Policy interventions implemented through sporting organisations for promoting healthy behaviour change (review)

Background
Sporting organisations provide an important setting for health promotion strategies that involve policies, communication of healthy messages and creation of health promoting environments. The introduction of policy interventions within sporting organisations is one strategy to target high risk behaviours such as smoking, alcohol consumption, excess sun exposure, unhealthy eating and discrimination.

Objectives
To review all controlled evaluation studies of policy interventions organised through sporting settings to increase healthy behaviour (related to smoking, alcohol, healthy eating, sun protection, discrimination, safety and access).

Search strategy
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsyclNFO, CINAHL, SPORTDiscus, Sociological Abstracts, Dissertation Abstracts, freely available online health promotion and sports-related databases hosted by leading agencies, and the internet using sport and policy-related key words. We identified further studies in the bibliographies of articles and by contacting authors of key articles in the area.

Selection criteria
We aimed to identify research that had used study designs that incorporated an evaluated intervention and comparison. Uncontrolled studies, meeting other inclusion criteria, were to be reported in an annex to the review.
Types of studies: Studies in which sporting organisations were allocated to a policy intervention or control/comparison group. No minimum follow-up required.
Types of participants: People of all ages.
Types of interventions: Any policy intervention implemented through sporting organisations to instigate and/or sustain healthy behaviour change, intention to change behaviour, or changes in attitudes, knowledge or awareness of healthy behaviour. Policies must address any of the following: smoking, alcohol, healthy eating, sun protection, access for disadvantaged groups, physical safety (not including injuries), and social and emotional health (e.g.. anti-vilification, anti-discrimination).
Types of outcome measures: Behaviour change, intention to change behaviour, change in attitudes, knowledge or awareness of healthy behaviour, and policy presence.

Data collection and analysis
We assessed whether identified citations were controlled evaluation studies and investigated the use of policy implemented in sporting settings. Abstracts were independently inspected by two reviewers and full papers were obtained where necessary. As no controlled evaluation studies were located, no data collection or analysis was undertaken. No uncontrolled studies meeting other inclusion criteria were identified and therefore no annex is presented.

Main results
No rigorous studies were located to test the effectiveness of policy interventions organised through sporting organisations to increase healthy behaviours, attitudes, knowledge or inclusion of health oriented policies within the organisarions.

Authors' conclusions
We were unable to find any controlled studies to guide the use of policy interventions used in sporting settings. The search process revealed a number of case studies with anecdotal reporting of outcomes. We strongly recommend that rigorous evaluation techniques are employed more commonly in this field to illuminate the impact of health promoting policy on outcomes, and the contexts and processes which are likely ro be effective in reducing harmful behaviours.

Using a monitored sip test to assess risk of aspiration in perioperative patients.

• PULMONARY ASPIRATION is associated with high morbidity and mortality rates. Older adult patients have been shown to be particularly at risk for aspiration.

• A RANDOMIZED CONTROLLED TRIAL was conducted to investigate the efficacy of a simple, noninvasive screening test—the monitored sip test—in identifying patients at risk for aspiration, including “silent aspirators.”

• BASED ON CLINICAL JUDGMENT using the study's outcome measures, incidence of aspiration-related lung injury was high (ie, 37.5%); however, no identification of patients at risk for aspiration occurred after either the use of the monitored sip test or routine cautious introduction of fluids during the data collection phase of the study.

A strategic approach to target marketing-choosing the preferred generic customer : a model of shareholder value performance

In recent years the contribution of the marketing function has changed and interest now centres on its contribution to a firm’s financial performance. The Marketing Science Institute in the USA has stated that it is the number one marketing issue facing corporate America. The Australian Marketing Institute is promoting a set of marketing metrics that will help Australian firms measure the function’s contribution to shareholder value creation. Much of the literature relates notions such as customer satisfaction and other marketing activities with a firm’s profit. A missing link appears to be the choice firms make in terms of which customer groups to target and the resultant impact on shareholder value performance. The generic customer groups comprise: existing customers, former customers and prospects. A review of the literature reveals that marketing costs and benefits vary across these groups. The challenge for management is to determine which group represents the best target and to allocate scarce marketing resources accordingly. The task is made even more challenging because the economic value of members within each group also varies and some product lines may be unprofitable and therefore, may not be worth pursuing. To generate superior shareholder value it may not simply be the case of acquiring the maximum number of new customers from any source but to find the appropriate mix of the generic customer groups and manage the individual customer relationships accordingly. This paper seeks to firstly summarise and review the recent literature on marketing and its relationship to shareholder value and secondly to propose a model for allocating marketing resources across generic customer groups in order to generate improved shareholder value performance. Importantly, the model not only covers increasing business with customers but also shedding customers or shedding the extent of business conducted with customers as means of generating shareholder value.

Perceived conditions of workers in different organizational settings

Purpose: – Research into office design and its effect on employee satisfaction and performance has attracted considerable contemporary research interest. However, most studies have tended to concentrate on the impact of the built environment on human performance, ignoring the actual needs of employees working in different organizational settings. This paper hence aims to investigate the nature and extent of occupant satisfaction with the built environment in different organizational settings in Australia for a range of climates.

Design/methodology/approach: – A survey was conducted in Australia from 2004-2005, comprising 41 buildings, including six government buildings, 14 educational buildings and 21 commercial buildings. The Kruskal-Wallis H test was used to explore whether there are differences in the mean ranking of office environment satisfaction amongst the three organizational settings, and the Mann-Whitney U test was employed to further test whether there are differences in the mean ranking of office environment satisfaction between any two groups.

Findings: – Significant differences were found in aspects of air, temperature, space suitability, flexibility, usability and controllability. Employees in commercial settings seem to be more satisfied with their physical work environment than employees in other organization types. Employees in educational settings showed the highest satisfaction with most variables in the workspace design and management category. Government employees showed a lower level of satisfaction with their physical work environment and workspace design and management.

Originality/value: – Moreover, the government and educational groups showed more similarity with each other, while the commercial group displayed significant difference.

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.

The effects of a simplified tai-chi exercise program (STEP) on the physical health of older adults living in long-term care facilities : a single group design with multiple time points

Background
Studies support the positive effects that Tai Chi has on the physical health of older adults. However, many older adults residing in long-term care facilities feel too weak to practice traditional Tai Chi, and a more simplified style is preferred.
Objective
To test the effects of a newly-developed, Simplified Tai-Chi Exercise Program (STEP) on the physical health of older adults who resided in long-term care facilities.
Design
A single group design with multiple time points: three pre-tests, one month apart; four post-tests at one month, two months, three months, and six months after intervention started.
Settings
Two 300–400 bed veteran homes in Taiwan.
Participants
The 51 male older adults were recruited through convenience sampling, and 41 of them completed six-month study. Inclusion criteria included: (1) aged 65 and over; (2) no previous training in Tai Chi; (3) cognitively alert and had a score of at least eight on the Short Portable Mental Status Questionnaire; (4) able to walk without assistance; and (5) had a Barthel Index score of 61 or higher. Participants who had dementia, were wheel-chair bound, or had severe or acute cardiovascular, musculoskeletal, or pulmonary illnesses were excluded.
Methods
The STEP was implemented three times a week, 50 min per session for six months. The outcome measures included cardio-respiratory function, blood pressure, balance, hand-grip strength, lower body flexibility, and physical health actualization.
Results
A drop in systolic blood pressure (p=.017) and diastolic blood pressure (p<.001) was detected six months after intervention started. Increase in hand-grip strength from pre to post intervention was found (left hand: p<.001; right hand: p=.035). Participants also had better lower body flexibility after practicing STEP (p=.038).
Conclusions
Findings suggest that the STEP be incorporated as a floor activity in long-term care facilities to promote physical health of older adults.

Crossing Bowen Street : mapping interventions in the classed subject

Synopsis: Crossing Bowen Street Crossing Bowen Street is an extended novel set in Melbourne, Australia. The protagonist, Meg Flanagan, is accepted to teachers' college. Meg is 24 years old and has worked, and lived out of home, since 17. Having completed her year 12 studies part time while working, she has applied to the Melbourne State College for a Bachelor of Education. Melbourne State College is subsequently 'amalgamated'A into Philip University, the original 19th century sandstone institution which borders MSC. Meg has worked as a medical secretary prior to commencing her studies. An only child, she is the first member of her family to go to university, indeed to finish high school. Tertiary study is exciting for Meg and the novel explores the psychic journey as well as the intellectual one, as Meg experiences challenges to the possibilities for her life and the trajectory along which she once assumed it would flow. The narrative is told through episodic and epistolary forms, with particular periods in Meg's cultural and academic life forming the focus, picking up the integral elements of her journey and examining the psychic context and action. Characters in the undergraduate chapters of the novel are somewhat transient, although very important to Meg's rapidly developing, changing sense of herself. The constant 'trying out' of ways of being and even lifestyles sees Meg losing old 'friendships' and making new, even temporary, ones all the time. This allows the opportunity for Meg to explore her feelings about connecting to others and the nature of her relationships. The Meg reflected back to her by others is of constant interest to her, particularly as she is frequently reminded that others see a very different Meg than she does. The novel commences at the outset of Meg's tertiary career, as she initially articulates the extent of her aspiration, of her sense of the possibility of her own life. Each vignette deals, chronologically, with an aspect of Meg's expanding sense of possibility, socially, emotionally, intellectually. Certain vignettes explore her relations with friends and acquaintances in the course, which in turn provide A In 1988, Federal Labor Minister for Education John Dawkins, devised a plan to end the streaming of Australian tertiary institutions and created what is called the Unified National System. This meant that colleges of advanced education and institutes of technology were either created universities in their own right, or more commonly, merged with an appropriate existing university. This process allows a fascinating insight into the class dimensions of hierarchies and stratifications. The need of universities and their members for status has been profoundly underscored. the background and context for her sexual relationships. That aspect of her developing subjectivity provides a marked contrast, which Meg uses as leverage, when set against her sense of herself as a scholar and her growing notion of entitlement, which allows her to 'choose', where previously she believed she had no choice; the choice is a scholarly career. Within all this, Meg discovers and is deeply empowered by certain political left, and feminist, discourses within the university community. She is equally dismayed and alienated by other feminist practices; her growing engagement with her own agency sees her quickly abandoning feminist subject positions previously dear to her, which served a particular purpose and are now superseded. This notion of feeling betrayed by the promise of a value system (or rather, its practitioners) will recur throughout the action of the novel, as Meg moves into an academic role, first as doctoral student and then as academic, seeking to live her values as practice and to remain true to what her trajectory has taught her. This is crystallised in the novel as the role played by the place she came from, and how that informs, and complicates, who she becomes. The novel seeks to explore the fundamental contradictions in doing so, through Meg's increasing awareness that the academy is not the harmonious, class aware institution she has idealised, but a world driven by status and hierarchies. This realisation must be reconciled in the light of Meg's anxieties about her working-class background. Meg's doctoral training at an elite university underscores her developing sense of what constitutes excellence and the role played by highly influential conservative institutions in maintaining social arrangements. As her academic career unfolds, the holding of a Cambridge PhD allows Meg opportunities to make change as certain privileges are afforded her by virtue of her Cambridge status. Yet it is this very notion that she seeks to challenge. Her growing passion for the State University of Victoria, an institution developed for the education of working-class people, informs her activism within the academy. Why are excellence and equity polarised? Why does the institution matter more than the scholarship? Why is so much practice within universities contrary to the values scholars often claim? These questions are explored through the dynamics of academic working life as student and later as a teacher at a university with an explicit equity agenda. The Start of the End (2003): The action commences on a late Friday after at SUV, when the Department of Communication & Cultural Studies has just been advised of Meg's promotion to Associate Professor. This vignette sees the initial soiree and celebrations and allows Meg to reflect on her experience. As her colleagues and friends are congratulating her, a particular student comes looking for Meg. It is clear that Angela Watson needs course advice particularly from Meg. Their discussion seems a straightforward one on the face of it, but it underscores many things; that Meg has come the full circle in her academic life, and what it is that her journey has really been about. The route to professorial appointment is considered, as is the source of Meg's greatest professional joy and fulfillment; is it scholarship, followed by leadership, in her discipline? It is knowing she has continued to speak and act to change the life chances of all students, wherever possible? Or is it the subtle distilling of both of these, along with the knowledge which emerges from the nexus of teaching and research. That scholarship, new knowledge, surely must be taking us somewhere specific in relation to others? The more we know, the more we can do...to what end? From this reflection, we see the action of the novel unfold. We return to this scene at the end of the novel, as Meg considers the trajectory of her life and its themes in her work. The novel ends as she is faced with the next challenge. Arrival (1989): Acceptance sees Meg as she is attempting to transform her life and create a new one. She has just been advised of her admission to an undergraduate Bachelor of Education program, at the major Melbourne teachers' college. Meg shares her rented home with her high school best friend, Anna, and her fiance, Jason, who appears to be superfluous in her life. Meg is aware he is a partner for who she used to be. We see Meg in her job as a medical secretary and this allows the mapping of Meg's sense of her own world, as she travels between home and work. This first stage of seeking her aspiration- to be an English teacher-evolves. As Meg considers the meaning of what she is about to do and how she knows it is right. This involves a consideration of what work means in our lives and how this is different for jobs according to how they are classed. Her relationship with the life she has known, the person she has been, is changing and this change is represented through her relationship with Jason. Meg's first day at teachers' college demonstrates that she is in a constant, often painful, dialogue with herself. The difficulties she encounters in making sense of the relation between her two 'lives' are thrown into sharp relief. The preparation for college sees Meg interrogating herself about how she can be different. Her initial experiences at the College resonate with her highest expectations of the life that awaits her, of the multiple possibilities currently being authored for her. Her first attendance at classes offers the opportunity to try out some of those possibilities, to test them against those she meets and to map the ways she could discover to 'be'. There is much tension and fear, but also endless excitement and these conflicting emotional states parallel and marble each other. It is on this day that she meets Jennifer Wren, her first real friend at university, who offers so many challenges to Meg. Their friendship involves a constant exhausting shift of subject positions, which Meg is able to look back on with affection in years to come. Going Bowling (1989): within a few weeks of commencing at university, Meg is socializing with some of her new friends, having neatly segmented her home and college lives. Meg has already realised that her friendships fall into separate groups; her friendship with Jennifer and the people Jennifer knows does not find its way into this group. They meet in the city to go bowling and have a meal. While Meg really enjoys these new people, already tensions are developing in relations between the group. Their unofficial leader, Rosemary Marshall, has a tendency to seek control and already resistance is showing. Rosemary particularly does not like Jennifer. Meg is enjoying her flirtation with Pete Danville, whom she has assumed to be gay. His very flattering attention has already developed Meg's confidence and stoked her ego, which has eroded in her stagnating relationship with Jason. Rosie has developed a crush on Pete and seems to take the flirtation with Meg personally. Dynamics in the group become slightly uncomfortable but Meg has grown quickly fond of her new friends, especially flamboyant Marina, another whom Rosemary seems to dislike. The discussions which occur during their evening deepen both the relationships and the tensions between them and draw lines which will determine the outcome of their various friendships. The Ball (1990): In the third year of her degree, much has happened to Meg. She is married to Jason, although she omits him from much of her psychic (and practical) life. Meg and her friends attend the Faculty's annual formal dinner dance. Meg has so far managed to balance the competitiveness which occurs between all of them, both academically and personally. The negotiation of her respective friendships with Jennifer and Marina requires a great deal of diplomacy; the subtext in this is very disturbing to Meg. What exactly is the conflict about? She can't be sure why they don't like each other; it could be Marina's smoking, or Jennifer's confidence to spare, but these things also annoy her, yet she does not fight with either girl as they do with each other. Rose has always insisted that the problem is Jennifer's private school background, but Marina went to a catholic girls' school, so what could the difference be? The ball is initially a happy occasion; the girls dress up and they dance and drink champagne together with the boys. But dynamics operating beneath the surface force their way up. Rosie is ready to force Pete to confront her continuing crush on him; Pete confronts Meg about their ongoing flirtation. Meg gives in and admits to herself for the first time that she does want to be with Pete. He is grown up and exciting and strong. He offers her something she has never had with Jason. Married less than a year, she pushes her husband out of her thoughts. The events of the ball force Meg to confront the differences between all her friends and the discomfort this affords everyone. Rosie's continued need for control over the group is acknowledged. Future Present (1991): Meg lives in Carlton with Pete. This is the busiest year thus far in her academic career and the financial, academic and emotional pressure is showing. This vignette gives us the range of Meg's academic activities and the way her life has fallen since the events at the ball eight months earlier. We see Meg grappling with her own evaluation of the changes in her 'way of being'; trying on different ways of living that she has idealised and finding them just as wanting as the last. Meg faces some key existential questions in this vignette and seeks answers which she finally discovers only she can give. Her relationship with Pete, the values and goals they share (and don't share) are thrown into sharp relief and provide a touchstone for the clearer determination of Meg's aspiration and future. Her relationship with various female friends is also revisited and this offers insight into Meg's constant checking of herself against idealised female templates. There is a crisis of identity and strength which constitutes an important fork in Meg's road. Beyond (1992): Beyond sees Meg determinedly seeking ways she can progress towards her goal, while still constantly checking against herself that postgraduate study (let alone a scholarly life) is available to her. We accompany Meg as she seeks and locates the academic path she wants; this is the backdrop for her further psychic exploration of the women who intimidate yet fascinate her, particularly Heloise Waul, who is a significant influence through Meg's postgraduate career. The sites in which Meg's personal struggles manifest are highlighted in this vignette, particularly in terms of dress and cultural pursuit. The conversations between Meg and Heloise also allow an exploration of the feminist politics of that milieu and the class tensions which operate tacitly within those politics. Bound to the Caucus (1992); Meg has now nearly completed her undergraduate degree and has been active for some time in university life and student politics. Her feminist and socialist education is well advanced. Bound to the Caucus shows us Meg in her student politics world for the first time, where the segue of her activism and academic life have taken her. Meg has found female friends who understand that part of her which struggles with inadequacy, although at this point in the novel this common struggle is not well understood or articulated. It is in this vignette that Meg admits her growing attraction for a Liberal student activist, Stuart Noble; this proscribed liaison raises many questions about values and aspiration, as well as the dominant sexual politics of the time and place. Bound to the Caucus also offers insight into the student activism occurring at universities like Philip in the early 1990s. Divergence (1993): Set in 1993, Meg is now in the early weeks of her honours program, although she has been at work on her thesis on the poet William Blake for some months. Living unhappily in a share household near the University, her relationship with Stuart Noble continues to develop, reaching a crisis point in this period. These events occur in the context of Meg's activist career in the Student Left, particularly as she encounters issues of identity around her class, feminism and difference amongst Left women. While Meg fights these battles passionately in an intense milieu, she considers them emotionally in terms of her changing sense of herself. Meg is increasingly aware that the personal impact of her class is changing for her. Additionally, she explores her relation with a 'boyfriend' of right wing political affiliation; Meg comes to recognise that this relationship is undermining her sense of herself in a way that her relationships with women in the left previously did. Honour Roll (1993): Meg is now undertaking honours and this vignette opens with Meg seeing the honours coordinator, Professor Michaela Moore, who approximates all those apparently middle-class traits to which Meg has such a push-pull relation. We see the return of a chapter of the honours thesis, discussion of the content and the constantly shifting subject positions these experiences offer Meg. This vignette also directly introduces Agnes. Mia and Agnes meet Meg after her supervision and this conversation allows very distinct if tacit class themes to develop. Meg has warmed quickly to Agnes, who is unlike anyone she has known; they have much in common in relation to their work and this binds them. Mia continually presents a viewpoint which irritates Meg, in relation to entitlement: to academic life, to funding, even to questioning how these things are enabled. Honour Roll allows us to see Meg's flourishing theoretical and intellectual life and its role in assisting her emotionally as she re-frames the same conundrums that previously constituted obstacles. The Cusp (1993): Meg's developing friendship with Agnes offers her enormous insights into difference and her developing sense of self and aspiration. While the girls come from diametrical backgrounds, they are united by their passion for their research and scholarly work. Meg is increasingly self-conscious through their discussions in terms of how she has seen herself and allowed herself to dream and seek. Cusp is set at the end of the honours year, prior to the release of results. Meg and Agnes explore their feelings about academia and this leads to discussions of purpose and the role of class within that. This vignette also documents Meg's growing social confidence and those aspects of herself which have become so sure to her, that she no longer considers them at all. Whom (1996): [Not included in this abridged edition]. Set at Cambridge, two thirds into Meg's doctorate, Whom shows Meg in the mental space which will take her back to Melbourne and the State University of Victoria. Having risen to the challenge of doctoral study, she is confronted now by deeper demons, and the need to explore and challenge them in the ambivalent context of Cambridge, which so excites her still, but which has proved empty of the profoundly held higher ideals she expected to see reflected. Set in the midst of Meg's doctoral study, this vignette is dramatically abridged in the submission novel. The importance of Whom lies in its concern with Meg's rapidly shifting sense of herself and her own scholarly subjectivity and the changes to these that the culture of Cambridge has wrought. By the second year of her PhD Meg is crystal clear about her goals and decides to spend the long break at home, rather than travelling, because she wishes to 'touch base' with her future. The action described segues into that in Courting the Enemy. Whom describes Meg's ambivalent and contradictory but passionate feelings about Cambridge. Whom demonstrates Meg's increasing anger at the status and privilege to which her education now automatically admits her, and her need to find some sort of stasis and safety in her emotional life. In this vignette, Meg meets her life partner, Jeremy McCallum (I have intentionally reduced the attention in the novel to Meg's romantic life as she matures into her career). Courting the Enemy (late 1990s): By this time, Meg is a senior lecturer in English at the State University of Victoria, which was established in the nineteenth century as the Worker's College. This vignette starts with Meg's attendance at a University Committee which is considering a transformation in relation to equity in admissions policy. Meg was drawn to SUV because of its transparent and determined commitment to educate the children of working-class people. An attack on the equity admission policy of her university galvanizes Meg and some of her colleagues. The action of the vignette considers the role of the scholar, and of such an institution as SUV, in the light of daily academic life. This vignette is primary in its demonstration of the themes of the novel. In the unabridged version, I took the opportunity to illustrate some of the vast range of administrative, intellectual and even physical demands on a senior scholar in the routine of academic life. In placing Meg in this context, I sought to highlight how a scholar of her values and commitment makes sense of the constantly shifting terrain of her working world and how this continually informs her practice. This vignette is also significant for its retrospective description of Meg's employment at SUV some years earlier. Locus: (1995). This piece of writing stands apart from the rest of the novel. I wished to write in a reflective voice, which might be from Meg's journal, were it not in the (omniscient) third person, in order to consider the headspace and meaning-making which occurs as Meg settles into Cambridge, and the lifestyle her situation allows her. Locus is a deeper engagement with Meg's sense of her identity. It considers the impact on her of the physical journeys she must make to match those of her psyche. These are thoughts too personal for a letter, even to Anna. Meg is exploring her ever shifting self and the growth in her self-belief allows her to explore what is rage; that she was bounded by illusions about her worth. Locus seeks to allow some context for Meg's anger at the role Cambridge plays. I seek to create the space in which Meg's dawning self understanding will lead her to her next, driven, purpose. Letters: throughout the novel letters are used to reveal and inform Meg's relationship with her family. This is an intentional device to distance the birth family in an attempt to blur and muddy an assessment of Meg's class through traditional measures. The letters between Meg and Aunty Jean particularly reveal much of the classed emotional antecedents of Meg's life. There are also letters exchanged with Meg's high school best friend, Anna, who has moved to the country and a very different lifestyle. Meg writes to Anna often, using the acceptance she feels in the friendship and her sense that Anna understands her, to touchstone her own emotional growth. Formal letters from institutions ring changes in settings and mark significant points in the geographical and academic trajectory of the character. All the letters serve to introduce time and event changes consistent with the episodic style of the narrative.

Women's cognitive and emotional processing during sexual arousal : the effects of erotic film and absorption

Sexual arousal is a complex and dynamic element of women’s sexuality. Accounts vary, however most multidimensional models highlight the cognitive, affective and physiological components of the female sexual arousal response. While literature examining the peripheral physiological changes that occur during female sexual arousal abounds, there has been a dearth of literature pertaining to the cognitive and affective components. Thus, while many authors have included cognitive and emotions as independent components of the female sexual arousal response, there has been little empirical research to validate this approach. The aim of the current thesis was to examine the cognitive and affective components of female sexual arousal in more depth, investigating the nature of the relationship between these components under various experimental conditions. In order to do so, two integrated studies were conducted, each highlighting the effects of either external or internal variables on women’s subjective sexual arousal, absorption, positive affect and negative affect. Study One was designed to evaluate women’s emotional and cognitive processing of two elements of erotic film – foreplay and erotic context. 60 women were asked to report their subjective sexual arousal, absorption, positive affect and negative affect in response to one of four erotic film excerpts. The erotic excerpts varied in accordance with the degree of foreplay (low vs. high) depicted and the context in which the sexual activities took place (novel vs. habitual context). Women in the study responded more favourably to the high foreplay erotic film excerpt, subsequently reporting higher degrees of subjective sexual arousal, absorption and positive affect. Women also responded favourably to the erotic excerpt filmed in a novel context, reporting greater subjective sexual arousal as a result. The environment in which the sexual encounters were filmed failed to have an effect however, on women’s absorption or their positive or negative affect. The results of Study One suggest that stimulus specific variables, such as the degree of foreplay depicted, have a significant influence on female cognitive and emotional processing of erotic film. The results also suggest that a relationship exists between absorption, subjective sexual arousal and positive affect, albeit a correlational one. Specifically, there was evidence of parallel processing during sexual arousal, as participant reported sexual arousal, absorption and positive affect all increased and decreased in unison. Based on the results it was suggested that future research attempt to experimentally manipulate one of these variables, to examine its direct effect on the remaining variable. Thus, Study Two aimed to examine the effects of absorption on women’s cognitive and emotional processing of erotica. Study Two manipulated absorption at two levels (high vs. low), examining the impact of these states on participants’ subsequent absorption, subjective sexual arousal and positive and negative affect. 62 women were asked to read one of two sets of test session instructions. The first, participant-oriented instruction set, instructed participants to immerse themselves in the erotic film excerpt, as if they were active participants in the sexual exchange. The second, spectator-oriented instruction set, directed participants to observe and evaluate the erotic film. These instructions were designed to elicit high and low degrees of absorption, respectively. The utility of this approach when manipulating female absorption, was demonstrated by self reported ratings of absorption, given at the conclusion of the film presentation. Participants were also asked to report their subjective sexual arousal and positive and negative affect at the conclusion of the erotic film presentation. The findings of this study suggest that the adoption of a participant-oriented (high absorption) perspective elicits more favourable responses from participants than a spectator-oriented (low absorption) perspective, with participants in the former experimental group reporting greater degrees of subjective sexual arousal and positive affect. Negative affect was equivalent across experimental conditions, with the participants reporting that they experienced little to no aversive feelings during either of the experimental conditions. The results suggest that the degree to which a women immerses and absorbs herself in a sexual stimulus has a significant impact in her subsequent cognitive and affective processing of that stimulus. More specifically, it appears that women respond more favourably when they are highly absorbed and immersed in a stimulus, reporting greater subjective sexual arousal and positive affect. Overall, the results of Studies One and Two highlight the dynamic and complex nature of female sexual arousal. It appears that women have definite cognitive and affective responses to sexual stimuli. The magnitude of these responses may be mediated by a number of factors however, including the intrinsic qualities of the stimulus and the degree to which the woman attends to the stimulus. Both these variables act to either enhance or inhibit the sexual arousal response. There results have important implications for current sexuality literature. While women’s cognitions and emotions in response to erotic film were generally highly correlated, in some instances they differed, warranting their inclusion as separate elements in models of female sexual arousal. Furthermore, it might be suggested that the inclusion of an additional variable – absorption – into current models of female sexual arousal would prove beneficial, aiding researchers to better understand and predict the arousal process. As such, recommendations are made for a revised model of female sexual arousal. In terms of future directions, the results of the present thesis have implications for the treatment of sexual dysfunctions, suggesting that clinicians need to understand the internal and external variables that might contribute to the aetiology and maintenance of their presenting problems.

Influence of an adventure learning program, using group adventure initiative tasks, on participant self-esteem

The purpose of this study was to assess the influence of an adventure learning program, based on participation in group adventure initiative tasks (GAITs), on participant self-esteem and, further, to examine any associated gender differences in the dependent variable. The study took place within the framework of the 'Group Dynamics in Action' unit offered at the University of South Australia, Underdale Campus, in semester 2, 1994. The course included participation in group adventure initiative tasks, the identification and examination of group dynamic processes, the investigation of individual roles within the small group and the review of these processes in the group setting. The program also included an experience on a high ropes course. Both quantitative and qualitative data was gathered to gain insight into gender differences and their relationship to the dependent variable and also to provide insight into any discrepancy in outcomes between males and females with regard to participation in group adventure initiative tasks. The sample set of participants was drawn from undergraduate students studying at the University of South Australia in the Bachelor of Teaching (Primary), Bachelor of Education (Secondary Physical Education Teaching) and Bachelor of Applied Science (Exercise and Sport Science) courses. Subjects were assigned to either experimental or control conditions and the experimental group were then randomly assigned to one of three treatment groups. Sixty one (N = 61) male and female subjects were tested pre and post-treatment period. Psychological tests included the Coopersmith Self Esteem Inventory (Coopersmith 1981) and an adaptation of Coopersmith's Behaviour Rating Form (Coopersmith 1967). Qualitative data was gathered using Kuhn's Twenty Statements Test (Kuhn and McPartland 1954), a self-esteem questionnaire, observations made by the researcher and other staff about subjects interactions and from weekly journals kept by subjects throughout the treatment. The duration of the treatment period was 14 weeks consisting of 14, 2 hour seminars.

Programmer friendly and efficient distributed shared memory integrated into a distributed operating system

Distributed Shared Memory (DSM) provides programmers with a shared memory environment in systems where memory is not physically shared. Clusters of Workstations (COWs), an often untapped source of computing power, are characterised by a very low cost/performance ratio. The combination of Clusters of Workstations (COWs) with DSM provides an environment in which the programmer can use the well known approaches and methods of programming for physically shared memory systems and parallel processing can be carried out to make full use of the computing power and cost advantages of the COW. The aim of this research is to synthesise and develop a distributed shared memory system as an integral part of an operating system in order to provide application programmers with a convenient environment in which the development and execution of parallel applications can be done easily and efficiently, and which does this in a transparent manner. Furthermore, in order to satisfy our challenging design requirements we want to demonstrate that the operating system into which the DSM system is integrated should be a distributed operating system. In this thesis a study into the synthesis of a DSM system within a microkernel and client-server based distributed operating system which uses both strict and weak consistency models, with a write-invalidate and write-update based approach for consistency maintenance is reported. Furthermore a unique automatic initialisation system which allows the programmer to start the parallel execution of a group of processes with a single library call is reported. The number and location of these processes are determined by the operating system based on system load information. The DSM system proposed has a novel approach in that it provides programmers with a complete programming environment in which they are easily able to develop and run their code or indeed run existing shared memory code. A set of demanding DSM system design requirements are presented and the incentives for the placement of the DSM system with a distributed operating system and in particular in the memory management server have been reported. The new DSM system concentrated on an event-driven set of cooperating and distributed entities, and a detailed description of the events and reactions to these events that make up the operation of the DSM system is then presented. This is followed by a pseudocode form of the detailed design of the main modules and activities of the primitives used in the proposed DSM system. Quantitative results of performance tests and qualitative results showing the ease of programming and use of the RHODOS DSM system are reported. A study of five different application is given and the results of tests carried out on these applications together with a discussion of the results are given. A discussion of how RHODOS’ DSM allows programmers to write shared memory code in an easy to use and familiar environment and a comparative evaluation of RHODOS DSM with other DSM systems is presented. In particular, the ease of use and transparency of the DSM system have been demonstrated through the description of the ease with which a moderately inexperienced undergraduate programmer was able to convert, write and run applications for the testing of the DSM system. Furthermore, the description of the tests performed using physically shared memory shows that the latter is indistinguishable from distributed shared memory; this is further evidence that the DSM system is fully transparent. This study clearly demonstrates that the aim of the research has been achieved; it is possible to develop a programmer friendly and efficient DSM system fully integrated within a distributed operating system. It is clear from this research that client-server and microkernel based distributed operating system integrated DSM makes shared memory operations transparent and almost completely removes the involvement of the programmer beyond classical activities needed to deal with shared memory. The conclusion can be drawn that DSM, when implemented within a client-server and microkernel based distributed operating system, is one of the most encouraging approaches to parallel processing since it guarantees performance improvements with minimal programmer involvement.

Correlates of screening mammography for Italian and Anglo-Australian women

The first aim of the research was to determine the applicability of certain variables from the Health Belief Model (HBM), the Theory of Reasoned Action (TRA), the risk dimensions from the Psychometric Paradigm, the Common-Sense Model of Illness Representations and the Locus of Control to Italian women’s beliefs and behaviours in relation to screening mammography. These models have predominantly been derived and evaluated with English-speaking persons. The study used quantitative and qualitative methods to enable explanation of research-driven and participant-driven issues. The second aim was to include Italian women in health behaviour research and to contrast the Italian sample with the Anglo-Australian sample to determine if differences exist in relation to their beliefs. In Australia many studies in health behaviour research do not include women whose first language is not English. The third aim was to evaluate the Anti-Cancer Council of Victoria’s (ACCV) Community Language Program (CLP) by: (a) identifying the strengths and weaknesses of the program as seen by the participants; and (b) assessing the impact of the program on women’s knowledge and beliefs about breast cancer, early detection of breast cancer, self-reported and intended breast screening behaviours. The CLP is an information service that uses women’s first language to convey information to women whose first language is not English. The CLP was designed to increase knowledge about breast and cervical cancer. The research used a pre-test-intervention-post-test design with 174 Italian-born and 138 Anglo-Australian women aged 40 years and over. Interviews for the Italian sample were conducted in Italian. The intervention was an information session that related to breast health and screening mammography. Demographic variables were collected in the Pre-Test only. Qualitative open-ended questions that related specifically to the information session were collected in the Post-Test phase of the study. Direct logistic regression was used with the participants’ beliefs and behaviours to identify the relevant variables for language (Italian speaking and English-speaking), attendance to an information session, mammography screening and breast self-examination (BSE) behaviour. Pre- and Post-Test comparisons were conducted using chi-square tests for the non-parametric data and paired sample t-tests for the parametric data. Differences were found between the Italian and Anglo-Australian women in relation to their beliefs about breast cancer screening. The Italian women were: (1) more likely to state that medical experts understood the causes of breast cancer; (2) more likely to feel that they had less control over their personal risk of getting breast cancer; (3) more likely to be upset and frightened by thinking about breast cancer; (4) less likely to perceive breast cancer as serious; (4) more likely to only do what their doctor told them to do; and (5) less likely to agree that there were times when a person has cancer and they don’t know it. A pattern emerged for the Italian and Anglo-Australian women from the logistic regression analyses. The Italian women were much more likely to comply with medical authority and advice. The Anglo-Australian women were more likely to feel that they had some control over their health. Specifically, the risk variable ‘dread’ was more applicable to the Italian women’s behaviour and internal locus of control variable was more relevant to the Anglo-Australian women. The qualitative responses also differed for the two samples. The Italian women’s comments were more general, less specific, and more limited than that of the Anglo-Australian women. The Italian women talked about learning how to do BSE whereas the Anglo-Australian women said that attending the session had reminded them to do BSE more regularly. The key findings and contributions of the present research were numerous. The focus on one cultural group ensured comprehensive analyses, as did the inclusion of an adequate sample size to enable the use of multivariate statistics. Separating the Italian and Anglo-Australian samples in the analyses provided theoretical implications that would have been overlooked if the two groups were combined. The use of both qualitative and quantitative data capitalised on the strengths of both techniques. The inclusion of an Anglo-Australian group highlighted key theoretical findings, differences between the two groups and unique contributions made by both samples during the collection of the qualitative data. The use of a pre-test-intervention-post-test design emphasised the reticence of the Italian sample to participate and talk about breast cancer and confirmed and validated the consistency of the responses across the two interviews for both samples. The inclusion of non-cued responses allowed the researcher to identify the key salient issues relevant to the two groups. The limitations of the present research were the lack of many women who were not screening and reliance on self-report responses, although few differences were observed between the Pre- and Post-Test comparisons. The theoretical contribution of the HBM and the TRA variables was minimal in relation to screening mammography or attendance at the CLP. The applicability of these health behaviour theories may be less relevant for women today as they clearly knew the benefits of and the seriousness of breast cancer screening. The present research identified the applicability of the risk variables to the Italian women and the relevance of the locus of control variables to the Anglo-Australian women. Thus, clear cultural differences occurred between the two groups. The inclusion of the illness representations was advantageous as the responses highlighted ideas and personal theories salient to the women not identified by the HBM. The use of the illness representations and the qualitative responses further confirmed the relevance of the risk variables to the Italian women and the locus of control variables to the Anglo-Australian women. Attendance at the CLP did not influence the women to attend for mammography screening. Behavioural changes did not occur between the Pre- and Post-Test interviews. Small incremental changes as defined by the TTM and the stages of change may have occurred. Key practical implications for the CLP were identified. Improving the recruitment methods to gain a higher proportion of women who do not screen is imperative for the CLP promoters. The majority of the Italian and Anglo-Australian women who attended the information sessions were women who screen. The fact that Italian women do not like talking or thinking about cancer presents a challenge to promoters of the CLP. The key theoretical finding that Italian women dread breast cancer but comply with their doctor provides clear strategies to improve attendance at mammography screening. In addition, the inclusion of lay health advisors may be one way of increasing attendance to the CLP by including Italian women already attending screening and likely to have attended a CLP session. The present research identified the key finding that improving Anglo-Australian attendance at an information session is related to debunking the myth surrounding familial risk of breast cancer and encouraging the Anglo-Australian women to take more control of their health. Improving attendance for Italian women is related to reducing the fear and dread of breast cancer and building on the compliance pattern with medical authority. Therefore, providing an information session in the target language is insufficient to attract non-screeners to the session and then to screen for breast cancer. Suggestions for future research in relation to screening mammography were to include variables from more than one theory or model, namely the risk, locus of control and illness representations. The inclusion of non-cued responses to identify salient beliefs is advantageous. In addition, it is imperative to describe the profile of the cultural sample in detail, include detailed descriptions of the translation process and be aware of the tendency of Italian women to acquiesce with medical authority.

Designing online usability strategies for multicultural Australia

The research found that multicultural societies need to acknowledge the importance of online usability as a social justice, access and equity issue. For effective usability, government public access websites need to be informed by the language and cultural needs of the diverse target groups, best realised through a user-centred design methodology. Utilising the thesis' research an accompanying website "The women of Scylla : a digital odyssey" was designed and included via the enclosed CD-ROM.

Evaluation of a community pharmacy-based intervention for improving patient adherence to antihypertensives: a randomised controlled trial

Background
The majority of patients using antihypertensive medications fail to achieve their recommended target blood pressure. Poor daily adherence with medication regimens and a lack of persistence with medication use are two of the major reasons for failure to reach target blood pressure. There is no single intervention to improve adherence with antihypertensives that is consistently effective. Community pharmacists are in an ideal position to promote adherence to chronic medications. This study aims to test a specific intervention package that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications - Hypertension Adherence Program in Pharmacy (HAPPY).

Methods/Design
The HAPPY trial is a multi-centre prospective randomised controlled trial. Fifty-six pharmacies have been recruited from three Australian states. To identify potential patients, a software application (MedeMine CVD) extracted data from a community pharmacy dispensing software system (FRED Dispense®). The pharmacies have been randomised to either 'Pharmacist Care Group' (PCG) or 'Usual Care Group' (UCG). To check for 'Hawthorne effect' in the UCG, a third group of patients 'Hidden Control Group' (HCG) will be identified in the UCG pharmacies, which will be made known to the pharmacists at the end of six months. Each study group requires 182 patients. Data will be collected at baseline, three and six months in the PCG and at baseline and six months in the UCG. Changes in patient adherence and persistence at the end of six months will be measured using the self-reported Morisky score, the Tool for Adherence Behaviour Screening and medication refill data.

Discussion
To our knowledge, this is the first research testing a comprehensive package of evidence-based interventions that could be integrated into the community pharmacy workflow to enable pharmacists to improve patient adherence and/or persistence with antihypertensive medications. The unique features of the HAPPY trial include the use of MedeMine CVD to identify patients who could potentially benefit from the service, control for the 'Hawthorne effect' in the UCG and the offer of the intervention package at the end of six months to patients in the UCG, a strategy that is expected to improve retention.

Trial Registration
Australian New Zealand Clinical Trial Registry ACTRN12609000705280

From rural beginnings to statewide roll-out : evaluation of facilitator training for a group-based diabetes prevention program

Objective: To evaluate the approach used to train facilitators for a large-scale group-based diabetes prevention program developed from a rural implementation research project.

Participants: Orientation day was attended by 224 health professionals; 188 submitted the self-learning task; 175 achieved the satisfactory standard for the self-learning task and attended the workshop; 156 completed the pre- and post-training questionnaires.

Main outcome measures: Two pre- and post-training scales were developed to assess knowledge and confidence in group-based diabetes prevention program facilitation. Principal component analysis found four factors for measuring training effectiveness: knowledge of diabetes prevention, knowledge of group facilitation, confidence to facilitate a group to improve health literacy and confidence in diabetes prevention program facilitation. Self-learning task scores, training discontinuation rates and satisfaction scores were also assessed.

Results: There was significant improvement in all four knowledge and confidence factors from pre- to post-training (P < 0.001). The self-learning task mean test score was 88.7/100 (SD = 7.7), and mean assignment score was 72.8/100 (SD = 16.1). Satisfaction with training scores were positive and 'previous training' interacted with 'change in knowledge of diabetes prevention program facilitation' but not with change in 'confidence to facilitate.'

Conclusions: The training program was effective when analysed by change in facilitator knowledge and confidence and the positive mean satisfaction score. Learning task scores suggest tasks were manageable and the requirement contributed to facilitator self-selection. Improvement in confidence scores in facilitating a group-based diabetes prevention program, irrespective of previous training and experience, show that program-specific skill development activities are necessary in curriculum design.

Does testosterone determine dominance in the house sparrow Passer domesticus? An experimental test

Badges of status function in many birds within a social context to establish dominance hierarchies and reduce antagonistic encounters. In order to maintain the honesty of the signalling system, such badges must be costly to produce or to maintain. The chest bib of the house sparrow functions as a badge of status and changes in size are known to be controlled by testosterone levels. We sought to test the relative importance of testosterone as opposed to bib size in determining dominance within a group of male house sparrows. We did this by manipulating testosterone levels independently during both breeding and post-breeding seasons in experimental birds and examining the effect of testosterone titre, as well as corticosterone titre relative to bib size on dominance levels. Dominance hierarchies within the groups were tested during both the breeding and post-breeding phases. We compared the results of these tests with dominance among intact (unmanipulated) birds. Results suggested that the breeding season dominance levels were largely determined by testosterone levels as well as bib size, whereas the post-breeding dominance levels were determined by postbreeding testosterone titre and previous breeding season dominance level. Within unmanipulated birds, basal corticosterone levels were significantly, negatively correlated with dominance level, but only during the breeding season. The influence of breeding season dominance on post-breeding dominance suggests social history is important in determining dominance interactions as well as current testosterone levels and bib size.