Futility and the law: Knowledge, practice and attitudes of doctors in end of life care

Despite the potential harm to patients (and others) and the financial cost of providing futile treatment at the end of life, this practice occurs. This article reports on empirical research undertaken in Queensland that explores doctors’ perceptions about the law that governs futile treatment at the end of life, and the role it plays in medical practice. The findings reveal that doctors have poor knowledge of their legal obligations and powers when making decisions about withholding or withdrawing futile treatment at the end of life; their attitudes towards the law were largely negative; and the law affected their clinical practice and had or would cause them to provide futile treatment.

Trial of the Primary Care Practice Improvement Tool: Building organisational performance in Australian general practice and primary health care

Objective: To nationally trial the Primary Care Practice Improvement Tool (PC-PIT), an organisational performance improvement tool previously co-created with Australian primary care practices to increase their focus on relevant quality improvement (QI) activities. Design: The study was conducted from March to December 2015 with volunteer general practices from a range of Australian primary care settings. We used a mixed-methods approach in two parts. Part 1 involved staff in Australian primary care practices assessing how they perceived their practice met (or did not meet) each of the 13 PC-PIT elements of high-performing practices, using a 1–5 Likert scale. In Part 2, two external raters conducted an independent practice visit to independently and objectively assess the subjective practice assessment from Part 1 against objective indicators for the 13 elements, using the same 1–5 Likert scale. Concordance between the raters was determined by comparing their ratings. In-depth interviews conducted during the independent practice visits explored practice managers’ experiences and perceived support and resource needs to undertake organisational improvement in practice. Results: Data were available for 34 general practices participating in Part 1. For Part 2, independent practice visits and the inter-rater comparison were conducted for a purposeful sample of 19 of the 34 practices. Overall concordance between the two raters for each of the assessed elements was excellent. Three practice types across a continuum of higher- to lower-scoring practices were identified, with each using the PC-PIT in a unique way. During the in-depth interviews, practice managers identified benefits of having additional QI tools that relate to the PC-PIT elements. Conclusions: The PC-PIT is an organisational performance tool that is acceptable, valid and relevant to our range of partners and the end users (general practices). Work is continuing with our partners and end users to embed the PC-PIT in existing organisational improvement programs.

Faster pairing computations on curves with high-degree twists

Research on efficient pairing implementation has focussed on reducing the loop length and on using high-degree twists. Existence of twists of degree larger than 2 is a very restrictive criterion but luckily constructions for pairing-friendly elliptic curves with such twists exist. In fact, Freeman, Scott and Teske showed in their overview paper that often the best known methods of constructing pairing-friendly elliptic curves over fields of large prime characteristic produce curves that admit twists of degree 3, 4 or 6. A few papers have presented explicit formulas for the doubling and the addition step in Miller’s algorithm, but the optimizations were all done for the Tate pairing with degree-2 twists, so the main usage of the high- degree twists remained incompatible with more efficient formulas. In this paper we present efficient formulas for curves with twists of degree 2, 3, 4 or 6. These formulas are significantly faster than their predecessors. We show how these faster formulas can be applied to Tate and ate pairing variants, thereby speeding up all practical suggestions for efficient pairing implementations over fields of large characteristic.

The mobile phone : the new communication drum of Papua New Guinea

This thesis examines the role of mobile telephony in rural communities in Papua New Guinea (PNG). It is a threshold study which reports on research conducted in the earliest stages of mobile phone adoption in these areas. It explores the ways in which this new technology changes people’s lives, social structures and relationships. The research focuses on non-urban communities, which previously had little or no access to modern communication technologies, but which are in some cases still using traditional forms of communication such as drums. It has found that the introduction of mobile telecommunications has generally been viewed positively, although several negative concerns have been strongly felt. Specific benefits related to enhanced communication with relatives and friends living away from home villages, and use of the technology in time-critical emergencies or crises. Difficulties have arisen with respect to the cost of owning and operating a handset, as well as financial and logistical challenges when recharging handset batteries, particularly in areas with no mains electricity supply. Perceived damaging effects of mobile phone access related to sex, crime and pornography. The changes taking place are described through a social lens, by foregrounding the perceptions of villagers. The perspectives of key informants, such as telecommunication company managers, are also discussed. Employing the technique of triangulation (using different methods and sources) has helped to validate the findings of the research project. The sources constantly overlap and agree on the main themes, such as those outlined above. PNG is a developing country which performs poorly on a wide range of development indicators. A large majority of the people live outside of the major towns and cities. It is therefore worthwhile investigating the introduction of mobile phone technology in rural areas. These areas often have poor access to services, including transport, health, education and banking. Until 2007, communities in such regions fell outside of mobile phone coverage areas. In the case of all ten villages discussed in this thesis, there has never been any landline telephone infrastructure available. Therefore, this research on mobile phones is in effect documenting the first ever access to any kind of phone in these communities. This research makes a unique contribution to knowledge about the role of communication in PNG, and has implications for policy, practice and theory. In the policy arena, the thesis aids understanding of the impact which communication sector competition and regulation can have on rural and relatively isolated communities. There are three practical problems which have emerged from the research: cost, battery recharging difficulties and breakage are all major obstacles to uptake and use of mobile telephony in rural communities. Efforts to reduce usage costs, enable easier recharging, and design more robust handsets would allow for increased utilisation of mobile phones for a range of purposes. With respect to the realm of theory, this research sits amongst the most recent scholarship in the mobile phone field, located within the broader communication theory area. It recommends cautionary reading of any literature which suggests that mobile phones will reduce poverty and increase incomes in poor, rural communities in developing countries. Nonetheless, the present research adds weight to mobile phone studies which suggest that the primary advantages of mobile phones in such settings are for the satisfactions of communication of itself, and for social interaction among loved ones.

Big, bigger, best? The impact of reforms on the not-for-profit sector in Queensland

Organisations within the not-for-profit sector provide services to individuals and groups that government and for-profit organisations cannot or will not consider. The not-for-profit sector has come to be a vibrant and rich agglomeration of services and programs that operate under a myriad of philosophical stances, service orientation, client groupings and operational capacities. In Australia these organisations and services are providing social support and service assistance to many people in the community; often targeting their assistance to the most difficult of clients. Initially, in undertaking this role, the not-for-profit sector received limited sponsorship from government. Over time governments assumed greater responsibility in the form of service grants to particular groups: ‘the worthy poor’. More recently, they have entered into contractual service agreements with the not-for-profit sector, which specify the nature of the outcomes to be achieved and, to a degree, the way in which the services will be provided. A consequence of this growing shift to a more marketised model of service contracting, often offered-up under the label of enhanced collaborative practice, has been increased competitiveness between agencies that had previously worked well together (Keast and Brown, 2006). Another trend emerging from the market approach is the entrance of for-profit providers. These larger organisations have higher levels of organisational capacity with considerable organisational slack to allow them to adopt new service roles. Shaped almost as ‘shadow governments’ they appear to be a strong preference for governments looking for greater accountability of outcomes and an easier way to control the interaction with the conventional not-for-profit sector. The question is will governments’ apparent preference for larger organisational arrangements lead to the demise of the vibrancy of the not-for-profit sector and impact on service provision to those people who fall outside of the remit of the new service providers? To address this issue, this paper uses information gleaned from a state-wide survey of not-for-profit organisations in Queensland, Australia which included organisational size, operational scope, funding arrangements and governance/management approaches. Supplementing this information is qualitative data derived from 17 focus groups and 120 interviews conducted over ten years of study of this sector. The findings contribute to greater understanding of the practice and theory of the future provision of social services.

Juggling competing public values : resolving conflicting agendas in social procurement in Queensland

Organisations within the not-for-profit sector provide services to individuals and groups government and for-profit organisations cannot or will not consider. This response by the not-for-profit sector to market failure and government failure is a well understood contribution to society by the nonprofit sector. Over time, this response has resulted in the development of a vibrant and rich agglomeration of services and programs that operate under a myriad of philosophical stances, service orientations, client groupings and operational capacities. In Australia, these organisations and services provide social support and service assistance to many people in the community; often targeting their assistance to clients facing the most difficult of clients with complex problems. Initially, in undertaking this role, the not-for-profit sector received limited sponsorship from government, relying on primarily on public donations to fund the delivery of services. (Lyons 2001). Over time governments assumed greater responsibility in the form of service grants to particular groups: ‘the worthy poor’. More recently, government has engaged in widespread procurement of services from the not-for-profit sector, which specify the nature of the outcomes to be achieved and, to a degree, the way in which the services will be provided. A consequence of this growing shift to a more marketised model of service contracting, often offered-up under the label of enhanced collaborative practice, has been increased competitiveness between agencies that had previously worked well together (Keast and Brown, 2006). One of the challenges which emerge from the procurement of services by government from third sector organisations is that public values such as effectiveness, efficiency, transparency and professionalism can be neglected (Jørgensen and Bozeman 2002), although this is not always the case (Brown, Furneaux and Gudmundsson 2012). While some approaches to the examination of social procurement - the intentional purchasing of social outcomes (Furneaux and Barraket 2011) - assumes that public values are lost in social procurement arrangements (Bozeman 2002; Jørgensen and Bozeman 2002), alternative approach suggest such inevitability is not the case. Instead, social procurement is seen to involve a set of tensions (Brown, Potoski and Slyke 2006) or a set of trade offs (Charles et al. 2007), which must be managed, and through such management, public values can be potentially safeguarded (Bruin and Dicke 2006). The potential trade-offs of public values in social procurement is an area in need of further research, and one which carries both theoretical and practical significance. Additionally, the juxtaposition of policies – horizontal integration and vertical efficiency – results in a complex, crowded and contested policy and practice environment (Keast et al., 2007),, with the potential for set of unintentional consequences arising from these arrangements. Further the involvement of for-profit, non-profit, and hybrid organisations such as social enterprises, adds further complexity in the number of different organisational forms engaged in service delivery on behalf of government. To address this issue, this paper uses information gleaned from a state-wide survey of not-for-profit organisations in Queensland, Australia which included within its focus organisational size, operational scope, funding arrangements and governance/management approaches. Supplementing this information is qualitative data derived from 17 focus groups and 120 interviews conducted over ten years of study of this sector. The findings contribute to greater understanding of the practice and theory of the future provision of social services.

Queer community archives in California since 1950

Purpose: This study provides insight into the histories and current statuses of queer community archives in California and explores what the archives profession can learn from the queer community archives and archivists. Through the construction of histories of three community archives (GLBT Historical Society; Lavender Library, Archives, and Cultural Exchange of Sacramento, Inc.; and ONE National Gay & Lesbian Archives), the study discovered why these independent, community-based archives were created, the issues that influenced their evolution, and the similarities and differences among them. Additionally, it compared the community archives to institutional archives which collect queer materials to explore the similarities and differences among the archives and determine possible implications for the archives profession. Significance: The study contributes to the literature in several significant ways: it is the first in-depth comparative history of the queer community archives; it adds to the cross-disciplinary research in archives and history; it contributes to the current debates on the nature of the archives and the role of the professional archivist; and it has implications for changing archival practice. Methodology: This study used social constructionism for epistemological positioning and new social history theory for theoretical framework. Information was gathered through seven oral history interviews with community archivists and volunteers and from materials in the archives’ collections. This evidence was used to construct the histories of the archives and determine their current statuses. The institutional archives used in the comparisons are the: University of California, Berkeley’s Bancroft Library; University of California, Santa Cruz’s Special Collections and University Archives; and San Francisco Public Library’s James C. Hormel Gay and Lesbian Center. The collection policies, finding aids, and archival collections related to the queer communities at the institutional and community archives were compared to determine commonalities and differences among the archives. Findings: The findings revealed striking similarities in the histories of the community archives and important implications for the archives’ survival and their relevancy to the archives profession. Each archives was started by an individual or small group collecting materials to preserve history that would otherwise have been lost as institutional archives were not collecting queer materials. These private collections grew and became the basis for the community archives. The community archives differ in their staffing models, circulation policies, and descriptive practices. The community archives have grown to incorporate more public programming functions than most institutional archives. While in the past, the community archives had little connection to institutional archives, today they have varying degrees of partnerships. However, the historical lack of collecting queer materials by institutional archives makes some members of the communities reluctant to donate materials to institutional archives or collaborate with them. All three queer community archives are currently managed by professionally trained and educated archivists and face financial issues impacting their continued survival. The similarities and differences between the community and institutional archives include differences in collection policies, language differences in the finding aids, and differing levels of relationships between the archives. However, they share similar sensitivity in the use of language in describing the queer communities and overlap in the types of materials collected. Implications: This study supports previous research on community archives showing that communities take the preservation of history into their own hands when ignored by mainstream archives (Flinn, 2007; Flinn & Stevens, 2009; Nestle, 1990). Based on the study’s findings, institutional archivists could learn from their community archivist counterparts better ways to become involved in and relevant to the communities whose records they possess. This study also expands the understanding of history of the queer communities to include in-depth research into the archives which preserve and make available material for constructing history. Furthermore, this study supports reflective practice for archivists, especially in terms of descriptions used in finding aids. It also supports changes in graduate education for archives students to enable archivists in the United States to be more fully cognizant of community archives and able to engage in collaborative, international projects. Through this more activist role of the archivists, partnerships between the community and institutional archives would be built to establish more collaborative, respectful relationships with the communities in this post-custodial age of the archives (Stevens, Flinn, & Shepherd, 2010). Including community archives in discussions of archival practice and theory is one way of ensuring archives represent and serve a diversity of voices.

The nurse researcher : an added dimension to qualitative research methodology

Nurse researchers are increasingly adopting qualitative methodologies for research practice and theory development. These approaches to research are, in many cases, more appropriate for the field of nursing inquiry than the previously dominant techno-rational methods. However, there remains the issue of adapting methodologies developed in other academic disciplines to the nursing research context. This paper draws upon my own experience with interpretive research to raise questions about the issue of nursing research within a social science research framework. The paper argues that by integrating the characteristics of nursing practice with the characteristics of research practice, the researcher can develop a 'nursing lens', an approach to qualitative research that brings an added dimension to social science methodologies in the nursing research context. Attention is drawn to the unique nature of the nurse-patient relationship, and the ways in which this aspect of nursing practice can enhance nursing research. Examples are given from interview transcripts to support this position.

Mediating identity narratives : a case study in queer digital storytelling as everyday activism

Digital Stories are short autobiographical documentaries, often illustrated with personal photographs and narrated in the first person, and typically produced in group workshops. As a media form they offer ‘ordinary people’ the opportunity to represent themselves to audiences of their choosing; and this amplification of hitherto unheard voices has significant repercussions for their social participation. Many of the storytellers involved in the ‘Rainbow Family Tree’ case study that is the subject of this paper can be characterised as ‘everyday’ activists for their common desire to use their personal stories to increase social acceptance of marginalised identity categories. However, in conflict with their willingness to share their personal stories, many fear the risks and ramifications of distributing them in public spaces (especially online) to audiences both intimate and unknown. Additionally, while technologies for production and distribution of rich media products have become more accessible and user-friendly, many obstacles remain. For many people there are difficulties with technological access and aptitude, personal agency, cultural capital, and social isolation, not to mention availability of the time and energy requisite to Digital Storytelling. Additionally, workshop context, facilitation and distribution processes all influence the content of stories. This paper explores the many factors that make ‘authentic’ self-representation far from straight forward. I use qualitative data drawn from interviews, Digital Story texts and ethnographic observation of GLBTQIS participants in a Digital Storytelling initiative that combined face-to-face and online modes of participation. I consider mediating influences in practice and theory and draw on strategies put forth in cultural anthropology and narrative therapy to propose some practical tools for nuanced and sensitive facilitation of Digital Storytelling workshops and webspaces. Finally, I consider the implications of these facilitation strategies for voice, identity and social participation.

Co-creating knowledge online : approaches for community artists

Forming peer alliances to share and build knowledge is an important aspect of community arts practice, and these co-creation processes are increasingly being mediated by the internet. This paper offers guidance for practitioners who are interested in better utilising the internet to connect, share, and make new knowledge. It argues that new approaches are required to foster the organising activities that underpin online co-creation, building from the premise that people have become increasingly networked as individuals rather than in groups (Rainie and Wellman 2012: 6), and that these new ways of connecting enable new modes of peer-to-peer production and exchange. This position advocates that practitioners move beyond situating the internet as a platform for dissemination and a tool for co-creating media, to embrace its knowledge collaboration potential. Drawing on a design experiment I developed to promote online knowledge co-creation, this paper suggests three development phases – developing connections, developing ideas, and developing agility – to ground six methods. They are: switching and routing, engaging in small trades of ideas with networked individuals; organising, co-ordinating networked individuals and their data; beta-release, offering ‘beta’ artifacts as knowledge trades; beta-testing, trialing and modifying other peoples ‘beta’ ideas; adapting, responding to technological disruption; and, reconfiguring, embracing opportunities offered by technological disruption. These approaches position knowledge co-creation as another capability of the community artist, along with co-creating art and media.

The examined life

When I began production on my autobiographical film Orchids: My Intersex Adventure in 2004, I must admit the ethics of what I was about to do were not something I had consciously considered. Yet they encircled the work I was about to undertake in a myriad of ways...

Boys 'doing' and 'undoing' media education : new possibilities for theory and practice

The purpose of this study is to investigate how secondary school media educators might best meet the needs of students who prefer practical production work to ‘theory’ work in media studies classrooms. This is a significant problem for a curriculum area that claims to develop students’ media literacies by providing them with critical frameworks and a metalanguage for thinking about the media. It is a problem that seems to have become more urgent with the availability of new media technologies and forms like video games. The study is located in the field of media education, which tends to draw on structuralist understandings of the relationships between young people and media and suggests that students can be empowered to resist media’s persuasive discourses. Recent theoretical developments suggest too little emphasis has been placed on the participatory aspects of young people playing with, creating and gaining pleasure from media. This study contributes to this ‘participatory’ approach by bringing post structuralist perspectives to the field, which have been absent from studies of secondary school media education. I suggest theories of media learning must take account of the ongoing formation of students’ subjectivities as they negotiate social, cultural and educational norms. Michel Foucault’s theory of ‘technologies of the self’ and Judith Butler’s theories of performativity and recognition are used to develop an argument that media learning occurs in the context of students negotiating various ‘ethical systems’ as they establish their social viability through achieving recognition within communities of practice. The concept of ‘ethical systems’ has been developed for this study by drawing on Foucault’s theories of discourse and ‘truth regimes’ and Butler’s updating of Althusser’s theory of interpellation. This post structuralist approach makes it possible to investigate the ways in which students productively repeat and vary norms to creatively ‘do’ and ‘undo’ the various media learning activities with which they are required to engage. The study focuses on a group of year ten students in an all boys’ Catholic urban school in Australia who undertook learning about video games in a three-week intensive ‘immersion’ program. The analysis examines the ethical systems operating in the classroom, including formal systems of schooling, informal systems of popular cultural practice and systems of masculinity. It also examines the students’ use of semiotic resources to repeat and/or vary norms while reflecting on, discussing, designing and producing video games. The key findings of the study are that students are motivated to learn technology skills and production processes rather than ‘theory’ work. This motivation stems from the students’ desire to become recognisable in communities of technological and masculine practice. However, student agency is not only possible through critical responses to media, but through performative variation of norms through creative ethical practices as students participate with new media technologies. Therefore, the opportunities exist for media educators to create the conditions for variation of norms through production activities. The study offers several implications for media education theory and practice including: the productive possibilities of post structuralism for informing ways of doing media education; the importance of media teachers having the autonomy to creatively plan curriculum; the advantages of media and technology teachers collaborating to draw on a broad range of resources to develop curriculum; the benefits of placing more emphasis on students’ creative uses of media; and the advantages of blending formal classroom approaches to media education with less formal out of school experiences.

Creating successful cultural Brokers : the pros and cons of a community of practice approach in arts management education

Arts managers play a critical role in creating a strong, sustainable arts and cultural sector. They operate as brokers, creating programs, and, more critically, coordinating the relationships between artists, audiences, communities, governments and sponsors required to make these programs a success. Based on study of model developed for a subject in the Master of Creative Industries (Creative Production & Arts Management) at Queensland University of Technology (QUT), this paper examines the pros and cons of a “community of practice” approach in training arts management students to act as cultural brokers. It provides data on the effectiveness of a range of activities – including Position Papers, Case Studies, Masterclasses, and offline and online conversations – that can be used facilitate the peer-to-peer engagement by which students work together to build their cultural brokering skills in a community of practice. The data demonstrates that, whilst students appreciate this approach, educators must provide enough access to voices of authority – that is, to arts professionals – to establish a well-functioning community of practice, and ensure that more expert students do not become frustrated when they are unwittingly and unwillingly thrust into this role by less expert classmates. This is especially important in arts management, where classes are always diverse, due to the fact that most dedicated programs in Australia, as in the US, UK and Europe, are taught via small-scale programs at graduate level which accept applicants from a wide variety of arts and non-arts backgrounds.