Cultural racism, language prejudice and discrimination in hospital contexts : an Australian study

This article explores the idea that racial and ethnic disparities in healthcare may be expressive of unacknowledged practices of cultural racism. In conducting this exploration, the researchers identify, describe and discuss the practice of language prejudice and discrimination by health service providers, discovered serendipitously in the context of a broader study exploring cultural safety and cultural competency in an Australian healthcare context. The original study involved individual and focus groups interviews with 145 participants recruited from over 17 different organisational and domestic home sites. Participants included health service managers, ethnic liaison officers, qualified health interpreters, cultural trainers/educators, ethnic welfare organisation staff, registered nurses, allied health professionals, and healthcare consumers. Participants self-identified as being from over 27 different ethnocultural and language backgrounds.

Analysis of the data revealed that English language proficiency, like skin colour, was used as a social marker to classify, categorise, and negatively evaluate people of non-English speaking backgrounds (NESB) in the contexts studied. Negative evaluations, in turn, were used to justify the exclusion of NESB people from healthcare relationships and resources. Further data analysis revealed that underpinning the negative attitudes and behaviours in hospital domains concerning people who spoke accented English or who did not speak English proficiently were a dislike of difference, fear of difference, intolerance of difference, fear of competition for scarce healthcare resources, repressed hostility toward difference, and ignorance.

Highlighting the implications of language prejudice for the safety and quality care of NESB people, the researchers call for further internationally comparative research and debate on the subject.

Ethical dilemmas of a large national multi-centre study in Australia

Aims and objectives: To examine the impact and obstacles that individual Institutional Research Ethics Committee (IRECs) had on a large-scale national multi-centre clinical audit called the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study.

Background: Multi-centre research is commonplace in the health care system. However, IRECs continue to fail to differentiate between research and quality audit projects.

Methods: The National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes study used an investigator-developed questionnaire concerning a clinical audit for heart failure programmes throughout Australia. Ethical guidelines developed by the National governing body of health and medical research in Australia classified the National Benchmarks and Evidence-based National Clinical guidelines for Heart failure management programmes Study as a low risk clinical audit not requiring ethical approval by IREC.

Results: Fifteen of 27 IRECs stipulated that the research proposal undergo full ethical review. None of the IRECs acknowledged: national quality assurance guidelines and recommendations nor ethics approval from other IRECs. Twelve of the 15 IRECs used different ethics application forms. Variability in the type of amendments was prolific. Lack of uniformity in ethical review processes resulted in a six- to eight-month delay in commencing the national study.

Conclusions: Development of a national ethics application form with full ethical review by the first IREC and compulsory expedited review by subsequent IRECs would resolve issues raised in this paper. IRECs must change their ethics approval processes to one that enhances facilitation of multi-centre research which is now normative process for health services.

Relevance to clinical practice: The findings of this study highlight inconsistent ethical requirements between different IRECs. Also highlighted are the obstacles and delays that IRECs create when undertaking multi-centre clinical audits. However, in our clinical practice it is vital that clinical audits are undertaken for evaluation purposes. The findings of this study raise awareness of inconsistent ethical processes and highlight the need for expedient ethical review for clinical audits.

The role of sister city relationships in the enhancement of trade : Latrobe City (Australia) and Taizhou (China)

Traditionally the role of Sister City relationships has been a political and cultural one involving local governments across the world. Over the decades this role has been questioned in both its efficacy as well as its
focus. Hundreds of Sister City relationships have developed and in Australia velY few can be said to have produced long term and worthwhile outcomes. New interpretations of the /ill1ctionality of Sister City relationships in Australia (and elsewhere) has resulted and has shifted towards an inclusion of a consideration of the commercial utility of such relationships and not solely cultural (0 'Toole 2001). Today especially with current strong trade relations with China, new models are sought to provide sustainability and long term prospects to such relations. This paper examines the possibility of special sister city relations between
Australian and Chinese cities using their sister city links. Specifically an examination in this paper is undertaken of the City of Latrobe and Taizhou as a case study of interest which provides sustainable trade potential between two strong small medium enterprise (SME) economies.

Calcium and bone health : position statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia

This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia.

Currently, the balance of evidence remains in favour of fracture prevention from combined calcium and vitamin D supplementation in elderly men and women.

Adequate vitamin D status is essential for active calcium absorption in the gut and for bone development and remodelling.

In adults with a baseline calcium intake of 500–900 mg/day, increasing or supplementing this intake by a further 500–1000 mg/day has a beneficial effect on bone mineral density.

Calcium intake significantly above the recommended level is unlikely to achieve additional benefit for bone health.

Modelling of birds and locust-control operations in Eastern Australia

Locust outbreaks provide an abundant, but unpredictable food source for many native species in Australia. For economic reasons, locust control is unavoidable and can affect a considerable area in Eastern Australia. Depending on the pesticide applied, locust control operations may affect birds in treated areas, either directly through intoxication of the predator, or indirectly, through elimination of its prey. As a preliminary step in identifying the potential impact of these operations on native species, the co-occurrence of birds and locust control operations was assessed using GIS mapping techniques. Data from the Birds of Australia New Atlas provided information about species' distribution between latitudes 17 and 37 degree S, and longitudes 136 and 152 degree E. Of the 834 species present in this region, 292 were chosen on the basis of their geographical distribution and occurrence west of the Great Dividing Range. Sightings for each species were mapped using reporting rates and number of observations per half-degree grid cells. Birds were categorised by habitat, distribution, movement and feeding habits and those species reported to consume Orthopterans were noted. APLC locust survey (1987–2000) and spraying data (1977–2002) were analysed and overlapped with soil and vegetation maps obtained from Geoscience Australia and Environment Australia to find significant hotspots for locust occurrence. These maps were then overlayed with bird distributions to identify the species most likely to be in areas of locust presence and spraying operations.

Central obesity as a precursor to the metabolic syndrome in the AusDiab study and Mauritius

Evidence from epidemiologic studies that central obesity precedes future metabolic change and does not occur concurrently with the appearance of the blood pressure, glucose, and lipid abnormalities that characterize the metabolic syndrome (MetS) has been lacking. Longitudinal surveys were conducted in Mauritius in 1987, 1992, and 1998, and in Australia in 2000 and 2005 (AusDiab). This analysis included men and women (aged 25 years) in three cohorts: AusDiab 2000–2005 (n = 5,039), Mauritius 1987–1992 (n = 2,849), and Mauritius 1987–1998 (n = 1,999). MetS components included waist circumference, systolic blood pressure, fasting and 2-h postload plasma glucose, high-density lipoprotein (HDL) cholesterol, triglycerides, and homeostasis model assessment of insulin sensitivity (HOMA-S) (representing insulin sensitivity). Linear regression was used to determine which baseline components predicted deterioration in other MetS components over 5 years in AusDiab and 5 and 11 years in Mauritius, adjusted for age, sex, and ethnic group. Baseline waist circumference predicted deterioration (P < 0.01) in four of the other six MetS variables tested in AusDiab, five of six in Mauritius 1987–1992, and four of six in Mauritius 1987–1998. In contrast, an increase in waist circumference between baseline and follow-up was only predicted by insulin sensitivity (HOMA-S) at baseline, and only in one of the three cohorts. These results suggest that central obesity plays a central role in the development of the MetS and appears to precede the appearance of the other MetS components.

Office building characteristics and the links with carbon emissions

Purpose – The purpose of this paper is to present research which analysed energy consumption in the Melbourne central business district (CBD) office stock and examined all buildings to identify CO2 emissions in 2005. The rationale was that, by profiling a large group of buildings, it would be possible to identify characteristics of the stock. For example, do older buildings typically emit more CO2 per square metre than newer buildings?
Design/methodology/approach – This research conducted a detailed analysis of all Melbourne CBD office stock to identify which patterns and trends emerged regarding building characteristics and carbon emissions. The study examined variables such as building size, number of employees, occupancy levels, physical characteristics and building age.
Findings – By examining all office stock and aggregating data, the results confirm that it is possible to identify general physical building characteristics and carbon emissions. This research confirmed that clear relationships existed within the Melbourne CBD office stock in terms of building size, age and the density of occupation in relation to CO2 emissions.
Originality/value – Practitioners can apply this knowledge to the professional advice they give to clients to assist in achieving increased energy efficiency in the office stock, for example in refurbishment being conscious that smaller buildings will be generally less energy-efficient than larger ones.

Alcohol use and related harms in school students in the USA and Australia

Recognizing there have been few methodologically rigorous cross-national studies of youth alcohol and drug behaviour, state student samples were compared in Australia and the USA. Sampling methods were matched to recruit two independent, state-representative, cross-sectional samples of students in Grades 5, 7 and 9 in Washington State, USA, (n = 2866) and Victoria, Australia (n = 2864) in 2002. Of Washington students in Grade 5 (age 11), 10.3% (95% CI 7.2–14.7) of boys and 5.2% (95% CI 3.4–7.9) of girls reported alcohol use in the past year. Prevalence rates were markedly higher in Victoria (34.2%, 95% CI 28.8–40.1 boys; 21.0%, 95% CI 17.1–25.5 girls). Relative to Washington, the students in Victoria demonstrated a two to three times increased likelihood of reporting substance use (either alcohol, tobacco or illicit drug use), and by Grade 9, experiences of loss-of-control of alcohol use, binge drinking (frequent episodes of five or more alcoholic drinks), and injuries related to alcohol were two to four times higher. The high rates of early age alcohol use in Victoria were associated with frequent, heavy and harmful alcohol use and higher overall exposure to alcohol or other drug use. These findings reveal considerable variation in international rates of both adolescent alcohol misuse and co-occurring drug use and suggest the need for cross-national research to identify policies and practices that contribute to the lower rate of adolescent alcohol and drug use observed in the USA in this study.

Collapse of an avifauna : climate change appears to exacerbate habitat loss and degradation

Aim. We characterized changes in reporting rates and abundances of bird species over a period of severe rainfall deficiency and increasing average temperatures. We also measured flowering in eucalypts, which support large numbers of nectarivores characteristic of the region.

Location.  A 30,000-km2 region of northern Victoria, Australia, consisting of limited amounts of remnant native woodlands embedded in largely agricultural landscapes.

Methods. There were three sets of monitoring studies, pitched at regional  (survey programmes in 1995–97, 2004–05 and 2006–08), landscape (2002–03 and 2006–07) and site (1997–2008 continuously) scales. Bird survey techniques used a standard 2-ha, 20-min count method. We used Bayesian analyses of reporting rates to document statistically changes in the avifauna through time at each spatial scale.

Results. Bird populations in the largest remnants of native vegetation (up to 40,000 ha), some of which have been declared as national parks in the past decade, experienced similar declines to those in heavily cleared andscapes. All categories of birds (guilds based on foraging substrate, diet, nest site; relative mobility; geographical distributions) were affected similarly. We detected virtually no bird breeding in the latest survey periods. Eucalypt flowering has declined significantly over the past 12 years of drought.

Main conclusions. Declines in the largest woodland remnants commensurate with those in cleared landscapes suggest that reserve systems may not be relied upon to sustain species under climate change. We attribute population declines to low breeding success due to reduced food. Resilience of bird populations in this woodland system might be increased by active management to enhance habitat quality in existing vegetation and restoration of woodland in the more fertile parts of landscapes.

Australia and East Timor : elitism, pragmatism and the national interest

For over two decades the issue of East Timor's right to self-determination has been a ‘prickly’ issue in Australian foreign policy. The invasion by Indonesian forces in 1975 was expected, as Australian policy-makers had been well informed of the events leading up to the punitive action being taken. Indeed, prior discussions involving the future of the territory were held between the Australian Prime Minister and the Indonesian President in 1974. In response to the events unfolding in the territory the Australian Labor Government at the time was presented with two policy options for dealing with the issue. The Department of Defence recommended the recognition of an independent East Timor; whereas the Department of Foreign Affairs proposed that Australia disengage itself as far as possible from the issue. The decision had ramifications for future policy considerations especially with changes in government. With the Department of Foreign Affairs option being the prevailing policy what were the essential ingredients that give explanation for the government's choice? It is important to note the existence of the continuity and cyclical nature of attitudes by Labor governments toward Indonesia before and after the invasion. To do so requires an analysis of the influence ‘Doc’ Evatt had in shaping any possible Labor tradition in foreign policy articulation. The support given by Evatt for the decolonisation of the Netherlands East Indies (Indonesia) gave rise to the development of a special relationship-so defined. Evidence of the effect Evatt had on future Labor governments may be found in the opinions of Gough Whitlam. In 1975 when he was Prime Minister, Whitlam felt the East Timor issue was merely the finalisation of Indonesia's decolonisation honouring Evatt's long held anti-colonialist tradition existing in the Australian Labor Party. The early predisposition toward Indonesia's cohesiveness surfaced again in the Hawke and Keating Labor governments of later years. It did not vary a great deal with changes in government The on-going commitment to preserving and strengthening the bilateral relationship meant Indonesia's territorial integrity became the focus of the Australian political elites’ regional foreign policy determinations. The actions taken by policy-makers served to promote the desire for a stable region ahead of independence claims of the East Timorese. From a realist perspective, the security dilemma for Australian policy-makers was how to best promote regional order and stability in the South East Asian region. The desire for regional cohesiveness and stability continues to drive Australian political elites to promote policies that gives a priority to the territorial integrity of regional states. Indonesia, in spite of its diversity, was only ever thought of as a cohesive unitary state and changes to its construct have rarely been countenanced. Australia's political elite justifications for this stance vacillate between strategic and economic considerations, ideological (anti-colonialism) to one of being a pragmatic response to international politics. The political elite argues the projection of power into the region is in Australia’s national interest. The policies from one government to the next necessarily see the national interest as being an apparent fixed feature of foreign policy. The persistent fear of invasion from the north traditionally motivated Australia's political elite to adopt a strategic realist policy that sought to ‘shore up’ the stability, strength and unity of Indonesia. The national interest was deemed to be at risk if support for East Timorese independence was given. The national interest though can involve more than just the security issue, and the political elite when dealing with East Timor assumed that they were acting in the common good. Questions that need to be addressed include determining what is the national interest in this context? What is the effect of a government invoking the national interest in debates over issues in foreign policy? And, who should participate in the debate? In an effort to answer these questions an analysis of how the ex-foreign affairs mandarin Richard Woolcott defines the national interest becomes crucial. Clearly, conflict in East Timor did have implications for the national interest. The invasion of East Timor by Indonesia had the potential to damage the relationship, but equally communist successes in 1975 in Indo-China raised Australia's regional security concerns. During the Cold War, the linking of communism to nationalism was driving the decision-making processes of the Australian policy-makers striving to come to grips with the strategic realities of a changing region. Because of this, did the constraints of world politics dominated by Cold War realities combined with domestic political disruption have anything to do with Australia's response? Certainly, Australia itself was experiencing a constitutional crisis in late 1975. The Senate had blocked supply and the Labor Government did not have the funds to govern. The Governor-General by dismissing the Labor Government finally resolved the impasse. What were the reactions of the two men charged with the responsibility of forming the caretaker government toward Indonesia's military action? And, could the crisis have prevented the Australian government from making a different response to the invasion? Importantly, and in terms of economic security, did the knowledge of oil and gas deposits thought to exist in the Timor Sea influence Australia's foreign policy? The search for oil and gas requires a stable political environment in which to operate. Therefore for exploration to continue in the Timor Sea Australia must have had a preferred political option and thoughts of with whom they preferred to negotiate. What was the extent of each government's cooperation and intervention in the oil and gas industry and could any involvement have influenced the Australian political elites’ attitude toward the prospect of an independent East Timor? Australia's subsequent de jure recognition that East Timor was part of Indonesia paved the way for the Timor Gap (Zone of Cooperation) Treaty signing in 1989. The signing underpinned Australia's acceptance of Indonesian sovereignty over East Timor. The outcome of the analysis of the issues that shaped Australia's foreign policy toward East Timor showed that the political elite became locked into an integration model, which was defended by successive governments. Moreover, they formed an almost reflexive defence of Indonesia both at the domestic and international level.

Inter-relationships between innovation and market orientation in SMEs

Purpose – This study aims to explore the nature of the interactions between two strategies, innovation and market orientation. By examining the components of these constructs the paper seeks to identify key components of market orientation that are antecedent factors of the innovation performance of the firm.

Design/methodology/approach – Correlation analysis was undertaken on data from a survey of 73 manufacturing firms in the Greater Western Sydney economic development zone in Australia. The data were supplemented by information obtained from the firm's annual reports.

Findings – Innovation was found to be positively correlated to market orientation (customer orientation, competitor orientation and inter-functional co-ordination) and both of these constructs were found to be positively correlated to firm performance and the degree of change in the firm's competitive environment.

Research limitations/implications – Possible limitations are: the low survey response rate; the nature of the sampled population; and the spread of industries involved, which could limit the generalisability of the results. The next steps will be to conduct deeper analysis into the factors that make up the subscales of the two constructs and to determine how market orientation or its associated activities interact with the innovation process.

Practical implications – In order to maximize a firm's financial performance, organizations should increase both their market orientation and their innovation activities as these factors operate synergistically.

Originality/value – This study is arguably the first to establish the finding that the degree of change in the competitive environment and the level of market orientation are linked, and the identification of the components of market orientation that are linked to firm innovation. These findings suggest that firm innovation and firm market orientation are strategic reactions to changes in the firm's competitive environment.

Twice born : Dionysos films and the establishment of Greek film circuit in Australia

From the late 1940s until the late 1970s Melbourne was home to a dynamic Greek cinema circuit made up of some 30 different inner-city and suburban venues operated by a handful of vertically integrated exhibition/distribution businesses. Dionysos Films was amongst the first Greek film exhibition/distribution companies to form in Australia and from 1949 until 1956 it operated with little significant competition, establishing the parameters for a diasporic Greek film circuit that stretched across regional and metropolitan Australia and into New Zealand. This article measures the shadow cast by Dionysos Films (and its charismatic proprietor Stathis Raftopoulos) over the history of Antipodean Greek film experiences and the implications that this neglected aspect of Australian and Greek film history has for our understanding of the national cinemas in both countries.

The disappearing mammal fauna of northern Australia : context, cause, and response

This article provides a context to, attempts an explanation for, and proposes a response to the recent demonstration of rapid and severe decline of the native mammal fauna of Kakadu National Park. This decline is consistent with, but might be more accentuated than, declines reported elsewhere in northern Australia; however, such a comparison is constrained by the sparse information base across this region. Disconcertingly, the decline has similarities with the earlier phase of mammal extinctions that occurred elsewhere in Australia. We considered four proximate factors (individually or interactively) that might be driving the observed decline: habitat change, predation (by feral cats), poisoning (by invading cane toads), and novel disease. No single factor readily explains the current decline. The current rapid decline of mammals in Kakadu National Park and northern Australia suggests that the fate of biodiversity globally might be even bleaker than evident in recent reviews, and that the establishment of conservation reserves alone is insufficient to maintain biodiversity. This latter conclusion is not new; but the results reported here further stress the need to manage reserves far more intensively, purposefully, and effectively, and to audit regularly their biodiversity conservation performance.

Australian and US interest rate swap markets : comparison and linkages

We investigate and compare the determinants of US and Australian interest rate swap spreads and the linkages between these markets. The slope of the risk-free term structure is the most significant determinant and its importance is greater for longer terms to maturity. Interest rate levels and, in Australia, the default premium also have some impact. The influences of interest rate volatility, the liquidity premium and (in the USA) the default premium are small or negligible. We hypothesise, and our evidence confirms, that the US swap market significantly affects the Australian swap market but not vice-versa.

Reference ranges for bone densitometers adopted Australia-wide : Geelong Osteoporosis Study

Bone densitometry reports a measure of fracture risk in comparison with young adults (T-scores) and age-matched peers (Z-scores). To date, each manufacturer has provided its own reference range resulting in lack of uniformity. The Australia and New Zealand Bone and Mineral Society and Osteoporosis Australia have recognized the need to standardize the reference range and have recommended that data generated by the Geelong Osteoporosis Study (GOS) be used Australia-wide. The GOS recruited a random, population-based sample of adult women and measured bone mineral density (BMD) at the proximal femur and spine using a Lunar DPX-L. These data were used to establish reference ranges for Lunar machines and, using conversion equations, for Norland and Hologic machines. The new standardized Australian reference ranges for BMD will enable consistent diagnosis of osteoporosis and categorization of fracture risk across different types of densitometers.