth and survival and the maintenance and enhancement of that reputation is a key responsibility of senior executives. However, relatively little is known about the main dimensions of corporate reputation and the amount of attention given to them by senior executives. Based on the corporate reputation and intangible resources literatures, thirteen reputational elements were identified and the amount of attention given to those elements in a large, longitudinal sample of annual reports from Australian firms was measured using computer aided text analysis. This identified five, main reputational dimensions that were both stable over time and related to firms’ future financial performance.

Why adopt now? Multiple case studies and survey studies comparing small, medium and large firms

While a number of factors have been highlighted in the innovation adoption literature, little is known about whether different factors are related to innovation adoption in differently-sized firms. We used preliminary case studies of small, medium and large firms to ground our hypotheses, which were then tested using a survey of 94 firms. We found that external stakeholder pressure and non-financial readiness were related to innovation adoption in SMEs; but that for large firms, adoption was related to the opportunity to innovate. It may be that the difficulties of adopting innovations, including both the financial cost and the effort involved, are too great for SMEs to overcome unless there is either a compelling need (external pressure) or enough in-house capability (non-financial readiness). This suggests that SMEs are more likely to have innovation “pushed” onto them while large firms are more likely to “pull” innovations when they have the opportunity.

HR practices and challenges in Chinese firms : comparison with Western firms

This research compares Chinese HRM with Western HRM, particularly in the areas of development of HR information systems (HRIS) and HR measurement systems and their relation to HR’s involvement as a strategic partner in firms. The research uses a 3-stage model of HRIS (workforce profiling, business insight, and strategic driver) based on studies of Irmer and Ellerby (2005) and Boudreau and Ramstad (2003) to compare the relative stages of development of Chinese and Western HRM. The quantitative aspect of the study comprises a survey of senior HR practitioners from 171 Chinese firms whose data is compared with data from Irmer and Ellerby’s study of Australian and U.S. HRM (2005) and Lawler et al’s series of studies of U.S firms (1995, 1998, 2001, 2004). The main results of the comparison are that Chinese HRM generally lags behind Western HRM. In particular, Chinese HR professionals allocate less time to strategic activities and their roles are less strategic than those of Western HR professionals. The HR measurement systems of Chinese firms are more limited in function, and the HR information systems of Chinese companies are less automated and integrated. However there is also evidence of a “two speed” HR system in China with a small proportion of firms having highly sophisticated HR systems but with a much larger proportion of Chinese firms than in the West having only the most basic HR information systems. This ‘two speed” system is in part attributable to a split between the relatively advanced HR systems of large State Owned Enterprises and the basic systems that predominate in smaller, growing Local Private firms. The survey study is complemented by a series of interviews with a number of senior Chinese HR practitioners who provide richer insights into their experiences and the challenges they face in contemporary Chinese firms.