Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation

Objective: To evaluate the clinical effectiveness and implementation of a falls prevention exercise programme for preventing falls in the subacute hospital setting.

Design: Randomized controlled trial, subgroup analysis.

Participants: Patients of a metropolitan subacute/aged rehabilitation hospital who were recommended for a falls prevention exercise programme when enrolled in a larger randomized controlled trial of a falls prevention programme.

Methods: Participants in both the control and intervention groups who were recommended for the exercise programme intervention were followed for the duration of their hospital stay to determine if falls occurred. Participants had their balance, strength and mobility assessed upon referral for the exercise programme and then again prior to discharge. Participation rates in the exercise programme were also recorded.

Results: Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However few differences in secondary balance, strength and mobility outcomes were evident.

Conclusion: This exercise programme provided in addition to usual care may assist in the prevention of falls in the subacute hospital setting.

Assessment and case conceptualization in sex offender treatment

The assessment of sexual offenders consists of the systematic collection of clinically relevant information in order to detect clinical phenomena or problems and to provide clear treatment targets. The result of this process is a conceptual model, or case formulation, representing the client’s various problems, the hypothesized underlying mechanisms, and their interrelationships. The focus of this article is on the importance of psychological assessment and case formulation in the rehabilitation and management of individuals convicted of sexual offences. First, we make a number of general points about the importance of evidence based assessment and clinical reasoning in case formulation. Second, we review key elements of contemporary sexual offender theory that highlights the heterogeneity evident among sex offenders and the implications for case formulation and treatment planning. Third, we discuss the role of case formulation for risk assessment and management. Finally, we illustrate our major points with a brief case study and conclude with a brief consideration of the value of case formulations.

The assessment and management of common male sexual difficulties in family practice

Sexual problems are distressing for patients, and their doctors need to feel comfortable giving advice about and treating the more common conditions. Treatment of sexual problems can prevent much anxiety and the development of depression. This article outlines approaches useful in managing the more common male sexual difficulties encountered in family practice.

Jazz cats unmasked : revealing tales/tails of jazz education, musicians and teachers

New Zealand jazz education has come of age in the last 30 years.  The presence of a jazz curriculum in schools and universities has reflected students' desire to study this vernacular music and an adherence to international shifts in music education.  Yet, the Jazz genre commands the least market share in terms of record sales and concert attendance worldwide.  Now often described as America's true 'classical music', the cogent questions would seem to be 'why jazz', 'why now' and 'why here'?  This book explores these questions through the narrative of two New Zealand-born jazz educators who have made considerable contributions in post-secondary settigns.  It takes a critical look at their musical lives, and the influence that experience, context  and self-perception has ontheir teaching philosophies.  Stripping back the layers created by predominant binaries of musician/educator, glocal/global, history/genealogy, formal/informal and generalist/specialist, thsi book makes liberal use of a range of  arts-informed methodologies to unmask the main actors in jazz education adding to the ongoing broader international discussion of future directions of the art.

Confidentiality and disclosure : assessment and intervention issues

This portfolio addresses the moral, ethical and legal issues that impact upon decisions to maintain or disclose confidential communications. The tensions and moral dilemmas that are created when a conflict between these aspects arises are considered. Risk assessment procedures that inform decisions to maintain or disclose confidential information are discussed, as are issues related to the practical implementation of planned interventions. The topic is addressed by firstly reviewing professional codes of conduct and legal requirements to maintain confidentiality. The limits of confidentiality and privileged communication are then reviewed together with legal requirements of “duty to warn” or “duty of care”. These requirements are then related to risk assessment procedures and relevant interventions. Four case studies that illustrate the practical application of assessment techniques in the decision process and planned interventions are presented. They cover such diverse topics as disclosure and suicidal intent, threat of harm to a third party, risk of transmission of the AIDS virus and “duty to warn” and maintenance of a minor’s confidential communications. The ways in which these issues were addressed and the outcome is presented. NOTE: All names and details that have the potential to identify the people whose cases are presented here have been changed to protect their anonymity.

Community-based environmental education : government and community, economics and environment

This thesis contends that government focus on policy implicitly defines community education as a means of overcoming barriers to government-initiated change, rather than as an input to governmental decision-making. The role of education is thus viewed as instrumentalist rather than as dialectical in nature. I argue that this role has been reinforced and driven by economic rationalism, as a mechanism related to scientific theory and practice. The thesis addresses the role of government in non-institutional community-based environmental education. Of interest is environmental education under the dominance of economic rationalism and as expressed in government-derived policy, in its own right, and as enacted in two government funded animal management projects. The main body of data, then, includes a review of some contemporary environmental policies and two case studies of 'policy in practice'. Chapter One provides an overview of environmentalism as it has emerged as part of the discourse of Western political systems. Recognised as part of this change is a move to environmentalism embued with the rhetoric of economic theory. The manifestation of this change can be seen in an emphasis on management for the natural environment's use as a resource for humans. Education under this arrangement is valued in terms of its ability to support initiatives that are perceived as economically viable and economically advantageous, maintaining centralised control of decision-making and serving the interests of those who profit from this arrangement. Government-derived environmental policies are presented in Chapter Two. They provide evidence of the conjoining of environment with economic rationalism and the adoption of a particular stance which is both utilitarian and instrumentalist. Emerging from this is an understanding of the limitations placed on environmental debates that do not respond to complex understandings of context and instead support and legitimate centralisation of decision-making and control. Chapter Three presents an argument for an historical approach to environmental education research to accommodate contextual dimensions, as well as scientific, economic and technical dimensions, of the subject under study. An historical approach to research, inclusive of biographical, intergenerational and geographical histories, goes some way to providing an understanding of current individual and collective responses to policy enactment within the two study sites. It also responds to the concealing of history which results from the reduction of environmental debates to economic terms. With this in mind, Chapters Four and Five provide two historical case studies of 'policy in practice'. Chapter Four traces the workings of a rabbit control project in the Sutton Grange district of Victoria and Chapter Five provides an account of a mouse plague project in the Wimmera and Mallee regions of Victoria. The Sutton Grange rabbit project is organised and controlled by district landholders while the Wimmera and Mallee mouse project is organised and controlled by representatives from a scientific organisation and a government agency. Considered in juxtaposition, the two case studies enable an analysis of two somewhat different expressions of the 'role of government'. Chapter Six investigates the competing processes of community participation in governmental decision-making and Australia's system of representative democracy, Despite a call for increased community participation, the majority of policies remain dominated by governmental rhetoric and ideology underpinned by a belief in impartiality. The primacy of economics is considered in terms of government and community interaction, with specific reference to the emergence of particular conceptual constructions, such as cost-benefit analysis, that support this dominance. Of specific importance to this thesis is the argument that economic theory is essentially anthropocentric and individualist and, thus, necessarily marginalises particular conceptions of environment that are non-anthropocentric and non-individualistic. Finally, Chapter Six examines two major interrelated tensions; those of central interests and community interests, and economic rationalism and environmentalist. Chapter Seven looks at examples of theories and practices that fall outside the rationality determined by scientistic knowledge. It is clear from the examination of environmental policy within this thesis that the role ascribed to environmental education is instrumentalist. The function of education is often to support, promote and implement policy and its advocated practices. It is also clear from the examination of policy and advocated processes that policy defines community education as a means of manifesting change as determined by policy, rather than as an input to governmental decision-making. The domination of scientific, economic and technocratic processes (and legitimation of processes) allows only for an instrumentalist approach to education from government. What is encouraged by government through the process of change is continuity rather than reform. It promotes change that will not disrupt the governing hegemony. Particular perspectives and practices, such as a critical approach to education, are omitted or considered only within the unquestioned rationale of the dominant worldview. Chapter Seven focuses on the consequence of government attention to policy which implicitly defines community education as a means of overcoming barriers to change, rather than as an input to governmental decision-making. Finally a list of recommendations is put forward as a starting point to reconstruct community-based environmental education. The role considered is one that responds to, and encourages engagement in, debates which expose disparate views, assumptions and positions. Community ideology must be challenged through the public practices of communication and understanding, decision-making, and action. Intervention is not on a level that encourages a preordinate outcome but, rather, what is encouraged is elaborate consideration of disparate views and rational opinions, and the exposure of assumptions and interests behind ideological positions.

Ongoing colonial legacy : contemporary education beliefs and practices in Papua New Guinea

In the late 1980ˇ¦s, a realisation that the western education system bequeathed to Papua New Guinea at the time of Independence had functioned to devalue and marginalise many of the traditional beliefs, knowledge and skills students brought with them to education, led to a period of significant education reform. The Reform was premised on the report of a Ministerial Review Committee called A Philosophy of Education. This report made recommendations about how education in Papua New Guinea could respond to the issues and challenges this nation faced as it sought to chart a course to serve the needs of its citizens on its own terms. The issues associated with managing and implementing institutionalised educational change premised on importing western values and practices are a central theme of this thesis. The impact of importing foreign curriculum and associated curriculum officers and consultants to assist with curriculum change and development in the former Language and Literacy unit of the Curriculum Development Division, is considered in three related sections of this report: „P a critical review of the imported educational system and related practices and related issues since Independence „P narrative report of the experience of two colleagues in western education „P evidential research based on curriculum Reform in the Language and Literacy Unit. How Papua New Guinea has sought to come to terms with the issues and challenges that arose in response to a practice of importing western curriculum both at the time of Independence and currently through the Reform, are explored throughout the thesis. The findings issues reveal much about the capacity of individuals and institutions to respond to a post-colonial world particularly associated with an ongoing colonial legacy in the principle researcherˇ¦s work context. The thesis argues that the challenges Papua New Guinea curriculum officers face today, as they manage and implement changes associated with another imported curriculum are caught up in existing power relations. These power relations function to stifle creative thinking at a time when it is most needed. Further, these power relations are not well understood by the curriculum officers and remained hidden and unquestioned throughout the research project. The thesis also argues that in the researcherˇ¦s work context, techniques of surveillance were brought to bear and functioned to curtail critical thinking about how the reformed curriculum could be sensitive and respectful of those beliefs and traditions that had sustained life in Papua New Guinea for thousands of years. Consequently, many outmoded beliefs and practices associated with an uncritical and ongoing acceptance of the superiority of western imports have been retained, thereby effectively denying the collective voices of Paua New Guineans in the current curriculum Reform.

Teachers’ ethics : education international and the forging of professional unity

The paper maintains that the current era, marked by a new global economy transforming economic and social development, has created the need for a reorganisation of teachers’ representation. This paper discusses a key development in teacher organisation, namely the emergence of Education International as a global hub for teacher unionism from across the world. This unique organisation, formulated in response to the emergence of global economies and supra-national figures, represents teachers’ response to globalised institutions and has instigated projects, such as the Professional Code of Ethics, which aim to create a sense of professional identity and unity amongst teachers. The organisation presents the political voice of teachers as a global collective that seeks to embed teachers’ interests in education reform and in the public debates concerning the direction of educational change in the era of globalisation. The paper concludes by outlining an ongoing issue that jeopardizes the collective voice of teachers and stresses how this needs to be further addressed in the ethical frameworks of what it means to be a teacher in the 21st century.

Security as an element in environmental assessment and decision making

he prominence of global warming as an environmental issue has illustrated the close relationship between natural resources, ecosystems and global security. Whilst environmental decision making often uses techniques such as economic valuation and risk management, the security component is often not considered, at least not from a security analyst’s perspective. Yet environmental security considerations can be global, regional and/or national in impact. Environmental change and policy can effect human health and well being as well as initiating conflict; it can affect the existence of life itself. These aspects are firmly in the domain of the security discipline although the protection of the global ecosystem has not traditionally been considered by those who create security policy. The idea of environmental/ecological security ranges from the eco-centric approach which examines the impact of human activities that impact on the security of the natural systems to the more traditional anthropocentric perspectives that look at varied issues such as conflict caused by natural resource competition and environmental degradation, and the greening of military operations. This paper will assert that the inclusion of the security factor in policy creation and environmental assessments is essential to give richer solutions to these complex socio-economic and ecological situations. Systems theory over the last few decades has emphasised the inclusion of as many perspectives on messy problems as possible to provide truly systemic outcomes. It is posited that the addition of such concepts as threat analyses will produce more effective and sustainable outcomes.

Global education, travel and new imaginaries for teachers' work

This study investigated how teachers‘ knowledge and identities are influenced through their experience of travel. Understanding how teachers make meaning from and respond to travel revealed aspects of knowledge creation and identity formation. Set within contexts of globalisation, the study also investigated global education through analysis of changing definitions and meanings by taking an historical stance.
Through qualitative methodology semi-structured interviews were conducted with two teachers who had recently been on a study tour. The other form of data collection included a collection of four ‗travel‘ stories written by the researcher. The social imaginary was the concept employed to explain and analyse the impact of travel on teachers work and lives.

This small case study of three participants provided a depth of responses to the following three research questions.
1. What is global education?
2. How does the experience of travel shape teachers‘ work and identities?
3. How does teachers‘ work reconfigure global education?
The findings from this study revealed that global education has shifted from a position of marginality in curriculum and teaching practices to a more central location in education policies. The analysis of participants‘ responses to travel as a feature of globalisation, revealed new knowledge, additional teaching pedagogies and greater awareness of stereotypes both held and disclosed from students. The practices and thinking described by participants were consistent with calls for greater cosmopolitan teaching.

This study contributed understanding about how teachers embed global imaginaries in their teaching. This in turn builds understanding around how globalisation is reshaping local contexts and individuals‘ thinking and being. The findings challenge global education as a discrete framework and suggest teachers‘ experiences as influential on education now in a global world. The study confirms that globalisation is reshaping educators‘ work and lives towards a global education.