The Centre of Clinical Research Excellence in Aboriginal Health : an operational rationale and some reflections on progress so far

The Centre of Clinical Research Excellence (CCRE) in Aboriginal and Torres Strait Islander Health was established in late 2003 through a major National Health and Medical Research Council (NHMRC) grant involving collaboration between the Aboriginal Health Council of South Australia (AHCSA), Flinders University, and Aboriginal Health Services. Our foundation research communities are the Aboriginal communities served by these Aboriginal Health Services in the Spencer Gulf / Eyre Peninsula region. In recent years a number of collaborative research programs involving chronic illness management, self-management and coordinated care have been implemented in these communities and this work is the basis of the initial CCRE activities. Key objectives of the CCRE are to improve the health status of Indigenous people through conducting relevant and meaningful Aboriginal controlled health research, providing formal training for Indigenous health researchers and developing innovative approaches to health care that can be readily translated and applied to support communities. The inclusion, empowerment and engagement of Indigenous people in the process of managing community health represent tangible strategies for achieving more equitable health outcomes for Aboriginal people. This paper outlines the CCRE operational rationale and presents early activities and outcomes across the three strategic areas of CCRE operations: research, education and training, and translation. Some critical reflections are offered on the progress and experience of the CCRE thus far. A common obstacle this CCRE has encountered is that the limited (especially staff) resources available to the Aboriginal Health Services with which we are collaborating make it difficult for them to engage with and progress the projects we are pursuing.

A school-based intervention incorporating smartphone technology to improve health-related fitness among adolescents : rationale and study protocol for the NEAT and ATLAS 2.0 cluster randomised controlled trial and dissemination study

INTRODUCTION: Physical inactivity has been described as a global pandemic. Interventions aimed at developing skills in lifelong physical activities may provide the foundation for an active lifestyle into adulthood. In general, school-based physical activity interventions targeting adolescents have produced modest results and few have been designed to be 'scaled-up' and disseminated. This study aims to: (1) assess the effectiveness of two physical activity promotion programmes (ie, NEAT and ATLAS) that have been modified for scalability; and (2) evaluate the dissemination of these programmes throughout government funded secondary schools. METHODS AND ANALYSIS: The study will be conducted in two phases. In the first phase (cluster randomised controlled trial), 16 schools will be randomly allocated to the intervention or a usual care control condition. In the second phase, the Reach, Effectiveness, Adoption, Implementation and Maintenance (Re-AIM) framework will be used to guide the design and evaluation of programme dissemination throughout New South Wales (NSW), Australia. In both phases, teachers will be trained to deliver the NEAT and ATLAS programmes, which will include: (1) interactive student seminars; (2) structured physical activity programmes; (3) lunch-time fitness sessions; and (4) web-based smartphone apps. In the cluster RCT, study outcomes will be assessed at baseline, 6 months (primary end point) and 12-months. Muscular fitness will be the primary outcome and secondary outcomes will include: objectively measured body composition, cardiorespiratory fitness, flexibility, resistance training skill competency, physical activity, self-reported recreational screen-time, sleep, sugar-sweetened beverage and junk food snack consumption, self-esteem and well-being.

Self-management and the treatment of gambling addiction: a rationale

Self-management programs are now a well-accepted approach to assisting people with chronic and complex health conditions to manage their illness and their lives more comprehensively, and, as a result, enjoy better quality of life and health outcomes. Such approaches have now been developed for a wide range of chronic conditions and many programs are generic in that they are not illness-specific. This paper explores the possibility of peer education and self-management as the next frontier in the treatment of gambling addiction and asks whether the expert patient approach that has been shown to be successful in the management of chronic disease might gainfully be applied to the treatment of problem gambling.

The ethics of hacking and computer abuse: Australian case studies

Organisations spend large sums of money to ensure that they are protected
against the risks associated with external threats. The perceived threats
against organisations are well known, and the losses can be quantifiable.
The perceived threat considered here is that associated with hackers. Much
is known about hackers, their rationale, and their ethical views. However,
it is harder to quantify what computer abuse is and what the associated
losses are. This chapter focuses on hackers, computer abuse, and ethical
issues.

Promoting and supporting requirements engineering creativity

Requirements Engineering (RE) is a commencing phase in the systems development life cycle and concerned with understanding and specifying the customer's requirements. RE has been recognized as a complex cognitive problem solving process which takes place in an unstructured and poorly understood problem .context. A recent understanding describes the RE process as inherently creative, involving cycles of incremental building followed by insight-driven econceptualization .of the problem space. This chapter relates this new understanding to various creative process models described in the creativity and psychology of problem solving literature.

A review of current attempts to support problem solving in RE using
various design rationale approaches suggests., that their common major
wealmess lies in the lack of support for the creative and insight-driven problem solving process in RE. In addressing this weakness, the chapter suggests a new approach to promoting and supporting RE creativity using design rationale. The suggested approach involves the ad hoc recording of rationale to support the creative exploration complemented by a post hoc conceptual characterization of the problem space to support insight driven reconceptualization.

Moving beyond mateship:reconstructing Australian men's practices

In this chapter I will explore the implications of the definitively Australian
style of masculine behaviour called 'mateship' for gender relations in
Australia. Mateship is part of the Australian male heritage; it originated in
colonial days and was glorified in war and sport. The feminist movement
in Australia has challenged the dominant form of masculinity inherent in
mateship and the basic rationale for gender relations that flow from it. In
this context, I will discuss Australian profeminist men's attempts to challenge patriarchal gender relations and construct non-patriarchal subjectivities and practices. Theorizing about masculinity in Australia has tended to be derivative of overseas literature. This is partly because publishers are looking for overseas markets for their books so they discourage writers on masculinity from grounding men's practices in a specifically Australian context. While there are benefits in generalizing about western masculinities, such writing misses the uniqueness of the lived experiences of Australian men. It is this uniqueness that I will address in this chapter. As McGrane and Patience (1995: 15) note, 'Australian masculinism has a history of its own that needs to be recognized at the same time as it can be usefully compared to the masculinisms of similar cultures'.

Numeracy across the curriculum: recognising and responding to the demands and numeracy opportunities inherent in secondary teaching

The 1998 Report of the National Standards and Guidelines for Initial Teacher Education Project, 'Preparing a Profession' illustrates the emphasis being placed in Australia on the development of numeracy skills amongst not only primary but also secondary school pupils. This report demands that graduates of all initial teacher training courses should not only be numerate themselves, but should also understand the contribution of numeracy to education and daily life, and be able to identify and respond to pupils' numeracy learning needs. This report and its implementation in Victoria through the 'Guidelines for the Evaluation of Teacher Education Courses' led to the introduction in 1999 of a compulsory unit 'Numeracy across the curriculum' for all Deakin University students in the final year of their secondary teacher training course. This paper discusses the nature of the current emphasis on numeracy. It also describes the rationale, development and delivery of the first year of the 'Numeracy across the curriculum' unit, provides a brief evaluation from the perspective of staff and students, and discusses what impact such teacher education programs might have on secondary schools' approaches to numeracy.

Exempt treatment of financial intermediation services under a value-added tax: an assessment of alternatives

Most countries with a value-added tax (VAT) exempt financial intermediation services from the tax. While exemption is generally perceived to be undesirable, it is also widely regarded as unavoidable because of technical difficulties in applying VAT to these services. This article reviews the standard rationale for exempt treatment and then considers the relative merits of two recent challenges raised in the tax literature. The first challenge involves the application of cash flow taxation to financial intermediation services in a manner that is consistent with an invoice/credit VAT (which is the dominant form). The second challenge proposes a comprehensive system of zero-rating of financial intermediation services, which is supported by a characterization of the household consumption of such services as non-taxable. The author argues that each of these alternatives to an exemption system suffers from both theoretical and practical implementation difficulties that make maintenance of exempt treatment the preferred approach, at least in the short term. There is, however, a simpler alternative to these fundamental reform options, involving modification of just one aspect of an exemption system to relieve some of its more problematic aspects. Many of the interpretative problems and associated inefficiencies that plague an exemption system arise from the need to distinguish between taxable and exempt financial services. The author argues that these difficulties can be eliminated, to a large extent, by basing the distinction on the form of prices. In support of this approach, he points out that it is consistent with the underlying reasons for the application of exempt treatment. The author considers a number of other possible modifications, but these are either rejected outright or viewed with a healthy skepticism. For example, the author is critical of the apparent rationale for the application of cash flow taxation to property and casualty insurers. He also rejects proposals that accept some looseness in the formulaic allocation by financial intermediaries of the costs of business inputs between exempt and taxable services for input credit purposes. In his view, an explicit reliance on pricing structures to draw the boundary between exempt and taxable services is preferable to the provision of relief for blocked input tax credits of financial intermediaries. Finally, the author is skeptical of the case for a policy response intended to address the tax bias under an exemption system for financial intermediaries to insource supplies.

Lifestyle pattern change in males following percutaneous transluminal coronary angioplasty/intracoronary stenting

tilizing a naturalistic inquiry approach, a semi-structured interview schedule and non-probability purposive sampling, this study provided detail on the rationale and influences behind the decisions of four males participants to change or not change their lifestyle patterns 3 months after a percutaneous transluminal coronary angioplasty/intracoronary stent procedure. One of the participants made a noticeable lifestyle pattern change in this period. The remaining participants failed to exhibit any discernible lifestyle pattern change or had continued with their previous behaviours. Results suggest a new 'positive' psychological health perspective, family considerations, return-to-work issues and a reluctance to participate in cardiac rehabilitation as the major factors influencing lifestyle pattern change. Because nurses spend the greatest amount of time with percutaneous transluminal coronary angioplasty/intracoronary stent patients during hospitalization, they have the best opportunity to provide up-to-date and relevant information to patients that will enable them to then make decisions concerning cardiac healthy lifestyle changes.

Copper in disorders with neurological symptoms: Alzheimer`s, Menkes, and Wilson Diseases

Copper is an essential element for the activity of a number of physiologically important enzymes. Enzyme-related malfunctions may contribute to severe neurological symptoms and neurological diseases: copper is a component of cytochrome c oxidase, which catalyzes the reduction of oxygen to water, the essential step in cellular respiration. Copper is a cofactor of Cu/Zn-superoxide-dismutase which plays a key role in the cellular response to oxidative stress by scavenging reactive oxygen species. Furthermore, copper is a constituent of dopamine-β-hydroxylase, a critical enzyme in the catecholamine biosynthetic pathway. A detailed exploration of the biological importance and functional properties of proteins associated with neurological symptoms will have an important impact on understanding disease mechanisms and may accelerate development and testing of new therapeutic approaches. Copper binding proteins play important roles in the establishment and maintenance of metal-ion homeostasis, in deficiency disorders with neurological symptoms (Menkes disease, Wilson disease) and in neurodegenerative diseases (Alzheimer’s disease). The Menkes and Wilson proteins have been characterized as copper transporters and the amyloid precursor protein (APP) of Alzheimer’s disease has been proposed to work as a Cu(II) and/or Zn(II) transporter. Experimental, clinical and epidemiological observations in neurodegenerative disorders like Alzheimer’s disease and in the genetically inherited copper-dependent disorders Menkes and Wilson disease are summarized. This could provide a rationale for a link between severely dysregulated metal-ion homeostasis and the selective neuronal pathology.

Blairgowrie: the meaning of place

Defining the meaning of a specific place is difficult. Blairgowrie is a peaceful and naturally protected beach haven on the Nepean Peninsula on the tip of the Mornington Peninsula, in Victoria, Australia. When a major development is perceived as threatening the quality of place, it is perhaps already too late to begin to name its characteristics or particular attributes. The evocative and poetic qualities of Blairgowrie do not reveal themselves immediately. Only over a period of time, and by visiting at various times of the day in all seasons, can one begin to fathom its moods, its soul, its many colours; and to touch its memories. Here sea and sky can meet, or divide, totally unobstructed, depending on climatic conditions, seasonal weather patterns and diurnal changes. It is still possible to get a sense of scale and wide-angle limitless vision. When a Safe Boat Harbour was proposed for Blairgowrie, residents came out in force to voice their objections or their support. A tribunal hearing was put in place. In light of the dismissal of qualitative data, of reflective experiential material, of community opinion, of values of the 'other' in planning tribunal hearings, this paper attempts to build a case for putting into words 'the meaning of place'. The Safe Boat Harbour proposal was the catalyst for this exploration of 'meaning of place', and is not itself primarily the subject of this paper. This very personal paper begins to examine the meaning of this place. Through images, perceptions, and representations; through time; history, topography; flora and fauna: it attempts to find a way of coming to terms with this extraordinary land/seascape. In the long term this project aims to produce relevant, authoritative, and defensible research that provides the context and rationale for the selection and assessment of places of outstanding heritage significance. Further, it will provide a case study in support of new planning regulations for 'place' zones (Mant, 2001) rather than the generic land use zones, which are current in Victoria.

What sort of mandatory penalties should we have?

The argument in favour of a widespread fixed penalty regime - adopting a primary rationale for punishment would facilitate a more coherent and exacting approach to sentencing - the central objections against fixed penalties are that they are too severe and lead to unfairness because they are unable to incorporate all the relevant sentencing variables - by adopting a utilitarian ethic as the primary rationale for punishment, these problems can be circumvented - no utilitarian justification for disproportionate punishment, and penalties should not exceed the seriousness of the offence - no foundation for most sentencing considerations - by disregarding irrelevant considerations, the remaining can be incorporated into a fixed penalty system - the way would then be open for a coherent sentencing law system in which criminal justice is governed by pre-determined rules and principles as opposed to the intuition of sentencers.

Outsourcing and downsizing: Processes of workplace change in public health

Throughout the 1990s, public hospitals embarked on a range of benchmarking exercises for support services, often accompanied by downsizing and, in some cases, outsourcing. These support services included clinical areas such as, radiology, pharmacy and pathology, and nonclinical areas of catering and cleaning, engineering and environmental services. The impetus for this trend was the introduction of the Federal Governments National Competition Policy with its rationale that private sector pressures and competition would make the public sector more efficient.
Through a case study approach, this paper discusses this process at two public hospitals, the aim being to investigate the reasons for outsourcing, outsourcings interconnectedness with downsizing, and the implications at the workforce level. Workplace issues discussed include consultation between management, unions and employees, changes to employee numbers and work practices, maintenance of workplace conditions, implications for staff recruitment and retention, and the relative power of management and unions. It concludes that benchmarking, outsourcing and downsizing have all been used to bring about workplace change. Whilst the choice between processes may be dependent on management perception of the workplace environment, implications for the workplace from each process have been similar.

Legal ethics is (just) normal ethics: towards a coherent system of legal ethics

The standards governing how lawyers ought to conduct themselves consist of a number disparate principles and rules, which are devoid of an overarching rationale. We argue that legal ethics is not a stand-alone social construct. Rather, it is the application of normal ethical principles so far as they relate to the law. Approached in this manner, legal ethics becomes a far more coherent and justifiable institution. In this paper we apply general moral theory to several key dilemmas facing lawyers. This results in outcomes which some may find counter-intuitive. We conclude that lawyers should not do pro bono work; that the first cab rank off the rank principle is unsound and that there is no relevant difference between expressly misleading the court and putting the other side to the proof of its case.

Provocation: the ongoing subservience of principle to tradition

The defence of provocation has been highly criticised. Most
commentators argue that the defence i" misguided. There does not appear
to be any community pressure to preserve the defence. Despite this,
legislatures are reluctant to abolish provocation as a partial defence to,
murder. This article examines the underlying rationale for tile defence. I1
concludes that the defence is founded on a flaw~ed assumption about
human nature-that people are captive to some of their emotional states.
It is also argued that the convoluted and confusing (if not confused) test
for provocation is evidence of the unsound nature of the defence-it is
simply a case of not being able to develop a feasible (and candid) principle
for a doctrine that is devoid of a sound justification.