The Australian Palliative Care Outcomes Collaboration (PCOC) : measuring the quality and outcomes of palliative care on a routine basis

Australia is leading the way in establishing a national system (the Palliative Care Outcomes Collaboration – PCOC) to measure the outcomes and quality of specialist palliative care services and to benchmark services across the country. This article reports on analysis of data collected routinely at point-of-care on 5939 patients treated by the first fifty one services that voluntarily joined PCOC. By March 2009, 111 services have agreed to join PCOC, representing more than 70% of services and more than 80% of specialist palliative care patients nationally. All states and territories are involved in this unique process that has involved extensive consultation and infrastructure and close collaboration between health services and researchers. The challenges of dealing with wide variation in outcomes and practice and the progress achieved to date are described. PCOC is aiming to improve understanding of the reasons for variations in clinical outcomes between specialist palliative care patients and differences in service outcomes as a critical step in an ongoing process to improve both service quality and patient outcomes. What is known about the topic? Governments internationally are grappling with how best to provide care for people with life limiting illnesses and how best to measure the outcomes and quality of that care. There is little international evidence on how to measure the quality and outcomes of palliative care on a routine basis. What does this paper add? The Palliative Care Outcomes Collaboration (PCOC) is the first effort internationally to measure the outcomes and quality of specialist palliative care services and to benchmark services on a national basis through an independent third party. What are the implications for practitioners? If outcomes and quality are to be measured on a consistent national basis, standard clinical assessment tools that are used as part of everyday clinical practice are necessary.

Attraction and image for the Australian rail industry

Despite the global financial downturn, the Australian rail industry is in a period of expansion. Reports indicate that the industry is not attracting sufficient entry level and mid-career engineers and skilled technicians from within the Australian labour market and is facing widespread retirements from an ageing workforce. This paper reports on a completed qualitative study that explores the perceptions of engineering students, their lecturers, careers advisors and recruitment consultants regarding rail as a brand and of careers in the rail industry. Findings are presented about career knowledge, job characteristic preferences, branding and image and indicate that rail as a brand has a dated image, that young people and their influencers have little knowledge of rail careers and that rail could better focus its image and recruitment strategies. Conclusions include suggestions for more effective attraction and image strategies for the industry and for further research.

The association between MC1R genotype and BRAF mutation status in cutaneous melanoma : findings from an Australian population

There is increasing epidemiological and molecular evidence that cutaneous melanomas arise through multiple causal pathways. The purpose of this study was to explore the relationship between germline and somatic mutations in a population-based series of melanoma patients to reshape and refine the divergent pathway model for melanoma. Melanomas collected from 123 Australian patients were analyzed for melanocortin-1 receptor (MC1R) variants and mutations in the BRAF and NRAS genes. Detailed phenotypic and sun exposure data were systematically collected from all patients. We found that BRAF-mutant melanomas were significantly more likely from younger patients and those with high nevus counts, and were more likely in melanomas with adjacent neval remnants. Conversely, BRAF-mutant melanomas were significantly less likely in people with high levels of lifetime sun exposure. We observed no association between germline MC1R status and somatic BRAF mutations in melanomas from this population. BRAF-mutant melanomas have different origins from other cutaneous melanomas. These data support the divergent pathways hypothesis for melanoma, which may require a reappraisal of targeted cancer prevention activities.

Airports of the future : incident response planning in Australian airports

Airports are typical examples of large and complex infrastructure systems. They serve a purpose of not only transporting people around the globe but are central to trade and commerce and, in a nation as large as Australia, an important means to connect people and regions. Reducing uncertainty and managing risk in such systems are not only critical tasks integral to effective management practice but equally important for border protection and national security outcomes. This latter issue has been emphasised on a national level in Australia with a number of recent enquiries taking place, most notably the Wheeler Review1 into aviation security in 2005 and the 2009 National Aviation Policy White Paper2 on the future of aviation in Australia.

Improvement through people for the emerging new work practices in manufacturing

This paper describes the changes occurring in manufacturing industries and their effect on knowledge and skills necessary to perform effectively in the new environments. The changes in knowledge and skills are presented as a summary to illustrate the extent of the change. The concept of multiskilling is used to conceptualise the emerging new knowledge and skills and finally some guidelines for designing training programs to acquire multiskilling are presented.

Policing lesbian, gay, bisexual and transgender young people : a gap in the research literature

This article argues for exploring lesbian, gay, bisexual, and transgender (LGBT) young people’s experiences with police. While research examines how factors such as indigeneity influence young peoples’ experiences with police, how sexuality and/or gender identity mediates these relationships remains largely unexplored. Key bodies of research suggest a need to explore this area further, including: literature documenting links between homophobic violence against LGBT young people and outcomes such as homelessness that fall within the gambit of policing work; research showing reluctance of LGBT communities to report crime to police; international research documenting homophobic police attitudes and Australian research demonstrating arguably homophobic court outcomes; and research outlining increasing police support of LGBT communities. Drawing on these bodies of literature, this article argues that LGBT young people experience policing warrants further research.

'Live your liberation - don't lobby for it' : Australian queer student activists' perspectives of same-sex marriage

One topic covered in Australian queer university student print media is the legalization of same-sex marriage. The legalization of same-sex marriage is currently generating much debate in Western queer communities. This paper explores Australian queer university student activists’ media representation of same-sex marriage, and the debates surrounding its legalization. It uses discourse analysis to examine a selection of queer student media from four metropolitan Australian universities, and the 2003 and 2004 editions of the national queer student publication Querelle. This paper thus contributes to the history of queer activism, documenting what one group of young people say about the legalization of same-sex marriage, and furthers research on queer perspectives of marriage and same-sex relationships.

Communicating friendships : a case study of women in an Australian 'seachange' town

This thesis proposes =friendworks‘ as an important sub-group of social networks, comprised of networks of friends. It investigates friendworks of a particular group of adult Australian women as a way of understanding neglected aspects of social networking practices. Friendworks are contextualised to highlight two main themes of interest: population mobility and communication practices. The impact of relocation on individuals, local communities and the wider society is explored through a case study of female friendworks in a seachange community. Research findings point to the importance of friendworks in building and cohering social and emotional support, well-being, belonging and senses of place and community. Different types of communication methods were used by research participants for mediating different kinds of social ties within the friendworks considered here. Communication patterns were influenced by geographical proximity to friends, and the type of social support required of them (emotional, instrumental or companionship). Most findings were consistent with broader social patterns of communication. For example, face-to-face interactions were the dominant and most favoured communication method between local friends, regardless of whether they were weak or strong ties. The fixed-telephone and the internet were commonly in use to maintain old and geographically distant social ties, while mobile phones were used the least among friends in comparison with other communication methods. The key finding of this thesis is that friendworks are an extremely important solid network in contemporary society, providing mooring relations in a mobile world. Paradoxically, however, for women in this study, the mobile phone, which is popularly perceived as a flexible, multi-purpose communication technology for people on the move, was the least versatile of all technologies for maintaining friendworks. The cost of services was the main inhibitor here. The internet was found to be the most versatile communication technology and was used to support various types of social ties: strong, weak, local and distant. This thesis also highlights the value of the concept of friendworks as well as networks for communication research and policy investigating individuals‘ motivations and practices.

A national English curriculum far all Australian youth: Making it work for teacher and students everywhere

The authors draw on some powerful practitioner research they have been associated with recently to nvision ways in which a national curriculum might redress the inequities experienced by Australia's most disadvantaged young people.

Does pornography harm young people?

In recent debates about the regulation of technologies that deliver pornographic content, the greatest concerns have been about the increasing ease with which young people can access such material. Because of the ethical difficulties in researching this topic, little data has been available on the potential harm done to young people by exposure to pornography. This paper gathers a number of data sources that address this issue indirectly—including the results of our own survey of over 1000 consumers of pornography—to explore this issue. Research shows that healthy sexual development includes natural curiosity about sexuality. Retrospective studies show that accidental exposure to real-life scenes of sexuality does not harm children. Our survey shows that age of first exposure to pornography does not correlate with negative attitudes towards women. Studies with non-explicit representations of sexuality show that young people who seek out sexualised representations tend to be those with a pre-existing interest in sexuality. These studies also suggest that current generations of children are no more sexualised than previous generations, that they are not innocent about sexuality, and that a key negative effect of this knowledge is the requirement for them to feign ignorance in order to satisfy adults’ expectations of them. Research also suggests important differences between pre- and post-pubescent attitudes towards pornography, and that pornography is not addictive.

Sound in the Aboriginal Australian Films of Rolf de Heer

Anna Hickey-Mody and Melissa Iocca invented a new name for the cinema-goer at "Bad Boy Bubby" (1993) when they wrote: "In de Heer's film, the viewer is primarily a listener, or aurator, and secondly a spectator" and I have argued the label 'aurator' can also be used for the person experiencing "Ten Canoes" (2006). This Aboriginal Australian Dreamtime fable features dialogue recorded entirely in the Ganalbingu language of the Indigenous people it stars, and is a prime example of what I would suggest can be labeled 'The Aboriginal Australian Films of Rolf de Heer'. "The Tracker" (2002) and "Dr. Plonk" (2007) have also included depictions of Aboriginal Australians and each of the trio utilizes Cat Hope's "innovative sound ideas" to present what I argue is an aural auteur's signature revealing a post-colonial Australian world-view that privileges the justice system and eco-spirituality of Aboriginal Australians.

Marking the liminal for true blue Aussies : the generic placement of Aboriginality in Australian soap operas.

This paper addresses a previously unconsidered history — that of Aboriginal characters in Australian soap operas. Rejecting critical approaches which have obtained even into the 1990s, it refuses to judge these characters as 'good' or 'bad' manifestations of indigeneity. Rather, using the idea that genre is a way of closing down interpretive possibilities, the paper looks at the manner in which generic expectations around soap operas produce particular valences for these representations of Aboriginality. It points to the many ways in which these indigenous characters are insistently constructed as liminal in soap operas' structural communities - simultaneously inside and outside of the group. This is seen to accord with the suggestions of Jakubowicz et al about the ways in which Aboriginal people are positioned by wider social discourses.

Challenging the assumptions of positivism : an analysis of the concept of society in Sampi on behalf of the Bardi and Jawi people v Western Australia [2010] and Bodney v Bennell [2008]

The requirement to prove a society united by a body of law and customs to establish native title rights has been identified as a major hurdle to achieving native title recognition. The recent appeal decision of the Federal Court in Sampi on behalf of the Bardi and Jawi People v Western Australia [2010] opens the potential for a new judicial interpretation of society based on the internal view of native title claimants. The decision draws on defining features of legal positivism to inform the court’s findings as to the existence of a single Bardi Jawi society of ‘one people’ living under ‘one law’. The case of Bodney v Bennell [2008] is analysed through comparitive study of how the application of the received positivist framework may limit native title recognition. This paper argues that the framing of Indigenous law by reference to Western legal norms is problematic due to the assumptions of legal positivism and that an internal view based on Indigenous worldviews, which see law as intrinsically linked to the spiritual and ancestral connection to country, is more appropriate to determine proof in native title claims.

An examination of the relationships between lifestyle factors and mental health among Australian midlife and older women

Background It is well known that lifestyle factors including overweight/obesity, physical inactivity, smoking and alcohol use are largely related with morbidity and mortality of chronic diseases including diabetes and cardiovascular diseases. The effect of lifestyle factors on people’s mental health who have a chronic disease is less defined in the research. The World Health Organisation has defined health as “a state of complete physical, mental and social well-being”. It is important, therefore to develop an understanding of the relationships between lifestyle and mental health as this may have implications for maximising the efficacy of health promotion in people with chronic diseases. Objectives The overall aim of the research was to examine the relationships between lifestyle factors and mental health among Australian midlife and older women. Methodology The current research measured four lifestyle factors including weight status, physical activity, smoking and alcohol use. Three interconnecting studies were undertaken to develop a comprehensive understanding of the relationships between lifestyle factors and mental health. Study 1 investigated the longitudinal effect of lifestyle factors on mental health by using midlife and older women randomly selected from the community. Study 2 adopted a cross-sectional design, and compared the effect of lifestyle factors on mental health between midlife and older women with and without diabetes. Study 3 examined the mediating effect of self-efficacy in the relationships between lifestyle factors and mental health among midlife and older women with diabetes. A questionnaire survey was chosen as the means to gather information, and multiple linear regression analysis was conducted as the primary statistical approach. Results The research showed that the four lifestyle factors including weight status, physical activity, smoking and alcohol use did impact on mental health among Australian midlife and older women. First, women with a higher BMI had lower levels of mental health than women with normal weight, but as women age, the mental health of women who were overweight and obese becomes better than that of women with normal weight. Second, women who were physically active had higher levels of mental health than those who were not. Third, smoking adversely impacted on women’s mental health. Finally, those who were past-drinkers had less anxiety symptoms than women who were non-drinkers as they age. Women with diabetes appeared to have lower levels of mental health compared to women without. However, the disparities of mental health between two groups were confounded by low levels of physical activity and co-morbidities. This finding underlines the effect of physical activity on women’s mental health, and highlights the potential of reducing the gap of mental health by promoting physical activity. In addition, self-efficacy was shown to be the mediator of the relationships between BMI, physical activity and depression, suggesting that enhancing people’s self-efficacy may be useful for mental health improvement. Conclusions In conclusion, Australian midlife and older women who live with a healthier lifestyle have higher levels of mental health. It is suggested that strategies aiming to improve people’s mental health may be more effective if they focus on enhancing people’s self-efficacy levels. This study has implications to both health education and policy development. It indicates that health professionals may need to consider clients’ mental health as an integrated part of lifestyle changing process. Furthermore, given that lifestyle factors impact on both physical and mental health, lifestyle modification should continue to be the focus of policy development.