Implementation of diabetes prevention programs in rural areas : Montana and south-eastern Australia compared

Objective: To identify the key elements that enabled the Greater Green Triangle Diabetes Prevention Project (GGT DPP) and the Montana Cardiovascular Disease and Diabetes Prevention (CDDP) programs successful establishment and implementation in rural areas, as well as identifying specific challenges or barriers for implementation in rural communities.
Methods: Focus groups were held with the facilitators who delivered the GGT DPP in Australia and the Montana CDDP programs in the USA. Interview questions covered the facilitators’ experiences with recruitment, establishing the program, the components and influence of rurality on the program, barriers and challenges to delivering the program, attributes of successful participants, and the influence of community resources and partnerships on the programs.
Results: Four main themes emerged from the focus groups: establishing and implementing the diabetes prevention program in the community; strategies for recruitment and retention of participants; what works in lifestyle intervention programs; and rural-centred issues.
Conclusions: The results from this study have assisted in determining the factors that contribute to developing, establishing and implementing successful diabetes prevention programs in two rural areas. Recommendations to increase the likelihood of success of programs in rural communities include: securing funding early for the program; establishing support from community leaders and developing positive relationships with health care providers; creating a professional team with passion for the program; encouraging participants to celebrate their small and big successes; and developing procedures for providing post-intervention support to help participants maintain their success.

Neighbourhood renewal in Victoria, Australia : an effective way to address social inclusion

People who live in disadvantaged communities are at increased risk of social exclusion through diminished access and quality of services, lack of opportunity and feeling powerless over decisions relating to their neighbourhoods. Neighbourhood Renewal (NR) is a Victorian State Government initiative that seeks to address this. This paper presents the findings from two individual project sites, side-by-side. Data were collected in 2004/5 and 2009 using face-to face interviewing with convenience samples of 900 NR residents across the two NR sites at each time period. A comparison group for each NR site consisted of a sample of 150 people living in the same suburb or town but outside the NR site, data were collected by telephone. Data were analysed separately for each NR project site. Findings indicate that neighbourhood renewal strategies can be effective in improving trust in government, perceptions of community participation, influence and control over community decisions and improved services. Community level strategies are valuable in addressing area-level determinants to improve social inclusion. The successes of the NR scheme support the implementation and continuation of area-specific interventions to address disadvantage and social exclusion across Victoria, Australia.

The geographies of the justice for janitors

On the heels of the successes of its Justice for Janitors (J4J) model to organize cleaners in the United States, the Service Employees International Union is exporting this model to Canada and Australia. In this article we examine the geographies of the implementation of the J4J model in these two contexts. And while the “ramping up” of the J4J to the globe makes sense to organize an increasingly globalizing cleaning industry, the model must nonetheless pay attention to the local scale and histories of existing organizations.

Jillong 2030 : mistakes, challenges & urban visions

Geelong has long been a second cousin to Melbourne economically and in development. Whilst historically wishing to capture the role as administrative capital of the new colony of Victoria, it missed out due to the entrepreneurism of Melbourne. Despite this, it embraced contemporary industrialism, particularly automotive, and built upon its port and wool export capacities. Politics, intransigence and lack of economic investment compounded the failure to create quality urban fabric and enable innovative planning. The last 50 years have witnessed attempts to re-chart a robust and co-ordinated urban framework and vision, aided by the former Geelong Regional Commission (GRC) and more recently the amalgamated City of Greater Geelong (CGG), resulting in varying successes and several failures. Urban design has repeatedly, and historically, surfaced as the catalyst for creative and successful growth in Geelong, or Jillong at the Wathaurong described the place. This paper considers the planning, urban design and environmental legacy of Geelong. It critiques its successes and failures, drawing out the salient issues and themes that underpin its opportunities and quality place-making adventures, and considers the key challenges it now faces. Importantly, it sets forth the six planning and design challenges it must confront in the next 10 years to create a robust, creative, healthy and environmentally liveable place, of which urban design regeneration surfaces as a core need, or the city will continue along its haphazard pathway without cohesion and purpose.

The roses of success

Sometimes success can be detrimental to learning while failure can be good. What appears as a disaster can often lay the foundations for future success.

Usually, educators and students focus on building confidence through successful completion of learning tasks, summarised by Vygotsky’s zone of proximal development. A positive feedback loop is established if learners are successful in mastering new ideas and skills. The problem is if teachers, trainers and instructors never challenge students to the fullest extent of their abilities, as this might also ensure overconfidence, slow progress and boredom.

We should not avoid the risk of failure; science is all about the possible risk of failure. Testable hypotheses have the potential to fail an experimental or computational test; ideas that are not testable are considered to be outside the realm of science. The occasional failure shows the limits and scope of an idea’s validity and enables us to advance scientific ideas.

There is a need to find the balance between challenge that extends students, and over-extension. The former results in greater and true confidence and ability, while the latter leads to catastrophic failure and crises of confidence. Education, like life and like all scientific endeavour is about taking responsible risks safely. When we cultivate the roses of success that grow from the ashes of disaster, we must not forget that roses have thorns, or that the occasional setback or failure is just as important for learning as a succession of successes.

Improving biodiversity monitoring

Effective biodiversity monitoring is critical to evaluate, learn from, and ultimately improve conservation practice. Well conceived, designed and implemented monitoring of biodiversity should: (i) deliver information on trends in key aspects of biodiversity (e.g. population changes); (ii) provide early warning of problems that might otherwise be difficult or expensive to reverse; (iii) generate quantifiable evidence of conservation successes (e.g. species recovery following management) and conservation failures; (iv) highlight ways to make management more effective; and (v) provide information on return on conservation investment. The importance of effective biodiversity monitoring is widely recognized (e.g. Australian Biodiversity Strategy). Yet, while everyone thinks biodiversity monitoring is a good idea, this has not translated into a culture of sound biodiversity monitoring, or widespread use of monitoring data. We identify four barriers to more effective biodiversity monitoring in Australia. These are: (i) many conservation programmes have poorly articulated or vague objectives against which it is difficult to measure progress contributing to design and implementation problems; (ii) the case for long-term and sustained biodiversity monitoring is often poorly developed and/or articulated; (iii) there is often a lack of appropriate institutional support, co-ordination, and targeted funding for biodiversity monitoring; and (iv) there is often a lack of appropriate standards to guide monitoring activities and make data available from these programmes. To deal with these issues, we suggest that policy makers, resource managers and scientists better and more explicitly articulate the objectives of biodiversity monitoring and better demonstrate the case for greater investments in biodiversitymonitoring. There is an urgent need for improved institutional support for biodiversity monitoring in Australia, for improved monitoring standards, and for improved archiving of, and access to, monitoring data. We suggest that more strategic financial, institutional and intellectual investments in monitoring will lead to more efficient use of the resources available for biodiversity conservation and ultimately better conservation outcomes.

Trials and tribulations of recruiting 2,000 older women onto a clinical trial investigating falls and fractures : vital D study

Background Randomised, placebo-controlled trials are needed to provide evidence demonstrating safe, effective interventions that reduce falls and fractures in the elderly. The quality of a clinical trial is dependent on successful recruitment of the target participant group. This paper documents the successes and failures of recruiting over 2,000 women aged at least 70 years and at higher risk of falls or fractures onto a placebo-controlled trial of six years duration. The characteristics of study participants at baseline are also described for this study.

Methods The Vital D Study recruited older women identified at high risk of fracture through the use of an eligibility algorithm, adapted from identified risk factors for hip fracture. Participants were randomised to orally receive either 500,000 IU vitamin D3 (cholecalciferol) or placebo every autumn for five consecutive years. A variety of recruitment strategies were employed to attract potential participants.

Results Of the 2,317 participants randomised onto the study, 74% (n = 1716/2317) were consented onto the study in the last five months of recruiting. This was largely due to the success of a targeted mail-out. Prior to this only 541 women were consented in the 18 months of recruiting. A total of 70% of all participants were recruited as a result of targeted mail-out. The response rate from the letters increased from 2 to 7% following revision of the material by a public relations company. Participant demographic or risk factor profile did not differ between those recruited by targeted mail-outs compared with other methods.

Conclusion The most successful recruitment strategy was the targeted mail-out and the response rate was no higher in the local region where the study had extensive exposure through other recruiting strategies. The strategies that were labour-intensive and did not result in successful recruitment include the activities directed towards the GP medical centres. Comprehensive recruitment programs employ overlapping strategies simultaneously with ongoing assessment of recruitment rates. In our experience, and others direct mail-outs work best although rights to privacy must be respected.

The relationship between coronary heart disease (CHD) and major depressive disorder (MDD) : key mechanisms and the role of quality of life

Various trials have been conducted evaluating depression management programs for patients with Coronary Heart Disease (CHD). However, to date, the most effective way to manage this co-morbidity in the real world setting remains unclear. To better understand the past successes and failures of previous trials and subsequently develop suitable interventions that target key components of health related quality of life (HRQOL) such as mental, physical and vocational functioning, we first need to understand the mechanisms underpinning the relationship between the two conditions. This paper will draw on the key literature in this field as identified by psychiatric, medical and social sciences databases (Cochrane Central Register of Controlled Trials, PubMed, OVID, Medline) available up to January 2012, with the aim to conduct a narrative review which explores: the aetiological relationship between depression and CHD; its association with HRQOL; the relationship between CHD, depression and vocational functioning; and the impact of depression treatment on these outcomes. Key recommendations are made regarding the management of this prevalent co-morbidity in clinical settings.

Disrupting disordered neurocircuitry : treating refractory psychiatric illness with neuromodulation

Despite the premature and somewhat infamous rise and fall of psychosurgery in the mid-20th century, the current era of functional neuromodulation proffers immense opportunity for surgical intervention in treatment-resistant psychiatric disorders. On the basis of recent successes with novel, focused, less invasive, and reversible treatment strategies for movement disorders, several therapeutic trials have been conducted to investigate the effectiveness of deep brain stimulation (DBS) in treatment-resistant depression, obsessive-compulsive disorder (OCD), and Tourette syndrome. The many anatomic targets for these psychiatric disorders are indicative of both the system-wide effects of DBS and the network-level dysfunction mediating the emotional and cognitive disturbances. To gain insight into the application of neuromodulation therapies and their further advancement, we must elucidate neuroanatomic networks involved in refractory psychiatric illness, the neurophysiological anomalies that contribute to disordered information processing therein, and the local and system-wide modulatory effects of DBS. This review discusses the history of psychosurgical procedures, recent DBS clinical data, current anatomic models of psychopathology, and possible therapeutic mechanisms of action of DBS neuromodulation. Our search criteria for PubMed included combinations of the following terms: neuromodulation, DBS, depression, OCD, Tourette syndrome, mechanism of action, and history. Dates were not restricted. As clinical and basic scientific investigations probe the neuromodulatory effects of DBS in the treatment of refractory neuropsychiatric illness, our knowledge of these disorders and our potential to treat them are rapidly expanding. Indeed, this modern era of neuromodulation may provide the key that unlocks many of the mysteries pertaining to the biological basis of disordered emotional neurocircuitry.

From blogging Central Asia to citizen media : a practitioners’ perspective on the evolution of the neweurasia blog project

This essay examines the development of one regional blogosphere, the Central Asian ‘Stanosphere’, through a focus on the neweurasia blog project. The neweurasia project began in 2005 as an Englishlanguage volunteer-run blog project about the former Soviet republics of Central Asia and the Caucasus, rapidly becoming one of the most visited blogs about the region. Following this auspicious start, over the next five years neweurasia developed into a multi-language locally driven project with more than 80,000 unique page views on average per month. Despite its indisputable successes, the project was often a steep learning curve for all involved. In this essay, we examine neweurasia’s evolution from ‘blogging Central Asia’ towards a citizen media project, and reflect on some of the issues and challenges encountered. On the basis of our discussion, we reflect upon how neweurasia, and citizen media in general, can maximise its impact on the nascent Stanosphere, in the process helping to give Central Asia a voice in the global blogosphere.

Exploring the global and local networks of national information system integration initiatives : a case study of national cultural collection integration from an actor-network perspective

Australian Museums Online (AMOL) was the earliest attempt to make Australia’s distributed cultural collections accessible from a single online resource. Despite early successes, significant achievements and the considerable value it offered certain groups, the project ran into operational difficulties and was eventually discontinued. By using Actor-Network Theory and analysing the global and local actor-networks, it is revealed that although the project originated from large, state museums, buy-in was restricted to individuals, rather than institutions and the most significant value was for smaller, regional institutions. Furthermore, although the global networks that governed the project could translate their visions through the local production networks, because the network’s underlying weaknesses were never addressed, over time this destablised the global networks. This case study offers advice for projects attempting to consolidate data sources from disparate sources, and highlights the importance of individual actors in championing the project.

Changing Aristotle's mind and world : critical notes on McDowell's Aristotle

Aristotle’s Nicomachean Ethics is central to John McDowell’s classic Mind and World. In Lectures IV and V of that work, McDowell makes three claims concerning Aristotle’s ethics: first, that Aristotle did not base his ethics on an externalist, naturalistic basis (including a theory of human nature); second, that attempts to read him as an ethical naturalist are a modern anachronism, generated by the supposed need to ground all viable philosophical claims on claims analogous to the natural sciences; and third, that a suitably construed Aristotelian conception of “second nature” can form the basis of a viable contemporary philosophy of mind, world, and normativity. This paper challenges each of these three claims. Aristotle’s ethics, we will claim alongside Terence Irwin, Bernard Williams, Philippa Foot, and many premodern commentators, is based in the kind of physics, metaphysics, and metaphysical biology that McDowell says it cannot be. Historically, we will argue that McDowell’s argument that Aristotle’s ethical reasoning is “autonomous” or “self-standing” is distinctly modern, citing evidence from the leading medieval commentators on the Nicomachean Ethics. The felt need to which McDowell responds, of reading Aristotle’s ethical or political thought as wholly non-metaphysical, arises from out of the successes of the natural sciences in the modern world, which he agrees discredit the Aristotelian, teleological account of nature. In the final part of the paper, we propose that McDowell’s account of normativity, rooted in the non-metaphysical “second nature” he reads into Aristotle, we will contend, is as it stands inescapably relativistic. On a different note, we need also to recognize, as McDowell does not, that this is a new Aristotle, one shaped by our requirements and space of reasons, not the mind and world of the Greek Philosopher himself.

The Edinburgh companion to the history of democracy

Democracy has never been more popular. It is successfully practiced today in a myriad of different ways by people across virtually every cultural, religious or socio-economic context. The 45 original essays collected in this companion suggest that the global popularity of democracy derives in part from its breadth and depth in the common history of human civilization. It sets a benchmark as the first collection on the history of democracy to present lesser known examples, such as those of ancient China, medieval Islam, colonial Africa or today's Burma, alongside more familiar cases like Athens, the English Parliament, the French Revolution and Women's Suffrage.

Undersdtanding where democracy comes from, and where its greatest successes and most dismal failures lie, is central to democracy's project of inventing ways to address the need of people everywhere to live in peace and freedom and with a say in the decisions that affect their lives.

Introduction : The complex and contested history of democracy

Democracy has never been more popular. It is successfully practiced today in a myriad of different ways by people across virtually every cultural, religious or socio-economic context. The forty-five essays collected in this companion suggest that the global popularity of democracy derives in part from its breadth and depth in the common history of human civilization. The chapters include exceptional accounts of democracy in ancient Greece and Rome, modern Europe and America, among peoples’ movements and national revolutions, and its triumph since the end of the Cold War. However, this book also includes alternative accounts of democracy’s history: its origins in prehistoric societies and early city-states, under-acknowledged contributions from China, Africa and the Islamic world, its familiarity to various Indigenous Australians and Native Americans, the various challenges it faces today in South America, Eastern Europe, the Middle East and Asia, the latest democratic developments in light of globalization and new technologies, and potential future pathways to a more democratic world. Understanding where democracy comes from, where its greatest successes and most dismal failures lie, is central to democracy’s project of inventing ways to address the need of people everywhere to live in peace, freedom and with a say in the decisions that affect their lives.

Prevention of common mental disorders: what can we learn from those who have gone before and where do we go next?

Objective: