Neoliberalism, individualisation and community: Regional restructuring in Australia

Since the early 1980s, Australian governments have embraced neoliberal policies as a means of improving the nation’s global economic competitiveness. The impacts of such policies in regional areas have been quite profound, leading to socio-economic polarisation, population loss, and the growth of anti-globalisation sentiments. In this paper, we examine the process of regional restructuring that arises from this trajectory in Australia, and examine current policy responses to change under the neoliberal regime. We argue that while many such responses are individualistic, and based upon policies of personal responsibility, self-advancement and entrepreneurship, others are imbued with the language of community, social capital and collective action. The existence of individualism and community within the same policy agenda may appear contradictory, yet it is suggested that neoliberalism brings together these two opposing discourses through a process of what Nikolas Rose calls ‘governing through community’. We explore how neoliberalism underpins community approaches to regional development in Australia, arguing that such strategies do little to counter the negative forces of globalisation in non-metropolitan parts of the country.

Principles and clinical application of assessing alterations in renal elimination pathways

Drugs and metabolites are eliminated from the body by metabolism and excretion. The kidney makes the major contribution to excretion of unchanged drug and also to excretion of metabolites. Net renal excretion is a combination of three processes - glomerular filtration, tubular secretion and tubular reabsorption. Renal function has traditionally been determined by measuring plasma creatinine and estimating creatinine clearance. However, estimated creatinine clearance measures only glomerular filtration with a small contribution from active secretion. There is accumulating evidence of poor correlation between estimated creatinine clearance and renal drug clearance in different clinical settings, challenging the 'intact nephron hypothesis' and suggesting that renal drug handling pathways may not decline in parallel. Furthermore, it is evident that renal drug handling is altered to a clinically significant extent in a number of disease states, necessitating dosage adjustment not just based on filtration. These observations suggest that a re-evaluation of markers of renal function is required. Methods that measure all renal handling pathways would allow informed dosage individualisation using an understanding of renal excretion pathways and patient characteristics. Methodologies have been described to determine individually each of the renal elimination pathways. However, their simultaneous assessment has only recently been investigated. A cocktail of markers to measure simultaneously the individual renal handling pathways have now been developed, and evaluated in healthy volunteers. This review outlines the different renal elimination pathways and the possible markers that can be used for their measurement. Diseases and other physiological conditions causing altered renal drug elimination are presented, and the potential application of a cocktail of markers for the simultaneous measurement of drug handling is evaluated. Further investigation of the effects of disease processes on renal drug handling should include people with HIV infection, transplant recipients (renal and liver) and people with rheumatoid arthritis. Furthermore, changes in renal function in the elderly, the effect of sex on renal function, assessment of living kidney donors prior to transplantation and the investigation of renal drug interactions would also be potential applications. Once renal drug handling pathways are characterised in a patient population, the implications for accurate dosage individualisation can be assessed. The simultaneous measurement of renal function elimination pathways of drugs and metabolites has the potential to assist in understanding how renal function changes with different disease states or physiological conditions. In addition, it will further our understanding of fundamental aspects of the renal elimination of drugs.

Adolescence: A useful concept for this millennium

‘Adolescence’ has become increasingly recognised as a nebulous concept. Previous conceptualisations of adolescence have adopted a ‘deficit’ view, regarding teenagers as ‘unfinished’ adults. The deficit view of adolescence is highly problematic in an era where adulthood itself is difficult to define. The terms ‘kidult’ or ‘adultescent’ have emerged to describe adult-age people whose interests and priorities match those of their teenage counterparts. Rather than relying on ‘lock-step’ models of physical, cognitive and social growth put forward by developmental psychology, adolescence can be more usefully defined by looking at the common experiences of people in their teenage years. Common experiences arise at an institutional level; for example, all adolescents are treated as the same by legal and education systems. The transition from primary to secondary schooling is a milestone for all children, exposing them to a new type of educational environment. Shared experiences also arise from generational factors. Today’s adolescents belong to the millennial generation, characterised by technological competence, global perspectives, high susceptibility to media influence, individualisation and rapid interactions. This generation focuses on teamwork, achievement, modesty and good conduct, and has great potential for significant collective accomplishments. These generational factors challenge educators to provide relevant learning experiences for today’s students. Many classrooms still utilise textbook-based pedagogy more suited to previous generations, resulting in disengagement among millennial students. Curriculum content must also be tailored to generational needs. The rapid pace of change, as well as the fluidity of identity created by dissolving geographical and vocational boundaries, mean that the millennial generation will need more than a fixed set of skills and knowledge to enter adulthood. Teachers must enable their students to think like ‘expert novices’, adept at assimilating new concepts in depth and prepared to engage in lifelong learning.