bluuebunny/crossref_metadata_2025 huggingface dataset:
Surface topography effects on glow discharge depth profiling analysis
Authors: Trigoulet N. , Hashimoto T. , Molchan I. S. , Skeldon P. , Thompson G. E. , Tempez A. , Chapon P.
Published: February 2010

Glow discharge optical emission spectroscopy (GD‐OES) has been shown to be of immense value in elemental depth profiling of thin or thick films on conductive or non‐conductive substrates. For aluminium, GD‐OES has been employed to examine locations of markers and tracers in anodic films, thereby assisting understanding of transport phenomena. In order to investigate the influence of surface topography on depth profiling analysis, anodic aluminium oxide films of various thicknesses, with incorporated electrolyte species, were produced on superpure aluminium substrates of controlled roughnesses. The distributions of incorporated species in the films were subsequently probed. Surface topography modifications and consequent depth resolution degradation were examined during depth profiling analysis performed by GD‐OES. The results reveal that the sputtering process leads to the roughening or smoothing of the surface topography of the specimen for a ratio of the film thickness to the amplitude of the substrate texture less, or greater, than 1 respectively. As a consequence of the surface topography dependence of the ion bombardment, analysis of thin films over rough surfaces suffers from depth resolution limitations due to sputtering‐induced topography changes, thereby limiting quantification of the resultant spectra. Copyright © 2010 John Wiley & Sons, Ltd.
An algebraic semantics for MOF
Authors: Boronat Artur , Meseguer José
Published: February 2010

In model-driven development, software artifacts are represented as models in order to improve productivity, quality, and cost effectiveness. In this area, the meta-object facility (MOF) standard plays a crucial role as a generic framework within which a wide range of modeling languages can be defined. The MOF standard aims at offering a good basis for model-driven development, providing some of the building concepts that are needed: what is a model, what is a metamodel, what is reflection in the MOF framework, and so on. However, most of these concepts are not yet fully formally defined in the current MOF standard. In this paper we define a reflective, algebraic, executable framework for precise metamodeling based on membership equational logic (mel) that supports the MOF standard. Our framework provides a formal semantics of the following notions:metamodel,model, andconformanceof a model to its metamodel. Furthermore, by using the Maude language, which directly supportsmelspecifications, this formal semantics isexecutable. This executable semantics has been integrated within the Eclipse modeling framework as a plugin tool called MOMENT2. In this way, formal analyses, such as semantic consistency checks, model checking of invariants and LTL model checking, become available within Eclipse to provide formal support for model-driven development processes.
Comparison of Preoperative Endoanal Ultrasonography with Intraoperative Findings for Fistula In Ano
Authors: Subasinghe Duminda , Samarasekera Dharmabandhu N.
Published: February 2010

Background

Fistula in ano is a common benign anal condition seen in surgical practice. If fistula anatomy is incorrectly delineated or an occult abscess is missed, there is a risk of incomplete healing, recurrence of the fistula, or even iatrogenic sphincter injury from surgery resulting in anal incontinence. Therefore, an imaging modality ideally would provide accurate information that can be used to delineate the tract(s) prior to surgery. The aim of this study was to determine the accuracy of endoanal ultrasonography (EAUS) during the preoperative assessment of anal fistula tracts in respect to the type of the fistula, horseshoeing of the tract, and localized collections.

Methods

A consecutive series of 64 patients underwent preoperative EAUS assessment of the fistula. All patients subsequently had surgical exploration under anesthesia irrespective of findings at sonography. The operative findings were compared with the US findings. The association between EAUS and operative findings was determined by nonparametric Spearman’s rank correlation (rho) coefficient test.

Results

The male/female ratio was 58:6. Mean age was 41.53 years (range 11–60 years). EAUS detected the fistula tract in most (95.3%). On EAUS, the primary tract was transsphincteric, intersphincteric, or superficial in 34 (53.1%), 25 (39.1%), and 2 (3.2%) patients, respectively. Localized collections were identified in 24 of the 64 (37.5%) patients (rho = 0.986). The fluid collection locations were 12 intersphincteric, 7 superficial, 4 infralevator, and 1 supralevator. At surgery, 38 (59.4%) fistula tracts were transsphincteric, 17 (26.6%) intersphincteric, 5 (7.8%) suprasphincteric, and 3 (4.7%) superficial. US correctly predicted the primary tract in 71.9% of fistulas (rho = 0.5).

Conclusions

EAUS has high accuracy for predicting the type of anal fistula and for detecting associated sepsis/fluid collections. This information is useful for preoperative planning of fistula treatment. EAUS therefore is an accurate test for determining fistula anatomy prior to surgery.
Peritoneal VEGF burden as a predictor of cytoreductive surgery outcome in women with epithelial ovarian cancer
Authors: Diniz Bizzo Solange Maria , Meira Débora Dummer , Lima José Marinaldo , Mororó Jânio da Silva , Casali‐da‐Rocha José Cláudio , Ornellas Maria Helena Faria
Published: February 2010

Objective

To determine whether peripheral plasma concentration, peritoneal fluid concentration, and/or peritoneal vascular endothelial growth factor (VEGF) burden can predict the possibility of optimal cytoreduction in women with epithelial ovarian carcinoma (EOC); and if so, to determine cutoff values below which optimal cytoreduction is likely to occur.

Methods

We measured plasma VEGF concentration, peritoneal VEGF concentration, and VEGF burden in 46 women undergoing cytoreductive surgery. Univariate analysis, bivariate analysis, correlation tests, and stepwise regression were performed with cytoreduction as the outcome.

Results

The VEGF burden best predicted the outcome. The area under the curve was 0.84 and the log‐transformed cutoff value was 15.52 log pg. Overall, the chance of optimal cytoreduction was 11 times greater when the VEGF burden was less than 15.52 log pg. For women with advanced disease, the chance was 6 times greater below this value.

Conclusion

The VEGF burden may quantify tumor activity, and it could be used when selecting patients likely to benefit from induction chemotherapy before undergoing cytoreductive surgery.
When to address level I lymph nodes in neck dissections?
Authors: Ozer Enver , Karapinar Ugur , Ryoo Cherie , Agrawal Amit , Schuller David E.
Published: February 2010

Objective

To investigate the involvement of level I neck lymph node groups in head and neck carcinoma and compare the effect of primary tumor sites, such as oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (Lx), on level I lymph node metastasis.

Study Design

Case series with chart review.

Setting

Comprehensive Cancer Center.

Subjects and Methods

A total of 243 patients with OC and laryngopharyngeal carcinoma who underwent neck dissections in the last three years were included in the study. The primary tumor site was OC, followed by OP, Lx, HP, and carcinoma of unknown primary (CUP).

Results

Level I was involved in 29 of 243 (11.9%) patients. The other levels were also positive in all but five (17.2%) level I–involved patients. The primary tumor site with level I lymph node metastasis was OC (19.1%), followed by CUP (11.1%), OP (9.8%), Lx (4.4%), and HP (0%). The Lx primary site involved level I only if there were multiple other adverse prognostic features, such as N3 neck, extracapsular spread, pathologic involvement of all resected lymph nodes, involvement of all levels I‐V, and invasion of the submandibular gland.

Conclusion

Although the submandibular content is resected as part of radical and modified radical neck dissections, level I–sparing selective neck dissections could be a safe and effective surgical neck management strategy in appropriately selected patients with OP, Lx, and HP carcinoma.
Pulsating aerosols for drug delivery to the sinuses in healthy volunteers
Authors: Möller Winfried , Schuschnig Uwe , Khadem Saba Gülnaz , Meyer Gabriele , Junge‐Hülsing Bernhard , Keller Manfred , Häussinger Karl
Published: February 2010

Objective

Approximately 10 to 15 percent of the European and U.S. population have chronic rhinosinusitis, but effective treatment remains a challenge. There has been limited success using topical drug delivery to the nose and the paranasal cavities/sinuses, in part because most nasally administered aerosol drug formulations are efficiently filtered at the nasal valve and fail to reach the osteomeatal area and sinuses.

Study Design

Feasibility study.

Setting

Nuclear medicine department.

Subjects and Methods

Pulsating airflows were applied to the nasal cavity and sinus ventilation was studied in five healthy human volunteers using dynamic 81mKr‐gas gamma camera imaging. Furthermore, deposition and retention of 99mTc‐DTPA radiolabeled aerosols delivered by nasal pump sprays or by pulsating aerosols was assessed in each volunteer over a 24‐hour period.

Results

Only the pulsating airflow demonstrated efficient 81mKr‐gas ventilation of the paranasal sinuses. No drug was deposited into the sinuses using nasal pump sprays, but up to 6.5 percent of the nasally administered drug was deposited into the sinuses using pulsating airflow. Clearance kinetics of the drug was reduced after pulsating aerosol delivery compared to nasal pump sprays. Residence time of the drug at the site of deposition was up to three‐fold longer with pulsating aerosol delivery than with nasal pump sprays.

Conclusion

Our data support the hypothesis that topical drug delivery in relevant quantities to the nose and osteomeatal areas, including the paranasal sinuses, is possible using pulsating airflows. Furthermore, the frequency of drug applications may be reduced due to a delayed clearance and longer residence time.
Towards Interracial Understanding and Identification: Spike Lee's Do the Right Thing and Chang-rae Lee's Native Speaker
Authors: LEE KUN JONG
Published: February 2010

African Americans and Korean Americans have addressed Black–Korean encounters and responded to each other predominantly in their favorite genres: in films and rap music for African Americans and in novels and poems for Korean Americans. A case in point is the intertextuality between Spike Lee's Do the Right Thing and Chang-rae Lee's Native Speaker. A comparative study of the two demonstrates that they are seminal texts of African American–Korean American dialogue and discourse for mutual understanding and harmonious relationships between the two races in the USA. This paper reads the African American film and the Korean American fiction as dialogic responses to the well-publicized strife between Korean American merchants and their African American customers in the late 1980s and early 1990s and as windows into a larger question of African American–Korean American relations and racialization in US culture. This study ultimately argues that the dialogue between Spike Lee's film and Chang-rae Lee's novel moves towards a possibility of cross-racial identification and interethnic coalition building.
How Syndicate Short Sales Affect the Informational Efficiency of IPO Prices and Underpricing
Authors: Bartling Björn , Park Andreas
Published: February 2010

When a company goes public, it is standard practice that the underwriting syndicate allocates more shares than are issued. The underwriter thus holds a short position that it commonly fills by aftermarket trading when market prices fall or, when prices rise, by executing the so-called overallotment option. This option is a standard feature of initial public offering (IPO) arrangements that allows the underwriter to purchase more shares from the issuer at the original offer price. We propose a theoretical model to study the implications of this combination of short position and overallotment option on the pricing of the IPO. Maximizing the sum of both the profits from their share of the offer revenue and the potential profits from aftermarket trading, we show that underwriters strategically distort the offer price. This results either in exacerbated underpricing when favorably informed underwriters lower prices to secure a signaling benefit, or in informationally inefficient offer prices when underwriters pool in offer prices irrespective of their information.
The renewable tradition: Le Corbusier and the East
Authors: Demirel Emre
Published: February 2010

This paper considers the problem of tradition in contemporary architectural practice in Turkey as well as in other countries of the world. When it is presented as the display of stylised historical images, tradition loses its relevance in the present and becomes perceived as something that always belongs to the past. In such a case tradition opposes itself against modernity as independent and sovereign. In her writings German-Jewish political theorist Hannah Arendt considers the problem of modernity as a problem of tradition which is mainly caused by the polarisation and particularisation between past and future. Addressing her writings, in the architectural realm, tradition becomes past orientated when it is perceived as something completed as appearances. However, perhaps tradition is more future directed and continuously attempts to actualise itself between past and future.
Corporate governance of public health services: Lessons from New Zealand for the State sector
Authors: Perkins Rod , Barnett Pauline , Powell Michael
Published: February 2010

New Zealand public hospitals and related services were grouped into 23 Crown HealthEnterprises and registered as companies in 1993. Integral to this change was the introductionof corporate governance. New directors, largely from the business sector, were appointed togovern these organisations as efficient and effective businesses. This article presents the resultsof a survey of directors of New Zealand publicly-owned health provider organisations.Although directors thought they performed well in business systems development, theyacknowledged their shortcomings in meeting government expectations in respect to financialperformance and social responsibility. Changes in public health sector provider performanceindicators have resulted in a mixed report card for the sector six years after corporategovernance was instituted.
The politics of health
Authors: Blewett Neal
Published: February 2010

Medicare entered the new millennium nearly 16 years old. Throughout its life the core elementshave remained untouched; most changes have been incremental and marginal, including those ofthe present Government. This stability contrasts starkly with the preceding fifteen years - from1968 to 1983 - during which at least six distinct health-financing systems were tried. In thoseyears Australia was the ideal laboratory for studying health finance, given our constant indulgencein new systems. Yet the sixteen years of relative stability since 1984 have been accompanied by amedia babble stressing instability and crisis. Scarcely a year has passed without predictions ofeither imminent breakdown or slow decay. (With the formal acceptance of Medicare by theLiberal-National coalition in 1996, after thirteen years of unremitting hostility, the fact that suchheadlines have been less apparent suggests a political dimension to such predictions.) Yet thesystem itself has simply contradicted the doomsayers. Indeed by virtually any measure Medicareis in a rude state of health. "It has become', in Stephen Duckett's words, 'part of Australia's socialinfrastructure'.
The performance of Australian DRGs
Authors: Reid Beth , Palmer George , Aisbett Chris
Published: February 2010

This paper reports the results of an evaluation study of the Australian National Diagnosis RelatedGroups (AN-DRGs). The evaluation was based on statistical rather than clinical criteria with theprincipal goal being to provide information for the future development of the classification system. Aswell as comparing versions 1.0 to 3.0 of AN-DRGs, the project included a comparison of these systemswith the most recent versions of the DRG systems from the United States. Taking all the evaluationcriteria together, Version 3.0 of AN-DRGs performed best of all the systems except for the All PatientRefined (APR)-DRGs with its much larger number of groups. However, the differences between all theclassifications were slight. Data of higher quality are needed if further refinements of the AN-DRGsare to produce substantial improvements in performance.
China in transition:the new health insurance scheme for the urban employed
Authors: Hindle Don
Published: February 2010

China has been very successful in achieving good health at a low cost, mostly through national programs for healthpromotion and illness prevention. However, increased prosperity in recent years has led to higher expectations fortherapeutic care, and the change to a socialist market economy has created new risks and opportunities for bothfinancing and care provision.After several years of experimentation, China committed itself in 1996 to a major reform program which includesimplementation of a new method of financing of care for the urban employed population. It comprises a mix ofgovernment-operated compulsory basic insurance, individual health savings accounts, and optional private healthinsurance.This paper outlines the new Scheme, and notes some tactical and strategic issues. I conclude that the Chinesegovernment is correctly choosing to balance new and old ideas, but that there are many challenges to be facedincluding integration of the new Scheme with the rest of the health care system.
Oranges are not the only fruit:the role of emergency departments in providing care to primary care patients
Authors: Bolton Patrick , Mira Michael , Sprogis Arn
Published: February 2010

Effective and integrated primary health care services are seen world wide as the lynch pin of an equitable,efficient and high quality health care. Health services dominated by specialist care suffer either fromuncontainable costs (USA with 14% of GDP) or poor quality care (Russia and other former members of theSoviet bloc). Ierachi et al. (2000) argue that Australia should take the retrograde step of endorsing a servicewhich aims to "provide rapid, high quality and continuously accessible unscheduled care, for conditions coveringthe full spectrum of acute illness and injury" (emphasis added). They aim to provide care "for conditions", notfor people. General practice provides care for people, not just diseases or injuries.
Thabo Mbeki and the AIDS 'jury'
Authors: Awofeson Niyi , Degeling Pieter , Ritchie Jan , Winters Mark
Published: February 2010

This paper examines the debate regarding efforts by the South African government to control the spread of HIVinfections, with particular reference to events surrounding the 13th International AIDS conference. We posit that thereaction of the medical, pharmaceutical, and media sectors to the stance by the President Mbeki on HIV controlamounts to an over-simplification of a very complex issue. Empathy and sincere partnership are required to addressSouth Africa's worsening AIDS situation.
Identification of factors contributing to increased length of stay in two Diagnosis Related Groups
Authors: Taylor Catherine , Gardner Brendon , Heslop Liza , Lowe Ella , Habner Maureen , Athan Dean
Published: February 2010

This paper discusses a study conducted to identify factors that contributed to increased length of stay for two diagnosis related groups (DRGs) and their consequential impact on nursing salaries, The study shows that three separate clusters of cost drivers (DRG-related, nurse-related, and patient-related) contributed to increased length of stay for DRG 177 (chronic obstructive airways disease) and DRG 367 (cholecystectomy without exploration of the common bile duct). It was not possible to establish a link between length of stay and nursing salaries due to lack of relevant data. The results of the study can be used to raise professional awareness to the difficulties encountered by nurse managers in controlling length of stay when there are substantial numbers of different DRGs in acute care wards. The results can also be used as a basis for conducting larger studies into DRGs with higher than expected lengths of stay.
Critical pathways for smaller hospitals in rural areas
Authors: Ham Jenni
Published: February 2010

Critical pathways, developed for utilisation in the health sector, are tools that are increasingly being used toimplement co-ordinated patient care. The introduction of critical pathways results in planned progress throughan episode of care, whilst optimising health outcomes and minimising resource utilisation. The advantages ofimplementing critical pathways are increasingly evident, with reports of increased co-ordination of activities,minimum delays in the provision of care, enhanced interdisciplinary communication, enhancedcommunication with clients, improved discharge planning processes and the implementation of a continuousquality improvement process (Pearson et al, 1995, p941-948).Hospitals in rural areas have not been excluded from the issue of providing quality care whilst containing costs.Distance, sparse population density and decreased resources intensify the need for co-ordinated care systems inrural areas. Co-ordinated care planning to date has centred on metropolitan, acute care hospitals, althoughinterest in the design and implementation of critical pathways has been demonstrated by many health agenciesin rural areas wanting to share in the advantages of implementing critical pathways (Spath, 1999, p45-48;Bertram, 1996 p54-66; Rawskey, 1996, p49-51; Ely, 1995, p66-64).
Long-term needs of motor vehicle accident victims: are they being met?
Authors: Jeavons Sue
Published: February 2010

This paper uses the context of a longitudinal rural study, which examined the extent of psychological trauma andpredictors of that trauma following road accidents, to highlight issues for road accident survivors. It then outlines whatcounselling and psychological services are currently offered to road accident victims by the insurance companies andby a voluntary agency, the Road Trauma Support Team. Overall it appears that psychological and emotional needs ofsurvivors are not always acknowledged or provided for.
The next Australian Health Care Agreements: what clinicians want
Authors: Dwyer John M
Published: February 2010

For the first time experienced clinicians are to be involved in the development of the Australian Health Care Agreements (AHCAs)(2003-2008). As a result doctors, nurses and allied health professionals are hoping that current impediments to necessary change will be removed. Numerous suggestions to improve the Agreement will come forward from the "front line". All clinicians will argue that the next Agreement must result in a marked increase in the funding available to public hospitals. The new Agreement must remove barriers hindering our capacity to integrate all of our healthcare services. Safe, appropriate and cost effective healthcare delivery must embrace a continuum of care involving patients and their primary care physician, community health services and hospitals. The Agreement must embody arrangements for markedly enhancing our public health efforts in the area of prevention of disease. Australia's clinicians are worried about inequity in terms of access and outcome for their patients and are willing to be partners in health care governance to improve the situation.
The price of choice: private health insurance in Australia
Authors: Stoelwinder Johannes U.
Published: February 2010

Private Health Insurance (PHI) is an integral part of the financing of the Australian health care system. PHI is popular and has strong political support because it is perceived to give choice of access and responsiveness. However, in the past increasing premiums have led to a progressive decline in membership. A package of reforms by the Commonwealth Government in support of the private health insurance has reinvigorated the industry over the last three years. Some strategies for achieving a sustainable PHI industry are described. The key challenge is to control claims cost to maintain affordable premiums. Many techniques to do this compromise choice and challenge the very rationale for purchasing the product. Funds and providers will have to establish a new level of relationship to meet this challenge.
Informing policy and service development at the interfaces between acute and aged care
Authors: Howe Anna L
Published: February 2010

This paper argues that policies to address the interfaces between acute care and aged care should view older people as members of the wider Australian population entitled to a range of health services under Medicare rather than focusing only on supposed "bed blockers". In seeking to explain the current level of policy interest in this area, three areas are canvassed: pressures on acute hospital care, particularly those attributed to population ageing; shrinking provision of residential aged care; and the proliferation of post acute services. If policy development is to maintain a wider rather than narrower perspective, attention needs to be given to improving collection and analysis of critical data that are currently unavailable, to developing system-wide funding arrangements for post acute care, and to reassessing what constitutes appropriate hospital activity for younger and older age groups alike.
The significant impacts of workplace change on medical scientists in Victoria
Authors: Weekes Kerryn
Published: February 2010

Pathology in Victoria has undergone considerable change in the last decade. The need for productivity gains, the effects of downsizing and budget cuts, alongside the effects of casemix funding, privatisation and the advent of Enterprise Bargaining Agreements (EBAs) have all placed considerable strain on medical scientists.This paper outlines the impacts of workplace change on medical scientists in Victoria, the most significant workplace stressors on medical scientists today, and what medical scientists feel needs to happen to enable them to regain control over their working lives.The findings from key informant interviews and focus groups of medical scientists show that radical changes in service requirements have occurred. The restructuring of laboratories to 'core' business and subsequent changes in client expectations has impacted on the standards of service delivery in pathology. These changes have resulted in considerable stress as the scientists struggle to cope with work intensification, increases in rostered work during 'unsociable' hours, the lack of control over change, and challenges to their professionalism as they feel that quality standards are not being met.
Workplace change and the internal labour market: evidence from the NSW hospital industry
Authors: De Ruyter Alex
Published: February 2010

After a decade of labour market reform and workplace change, increasing attention has focussed on public sector industries. In this paper, Domestic and maintenance occupations in the hospital industry are examined, as previous work has focussed on nursing, with other occupations being largely ignored. Grimshaw and Rubery's (1998) model of internal labour markets is adopted as the preferred theoretical approach. This model, in acknowledging external factors, the role of workers, and custom and norms within the firm, provides a basis from which to examine labour use practices within the hospital industry.
Variation in levels of uptake of Enhanced Primary Care item numbers between medical practices, within Divisions of General Practice and jurisdictions
Authors: Wilkinson David , McElroy Heather , Beilby Justin , Mott Kathy , Price Kay , Morey Sue , Best John
Published: February 2010

We aimed to report on variation in levels of uptake of services between medical practices across Divisions of General Practice, and jurisdictions, through the Enhanced Primary Care (EPC) program between November 1999 and October 2001.No Divisions had levels of EPC uptake outside upper control limits plus/minus three standard deviations the national level, suggesting limited substantial systematic variation relating to high uptake. Four Divisions had rates of practices providing EPC services (33.3%-67.7%)substantially lower than the national rate (81.2%). For all EPC services combined and for health assessments (HAs) there is substantial variation between practices in almost all Divisions of General Practice, and in some this is extreme. For care plans (CPs), while several Divisions show wide variation in rates across practices (and in a few there is extreme variation), in other Divisions there are very low rates of CP across all practices. For case conferences (CCs) the picture is even more extreme, and these patterns are expressed across all jurisdictions. There is substantial variation in the level of uptake of EPC services across medical practices in Australia.
The nursing workforce in Canada and Australia: two sides of the same coin
Authors: Duffield Christine , O'Brien-Pallas Linda
Published: February 2010

This paper compares characteristics of the nursing workforce in Canada and Australia and provides insights into reasons why the shortage of nurses is more critical today than ever before. Workplace issues are discussed in a global context. Factors that affect retention and recruitment are described. Factors that make the current shortage moreserious and different than at other times are also presented. Despite the shortage of registered nurses, their replacementwith unskilled workers jeopardises the quality of care.
Subacute care and rehabilitation
Authors: Gray Len
Published: February 2010

Subacute and rehabilitation services are likely to play an increasingly important role in the health and long-term care systems, as population ageing increases the prevalence of chronic disease and disability. The role and scope of these services is difficult to assess in the Australian context due to the paucity of standardised definitions and administrative reporting systems. This paper appraises the role of these services and reflects on principles and evidence that might underpin their future development.
Jaggers in the pokey: understanding tattooing in prisons and reacting rationally to it
Authors: Awofeso Niyi
Published: February 2010

The legalisation of tattooing in prisons, as well as the provision of access by inmates to professional tattooists duringincarceration, have remained contentious issues between custodial and health authorities in most Western prisons. This article examines the arguments of both stakeholders as well as the attitudes of inmates vis-�-vis tattooing, and suggestsa multifaceted approach that takes cognisance of inmates' motivation to have prison tattoos, and (potential) public health implications of tattooing in correctional settings.
Hospital services and casemix in Western Australia
Authors: Hendrie Delia , Boldy Duncan
Published: February 2010

The Health Department of WA currently operates as a single integrated funder and purchaser of health services for the State. Health Service Agreements defining the level of health provision are negotiated with the various health services in WA. During the latter part of the 1990s, the funding of public hospitals for acute inpatient care moved away froma historical basis to output-based funding using a casemix approach based on Diagnosis Related Groups (DRGs).Other hospital services are still mainly purchased using historical funding levels, negotiated block funding or bedday payments, with output-based funding mechanisms under investigation. WA has developed its own approach toclassifying admitted patients that recognises differences in complexity of care among episodes grouped to the same DRG. WA also has a unique cost estimation model for calculating DRG cost weights, which is based on a linear estimate of the relationship between nights of stay in hospital and the cost of hospital care for each DRG. Another emerging trendin the provision of public hospital services in WA has been the greater involvement of the private sector through the contracting of private providers to operate public hospitals. While no close examination has been undertaken of the outcomes of these changes in terms of their effect on efficiency or other relevant indicators of hospital performance,current purchasing arrangements are being reviewed following recommendations made in a report by the HealthAdministrative Review Committee. No decision has yet been made as to future changes to the funding policy of WA public hospitals.
Lessons from the Inquiry into Obstetrics and Gynaecology Services at King Edward Memorial Hospital 1990-2000
Authors: Mclean Jenny , Walsh Michael
Published: February 2010

The Douglas Inquiry investigated the Obstetrics and Gynaecological services at King Edward Memorial Hospital from 1990-2000.Performance deficiencies were identified at state,board and hospital level contributing to poor outcomes for women,babies and families.The Inquiry raises important issues about clinical governance,leadership and culture, accountability and responsibility, safety and quality systems, staff support and development, and concern for patients and their families.The King Edward,Bristol and Royal Melbourne Hospital inquiries reveal important similarities and key lessons for governments,health care leaders and providers.The health care industry must ensure effective clinical governance supporting a culture of inquiry and open disclosure,and must build rigorous systems to monitor and improve health care safety and quality.
Commentary on the King Edward Inquiry: every defect a treasure
Authors: Duckett Stephen
Published: February 2010

Commentary on the King Edward Inquiry by Stephen Duckett, Professor of Health Policy, La Trobe University and Chair of the Board of Directors,Bayside Health.
An audit of the use of epidural injections for back pain and sciatica
Authors: Jackson Christopher , Broadhurst Norman , Nikolai Bogduk and
Published: February 2010

An audit was conducted to determine if epidural injections for back pain and sciatica were practised in accordance with guidelines prescribed by the National Health and Medical Research Council (NHMRC). More than 80% of injections were used for conditions for which they were not indicated, and which the NHMRC considers experimental. Most commonly, epidural injections afforded no benefit to the patients, yet were often repeated. In no instance was informed consent recorded as recommended by the NHMRC. The practice of epidural injections is dissonant both with the evidence-based literature and with recommended guidelines, and squanders both financial and professional resources.
Integrated Services Pathways (ISP): a best practice model
Authors: Wilson Brenda , Rogowski Dianne , Popplewell Robyn
Published: February 2010

Under the National Demonstration Hospitals Program, Phase 3 (NDHP3), Flinders Medical Centre (FMC) developed a best practice model for integrating acute care services with primary and community services. The project methodology included the examination of existing literature, involvement of consumers and other key stakeholders and the application of contemporary change and project management practices. Common elements were identified from four NDHP3 clinical service enhancement projects - aged care, cardiac surgical, gastroenterology and orthopaedic services. The generic elements were transferred to the model.FMC's approach focused on developing a generic model that could be applied to clinical programs in a range of acute care settings. Although a number of barriers were encountered, the NDHP3 experience has shown that integration can be improved at the clinical program level without changing financial and management structures.
Why outpatients fail to attend their scheduled appointments: a prospective comparison of differences between attenders and non-attenders
Authors: Collins Jacinta , Santamaria Nick , Clayton Lexie
Published: February 2010

TOutpatient departments lie at a critical interface between primary care and acute services. Increasing pressure to ensure efficient and effective health care delivery has resulted in outpatient departments investigating ways to minimise the number of patients failing to attend their scheduled clinic appointments. Failure to attend (FTA) is an expensive and persistent problem worldwide with rates of between 5 -39 %reported in the literature. Similar FTA rates have also been detected in the Australian context. This study was undertaken to further investigate the reasons for FTA by conducting a prospective comparison of 100 patients who attended their outpatient appointment with 100 patients who did not attend. Discriminant function analysis revealed that the major reason for non-attendance was the patients' opinion about the difficulty in getting to the hospital. Previous non-attendance was found to be the strongest predictor of future FTA behaviour. A number of operational and system recommendations are made that based on the results, which may assist management to develop interventions to improve attendance rates.
Organisational reform in healthcare in China: impacts on the social functions of public hospitals
Authors: Shi Guang , O'Rourke Michael , Liu Jinfeng , Zhong Dongbo , Liu Xiuying , Li Jing
Published: February 2010

Public hospital reform in China since the mid 1980s has had detrimental effects on hospitals' social functions,especially the provision of care for poor people. This study of hospitals in Northern China, using a range of economicmeasurements, indicated that there has been an overall decline in social functions since 1985, especially in secondaryand tertiary level hospitals. Reason for this include the increasingly competitive medical market in China and, underthe decentralisation reforms, the imperative for hospitals to generate revenue. We put forward policies to strengthenhospital social functions, including funding for essential packages of services to specifically benefit the poor andvulnerable, and increased government subsidies to support social functions in primary level hospitals where care canbe more easily accessed.
The transition from paediatric to adult health care services for young adults with a disability: an ethical perspective
Authors: Bailey Susan , O'Connell Bev , Pearce Julian
Published: February 2010

Young children with disabilities and their carers or parents tend to form a long-term dependent relationship with a paediatrician throughout childhood. At some stage when the young person with a disability reaches early adulthood, the relationship is severed. This paper draws upon recent research undertaken by the authors that describes the difficulties experienced by young people with disabilities as they go through the transition from paediatric care to adult mainstream health care services. The purpose of this article is to present the argument that the dependent,paternalistic relationship that tends to exist between young people with disabilities (and/or their carers) and paediatricians throughout childhood does not facilitate the successful negotiation of adult mainstream health care services, nor optimally promote the well-being of these young people with disabilities. It is proposed that the promotion of autonomy (or self-determination) via a well planned transition program will increase the likelihood that young adults with disabilities and/or their carers will be empowered to successfully negotiate the current mainstream health care system in Australia, and will enhance the well-being of young adults with disabilities.
More rural and Aboriginal students for health related university courses - are we making progress?
Authors: Han Gil-Soo , Mahnken Julie , Belcher Sally
Published: February 2010

The shortage of health professionals in rural and remote areas has been a serious concern. Rural healthprofessionals are constantly leaving for urban practice. The training and recruitment of health professionals whomay be prepared to serve rural communities for a lengthy period is a challenge if a nation is committed to theprovision of equitable health services to its rural population.
Medical students' and GP registrars' accommodation needs in the rural community: insight from a Victorian study
Authors: Han Gil-Soo , Wearne Ben , O'Meara Peter , McGrail Matthew , Chesters Janice
Published: February 2010

Medical education in Australia is currently entering a new era, including support for the significant extension of medical students and general practitioner (GP)registrars' training programs in rural communities. This commitment to rural medical student and general practitioner recruitment and retention has made the provision of accommodation in rural communities a vital issue. This study has found that approximately half of all medical students on placement with rural GPs are currently accommodated with their GP supervisor or with other practice staff. This is a burden for many GPs and when the anticipated increase in the frequency and length of rural placements occurs what is currently a burden will become unsustainable. The changing gender and cultural demographics of medical students and rural general practitioners will also contribute to stresses on this accommodation system. It is important to have a systematic approach towards more appropriate and sustainable models of accommodation for both medical students and GP registrars.
How empowerment and social support affect Australian nurses' work stressors
Authors: Joiner Therese A , Bartram Timothy
Published: February 2010

We surveyed 157 nurses at a private hospital in
Melbourne to examine the role of social support
and empowerment in reducing work stress among
Australian nurses. Our findings reveal that social
support, derived from either the supervisor or
work colleagues, is negatively associated with the
main work stressors, such as role conflict, role
ambiguity, work overload and resource inadequacy.
Empowerment, too, is negatively associated
with the main work stressors, apart from
work overload. We discuss contributions of this
study and implications for research and practice in
health sector management.
Retrospective
Authors: Hughes Allan D
Published: February 2010

IT HAS TAKEN MORE THAN 30 YEARS for Australian
Health Review to evolve into the prestigious professional
journal that it is today.
In the early years, the Australian Healthcare
Association, the Australian College of Healthcare
Executives and the Australian Public Health Association
each recognised the need for a publication
to facilitate dissemination of ideas, publish
research results, report on innovations and
encourage active debate on health care issues.
Each struggled in their own way, at times separately,
at times collectively, and various attempts
were made at commercialisation.
The journal as it is known today was first
published in September 1978.
In recognition of the collective effort that has
been made by many to establish and manage this
professional journal, past editors of AHR and its
predecessor publications were invited to contribute
an article for this collection. Not all were able
to be located and not all were able to accept the
invitation. However, it is a pleasure to present this
collection of interesting and diverse reflections
from my colleagues.
Acute Transition Allliance: rehabilitation at the acute/aged care interface
Authors: Kroemer Dawn J , Bloor Geoffrey , Fiebig Jeff
Published: February 2010

The acute/aged care interface has presented
many challenges to funders, providers and planners
in the health and aged care sectors. Concerns
have long been expressed in the aged care
sector about the changing needs of clients admitted
permanently into residential aged care from
hospitals where the decision for placement would
often have been made in a crisis situation, without
the opportunity to explore appropriate options.
This article describes the process and outcomes
to date of a collaborative effort between the acute
care and aged care sectors in South Australia to
develop a more integrated approach to discharge
opportunities for older people. The program
involves both residential and community care elements
and seeks to provide rehabilitation, to
restore function and to avoid inappropriate permanent
residential care for older Australians following
acute admissions to a public hospital. Interim
outcomes are promising and show only 17% of
those admitted to the program are discharged to
long-term residential care.
Consultation with non-English speaking communities: rapid bilingual appraisal
Authors: Whelan Anna M
Published: February 2010

Government services, including health departments,
are insisting that consumers or users of
health services be consulted. Linguistic diversity
in communities can pose challenges to planners
and policymakers in this communication and
consultation agenda. This article presents rapid
bilingual appraisal as a useful technique for
health services to meet the requirements set by
equity and access guidelines and legislation.
This method was used in an area health service
as part of an independent feasibility study. Health
services should recognise the need for such
consultation and allocate appropriate resources
and time to conduct such consultations, and for
skilled bilingual facilitators and qualified interpreters
to be employed and developed as part of
the team.
Health system costs of falls of older adults in Western Australia
Authors: Hendrie Delia , Hall Sonja E , Arena Gina , Legge Matthew
Published: February 2010

The aim of this study was to determine the health
system costs associated with falls in older adults
who had attended an emergency department (ED)
in Western Australia. The data relating to the ED
presentations and hospital admissions were
obtained from population-based hospital administrative
records for 2001?2002. The type of other
health services (eg, outpatient, medical, community,
ancillary and residential care), the quantity,
and their cost were estimated from the literature.
In adults aged 65 years and above, there were
18 706 ED presentations and 6222 hospital
admissions for fall-related injuries. The estimated
cost of falls to the health system was $86.4
million, with more than half of this attributable to
hospital inpatient treatment. Assuming the current
rate of falls remains constant for each age group
and gender, the projected health system costs of
falls in older adults will increase to $181 million in
2021 (expressed in 2001?02 Australian dollars).
The economic burden to the health services
imposed by falls in older adults is substantial, and
a long-term strategic approach to falls prevention
needs to be adopted. Policy in this area should be
targeted at both reducing the current rate of falls
through preventing injury in people from high-risk
groups and reducing the future rate of falls
through reducing population risk.
Mental health care: take 2
Authors: Leggat Sandra G
Published: February 2010

We are pleased to present our second issue on
mental health care. Perhaps indicative of the
needs in this sector, the original call for papers
generated more interest than could be accommodated
in one issue. We are also pleased to report
that there has been some momentum in improving
mental health care.
The 2006?07 national budget delivered the
government?s commitment for $1.9 billion to
improve services for people with a mental illness.
The largest component of the funding was allocated
to Medicare rebates designed to improve
access to general practitioners, psychiatrists and
psychologists. Funding was also allocated to
additional training places, to increase availability
of mental health nurses and clinical psychologists.
Funding for mental health programs
included a focus on services for rural, remote and
Indigenous communities of Australia, drug and
alcohol, suicide prevention, early detection and
social activity.