bluuebunny/crossref_metadata_2025 huggingface dataset:
PBS copayments and safety nets - A commentary on Sweeny and Doran and Robertson
Authors: Lopert Ruth
Published: February 2010

IN ANY DISCUSSION of key pharmaceutical policy
issues, Australia?s National Medicines Policy
(NMP) is an important touchstone of which
Australians can be justly proud. Those familiar
with the stalled evolution of the Canadian
National Pharmaceuticals Strategy and the uneven
provincial patchwork of pharmaceutical coverage
in Canada for example, may wonder why it is that
a country with longstanding universal health care
has neither universal coverage of medicines nor a
cohesive national policy framework like Australia?s
NMP.
One of the fundamental objectives of the NMP
is to deliver ?timely access to the medicines that
Australians need, at a cost individuals and the
community can afford?. It also says that ?cost
should not constitute a substantial barrier to
people?s access to medicines they need? and that
while ?. . . the Pharmaceutical Benefits Scheme
(PBS) facilitates access to certain prescribed medicines
by subsidising costs . . . (S)uch subsidies
are not costless, and the community as a whole
must bear them?. Importantly it also says that ?. . .
access to medicines should support the rational
use of those medicines?.
Discharge delay in acute care: reasons and determinants of delay in general ward patients
Authors: Ou Lixin , Young Lis , Chen Jack , Santiano Nancy , Baramy La-Stacey , Hillman Ken
Published: February 2010

To identify the reasons and determinants of discharge
delay in acute care patients, information
associated with delayed discharge was extracted
from the medical record of 1958 patients in a
tertiary referral hospital in New South Wales. A
logistic regression model was used to examine the
association between demographic factors and
reasons for discharge delay. Delayed discharge
was most commonly associated with the patient?s
medical conditions, delayed health care or medical
consultation, delayed diagnostic services and
delayed allied health services. Elderly patients,
those living alone and patients from a non-English-
speaking background were more likely to
have these reasons for delayed discharge.
Book review: Enhancing patient care: a practical guide to improving quality and safety in hospitals
Authors: Day Gary
Published: February 2010

WHAT AN INTERESTING, topical and refreshing
text on patient safety and quality! As the name of
the book implies, this is a practical text that takes
the reader systematically through the concepts,
practices and pitfalls of implementing a hospitalbased
patient safety and quality program.
The pleasing aspect of this book is that is
written from the perspective of implementing a
safety and quality program in an Australian health
service. The authors are hands-on clinicians who
have written this book like a personal quality
journey. This approach has been very effective in
presenting the reader with practical applications,
approaches and challenges in developing programs
that enhance patient care.
This offering fills an important gap in the
market. There are many texts that approach
quality, safety and risk management from a theoretical
or quantitative perspective. This book
takes the available research and theory and illustrates
how a health service can harness the available
literature to develop a working guide to
improving patient services.
The chapter that
provided very
straightforward explanations
of a range of
change, motivation
and social interaction
theories particularly
impressed me. One of
the real revelations
was the chapter that
covered eighteen
practical steps for
implementing a clinical
risk management program in a health service.
This chapter goes to the heart of why this text is
particularly useful.
I found the book extremely useful as it provides
a great framework for those wanting to start or
enhance their hospital-based quality improvement
and safety program. The book is well set
out, easy to read and provides a wealth of examples
of forms, audits and other quality tools ?
and at $49.95, this local text is also excellent
value for money.
Anger and depression predict hospital use among chronic heart failure patients
Authors: Jenner Roslyn C , Schweitzer Robert D , Strodl Esben S
Published: February 2010

Costly hospital readmissions among chronic heart failure (CHF) patients are expected to increase dramatically with the ageing population. This study investigated the prognostic ability of depression, anger and anxiety, prospectively, and after adjusting for illness severity, on the number of readmissions to hospital and the total length of stay over one year. Participants comprised 175 inpatients with CHF. Depression, anger, anxiety, and illness severity were measured at baseline. One year later, the number of readmissions and length of stay for each patient were obtained from medical records. Depression and anger play a detrimental role in the health profile of CHF patients.
The distribution of health services for older people in Australia: where does transition care fit?
Authors: Giles Lynne C , Halbert Julie A , Crotty Maria , Cameron Ian D , Gray Len C
Published: February 2010

Introduction:

The purpose of this study was to describe the distribution of hospital and aged care services for older people, with a particular focus on transition care places, across Australia and to determine the relationships between the provision of these services.
Methods:

Aggregation of health and aged care service indicators by Aged Care Assessment Team (ACAT) region including: public and private acute and subacute (rehabilitation and geriatric evaluation and management) hospital beds, flexible and mainstream aged care places as at 30 June 2006.
Results:

There was marked variation in the distribution of acute and subacute hospital beds among the 79 ACAT regions. Aged care places were more evenly distributed. However, the distribution of transition care places was uneven. Rural areas had poorer provision of all beds. There was no evidence of coordination in the allocation of hospital and aged care services between the Commonwealth and state/territory governments. There was a weak relationship between the allocation of transition care places and the distribution of health and aged care services.
Discussion:

Overall, the distribution of services available to older persons is uneven across Australia. While the Transition Care Program is flexible and is providing rural communities with access to rehabilitation, it will not be adequate to address the increasing needs associated with the ageing of the Australian population. An integrated national plan for aged care and rehabilitation services should be considered.
Insights from the Northern Territory on factors that facilitate effective palliative care for Aboriginal peoples
Authors: Phillips Emma L , McGrath Pam D
Published: February 2010

This article aims to assist remote communities to develop their own palliative care services by providing findings on successful strategies identified through a 2-year research project which developed an innovative model for Indigenous palliative care. The discussion is set in the context of an understanding of the notion of cultural safety and discusses the positive experiences of the benefits of palliative care from the perspectives of both consumers and health professionals. The findings show that successful outcomes are derived from generic factors associated with palliative care philosophy and practice and from more specific factors, including the provision of pragmatic support to overcome practical problems, and community visits by health professionals. Factors specific to cultural respect are important, including familiarity and continuity of health care providers, cultural respect for grieving practices, provision of comfort food and bush tucker, development of culturally appropriate built environments, use of traditional healers and respect for spiritual practices.
Delirium in the elderly. A survey of environmental policies and procedures in Melbourne hospitals
Authors: Watson Rosie , LoGiudice Dina C , Watson Ray , Brand Caroline A
Published: February 2010

This study aimed to review the presence of policies for management of behavioural symptoms and physical restraints, the availability of delirium management protocols and educational programs, and accessibility of a physical environment appropriate for the management of delirium in Melbourne hospitals. A structured survey tool was developed, and 70 Melbourne hospitals were surveyed seeking responses from a senior member of the nursing staff. Overall, 90% of Melbourne hospitals responded to the survey. It was found that smaller hospitals have fewer policies relating to the management of behavioural symptoms, and fewer delirium management protocols. Some education is available for nursing staff; however, less for the night staff, who often manage behavioural symptoms associated with delirium. Physical restraint policies exist at most hospitals. Single rooms and night lights are generally available, but low-low beds and orientation devices are relatively uncommon.
A proposal for managed care payment options for patients with chronic conditions
Authors: Jackson Terri
Published: February 2010

This paper proposes an episode of care payment system for patients with chronicillnesses, extending earlier published work on this model of ambulatory care (Duckett& Jackson 1993). The payment system relies on annual voluntary enrolment andsome marginal broadening of Medicare coverage in exchange for patients? willingnessto participate in an ambulatory managed care arrangement. In the context ofAustralian health ministers? enthusiasm for managed care, the proposal embodiesan intermediate policy approach which supports greater health care efficiency whileminimising the prospect for reductions in patient autonomy or serious distortionsin patterns of care. The policy is not designed to be applied population-wide, butto address the issues involved with a resource-intensive patient group, those requiringongoing management of chronic conditions.
Does the NAIP classification predict length of stay in rehabilitation,geriatrics and palliative care?
Authors: Lee Lynette , Kennedy Carmel , Aitken Jane
Published: February 2010

The Australian National Non-Acute Inpatient Project (NAIP) reported its findingson casemix in rehabilitation and slow stream geriatric medicine in October 1992.It proposed a per diem NAIP classification of 19 classes using six major clinicalgroups and the resource utilisation groups version three activities of daily living index(RUG III ADL index). Weightings were determined based on time spent by clinicalstaff in treating these patients.A quality management study was undertaken in the rehabilitation, geriatrics andpalliative care wards of the Illawarra Area Health Service for three months in 1993,analysing length of stay and cost against the predictive weights of the NAIP classification.The study concluded that this classification was an acceptable predictor of per diem costsof care in these wards of the Illawarra but was not a good predictor of length of stay.
Waiting times: The search for equitable solutions
Authors: Pearson Kate , Meyer Helen
Published: February 2010

For the survival of any health care organisation, evidence-based practice isfundamental, particularly in today?s economic climate. The Mater MisericordiaeAdult Public Hospital in Brisbane is committed to providing a flexible health caresystem that is responsive and accountable to the needs of the customers. As part of theMater?s continuous quality improvement program, a Continuum of Care ServiceDelivery Model was developed. This model comprises many innovative clinicalmanagement systems which have evolved over recent years. Clinical pathways, caremanagement, pre-admission clinics, variance management and evidence-basedpractice are core components of the model.
Matching needs to services:The quick response
Authors: O'Grady Sharyn , Fairbrother Greg
Published: February 2010

A Quick Response Program (QRP) was developed and implemented at St GeorgeHospital during 1995 and 1996. The program sought to improve the service providedto elderly people presenting to the emergency department by offering a new rapidresponse service pathway to community-based care. Emergency department dischargeplanning and crisis intervention evolved as important QRP functions during theprogram?s life. Evaluation findings indicated that QRP penetration into the elderlysub-acute emergency department patient population was high, and that hospitaladmissions were avoided without affecting emergency department process times.Health outcomes were not compromised by the program, and patient and generalpractitioner satisfaction were high. The program grappled with the inherent conflictof interest between the aims of the hospital (acute care services) and those of thecommunity service (support and maintenance). The program sought to bridge the gapbetween these service parameters in the name of meeting patient needs.
The Australian Cancer Network ?A strategy to improve cancer health outcomes
Authors: Kober Thilo
Published: February 2010

Cancer control in Australia has become a major social priority because of theincreasing impact of cancer on providers and users of health care. In recognition ofthis situation there is now an increased response by government agencies, non-governmentorganisations, health planners and the community at large to focus oncancer as part of a National Health Goals and Targets Strategy for better healthoutcomes in the next century. The following paper explores how the AustralianCancer Network effectively contributes to a national cancer control strategy.
Turning around patient complaints in a regional hospital
Authors: Douglas David , Harrison Robyn D
Published: February 2010

This paper describes the introduction by a regional general hospital of a differentsystem for handling complaints from patients. It outlines the underlying philosophyof the new system and the experiences of the hospital as the new system matured. Thepaper provides data for the first six quarters of operation of the system.
Problems in counting and paying for multidisciplinary outpatient clinics
Authors: Jackson Terri , Sevil Petia
Published: February 2010

Policy-makers have always found it problematic to formulate fair and consistentcounting rules for public hospital outpatient activities. In the context of output-based funding, such rules have consequences which can affect patient care. This paper reviews the rationale for organising multidisciplinary clinics and reports on a series of focus groups convened in four Melbourne teaching hospitals to consider funding policy for such clinics. It discusses issues of targeting outpatient services, along with implications for payment policy. It evaluates counting rules in terms of intended andunintended consequences in the context of Victoria?s introduction of output-basedfunding for outpatient services.
Managing potentially ischaemic chestpain and coronary care beds effectively
Authors: Edmonds Elizabeth , Kelly Anne-Maree
Published: February 2010

One of the most common reasons why patients attend emergency departments inAustralia is chest pain that is potentially due to coronary artery disease (myocardialinfarction, unstable or stable angina pectoris). A number of models for theinvestigation and treatment of these patients have been employed over the last fiveto ten years. This paper describes the evolution of a model for managing ischaemicchest pain that aims to avoid potentially preventable deaths from undiagnosedmyocardial infarction, to admit to hospital patients who could benefit from inpatienttreatment, to admit to a coronary care unit patients at significant risk ofcomplications, and to avoid inter-hospital transfer of patients. Introduction of themodel has led to an increase in the appropriate hospital admission of patients withischaemic chest pain, a marked reduction in inter-hospital transfers, and betterutilisation of coronary care beds. Unmonitored, general ward management of low riskpatients with clinical unstable angina has not resulted in compromised outcomes.
Total quality management in accredited New South Wales hospitals: A public/private comparison
Authors: Bartlett Mark , Hatcher Deborah , Johnson Amanda
Published: February 2010

Analysis of data collected in a 1994?95 survey of accredited New South Waleshospitals examined the adoption of key elements of total quality management practicein the public and private sectors. In a number of areas of practice widely consideredto be central to a hospital?s total quality management efforts, there was no statisticallysignificant difference between the two sectors. Where differences existed, total qualitymanagement practices more likely to be adopted by public hospitals were limited intheir scope and likely to be explained by structural peculiarities. In contrast, privatehospitals were more likely to adopt practices more critical to the successfulimplementation of total quality management.
Benchmarking in health care: A review of the literature
Authors: Higgins Isabel
Published: February 2010

This paper provides a review of the 10 significant publications related tobenchmarking in health care. The discussion which follows is presented according tofour headings: what the study did, how the study was conducted, what was learntfrom the experience, and what the implications were for health care generally. Thefindings of this review are reassuring in that all studies provided valuable information,in terms of clinical practice and the health care service or the benchmarking process.They highlight the importance of the maintenance of quality health care, thereduction of health care costs and the need for improved efficiency and effectivenessin providing health care.
Impact of a management assessment centre in developing proficient health managers
Authors: Hartley Ross , Garrett Wendy
Published: February 2010

There is growing use of management assessment centres within parts of New SouthWales Health. The present study examined outcome benefits from managers whoparticipated in the Australasian Management Competencies Assessment Centre R , some123 staff from one rural and one metropolitan area health service. Results confirmedgreater use of personal development plans and increased attendance at continuingprofessional development among participants compared with like managers who hadnot participated. The paper argues strongly in favour of widespread use ofmanagement competencies assessment centres as a way to implement planned culturalchange.
Strategic planning in hospitals in two Australian States: An exploratory study of its practice using planning documentation
Authors: Jayasuriya Rohan , Sim A B
Published: February 2010

Hospitals are under pressure to respond to new challenges and competition. Manyhospitals have used strategic planning to respond to these environmental changes. Thisexploratory study examines the extent of strategic planning in hospitals in twoAustralian States, New South Wales and Victoria, using a sample survey. Based onplanning documentation, the study indicated that 47% of the hospitals surveyed didnot have a strategic or business plan. A significant difference was found in thecomprehensiveness of the plans between the two States. Plans from Victorian hospitalshad more documented evidence of external/internal analysis, competitor orientation and customer orientation compared with plans from New South Wales hospitals. The paper discusses the limitations of the study and directions for future research.
Funding arrangements for telehealth: Encouraging efficiency rather than proliferation
Authors: Viney Rosalie , Haas Marion
Published: February 2010

The use of telehealth as a basis for delivering health services is growing acrossAustralia, and there is clear potential for these technologies to address some of the enduring issues of access and costs of service delivery. However,appropriate incentives must be created to encourage clinicians and managers to evaluate the true opportunity costs and benefits of delivering services in this way against the relevant alternative.This paper examines how different funding arrangements might encourage or discourage efficient use of telehealth.
Leadership in health: Effecting change
Authors: Nelson Brendan
Published: February 2010

The following article is an edited version of a paper presented to the joint AustralianPrivate Hospitals Association and Australian Healthcare Association Conference,?Caring with Skill?, held at Southport, Queensland, on 7?8 April 1998.
A review of hospital medical record audits: Implications for funding and training
Authors: Stevens Suzanne , Elizabeth Unwin C , Philip Codde James
Published: February 2010

As new methods of electronic data storage and distribution appear in hospitals, newchallenges in protecting confidentiality have emerged. At the same time, demands for?seamless? care and the desire to share information between clinicians are motivatinghospitals to relax barriers to the transfer of patient information.Increasing numbers of users at multiple sites compound the difficulty of ensuringinformation systems security. Hospital policy may demand that requests by patientsto restrict the distribution of personal information be respected, while existingelectronic systems are not able to deliver on this promise.Compliance with the Information Privacy Principles of the Commonwealth PrivacyAct 1988 and the Australian Standard 4400?1995 ?Personal privacy protection inhealth care information systems? will provide a useful framework for managing these challenges. However, their implementation will require some forethought.
Community Parenteral Therapy Project: A pilot study
Authors: Foster Lynelle , McMurray Anne
Published: February 2010

The pilot study reported in this paper was devised to develop and compare servicedelivery models that would achieve the provision of high quality parenteral therapycare to patients in the Gold Coast District Health Service community. All data werecollected on 113 patients for a 12-month period, January to December 1996. Thestudy compared the provision of outreach nursing services and contracted nursingservices on measures of satisfaction and cost.The study showed that patient and carers indicated a preference for community care,medical officers advocated the benefits of administering parenteral therapies in thecommunity, general practitioners were interested in managing future communityparenteral therapies, and contracted (nurse) service providers endorsed the developmentof a parenteral therapy resource centre. The findings also revealed considerablepotential cost savings in community-based care.
Developing a funding model for an after-hours primary medical care service in a rural town
Authors: O'Meara Peter , Hall Robert H , Strasser Roger
Published: February 2010

The study described in this paper aimed to determine a funding model for an after-hoursprimary medical care service in the rural town of Moe, a socioeconomicallydisadvantaged area of Victoria suffering the rigours of industry restructuring andprivatisation. It has 12.5 equivalent full-time general practitioners servicing 21- 966persons.A break-even analysis of the financial viability compared the expected costs ofproviding the service with the anticipated income. A mixed funding model isrecommended. This would incorporate a general practitioner incentive scheme andState Government underwriting of infrastructure and basic non-medical staffing costsduring the business development phase to supplement the income from the HealthInsurance Commission.
Acute hospital medical staffing during the night shift
Authors: Hillman Ken , Beehan Sean
Published: February 2010

There has been little or no attempt to define the need for 24-hour medical cover, norits appropriateness in acute hospitals, despite the great cost implications and thequestion of the quality of that care. This study examined the medical activity duringthe ?night shift? in an acute hospital. There were an average of 2.59 calls per night,most from the emergency department (247/475) and general wards (108/475). Manycalls were related to active resuscitation (88/475) and immediate treatment (83/475).Over 40% (81/286) of patients had to be transferred to a higher level of care, suchas an intensive care unit within the hospital. By collecting data on the demands ofhealth care during what amounts to over a third of the hospital?s time, it wasestablished that a high level of medical care was required. Appropriate levels ofstaffing, using junior doctors trained in acute medicine, was able to be provided tomatch need as determined by these data, and extra staff at higher costs were avoided.
Applying a health outcomes approaching a health service unit
Authors: Rissel Chris , Holt Phoebe , Ward Jeanette
Published: February 2010

An explicit focus on health outcomes has the potential to improve health if appliedat the local level. However, clinical services require clear and practical support in themeasurement and analysis of health outcome indicators. This paper suggests 12 stepsfor departments or services to take in promoting an outcomes orientation, based onour experiences in the Central Sydney Area Health Service. These include determiningcommitment at the service level, setting up a working group, specifying serviceconsumers, their health problems and intervention processes, specifying desired healthchanges, consulting the literature and peers, identifying existing resources, pilot-testingand refining outcome measures, collecting data and responding to sub-optimal resultswith evidence-based interventions. The paper also reviews common criticisms of thehealth outcomes approach and key issues which have arisen in the course of applyingthese steps at the local level.
Making sense of integrated care in New Zealand
Authors: Davies Philip
Published: February 2010

Integrated care is becoming a significant feature of New Zealand's current health system.Initiatives to date focus on service coordination or devolution of purchasing, which may be viewed as complementary approaches aimed at meeting a common goal of improving services.They are, however, likely to yield different benefits and pose different risks. This article outlines the background to current integrated care developments in New Zealand and offers a conceptual framework for distinguishing the approaches adopted. It also discusses a number of practical issues that will need to be addressed as such initiatives evolve, and considers some of the factors that need to be taken into account when considering where health care purchasing decisions are best made.
Privatising general practice in Mongolia: A trial of needs-adjusted capitation
Authors: Hindle Don , O'Rourke Michael , Batsuury Ravjir , Orgil Bunijav
Published: February 2010

Mongolia's family doctors have long been salaried government employees. The crisis caused by the break-up of the Soviet Bloc required the government to seek a balance between command and market economies, and this influenced the decision to introduce capitated private practice for family doctor services on a trial basis. This article explains why and how a risk-adjusted capitation model was developed by a blend of empirical analysis and expert judgement, which comprises ten classes of clients defined by age-sex and poverty groupings. Payment relativities across the classes were set in proportion to a desirable (or target) number of contacts per year. Separate processes were used to set the targets for patient-initiated and active (health promotion and illness prevention) contacts.The model is intended to lead to greater equity of service access and provision. It should also encourage a greater concern for health outcomes, sensitivity to clients' views, and operational efficiency.
When knowing the answer is only half the solution: Introducing changes to a mental health rehabilitation service
Authors: Tobin Margaret , Aldridge Greg , Chen Luxin
Published: February 2010

An Action Research methodology was used to revise the St George Mental Health Rehabilitation Service. A review committee found several limitations in the existing system, and a new model to address these problems was devised. During an 18-month period, the new model was implemented. Obstacles to change, such as staff resistance,were not systematically encountered due to the method of change used. The organisational changes that emerged concurrently improved the standard of service, raised staff morale, resulted in the routine use of standardised client outcome measures, enhanced the professional status of rehabilitation workers and led to empowerment of staff and consumers.
Unintended outcomes of health care delivery and the need for a national risk management approach
Authors: O'Donnell Carol
Published: February 2010

Unlike the situation in occupational health and safety, there is no nationally coordinated approach to risk management to prevent unintended outcomes of healthcare provision and improve health care quality. There is a related absence of linkages between quality assurance processes, other programs aimed at patient injury prevention and professional indemnity insurance systems. This article discusses the Australian health policy direction and argues for a coordinated national health risk management approach developed through contract requirements which include duty of care and information provision, nationally approved standards and codes, professional liability requirements, and supporting health education, research and information technology development.
The effects of income inequality on health
Authors: Lawrence Carmen
Published: February 2010

Much of the discussion about individual and group differences in illness and life expectancy has focused on the effects of individual characteristics, both status and behavioural. This is also characteristic of much of the literature, which attempts to explain why men have higher rates of disease and lower life expectancy than women.After a period in which 'social policy was no longer such an important part of preventive health policy', there is now renewed interest in the influence of the socioeconomic environment on health. Indeed, recently compiled evidence indicates that increasing income inequality is likely to have adverse effects on the community's health. These findings highlight the potential dangers of policy changes which accelerate social and economic divisions.
Public health funding mechanisms in New Zealand [Commentary by Rosalie Viney, pp. 115–117]
Authors: Durham Gillian , Kill Bette
Published: February 2010

The funding of population-based public health services (health protection, health promotionand disease prevention) has received little attention in the international literature on healthreforms, and yet these services are of fundamental importance to the health of populationsand to the economy. This article provides justification for health policy-makers placing moreemphasis on the level of public health funding compared with funding on personal healthservices, and accountability arrangements for its expenditure, when considering options toimprove the performance of their health sectors. The New Zealand experience of fundingpublic health services is described within the context of the health reforms. The strengths andweaknesses of the adopted approach are analysed.
Managed competition:The policy context
Authors: Scotton Richard
Published: February 2010

In order to maintain universal access to medically effective care for all, costs must be contained at both the system-wide and micro levels. The managed competition model offers a framework within which increased efficiency could be pursued without sacrificing the goal of universal access and without impairing health outcomes and social cohesion. It would do this by removing structural impediments to rational decision-making and allocating to markets and governments the functions they perform best.
Application and comparison of two modelling techniques for hospital bed management
Authors: Mackay Mark , Millard Peter H
Published: February 2010

The use of the bed occupancy management and planning system (BOMPS) and the Sorensen multi-phased bed model were used to assess the implications of a hospital expanding its emergency facility. BOMPS flow modelling generates resource utilisation data dependent on the best visual and statistical fit between mixed exponential equations and time of bed occupancy; the Sorensen model creates models based on probabilities and length of stay distributions. Both models identified the presence of two streams of flow. However, there were differences in the number of beds identified as being short and longer stay. The advantage of flow modelling is that it enables decision-makers to pre-test their decisions.
The Australian National Sub-Acuteand Non-Acute Patient casemix classification
Authors: Eagar Kathy
Published: February 2010

The Australian National Sub-Acute and Non-Acute Patient (AN-SNAP) Version 1 casemix classification was completed in 1997. AN-SNAP is designed for the classification of sub-acute and non-acute care provided in both inpatient and ambulatory settings and is intended to be useful for both funding and clinical management purposes. The National Sub-Acute and Non-Acute Casemix Classification study has produced the first version of a national classification of sub-acute and non-acute care. Ongoing refinement (leading to Version 2)will be possible through further analysis of the existing data set in combination with analysis of the results of a carefully planned and phased implementation.
Atomic details of near-transition state conformers for enzyme phosphoryl transfer revealed by MgF3- rather than by phosphoranes
Authors: Baxter Nicola J. , Bowler Matthew W. , Alizadeh Tooba , Cliff Matthew J. , Hounslow Andrea M. , Wu Bin , Berkowitz David B. , Williams Nicholas H. , Blackburn G. Michael , Waltho Jonathan P.
Published: February 2010

Prior evidence supporting the direct observation of phosphorane intermediates in enzymatic phosphoryl transfer reactions was based on the interpretation of electron density corresponding to trigonal species bridging the donor and acceptor atoms. Close examination of the crystalline state of β-phosphoglucomutase, the archetypal phosphorane intermediate-containing enzyme, reveals that the trigonal species is not

PO
3
-

, but is

MgF
3
-

(trifluoromagnesate). Although

MgF
3
-

complexes are transition state analogues rather than phosphoryl group transfer reaction intermediates, the presence of fluorine nuclei in near-transition state conformations offers new opportunities to explore the nature of the interactions, in particular the independent measures of local electrostatic and hydrogen-bonding distributions using

F

19

NMR. Measurements on three

β
-
PGM
-

MgF
3
-

-sugar phosphate complexes show a remarkable relationship between NMR chemical shifts, primary isotope shifts, NOEs, cross hydrogen bond

F
⋯
H
-
N

scalar couplings, and the atomic positions determined from the high-resolution crystal structure of the

β
-
PGM
-

MgF
3
-

-
G
6
P

complex. The measurements provide independent validation of the structural and isoelectronic

MgF
3
-

model of near-transition state conformations.
A tableau approach of the KSS nest
Authors: Peng Wenjuan , Qiu Weiyuan , Roesch Pascale , Tan Lei , Yin Yongcheng
Published: February 2010

The KSS nest is a sophisticated choice of puzzle pieces given in [Ann. of Math. 165 (2007), 749–841]. This nest, once combined with the KL-Lemma, has proven to be a powerful machinery, leading to several important advancements in the field of holomorphic dynamics. We give here a presentation of the KSS nest in terms of tableau. This is an effective language invented by Branner and Hubbard to deal with the complexity of the dynamics of puzzle pieces. We show, in a typical situation, how to make the combination between the KSS nest and the KL-Lemma. One consequence of this is the recently proved Branner–Hubbard conjecture. Our estimates here can be used to give an alternative proof of the rigidity property.
CandiSNPer: a web tool for the identification of candidate SNPs for causal variants
Authors: Schmitt Armin O. , Aßmus Jens , Bortfeldt Ralf H. , Brockmann Gudrun A.
Published: February 2010

Summary: Human single nucleotide polymorphism (SNP) chips which are used in genome-wide association studies (GWAS) permit the genotyping of up to 4 million SNPs simultaneously. To date, about 1000 human SNPs have been identified as statistically significantly associated with a disease or another trait of interest. The identified SNP is not necessarily the causal variant, but it is rather in linkage disequilibrium (LD) with it. CandiSNPer is a software tool that determines the LD region around a significant SNP from a GWAS. It provides a list with functional annotation and LD values for the SNPs found in the LD region. This list contains not only the SNPs for which genotyping data are available, but all SNPs with rs-IDs, thus increasing the likelihood to include the causal variant. Furthermore, plots showing the LD values are generated. CandiSNPer facilitates the preselection of candidate SNPs for causal variants.

Availability and Implementation: The CandiSNPer server is freely available at http://www2.hu-berlin.de/wikizbnutztier/software/CandiSNPer. The source code is available to academic users ‘as is’ upon request. The web site is implemented in Perl and R and runs on an Apache server. The Ensembl database is queried for SNP data via Perl APIs.

Contact:  armin.schmitt@agrar.hu-berlin.de
Temporal and spatial patterns of sea lice levels on sea trout in western Scotland in relation to fish farm production cycles
Authors: Middlemas S. J. , Raffell J. A. , Hay D. W. , Hatton-Ellis M. , Armstrong J. D.
Published: February 2010

The relationship between aquaculture and infestations of sea lice on wild sea trout (
Salmo trutta
) populations is controversial. Although some authors have concluded that there is a link between aquaculture and lice burdens on wild fish, others have questioned this interpretation. Lice levels have been shown to be generally higher on Atlantic salmon farms during the second years of two-year production cycles. Here we investigate whether this pattern relates to lice burdens on wild fish across broad temporal and spatial axes. Within Loch Shieldaig across five successive farm cycles from 2000 to 2009, the percentage of sea trout with lice, and those above a critical level, were significantly higher in the second year of a two-year production cycle. These patterns were mirrored in 2002–2003 across the Scottish west coast. The results suggest a link between Atlantic salmon farms and sea lice burdens on sea trout in the west of Scotland.
Selection on innate immunity and body condition in Florida scrub-jays throughout an epidemic
Authors: Wilcoxen Travis E. , Boughton Raoul K. , Schoech Stephan J.
Published: February 2010

Opportunities to investigate selection in free-living species during a naturally occurring epidemic are rare; however, we assessed innate immunocompetence in Florida scrub-jays before the population suffered the greatest over-winter mortality in 20 years of study. Propitiously, three months prior to the epidemic, we had sampled a number of male breeders to evaluate a suite of physiological measures that are commonly used to estimate the overall health-state of an individual. There was a significant, positive selection gradient for both
Escherichia coli
bacterial killing capability and body condition, suggesting that directional selection had occurred upon each of these traits during the disease epidemic.
Anthropogenic noise affects risk assessment and attention: the distracted prey hypothesis
Authors: Chan Alvin Aaden Yim-Hol , Giraldo-Perez Paulina , Smith Sonja , Blumstein Daniel T.
Published: February 2010

Many studies have focused on the effects of anthropogenic noise on animal communication, but only a few have looked at its effect on other behavioural systems. We designed a playback experiment to test the effect of noise on predation risk assessment. We found that in response to boat motor playback, Caribbean hermit crabs (Coenobita clypeatus) allowed a simulated predator to approach closer before they hid. Two hypotheses may explain how boat noise affected risk assessment: it masked an approaching predator's sound; and/or it reallocated some of the crabs' finite attention, effectively distracting them, and thus preventing them from responding to an approaching threat. We found no support for the first hypothesis: a silent looming object still got closer during boat motor playbacks than during silence. However, we found support for the attentional hypothesis: when we added flashing lights to the boat motor noise to further distract the hermit crabs, we were able to approach the crabs more closely than with the noise alone. Anthropogenic sounds may thus distract prey and make them more vulnerable to predation.
Interactive effects of temporal correlations, spatial heterogeneity and dispersal on population persistence
Authors: Schreiber Sebastian J.
Published: February 2010

It is an ecological truism that population persistence depends on a population's growth rate when rare. To understand the interplay between temporal correlations, spatial heterogeneity and dispersal on persistence, an analytic approximation for this growth rate is derived for partially mixing populations. Partial mixing has two effects on population growth. In the absence of temporal correlations in relative fitness, greater movement to patches with, on average, higher relative fitness increases population growth rates. In the absence of spatial heterogeneity in the average relative fitnesses, lower dispersal rates enhance population growth when temporal autocorrelations of relative fitness within a patch exceed temporal cross-correlations in relative fitness between patches. This approximation implies that metapopulations whose expected fitness in every patch is less than 1 can persist if there are positive temporal autocorrelations in relative fitness, sufficiently weak spatial correlations and the population disperses at intermediate rates. It also implies that movement into lower quality habitats increases the population growth rate whenever the net temporal variation in
per capita
growth rates is sufficiently larger than the difference in the means of these
per capita
growth rates. Moreover, temporal autocorrelations, whether they be negative or positive, can enhance population growth for optimal dispersal strategies.
From spectral information to animal colour vision: experiments and concepts
Authors: Kelber Almut , Osorio Daniel
Published: February 2010

Many animals use the spectral distribution of light to guide behaviour, but whether they have colour vision has been debated for over a century. Our strong subjective experience of colour and the fact that human vision is the paradigm for colour science inevitably raises the question of how we compare with other species. This article outlines four grades of ‘colour vision’ that can be related to the behavioural uses of spectral information, and perhaps to the underlying mechanisms. In the first, even without an (image-forming) eye, simple organisms can compare photoreceptor signals to locate a desired light environment. At the next grade, chromatic mechanisms along with spatial vision guide innate preferences for objects such as food or mates; this is sometimes described as wavelength-specific behaviour. Here, we compare the capabilities of di- and trichromatic vision, and ask why some animals have more than three spectral types of receptors. Behaviours guided by innate preferences are then distinguished from a grade that allows learning, in part because the ability to learn an arbitrary colour is evidence for a neural representation of colour. The fourth grade concerns colour appearance rather than colour difference: for instance, the distinction between hue and saturation, and colour categorization. These higher-level phenomena are essential to human colour perception but poorly known in animals, and we suggest how they can be studied. Finally, we observe that awareness of colour and colour qualia cannot be easily tested in animals.
Rapid viability analysis for metapopulations in dynamic habitat networks
Authors: Drechsler Martin , Johst Karin
Published: February 2010

For land-use planning, numerically fast and easily applicable tools are urgently needed that allow us to assess how landscape structure and dynamics affect biodiversity. To date, such tools exist only for static landscapes. We provide an analytical formula for the mean lifetime of species in fragmented and dynamic habitat networks where habitat patches may be destroyed and created elsewhere. The formula is able to consider both patch size heterogeneity and dynamics additionally to patch number and connectivity. It is validated through comparison with a dynamic and spatially explicit simulation model. It can be used for the optimization of spatio-temporal land-use patterns in real landscapes and for advancing our general understanding of key processes affecting the survival of species in fragmented heterogeneous dynamic landscapes.
Energy and emission assessments of continuous descent approach
Authors: Turgut Enis T. , Usanmaz Oznur , Ozan Canarslanlar Ali , Sahin Ozlem
Published: February 2010

Purpose

Continuous descent approach (CDA) is a method, which allows the aircraft flying its individual optimal vertical profile down to runway threshold with engines operating at low‐thrust power. The main objective of this paper is to provide less‐fuel consumption, less noise and less emission with using CDA procedures instead of conventional procedures.

Design/methodology/approach

Conventional and CDA procedures were modelled in the Istanbul terminal area (TMA), which has five entry points. The real speed and the real altitude limitations were maintained on these entry points. System for Assessing Aviation's Global Emissions research results were also used to determine the emission savings.

Findings

With CDA procedures, more than 40 kg fuel and 2 min time savings per flight are obtained; furthermore, regarding CO2and H2O, significant emission savings are also noted.

Originality/value

Some of the benefits of CDA procedures are reported for Istanbul TMA by using true flight data.
Fruit and vegetable playing cards
Authors: Torkar Gregor , Pintarič Miša , Koch Verena
Published: February 2010

Purpose

The purpose of this paper is to measure the effectiveness of fruit and vegetable playing cards for teaching schoolchildren about fruits and vegetables, health, and nutrition.

Design/methodology/approach

The participants come from two primary schools in Slovenia: 53 boys and 57 girls. Their average age is 10 (8, 11). The pre‐intervention questioning is completed two or three days before and post‐intervention questioning is completed a week after playing the card game. The participating children answer ten multiple‐choice questions and one open‐ended question. Each participant plays the game for two 45‐min lessons. The main goal of the research is to measure changes in their knowledge about fruits and vegetables, health, and nutrition.

Findings

After the intervention more children understand why the human body needs dietary fiber, water, and vitamins. The majority of those questioned also understand why fruits and vegetables are important in nutrition. The children learn which fruits and vegetables contain the most vitamin A, vitamin C, vitamin E, dietary fiber, and water.

Originality/value

The evaluation of the fruit and vegetable playing cards demonstrates that this game helps teach children about the nutrients in fruits and vegetables and importance of fruits and vegetables in a healthy diet.