A conceptual multi-criteria mechanism for stakeholder participation in urban development

Australia is one of the world’s most urbanised nations, with 74.92% of the population living in 17 major cities of 100,000 people or more. To improve the productivity, liveability and sustainability of Australia’s cities, there is an increasing emphasis in urban management policies on democratic stakeholder participation. In order to obtain a full picture of stakeholders’ concerns efficiently, and manage antagonism, prejudice and conflicts between stakeholders effectively, it is important for participatory decision-making in urban development to be able to select and integrate stakeholder analysis and engagement methods. This paper investigates the characteristics of stakeholder participation approaches in urban development, and proposes criteria for approach selection and integration. The outcome is a multi-criteria mechanism for selecting and integrating approaches to stakeholder participation. This could enable effective, efficient and democratic participation in decision-making process of urban development. Meanwhile, the capacity of Australian state, territory and local governments can be largely enhanced to understand and unpack the complex challenges of urban-ecological conditions, and generate a compromise solution that best represents the preferences of stakeholders.

Stakeholder analysis in urban development : the application of stakeholder circle methodology and social network analysis

The increasing research interest on stakeholder analysis in urban planning reflects a growing recognition that stakeholders can and should influence the decision-making. This paper concentrates on exploring the techniques for analysing stakeholders, especially the application of the Stakeholder Circle tool and Social Network Analysis. An urban renewal project and an infrastructure project in Australia are presented as case studies to verify the use of these two techniques. The stakeholders are identified and prioritized from two different points of view, namely, the attribute evaluations in the Stakeholder Circle tool, and the relationship network analysis. The paper ends with a discussion on the strengths and limitations of the techniques for stakeholder analysis. No method for stakeholder identification and prioritization is perfect. The selection of the approaches is an art with extensive considerations of ‘when, what, and how’ to choose methods to achieve the project objectives. Each method has its own strengths and limitations. Combining several methods when necessary is the best way to analyse stakeholders.

Effectiveness of pain management in hospital in the home programs

Objectives: The objective of the study was to examine patients’ experiences of pain in Hospital in the Home (HITH) programs and
identify the issues related to providing optimal pain management for acute care patients in the home environment.
Methods: A descriptive survey of patients’ experience of pain and pain management in 3 HITH programs in metropolitan Melbourne,
Australia (n=359). Data were collected by telephone interview using a modified version of The American Pain Society’s Patient Outcome Questionnaire. Patients were interviewed 48 to 72 hours after admission to the HITH program. Consecutive, adult, acute care patients were invited to participate in the study. Patients who had previously participated or had communication difficulties unable to be overcome with the assistance of an interpreter were excluded.
Results: Sixty-nine percent of patients interviewed experienced pain at home and 86% of these patients had experienced pain in the 24 hours before the interview. Over half (56%) of the patients had experienced moderate-to-severe worst pain in the previous 24 hours and 33% reported moderate-to-severe pain as their average pain experience. Two hundred thirty-two (93.2%) of the 250 patients who experienced pain had pain in hospital before being transferred to HITH. Of these patients, 52.2% (n=132) were prescribed analgesics to take home with them; the remaining 118 patients experiencing pain were not prescribed analgesics and either sourced analgesics once home (n=81, 68.1%) or did not take any analgesics (n=38, 31.9%).
Discussion: Treatment of pain at home was suboptimal with patients experiencing moderate-to-severe pain and discomfort during the treatment phase of their illness. Lack of appropriate discharge planning strategies meant that patients went home without adequate analgesia and use of non prescribed pain medication was common. The number of patients transferred home without analgesics indicates a worrying under recognition of the need for analgesia in this care context and poses a risk to patient safety that is no less significant because patients are at home.

Effects of exposure to traffic noise on health

Traffic noise causes adverse effects on the health and quality of life of individuals and communities exposed to it, including annoyance, sleep disturbance, decreased performance at school/work, stress, hypertension, and ischemic heart disease. In Australia there are few standards or policies addressing noise in urban environments, with many discrepancies in noise level thresholds when comparing states and regions. Currently Victoria has a day-to-night threshold for noise levels well above accepted levels in Europe, and there is no standard for the late night period. A better understanding of the health impacts of noise in the Australian context is vital for informing development and implementation of policy and legislation for road traffic noise management. This paper reviews the evidence base and policies related to traffic noise in urban areas, and presents a case study of noise mapping and assessing population health impacts (eg. sleep disturbance), in Geelong,Vcitoria,Australia.

Is chemotherapy dose intensity adequate in breast cancer management in the Australian healthcare setting: a retrospective analysis

Aim
To determine the adequacy of chemotherapy received dose intensity (RDI) in breast cancer treatment in a general population and to identify factors that influence RDI.

Methods
A retrospective analysis of breast cancer patients who commenced a course of i.v. chemotherapy in 2008 was undertaken. Data were collected on patient and tumor characteristics, chemotherapy regimen, dose (including delays, reductions and the reasons for these), granulocyte colony-stimulating factor (G-CSF) use and febrile neutropenia incidence. RDI was calculated using the planned and actual dose received and time taken. A level of ≥85% RDI was considered acceptable for treatment given with curative intent.

Results
In all, 131 patients (aged 28 to 77 years) received chemotherapy in adjuvant (n = 76, 58%), neoadjuvant (n = 11, 8%) and metastatic settings (n = 44, 34%). RDI did not reach 85% for 12% adjuvant, 36% neoadjuvant and 34% metastatic cases (χ2 = 10.55, P = 0.005). Overall, 43% of patients received G-CSF.

Conclusion
Acceptable chemotherapy RDI was delivered for most patients in the adjuvant setting but not in the neoadjuvant setting. G-CSF treatment contributed to the optimization of dose intensity in the adjuvant setting only. Dose intensity in the metastatic setting was considered satisfactory where quality of life is the primary focus. Other factors can be modified to improve RDI.

Anxiety disorders : assessment and management in general practice

Background: Anxiety is a normal physiological response to a threat. Anxiety disorders occur when this normal physiological response is associated with high levels of autonomic arousal, erroneous cognitions and dysfunctional coping strategies. Anxiety disorders are highly prevalent and present commonly to general practice. Anxiety disorders are often comorbid with other psychiatric and medical disorders and may be associated with significant morbidity.

Objective: This article describes the diagnosis, assessment and management of anxiety disorders in the general practice setting.

Discussion: Assessment in patients presenting with anxiety symptoms involves excluding a medical cause, identifying features of specific anxiety disorders as well as other coexisting psychiatric disorders, and assessing the degree of distress. Management options include psychoeducation, psychological treatments (particularly cognitive behaviour therapy) and pharmacological treatments. Patients with a diagnosis of an anxiety disorder can access Medicare funded psychological care under a number of Australian government initiatives. Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors are the first line pharmacological agents used to treat anxiety disorders. Regular review is vital to monitor for clinical improvement and more complex presentations may require specialist psychological or psychiatric referral.

A cluster randomised controlled trial of vascular risk factor management in general practice

Letter to the editor: Harris and colleagues report failure to obtain reduction in several important risk factor-based intermediate outcomes for vascular disease from their lifestyle intervention in the Health Improvement and Prevention Study (HIPS).1 Using intention-to-treat analysis, if only 117 of 384 participants completed at least two of six group sessions, a positive result could not be expected. We know that interventions for prevention of cardiovascular disease (CVD) and diabetes can be run successfully in Australian primary care, which raises questions about the design of Harris et al’s intervention.

Urban growth in arid environments : developing water sustainability indicators for Abu Dhabi (UAE)

The United Arab Emirates (UAE) face a serious water problem. It has a very dry climate, high evaporation rate, combined with large water consumption from fast growing population, economic activities and uncontrolled uses of water for irrigation. Currently, UAE has one of the largest water footprints in the world. Groundwater is overexploited. Waste water is increasingly being treated to supply non-drinking water, but it still cover a small proportion of the demand. Desalination of sea water is the main source of potable water in UAE, but the high economic cost of desalination, its intensive energy demand and the adverse effects of its effluents on the marine life are a major concern. Other factors contributing to the problem are the focus of water management policies on keep supplying the growing demand for water, the increase of the per capita water consumption, and the free water charge for most of population. This research goal is to develop a water sustainability set of indicators for the challenging context of UAE. This paper presents the first stage of the research. Based on a review of the literature, the proposed framework involves 19 indicators, divided into four categories: water availability; water quality; water use efficiency; and policy and governance. Using an integrated cause-effect approach (DSR - Driving force, State, Response), the indicators were related in terms of their interdependencies, with a holistic view of the city water cycle. A preliminary test of the indicators to Abu Dhabi as a case study allowed an evaluation of the main 'Driving force' on the system, such as the scarcity of water due to natural constraints of the region, and increasing water consumption patterns of modern society; an assessment of the current 'state', which is under serious water stress. Also it indicated some potential 'responses', such as implementing policies for increasing efficient use.

Business relationship development and management in China

The Australian Government's White Paper on Australia in the Asian Century, released in October 2012, is based on the premise that the transformation of the Asian region into the world's economic powerhouse is not only unstoppable, it is gathering pace. Asia's extraordinary ascent has already changed the Australian economy, society and strategic environment. Within a few years, Asia will be the world's largest producer of goods and services, as well as the largest consumer market and the home of the majority of the world's middle class. The White Paper notes that thriving in the Asian century requires the Australian nation to have a clear plan to seize the economic opportunities and manage the strategic challenges that will arise, by taking a farsighted approach focused on fairness. To do so, Australians must be Asia-literate and Asia-capable, with a thorough understanding of Asian cultures and languages. These capabilities are needed to build stronger connections and partnerships across the region. Australia's commercial success in the region requires that highly innovative, competitive Australian firms and institutions develop collaborative relationships with others m the region. Australian firms need new business models and new mind-sets to operate and connect with Asian markets. Against this backdrop, this chapter discusses several important issues relating to Australian firms developing and managing their business relationships in China, in the context of urban planning, architecture, civil engineering and construction. The chapter examines the Chinese business environment, in terms of guanxi, business opportunities, risks and strategies, in a case study of the successful partnerships established to manage the 'Water Cube' for the Beijing Olympic Games in 2008.

A new beginning? John Yandell's the social construction of reading in urban classrooms

John Yandell’s The Social Construction of Meaning: Reading Literature in Urban Classrooms provides a powerful counterpoint to current policy discourse in education. By focusing on the social interactions that occur in the classrooms of two English teachers, Yandell shows how their pupils are able to explore dimensions of language and experience that far exceed the outcomes prescribed by official curriculum documents. This is because their teachers conceive of reading as a social activity in which everyone can participate. Yandell thereby affirms the value of a literary education as an integral part of an educational project that is genuinely democratic and inclusive.

The moderating effects of demographic factors and hukou status on the job satisfaction-subjective well-being relationship in urban China

This study tests the moderating effect of job complexity and social status, proxied by a unique Chinese cultural variable (hukou status), on the relationship between job satisfaction and subjective well-being in urban China. Data on these and a range of demographic variables were collected from 1025 workers in Fujian Province in the People's Republic of China. Results confirm that hukou status does moderate the job satisfaction-subjective well-being relationship in this sample. Several further moderating relationships are also detected. The study adds the empirical literature on job satisfaction and subjective well-being in China and also furthers understanding of the complex relationship between these constructs. © 2011 Taylor & Francis.

Uneasy alliances: Traditional dynamics in women's relationships in urban Hindu society (1910-2010)

This paper argues that in spite of the phenomenal economic progress made by India, the urban Indian Hindu woman still faces major challenges and hindrances in charting the course of her existence, some aspects of which are still located within a very traditional discourse. Women of particular age groups combine highly competitive careers in medicine, management, engineering, and other demanding professions with marriage and motherhood, while simultaneously juggling the eternal roles of the docile, hardworking daughter-in-law and the dutiful daughter. It is, yet again, another sacrifice of individual needs and time on the part of the urban Indian Hindu woman within a discourse that imposes constant adjustment and compromise from one's birth as a female child. The economic context might appear to be very different in this century, and the socio-cultural discourse may appear to have changed along with it, but the expectations and the status quo of the urban Hindu woman has not changed very much, given the underlying historical and socio-cultural discourse that is still extant.

Variation at the DRD4 locus is associated with wariness and local site selection in urban black swans

 BACKGROUND: Interactions between wildlife and humans are increasing. Urban animals are often less wary of humans than their non-urban counterparts, which could be explained by habituation, adaptation or local site selection. Under local site selection, individuals that are less tolerant of humans are less likely to settle in urban areas. However, there is little evidence for such temperament-based site selection, and even less is known about its underlying genetic basis. We tested whether site selection in urban and non-urban habitats by black swans (Cygnus atratus) was associated with polymorphisms in two genes linked to fear in animals, the dopamine receptor D4 (DRD4) and serotonin transporter (SERT) genes.

RESULTS: Wariness in swans was highly repeatable between disturbance events (repeatability = 0.61) and non-urban swans initiated escape from humans earlier than urban swans. We found no inter-individual variation in the SERT gene, but identified five DRD4 genotypes and an association between DRD4 genotype and wariness. Individuals possessing the most common DRD4 genotype were less wary than individuals possessing rarer genotypes. As predicted by the local site selection hypothesis, genotypes associated with wary behaviour were over three times more frequent at the non-urban site. This resulted in moderate population differentiation at DRD4 (FST = 0.080), despite the sites being separated by only 30 km, a short distance for this highly-mobile species. Low population differentiation at neutrally-selected microsatellite loci and the likely occasional migration of swans between the populations reduces the likelihood of local site adaptations.

CONCLUSION: Our results suggest that wariness in swans is partly genetically-determined and that wary swans settle in less-disturbed areas. More generally, our findings suggest that site-specific management strategies may be necessary that consider the temperament of local animals.

Implementation of clinical guidelines on diabetes and hypertension in urban Mongolia: a qualitative study of primary care providers' perspectives and experiences

BACKGROUND: Hypertension and diabetes, key risk factors for cardiovascular disease, are significant health problems globally. As cardiovascular disease is one of the leading causes of mortality in Mongolia since 2000, clinical guidelines on arterial hypertension and diabetes were developed and implemented in 2011. This paper explores the barriers and enablers influencing the implementation of these guidelines in the primary care setting.

METHODS: A phenomenological qualitative study with semi-structured interviews was conducted to explore the implementation of the diabetes and hypertension guidelines at the primary care level, as well as to gain insight into how practitioners view the usability and practicality of the guidelines. Ten family health centres were randomly chosen from a list of all the family health centres (n = 136) located in Ulaanbaatar City. In each centre, a focus group discussion with nurses (n = 20) and individual interviews with practice doctors (n = 10) and practice managers (n = 10) were conducted. Data was analysed using a thematic approach utilising the Theoretical Domains Framework.

RESULTS: The majority of the study participants reported being aware of the guidelines and that they had incorporated them into their daily practice. They also reported having attended guideline training sessions which were focused on practice skill development. The majority of participants expressed satisfaction with the wide range of resources that had been supplied to them by the Mongolian Government to assist with the implementation of the guidelines. The resources, supplied from 2011 onwards, included screening devices, equipment for blood tests, medications and educational materials. Other enablers were the participants' commitment and passion for guideline implementation and their belief in the simplicity and practicality of the guidelines. Primary care providers reported a number of challenges in implementing the guidelines, including frustration caused by increased workload and long waiting times, time constraints, difficulties with conflicting tasks and low patient health literacy.

CONCLUSIONS: This study provides evidence that comprehensive and rigorous dissemination and implementation strategies increase the likelihood of successful implementation of new guidelines in low resource primary care settings. It also offers some key lessons that might be carefully considered when other evidence-based clinical guidelines are to be put into effect in low resource settings and elsewhere.