Australian Approach Research Articles

A question prompt list for patients with advanced cancer in the final year of life: Development and cross-cultural evaluation

Background: Clinicians and patients find prognosis and end-of-life care discussions challenging. Misunderstanding one’s prognosis can contribute to poor decision-making and end-of-life quality of life. A question prompt list (booklet of questions patients can ask clinicians) targeting these issues may help overcome communication barriers. None exists for end-of-life discussions outside the palliative care setting. Aim: To develop/pilot a question prompt list facilitating discussion/planning of end-of-life care for oncology patients with advanced cancer from Australia and the United States and to explore acceptability, perceived benefits/challenges of using the question prompt list, suggestions for improvements and the necessity of country-specific adaptations. Design: An expert panel developed a question prompt list targeting prognosis and end-of-life issues. Australian/US semi-structured interviews and one focus group elicited feedback about the question prompt list. Transcribed data were analysed using qualitative methods. Setting/participants: Thirty-four patients with advanced cancer (15 Australian/19 US) and 13 health professionals treating such patients (7 Australian/6 US) from two Australian and one US cancer centre participated. Results: Most endorsed the entire question prompt list, though a minority queried the utility/appropriateness of some questions. Analysis identified four global themes: (1) reinforcement of known benefits of question prompt lists, (2) appraisal of content and suggestions for further developments, (3) perceived benefits and challenges in using the question prompt list and (4) contrasts in Australian/US feedback. These contrasts necessitated distinct Australian/US final versions of the question prompt list. Conclusions: Participants endorsed the question prompt list as acceptable and useful. Feedback resulted in two distinct versions of the question prompt list, accommodating differences between Australian and US approaches to end-of-life discussions, highlighting the appropriateness of tailoring communication aides to individual populations.

Going Dutch? Comparing Approaches to Preventing Organised Crime in Australia and the Netherlands

This article contributes to the growing literature on organised crime prevention by examining the approaches of two countries, Australia and the Netherlands. In many respects these countries are similar. They also have many organised crime problems in common. But their responses to those problems have been quite distinct. The Dutch administrative approach has been hailed as both unique and successful, while the Australian approach, primarily a reactive criminal law-based response, has encountered a storm of criticism. The article compares the two approaches and addresses the questions of whether and what Australia should learn from the Dutch approach.

Toward A Population-Based Approach to End-Of-Life Care Surveillance in Canada: Initial Efforts and Lessons

This paper describes a project undertaken by the Hospice Palliative End-of-Life Care Surveillance Team Network--one of four Cancer Surveillance and Epidemiology Networks established by the Canadian Partnership Against Cancer in 2009 to create information products that can be used to inform cancer control. The project was designed to improve the quality and use of existing electronic patient databases in its member organizations. The project's intent was to better understand terminally ill cancer patients in their final year of life, with noncancer as comparison. The network created an early design for a Web-based end-of-life care surveillance system prototype. Using a flagging process, anonymized data sets on cancer/ noncancer palliative patients and those who died in 2008-2009 were extracted and analyzed. The Australian palliative approach was adapted as the conceptual model based on the data sets available. Common data elements were defined then mapped to local data sets to create a common data set. Information products were created as online reports. Throughout the project, members were engaged in knowledge translation. Overall, the project was well received by network members. There are still major data-quality and linkage issues that require further work.

Metastatic colorectal cancer (mCRC) with primary in situ: An Australian registry.

498 Background: The role of primary tumor resection in patients presenting with mCRC remains controversial. While recent data suggest resection of the primary tumor is unnecessary with modern systemic therapies, other series indicate that non-operative intervention may be associated with inferior survival outcomes. We aimed to evaluate the Australian approach to primary tumor resection in patients with mCRC and to explore its impact on survival outcomes. Methods: This study was conducted using a clinician-designed mCRC registry involving 15 participating Australian sites. Patients were excluded if planned for curative resection of metastatic disease or had incomplete data. Cox logistic regression analyses were used to identify and quantify associations between overall survival (OS) and patient/clinical variables. Results: We identified 533 mCRC patients with median follow up 12.5 mo. 41% (n=220) had their primary in-situ. Rates of primary tumor resection were higher in older patients (>70 yrs old) (64.5% vs 52.7%; p=0.006), colon versus rectal primaries (64.6% vs 42.7%; p<0.001) and those without liver metastases (70.7% vs 52.9%; p<0.001). Median OS was significantly better in patients undergoing primary tumor resection compared to the non-resected population (28.3 mo vs 15.9 mo; Hazard Ratio (HR): 0.52; log-rank p<0.001). Univariate analyses indicate that older age (HR: 1.69; p<0.001), poor performance status (HR: 4.44; p<0.001) and peritoneal involvement (HR: 1.94; p<0.001) were associated with poorer survival outcomes while chemotherapy administration (HR: 0.33; p<0.001) predicted improved survival. Multivariate analyses, when adjusted for known prognostic factors, confirms that primary tumor resection remains an independent predictor of better survival (HR: 0.50; p<0.001). Conclusions: The 41% of primary cancers in-situ is higher than previous mCRC studies and suggests a tendency for non-operative intervention in Australia. Given the survival outcomes demonstrated in this study, a review of Australian clinical practice is required. Future studies will examine the survival differences in patients with de novo versus relapsed metastatic disease, motivation for resection and other confounding variables.

Asian and Australian options: A common perspective

We show that Australian options are equivalent to fixed or floating strike Asian options and consequently that by studying Asian options from the Australian perspective and vice versa, much can be gained. One specific application of this “Australian approach” leads to a natural dimension reduction for the pricing PDE of Asian options, with or without stochastic volatility, featuring time independent coefficients. Another application lies in the improvement of Monte Carlo schemes, where the “Australian approach” results in a path-independent method. We also show how the Milevsky and Posner (1998) result on the reciprocal Γ-approximation for Asian options can be quickly obtained by using the connection to Australian options. Further, we present an analytical (exact) pricing formula for Australian options and adapt a result of Carr et al. (2008) to show that the price of an Australian call option is increasing in the volatility and by doing this answering a standing question by Moreno and Navas (2008).

The Solution to the Financial Literacy Problem: What is the Answer?

Over the last two decades the need for a financially literate population has grown in importance. Hence in Australia, it is imperative that individuals possess both the financial knowledge and capability to make sound financial decisions. In contrast, the results of the Australian & New Zealand Bank (ANZ) surveys from 2003 to 2010 have demonstrated that there is a substantial deficiency in the level of financial literacy amongst many of the Australian population. Both the government and the private sector have encouraged the development of financial education programs as an important tool in remedying the detected low levels of financial literacy as reported in the ANZ research. The Australian Security and Investment Commission (ASIC), the government regulator, has strongly promoted the need to develop confident and informed consumers and investors through the provision of quality financial education. ASIC’s focus was reiterated in its Report 229, the National Financial Literacy Strategy. This report which was announced in March 2011 set out the strategy for the development and delivery of initiatives to improve financial literacy levels in Australia (ASIC 2011). In particular, the National Strategy has been developed to improve the level of financial literacy among Australian students. The focus is on incorporating financial education through the existing school curriculum, beginning in kindergarten through to year 12 students. The aim of this research paper is to challenge and ask questions relating to the Australian Government’s financial literacy strategy directed at schools. This direction would appear to have limited support of success, given the evidence published in the USA, and to a limited extent in the United Kingdom and Europe. This study reviews the current evidence available in both Australia and the USA in relation to financial literacy projects in schools. In respect of the international experience this paper explores the possible reasons for their limited success, and in some cases failure, to deliver the desired outcomes. In Australia there has been no academic research as to the possible effectiveness of teaching financial literacy at a school level. Given the USA research into such initiatives, this paper seeks to question the policy direction of the government in Australia. This paper also challenges the validity of the current Australian approach. The emphasis placed upon school financial literacy programs defies the wealth of evidence overseas which has failed to identify any measurable improvement in financial knowledge, attitudes and behaviour as a result of embedding financial

Four Questions about the Australian Approach to Fair Dealing Defenses to Copyright Infringement

Focusing principally on the copyright law of Australia, this article aims to provide some further context for the dealing/fair use debate. The article raises four questions about the differences between the Australian and US approaches to permitted uses. These questions concern: implications of the differences in each nation's legislative drafting techniques; the significance of the relative paucity of case law in the Australian context; the relevance of other defenses; and the recent adoption in Australia of a new defense for fair dealing for the purposes of parody or satire. The article concludes by noting some of the private international law implications of the distinctions between dealing and use.

Between assimilation and multiculturalism: models of integration in Australia

ABSTRACT This paper outlines the ways in which the conception of social integration and its practical realization have developed over time in Australia, and the various pathways that models of integration have followed. It makes a distinction between the approaches to inclusion of the indigenous population, the Australian Aborigines in broader Australian social life and social institutions, and those dealing with populations of incoming migrants, refugees and asylum-seekers. Although there are similarities in the models of integration mobilized in both arenas, the differences and interactions are also significant and characteristic of what is specific about settler-colonial societies. The central models in both fields are assimilation, integration and multiculturalism, and the paper will sketch briefly how each model has operated both in theory and in practice, how they have succeeded and interacted with each other, how they have intersected with other types of concerns, such as citizenship, civilization and security, as well as what might be distinctive about the Australian approach to social integration in comparison with other countries.

Monism and Dualism – An Australian Perspective

This chapter will examine how Australia receives and approaches international law, and explore and assess Australia’s position within the schema of monist, dualist or a hybrid of both. This chapter will briefly examine the development of the Australian legal system, a common law system that developed as a result of Australia’s colonisation by the British in 1788. The chapter will then look at the Australian approach to and reception of international law, including the differing roles of the executive, judiciary and legislature. The chapter will examine how these branches of government have dealt with international law in treaty and customary form, and how the judiciary has negotiated and reconciled the complexities and ambiguities that arise out of the interaction between Australia’s international law obligations, and its domestic legal system. Finally, the chapter will then assess Australia’s relationship to international law within the monist-dualist dynamic.

Comparison of Australian and American orthodontic clinical approaches towards root resorption

Abstract Aims: As part of The Rocky Mountain Travelling Fellowship, a pilot survey was conducted to assess current diagnostic and clinical approaches to the management of orthodontic patients in relation to root resorption. Methods: Groups comprising Australians (Sydney, New South Wales) and North Americans (Los Angeles, California), in two stages of their orthodontic careers (post-graduate orthodontic students from the University of Sydney and University of Southern California and qualified practising orthodontists) were asked to complete a questionnaire. The questions examined diagnosis and management approaches related to root resorption used in their clinical practice. Results: Replies demonstrated that there were differences in management depending on operator experience and the country of clinical practice. However, a summarised common approach to orthodontic root resorption comprised (1) the use of an orthopantomogram as a screening diagnostic tool, followed by periapical radiographs for those perceived as ‘higher risk’ patients, particularly individuals with a history of root resorption; (2) a six monthly radiographic review during treatment; (3) the use of light forces and/or rest periods (discontinuous forces) every two to three months; (4) the extraction of deciduous teeth if permanent successors were erupting ectopically and causing damage to adjacent root structures; and (5) the use of fixed retention after treatment. Conclusion: This project was intended to initiate discussion and form a basis for further investigation into the clinical management of orthodontic root resorption.

PHP188 Funding the Unfundable: The Australian Approach for Specialty Pharmaceuticals

PHP188 Funding the Unfundable: The Australian Approach for Specialty Pharmaceuticals

Tax Deductibility of Cross-Border Giving: Australia Gives No Quarter

Australia’s tax law concerning deductibility of gifts to charities imposes one of the highest barriers to cross-border philanthropy in the world. All countries impose some restrictions on tax concessions for foreign donations or activities of charities. However, Australia’s approach is strict compared with the approach of many other countries especially in the European Union. A Bill currently before the Parliament will codify and tighten the existing restrictions. This Working Paper applies Australian tax law to a Case Study prepared for the International Fiscal Association 66th Congress, Boston, 2012 and considers the policy for the strict Australian approach.

The political response to rural social and economic sustainability: A cross-national study of Thai and Australian rural policy, 1997–2007

This article provides a cross-national examination of Thai and Australian political responses to rural social and economic inequity during the period 1997–2007 using an historical lens. It highlights different policy approaches and their philosophical underpinnings. Both the National Party and Thai Rak Thai Party shared similar policy positions. Village funds and rural community development programmes were aimed at providing capital to encourage the establishment of new enterprises or partnerships in building infrastructure. In some respects they were compensationary for changes in global agricultural commodity trading conditions and an acknowledgement that markets fail producers in the rural sector. The contrast between Thai and Australian approaches to rural policy is in the philosophy of ‘Sufficiency Economy’. A philosophy rejected by the Thai Rak Thai Party, Sufficiency Economy, was essentially building upon long held peasant traditions.

Open Justice: Concepts and Judicial Approaches

Recent years have seen an increase in the number and scope of non-publication orders and other limits on open justice, an increase in the number of statutes that regulate or threaten open justice and the articulation of an Australian constitutional principle (of institutional integrity) that has the potential to protect some aspects of open justice. The purposes and values of open justice are, however, rarely examined in a comprehensive or theoretically-informed manner. This article provides a theory of open justice which accounts for its heterogeneous nature. Australian judicial approaches to the substance, limits and constitutional dimensions of open justice are analysed in light of the purposes and values of open justice, and a comparison with the much more coherent Canadian approach is supplied. The author concludes that threats to open justice are best managed by an analytical framework which systematically identifies both the benefits of open justice and the countervailing values that are at stake in a given case, and which seeks to provide maximum protection to all of these values on a case-by-case basis.

Open Justice: Concepts and Judicial Approaches

Recent years have seen an increase in the number and scope of non-publication orders and other limits on open justice, an increase in the number of statutes that regulate or threaten open justice, and the articulation of an Australian constitutional principle (of institutional integrity) that has the potential to protect some aspects of open justice. The purposes and values of open justice are, however, rarely examined in a comprehensive or theoretically-informed manner. This article provides a theory of open justice which accounts for its heterogeneous nature. Australian judicial approaches to the substance, limits, and constitutional dimensions of open justice are analyzed in light of the purposes and values of open justice; and a comparison with the much more coherent Canadian approach is supplied. The author concludes that threats to open justice are best managed by an analytical framework which systematically identifies both the benefits of open justice and the countervailing values that are at stake in a given case, and which seeks to provide maximum protection to all of these values on a case-by-case basis.

Health in All Policies: Evaluating the South Australian Approach to Intersectoral Action for Health

Health in All Policies: Evaluating the South Australian Approach to Intersectoral Action for Health

Horton's lesson: Australia's struggle with ‘truth in drafting’

The Federal Court of Australia has ruled that the Australian GST legislation was ‘drafted in a way which in many respects differs from comparable legislation in other jurisdictions'. Some of the differences are illustrated in the Australian decision of Travelex Ltd v Commissioner of Taxation, which is a useful case study of the Australian legislature's approach to the fundamental concepts in a value-added tax of (a) exemption of financial supplies, (b) exported services and (c) the conditions for input tax relief. While the Australian choice of drafting seems to have been deliberate, one is left with the question ‘is that what the legislature meant?’ The Australian experience contains lessons for jurisdictions that might consider adopting a value-added tax or changing existing provisions dealing with cross border transactions, financial services or input tax relief—other countries' VAT law does not always mean what it says and say what it means. It also illustrates that, in seeking to improve legislation by being different and modern in language, you might end up being different in substance. Staying with the old, cumbersome language can give more clarity of meaning—strange but true!

Managing mosquitoes without destroying wetlands: an eastern Australian approach

Recognising both the importance of intertidal wetlands and their role in mosquito-borne disease we discuss wise management to conserve wetland values and to reduce vector borne disease health risks. First we summarise the mosquito-borne diseases associated with intertidal wetlands in sub-tropical and tropical Australia. We consider the Ramsar Strategic Plan, its reflection in some key Australian statutes and the relationship between environment-focussed legislation and health legislation. This is followed by a brief overview of mosquito control and its impact on human health. Using a salt marsh example of an integrated process, we describe the development of what was, in the 1980s in Australia, a novel method of habitat modification (runnelling) for mosquito control. Runnelling modifies the tidal water flow on salt marshes, reducing mosquito larval numbers and minimising environmental impacts. The approach is related to two of the Ramsar goals (wise use and institutional capacity and effectiveness). We then describe the extension of its rationale to a complex mangrove system. Finally, with a concept model, we consider the convergence between minimal habitat modification for wetland conservation and human health protection using an interdisicplinary approach involving multiple stakeholders.

Australia, the ‘Marshall experiment’ and the decolonisation of Singapore, 1955–56

As decolonisation gathered pace in Southeast Asia, Singapore became a source of considerable concern to the Robert Menzies government. Britain's hold on its colony appeared increasingly precarious as political turbulence gripped the island. With a predominantly Chinese population, Singapore was considered susceptible to communist China's propaganda and subversion. By relying on previously classified Australian and British diplomatic documents, this article sheds light on the Australian approach to Singapore's political and constitutional development between 1955 and 1956 and, in so doing, it hopes to make a contribution to a better understanding of Australia's policies in a rapidly decolonising Southeast Asia.

Renewed Demands for Mine Water Management

The intensity and diversity of resource development projects has increased by orders of magnitude over the past two decades. At the same time, there has been an emphasis on environmental issues, decontamination of former industrial sites, a recognition of global warming issues, and a focus on the ability of project developers to initiate, operate, and close transient projects without compromising the land and water resource values that underpin existing and future land uses. This concurrence of issues is creating a massive demand for hydrogeologists and groundwater engineers throughout the world. Neither academic institutions nor their funding bodies have foreseen this demand. As a consequence, Australia is seeking to fill its demands by either temporary or permanent importation of skills but, since the same issues afflict other countries, or may come to do so in the near future, the Australian approach will probably be only marginally successful. Another issue confronting all countries active in groundwater management is that the range of skills now required for competent groundwater management around resource development projects have increased. These cannot be readily met by simply increasing the training load on new industry entrants. Rather, delegation of expertise will be necessary and management teams will need to include diverse professions in teams in order to cover the range of responsibilities that must be applied if sustainable decisions are to be made. The authors believe that there is an urgent need for groundwater managers to take up the learning opportunities and expand their skills by working even more internationally. This process should ensure cross fertilization of experience to the benefit of all the countries where groundwater issues are taken seriously.