Study protocol : establishing good relationships between patients and health care providers while providing cardiac care. Exploring how patient-clinician engagement contributes to health disparities between indigenous and non-indigenous Australians in South Australia

Abstract Background: Studies that compare Indigenous Australian and non-Indigenous patients who experience a cardiac event or chest pain are inconclusive about the reasons for the differences in-hospital and survival rates. The advances in diagnostic accuracy, medication and specialised workforce has contributed to a lower case fatality and lengthen survival rates however this is not evident in the Indigenous Australian population. A possible driver contributing to this disparity may be the impact of patient-clinician interface during key interactions during the health care process. Methods/Design: This study will apply an Indigenous framework to describe the interaction between Indigenous patients and clinicians during the continuum of cardiac health care, i.e. from acute admission, secondary and rehabilitative care. Adopting an Indigenous framework is more aligned with Indigenous realities, knowledge, intellects, histories and experiences. A triple layered designed focus group will be employed to discuss patient-clinician engagement. Focus groups will be arranged by geographic clusters i.e. metropolitan and a regional centre. Patient informants will be identified by Indigenous status (i.e. Indigenous and non-Indigenous) and the focus groups will be convened separately. The health care provider focus groups will be convened on an organisational basis i.e. state health providers and Aboriginal Community Controlled Health Services. Yarning will be used as a research method to facilitate discussion. Yarning is in congruence with the oral traditions that are still a reality in day-to-day Indigenous lives. Discussion: This study is nestled in a larger research program that explores the drivers to the disparity of care and health outcomes for Indigenous and non-Indigenous Australians who experience an acute cardiac admission. A focus on health status, risk factors and clinical interventions may camouflage critical issues within a patient-clinician exchange. This approach may provide a way forward to reduce the appalling health disadvantage experienced within the Indigenous Australian communities. Keywords: Patient-clinician engagement, Qualitative, Cardiovascular disease, Focus groups, Indigenous

Determining reverse salient types and evolutionary dynamics of technology systems with performance disparities

Technological system evolution is marked by the uneven evolution of constituent sub-systems. Subsequently, system evolution is hampered by the resulting state of unevenness, or reverse salience, which results from the presence of the sub-system that delivers the lowest level of performance with respect to other sub-systems, namely, the reverse salient. In this paper, we develop absolute and proportional performance gap measures of reverse salience and, in turn, derive a typology of reverse salients that distinguishes alternative dynamics of change in the evolving system. We subsequently demonstrate the applicability of the measures and the typology through an illustrative empirical study of the PC (personal computer) technological system that functions as a gaming platform. Our empirical analysis demonstrates that patterns of temporal dynamics can be distinguished with the measurement of reverse salience, and that distinct paths of technological system evolution can be identified as different types of reverse salients emerge over time.

Adding paths to resilience and daily accounts to an already rich field of inquiry: A brief commentary on James Jackson's "Social structure and health disparities"

In absolute terms, there have been improvements in social resources for all racial and ethnic groups in the United States. The rise in education levels among blacks and Hispanics, for instance, suggests a lessening of the gap between classes, beginning in the later part of the 1960’s (Kao & Thompson, 2003). Yet the divide in income and to a lesser extent education between peoples who differ in gender, skin color and ethnic origin continues and in many ways is greater now than ever (Danziger & Gottschalk, 1997); (Gottschalk, 1997). The psychological distance between those high and those low in social-economic status continues unabated and threatens to undermine the capacity of communities to foster the positive architecture of hope, optimism and equal opportunity that holds us together as a nation...

Towards ubiquitous city : concept, planning, and experiences in the Republic of Korea

Information and communication technologies (ICTs) had occupied their position on knowledge management and are now evolving towards the era of self-intelligence (Klosterman, 2001). In the 21st century ICTs for urban development and planning are imperative to improve the quality of life and place. This includes the management of traffic, waste, electricity, sewerage and water quality, monitoring fire and crime, conserving renewable resources, and coordinating urban policies and programs for urban planners, civil engineers, and government officers and administrators. The handling of tasks in the field of urban management often requires complex, interdisciplinary knowledge as well as profound technical information. Most of the information has been compiled during the last few years in the form of manuals, reports, databases, and programs. However frequently, the existence of these information and services are either not known or they are not readily available to the people who need them. To provide urban administrators and the public with comprehensive information and services, various ICTs are being developed. In early 1990s Mark Weiser (1993) proposed Ubiquitous Computing project at the Xerox Palo Alto Research Centre in the US. He provides a vision of a built environment which digital networks link individual residents not only to other people but also to goods and services whenever and wherever they need (Mitchell, 1999). Since then the Republic of Korea (ROK) has been continuously developed national strategies for knowledge based urban development (KBUD) through the agenda of Cyber Korea, E-Korea and U-Korea. Among abovementioned agendas particularly the U-Korea agenda aims the convergence of ICTs and urban space for a prosperous urban and economic development. U-Korea strategies create a series of U-cities based on ubiquitous computing and ICTs by a means of providing ubiquitous city (U-city) infrastructure and services in urban space. The goals of U-city development is not only boosting the national economy but also creating value in knowledge based communities. It provides opportunity for both the central and local governments collaborate to U-city project, optimize information utilization, and minimize regional disparities. This chapter introduces the Korean-led U-city concept, planning, design schemes and management policies and discusses the implications of U-city concept in planning for KBUD.

E-Government and the digital divide

Many governments world wide are attempting to increase accountability, transparency, and the quality of services by adopting information and communications technologies (ICTs) to modernize and change the way their administrations work. Meanwhile e-government is becoming a significant decision-making and service tool at local, regional and national government levels. The vast majority of users of these government online services see significant benefits from being able to access services online. The rapid pace of technological development has created increasingly more powerful ICTs that are capable of radically transforming public institutions and private organizations alike. These technologies have proven to be extraordinarily useful instruments in enabling governments to enhance the quality, speed of delivery and reliability of services to citizens and to business (VanderMeer & VanWinden, 2003). However, just because the technology is available does not mean it is accessible to all. The term digital divide has been used since the 1990s to describe patterns of unequal access to ICTs—primarily computers and the Internet—based on income, ethnicity, geography, age, and other factors. Over time it has evolved to more broadly define disparities in technology usage, resulting from a lack of access, skills, or interest in using technology. This article provides an overview of recent literature on e-government and the digital divide, and includes a discussion on the potential of e-government in addressing the digital divide.

‘Small Pricks’ at Lunchtime : Some notes on Botox

Cosmetic enhancement technologies have been subject to extended discussion in sociological literature. Botox, however, seems to have been mostly sidelined in this discussion in favour of more ‘extreme’ forms of cosmetic enhancement, such as those performed under general anaesthetic. In this paper, we suggest the need to further examine Botox as a sociological issue. We do this by highlighting some of the disparities and parallels that Botox shares with the existing literature on cosmetic enhancement technologies.

A comparison of international occupational therapy competencies : implications for Australian standards in the new millennium

Background/aim: A timely evaluation of the Australian Competency Standards for Entry-Level Occupational Therapists© (1994) was conducted. This thorough investigation comprised a literature review exploring the concept of competence and the applications of competency standards; systematic benchmarking of the Australian Occupational Therapy Competency Standards (OT AUSTRALIA, 1994) against other national and international competency standards and other affiliated documents, from occupational therapy and other cognate disciplines; and extensive nationwide consultation with the professional community. This paper explores and examines the similarities and disparities between occupational therapy competency standards documents available in English from Australia and other countries.----- Methods: An online search for national occupational therapy competency standards located 10 documents, including the Australian competencies.----- Results: Four 'frameworks' were created to categorise the documents according to their conceptual underpinnings: Technical-Prescriptive, Enabling, Educational and Meta-Cognitive. Other characteristics that appeared to impact the design, content and implementation of competency standards, including definitions of key concepts, authorship, national and cultural priorities, scope of services, intended use and review mechanisms, were revealed.----- Conclusion: The proposed 'frameworks' and identification of influential characteristics provided a 'lens' through which to understand and evaluate competency standards. While consistent application of and attention to some of these characteristics appear to consolidate and affirm the authority of competency standards, it is suggested that the national context should be a critical determinant of the design and content of the final document. The Australian Occupational Therapy Competency Standards (OT AUSTRALIA, 1994) are critiqued accordingly, and preliminary recommendations for revision are proposed.

Videogames, learning, and the social context : approaches to an ethnographic case study

Focusing on the role-playing simulation game SCAPE (Sustainability, Community and Planning Education), this paper proposes that potential disparities between game design practice and the meaning-making process of the players need to be addressed in a wider ecology of learning. The cultural setting of the gameplay experience, and also the different levels of engagement of the players, can be seen to pose vital questions, which are in and of themselves objects of inquiry. This paper argues that ethnographic participant-observation, which is a recognized approach in game studies, allows taking the wider ecology of learning into account to explore the various relations that shape the gameplay.

An examination of the sentencing remarks of Indigenous and non-Indigenous criminal defendants in South Australia’s Higher Courts

Recent Australian research on Indigenous sentencing primarily explores whether disparities in sentencing outcomes exist. Little is known about how judges perceive or refer to Indigenous defendants and their histories, and how they interpret the circumstances of Indigenous defendants in justifying their sentencing decisions. Drawing on the ‘focal concerns’ approach, this study presents a narrative analysis of a sample of judges’ sentencing remarks for Indigenous and non-Indigenous criminal defendants convicted in South Australia’s Higher Courts. The analysis found that the sentencing stories of Indigenous and non-Indigenous offenders differed in ways that possibly reduced assessments of blameworthiness and risk for Indigenous defendants.

Collaborative voices: Ongoing reflections on cultural competency and the health care of Australian Indigenous people

The issue of cultural competency in health care continues to be a priority in Australia for health and human services professionals. Cultural competence in caring for Aboriginal and Torres Strait Islander peoples is of increasing interest, and is a priority in closing the gap in health disparities between Indigenous and non-Indigenous Australians. Through a collaborative conversation, the authors draw on a case study, personal experience and the literature to highlight some of the issues associated with employing culturally appropriate, culturally safe and culturally competent approaches when caring for Aboriginal and Torres Strait Islander peoples. The intent of this article is to encourage discussion on the topic of cultural competency, and to challenge health professionals and academics to think and act on racism, colonialism, historical circumstances and the political, social, economic, and geographical realms in which we live and work, and which all impact on cultural competency.

Electron interaction with gel dosimeters : effective atomic numbers for collisional, radiative and total interaction processes

The effective atomic number is widely employed in radiation studies, particularly for the characterisation of interaction processes in dosimeters, biological tissues and substitute materials. Gel dosimeters are unique in that they comprise both the phantom and dosimeter material. In this work, effective atomic numbers for total and partial electron interaction processes have been calculated for the first time for a Fricke gel dosimeter, five hypoxic and nine normoxic polymer gel dosimeters. A range of biological materials are also presented for comparison. The spectrum of energies studied spans 10 keV to 100 MeV, over which the effective atomic number varies by 30 %. The effective atomic numbers of gels match those of soft tissue closely over the full energy range studied; greater disparities exist at higher energies but are typically within 4 %.

Chronic disease, geographic location and socioeconomic disadvantage as obstacles to equitable access to e-health

Despite recent public attention to e-health as a solution to rising healthcare costs and an ageingpopulation, there have been relatively few studies examining the geographical pattern of e-health usage. This paper argues for an equitable approach to e-health and attention to the way in which e-health initiatives can produce locational health inequalities, particularly in socioeconomically disadvantaged areas. In this paper, we use a case study to demonstrate geographical variation in Internet accessibility, Internet status and prevalence of chronic diseases within a small district. There are signifi cant disparities in access to health information within socioeconomically disadvantaged areas. The most vulnerable people in these areas are likely to have limited availability of, or access to Internet healthcare resources. They are also more likely to have complex chronic diseases and, therefore, be in greatest need of these resources. This case study demonstrates the importance of an equitable approach to e-health information technologies and telecommunications infrastructure.

E-Government and the digital divide

Many governments world wide are attempting to increase accountability, transparency, and the quality of services by adopting information and communications technologies (ICTs) to modernize and change the way their administrations work. Meanwhile e-government is becoming a significant decision-making and service tool at local, regional and national government levels. The vast majority of users of these government online services see significant benefits from being able to access services online. The rapid pace of technological development has created increasingly more powerful ICTs that are capable of radically transforming public institutions and private organizations alike. These technologies have proven to be extraordinarily useful instruments in enabling governments to enhance the quality, speed of delivery and reliability of services to citizens and to business (VanderMeer & VanWinden, 2003). However, just because the technology is available does not mean it is accessible to all. The term digital divide has been used since the 1990s to describe patterns of unequal access to ICTs—primarily computers and the Internet—based on income, ethnicity, geography, age, and other factors. Over time it has evolved to more broadly define disparities in technology usage, resulting from a lack of access, skills, or interest in using technology. This article provides an overview of recent literature on e-government and the digital divide, and includes a discussion on the potential of e-government in addressing the digital divide.

Making sense of dementia : understanding amongst indigenous Australians

Dementia is a growing health and social concern for all Australians. Whilst the prevalence of dementia amongst Australia's indigenous people is unclear, there is some evidence that dementia rates are five times that of the general Australian population. To date no studies have examined dementia knowledge levels in indigenous communities. Purpose of the study: This paper aims to explore indigenous Australians' understanding, knowledge and misconceptions of dementia. Design and methods: Hundered and seventy-four indigenous adults participated in a cross-sectional survey using a modified version of the Alzheimer's Disease Knowledge Test (ADK). The survey included demographic information, two open-ended questions and 20 multiple choice questions. Each ADK item was examined to identify responses that revealed commonly held correct beliefs, knowledge gaps and misconceptions. Results: The overall level of understanding of dementia was poor. Younger participants were significantly more likely to have no knowledge of Alzheimer's Disease, whereas the other age groups were most likely to have at least some knowledge. It was also revealed that there are common misconceptions about Alzheimer's Disease held by both indigenous and non-indigenous communities. Implications: Culturally appropriate awareness campaigns and targeted educational interventions need to be implemented to improve the general level of understanding of dementia in indigenous communities.

Consumers’ intentions to adopt 3G in regional cities in China : a comparative study

Rapid mobile technological evolution and the large economic stake in commercial development of mobile technological innovation make it necessary to understand consumers' motivations towards the latest advanced and updated technologies and services. 3G (the third generation of mobile communication technology) recently started its commercial development in the world‘s largest mobile communication market, China, after being delayed for a few years. Although China fell behind in commercially developing 3G, it is difficult to ignore studying this area, given the size of the market and promising future developments. This market deserves focused research attention, especially in terms of consumer behaviour towards the adoption of mobile technological innovation. Thus, the program of research in this thesis was designed to investigate how Chinese consumers respond to the use of this newly launched mobile technological innovation, with a focus on what factors affect their 3G adoption intentions. It aimed to yield important insights into Chinese consumers‘ innovation adoption behaviours and to contribute to marketing and innovation adoption research. Furthermore, it has been documented that Chinese consumers vary widely between regions in dialect, lifestyle, culture, purchasing power and consumption attitudes. Based on economic development and local culture, China can be divided geographically into distinctive regional consumer markets. Consequently, the results of consumer behaviour research in one region may not necessarily be extrapolated to other regions. In order to better understand Chinese consumers, the disparities between regions should not be overlooked. Therefore, another objective of this program of research was to examine regional variances in consumers' innovation adoption, specifically to identify the similarities and differences in factors influencing 3G adoption, contributing to intra-cultural studies. An extensive literature review identified two gaps: current China-based innovation adoption research studies are limited in providing adequate prediction and explanation of Chinese consumers' intentions to adopt 3G; and there was limited knowledge about the differences between regional Chinese consumers in innovation adoption. Two research questions therefore were developed to address these gaps: 1) What factors influence Chinese consumers' intentions to adopt 3G? 2) How do Chinese consumers differ between regional markets in the relative influence of the factors in determining their intentions to adopt 3G? In accordance with postpositivist research philosophy, two studies were designed to answer the research questions, using mixed methods. To meet the research objectives, the two studies were both conducted in three regional cities, namely Beijing, Shanghai and Wuhan, centred in the three regions of North China, East China and Central China respectively, with sufficient cultural and economical regional variances. Study One was an exploratory study with qualitative research methods. It involved 45 in-depth interviews in the three research cities to gain rich insights into the research context from natural settings. Eight important concepts related to 3G adoption were generated from analysis of the interview data, namely utilitarian expectation, hedonic expectation, status gains, status loss avoidance, normative influence, external influence, cost and quality concern. The concepts of social loss avoidance and quality concern were two unique findings, whereas the other concepts were similar to the findings in Western innovation adoption studies. Moreover, variances in 3G adoption between three groups of regional consumers were also identified, focusing on the perceptions of two concepts, namely status gains and normative influence. The conceptual research model was then developed incorporating the eight concepts plus the dependent variable of adoption intention. The hypothesized relationships between the nine constructs and hypotheses about the differences between regional consumers in 3G adoption were informed by the findings of Study One and the literature reviewed. Study Two was a quantitative study involving a web-based survey and statistical analysis procedure. The web-based survey attracted 800 residents from the three research cities, 270 from Beijing, 265 from Shanghai and 265 from Wuhan. They comprised three research samples for this study and consequently three sets of data were obtained. The data was analysed by Structural Equation Modelling together with Multi-group Analysis. The analysis confirmed that the concepts generated in Study One were influential factors affecting Chinese consumers' 3G adoption intention, with the exception of the concept external influence. Differences were found between the samples in the three research cities in the effect of hedonic expectation, status gains, status loss avoidance and normative influence on 3G adoption intention. The two Studies undertaken in this thesis contributed a better understanding of Chinese consumers' intentions to adopt advanced mobile technological innovation, namely 3G, in three regional markets. This knowledge contributes to innovation adoption and intra-cultural research, as well as consumer behaviour theory. It is also able to inform international and domestic telecommunication companies to develop and deliver more effective marketing strategies across Chinese regional markets. Limitations in the research were identified in terms of the sampling techniques used and the design of the two Studies. Future research was suggested in other Chinese regional markets and into consumer adoption of other types of mobile technological innovations.