Developing a web-based information resource for palliative care : an action-research inspired approach

Background : General Practitioners and community nurses rely on easily accessible, evidence-based online information to guide practice. To date, the methods that underpin the scoping of user-identified online information needs in palliative care have remained under-explored. This paper describes the benefits and challenges of a collaborative approach involving users and experts that informed the first stage of the development of a palliative care website.

Method : The action research-inspired methodology included a panel assessment of an existing palliative care website based in Victoria, Australia; a pre-development survey (n = 197) scoping potential audiences and palliative care information needs; working parties conducting a needs analysis about necessary information content for a redeveloped website targeting health professionals and caregivers/patients; an iterative evaluation process involving users and experts; as well as a final evaluation survey (n = 166).

Results : Involving users in the identification of content and links for a palliative care website is time-consuming and requires initial resources, strong networking skills and commitment. However, user participation provided crucial information that led to the widened the scope of the website audience and guided the development and testing of the website. The needs analysis underpinning the project suggests that palliative care peak bodies need to address three distinct audiences (clinicians, allied health professionals as well as patients and their caregivers).

Conclusion : Web developers should pay close attention to the content, language, and accessibility needs of these groups. Given the substantial cost associated with the maintenance of authoritative health information sites, the paper proposes a more collaborative development in which users can be engaged in the definition of content to ensure relevance and responsiveness, and to eliminate unnecessary detail. Access to volunteer networks forms an integral part of such an approach.

Addressing online information needs in palliative care : an action research-inspired approach

Whereas user participation has been embraced worldwide as a means to provide better patient outcomes, the implementation of formative, action research approaches in online health information has remained under-explored. The purpose of this study is to present an action research-based methodology that allows the scoping of health information and design needs in complex, multi-user online environments. The project's four main stages were informed by an iterative, formative approach involving continuous expert and user evaluation. The study suggests that an action research-inspired formative approach can be successfully employed to generate user-participation. Moreover, sustained user-participation effectively addresses most quality issues regarding content, language, and accessibility raised in the recent literature. The paper concludes that an action research approach geared to develop online health resources deserves more attention.

Effects of financial disadvantage on use and non-use of after hours care in Australia

Policy addressing the provision of primary care after hours (AH) is currently in flux because of concerns about equity of access and cost. In this study we examine the effects of socioeconomic disadvantage on access to AH care and episodes of not seeking AH care when needed among users and non-users of AH care. The effects of health on these relationships were also explored. The total sample consisted of 5538 users of AH care and 891 non-users of AH care who were randomly selected for telephone interviews. Factors determining AH care included accessibility that is structural barriers to use of care such as distance and transport, as well as affordability and availability. Logistic regression was used to determine the impact of financial disadvantage on episodes of not seeking AH care. Barriers to use of AH care and household health were subsequently added to the models to assess their impact. The results suggested that there were inequities in access to AH care but these were a function of barriers to AH care use rather than financial disadvantage per se. Accessibility and availability were significant barriers to use of AH clinics among both user and non-user samples. Affordability was only a significant barrier among users of AH care. The study suggests that policy aimed at reducing these barriers may effectively address inequities in AH care but that to be optimally effective policy change would also need to be accompanied by changes in consumer awareness.

Barriers to care for depressed older people : perceptions of aged care among medical professionals

The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care, multiple co-morbidities, reluctance by older people to discuss depression, negative attitudes among carers, as well as a lack of skills all contributed to a failure to detect and treat depression. The implications of these findings for training programs for professional carers are discussed.

Neighbourhood socioeconomic inequalities in food access and affordability

This study investigated whether the availability and accessibility of supermarkets and fruit and vegetable stores, and the availability, variety and price of foods within these stores, varied across areas of different levels of socioeconomic disadvantage in Melbourne, Australia. Data on food store locations, and food variety and price within stores were obtained through objective audits of 45 neighbourhoods of varying socioeconomic disadvantage. Geographical accessibility of healthy food stores was mostly better amongst those living in more advantaged neighbourhoods. Availability of healthy foods within stores only slightly favoured those in advantaged neighbourhoods. However food prices favoured those living in disadvantaged areas.

Towards the development of a conceptual design management model for remote sites

Remote and environmentally sensitive sites present unique challenges for participants involved in the design and construction process. Worldwide advances in information technology coupled with improved site accessibility and manageability has enabled the construction industry to undertake such projects with greater ease. Furthermore, research on information technology in construction has begun to focus our attentions on our increased ability to work virtually in distributed teams. These remote sites have a range of development potential as clients have varied interests including; tourism, scientific investigation and resource exploration and processing which impact upon the management of the design process. These sites pose unique challenges to the project teams and in particular for the management of project design. The conceptual design phase is often marked by an iterative and creative process, which tends to be a sociologically oriented world where designers respond to a range of functional, aesthetic, environmental and even spiritual concerns. Strategic decisions made during the briefing and conceptual design stage may impact upon construction logistics and sustainability. Detailed design for construction tends to be a production oriented world. There is a significant body of literature that addresses the application of lean thinking to improving the interface between detailed design and construction production. There is little literature that takes a holistic view of design management for remote sites. The lean design management field of research has much to contribute to the design management of these projects. The review of the literature indicated that much of the lean thinking has been primarily concerned with sequential production. However, lean thinking is based upon principles of flow and value, which is also conducive to the complex process involved in design management for remote sites. A conceptual model is developed that considers both the production and sociological approaches to design management, in response to the peculiar demands of the site and their project teams.

Enablers and barriers to accessing mental health services for adults with high prevalence psychological disorders in South West Victoria

Knowing what services are available and how to access them can be challenging in rural areas. The aim of the South West Mental Health Mapping project was to identify the level, accessibility and effectiveness of mental health services for high prevalence psychological disorders amongst the adult population in the South West region of Victoria. This study includes data from a number of sources: regional records of the number and location of health professionals; a telephone survey of 1297 people in five Local Government Areas in the region; and a social network analysis of contact points. Additional qualitative interviews and surveys were conducted with 25 service recipients and 37 health professionals to identify issues from different perspective. This paper will focus on the social network analysis of the project. It highlights the relative prominence of each type of service provider within the overall network. The social network map shows the centrality of the General Practitioner and the wide range of agencies that become involved in supporting people with mental health issues. The discussion identifies primary contact points for people seeking help and places of referral. The main barrier acknowledged by people requiring assistance was lack of knowledge about where to go for help. Enablers included Medicare Better Access funded schemes. The findings show that there is a reasonable range of mental health professionals across the region, although there are challenges with recruitment and retention of staff. Even with available services, a major problem is communicating this information to potential consumers

Board structure and firm performance : evidence from India's top companies

Manuscript Type: Empirical

Research Question/Issue: This paper investigates the relationship between internal governance structures and financial performance of Indian companies. The effectiveness of boards of directors, including board composition, board size, and aspects of board leadership including duality and board busyness are addressed in the Indian context using two theories of corporate governance: agency theory and resource dependency theory.

Research Findings/Insights: The study used a sample of top Indian companies taking into account the endogeneity of the relationships among corporate governance, corporate performance, and corporate capital structure. The study provides some support for aspects of agency theory as a greater proportion of outside directors on boards were associated with improved firm performance. The notion of separating leadership roles in a manner consistent with agency theory was not supported. For instance, the notion that powerful CEOs (duality role, CEO being the promoter, and CEO being the only board manager) have a detrimental effect on performance was not supported. There was some support for resource dependency theory. The findings suggest that larger board size has a positive impact on performance thus supporting the view that greater exposure to the external environment improves access to various resources and thus positively impacts on performance. The study however failed to support the resource dependency theory in terms of the association between frequency of board meetings and performance. Similarly the results showed that outside directors with multiple appointments appeared to have a negative effect on performance, suggesting that "busyness" did not add value in terms of networks and enhancement of resource accessibility.

Theoretical/Academic Implications: The two theories of corporate governance, namely agency and resource dependence theory, were each only partially supported, by the findings of this study. The findings add further to the view that no single theory explains the nexus between corporate governance and performance.

Practitioner/Policy Implications: This study demonstrates that corporate governance measures utilized in developed economies related to boards of directors have some synergies and relevance to emerging economies, such as India. However, the nature of business structures in India, for example the large number of family businesses, may limit the generalizability of the findings and signals the need for further investigation of these businesses. The evidence related to multiple appointments of directors suggests that there may be support for restricting the number of directorships held by any one individual in emerging economies, given that the "busyness" of directors was negatively associated with firm performance.

An examination of police officers' notes of interviews with alleged child abuse victims

This study provided a critical examination of handwritten records (notes) of interviews contained in a sample of 89 police case files about alleged child abuse. Some of the notes examined related to initial disclosure (complaint) interviews which were not electronically recorded and were meant to be recorded verbatim. Notes of electronically recorded interviews, which merely constituted a convenient summary of the case details, were also examined. Collectively, the analyses focused on the accessibility, completeness and accuracy of the notes, and the degree to which the interviewers' questions and witnesses' answers were differentiated. In relation to the disclosure interviews, a substantial proportion of these were not accessible. Of those where the notes were obtained, the detail recorded was not a complete record of conversation, and there was often poor delineation of questions and responses. Analysis of the electronically recorded interviews showed that these were not an entirely accurate summary of event details even though the note takers' sole task was to document the interview. The implications of these findings are discussed.

Giorgio de Chirico and the idea of enigmatic imagery : the innocence of becoming

My paintings emerge from within a context best explained by reference to Nietzsche's perspectivism. That is an intellectual attitude that deprivileges rationalism and accommodates scepticism or unknowing as an acceptable starting point From this standpoint art/language can be seen as being in a state of becoming rather than as representing a state of being. This thesis aims to demonstrate, not only by a philosophical encounter with Giorgio de Chirico's work: ie. his use of myth, his Nietzschean perspectivism and his enigmatic interpretation of figuration, that the most helpful context and understanding of my work can be realied. De Chirico's art, like Nietzsche's philosophy seeks in its processes to explore the possible unity of Dionysian aesthetic force with the Apollonian. Neither Nietzsche nor de Chirico considered within a post-Socratic world that this unity was realizable. Nevertheless they both share in their respective art forms a need to represent the relentless struggle to enact the disjunction of the two aesthetic forces in a secular world. The artist’s enigmatic imagery is characterized by a consideration of appearance and reality and it is for this reason that the work was selected as a model for investigating the nature of enigma. His use of seemingly straightforward, ordinary images suggests a sense of accessibility, yet at the same time they are irreducible to knowing and my own image-making was greatly expanded by investigating these concerns. I am not arguing that de Chirico was influenced by Nietzsche but instead that Nietzsche's philosophical point of view and his use of poetic language to express these views lay in discovering the qualities and substance of the Dionysian spirit As well as working within a Nietzschean world-view set out in The Birth of Tragedy, de Chirico has also drawn on the Italian unification, specifically the Risorgimento and the lineage of these political and mythical figures were endemic to his art and they interface the with his use of the Apollonian-Dionysian disunity first explored by Nietzsche. The focus of the exegesis will be to present the poetic and philosophical use made of the latter in de Chirico’s art It is anticipated that this philosophical encounter with the aesthetic, social and political world of de Chirico will, not only assist in interpreting his life's work anew, but will also provide a context in which my paintings of enigma might be interpreted.

Family food environments as determinants of children's eating : implications for obesity prevention

The prevalence of childhood obesity is escalating rapidly and it considered to be a major public health problem. Diet is a recognised precursor of fatness, and current evidence supports the premise that in Westernised countries, the dietary intakes of children are likely to be important in obesity genesis. However, we have a relatively poor understanding of the environments in which a child’s eating is learnt and maintained. Much of the existing work in this area is based on small-scale or experimental studies, or has been derived from homogeneous populations within the USA. Despite these limitations, there is evidence that aspects of the child’s family environment are likely to be important in determining obesity risk in children. This thesis examines the impact of the family food environment on a child’s eating through two related studies. The first study, titled the Children and Family Eating (CAFÉ) study comprised three phases. Phase one involved qualitative interviews with 17 parents of 5-6 year-old children to explore parental perceptions regarding those factors in a child’s environment believed to influence the development of their child’s eating habits. These interviews were used to inform the development of quantitative measures of the family food environment. The second phase involved the development of a Food Frequency Questionnaire (FFQ) to assess dietary intake in 5-6 year-olds. The FFQ was informed by analysis of 1995 Australian National Nutrition Survey data. In the final phase the relationships between dietary intakes of 5-6 year-old children, and potential predictors of dietary intake were examined in a cross-sectional study of 560 families. Predictors included measures of: parental perceptions of the adequacy of their child’s diet; food availability and accessibility; child-feeding; the opportunities for parental modelling of food intake; a child’s television exposure; maternal Body Mass Index; and maternal education. Analysis of the CAFÉ data provides unique information regarding the relationships between a child’s family food environment and their food consumption. Models developed for a range of dietary outcomes considered to be predictive of increased risk for obesity, including total energy and fat intakes, vegetable variety, vegetable consumption, and high-energy (non-dairy) fluid consumption, explained between 11 and 20 percent of the variance in dietary intake. Two aspects of the family food environment, parental perception of a child’s dietary adequacy, and the total minutes of television viewed per day, were frequently found to be predictive of dietary outcomes likely to promote fatness in these children. The second study, titled the Parent Education and Support (PEAS) Feeding Intervention Study, was a prospective pre/post non-randomised intervention trial that assessed the impact of a feeding intervention to 240 first-time mothers of one-year-old children. This intervention focused on one aspect of the family food environment, child-feeding, which has been proposed as influential in the development of obesogenic eating behaviours. In this study, Maternal and Child Health Nurses (MCHNs), using a ‘Division of Responsibility’ model of feeding, taught parents to provide nutritious food at regular intervals and to let children decide if to eat and how much to eat. Thus parents were encourages to food their child without exerting pressure, or employing coercion or rewards (controlling behaviours). The aim was to influence parental attitudes and beliefs regarding child-feeding. Through the use of these feeding techniques, this intervention also aimed to increase the variety of fruits and vegetables a child consumed by teaching parents to persist with offering these foods, over the year of the intervention, in non-emotive environments. Fruits and vegetables were chosen in this intervention because they are likely to be protective in the development of obesity. Analysis of the PEAS data suggests that this low-level feeding intervention, delivered through existing Maternal and Child Health services, was modestly effective in changing parental attitudes and beliefs regarding the feeding of young children. Further, the validity of fruits offered to intervention group children increased. This thesis expands the existing knowledge base by providing a comprehensive analysis of the relative impact of aspects of the family environment on dietary intakes of 5-6 year-olds. Further, the analysis of a feeding intervention in first-time parents provides important insights regarding the potential to influence child-feeding and the impact this may have on the promotion of eating behaviours protective against obesity.

Language, power and ruling relations in vocational education and training

This thesis uses institutional ethnography to explore the text-based regulatory framework of the Australian Vocational Education and Training (VET) sector. Training Packages are national competency standards used to assess local workplace practice. The Australian Quality Training Framework (AQTF) is a national compliance framework used to audit local learning and assessment practice. These texts operate in a ‘symbiotic relationship’ to achieve a policy goal of national consistency. The researcher explicates the social relations of VET starting from her disquiet as a practitioner. The thesis argues that Training Packages and the AQTF socially organise the content and delivery of local learning and assessment activities. VET practitioners struggle to use these texts to support good practice, and their hidden work maintains an unstable VET system. Yet the extralocal mode of ruling offers no room to challenge VET policy. The thesis explicates three themes. Interview data is used to explore the contrast between the institutional language of Training Packages and the vernacular of workplaces in which these texts are activated. Many practitioners and participants simply do not understand Training Package competency standards. Using these texts to judge employee performance shifts the policing of workplace practice from local sites to external VET authorities. A second theme emerges as the analysis explores why VET practitioners use this excluding language in their work with participants. Interview data reveals that local training organisations achieve different readings as they engage with ruling VET texts. Some organisations use the national texts as broad frameworks, allowing practitioners to create spaces for meaningful learning. Other organisations adopt a narrow and rule-bound reading of national texts, displacing practitioners’ authority over their own practice. A third theme is explored through examination of a sequence of VET texts. The review and redevelopment of the mandatory qualifications for VET practitioners identified the language of the competency standards as a significant accessibility issue. These concerns were reshaped and subsumed in an official response that established the use of this language as a compulsory assessable requirement and a language and literacy benchmark. The thesis presents a new understanding of VET as a regulatory framework established through multiple levels of ruling texts that connect local sites to national government agendas. While some individual practitioners are able to navigate through this system, there is an urgent need for practitioners as a profession to challenge national hegemony.

Envisioning Indochina : the spatial and social ordering and imagining of a French colony

The emergence of Indochina in the French imagination was articulated in both representational and institutional modes. Representation involves the transmission of colonial ideals through more obtuse means; that is, through literary texts, travelogues, exhibitions, film and advertising. However, these textual sites feed from and invest in a material situation, which was the institutional arm of colonialism. Indochina was institutionally articulated in cartographic maps and surveys, in the new social spaces of cities and towns, in architectural and technological forms, through social technologies of discipline and welfare and in cultural and religious organisations. The aim of this thesis is to analyse, across a number of textual sites, the representation and institutionalisation of Otherness through the politics of space in the French colony of Indochina, Indochine in this sense becomes a spatial discourse. The French constructed a mental and physical space for Indochina by blanketing and suffocating the original cultural landscape, which in fact had to be ignored for this process to occur. What actually became manifest as a result of this projection stemmed from the French imagination. Just as the French manipulated space, language also underwent the same process of reduction. The Vietnamese script was latinised to make it more 'useable' and ‘accessible’. Through christening the union of Indochina; initiating a comprehensive writing reform; and renaming the streets in the colonial cities, the French used language us another tool for 'making transparent'. Furthermore, the colonial powers established a communication and transport network throughout the colony in an attempt to materialise their fictive (artificial) vision of a unified French Indochinese space. The accessibility and design of these different modes of transport reflected the gendered, racial and class divisions inherent in the colonial establishment. At the heart of representing and institutionalising Indochina was the desire to control and contain. This characterised French imperial ordering of space in the city and the rural areas. In rural areas land was divided into small parcels and alienated to individuals or worked into precise grids for the rubber plantation. In urban centres the native quarter was clearly demarcated from the European quarter which functioned as its modern, progressive Other. The rationale behind this segregation was premised on European, nineteenth century discourses of race, class, gender and hygiene. Influenced by Darwinian and neo-Lamarkian theories of race, this biological discourse identified the 'working class', 'women' and 'the native' as not only biologically but also culturally inferior. They were perceived as a potential, degenerative threat to the biological, cultural and industrial development of the nation. In the colonial context, space was thus ordered and domesticated to control the native population. Coextensively, the literature which springs from such a structure will be tainted by the same ideas, and thus the spaces it formulates within the readers mind feed on and reinforce this foundation. Examples of gender and indigenous narratives which contest this imaginative, transparent topography are analysed throughout this thesis. They provide instances of struggle and resistance which undermine the ideal/stereotypical level of architectural and planned space and delineate an alternative insight into colonial spatial and social relations. The fictional accounts of European women and indigenous writers both challenge and reaffirm the fixity of some of these idealised colonial boundaries. In various literary, historical, political, architectural and cinematic discourses Indochina has been und continues to be depicted as a modern city and exotic Utopia. Informed by the mood of nostalgia, exotic images of Indochina have resurfaced in contemporary French culture. France's continued desire to create, control and maintain an Indochinese space in the French public imagination reinforces the multi-layered, interconnected and persistent nature of colonial discourse.

Living high but healthy : high-rise housing, nature, health and wellbeing

This exploratory mixed method study investigated the factors, including access to nature (i.e. parks and gardens), impacting on inner city high-rise residents' health and wellbeing. Analysis of the integrated findings revealed that a range of factors (including accessibility, choice and control and tenure) impact on residents' health and wellbeing.

Self-aware virtualised autonomic self-management of non-dedicated clusters

This research aims at improving the accessibility of cluster computer systems by introducing autonomic self-management facilities incorporating; 1) resource discovery and self awareness, 2) virtualised resource pools, and 3) automated cluster membership and self configuration. These facilities simplify the user's programming workload and improve system usability.