Hepatitis C, mental health and equity of access to antiviral therapy : a systematic narrative review

Introduction Access to hepatitis C (hereafter HCV) antiviral therapy has commonly excluded populations with mental health and substance use disorders because they were considered as having contraindications to treatment, particularly due to the neuropsychiatric effects of interferon that can occur in some patients. In this review we examined access to HCV interferon antiviral therapy by populations with mental health and substance use problems to identify the evidence and reasons for exclusion. Methods We searched the following major electronic databases for relevant articles: PsycINFO, Medline, CINAHL, Scopus, Google Scholar. The inclusion criteria comprised studies of adults aged 18 years and older, peer-reviewed articles, date range of (2002--2012) to include articles since the introduction of pegylated interferon with ribarvirin, and English language. The exclusion criteria included articles about HCV populations with medical co-morbidities, such as hepatitis B (hereafter HBV) and human immunodeficiency virus (hereafter HIV), because the clinical treatment, pathways and psychosocial morbidity differ from populations with only HCV. We identified 182 articles, and of these 13 met the eligibility criteria. Using an approach of systematic narrative review we identified major themes in the literature. Results Three main themes were identified including: (1) pre-treatment and preparation for antiviral therapy, (2) adherence and treatment completion, and (3) clinical outcomes. Each of these themes was critically discussed in terms of access by patients with mental health and substance use co-morbidities demonstrating that current research evidence clearly demonstrates that people with HCV, mental health and substance use co-morbidities have similar clinical outcomes to those without these co-morbidities. Conclusions While research evidence is largely supportive of increased access to interferon by people with HCV, mental health and substance use co-morbidities, there is substantial further work required to translate evidence into clinical practice. Further to this, we conclude that a reconsideration of the appropriateness of the tertiary health service model of care for interferon management is required and exploration of the potential for increased HCV care in primary health care settings.

Facebook, telecollaboration, and international access to technology in the classroom

This study uses the well-known social networking site, Facebook (FB), for a study of differences in perceptions on the use of technologies in the classroom around the world. This study is part of a larger project exploring telecollaboration and the use of online discussions between graduate students in an online masters program based in Australia and students in the graduate education program at a regional university in Greece. Postings reveal more similarities between the situations and perceptions of the participants from the different countries than differences. Most participants indicated that while they and their students had access in general to computers and the internet, they did not necessarily have this access in the classroom. Even when technologies were available in schools, participants identified a critical need for professional development to increase teachers’ use of ICT. These findings are relevant to educators and policy development in terms of implementation of ICT or social networking in the language classroom.

Access to commercial destinations within the neighbourhood and walking among Australian older adults

BACKGROUND: Physical activity, particularly walking, is greatly beneficial to health; yet a sizeable proportion of older adults are insufficiently active. The importance of built environment attributes for walking is known, but few studies of older adults have examined neighbourhood destinations and none have investigated access to specific, objectively-measured commercial destinations and walking. METHODS: We undertook a secondary analysis of data from the Western Australian state government's health surveillance survey for those aged 65--84 years and living in the Perth metropolitan region from 2003--2009 (n = 2,918). Individual-level road network service areas were generated at 400 m and 800 m distances, and the presence or absence of six commercial destination types within the neighbourhood service areas identified (food retail, general retail, medical care services, financial services, general services, and social infrastructure). Adjusted logistic regression models examined access to and mix of commercial destination types within neighbourhoods for associations with self-reported walking behaviour. RESULTS: On average, the sample was aged 72.9 years (SD = 5.4), and was predominantly female (55.9%) and married (62.0%). Overall, 66.2% reported some weekly walking and 30.8% reported sufficient walking (>=150 min/week). Older adults with access to general services within 400 m (OR = 1.33, 95% CI = 1.07-1.66) and 800 m (OR = 1.20, 95% CI = 1.02-1.42), and social infrastructure within 800 m (OR = 1.19, 95% CI = 1.01-1.40) were more likely to engage in some weekly walking. Access to medical care services within 400 m (OR = 0.77, 95% CI = 0.63-0.93) and 800 m (OR = 0.83, 95% CI = 0.70-0.99) reduced the odds of sufficient walking. Access to food retail, general retail, financial services, and the mix of commercial destination types within the neighbourhood were all unrelated to walking. CONCLUSIONS: The types of neighbourhood commercial destinations that encourage older adults to walk appear to differ slightly from those reported for adult samples. Destinations that facilitate more social interaction, for example eating at a restaurant or church involvement, or provide opportunities for some incidental social contact, for example visiting the pharmacy or hairdresser, were the strongest predictors for walking among seniors in this study. This underscores the importance of planning neighbourhoods with proximate access to social infrastructure, and highlights the need to create residential environments that support activity across the life course.

Media and information literacy : policy and strategy guidelines

In the evolving knowledge societies of today, some people are overloaded with information, others are starved for information. Everywhere, people are yearning to freely express themselves,to actively participate in governance processes and cultural exchanges. Universally, there is a deep thirst to understand the complex world around us. Media and Information Literacy (MIL) is a basis for enhancing access to information and knowledge, freedom of expression, and quality education. It describes skills, and attitudes that are needed to value the functions of media and other information providers, including those on the Internet, in societies and to find, evaluate and produce information and media content; in other words, it covers the competencies that are vital for people to be effectively engaged in all aspects of development.

Equal access to the opportunities available? Equity and diversity laws and policies in Australia

Australia has been populated for more than 40,000 years with Indigenous Australians joined by European settlers only 230 years ago. The first settlers consisted of convicts from more than 28 countries and members of the British army who arrived in 1788 to establish a British penal colony. Mass migration in the nineteenth century with one and a half million immigrants from Europe, principally from the United Kingdom and Ireland (Haines and Shlomowitz, 1992), established the continent as an Anglo society in the Pacific. In the twentieth century immigrants came from many European countries and in the latter decades from many parts of Asia and the Middle East (Collins, 1991, pp.10-13). In the 21st century Australia has an ethnically and culturally diverse population. The original Indigenous population of Australia accounts for approximately 460,000 or 2.5 per cent of the total population (ABS, 2006a). Estimates are that around 4.5m. persons in the population (close to 20 per cent), were born outside Australia with the majority of these arriving from Europe, principally the United Kingdom, and New Zealand (ABS, 2006b). Like many other countries, Australia has a legacy of discrimination and inequality in employment. Propelled by racist ideologies and the male breadwinner ideology, Indigenous Australians, and non-European immigrants, and women were barred from certain jobs and paid less for their work than any white male counterpart. These conditions were legally sanctioned through the industrial relations system and other laws in the nineteenth and first half of the twentieth century. Since the 1960s a dramatic change has occurred in social policy and national legislation and Australia today has an extensive array of laws which forbid employment discrimination on race, ethnicity, gender and many other characteristics, and other approaches which promote proactive organizational plans and actions to achieve equity in employment. This chapter outlines these developments.

Open access to infinite content (or "in praise of law reviews")

This Article is about legal scholarly publication in a time of plenitude. It is an attempt to explain why the most pressing questions in legal scholarly publishing are about how we ensure access to an infinity of content. It explains why standard assumptions about resource scarcity in publication are wrong in general, and how the changes in the modality of publication affect legal scholarship. It talks about the economics of open access to legal material, and how this connects to a future where there is infinite content. And because student-edited law reviews fit this future better than their commercially-produced, peer-refereed cousins, this Article is, in part, a defense of the crazy-beautiful institution that is the American law review.

SCRAMSPACE : Radical-Farming Scramjet for access to space

Scramjet-based launch systems offer considerable promise for safe, reliable and economical access to space. A general Scramjets introduction is first provided, followed by the specifics of Australian Scramjet Research and the recent progress in inlet-injection radical-farming scramjets as part of the SCRAMSPACE program. Through both flight and ground tests, leveraging Australias world leadership in scramjet R&D, the SCRAMSPACE project is designed to answer key scientific and technological questions and build an industry-ready talent pool for a future Australian space industry. An extensive descriptions of all phases of the development of the SCRAMSPACE I scramjet-powered free-flight experiment are described in these lecture notes.

Does the housing market respond to information disclosure? : Effects of toxicity indices in Japan

The policy instruments that provide information on a firm's or facility's environmental performance, such as the U.S. Toxic Release Inventory (TRI) and the Pollutant Release and Transfer Register system (PRTRs) used in some European countries and Japan, play an important role in encouraging firms or facilities to improve their environmental performance, if investors, consumers and residents recognize their environmental performance. This study uses a hedonic approach to explore how the Japanese rental housing market responds to carcinogenic risk arising from releases and transfers of chemical substances produced and used at close facilities. We found that residents do not perceive carcinogenic risk generated more than 1.0 km away from their residence and that they seem to recognize the increased carcinogenic risk at distances from 0.5 km to 1.0 km away; a 1% increase in carcinogenic risk reduces the average rent by 0.0007%. The distance at which residents perceive the risk arising from such facilities is less than in previous studies. This suggests that the risk perception recognized in previous studies may capture the other externalities in addition to the chemical risk because the risk is measured by the distance.

The game of clones and the Australia tax : divergent views about copyright business models and the willingness of Australian consumers to infringe

It is often said that Australia is a world leader in rates of copyright infringement for entertainment goods. In 2012, the hit television show, Game of Thrones, was the most downloaded television show over bitorrent, and estimates suggest that Australians accounted for a plurality of nearly 10% of the 3-4 million downloads each week. The season finale of 2013 was downloaded over a million times within 24 hours of its release, and again Australians were the largest block of illicit downloaders over BitTorrent, despite our relatively small population. This trend has led the former US Ambassador to Australia to implore Australians to stop 'stealing' digital content, and rightsholders to push for increasing sanctions on copyright infringers. The Australian Government is looking to respond by requiring Internet Service Providers to issue warnings and potentially punish consumers who are alleged by industry groups to have infringed copyright. This is the logical next step in deterring infringement, given that the operators of infringing networks (like The Pirate Bay, for example) are out of regulatory reach. This steady ratcheting up of the strength of copyright, however, comes at a significant cost to user privacy and autonomy, and while the decentralisation of enforcement reduces costs, it also reduces the due process safeguards provided by the judicial process. This article presents qualitative evidence that substantiates a common intuition: one of the major reasons that Australians seek out illicit downloads of content like Game of Thrones in such numbers is that it is more difficult to access legitimately in Australia. The geographically segmented way in which copyright is exploited at an international level has given rise to a ‘tyranny of digital distance’, where Australians have less access to copyright goods than consumers in other countries. Compared to consumers in the US and the EU, Australians pay more for digital goods, have less choice in distribution channels, are exposed to substantial delays in access, and are sometimes denied access completely. In this article we focus our analysis on premium film and television offerings, like Game of Thrones, and through semi-structured interviews, explore how choices in distribution impact on the willingness of Australian consumers to seek out infringing copies of copyright material. Game of Thrones provides an excellent case study through which to frame this analysis: it is both one of the least legally accessible television offerings and one of the most downloaded through filesharing networks of recent times. Our analysis shows that at the same time as rightsholder groups, particularly in the film and television industries, are lobbying for stronger laws to counter illicit distribution, the business practices of their member organisations are counter-productively increasing incentives for consumers to infringe. The lack of accessibility and high prices of copyright goods in Australia leads to substantial economic waste. The unmet consumer demand means that Australian consumers are harmed by lower access to information and entertainment goods than consumers in other jurisdictions. The higher rates of infringement that fulfils some of this unmet demand increases enforcement costs for copyright owners and imposes burdens either on our judicial system or on private entities – like ISPs – who may be tasked with enforcing the rights of third parties. Most worryingly, the lack of convenient and cheap legitimate digital distribution channels risks undermining public support for copyright law. Our research shows that consumers blame rightsholders for failing to meet market demand, and this encourages a social norm that infringing copyright, while illegal, is not morally wrongful. The implications are as simple as they are profound: Australia should not take steps to increase the strength of copyright law at this time. The interests of the public and those of rightsholders align better when there is effective competition in distribution channels and consumers can legitimately get access to content. While foreign rightsholders are seeking enhanced protection for their interests, increasing enforcement is likely to increase their ability to engage in lucrative geographical price-discrimination, particularly for premium content. This is only likely to increase the degree to which Australian consumers feel that their interests are not being met and, consequently, to further undermine the legitimacy of copyright law. If consumers are to respect copyright law, increasing sanctions for infringement without enhancing access and competition in legitimate distribution channels could be dangerously counter-productive. We suggest that rightsholders’ best strategy for addressing infringement in Australia at this time is to ensure that Australians can access copyright goods in a timely, affordable, convenient, and fair lawful manner.

An economic case for providing free access to antiretroviral therapy for HIV-positive people in South Australia

Background As financial constraints can be a barrier to accessing HIV antiretroviral therapy (ART), we argue for the removal of copayment requirements from HIV medications in South Australia. Methods Using a simple mathematical model informed by available behavioural and biological data and reflecting the HIV epidemiology in South Australia, we calculated the expected number of new HIV transmissions caused by persons who are not currently on ART compared with transmissions for people on ART. The extra financial investment required to cover the copayments to prevent an HIV infection was compared with the treatment costs saved due to averting HIV infections. Results It was estimated that one HIV infection is prevented per year for every 31.4 persons (median, 24.0–42.7 interquartile range (IQR)) who receive treatment. By considering the incremental change in costs and outcomes of a change in program from the current status quo, it would cost the health sector $17 860 per infection averted (median, $13 651–24 287 IQR) if ART is provided as a three-dose, three-drug combination without requirements for user-pay copayments. Conclusions The costs of removing copayment fees for ART are less than the costs of treating extra HIV infections that would result under current conditions. Removing the copayment requirement for HIV medication would be cost-effective from a governmental perspective.

How does access to development finance shape our cities?

In market economies the built environment is largely the product of private sector property development. Property development is a high-risk entrepreneurial activity executing expensive projects with long gestation periods in an uncertain environment and into an uncertain future. Risk lies at the core of development: the developer manages the multiple risks of development and it is the capital injection and financing that is placed at risk. From the developer's perspective the search for development capital is a quest: to access more finance, over a longer term, with fewer conditions and at lower rates. From the supply angle, capital of various sources - banks, insurance companies, superannuation funds, accumulated firm profits, retail investors and private equity - is always seeking above market returns for limited risk. Property development presents one potentially lucrative, but risky, investment opportunity. Competition for returns on capital produces a continual dynamic evolution of methods for funding property developments. And thus the relationship between capital and development and the outcomes for the built environment are in a restless continual evolution. Little is documented about the ways development is financed in Australia and even less of the consequences for cities. Using publicly available data sources and examples of different development financing from Australian practice, this paper argues that different methods of financing development have different outcomes and consequences for the built environment. This paper also presents an agenda for further research into these themes.

Improving access to housing for low-income communities in Dhaka: From rhetoric to reality in community participation

The research explores how community participation can address affordable housing problems of the poor in Dhaka. The research, based on extensive interviews, community focus groups and household surveys in different Dhaka slums, identifies the limiting factors to promote community participation in affordable housing creation. In Dhaka housing options for poor are currently limited to affordable shelters in informal settlements. Public housing programs have failed to reach the poor and meet affordability levels due to a number of factors including lack of beneficiary participation. Beneficiary participation, though widely recognized for success in housing initiatives, often deteriorates in process of implementation into mere involvement, not reflecting community needs and aspirations and thus failing to meet its core objectives. This research identified the most significant impediments as well as opportunities to advance participation in their own housing provisions in Dhaka city.

Access to the Internet Submission to ALRC IP 46

This submission is directed to issues arising in respect of the need to recognise and support access to the internet for all Australian residents and citizens. As such it addresses the following questions only: Questions 2-1: What general principles or criteria should be applied to help determine whether a law that interferes with freedom of speech is justified? Question 2-2: Which Commonwealth laws unjustifiably interfere with freedom of speech, and why are these laws unjustified?

Cross cultural similarities in using mobile technologies to engage and connect with students

The access to mobile technologies is growing at an exponential rate in developed and developing countries, with some developing countries surpassing developed countries in terms of device ownership. It is both the demand for, and high usage of mobile technologies that have driven new and emerging pedagogical practices in higher education. These technologies have also exponentially increased access to information in a knowledge economy. While differences are often drawn between developing and developed countries in terms of the access and use of information and communication technologies (ICT), this paper will report on a study detailing how higher education students use mobile technologies and social media in their studies and in their personal lives. It will contrast the similarities in how students from an Australian and Vietnamese university access and use mobile and social media technologies while also highlighting ways in which these technologies can be embraced by academics to connect and engage with students.