KPMG (Australia)

Understanding the 'university of origin' of general practice and rural generalist trainees informs workforce planning.

Coronary artery calcification (CAC) provides robust prediction for major adverse cardiovascular events (MACE), but current techniques disregard plaque distribution and protective effects of high CAC density. We investigated whether a novel CAC-dispersion and density (CAC-DAD) score will exhibit superior prognostic value compared with the Agatston score (AS) for MACE prediction. We conducted a multicenter, retrospective, cross-sectional study of 961 patients (median age, 67 years; 61% men) who underwent cardiac computed tomography for cardiovascular or perioperative risk assessment. Blinded analyzers applied deep learning algorithms to noncontrast scans to calculate the CAC-DAD score, which adjusts for the spatial distribution of CAC and assigns a protective weight factor for lesions with ≥1000 Hounsfield units. Associations were assessed using frailty regression. Over a median follow-up of 30 (30-460) days, 61 patients experienced MACE (nonfatal myocardial infarction or cardiovascular mortality). An elevated CAC-DAD score (≥2050 based on optimal cutoff) captured more MACE than AS ≥400 (74% versus 57%; P=0.002). Univariable analysis revealed that an elevated CAC-DAD score, AS ≥400 and AS ≥100, age, diabetes, hypertension, and statin use predicted MACE. On multivariable analysis, only the CAC-DAD score (hazard ratio, 2.57 [95% CI, 1.43-4.61]; P=0.002), age, statins, and diabetes remained significant. The inclusion of the CAC-DAD score in a predictive model containing demographic factors and AS improved the C statistic from 0.61 to 0.66 (P=0.008). The fully automated CAC-DAD score improves MACE prediction compared with the AS. Patients with a high CAC-DAD score, including those with a low AS, may be at higher risk and warrant intensification of their preventative therapies.

ABSTRACT While conflict in multi-stakeholder relationship is widely acknowledged, few studies explore how conflicts pertaining to cultural heritage, power dynamics, and institutional constraints are navigated in Indigenous tourism co-creation. In that regard, this study examines how tourism stakeholders negotiate social conflict during value co-creation in Patan, Nepal. Using a decolonial approach, data were collected through interviews, observation and Netnography. The study highlights the transformative role of culturally empowered community associations in fostering co-creative engagement through knowledge synergy, psychological empowerment, and strategic partnerships. It reconceptualises co-creation as a conflict negotiation process and offers practical insights for Indigenous-led value co-creation in tourism.

Australia’s decommissioning portfolio is forecasted to increase substantially over the next 50 years amounting to US$40.5 billion nationally, with 90% of decommissioning by 2060. High costs, the complexity of our infrastructure geography, ensuring circular economy and carbon efficient principles, will be challenges the industry will need to collaborate through. But Australia has a skilled workforce, a strong sustainability commitment, a mindset of partnership and collaboration as well as a tradition for innovation. These strategic advantages will enable the establishment of new industries early to be a regional player in decommissioning. As the assets are decommissioned offshore, travel to the beach, transported to identified waste providers and go through final end-of-life cycle management including recycling and repurposing, strategic linkages of the value chain will be key for a successful decommissioning industry set up. Understanding the oil and gas (O&G) decommissioning industry’s needs, opportunities and challenges early will strategically enable Australia to pave the way for building decommissioning expertise, critical infrastructure, and sustainable practices. This includes understanding where ports should intersect with waste storage, processing, recycling and disposal capabilities, as we have an opportunity to think differently about turning waste into new resources. And most importantly, how do we ensure availability of a skilled workforce in an already resource-crunched market? As we analyse the port to disposal value chain, it is important to overlay the carbon footprint, regulation, and socio-economic lenses on the journey to support the industry and to ensure long-term viability to minimise conflict with other competing industries or activities.

Presented on Wednesday 17 May: Session 14 Attitudes and behaviours towards energy transformation are varied and evolving – understanding them is critical to inform enterprise decisions. Proactive and inclusive engagement is needed to build trust, reputation and social licence. There will be more interest and acceptance in adopting new energy products and services when they are better understood and there is a shared benefit. Trust needs to be solidified as the technology and transition evolves – there are three characteristics of a trustworthy organisation: purpose, culture and reputation. If any of these are missing, trust will be undermined, and poses significant risk to reputation and social licence. Whilst some industries have embedded a customer-centric mindset – for others on the energy transformation journey it’s new. As the energy mix continues to evolve, the oil and gas industry needs to play a part in this narrative. Now is the critical time to be more human-centric as the imbalance of the energy trilemma begins to demonstrate its impact on end users. Individuals, communities and consumers can become more engaged and educated through technology and communication platforms, however anyone who will face barriers to participate or who may find the increasingly complex energy market difficult to navigate must also be considered. Principles of a more human-centric engagement need to move beyond tick the box, compliance and one off – it needs to be embedded to stay abreast of evolving needs. As transformation progresses, all must be understood, included to ensure no-one gets left behind. To access the Oral Presentation click the link on the right. To read the full paper click here

ABSTRACT The Insurance Council of New Zealand’s Disaster List documents private sector insurance payouts caused by natural perils since April 1968. We normalise these and, where possible, payments made by the Earthquake Commission, a government natural disaster insurance scheme, as if historical events were to impact current societal conditions, defined here as the 12-month period from 1 July 2018. The methodology employs changes in the number, size and nominal cost of new residential dwellings as key normalising factors. Since 1968, earthquakes account for 79% of the normalised losses with the 2010–2011 Canterbury Earthquake Sequence (CES) at NZD20.1 billion the single most expensive event. The redlining of residential suburbs shown to be vulnerable to liquefaction and the introduction of more stringent building codes are estimated to reduce normalised losses for a repeat of the CES by about one-third. More frequent losses due to extreme weather, notably storms of tropical, sub-tropical and extra-tropical origin, when combined and after adjusting for changing societal factors, show no trend over the record length. We explore why an attempt to use the Fraction of Attributable Risk to cost the contribution of anthropogenic climate change to weather-related event losses delivers results inconsistent with most normalisation studies.

§ 22 Abs 1 GmbHG und § 82 AktG verpflichten die Geschäftsleitung zur Einführung eines den Anforderungen des Unternehmens entsprechenden internen Kontrollsystems (IKS). In Rsp und (juristischer) Lit wurden diese Anforderungen und die sich daraus ergebenden Konsequenzen für die (mangelhafte) Ausgestaltung des IKS – insbesondere seit Einführung der Business Judgement Rule (BJR) – kaum näher diskutiert. Dieser Beitrag widmet sich diesen Fragen und stellt (i) die bislang etablierte „Best Practice“ und (ii) im Rahmen von Abschlussprüfung und Compliance Audits gehäuft festgestellte Mängel dar. Abschließend wird – unter Berücksichtigung der jüngst ergangenen Entscheidung des OGH zu 9 ObA 136/19v – auf die Rechtsfolgen eines Verstoßes gegen § 22 Abs 1 GmbHG eingegangen.

Hydrogen is emerging as an alternate carrier of energy. It has the potential to play a key role in the decarbonisation of the energy sector. Governments around the world and in Australia are signalling interest in moving the hydrogen economy forward. Current efforts are focused on developing hydrogen visions and strategies, supported by investments and partnerships with industry to progress technology and unlock the barriers across the hydrogen value chain. KPMG has worked with CSIRO, ATCO Gas and the Australian Renewable Energy Agency (ARENA) in the development of a Hydrogen City tool (H2City Tool) (available for public download from the ARENA website). The H2City Tool assists users with screening communities that may be suitable for transitioning to a hydrogen-based energy future and provides two broad pathways: a hydrogen pathway and an electrification pathway, allowing a relative comparison to be made between these options. This abstract provides a summary of outcomes arising from analysis performed by KPMG using the H2City Tool, which illustrates the conditions and viability of several pathways to convert to a hydrogen-based energy future. These pathways were: Scenario 1 – converting a large metropolitan community to hydrogen; Scenario 2 – adopting hydrogen to fuel transport at scale; Scenario 3 – adopting hydrogen in electricity grid firming at scale; and Scenario 4 – adopting the concept of hydrogen hubs in regional Australia.