Rural and Urban Differentials in Primary Care Management of Chronic Heart Failure: New Data from the CASE Study

Objective: To determine whether primary care management of chronic heart failure (CHF) differed between rural and urban areas in Australia. Design: A cross-sectional survey stratified by Rural, Remote and Metropolitan Areas (RRMA) classification. The primary source of data was the Cardiac Awareness Survey and Evaluation (CASE) study. Setting: Secondary analysis of data obtained from 341 Australian general practitioners and 23 845 adults aged 60 years or more in 1998. Main outcome measures: CHF determined by criteria recommended by the World Health Organization, diagnostic practices, use of pharmacotherapy, and CHF-related hospital admissions in the 12 months before the study. Results: There was a significantly higher prevalence of CHF among general practice patients in large and small rural towns (16.1%) compared with capital city and metropolitan areas (12.4%) (P < 0.001). Echocardiography was used less often for diagnosis in rural towns compared with metropolitan areas (52.0% v 67.3%, P < 0.001). Rates of specialist referral were also significantly lower in rural towns than in metropolitan areas (59.1% v 69.6%, P < 0.001), as were prescribing rates of angiotensin-converting enzyme inhibitors (51.4% v 60.1%, P < 0.001). There was no geographical variation in prescribing rates of β-blockers (12.6% [rural] v 11.8% [metropolitan], P = 0.32). Overall, few survey participants received recommended “evidence-based practice” diagnosis and management for CHF (metropolitan, 4.6%; rural, 3.9%; and remote areas, 3.7%). Conclusions: This study found a higher prevalence of CHF, and significantly lower use of recommended diagnostic methods and pharmacological treatment among patients in rural areas.

Implementing dance in a Queensland primary school : a descriptive case study

This research documents and analyses the modes of implementation of the Dance component of The Arts Essential Learnings in a Queensland school. The research identifies what makes good practice in dance education and the multiple modes of implementation that support this practice. The primary purpose of this research is to describe the factors that influence dance education, as it is delivered, in a Queensland primary school to inform the development of further support for primary teachers and to improve the quality of dance education in Prep -7 schooling. The literature review investigates dance education both in Queensland, Australia and internationally, identifying current issues related to the delivery of dance in a primary school environment including barriers to implementation of dance, authentic learning and integrated approaches to learning. Based on Engestrom.s reformulation of Vygotsky.s theory of socially mediated learning, the implementation of dance education curriculum was explored through descriptive case study method. The case study was conducted in a regional Queensland school identified as delivering the dance curriculum in a variety of ways. The research project provided opportunities to observe, document and analyse how teachers deal with pedagogical dilemmas and solve logistical problems associated with teaching the dance component of the Arts curriculum in this school. Teachers. practices were contextualised through investigation of the whole school context of dance curriculum development. The findings revealed a range of teaching approaches that influenced teachers. interpretation and children.s experience of the dance curriculum. The features of a supportive whole school and cultural environment for dance were identified. These have been captured in a reworked version of Engestrom.s Second Generation Activity Theory that can be applied to the implementation of dance education in primary schools.

Crisis communication under transformative change : the emergent context and roles of primary and secondary organisations

In an era of complex challenges that draw sustained media attention and entangle multiple organisational actors, this thesis addresses the gap between current trends in society and business, and existing scholarship in public relations and crisis communication. By responding to calls from crisis communication researchers to develop theory (Coombs, 2006a), to examine the interdependencies of crises (Seeger, Sellnow, & Ulmer, 1998), and to consider variation in crisis response (Seeger, 2002), this thesis contributes to theory development in crisis communication and public relations. Through transformative change, this thesis extends existing scholarship built on a preservation or conservation logic where public relations is used to maintain stability by incrementally responding to changes in an organisation‘s environment (Cutlip, Center, & Broom, 2006; Everett, 2001; Grunig, 2000; Spicer, 1997). Based on the opportunity to contribute to ongoing theoretical development in the literature, the overall research problem guiding this thesis asks: How does transformative change during crisis influence corporate actors’ communication? This thesis adopts punctuated equilibrium theory, which describes change as alternating between long periods of stability and short periods of revolutionary or transformative change (Gersick, 1991; Romanelli & Tushman, 1994; Siggelkow, 2002; Tushman, Newman, & Romanelli, 1986; Tushman & Romanelli, 1985). As a theory for change, punctuated equilibrium provides an opportunity to examine public relations and transformative change, building on scholarship that is based primarily on incremental change. Further, existing scholarship in public relations and crisis communication focuses on the actions of single organisations in situational or short-term crisis events. Punctuated equilibrium theory enables the study of multiple crises and multiple organisational responses during transformative change. In doing so, punctuated equilibrium theory provides a framework to explain both the context for transformative change and actions or strategies enacted by organisations during transformative change (Tushman, Newman, & Romanelli, 1986; Tushman & Romanelli, 1985; Tushman, Virany, & Romanelli, 1986). The connections between context and action inform the research questions that guide this thesis: RQ1: What symbolic and substantive strategies persist and change as crises develop from situational events to transformative and multiple linked events? RQ2: What features of the crisis context influence changes in symbolic and substantive strategies? To shed light on these research questions, the thesis adopts a qualitative approach guided by process theory and methods to explicate the events, sequences and activities that were essential to change (Pettigrew, 1992; Van de Ven, 1992). Specifically, the thesis draws on an alternative template strategy (Langley, 1999) that provides several alternative interpretations of the same events (Allison, 1971; Allison & Zelikow, 1999). Following Allison (1971) and Allison and Zelikow (1999), this thesis uses three alternative templates of crisis or strategic response typologies to construct three narratives using media articles and organisational documents. The narratives are compared to identify and draw out different patterns of crisis communication strategies that operate within different crisis contexts. The thesis is based on the crisis events that affected three organisations within the pharmaceutical industry for four years. The primary organisation is Merck, as its product recall crisis triggered transformative change affecting, in different ways, the secondary organisations of Pfizer and Novartis. Three narratives are presented based on the crisis or strategic response typologies of Coombs (2006b), Allen and Caillouet (1994), and Oliver (1991). The findings of this thesis reveal different stories about crisis communication under transformative change. By zooming in to a micro perspective (Nicolini, 2009) to focus on the crisis communication and actions of a single organisation and zooming out to a macro perspective (Nicolini, 2009) to consider multiple organisations, new insights about crisis communication, change and the relationships among multiple organisations are revealed at context and action levels. At the context level, each subsequent narrative demonstrates greater connections among multiple corporate actors. By zooming out from Coombs‘ (2006b) focus on single organisations to consider Allen and Caillouet‘s (1994) integration of the web of corporate actors, the thesis demonstrates how corporate actors add accountability pressures to the primary organisation. Next, by zooming further out to the macro perspective by considering Oliver‘s (1991) strategic responses to institutional processes, the thesis reveals a greater range of corporate actors that are caught up in the process of transformative change and accounts for their varying levels of agency over their environment. By zooming in to a micro perspective and out to a macro perspective (Nicolini, 2009) across alternative templates, the thesis sheds light on sequences, events, and actions of primary and secondary organisations. Although the primary organisation remains the focus of sustained media attention across the four-year time frame, the secondary organisations, even when one faced a similar starting situation to the primary organisation, were buffered by the process of transformative change. This understanding of crisis contexts in transforming environments builds on existing knowledge in crisis communication. At the action level, the thesis also reveals different interpretations from each alternative template. Coombs‘ (2006b) narrative shows persistence in the primary organisation‘s crisis or strategic responses over the four-year time frame of the thesis. That is, the primary organisation consistently applies a diminish crisis response. At times, the primary organisation drew on denial responses when corporate actors questioned its legitimacy or actions. To close the crisis, the primary organisation uses a rebuild crisis posture (Coombs, 2006). These finding are replicated in Allen and Caillouet‘s (1994) narrative, noting this template‘s limitation to communication messages only. Oliver‘s (1991) narrative is consistent with Coombs‘ (2006b) but also demonstrated a shift from a strategic response that signals conformity to the environment to one that signals more active resistance to the environment over time. Specifically, the primary organisation‘s initial response demonstrates conformity but these same messages were used some three years later to set new expectations in the environment in order to shape criteria and build acceptance for future organisational decisions. In summary, the findings demonstrate the power of crisis or strategic responses when considered over time and in the context of transformative change. The conclusions of this research contribute to scholarship in the public relations and management literatures. Based on the significance of organisational theory, the primary contribution of the theory relates to the role of interorganisational linkages or legitimacy buffers that form during the punctuation of equilibrium. The network of linkages among the corporate actors are significant also to the crisis communication literature as they form part of the process model of crisis communication under punctuated equilibrium. This model extends existing research that focuses on crisis communication of single organisations to consider the emergent context that incorporates secondary organisations as well as the localised contests of legitimacy and buffers from regulatory authorities. The thesis also provides an empirical base for punctuated equilibrium in public relations and crisis communication, extending Murphy‘s (2000) introduction of the theory to the public relations literature. In doing this, punctuated equilibrium theory reinvigorates theoretical development in crisis communication by extending existing scholarship around incrementalist approaches and demonstrating how public relations works in the context of transformative change. Further research in this area could consider using alternative templates to study transformative change caused by a range of crisis types from natural disasters to product tampering, and to add further insight into the dynamics between primary and secondary organisations. This thesis contributes to practice by providing guidelines for crisis response strategy selection and indicators related to the emergent context for crises under transformative change that will help primary and secondary organisations‘ responses to crises.

(Re)focusing the Lens to Make Diversity and Difference Visible : Teaching for Quality and Equity

Despite the evidence that Australia’s children are learning literacy, there is also significant evidence that the poorest and most disadvantaged children are being left behind. To date our understanding of the place of transitions in this has been limited, although there has been work on the fourth grade slump (Gee, 2000, 2008), the transition from primary years to secondary years (e.g. Bahr & Pendergast, 2007; Pendergast & Bahr, 2005, 2010), and transitions when changing schools (Henderson, 2008). In this chapter, we consider the notion of transitioning, as we unpack issues related to recognising and valuing student diversity and difference. We want to highlight ways of providing high quality and high equity literacy pedagogy and literacy outcomes for middle years students. We will also discuss the importance of recognising that students transit to schools and school learning from other significant contexts, each with their own combinations of literacy practices, rituals and values.

Elementary teacher’s conceptions of inquiry teaching : messages for teacher development

The advocacy for inquiry-based learning in contemporary curricula assumes the principle that students learn in their own way by drawing on direct experience fostered by the teacher. That students should be able to discover answers themselves through active engagement with new experiences was central to the thinking of eminent educators such as Pestalozzi, Dewey and Montessori. However, even after many years of research and practice, inquiry learning as a referent for teaching still struggles to find expression in the average teachers' pedagogy. This study drew on interview data from 20 elementary teachers. A phenomenographic analysis revealed three conceptions of teaching for inquiry learning in science in the elementary years of schooling: (a) The Experience- centred conception where teachers focused on providing interesting sensory experiences to students; (b) The Problem-centred conception where teachers focused on challenging students with engaging problems; and (c) The Question-centred conception where teachers focused on helping students to ask and answer their own questions. Understanding teachers' conceptions has implications for both the enactment of inquiry teaching in the classroom as well as the uptake of new teaching behaviours during professional development, with enhanced outcomes for engaging students in Science.

Collaborative inquiries into literacy, place and identity in changing policy contexts : implications for teacher development

In this chapter we describe a history of collaboration between university-based literacy researchers and school-based teachers in teacher development programs and practitioner inquiries designed to improve literacy outcomes for students living in low-socioeconomic circumstances. We consider how an inquiry stance has informed teachers working for social justice through curriculum and pedagogy designed to connect children’s developing literacy repertoires with their changing material, social and linguistic contexts. We use examples from the practices of two of our long-term teacher-collaborators to show what has been possible to achieve, even in radically different policy contexts, because of teachers’ continued commitment to themes of place and belonging, and language and identity.

The differential recognition of children’s cultural practices in middle primary literacy classrooms

This paper argues that teachers’ recognition of children’s cultural practices is an important positive step in helping socio-economically disadvantaged children engage with school literacies. Based on twenty-one longitudinal case studies of children’s literacy development over a three-year period, the authors demonstrate that when children’s knowledges and practices assembled in home and community spheres are treated as valuable material for school learning, children are more likely to invest in the work of acquiring school literacies. However they show also that whilst some children benefit greatly from being allowed to draw on their knowledge of popular culture, sports and the outdoors, other children’s interests may be ignored or excluded. Some differences in teachers’ valuing of home and community cultures appeared to relate to gender dimensions.

Successes and stresses : A case study on relations between international higher degree students in Australia and their universities.

The paper examines the situation of postgraduate international students studying in Australia, mostly at doctoral level; a group widely seen as sought-after by Australian universities and employers, though also exposed to difficulties in aspects like learning culture, language and temporary employment. The investigation follows a novel path, as an exercise in practice-led research on issues involved in Higher Degree supervision. It is in fact an exercise within an advanced program of professional development for HD research supervisors. It begins by deploying a journalistic method, to obtain and present information. This has entailed the publishing of two feature articles about the lives of scholars for Subtropic, a campus based online magazine in Brisbane, www.subtropic.com.au. The next step is a review of a set of supervisions, citing issues raised in individual cases. Parallels can be seen between the two information-getting and analytical processes, with scope for contradictions. An exegetical statement deals with supervisory issues that have been exposed, and implications for learning, with recommendations for developing the quality of the experience of these students.

Bouncing back : the role of design in facilitating students to understand and deal with adversity

After state-wide flooding and a category-5 tropical cyclone, three-quarters of the state of Queensland was declared a disaster zone in early 2011. This deluge of adversity had a significant impact on university students, a few weeks prior to the start of the academic semester. The purpose of this paper is to examine the role that design plays in facilitating students to understand and respond to, adversity. The participants of this study were second and fourth year architectural design students at a large Australian University, in Queensland. As a part of their core architectural design studies, students were required to provide architectural responses to the recent catastrophic events in Queensland. Qualitative data was obtained through student surveys, work design work submitted by students and a survey of guests who attending an exhibition of the student work. The results of this research showed that the students produced more than just the required set of architectural drawings, process journals and models, but also recognition of the important role that the affective dimension of the flooding event and the design process played in helping them to both understand and respond to, adversity. They held the ‘real world’ experience and practical aspect of the assessment in higher regard than their typical focus on aesthetics and the making of iconic design. Perhaps most importantly, the students recognised that this process allowed them to have a voice, and a means to respond to adversity through the powerful language of design.

Butterpaper, sweat & tears : the affective dimension of engaging students during the architectural critique

Considering how dominant a feature of architectural education the critique has been, and continues to be, little has been written about the affective dimension of engaging students during this key final stage of the design or documentation process. For most students, the critique is unlike any previous educational or life experience that they have ever confronted, and the abrupt change in the instructor’s role, from tutor to judge, can be disconcerting at a time when the student is feeling their most vulnerable. The fact that the period immediately leading up to the critique habitually entails not only a focused and sustained effort, but also sleepless nights of intensive work, further exacerbates this. The purpose of this paper is to recognise the affective phenomena influencing student engagement, during the critique. The participants of this research were second to fourth year architecture students at a major Australian university. Following the implementation of trials in alternative modes of critique in architectural design and technology studios, qualitative data was obtained from students, through questionnaires and interviews. Six indicators of engagement were investigated through this research: motivation and agency, transactional engagement with staff, transactional engagement with students, institutional support, active citizenship, and non-institutional support. This research confirms that affective phenomena play a significant role in the events of the critique; the relationship between instructor and student influences student engagement, as does the choreography and spatial planning of the critique environment; and these factors ultimately have an impact on the depth of student learning.

Assessing students in senior science: an analysis of questions in contextualised chemistry exams

This study explores the development of a coding system for analysing test questions in two context-based chemistry exams. We describe our unique analytical procedures before contrasting the data from both tests. Our findings indicate that when a new curriculum is developed such as a context-based curriculum, teachers are required to combine the previously separate domains of context and concept to develop contextualised assessment. We argue that constructing contextualised assessment items requires teachers to view concepts and context as interconnected rather than as separate entities that may polarise scientific endeavour. Implications for practice, curriculum and assessment-development in context-based courses are proposed.