Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

Towards solutions for a liveable future: progress, practice, performance, people: Proceedings of the 41st Annual Conference of the Architectural Science Association ANZAScA

There is hope! Since Al Gore disclosed the inconvenient truth, the climate has changed. The time of denial is over; the era of well-informed action and sound development is with us. Sustainability has now moved from the fringe, into the mainstream of politics, society, architecture and building practice. In this new context architectural science will contribute to two main tasks: prevent further damage to our environment, and respond to challenges invoked by climate change.
The built environment and human activity within it account for a large part of the problem. Architectural science and architectural practice are part of the solution. The ANZAScA 2007 conference focuses on the solutions architectural science has to offer toward a liveable future through the following generic themes:
progress – the evaluation and improvement of built facilities, new and existing, in terms of energy intensity, financial reward and environmental impact.
practice – the relationship between our cultural heritage, new facility design, retrofit design and its realisation
through construction.
performance – the connection between building operation targets, validation of performance, and user comfort and interaction in new and existing environments.
people – the effect of space on user behaviour, user responsibility and social wealth.
In response to this challenge, architectural science researchers including students, educators, and practitioners at ANZAScA 2007, present a broad range of research activity and concern within the built environment from global issues down to the specific actions of individuals.

Influences on the supply of accounting graduates in Australia: a focus on international students

This paper examines the influences on the potential supply of accounting graduates in Australia with reference to the personal and social influences on the decision to major in accounting using the Theory of Reasoned Action and focusing on differences between local and international students. Responses from 437 accounting majors' found that personal attitudes linked to 'intrinsic interest' and 'extrinsic interest' was influential in choice of major. 'Reference groups' were an important social influence for international students. The findings have implications for government policy and the accounting profession in terms of attracting students and particularly international students, who are sufficiently interested in accounting as a career choice to address the skill shortage in Australia.

Exploring general practitioners' experience of informing women about prenetal screening tests for foetal abnomalities : a qualitative focus group study

Background: Recent developments have made screening tests for foetal abnormalities available earlier in pregnancy and women have a range of testing options accessible to them. It is now recommended that all women, regardless of their age, are provided with information on prenatal screening tests. General Practitioners (GPs) are often the first health professionals a woman consults in pregnancy. As such, GPs are well positioned to inform women of the increasing range of prenatal screening tests available. The aim of this study was to explore GPs experience of informing women of prenatal genetic screening tests for foetal abnormality.
Methods: A qualitative study consisting of four focus groups was conducted in metropolitan and rural Victoria, Australia. A discussion guide was used and the audio-taped transcripts were independently coded
by two researchers using thematic analysis. Multiple coders and analysts and informant feedback were employed to reduce the potential for researcher bias and increase the validity of the findings.
Results: Six themes were identified and classified as 'intrinsic' if they occurred within the context of the consultation or 'extrinsic' if they consisted of elements that impacted on the GP beyond the scope of the
consultation. The three intrinsic themes were the way GPs explained the limitations of screening, the extent to which GPs provided information selectively and the time pressures at play. The three extrinsic
factors were GPs' attitudes and values towards screening, the conflict they experienced in offering screening information and the sense of powerlessness within the screening test process and the health
care system generally. Extrinsic themes reveal GPs' attitudes and values to screening and to disability, as well as raising questions about the fundamental premise of testing.
Conclusion: The increasing availability and utilisation of screening tests, in particular first trimester tests,has expanded GPs' role in facilitating women's informed decision-making. Recognition of the importance
of providing this complex information warrants longer consultations to respond to the time pressures that GPs experience. Understanding the intrinsic and extrinsic factors that impact on GPs may serve to shape
educational resources to be more appropriate, relevant and supportive.

Adiposity and tendinopathy

Purpose. Tendon injuries (tendinopathy) are prevalent across the population, affecting active and inactive individuals and manual workers. The aetiology of tendinopathy is not known. However, extrinsic factors such as load are known to affect the prevalence. More recently, intrinsic factors have been shown to also affect tendons; genes, biomechanics, and strength have been shown to influence tendon disease. One intrinsic factor that appears to have an association with tendinopathy is body composition; more specifically central adiposity. Several studies have reported this association, and several studies have found the association when reporting other aspects of tendinopathy.

Method. This paper will detail what is known about the association between tendinopathy and body composition, examine the strength of the association by evaluating studies in the area and speculate on potential mechanisms for the association.

Results. The association between tendon health and adiposity, especially central adiposity, warrants further investigation.

Conclusion. There may be an interaction between adiposity and tendon pathology. Adiposity may be a key intrinsic risk factor that is translated into tendon disease in the presence of additional intrinsic (e.g., diabetes) and extrinsic factors (e.g., load).

Factors influencing population dynamics in island and mainland populations of the Swamp Antechinus (Antechinus minimus)

Simultaneously analysing demographic processes of small mammals living in different ecological contexts may help to understand mechanisms that influence the growth and decline of these populations. The size and demography of swamp antechinus (Antechinus minimus) populations located in a coastal mainland habitat and on a small offshore island in south-eastern Australia were investigated. Large demographic differences occurred between the two ecosystems, with the island population density often 100 times greater than that on the mainland. The swamp antechinus in the mainland habitat was influenced by extrinsic climatic forces, with juvenile recruitment, individual body mass and overall population size being affected by rainfall, a factor likely to influence food availability for the species. However, the island population did not appear to be affected by drought to the same degree where allochthonous marine nutrient inputs may have offset any drought-induced reduction in primary production. Significantly greater juvenile recruitment in the island habitats combined with restricted emigration and potentially reduced predation and interspecific competition are likely to be responsible for the high population densities on the island. Although island populations appear robust, future conservation efforts should focus on mainland populations given the genetic deficiencies in the island populations.

A clarification of the ERI model : the importance of personality

The present study aimed to investigate the role of personality in the etfort-reward imbalance model along with the construct validity of overcommitment in relation to Type A behaviour. The study sample consisted of 898 operational law enforcement persolllel from a large Australian police service. Factor analysis revealed that the overcommitment construct was psychologically related to, but distinct from, the Type A dimensions achievement striving, impatience-irritability and hostility despite the hypothesised interrelatedness of the measures. Multiple regression analyses including tests for curvilinear effects revealed that the Type A dimensions made a significant improvement to the prediction of employee wellbeing and job satisfaction, The results of the study provide theoretical implications in terms of the augmentation of the effort-reward imbalance model.

Ethical, economic and efficient sector : is it a gamble? The case of New Zealand Health

The New Zealand public sector has gone through major reform as a result of fiscal deficit in 1984 (KettI, 1997; Schwartz, 1997), resulting in shift of emphasis from quality service provision to establishing financial supremacy (Kettl, 1997). This raises concern as to how public sector employees are attaining balance between their service objectives with financial ones and how is the ethics negotiated in this process. Following this concern, this paper focuses on determining the organisational variables consisting of organisational policies in the District Health Boards (DHBs) and hospitals of New Zealand on ethical behaviours of managers and the ethical climate of these departments. The aim of this study is to increase our understanding of the ethical climate of the public health. Our findings suggest that little emphasis has been provided to the aspect of ethics in New Zealand health sector. There is no reward for employees who exhibit exemplary ethical behaviour, no hot line to consult/report about ethics, any detailed guidelines and policies, and not enough ethics-related training provided to staff.

Chemical modification of timber decking : assessing the parameters of acceptability

The criteria for accepting or rejecting a technology extend beyond the intrinsic properties of the finished product such as physical performance. There are also extrinsic factors such as the history of the product and trust in the manufacturers and suppliers, as well as the perceptions and risk management strategies of various stakeholder groups. A methodology was trialled to take into account the extended supply chain of the product, while simultaneously engaging stakeholders to determine and to understand their perceptual frameworks. Three pine decking products manufactured using different amounts and types of chemical modification were compared using life cycle assessment and the comments of 114 respondents from six stakeholder groups in New Zealand. The results of the perceptual research include a quadrant diagram which allows a visual comparison of the responses of different stakeholders to actual or hypothetical products, aiding the identification of when and why certain technologies may be disqualified from acceptability or become the topic of public debate.

Estimating expected excess returns using historical and option-implied volatility

We test the relation between expected and realized excess returns for the S&P 500 index from January 1994 through December 2003 using the proportional reward-to-risk measure to estimate expected returns. When risk is measured by historical volatility, we find no relation between expected and realized excess returns. In contrast, when risk is measured by option-implied volatility, we find a positive and significant relation between expected and realized excess returns in the 1994–1998 subperiod. In the 1999–2003 subperiod, the option-implied volatility risk measure yields a positive, but statistically insignificant, risk-return relation. We attribute this performance difference to the fact that, in the 1994–1998 subperiod, return volatility was lower and the average return was much higher than in the 1999–2003 subperiod, thereby increasing the signal-to-noise ratio in the latter subperiod.

RTKN2 induces NF-KappaB dependent resistance to intrinsic apoptosis in HEK cells and REgulates BCL-2 genes in human CD4+ lymphocytes

The gene for Rhotekin 2 (RTKN2) was originally identified in a promyelocytic cell line resistant to oxysterol-induced apoptosis. It is differentially expressed in freshly isolated CD4+ T-cells compared with other hematopoietic cells and is down-regulated following activation of the T-cell receptor. However, very little is known about the function of RTKN2 other than its homology to Rho-GTPase effector, rhotekin, and the possibility that they may have similar roles. Here we show that stable expression of RTKN2 in HEK cells enhanced survival in response to intrinsic apoptotic agents; 25-hydroxy cholesterol and camptothecin, but not the extrinsic agent, TNFα. Inhibitors of NF-KappaB, but not MAPK, reversed the resistance and mitochondrial pro-apoptotic genes, Bax and Bim, were down regulated. In these cells, there was no evidence of RTKN2 binding to the GTPases, RhoA or Rac2. Consistent with the role of RTKN2 in HEK over-expressing cells, suppression of RTKN2 in primary human CD4+ T-cells reduced viability and increased sensitivity to 25-OHC. The expression of the pro-apoptotic genes, Bax and Bim were increased while BCL-2 was decreased. In both cell models RTKN2 played a role in the process of intrinsic apoptosis and this was dependent on either NF-KappaB signaling or expression of downstream BCL-2 genes. As RTKN2 is a highly expressed in CD4+ T-cells it may play a role as a key signaling switch for regulation of genes involved in T-cell survival.

Reducing corruption in international business decisions : prospects, frameworks & techniques

This paper reports the results of a rare interview/questionnaire survey of 41 multinational business managers in India regarding their personal experiences of corrupt practices. Despite current trends and traditional scepticism, quite favourable prospects for reducing corruption are indicated, provided that multifaceted approaches are adopted that appeal to intrinsic and extrinsic motives. Accordingly, a corruption related decision-making model is proposed, for use as an heuristic guide in circumstances involving corrupt business practices.

Conceptualising a voluntary certification system for highly accomplished teachers

In this paper I argue that a voluntary certification system for highly accomplished teachers must be part of a coherent system of professional accountability which is developed, implemented and managed by the profession. This would be a system that engages professional judgement of evidence provided by teachers in relation to their professional knowledge and practice, and professional standards for teaching would provide the organising framework for that judgment. It would be a system incorporating and aligning all forms of professional licensure, including entry into the profession and subsequent professional milestones. It would be a system that all partners in the profession across Australia—employers, professional associations, and registration authorities—endorse, participate in and align with.

The profession can take the lead in developing and implementing such a coherent and coordinated national approach by carefully developing a system to recognise and reward highly accomplished teaching. Such a system should aim to recognise and build teacher quality by defining what it is highly accomplished teachers know and are able to do. Moreover, such a system must fi nd ways of making teaching public and acknowledging teaching as intellectual work which involves professional judgment that draws on a recognised professional knowledge base and contextualised knowledge about students and their learning.

The paper is presented in two main sections. First, a proposed conceptual framework for the professional recognition and certification of highly accomplished teachers is outlined. Then, the argument for this proposed conceptual framework is presented drawing on learnings from relevant research and professional activity in both Australia and the USA.

The influence of Sport Education on student motivation in physical education

Background: Physical educators are faced with trying to provide motivating and enjoyable experiences in physical education. Sport Education is an instructional model that aims to provide positive motivational sport experiences by simulating the features of authentic sport. Research support for Sport Education is positive, however, the effects on student motivation and the motivational climate are not well understood.

Purpose: To investigate the influence of the Sport Education model on student motivation (intrinsic/extrinsic motivation, goal orientations, and perceived motivational climate) in secondary physical education.

Setting: Six classes were selected according to teacher and class availability in the sports of soccer, hockey, and football codes in a co-educational government school.

Participants: Participants were 115 (male = 97, female = 18) Year-8 students (aged 13-14 years), in a Sport Education condition (n = 41) and a Traditional condition (n = 74).

Measures: At pre- and post-test, all participants completed three questionnaires: the Intrinsic Motivation Inventory, the Task and Ego Orientation in Sport Questionnaire, and the Perceived Motivational Climate in Sport Questionnaire.

Intervention: Participants completed either a Sport Education condition or a Traditional condition for one double period (100 minutes) one day per week for 10 weeks (Sport Education condition) or for five weeks (Traditional condition). The Sport Education condition incorporated six distinctive features: seasons, affiliation, formal competition, record keeping, festivity, and a culminating event. The Traditional condition used whole-group instruction led by the teacher.

Research design: The study used a non-equivalent control group design with pre- and post-test procedures. The independent variable was teaching condition and the dependent variable was student motivation (assessed by intrinsic motivation, goal orientations, and motivational climate). The groups were already established and selected for convenience purposes.

Data collection and analysis: Participants completed pre-test measures and then participated in their pre-established classes. Post-test measures were completed in the last class in each condition. A reliability analysis on measures was conducted using Cronach's alphas. A pre-test manipulation check was performed to check for any initial differences in motivation. To compare the difference in changes between conditions on motivation, a series of 2 times 2 repeated measures analyses of variance were conducted. A comparison of the relationship between motivation measures was conducted using Pearson's product moment correlation coefficients.

Findings: There was a significant difference between the conditions on changes in perceived competence, task orientation, and mastery climate, with the Traditional condition decreasing significantly from pre- to post-test compared with the Sport Education condition. There were no significant differences on interest/enjoyment, effort/importance, pressure/tension, ego orientation, or performance climate. A mastery climate was positively related to task orientation and intrinsic motivation and a performance climate was related to ego orientation.

Conclusions: The Sport Education condition was more successful in maintaining high levels of intrinsic motivation, task orientation, and mastery climate than the Traditional condition. That is, the Traditional condition was associated with a decrease in adaptive aspects of motivation for students, whereas the Sport Education condition maintained existing levels of motivation.

Applying self-determination theory to understand the motivation for becoming a physical education teacher

This study explored the reasons people choose physical education teaching as a profession and investigated the relationship of these choices with motivation. Physical education pre-service teachers (n = 324) completed the Academic Motivation Scale (AMS) and a measure of reasons for choosing physical education teaching. Confident interpersonal service reasons were linked with intrinsic motivation; whereas sport and physical activity reasons were related to extrinsic motivation. Enrolling because teaching seemed easy was linked with amotivation. Motivation was similar for different course entry methods, however, females were more intrinsically motivated than males and third year students were lower in motivation than other year levels.