Approved, eventually

After twelve hours, at Neo-libs don't care for carers

Angst Sans Sushi 7:24am today

I challenge your down-trodden, careworn masses with a series of op-eds and glossy articles in the weekend supplements. How the successful mothers-of-five, back to work as full-time corporate lawyers, manage to "look after" themselves and maintain their sexy allure, and organise the care of the elderly parents with dementia. Every one is a "thin, attractive blonde" with several tertiary qualifications, a Facebook circle of prominent identities and a novel with the publisher.

Bill Marler: costs of food-borne illness

Five cases

1. $55,444.49
   
   
2. ... medical bills during her acute illness exceeded $200,000, and the value of her projected future medical expenses and future economic losses total between $6 and $7.5 million.
   
   
3. $113.959.04
   
   
4. $352,960
   
   
5. $42,853

We can cut costs, say pharmacists

First, Kon, declare your alprazolam sales figures.

DentiCare should be extracted from the grand vision

Why?
Well, will taxpayers shell out for lazy blighters who can't be bothered looking after their teeth?
Why don't public hospitals install dental chairs so the indigent and those with chronic health problems can have quick and easy solutions for teeth that cannot be saved?

Kaxgar

Letters editor, The Australian

Paul Kelly's call to arms ('PM must think like a war leader or quit field', 22/7) is a cogent statement of facts. He presents the case for a righteous mission that is at risk of losing popular support. But the other half of the narrative stems from the position of Western liberalism, as we are flanked by two emergent tyrannies. Extreme Islam is a form of theocratic totalitarianism, in that it brooks no redaction of its sacred foundational text.

In that context, one of the West's strengths resides in religious pluralism. In terms of local relationships, it is good to hear of increasing cooperation at many levels between secular Australia and Indonesia with its plurality of expressions of Islam.

But, as Kelly alludes, the endurance of our rule of law is in its' ability continually to adapt and refine, with fulsome input from public debate. It is our system of law that upholds, refines and codifies our military endeavours. This estate seems to be in stark contrast with the state system in China. Some may look to China for the manner in which it deals with the threat of disturbance by minority groups. In that direction, however, is as profound a mistake as bending to Sharia.

We are looking into a dark and forbidding place when we face the dilemma of the detention in China of Mr Hu Stern. It seems every step of that process is in contrast to what we expect and demand from our own laws. So, it's not too much of a stretch to observe that our approaches to situations arising in the Central Asian republics, Afghanistan and Pakistan will be warped by the lens of China's laws.

We could hope that Australia and China engage in a permanent and friendly dialogue over our disparate legal systems. It is important to have that forum, not just for Mr Hu Stern and those that will follow him, but for the sake of Afghanistan's future.

--
Letters editor, The Australian Financial Review

The situation of Mr Hu Stern is part of the kaleidoscope that is Australia's future. It should not be restricted to a case that can be considered on its own merits (Paul Kerin, 'China says it has evidence against Hu', 23/7). It is part of a broad narrative that takes in the reasons behind our military presence in Afghanistan.

Western liberalism is flanked by two emergent tyrannies. Extreme Islam is a form of theocratic totalitarianism, in that it brooks no redaction of its sacred foundational text. In that context, one of the West's strengths resides in religious pluralism. In terms of local relationships, it is good to hear of increasing cooperation at many levels between secular Australia and Indonesia with its many expressions of Islam.

Our rule of law endures by its' ability continually to adapt and refine, with fulsome input from public debate. It is our system of law that upholds, refines and codifies our military endeavours. This estate seems to be in stark contrast with the state system in China. Some may look to China for the manner in which it deals with the threat of disturbance by minority groups. In that direction, however, is as profound a mistake as bending to Sharia.

We are looking into a dark and forbidding place when we face the dilemma of the detention in China of Mr Hu Stern. It seems every step of that process is in contrast to what we expect and demand from our own laws. So, it's not too much of a stretch to observe that our approaches to situations arising in the Central Asian republics, Afghanistan and Pakistan will be warped by the lens of China's laws.

We could hope that Australia and China engage in a permanent and friendly dialogue over our disparate legal systems. It is important to have that forum, not just for Mr Hu Stern and those that will follow him, but for the sake of Afghanistan's future.

Better run it past CSL

Dear Editors
It's very good news that the government will pay to have an extra two million Australians vaccinated against the seasonal influenza. Let's overlook the matter that these vulnerable groups could have been offered free annual injections well before this.
We do need to concentrate our attention on provisions for the future. There are two issues, crucial to the planning of vaccination for influenza, about which we know almost nothing. One is whether or not the current vaccine for seasonal influenza affords any protection against the new H1N1 variant. The first question, then, is resolved by looking at the data. But, where is that data and who is responsible for collating it into evidence of effectiveness?
The second issue is vital for success of any plan to vaccinate the whole population against the new variant. The World Health Organisation has stated, very clearly, that any program of immunisation against the new variant must be followed with rigorous surveillance in order to identify any harmful outcomes of vaccination. That's because it is highly likely that entirely new methods of vaccine production will be used and citizens will be exposed to synthetic, novel molecules.
If the new variant remains in its present state and runs through the population without any greater morbidity and mortality than any other variety of influenza, the community will have plenty of time to be involved in proposed plans. However, in the event of increased deaths of healthy young people, buttons will be pushed to accelerate a program of mass vaccination. In that scenario of heightened concern, it may be suggested that arguments for the usual, cautious process will be out-weighed and that short-cuts should be taken.
Now is the time to address the matter of post-marketing surveillance of new vaccines. Who pays for it, who collects the data, who owns the data and will it be scrutinised by methods accessible to the public?

A Passion for Policy

Essays in Public Sector Reform from ANZSOG

The Role of Departmental Secretaries
Personal refections on the breadth of responsibilities today
Andrew Podger

Not In Service

MTR

http://www.treasury.gov.au/documents/1536/PDF/02_Overview.pdf

Press Release - Car Dealer Financing Special Purpose Vehicle ...

Swan on SPV 18/12/08

http://psdblog.worldbank.org/psdblog/2009/06/what-can-the-london-underground-tells-us-about-corporate-governance-in-ppp-projects.html

Special Purpose Vehicle (diagram at UK NAO)

Special Purpose Entity

Ignored by David Penberthy. Pffft!

Hi David

I don't know what Web3.0 (or 1.7 for that matter) means. But I can see with my own eyes that the tail of your piece today looks like

You can read Downer's piece at www.adelaidenow.com.au or by typing this tiny url into your browser: http://tinyurl.com/pf8lcj

In my browser (Firefox 3) both URLs are highlighted and can be clicked to go to the location. So the advice to 'type the tiny url' is not only redundant, it looks a bit silly.

There's an article in the Business section on Rupert Murdoch's visions (or nightmares) about digital news. RM is quoted as saying "You'll be able to get ... everything on your Blackberry, or Palm, or whatever ...". Can you see there is something missing, a glaring omission that makes me think RM has dissed Apple? Steve Jobs has 62m Google hits, cf RM's 2m, so I cannot believe RM has not been toiling away at a business model for news delivery that includes the iPhone. Young people lust for the Apple tool. Maybe if RM is thinking of concentrating his digital subscription model at the high end (where punters pay $3 for the AFR) then maybe he will give away his newspapers? Apple will have noticed.

Anyway, the Downer piece was very good. But I must disclose that one of our kids is pedalling across Central Asia http://www.steppebysteppe.com.au/ and their GPS tracker stopped signalling a week ago. Probably a technical fault, but ...

Adverse events in hospital care

http://www.aihw.gov.au/publications/hse/hse-71-10776/hse-71-10776-c04.pdf
p53

Adverse events are defined as incidents in which harm resulted to a person receiving health care. They include infections, falls resulting in injuries, and medication and medical device problems. Some of these adverse events may be preventable. Separations with adverse events are included within the Safety dimension of the revised National Health Performance Framework.

The separations data include ICD-10-AM diagnoses, places of occurrence, and external causes of injury and poisoning which indicate that an adverse event was treated and may have occurred during the hospitalisation.

However, other ICD-10-AM codes may also indicate that an adverse event occurred or was treated, and some adverse events are not identifiable using these codes. The data presented in Table 4.13 can therefore be interpreted as representing selected adverse events in health care that have resulted in, or have affected, hospital admissions, rather than all adverse events that occurred in hospitals.

In 2007–08, there were 382,000 separations with an ICD-10-AM code for an adverse event (4.8 per 100 separations) (Table 4.13). There were 268,000 separations with adverse events in the public sector (5.6 per 100 separations) and 115,000 separations in the private sector (3.7 per 100 separations). However, the data for public hospitals are not comparable with the data for private hospitals because their casemixes differ and recording practices may be different.

Influenza seroprevalence in pigs

http://www.medscape.com/viewarticle/574904

From Influenza and Other Respiratory Viruses
Seroprevalence of H1N1, H3N2 and H1N2 Influenza Viruses in Pigs in Seven European Countries in 2002-2003
Kristien Van Reeth; Ian H. Brown; Ralf Dürrwald; Emanuela Foni; Geoffrey Labarque; Patrick Lenihan; Jaime Maldonado; Iwona Markowska-Daniel; Maurice Pensaert; Zdenek Pospisil; Guus Koch

Authors and Disclosures

Published: 06/18/2008

Abstract and Introduction
Materials and Methods
Results
Discussion
References

Abstract
Objectives: Avian-like H1N1 and human-like H3N2 swine influenza viruses (SIV) have been considered widespread among pigs in Western Europe since the 1980s, and a novel H1N2 reassortant with a human-like H1 emerged in the mid 1990s. This study, which was part of the EC-funded 'European Surveillance Network for Influenza in Pigs 1', aimed to determine the seroprevalence of the H1N2 virus in different European regions and to compare the relative prevalences of each SIV between regions.
Design: Laboratories from Belgium, the Czech Republic, Germany, Italy, Ireland, Poland and Spain participated in an international serosurvey. A total of 4190 sow sera from 651 farms were collected in 2002-2003 and examined in haemagglutination inhibition tests against H1N1, H3N2 and H1N2.
Results: In Belgium, Germany, Italy and Spain seroprevalence rates to each of the three SIV subtypes were high (≥30% of the sows seropositive) to very high (≥50%), except for a lower H1N2 seroprevalence rate in Italy (13·8%). Most sows in these countries with high pig populations had antibodies to two or three subtypes. In Ireland, the Czech Republic and Poland, where swine farming is less intensive, H1N1 was the dominant subtype (8·0-11·7% seropositives) and H1N2 and H3N2 antibodies were rare (0-4·2% seropositives).
Conclusions: Thus, SIV of H1N1, H3N2 and H1N2 subtype are enzootic in swine producing regions of Western Europe. In Central Europe, SIV activity is low and the circulation of H3N2 and H1N2 remains to be confirmed. The evolution and epidemiology of SIV throughout Europe is being further monitored through a second 'European Surveillance Network for Influenza in Pigs'.

Introduction
The epidemiology of swine influenza (SI) has become increasingly complex over the last decade. Three influenza A virus subtypes - H1N1, H3N2 and H1N2 - are currently circulating in swine worldwide, but the origins and the antigenic and genetic characteristics of these swine influenza virus (SIV) subtypes differ in different continents or regions of the world.[1] The first significant outbreaks of SI on the European mainland occurred in the late 1970s after the transmission of an H1N1 virus from wild ducks to pigs.[2] This 'avian-like' H1N1 virus has become established in the European pig population and ultimately became the dominant H1N1 SIV strain.[3] Viruses of human origin, A/Hong Kong/68-like H3N2 formed a stable lineage in European pigs since the early 1970s, but reassortant H3N2 viruses with human haemagglutinin (HA) and neuraminidase (NA) genes and avian-like swine H1N1 internal protein genes have become dominant since the mid 1980s.[4,5] Finally, 'triple reassortant' H1N2 viruses have been isolated frequently from pigs throughout Europe since the mid 1990s.[6-10] These viruses contain an HA of human influenza virus origin, a NA of swine H3N2 virus origin and internal protein genes of avian-like swine H1N1 virus origin.[11] The HA of these H1N2 viruses shows low antigenic and genetic homology (70·4% amino acid identity in the HA1 region) with avian-like H1N1 viruses and there is no cross-reaction between H1N1 and H1N2 viruses in the HI test.[12] Though most SIV infections are clinically mild or subclinical, all three subtypes have been associated frequently with typical outbreaks of 'swine flu' and SIV may be responsible for up to 50% of acute respiratory disease outbreaks in pigs.[1]

Viruses of H1N1 and H3N2 SIV subtypes are considered widespread and endemic in pig populations in Austria, Belgium, Denmark, France, Germany, Great Britain, Italy, The Netherlands and Spain.[13] Occasional serological investigations of pigs sampled at slaughter have been performed in most of these countries in the 1980s and early 1990s and revealed seropositivity to H1N1 and H3N2 in >50% of the tested population. However, over the last few years H3N2 activity is believed to be low or absent in France (Brittany) and Great Britain (Brown I., Veterinary Laboratories Agency, Weybridge, UK, unpublished observations; Kuntz-Simon G., Agence Française de Sécurité Sanitaire des Aliments, Ploufragan, France, personal communication). Either or both subtypes have also been reported in Bulgaria, the former Czechoslovakia, Greece, Hungary, Ireland, Macedonia, Poland and Sweden.[13] As for the H1N2 virus, a limited serosurvey in sows in Belgium in 1999 has shown seropositivity in 69% of the 443 sera examined.[7] However, there is limited H1N2 seroprevalence data for other European countries and there is little information on the evolution of H1N1 or H3N2 seroprevalence rates in Europe.

The 'European Surveillance Network for Influenza in Pigs 1' (ESNIP1) was a concerted action in the 5th Framework Research Programme of the European Commission (QLK2-CT-2000-01636, 01-01-2001 until 31-12-2003) that involved 14 partners from 10 different European countries. This action was initiated through the need for standardisation of diagnostic techniques for SI and for a more organised surveillance. The present paper reports the results of a first international serosurvey undertaken by ESNIP1 partners from Belgium, the Czech Republic, France, Italy, Ireland and Poland and by voluntary participants from Germany and Spain. The study aimed to determine the seroprevalence of the novel H1N2 virus in different geographic regions of Europe, and to compare the relative prevalences of each SIV between countries and regions where possible.

Medical response in chaos in swine flu pandemic

Articles in The Oz, SMH, etc expose IdM.
At one extreme, compliant household in self-imposed quarantine, but not ill, only marked as contacts, wait for days to get call back about meds and supplies. Eventually tests are negative.
At other extreme, sick person roams around, even interstate or o/s, while authorities try to contact him.
With a national IdM system, flags could be set to pick up card transactions, even mbl locations.

Extra soft and sorbent

Jimmy Carr is on Twitter. He's signed a letter to Guardian, along with Gordon Brown and a few other identities.

The "racism" topic is right there, because we are not an island. Another potent link into discussions of ethnicity in the white man's paradise is this article in Frontline (online magazine, India).

The origin of the "sea of refugees" from Pakistan was described in a British documentary on SBS, originally broadcast in the UK in March.

The sombre fact that Jacqui Smith has resigned over a couple of porn flics is germaine to the debate about the future of Af-Pak, in that powerful democracies can be unsettled by the actions of stupid people.
There are seven live web feeds from Parliament this morning. It'll be very disappointing if QT descends again into crude theatricals.

It's pleasing to note that Colbert has beaten out the "reverse racism" argument over Sonia Sotomayor, but, it's hard to believe, a local harijan has arrived days late to strumpet it as a "poor choice". It's no wonder the web had consigned print to the outhouse.

Rorting the Extended Medicare Safety Net (EMSN)

Extended Medicare safety net review report

These fee increases have resulted in considerable leakage of government benefits towards providers’ incomes, rather than reduced costs for patients. A conservative estimate is that, for every dollar spent on the EMSN in 2008, providers received 43 cents and patients received 57 cents. However, for Medicare services that are associated with high out-of-pocket costs (that is greater than $50), this estimate is as high as 78 cents for providers and 22 cents for patients. Services in this group include those associated with assisted reproductive technologies as well as procedures to treat varicose veins and vision impairments.

Lou Irving talks sense

Lou Irving on ABC radio 27/5/09 gave three good reasons why all the effort is being put into trying to contain the imminent spread of the new H1N1.

1) Allows more chance of promoting basic health education re preventive behaviours.
2) It will be at least 3 months before a vaccine is available and the best outcome is to have the most people vaccinated before conditions for mass transmissions.
3) Slower infection rate allows health system to cope with increased load.

Coughs and sneezes spread diseases

Virologist Alan Hampson stated on ABC TV's Stateline of May 22nd, "If there are people out there who are unwittingly spreading influenza, maybe because they have very low grade symptoms or no symptoms at all, then there’s no telling how many people they may have passed it on to in the interim." (transcript available at http://www.abc.net.au/stateline/vic/content/2006/s2578513.htm)

While perhaps technically correct, it is that kind of unqualified expert opinion that drives fears through the community. It conjures images of perfectly well people going about their ordinary business of the day, while mysteriously exuding highly infectious particles from every pore of their skin. It ignores the simple fact that respiratory infections are transmitted when people cough and sneeze, that is, while they most certainly do have symptoms, even if they do not want to be labelled as ill. The number of influenza viruses dispersed by an unguarded cough or sneeze is incomparably greater than any released by talking or laughing before symptoms are present.

Perhaps it is that kind of misinformation that underlies some of the anxiety surrounding issues of management at Clifton Hill Primary School. If parents have been told that the virus is highly contagious before symptoms erupt, as Tracie Winch ('Struck down by a bad case of bureaucracy', 24/5) wrote, "over a two-day period during the girl's potentially most infectious time", it's no wonder she was bemused by the different responses to her queries.

If parents have been given to believe that influenza is highly infectious in the interval of one or two days between the minute when transmission occurred and the beginning of symptoms, then it's no wonder they are frightened and confused. The propagation of untruths is a serious matter, especially in a setting where members of the community do not have a grasp of the basic scientific facts.

People may volunteer for prolonged isolation (quarantine) while they are not infectious, especially if they are scared out of their wits. But it is not 1347, the current wave of new influenza strains will not cause an outbreak of the Black Death, and most responsible members of the community will heed advice that is based on current knowledge.

The fact is that we do not take seriously our responsibilities to our fellows when we are coughing and sneezing. While blithely ignorant of the cause, we don't care where our secretions end up. We need always to be conscious of the potential for infecting others, not just when the vapours of Swine Flu are wafting through the air.

Making a fat buck

From the newsletter:

The Role of Obesity Surgery in Diabetes Management

This is an opportunity for GPs to hear from a number of experts in obesity surgery: two world renowned professors from Victoria, experienced local bariatric surgeons and specialist physicians, together with diabetes educators conducting research in local divisions.

Date: Wednesday 27th May.

Time: 6:30pm Registration and refreshments; 7:00pm–9:00pm Presentations and Discussion.

Venue: Moonee Valley Racecourse, The Chairman’s Room, Level 4 of Main Grandstand, McPherson St, Moonee Ponds.

For enquiries and RSVP contact Collean Fahy at PivotWest on Tel. 9689 4566.

QA&CPD: 4 x Category 2 RACGP points.

The world through the prism of The Age

Another half million or so refugees on the road, World trembles as Pakistan teeters.
The Age flogs the share-price of CSL-Merck, by boosting the power of the HPV vaccine to prevent genital warts. How long before we are told tax-payers have to pay to vaccinate 12yo boys?

O, Caroline.

Dare you
Well, I see it that she is rehearsing for a part in a little drama and we should be patient and wait for the curtain.
You see, Ms Roxon has heard how innocent people can pay their (tax-payer subsidised) private health insurance, and never having had to call on it until the knee finally gives out. They go into a private hospital, with the surgeon of their GP's choice, for a knee replacement. But it gets infected and she has to hobble round in a go-cart. However, it's not all bad news, because the private doctor and the private hospital and the private pharmacy all keep getting paid at top rates, for the extra length of stay, the extra procedures and the expensive antibiotics. But there's a gap to pay, there's always a gap. Ms Roxon is finding out what it's like to pay extra for a bad outcome.
Hmmm, maybe that's what she means, about paying doctors on their performance. I think the AMA is in for a good, old-fashioned hiding, and it's about time. But first, the highly ethical doctors will seek to blame the patients, the nurses, the ward cleaners, anybody else, rather than take responsibility for bad outcomes as well as reduced income.
It's Rosa Capolingua who'll be needing the little red golf-cart.
Here's a suggestion for anyone with the enthusiasm for investigative journalism, and the guts to stand up to the most powerful union in the land, go out and find out how much those bad procedural outcomes are costing the nation. Or, ask around your friends and relatives what they had to shell out for exorbitantly priced chemo drugs for their breast cancers. If Ms Roxon can beat down on the doctors and the pharmaceutical companies (O, Vioxx!) to get a fair go for women who have cancer, then she can ride around on a broomstick, for all I care.

Chemotherapy

Link to comment at Gene Patenting.
..
Budget to unveil $600m in cancer drug subsidies

Unauthorised entry

http://andrewbartlett.com/?p=7200

Steppe by Steppe on the Quike

Follow Roger and Megan at http://www.steppebysteppe.com.au/

Maps? Plans?

First thing, I'm in the construction business. The Economic Stimulus Plan is paying $$$ for old rope. There are shortages, you see.
Second, it was the subbies idiot operator on the backhoe. Or his cousin's friend, or the backpacker from Romania, how would I know?
Third, I demand to know why Nathan Rees was not there to stop the backhoe ripping up the cable.
Finally, we covered our tracks pretty well. Isn't that the Australian way?

Why invite comments?

Ruddnet is too good to be true
>>
Just the person I've been looking for.
Malcolm, I'm a courier, a one-man show. My competitors are getting 3G phones with maps and the options to pay for instant step-by-step voice instructions to the points of delivery.
Can you advise me, please, on which plan (out of many) best suits my needs? Or, should I wait until there are more phones and plans on the market?
After we've sorted out that one, I'll get you to help me buy a phone for my wife. She doesn't need a camera, but wants to be able to SMS and talk. Which plan and phone is best for her? Or should she buy outright?
You see, Malcolm, I think you threw away your case when you bagged those big road projects (and how about the rail link to Darwin?) as failures. Why couldn't the private corporations see it coming? Surely not because some consultants picked up their cheques are walked away laughing?
Malcolm, what are you saying? It will cost too much? Fair enough, we do want free beer, as well. It won't work? Sorry, Malcolm, you are up against stiff competition - the huge media and entertainment conglomerates.
Malcolm, the surest way for the government to protect us against the predations of providers, in a market that is driven to crazy complexity, is to underwrite the construction costs.
<<
Too slow at The Australian.

Name change

Had to find new name because previous was already in use by Matt Tilley. Am pretty sure this one is OK.

090411KTZ

The Kazakhstan railway system could be a template for Australian Government plans for national broadband network (NBN).

The current rail network is based on the inheritance from the former Soviet Union and as such has a broad gauge of 1,520 mm (4 ft 11⅞ in). While this provides a smooth transit at international borders to countries of the former Soviet Union, the railway in China has the standard gauge of 1,435 mm (4 ft 8½ in); thus there is a break-of-gauge at the eastern border at Druzhba.

The NBN may be an(other) example of woolly, blue-sky dreaming, but it's likely Rudd's concepts are bounded by firewalls. One aspect of a grand scheme that must be bounded within solid envelopes of rationality is to do with the nuts and bolts, that is, engineering standards. At the other end is the critical matter of governance. Rudd must be satisfied that the highest standards of probity will be applied to a multi-billion dollar undertaking. He must be sure in his own heart that he has done all he can to lessen the hazards of corruption and conflicts of interest. If lessons can be imported, the Obama administration has entered a new phase of accountable government. The White House has made available the personal disclosures of financial interests, in great detail, for everyone in the administrative offices. The spectre hanging over the head of commercialism is the example of Bernie Madoff, the guru of investment who was the biggest crook of them all.

Once Rudd has firewalled the two pillars, standards and transparency, government should be able to give free reign to commerce so that the benefits of competition can operate under 'light touch' regulation.

Tim Harford (The Undercover Economist) wrote about railways in the chapter Rational Insanity, page 154.

So, even the best rail companies weren't great investments, and the worst were financial disasters. But nobody disputes the fact that the railways completely transformed developed economies. Conservative estimates are that they added 5-15 per cent to the total value of the US economy by 1890 - a staggering amount, when you think about it. But competition to build and operate rail lines kept profits modest. As long as competition is strong, the railways had little scarcity power.

This snippet is embedded in an insightful discourse about technology. The book is highly recommended.

The health care sector will be a beneficiary of the NBN. Telstra, and others, have been promoting telehealth, which needs fast downloads. An article in today's The Age, Half state's hospitals in red, laments "dissatisfaction with the statewide health IT upgrade, HealthSmart". The taxpaying community, and Mr Rudd, will be looking to the health sector for quick returns on faster broadband.

The HealthSmart project would benefit from closer attention to standards and transparency.