Enablers and barriers to accessing mental health services for adults with high prevalence psychological disorders in South West Victoria

Knowing what services are available and how to access them can be challenging in rural areas. The aim of the South West Mental Health Mapping project was to identify the level, accessibility and effectiveness of mental health services for high prevalence psychological disorders amongst the adult population in the South West region of Victoria. This study includes data from a number of sources: regional records of the number and location of health professionals; a telephone survey of 1297 people in five Local Government Areas in the region; and a social network analysis of contact points. Additional qualitative interviews and surveys were conducted with 25 service recipients and 37 health professionals to identify issues from different perspective. This paper will focus on the social network analysis of the project. It highlights the relative prominence of each type of service provider within the overall network. The social network map shows the centrality of the General Practitioner and the wide range of agencies that become involved in supporting people with mental health issues. The discussion identifies primary contact points for people seeking help and places of referral. The main barrier acknowledged by people requiring assistance was lack of knowledge about where to go for help. Enablers included Medicare Better Access funded schemes. The findings show that there is a reasonable range of mental health professionals across the region, although there are challenges with recruitment and retention of staff. Even with available services, a major problem is communicating this information to potential consumers

Examining the development of the Victorian Certificate of Applied Learning and its implications for schools and teacher education in Australia

The Victorian Certificate of Applied Learning (VCAL) is a very successful senior secondary school qualification introduced in the Australian state of Victoria in 2002. Applied learning in the VCAL engages senior students in a combination of work-based learning, service-learning, and project-based learning and aims to provide them with the skills, knowledge, and attitudes to make informed choices regarding pathways to work and further education. The program has enjoyed rapid growth and its system-wide adoption by Victorian secondary schools, Technical and Further Education (TAFE) institutions, Registered Training Organizations (RTOs), and Adult and Community Education (ACE) providers has broadened significantly the range of senior schooling pathway options for young people. This paper will examine reasons for developing an applied learning senior secondary certificate and its rapid growth in Victoria since 2002. The authors draw on a number of case studies to profile the unique nature of applied learning in the VCAL, including its dimensions of service learning, work-based learning, and project-based learning. These case studies are also used to discuss a number of implications that have emerged from the use of applied learning in the VCAL, including approaches to teaching and assessment that will support applied learning and the development of new partnerships between VCAL providers and community partners. Finally, the paper considers significant implications the VCAL has created for teacher education in Victoria by discussing the new Graduate Diploma of Education (Applied Learning) developed by Deakin University.

Elevated intracardiac angiotensin II leads to cardiac hypertrophy and mechanical dysfunction in normotensive mice

Introduction
Angiotensin II (Ang II) is known to induce cardiac growth and modulate myocardial contractility. It has been reported that elevated levels of endogenous Ang II contribute to the development of cardiac hypertrophy in hypertensives. However, the long-term functional effects of cardiac exposure to Ang II in normotensives is unclear.

A recently developed transgenic mouse (TG1306/1R), in which cardiac-specific overproduction of Ang II produces primary hypertrophy, provides a new experimental model for investigation of this phenotype. The aim of the present study was to use this model to investigate whether there is a functional deficit in primary hypertrophy that may predispose to cardiac failure and sudden death. We hypothesised that primary cardiac hypertrophy is associated with mechanical dysfunction in the basal state.

Methods
Normotensive heterozygous TG1306/1R mice harbouring multiple copies of a cardiac-specific rat angiotensinogen gene were studied at age 30—40 weeks and compared with age-matched wild-type littermates. Left ventricular function was measured ex vivo in bicarbonate buffer-perfused, Langendorffmounted hearts ( at a perfusion pressure of 80 mmHg, 37°C) using a fluid-filled PVC balloon interfaced to a pressure transducer and digital data acquisition system.

Results
There was no difference in the mean (±SEM) intrinsic heart rate of TG1306/1R and wild-type control mice (357.4±11.8 vs. 367.5±20.9 bpm, n=9 & 7). Under standardised end-diastolic pressure conditions, TG1306/1R hearts exhibited a significant reduction in peak developed pressure (132.2±9.4 vs. 161.5±3.1 mmHg, n=9 & 7, p<0.05) and maximum rate of pressure development (3566.7±323.7 vs. 4486.3±109.4 mmHg, n=9 & 7, p<0.05). TG1306/1R mice show a significant correlation between incidence of arrhythmia and increasing heart size (Spearman's correlation coefficient 0.61).

Conclusion
These data demonstrate that chronic in vivo exposure to elevated levels of intra-cardiac Ang II is associated with significant contractile abnormalities evident in the ex vivo intact heart. Our findings suggest that endogenous overproduction of cardiac Ang II, independent of changes in blood pressure, is sufficient to induce ventricular remodelling that culminates in impaired cardiac function which may precede failure.

Investigation of overweight and obesity management in a rural primary health care setting

Background : The rural region of interest has one main central medical clinic and several smaller outlying clinics. The services available for weight management include dietetic services, community-based groups and bariatric surgery. At present, no formal area specific referral pathway exists for the treatment of overweight and obesity.
Aims & rationale/Objectives : To investigate general practitioners':
- assessment practices and experiences with overweight and obese clients
- experience of different treatment options for overweight and obesity
- perceived barriers to overweight and obesity management.
Methods : A self-administered survey will be sent to general practitioners within the region of interest. The survey was designed to investigate current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management. Participants will also be offered a brief interview to discuss the following topics; Usefulness of NHMRC's Overweight and Obesity Guidelines; barriers and frustrations of weight management, GP's and dietitian's roles in overweight and obesity treatment.
Principal findings : It is expected the principal findings will include details about methods used to determine overweight and obesity; factors considered when selecting patients for treatment; favoured treatment options of GPs; perceived barriers and frustrations of managing overweight and obese patients.
Discussion : Overweight and obesity are significant health issues in Australia, with recent data indicating more than 60% of Australian adults are affected (NHMRC, 2003). Studies have also suggested that the prevalence of overweight and obesity is higher in rural populations (Coulson, 2005). GPs have been recognised as an important contributor in the treatment of overweight and obesity (Campbell, 2000). There have been guidelines produced to assist GPs, however the extent to which guidelines are utilised or their perceived effectiveness have not yet been investigated.
Implications : It is thought that an investigation into current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management will provide valuable information to inform primary health care service provision and future quality improvement directions.
Presentation type : Poster
Session theme : Primary health care delivery

Research indepedence matters for practitioners and researchers in the addictions

As governments, industry bodies, and other interest groups become more adept at influencing the conduct and dissemination of research, it is increasingly important that the alcohol and other drug (AOD) sector maintains and protects the integrity of its evidence base. This commentary discusses the level and type of influence being exerted on the research process by different interest groups within the field. It explores the impact and influence of funding bodies, other interest groups, and social systems on addiction and recovery using relevant examples to identify questions for practitioners and researchers to consider when encountering interested parties in their day-to-day practice. Ultimately, it is service users and clinicians at the "front line" of recovery who have the most to lose from research findings that have been unduly influenced. The best protection against bias in these forms is to practice critical self-reflection and to keep openly and honestly debating those things that we find most challenging.

Medical tourism : a comparison of Australian, French and South Korean medical and health tourists to Thailand.

The high cost of surgery in Western countries has led to an increase in the demand for surgery in developing countries (York, 2008). The objective of this article is to examine the utilization and satisfaction with medical and health services purchased by Australian, French and South Korean visitors to Thailand. In late 2006 a face-to-face survey was conducted with 1,200 randomly selected tourists who had visited Thailand. Results show substantial usage of medical and health services. Satisfaction levels vary across type of service provided and by country of origin of tourist. Recommendations are provided to the national tourism authority. Future research directions are discussed.

Modification of thermoplastic coatings for improved cathodic disbondment performance on a steel substrate : a study on failure mechanisms

The effect of blending two different materials with a medium density polyethylene for use as pipe coatings is presented. The influence of such blending on properties such as cathodic disbondment (CD) and wet adhesion on steel is investigated. The components blended include a functionalised polyethylene (PE) containing the polar functionality, maleic anhydride (MAH) and an amorphous elastomer, ethylene-propylene-diene terpolymer (EPDM). It was found that modification of PE with small amount (2.5–3 wt%) of either blended MAH-g-PE or EPDM resulted in a significant improvement in CD performance and wet adhesion strength. The mode of failure and disbondment mechanism was investigated using energy dispersive X-ray spectroscopy (EDXS) and X-ray photoelectron spectroscopy (XPS). The greater resistance of migration of sodium ions increases with the incorporation of the modifiers, and it is proposed that this results in an increase in CD performance.

Delivering categorized news items using RSS feeds and web services

In the past decade the massive growth of the Internet brought huge changes in the way humans live their daily life; however, the biggest concern with rapid growth of digital information is how to efficiently manage and filter unwanted data. In this paper, we propose a method for managing RSS feeds from various news websites. A Web service was developed to provide filtered news items extracted from RSS feeds and these were categorized based on classical text categorization algorithms. A client application consuming this Web service retrieves and displays such filtered information. A prototype was implemented using Rapidminer 4.3 as a data mining tool and SVM as a classification algorithm. Experimental results suggest that the proposed method is effective and saves a significant amount of user processing time.

Domestic and sexual violence and abuse : findings from a Delphi expert consultation on therapeutic and treatment interventions with victims, survivors and abusers, children adolescents, and adults

This report presents the results of one piece of research conducted as a part of the Victims of Violence and Abuse Prevention Programme (VVAPP) in the UK, namely a three round Delphi consultation. This Delphi consultation was undertaken to identify where there is and is not consensus among experts about what is known and what works in the treatment and care of people affected by child sexual abuse, domestic violence and abuse, and rape and sexual assault. It enables the identification of areas of agreement and disagreement about effective mental health service responses, and thereby contributes to the evidence base in this area.

Keeping talents for advancing service firms in Asia

Purpose – Skill shortages worldwide have intensified the need for talent management. Few papers examine the pattern of human resource (HR) and talent management practices that help retain competent employees among service multinational companies (MNCs) in Asia. The purpose of this paper is to map out a number of HR practices used by service companies and to examine the effect of talent retention as perceived by MNC managers on service delivery capacity and business growth.

Design/methodology/approach – A survey data of 281 service MNCs in six Asian countries (namely Indonesia, Malaysia, Philippines, Singapore, Taiwan, and Thailand) are used to compare country and sectoral differences. Standard multiple regression analysis is conducted to test the link between HR practices, employee retention, and service firm performance.

Findings – The results confirm that there are statistically significant linkages between HR practices, talent retention and firm performance. In particular, various skill training and development programs are seen to be significantly associated with capacity to deliver quality service and on firm growth as perceived by managers surveyed. Informal recruitment methods that are used more by Asian-bred firms have contributed to better retention rates. Not all formalised HR practices lead to talent retention; and the degree to which HR is perceived to have impacted on firm performance varies.

Research limitations/implications – The paper focuses on examining the perceptual impacts of human resource management (HRM) practices on firm performance, rather than actual HRM impacts. The interpretation of results should be taken with caution.

Originality/value – Talent management is influenced by country specific variables. This paper shows how important it is for service firms to focus on strategic selection of both formal and informal HR practices in order to deliver high quality service and to drive service firm growth.

Manufacturing to Asia : who will win the emerging battle for talent between Dragons and Tigers?

Purpose – The purpose of this study is to examine the issues relating to recruiting highly skilled managerial and professional staff experienced by multinational companies (MNCs) manufacturing in six Asian countries, namely Indonesia, Malaysia, Philippines, Singapore, Taiwan and Thailand.

Design/methodology/approach – Data collected from 529 MNCs were used to examine critical human resource planning and recruitment concerns of companies operating in high growth “Dragon” and newly developed “Tiger” economies. The study examined the differences in recruitment practices between manufacturing and service companies and the issues relating to how manufacturers maintain an adequate skills basis.

Findings – There appears a considerable extent of battle for talent among Dragon and Tiger economies with the latter required to be more aggressive as they attempt to sustain growth. Manufacturing companies are experiencing a higher demand for more job-related managerial and technical capabilities whilst competing with service companies that are also in need for more talent. To succeed, manufacturing MNCs will need to adopt a strategic approach for recruitment and retention, and internal capability training to maintain their skilled employees in order to sustain competitive advantage.

Originality/value – The results shown in the paper provide manufacturing MNCs with insights into managerial and professional recruitment trend in Asia.

Energy-efficient management of data center resources for cloud computing : a vision, architectural elements, and open challenges

Cloud computing is offering utility-oriented IT services to users worldwide. Based on a pay-as-you-go model, it enables hosting of pervasive applications from consumer, scientific, and business domains. However, data centers hosting Cloud applications consume huge amounts of energy, contributing to high operational costs and carbon footprints to the environment. Therefore, we need Green Cloud computing solutions that can not only save energy for the environment but also reduce operational costs. This paper presents vision, challenges, and architectural elements for energy-efficient management of Cloud computing environments. We focus on the development of dynamic resource provisioning and allocation algorithms that consider the synergy between various data center infrastructures (i.e., the hardware, power units, cooling and software), and holistically work to boost data center energy efficiency and performance. In particular, this paper proposes (a) architectural principles for energy-efficient management of Clouds; (b) energy-efficient resource allocation policies and scheduling algorithms considering quality-of-service expectations, and devices power usage characteristics; and (c) a novel software technology for energy-efficient management of Clouds. We have validated our approach by conducting a set of rigorous performance evaluation study using the CloudSim toolkit. The results demonstrate that Cloud computing model has immense potential as it offers significant performance gains as regards to response time and cost saving under dynamic workload scenarios.

Potential applications of discrete-event simulation and fuzzy rule-based systems to structural reliability and availability

This chapter discusses and illustrates some potential applications of discrete-event simulation (DES) techniques in structural reliability and availability analysis, emphasizing the convenience of using probabilistic approaches in modern building and civil engineering practices. After reviewing existing literature on the topic, some advantages of probabilistic techniques over analytical ones are highlighted. Then, we introduce a general framework for performing structural reliability and availability analysis through DES. Our methodology proposes the use of statistical distributions and techniques – such as survival analysis – to model component-level reliability. Then, using failure- and repair-time distributions and information about the structural logical topology (which allows determination of the structural state from their components’ state), structural reliability, and availability information can be inferred. Two numerical examples illustrate some potential applications of the proposed methodology to achieving more reliable and structural designs. Finally, an alternative approach to model uncertainty at component level is also introduced as ongoing work. This new approach is based on the use of fuzzy rule-based systems and it allows the introduction of experts’ opinions and evaluations in our methodology.

Service innovation in Australia : a preliminary exploration of the Cinderella sector

Service innovation is of increasing importance in the Australian economy, yet it remains a largely neglected area of study. Recent studies overseas have shown that services are becoming more engaged with innovation, and that service innovation is complex and multi-dimensional. Official R&D and business innovation statistics in Australia are examined, and they reveal that service providers across all service industries in Australia are performing R&D and are actively innovating, a finding that is consonant with the overseas studies. However, innovation performance varies across and within service industries, reflecting differences in the nature and structure of those industries. A clear need for further research is identified, both to provide a clearer understanding of the nature of service innovation and to provide a basis for practical recommendations.

The validity of the CGI severity and improvement scales as measures of clinical effectiveness suitable for routine clinical use

Objective The Clinical Global Impression Scale (CGI) is established as a core metric in psychiatric research. This study aims to test the validity of CGI as a clinical outcome measure suitable for routine use in a private inpatient setting.

Methods The CGI was added to a standard battery of routine outcome measures in a private psychiatric hospital. Data were collected on consecutive admissions over a period of 24 months, which included clinical diagnosis, demographics, service utilization and four routine measures (CGI, HoNOS, MHQ-14 and DASS-21) at both admission and discharge. Descriptive and comparative data analyses were performed.

Results Of 786 admissions in total, there were 624 and 614 CGI-S ratings completed at the point of admission and discharge, respectively, and 610 completed CGI-I ratings. The admission and discharge CGI-S scores were correlated (r = 0.40), and the indirect improvement measures obtained from their differences were highly correlated with the direct CGI-I scores (r = 0.71). The CGI results reflected similar trends seen in the other three outcome measures.

Conclusions The CGI is a valid clinical outcome measure suitable for routine use in an inpatient setting. It offers a number of advantages, including its established utility in psychiatric research, sensitivity to change, quick and simple administration, utility across diagnostic groupings, and reliability in the hands of skilled clinicians.