Unfolding changes warrant greater scrutiny

As Australia moves towards a deregulated aged care market, one based on greater competition, international and local research suggests that we need to closely monitor the impacts on quality. But the lack of good data in Australia will compound the challenge, writes Dr Richard Baldwi

The financial viability and sustainability of the aged care sector

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The aged care workforce in Australia

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Temporal variability of Delta C-14, delta C-13, and C/N in sinking particulate organic matter at a deep time series station in the northeast Pacific Ocean

A 6-year time series of Delta(14) C, delta(13) C, and C/N measurements in deep sinking particulate organic matter ( POM) is presented for an abyssal site, Station M in the northeast Pacific Ocean. The Delta(14)C values revealed that sinking POM at 3450 m depth ( 650 m above bottom) contained old carbon despite its presumed short transit time in the water column. The isotopic and chemical properties of the sinking POM varied with time and appear to be controlled by more than one major process. In 1993, 1994, and late 1996, isotopic signatures and C/N molar ratios indicate negligible or vertically homogeneous influence of resuspended particles from the bottom or particles laterally transported from the margin to the study site. However, during early 1995 and 1998, Delta(14)C values were lower than those during other periods and C/N values at three deep depths were not equal, indicating that the study site was influenced by resuspended sediments more severely than during other periods. During mid-1995 to mid-1996, delta(13)C values decreased abruptly while Delta(14)C values increased slightly, and C/N values were extremely high ( up to -80) at 50 and 600 m above bottom; these results suggest input of degraded, modern, terrestrial organic matter. The periods of anomalous isotopic signatures, as well as vertically heterogeneous C/N values [ Smith et al., 2001], were correlated with high discharge periods of California rivers with a time lag of 2 to 4 months. The correlation suggests that regional meteorological events are important in controlling the biogeochemical properties of particles at Station M by varying the intensity of resuspension and transport of organic matter from the continental margin

The liminality of trajectory shifts in institutional entrepreneurship

In this paper, we develop a process model of trajectory shifts in institutional entrepreneurship. We focus on the liminal periods experienced by institutional entrepreneurs when they, unlike the rest of the organization, recognize limits in the present and seek to shift a familiar past into an unfamiliar and uncertain future. Such periods involve a situation where the new possible future, not yet fully formed, exists side-by-side with established innovation trajectories. Trajectory shifts are moments of truth for institutional entrepreneurs, but little is known about the underlying mechanisms of how entrepreneurs reflectively deal with liminality to conceive and bring forth new innovation trajectories. Our in-depth case study research at CarCorp traces three such mechanisms (reflective dissension, imaginative projection, and eliminatory exploration) and builds the basis for understanding the liminality of trajectory shifts. The paper offers theoretical implications for the institutional entrepreneurship literature

Lung Screen Uptake Trial (LSUT): Randomized Controlled Clinical Trial Testing Targeted Invitation Materials

Rationale: Low uptake of low-dose computed tomography (LDCT) lung cancer screening, particularly by current smokers of a low socioeconomic position, compromises effectiveness and equity. Objectives: To compare the effect of a targeted, low-burden, and stepped invitation strategy versus control on uptake of hospital-based Lung Health Check appointments offering LDCT screening. Methods: In a two-arm, blinded, between-subjects, randomized controlled trial, 2,012 participants were selected from 16 primary care practices using these criteria: 1) aged 60 to 75 years, 2) recorded as a current smoker within the last 7 years, and 3) no prespecified exclusion criteria contraindicating LDCT screening. Both groups received a stepped sequence of preinvitation, invitation, and reminder letters from their primary care practitioner offering prescheduled appointments. The key manipulation was the accompanying leaflet. The intervention group’s leaflet targeted psychological barriers and provided low-burden information, mimicking the concept of the U.K. Ministry of Transport’s annual vehicle test (“M.O.T. For Your Lungs”). Measurements and Main Results: Uptake was 52.6%, with no difference between intervention (52.3%) and control (52.9%) groups in unadjusted (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.82–1.16) or adjusted (OR, 0.98; 95% CI, 0.82–1.17) analyses. Current smokers were less likely to attend (adjusted OR, 0.70; 95% CI, 0.56–0.86) than former smokers. Socioeconomic deprivation was significantly associated with lower uptake for the control group only (P < 0.01). Conclusions: The intervention did not improve uptake. Regardless of trial arm, uptake was considerably higher than previous clinical and real-world studies, particularly given that the samples were predominantly lower socioeconomic position smokers. Strategies common to both groups, including a Lung Health Check approach, could represent a minimum standard. Clinical trial registered with www.clinicaltrials.gov (NCT02558101) and registered prospectively with the International Standard Registered Clinical/Social Study (N21774741)

Genetic variation in the HLA region is associated with susceptibility to herpes zoster.

Herpes zoster, commonly referred to as shingles, is caused by the varicella zoster virus (VZV). VZV initially manifests as chicken pox, most commonly in childhood, can remain asymptomatically latent in nerve tissues for many years and often re-emerges as shingles. Although reactivation may be related to immune suppression, aging and female sex, most inter-individual variability in re-emergence risk has not been explained to date. We performed a genome-wide association analyses in 22,981 participants (2280 shingles cases) from the electronic Medical Records and Genomics Network. Using Cox survival and logistic regression, we identified a genomic region in the combined and European ancestry groups that has an age of onset effect reaching genome-wide significance (P&gt;1.0 × 10(-8)). This region tags the non-coding gene HCP5 (HLA Complex P5) in the major histocompatibility complex. This gene is an endogenous retrovirus and likely influences viral activity through regulatory functions. Variants in this genetic region are known to be associated with delay in development of AIDS in people infected by HIV. Our study provides further suggestion that this region may have a critical role in viral suppression and could potentially harbor a clinically actionable variant for the shingles vaccine

Observation of a One-Dimensional Spin-Orbit Gap in a Quantum Wire

Understanding the flow of spins in magnetic layered structures has enabled an increase in data storage density in hard drives over the past decade of more than two orders of magnitude1. Following this remarkable success, the field of 'spintronics' or spin-based electronics is moving beyond effects based on local spin polarisation and is turning its attention to spin-orbit interaction (SOI) effects, which hold promise for the production, detection and manipulation of spin currents, allowing coherent transmission of information within a device. While SOI-induced spin transport effects have been observed in two- and three-dimensional samples, these have been subtle and elusive, often detected only indirectly in electrical transport or else with more sophisticated techniques. Here we present the first observation of a predicted 'spin-orbit gap' in a one-dimensional sample, where counter-propagating spins, constituting a spin current, are accompanied by a clear signal in the easily-measured linear conductance of the system.Comment: 10 pages, 5 figures, supplementary informatio