bluuebunny/crossref_metadata_2025 huggingface dataset:
Development, analysis and control of a high-speed laser-free atomic force microscope
Authors: Bashash Saeid , Saeidpourazar Reza , Jalili Nader
Published: February 2010

This paper presents the development and control of a laser-free atomic force microscopy (AFM) system for high-speed imaging of micro- and nanostructured materials. The setup uses a self-sensing piezoresistive microcantilever with nanometer accuracy to abolish the need for a bulky and expensive laser measurement system. A basic model for the interaction dynamics of AFM tip and sample in the high-speed open-loop imaging mode is proposed, accounting for their possible separation. The effects of microcantilever and sample stiffness and damping coefficients on the accuracy of imaging are studied through a set of frequency-domain simulations. To improve the speed of operation, a Lyapunov-based robust adaptive control law is used for the AFM XY scanning stage. It is shown that the proposed controller overcomes the frequency limits of the PID (Proportional-Integral-Derivative) controllers typically used in AFM. Finally, the paper presents a set of experiments on a standard calibration sample with 200 nm stepped topography, indicating accurate imaging up to the scanning frequency of 30 Hz.
The intensity correlation function in evanescent wave scattering
Authors: Cichocki B. , Wajnryb E. , Bławzdziewicz J. , Dhont J. K. G. , Lang P. R.
Published: February 2010

As a first step toward the interpretation of dynamic light scattering with evanescent illumination from suspensions of interacting spheres, in order to probe their near wall dynamics, we develop a theory for the initial slope of the intensity autocorrelation function. An expression for the first cumulant is derived that is valid for arbitrary concentrations, which generalizes a well-known expression for the short-time, wave-vector dependent collective diffusion coefficient in bulk to the case where a wall is present. Explicit expressions and numerical results for the various contributions to the initial slope are obtained within a leading order virial expansion. The dependence of the initial slope on the components of the wave vector parallel and perpendicular to the wall, as well as the dependence on the evanescent-light penetration depth are discussed. For the hydrodynamic interactions between colloids and between the wall, which are essential for a correct description of the near-interface dynamics, we include both far-field and lubrication contributions. Lubrication contributions are essential to capture the dynamics as probed in experiments with small penetration depths. Simulations have been performed to verify the theory and to estimate the extent of the concentration range where the virial expansion is valid. The computer algorithm developed for this purpose will also be of future importance for the interpretation of experiments and to develop an understanding of near-interface dynamics, at high colloid concentrations.
Anomalous and normal Hall effect in hydrogenated amorphous Si prepared by plasma enhanced chemical vapor deposition
Authors: Crupi I. , Mirabella S. , D’Angelo D. , Gibilisco S. , Grasso A. , Di Marco S. , Simone F. , Terrasi A.
Published: February 2010

The double sign anomaly of the Hall coefficient has been studied in p-doped and n-doped hydrogenated amorphous silicon grown by plasma enhanced chemical vapor deposition and annealed up to 500 °C. Dark conductivity as a function of temperature has been measured, pointing out a conduction mechanism mostly through the extended states. Anomalous Hall effect has been observed only in the as-deposited n-doped film, disappearing after annealing at 500 °C, while p-doped samples exhibit normal Hall effect. When Hall anomaly is present, a larger optical band gap and a greater Raman peak associated with Si–H bond are measured in comparison with the cases of normal Hall effect. The Hall anomaly will be related to the hydrogen content and implication on photovoltaic applications will be discussed.
Toward determinism in surface damaging of dielectrics using few-cycle laser pulses
Authors: Sanner N. , Utéza O. , Chimier B. , Sentis M. , Lassonde P. , Légaré F. , Kieffer J. C.
Published: February 2010

We introduce a quantitative measurement of the determinism of laser-induced damaging at the surface of a dielectric material, e.g., fused silica. Using laser pulses ranging from 7 to 300 fs, we demonstrate that laser damage occurrence tends to be dramatically deterministic at 7 fs, which is attributed to the increasing importance of tunneling ionization as the major channel for the generation of free-carriers in the conduction band.
Determination of molecular dipole orientation in doped fluorescent organic thin films by photoluminescence measurements
Authors: Frischeisen Jörg , Yokoyama Daisuke , Adachi Chihaya , Brütting Wolfgang
Published: February 2010

The orientation of the transition dipole moments of fluorescent organic molecules doped into a matrix material is determined by photoluminescence measurements of the angular dependent emission spectra and by comparison with simulations. The analysis of two small molecular materials doped into a 4,4′-bis(N-carbazole)-biphenyl matrix is demonstrated, yielding a horizontal orientation of 91% for 4,4′-bis[4-(diphenylamino)styryl]biphenyl and a completely random orientation in case of tris-(8-hydroxyquinoline)aluminum (Alq3). This expeditious technique does not require detailed information about the optical properties of the dopant, making this method particularly suitable for characterizing newly developed materials for organic light-emitting diodes with enhanced light-outcoupling efficiency.
A multichannel time-of-flight system for observation of energetic ions of multispecies generated from relativistic laser plasma
Authors: Matsukado K. , Fujimoto M. , Takahashi H. , Kawada Y. , Ohsuka S. , Aoshima S.
Published: February 2010

A multichannel time-of-flight (TOF) system was constructed to observe the ions generated from relativistic laser plasma, where the ions have polychromatic energies and multiple species. The TOF system is composed of a ten-channel scintillation detector array and an electromagnet that generates a magnetic field of 0–1.24 T. The magnet field enables us to analyze protons, deuterons, and full-stripped carbon ions to 50, 25, and 150 MeV, respectively. The system experimentally identified protons of 0.27–1.6 MeV energy and ions of a half specific charge (deuterons of 0.3–0.8 MeV and full-stripped carbons of 1.8–4.8 MeV). The measured TOF values agree well with the calculated values within the designed accuracy; ±2.5 ns for protons and ±5 ns for the others (d or C6+) on each detector channel. Comparison of ion numbers detected by a track detector (CR-39) and the TOF system enabled us to obtain the number of ions detected on each scintillation counter with less than 16% error.
Kinetic Monte Carlo simulations of nanocolumn formation in two-component epitaxial growth
Authors: Zheng Shu , Zhu Wenguang , Gao Y. F. , Stocks G. M. , Zhang Zhenyu
Published: February 2010

Recent experiments have demonstrated that well-ordered one-dimensional column nanostructures can be formed via self-assembly in a variety of two-component epitaxial systems, including diluted magnetic semiconductors and high-TC superconductors. Here we use kinetic Monte Carlo simulations based on a (1+1)-dimensional lattice model to study the morphological evolution of strain-free two-component films during epitaxial growth in the nonequilibrium kinetic regime. Our simulations show that columnlike nanostructures are only formed in the system when the interatomic bond energies EAA, EBB, and EAB satisfy the inequality of EAB⪡(EAA+EBB)/2 at sufficiently high growth temperatures and low deposition rates.
Surface plasmon enhanced energy transfer between type I CdSe/ZnS and type II CdSe/ZnTe quantum dots
Authors: Wang C. H. , Chen C. W. , Chen Y. T. , Wei C. M. , Chen Y. F. , Lai C. W. , Ho M. L. , Chou P. T. , Hofmann M.
Published: February 2010

Fluorescence resonant energy transfer (FRET) has been investigated between donor-acceptor pairs of type I CdSe/ZnS and type II CdSe/ZnTe quantum dots (QDs). An Au nanoparticles assisted FRET enhancement was clearly demonstrated. It is found that the efficiency of the energy transfer depends on the excitation wavelength and is largest when in resonance with the Au surface plasmon mode. With the large tunability of the emission intensity in near infrared region, our finding paves an excellent route for creating highly efficient optoelectronic devices and bioimaging labels derived from type II QDs.
Application of magnetic atom induced bound states in superconducting gap for chemical identification of single magnetic atoms
Authors: Ji Shuai-Hua , Zhang Tong , Fu Ying-Shuang , Chen Xi , Jia Jin-Feng , Xue Qi-Kun , Ma Xu-Cun
Published: February 2010

Elemental identification at single atom level has been achieved with a low temperature scanning tunneling microscope. Magnetic atoms (Mn or Cr) adsorbed on a superconducting Pb substrate induce a set of well-defined resonance states inside the superconductor gap in scanning tunneling spectroscopy. We show that these localized characteristic bound states could serve as fingerprint for chemical identification of the corresponding atoms, similar to atomic/molecular spectra widely used in optical spectrometry. The experiment demonstrates a technique for element-resolved spectroscopy with simultaneous atomic-level spatial resolution. The influence of magnetic impurity concentration on the bound states has also been investigated.
Multimode transmission in complementary plasmonic structures at terahertz frequencies
Authors: Zhang Zhongxiang , Chan Kam Tai , Cui Yanxia , He Sailing , Wang Changlei , Xing Qirong , Wang Qingyue
Published: February 2010

A three-dimensional subwavelength structure with periodic complementary metal patterns operating in the terahertz range has been proposed and fabricated. The device clearly exhibits three transmission modes under normal incidence, where experimental results obtained by terahertz time domain spectroscopy and simulated results agree very well with each other. The multimode transmission characteristics are found to arise from both localized coupling of fields between the interacting layers and propagating surface waves due to Bloch excitations on the surface of the periodic structure.
Collective dynamics in a liquid polyvalent metal: Liquid thallium at the melting point
Authors: Bryk Taras , Wax J.-F.
Published: February 2010

Collective dynamics in liquid thallium at the melting point in a wide range of wave numbers and frequencies is studied by molecular dynamics simulations and a theoretical analysis of time correlation functions within the approach of generalized collective modes. The heat fluctuations were explicitly treated in the theoretical scheme within the thermoviscoelastic dynamic model. We report dispersion and damping of generalized longitudinal sound excitations, nonhydrodynamic shear and heat waves, as well as wave number dependence of main relaxation processes. Generalized wave number-dependent thermodynamic quantities and transport coefficients in liquid Tl are discussed.
A pathway for self-assembly of metallic nanostructures on quantum-modulated flat Pb(111)/Si(111) substrate
Authors: Zhang Cuipeng , Li Maozhi
Published: February 2010

A mechanism of self-assembly of metallic nanostructures on a quantum-modulated flat Pb(111) thin film with patterned Si(111) substrate is proposed based on recent experimental observations [S. M. Binz, M. Hupalo, and M. C. Tringides, Phys. Rev. B 78, 193407 (2008)] which indicates that because of quantum size effects (QSE), the buried steps act as real steps on surfaces. This intriguing feature offers a potential pathway for self-assembly of functional metallic nanostructures, e.g., nanowires on flat Pb(111) films with designed patterned Si(111) surface as substrate, where QSE can be controlled artificially. The growth conditions for nanowires on a designed Pb(111)/Si(111) substrate is explored by kinetic Monte Carlo simulations.
Insight into the performance enhancement of double-gated polycrystalline silicon thin-film transistors with ultrathin channel
Authors: Lin Zer-Ming , Lin Horng-Chih , Chen Wei-Chen , Huang Tiao-Yuan
Published: February 2010

In this letter, characteristics of independently-controllable double-gated polycrystalline silicon (poly-Si) thin-film transistors (TFTs) with ultrathin channel are characterized and analyzed experimentally and theoretically. As compared with the single-gated mode where only one of the gates is used for driving the device, 1.3–2.1 fold increase in drive current is achieved under double-gated mode as the two gates are biased simultaneously for driving the device. A remarkable lowering of barrier height 7–12 meV in the latter case due to the coupling of the two gate biases is identified as the major origin for such performance enhancement.
Clinical pathways: a direction forward in health care
Authors: Choo Janet , Cheah Jason
Published: February 2010

As in many developed nations, health care consumers in Singapore are demanding better (and morecostly) services. At the operational level, one way to address consumers' demands while ensuring cost-effectivenessis through the implementation of a clinical pathway program. This paper provides anoverview of the program at Changi General Hospital (CGH), a regional general acute care hospital inthe Republic of Singapore. The paper highlights the problems encountered during the planning,developing and implementing phases. It concludes by predicting what the future might hold for clinicalpathways in Singapore and the South East Asian Region.
Community and consumer participation in Australian health services
Authors: Johnson Anne , Silburn Kate
Published: February 2010

This article briefly describes recent initiatives to improve consumer participation in health services that have led tothe establishment of the National Resource Centre for Consumer Participation in Health. The results of a componentof the needs assessment undertaken by the newly established Centre are presented. They provide a 'snapshot' of thetypes of feedback and participation processes mainly being utilised by Australian health services at the different levelsof seeking information, information sharing and consultation, partnership, delegated power and consumer control.They also allow identification of the organisational commitment made by Australian health services to support a morecoordinated approach to community and consumer feedback and participation at different levels of health servicessuch as particular emphasis on determining the presence of community and consumer participation in keyorganisational statements, specific consumer policies and plans, identifiable leadership, inclusion into job descriptions,allocation of resources, and staff development and consumer training. Discussion centres around four key observationsand some of the key perceived external barriers.
Casemix funding for a Specialist Paediatrics Hospital:A hedonic regression approach
Authors: Bridges John F P , Hanson Ralph M
Published: February 2010

This paper inquires into the effects that Diagnosis Related Groups (DRGs) have had on the ability to explain patient-levelcosts in a specialist paediatrics hospital. Two hedonic models are estimated using 1996/97 New Children'sHospital (NCH) patient level cost data, one with and one without a casemix index (CMI). The results show thatthe inclusion of a casemix index as an explanatory variable leads to a better accounting of cost. The full hedonicmodel is then used to simulate a funding model for the 1997/98 NCH cost data. These costs are highly correlatedwith the actual costs reported for that year. In addition, univariate regression indicates that there has been inflationin costs in the order of 4.8% between the two years. In conclusion, hedonic analysis can provide valuable evidencefor the design of funding models that account for casemix.
Developing mental health rehabilitation services in a culturally appropriate context
Authors: Tobin Margaret
Published: February 2010

The present study illustrates the efforts by a community mental health service to restructure the MentalHealth Rehabilitation Program to meet more adequately the needs of the Arabic-speaking population.It was discovered that the principles of mental health rehabilitation theory are inherently Anglo-Australianand not suitable for the Arabic-speaking population. Action research methodology was usedas a tool to drive the changes necessary to implement effective mental health rehabilitation acrosscultures. Two new culturally relevant programs were developed, staff attitudes to rehabilitation werechanged and assertive strategies were introduced to alter clients' attitudes and perceptions about mentalhealth rehabilitation.Introduction
The Australian DRG classification:are we ready for structural changes?
Authors: Hindle Don
Published: February 2010

The Australian DRG variant compares favourably with other variants in use around the world. This view is supported by a variety of empirical studies and by experiences of its adoption by several health care systems. An example is its recent selection for use in Germany (Hindle & Lenz, 2000).
Internal collaborative partners:a business agreement case study
Authors: Hockley Charmaine
Published: February 2010

In the future many organisations in Australia will be turning towards collaborative arrangements with otherindustry partners in order to survive financially. This paper introduces an internal collaborative arrangementresponsive to the challenges of meeting increased demand for services with limited resources. The development of thisexciting approach has in part provided a solution to funding and management issues within one organisation. Thispaper is about the first two years of a negotiated service agreement between the education director and three regionaldirectors of the same organisation.
Falls Clinics in Australia: a survey of current practice, and recommendationsfor future development
Authors: Hill Keith , smith Robyn , Schwarz Jenny
Published: February 2010

The aim of this study was to identify common themes and differences in structure and function of Falls Clinics in Australia, to provide a framework for planning future activity. A paper-based survey was circulated to 20 identified Falls Clinic services throughout Australia in late 2000. Fifteen responses (75%) were received, although two of the 15 Clinics were not operating at the time of the survey, and so their responses were not included. Nine of the Clinics had commenced operation since 1998. Staffing commonly included a physiotherapist, geriatrician, and an occupational therapist, with the comprehensive multidisciplinary assessment process taking an average of 130 minutes. Although standard assessment tools were used by more than half of the Clinics, there were no universally applied assessment tools. Waiting lists for initial assessments ranged up to 16 weeks (average 6 weeks). Most Clinics instituted a number of management options themselves, but also used a range of existing community services to provide some of the planned interventions. Limited formal evaluation of the effectiveness of Clinics was reported. Recommended future activity included increasing staff levels and operating times for Clinics to more adequately meet identified need, increased networking and data sharing between Clinics, and a greater emphasis on research and staff training.
Using non-geriatric clinical indicatorsin a department of rehabilitationand aged care
Authors: Loh PK , Criddle Arthur , Inderjeeth Charles
Published: February 2010

We describe an audit using Gastroenterology Clinical Indicators (CIs) to measure quality of care for older patients with gastrointestinal haemorrhage. The gastroenterology CI for gastroscopy within 24 hours of admission was 60%, it was 70% for diagnosis of a cause of acute gastrointestinal bleeding after upper gastroscopy, and it was 30% for death after blood transfusion in a geriatric restorative unit. We discuss whether it is appropriate for a hospital department (Geriatric Medicine) to use the CIs for the specialty (Gastroenterology) providing the service to measure the quality of service being provided. This may be a useful approach given the trend towards cost recouping between different clinicaldepartments.
Renegotiation of the Australian Health Care Agreements 2003-2008: from a State's perspective
Authors: Thwaites John
Published: February 2010

The renegotiation process for the next Australian Health Care Agreements 2003-2008 presents an opportunity for State and Territory Governments to suggest reforms to improve acute and sub acute health services and health outcomes. Four key issues to Victoria are discussed, emergency departments and primary care interface, workforce planning, aged care and the continuum of care.
Privatised family group practices in Mongolia: an initial assessment of service access
Authors: Orgil Bunijav , Hindle Don , Sonin Sodov , Dashzeveg Galsav , Batsurry Ravjir
Published: February 2010

Mongolia is changing the way that primary care is delivered, by replacing salaried government staff with private family group practices (FGPs) paid by risk-adjusted capitation. As part of a mid-project evaluation, we surveyed a sample of FGPs in order to assess the patterns of access to care. We found that generally satisfactory services are being provided in an equitable way, and therefore that the main goals of the new model are being achieved. However, there are some concerns. Inter alia, we argue that more should be done to establish better standards of clinical practice through the distribution of protocols and illustrative pathways, and to increase the extent to which services are organised in a manner that is sensitive to informed consumers' needs. A design limitation meant that few baseline data were available, and the survey will need to be repeated if valid conclusions are to be drawn.
Planning Australia's hospital workforce
Authors: Harris Mary , Gavel Paul , Conn Warwick
Published: February 2010

Growing government support has been evident during the past decade for macro-level workforce planning to ensure that future populations have access to appropriate health care services. Population ageing is impacting on workforce requirements and on workforce supply within Australia and internationally. Changes in financing and the organisation of health services are impacting on the availability of training and on the quality of working life. The age and gender profile and career expectations of young Australians are changing. These factors are all adding to the importance and complexity of workforce planning. This paper draws on data from various sources to describe Australia's hospital workforce, to explore supply-side workforce trends and to discuss some contemporary issues of concern to policy makers and workforce planners. The paper finds that in recent years there has been a 3 per cent decline in the number of full time equivalent staff in public hospitals, while the number in the private hospital workforce has increased by 28 per cent. The paper concludes that, nationally, there are serious limitations in the data available to describe and monitor the hospital workforce and that there is a need to remedy this situation.
Has the increase in private health insurance uptake affected the Victorian public hospital surgical waiting list?
Authors: Hanning Brian
Published: February 2010

It was anticipated that increased uptake of Private Health Insurance (PHI) would reduce demand on public sector surgical waiting lists. The best measure of changed demand is the comparison of the actual cases added to that projected given previous trends in PHI uptake. Detailed Victorian data is available up to 2000-1.The total waiting list has varied little, reflecting significant decreases in both in patients added to and removed. There was a marked increase in private sector elective surgery cases coinciding with the fall in additions to the public sector waiting list and in public sector elective surgical cases. The June 2001 Victorian surgical waiting list would have been 69,599 not 41,838 if the PHI uptake rate had continued to fall in line with pre-1999 trends, and that of June 2002 about 100,000 compared to 40,458 in March 2002.Limited data from other states suggests the Victorian trends are representative of all Australia.
Interpretation of hospital-specific outcome measures based on routine data
Authors: Coory Michael , Youlden Danny , Baker Philip
Published: February 2010

Hospital-specific outcome measures based on routine data are useful for stimulating interest in quality of care and for suggesting avenues for more in-depth analyses. They might also identify serious, once-in-a-lifetime failures of health care. However, such analyses are not definitive. They are a way of screening large amounts of routine data and, like all screening tools, they can generate false positives and false negatives. This is because differences in outcome measures across hospitals can be due to differences in types of patients seen (casemix), differences in data quality, and the play of chance; rather than differences in the quality of care. End-users of such analyses should be aware of these technical difficulties, otherwise skilled health workers in high-quality hospitals might be subjected to unwarranted criticism.
Description of an early discharge post-acute care program: length of hospital stay, patient and carer needs and cost
Authors: Bonevski Billie , Doran Chris , Bailey Carolyn , Lowe Julia
Published: February 2010

The objective of the project was to evaluate a pilot Post Acute Community Care (PACC) program for orthopaedicpatients. A series of cross-sectional surveys elicited responses of patient and home carer needs and GP and hospital staff acceptability while a cost-minimisation analysis compared the average cost of the PACC program with general orthopaedic hospital care. Patients were classified according to Australian National Diagnosis Related Groups (DRGs). Average length of hospital stay in 1998/99 for PACC patients was 7.7 days compared to 12.3 for generalorthopaedic patients. Only 3% of patients had an unplanned readmission to hospital. Patients and carers expressed a number of unmet needs. This study confirms the popularity of early discharge schemes with patients, and provides little evidence of adverse health outcomes or that the burden of care is shifted to carers in a way that is unacceptable for this older population.
Safety and quality
Authors: Smyth Tim
Published: February 2010

Safe and high quality health care is an objective that everybody supports.With so much written about it and everybody committed to it, why are we still struggling to achieve it? The successful acceptance and adoption of casemix provides some clues as to the answer. This paper examines the factors that assisted casemix and the obstacles to achieving progress with safety and quality. It concludes that both the health industry and community's tolerance of risk in health is too high. The lessons from the casemix story can be applied to advance the safety and quality agenda. A good place to start is a determined campaign focussing on improving safety.
Geriatric assessment - lessons from personal experience
Authors: Mykyta Ludomyr , English Justin
Published: February 2010

The aim of this study was to develop a framework for comprehensive specialist geriatric assessment in rural settings. A protocol that used a number of standardised assessment instruments was developed and applied routinely. Data from two rural centres in South Australia over a two-year period were analysed. Study results offer important insights and have implications for clinical practice and policy development. They particularly reinforce the need for a comprehensive assessment irrespective of the information received from the referrer.
Patterns and characteristics of ethnic Australian women utilising ethno-specific maternal and child health services
Authors: Tran Mai , Phung Hai , Young Lisa , Hopper Ursula , Hillman Ken
Published: February 2010

Few studies have explored the socio-economic profile, service utilisation, obstetric history and pregnancy outcomes of ethnic women who utilise ethno-specific obstetric services in Australia. The purpose of this study was to form a profile of women who accessed the Ethnic Obstetric Liaison Services (EOLO) in South Western Sydney Area Health Service (SWSAHS), New South Wales and explore their beliefs about using maternal and infant health services. We found that the prevalence of risks and special needs varied significantly by language groups in this study sample. Our results suggest that equity of access to quality care for this group of mothers and infants can be assured if models similar to the EOLO in SWSAHS are thoroughly planned and developed, and take account of cultural appropriateness for the population served.
Training in routine mental health outcome assessment:the Victorian experience
Authors: Trauer Tom , Coombs Tim , Eagar Kathy
Published: February 2010

The routine assessment of client outcomes was set as an objective in the Australian National Mental Health Policy in 1992. Victoria was the first jurisdiction to begin the implementation. This paper reports this process, and describes the background to outcome measurement in mental health, assembly of the implementation team, certain key concepts,development of the training materials, the approach to training, and a brief description of the evaluation. We end witha number of observations and recommendations that arose out of the project.
Funding of South Australian public hospitals
Authors: Moss John
Published: February 2010

Since the 1994-95 financial year, inpatient episodes of care in South Australian public hospitals have been funded according to their casemix. This paper describes the current funding system, sets it in some context and examines what can be established about hospital performance.
Promoting the health and well being of older carers: A proactive strategy
Authors: O'Connell Bev , Bailey Susan , Walker Arlene
Published: February 2010

Research has indicated that carers are concerned about their ageing status, their deteriorating health and their abilityto continue to care for their dependants. Given that the health care system will become increasingly reliant on carersthe health care needs of carers should be a concern for all health care professionals. This paper describes the first stageof a project designed to enhance older carers health promotion knowledge and skills and improve their healthpromoting behaviors. This stage investigated the mental and physical health status of older carers. It also soughtinformation on older carers' levels of participation in health related and social activities and identification of barriersto participation in these types of activities. The results highlighted that carers responding to the survey experiencedcompromised physical and mental health. Many carers reported being unable to participate in social and health-typeactivities as they were unable to leave the care recipient. Of note, is that carers identified their own mental fragilityand felt they needed further emotional support.
Challenges associated with implementing an education program in a residential aged care setting
Authors: Edwards Helen , Chapman Helen , Forster Elizabeth , Gaskill Deanne , Morrison Paul , Sanders Fran
Published: February 2010

The link between independence and well-being of older people in residential care is well established. This paper reportssome challenges encountered during implementation of an education program designed to assist nursing staff to adoptan independence-supporting model of residential care. The education program was part of a larger project aimed atdeveloping an example of best practice in supported care which promotes independence, well-being and communitylinkages. Implementation of the program created many interesting challenges which were overcome by strategies andfacilitating forces such as support from management and some staff, and the collaborative nature of the project. Positiveoutcomes of the education program included increased awareness of, and change in, practice; increased staff-residentinteraction; and increased encouragement for residents to be independent and to engage with the wider community.Moreover, a facilitator manual - Promoting Independence: A Learning Resource for Aged Care Workers wassubsequently developed so that the program can be implemented in aged care facilities elsewhere.
Community management structures to promote health
Authors: O'Donnell Carol
Published: February 2010

This article describes key requirements of effective health service management that emerge from a review of Australian developments in the respective roles of government and the market. From a public interest perspective, community and industry ownership and management of funds appear superior to market-driven health management approaches. The clear separation of public interest-based policy and administrative functions is vital for effective fund management. Greater transparency, more community input to broadly planned service delivery, casemix funding systems and better outcome data are required to tap the potential benefits of this policy-led model. A pooled funding approach to service provision may assist regional communities achieve their health aims, and the service breadth and flexibility which appear to be necessary to support health and related regional goals.
Reducing utilisation of hospital services by case management: a randomised controlled trial
Authors: Leung Antony C T , Yau Daniel C N , Liu Chi-pun , Yeoh Chak-sum , Chui Tak-yi , Chi Iris , Chow Nelson W S
Published: February 2010

A 12-month randomised controlled trial was conducted
in Hong Kong to evaluate the effectiveness
of case management provided to a group of
home-dwelling, frail elderly patients (control
group: n = 47; intervention group: n = 45) in terms
of utilisation of hospital services by these patients.
Significant reductions (significance at P<0.05) in
mean total number of hospital bed-days
(P<0.001), mean total episodes of hospital
admissions (P<0.001), and mean total number of
attendances at the outpatient department
(P< 0.05) were observed when the baseline and
post-intervention differences between the intervention
and control groups were compared.
The study demonstrated that utilisation of hospital
services could be significantly reduced when a
group of elderly patients and their caregivers
received timely interventions and appropriate
services through case management services.
Pharmaceuticals and the consumer movement: the ambivalences of ‘patient power'
Authors: Lofgren Hans
Published: February 2010

Consumer and patient advocacy groups (PAGs)
are important participants in the politics of pharmaceuticals.
Yet very little is known about the
precise nature and extent of their influence. It is
argued in this article that PAGs fulfil a mixed role
within the health system at national and transnational
levels, and that they are at times fully
incorporated into economic and political power
structures. Their frequent dependence on pharma
industry funding is of particular concern. PAGs
provide a means of direct industry interaction with
the final customer, thereby partially bypassing and
putting additional pressure on doctors and regulators.
The article presents the case for research to
establish a better empirical base for discussions
about the role of PAGs within contemporary neoliberal governance structures.
Community pharmacy in Australia
Authors: Benrimoj Shalom I , Frommer Michael S
Published: February 2010

This article describes the evolution of community
pharmacy in the Australian health system, and
assesses its current and potential future contribution
to health care. A central theme is the unique
extent and accessibility of community pharmacy to
the public, with a vast and dispersed infrastructure
that is funded by private enterprise. The viability of
community pharmacy as a retail trade depends on
a diversification of its service roles and retention
of its product-supply roles. Initiatives by the pharmacy
profession, the pharmacy industry and the
Australian Government are likely to give community
pharmacy an increasingly prominent place in
health promotion and primary, secondary and
tertiary prevention, especially in relation to the
management of chronic diseases.
The shifting cost of care: early discharge for rehabilitation
Authors: Dow Briony
Published: February 2010

This article tells the stories of two family carers,
each of whom is caring for someone who has
been discharged early from hospital to have their
rehabilitation at home. These stories illustrate the
personal impact of early discharge for rehabilitation.
The article argues that through its policy of
early discharge from hospital, the state has shifted
care from hospital to home, resulting in the work of
caring and its associated costs being rendered
invisible. This is possible because the prevailing
ideology on both sides of politics is that individuals
? rather than the state ? should be responsible
for their own and their family?s well-being.
After-hours general practice clinics are unlikely to reduce low acuity patient attendances to metropolitan Perth emergency departments
Authors: Nagree Yusuf , Ercleve Tor N O , Sprivulis Peter C
Published: February 2010

Objective: To model the effectiveness of afterhours
general practice (GP) in reducing metropolitan
Perth emergency departments? (ED) low acuity
patient (LAP) attendances and costs.
Methods: We estimated LAP attendances by
comparison of the product of (A) the difference
between self-referred and GP-referred ED discharge
rates and (B) total self-referred attendances
(LAP attendances = A - B). We then
compared after-hours ED LAP attendance rates
and costs with inner metropolitan 'working-week'
ED LAP attendance rates and costs, when GP
services are maximally available.
Results: Working-week LAP attendances comprised
8.2% (95% CI, 8.0%?8.4%) of inner metropolitan
ED attendances. Excess weekend and
evening LAP attendances were estimated to comprise
16.5% (95%CI, 15.9%?17.0%) and 4.5%
(95%CI, 4.1%?4.9%) of outer and inner metropolitan
ED attendances respectively and totalled less
than 3.0% of ED costs.
Conclusions: Low acuity patients form a relatively
constant, inexpensive proportion of ED workloads.
After-hours GP LAP services are unlikely to
significantly reduce ED attendances or costs.
Impact on public hospitals if private health insurance rates in Victoria declined
Authors: Hanning Brian W T
Published: February 2010

The additional cost of treating acute care type
Victorian private patients as public patients in
Victorian public hospitals based on the current
public sector payment model and rates was
calculated, as was the loss of health fund income
to public hospitals. If all private cases became
public the net recurrent cost would be $1.05
billion assuming all patients were still treated. If
private health insurance (PHI) uptake had
declined to 23.3% as was projected without
Lifetime Health Cover and the 30% rebate, the
additional operating cost and income loss would
be $385 million. This compares to the Victorian
cost of the 30% rebate for acute hospital cases of
$383 million. This takes no account of capital
costs and possible public sector access problems.
The analysis suggests that 31 extra operating
theatres would be needed in the public sector
(had the transfer of surgical patients from the
public sector to the private sector not occurred).
This analysis suggests that without the PHI
rebate the current stresses on Victorian public
hospitals would be increased, not decreased.
Generic drugs: international trends and policy developments in Australia
Authors: Lofgren Hans
Published: February 2010

Public and private third-party payers in many countries encourage or mandate the use of generic drugs. This articleexamines the development of generics policy in Australia, against the background of a description of internationaltrends in this area, and related experiences of reference pricing programs. The Australian generics market remainsunderdeveloped due to a historical legacy of small Pharmaceutical Benefits Scheme price differentials betweenoriginator brands and generics. It is argued that policy measures open to the Australian government can be conceivedas clustering around two different approaches: incremental changes within the existing regulatory framework, or a shifttowards a high volume/low price role of generics which would speed up the delivery of substantial cost savings, andcould provide enhanced scope for the financing of new, patented drugs.
Rethinking midwifery refresher programs as a recruitment strategy
Authors: Flowers Karen , Carter Amanda
Published: February 2010

This paper presents a case study on an innovative Midwifery Refresher Program in the context of current midwiferyworkforce issues. The refresher program was developed specifically as a recruitment strategy to address a staffing crisisat the Mater Misericordiae Mothers' Hospital, a busy tertiary maternity hospital in Brisbane, Australia. Features ofthe program that contributed to its success include collaboration with an industry partner, high levels of clinicalsupport for participants, flexibility for women with family responsibilities and low financial costs for all stakeholders.This type of recruitment strategy may be useful for health care services experiencing staff shortages.
The 'right story' to the 'right person': communication issues in end-of-life care for Indigenous people
Authors: McGrath Pam , Ogilvie Katherine F , Rayner Robert D , Holewa Hamish F , Patton Mary Anne S
Published: February 2010

Objectives: To explore communication issues
faced by health care workers and Indigenous
patients and their families in a palliative care
setting. Effective communication with Aborigines
is especially important because Aboriginal beliefs
of health and sickness are so different from Western
views.
Method: Data were collected from 72 qualitative
interviews conducted throughout the regional,
rural and remote areas of the Northern Territory
with Indigenous patients and carers and the
health professionals who care for them.
Results: Participants highlighted the struggle
associated with effective communication when
working in a cross-cultural setting at the interface
of Indigenous and Western health care. The findings
record the wisdom and insight from practitioners
who have extensive experience dealing
with communication difficulties.
An integrated service network in maternity— the implementation of a midwifery-led unit
Authors: Tracy Sally K , Hartz Donna , Nicholl Michael , McCann Yvonne , Latta Deborah
Published: February 2010

Maternity services in Australia are in urgent need of
change. During the last 10 years several reviews
have highlighted the need to provide more continuity
of care for women in conjunction with the rationalisation
of services. One solution may lie in the
development of new integrated systems of care
where primary-level maternity units offer midwiferyled
care and women are transferred into perinatal
centres to access tertiary-level obstetric technology
and staff when required.
This case study outlines the introduction of
caseload midwifery into an Area Health Service in
metropolitan Sydney. Our objective is to explore the
concept of caseload midwifery and the process of
implementing the first midwifery-led unit in NSW
within an integrated service network. The midwifeled
unit is a small but growing phenomenon in many
countries.1 However, the provision of ?continuity?
and ?woman-centred? midwifery care involves radical changes to conventional hospital practice.
Scheduling unplanned surgery: a tool for improving dialogue about queue position on emergency theatre lists
Authors: Fitzgerald Janna , Lum Martin , Dadich Ann
Published: February 2010

Theatre use is heavily influenced by the presentation
and scheduling of emergency cases for unplanned
surgery. This research guided the development of a
triage standard for scheduling emergency surgery in
New South Wales public hospitals and aimed to
contribute to a better understanding of decisionmaking
practices.
An emergency-surgery survey asked questions
about urgency of a set of clinical conditions and
appropriate time frames for patients to receive surgical
treatment for these conditions. Surveys were
distributed via 71 NSW public hospitals. A total of
198 decision makers responded: surgeons (42.8%),
anaesthetists (24.7%), and nurses (32.5%). Principal
component analysis was applied to reduce the
data to three urgency classifications, and analysis of
variance was used to assess variance of opinions
between professional groups. The data suggested
that the parameters that distinguish the codes (1,
very urgent; 2, semi-urgent; 3, least urgent) were not
unequivocally apparent. Although there was a consistent
approach to the ?urgency 1? and ?urgency 3?
categories, there were significant differences
between responses when determining ?urgency 2?.
The data indicated that when making decisions,
anaesthetists act as intermediaries between surgeons
and nurses. There was significant disparity
between individuals when respondents were
asked to state an ideal time for the commencement
of surgery and the maximum length of time
that the surgery could wait. This presented a need
for a risk assessment tool to be incorporated when
developing a dynamic prototype triage instrument.
Models of psychological service provision under Australia's Better Outcomes in Mental Health Care program
Authors: Pirkis Jane , Burgess Philip , Kohn Fay , Morley Belinda , Blashki Grant , Naccarella Lucio
Published: February 2010

The Access to Allied Psychological Services component
of Australia?s Better Outcomes in Mental
Health Care program enables eligible general
practitioners to refer consumers to allied health
professionals for affordable, evidence-based mental
health care, via 108 projects conducted by
Divisions of General Practice. The current study
profiled the models of service delivery across
these projects, and examined whether particular
models were associated with differential levels of
access to services. We found:
� 76% of projects were retaining their allied
health professionals under contract, 28% via
direct employment, and 7% some other way;
� Allied health professionals were providing
services from GPs? rooms in 63% of projects,
from their own rooms in 63%, from a third
location in 42%; and
� The referral mechanism of choice was direct
referral in 51% of projects, a voucher system in
27%, a brokerage system in 24%, and a
register system in 25%.
Many of these models were being used in combination.
No model was predictive of differential
levels of access, suggesting that the approach of
adapting models to the local context is proving
successful.