Shared decision making: what do clinicians need to know and why should they bother?

Shared decision making enables a clinician and patient to participate jointly in making a health decision, having discussed the options and their benefits and harms, and having considered the patient's values, preferences and circumstances. It is not a single step to be added into a consultation, but a process that can be used to guide decisions about screening, investigations and treatments. The benefits of shared decision making include enabling evidence and patients' preferences to be incorporated into a consultation; improving patient knowledge, risk perception accuracy and patient-clinician communication; and reducing decisional conflict, feeling uninformed and inappropriate use of tests and treatments. Various approaches can be used to guide clinicians through the process. We elaborate on five simple questions that can be used: What will happen if the patient waits and watches? What are the test or treatment options? What are the benefits and harms of each option? How do the benefits and harms weigh up for the patient? Does the patient have enough information to make a choice? Although shared decision making can occur without tools, various types of decision support tools now exist to facilitate it. Misconceptions about shared decision making are hampering its implementation. We address the barriers, as perceived by clinicians. Despite numerous international initiatives to advance shared decision making, very little has occurred in Australia. Consequently, we are lagging behind many other countries and should act urgently.

The payment of dividends : legal confusion, complexities and the need for comprehensive reform

Submissions have closed on exposure draft legislation intending to amend thetest for payment of dividends under s 254T of the Corporations Act 2001 (Cth).Until 2010, a dividend could only be paid out of profits of a company. Sincethen, the dividends provision has been repealed and replaced with a newprovision, which allows a company to pay dividends if it satisfies an “assetsgreater than liabilities”, “fair and reasonable to shareholders” and “no materialprejudice to creditors” test. This article first examines why the profits test wasomitted from s 254T, before examining the current dividends provision,identifying the shortcomings of the 2010 reforms and critically evaluating theprovisions proposed to replace the current s 254T. The article then considersinternational developments, with a focus on New Zealand and a look at SouthAfrica, as examples of dividends tests in overseas jurisdictions, beforeproposing how to address the current confusion and uncertainty. The articleconcludes that the proposed amendments to s 254T will only partly addressexisting problems. Thus, comprehensive reform in this area of the Australiancorporation’s law is recommended.

Proportionality in sentencing: the need to factor in community experience, not public opinion

This is the first book to address the question of what role public opinion should play in the way criminal offenders are punished.Should public opinion determine—or even influence—sentencing policy and practice? Should the punishment of criminal offenders reflect what the public regards as appropriate? These deceptively simple questions conceal complex theoretical and methodological challenges to the administration of punishment.In the West, politicians have often answered these questions in the affirmative; penal reforms have been justified with direct reference to the attitudes of the public. This is why the contention that politicians should bridge the gap between the public and criminal justice practice has widespread resonance. Criminal law scholars, for their part, have often been more reluctant to accept public input in penal practice, and some have even held that the idea of consulting public opinion constitutes a populist approach to punishment.The purpose of this book is to examine the moral significance of public opinion for penal theory and practice. For the first time in a single volume the editors, Jesper Ryberg and Julian V. Roberts, have assembled a number of respected criminologists, philosphers, and legal theorists to address the various aspects of why and how public opinion should be reflected in the way the criminal justice system deals with criminals. The chapters address the myriad complexities surrounding this issue by first weighing the justifications for incorporating public views into punishment practices and then considering the various ways this might be achieved through juries, prosecutors, restoratifve justice programs, and other means.

Sentencing: from vagueness to arbitrariness - the need to abolish the stain that is the instinctive synthesis

Criminal sanctions involve the deliberate infliction of hardship on offenders. In sentencing, the state acts in its most coercive and decisive manner: ‘the state may use its most awesome power: the power to use force against its citizens and others’. Despite the importance of the interests at stake in the sentencing realm,sentencing is arguably the least coherent, predictable and principled area of law. The High Court of Australia has not facilitated attempts to inject clarity and precision into sentencing determinations. It has repeatedly endorsed the ‘instinctive synthesis’ approach to sentencing, emphasising the need for ‘individual justice’ over the need for transparency and a step-wise systematic approach to sentencing.

Effect of mood, social connectivity and age in online depression community via topic and linguistic analysis

Depression afflicts one in four people during their lives. Several studies have shown that for the isolated and mentally ill, the Web and social media provide effective platforms for supports and treatments as well as to acquire scientific, clinical understanding of this mental condition. More and more individuals affected by depression join online communities to seek for information, express themselves, share their concerns and look for supports [12]. For the first time, we collect and study a large online depression community of more than 12,000 active members from Live Journal. We examine the effect of mood, social connectivity and age on the online messages authored by members in an online depression community. The posts are considered in two aspects: what is written (topic) and how it is written (language style). We use statistical and machine learning methods to discriminate the posts made by bloggers in low versus high valence mood, in different age categories and in different degrees of social connectivity. Using statistical tests, language styles are found to be significantly different between low and high valence cohorts, whilst topics are significantly different between people whose different degrees of social connectivity. High performance is achieved for low versus high valence post classification using writing style as features. The finding suggests the potential of using social media in depression screening, especially in online setting.

Affective, linguistic and topic patterns in online autism communities

Online communities offer a platform to support and discuss health issues. They provide a more accessible way to bring people of the same concerns or interests. This paper aims to study the characteristics of online autism communities (called Clinical) in comparison with other online communities (called Control) using data from 110 Live Journal weblog communities. Using machine learning techniques, we comprehensively analyze these online autism communities. We study three key aspects expressed in the blog posts made by members of the communities: sentiment, topics and language style. Sentiment analysis shows that the sentiment of the clinical group has lower valence, indicative of poorer moods than people in control. Topics and language styles are shown to be good predictors of autism posts. The result shows the potential of social media in medical studies for a broad range of purposes such as screening, monitoring and subsequently providing supports for online communities of individuals with special needs.

Food security: one of a number of ‘securities’ we need for a full life: an Australian perspective

Although agriculture in Australia is very productive, the current food supply systems in Australia fail to deliver healthy diets to all Australians and fail to protect the natural resources on which they depend. The operation of the food systems creates ‘collateral damage’ to the natural environment including biodiversity loss. In coming decades, Australia’s food supply systems will be increasingly challenged by resource price inflation and climate change. Australia exports more than half of its current agricultural production. Government and business are aiming to substantially increase production to bolster exports. This will increase pressure on agricultural resources and exacerbate ‘collateral’ damage to the environment. The Australian public have a deep and ongoing interest in a very wide range of issues associated with the food systems including the environment, health and sustainability. Food is something we require in order to live and a good diet is something we have to have to be healthy. For health over a life-time we need food security. However, we also require a range of other material goods and social arrangements in order to develop and flourish as human beings. And we need these other things to be secure over a life-time. Food is therefore one security among a range of other securities we need in order to flourish. The paper outlines a number of approaches, as examples, that help to identify what these other goods and arrangements might be. The approaches mentioned in this paper include human rights, national securities, human needs, authentic happiness, capabilities, sustainability and environmental ethics. The different approaches provide a way of evaluating the current situation and indicating a direction for change within the food systems that will address the problems. However, changing large systems such as those involved in food supply is difficult because inertias and vested interests make the current food supply systems resilient to change. The paper suggests that one of the first and ongoing tasks is to develop an understanding of the situation from a comprehensive social–ecological systems perspective. The paper also suggests that a practical leverage point for system change is restructuring the flow of information on the health, natural resources and biodiversity loss issues related to the food supply systems.

Challenge demands, hindrance demands, and psychological need satisfaction: their influence on employee engagement and emotional exhaustion

The job demands-resources (JD-R) model provides a well-validated account of how job resources and job demands influence work engagement, burnout, and their constituent dimensions. The present study aimed to extend previous research by including challenge demands not widely examined in the context of the JD-R. Furthermore, and extending self-determination theory, the research also aimed to investigate the potential mediating effects that employees' need satisfaction as regards their need for autonomy, need for belongingness, need for competence, and need for achievement, as components of a higher order needs construct, may have on the relationships between job demands and engagement. Structural equations modeling across two independent samples generally supported the proposed relationships. Further research opportunities, practical implications, and study limitations are discussed.