Prioritization of psychological well-being in the care of diabetes: moving beyond excuses, bringing solutions

Jones and colleagues recently made a plea for the prioritization of psychological well-being in diabetes care [1]. Such calls to action began over 20 years ago with the 'St Vincent Declaration' guidelines [2]. A 'plea' two decades later emphasizes that this paradigm shift is a long, slow burn. In the 21st century, people with diabetes are now adding their powerful voices via social media, advocating for better psychological support, as active consumers (and constructive critics) of health care [3]. We can learn considerably from organizations such as Cancer Voices (www.cancervoicesaustralia.org) - they demonstrate how consumer representation and involvement in research agendas, policy and service provision play an integral part in shaping holistic health care. This article is protected by copyright. All rights reserved.

Gender differences in conference presentations: a consequence of self-selection?

Women continue to be under-represented in the sciences, with their representation declining at each progressive academic level. These differences persist despite long-running policies to ameliorate gender inequity. We compared gender differences in exposure and visibility at an evolutionary biology conference for attendees at two different academic levels: student and post-PhD academic. Despite there being almost exactly a 1:1 ratio of women and men attending the conference, we found that when considering only those who presented talks, women spoke for far less time than men of an equivalent academic level: on average student women presented for 23% less time than student men, and academic women presented for 17% less time than academic men. We conducted more detailed analyses to tease apart whether this gender difference was caused by decisions made by the attendees or through bias in evaluation of the abstracts. At both academic levels, women and men were equally likely to request a presentation. However, women were more likely than men to prefer a short talk, regardless of academic level. We discuss potential underlying reasons for this gender bias, and provide recommendations to avoid similar gender biases at future conferences.

Coproduction and Casula's Pacifica Program: Initial research findings

This research takes Casula Powerhouse Art Centre’s Pacifica program as a case study to investigate the ways in which museum and galleries are involved in coproduction with culturally diverse communities. Coproduction is defined here as:Museum and gallery practice conducted jointly with communities or other external partiesThe benefits of coproduction are that it leads to more effective and efficient public services (including arts and cultural services) while also building the skills and capacity of the community. However coproduction is not easy, particularly because it requires public service providers and communities to work in ‘equal and reciprocal’ relationships.As an organisation with strong and strategic alliances to its governing body (Liverpool City Council), Casula brings a strong capacity for coproduction. Internally it has support and commitment to coproduction from across the organisation. The staff at Casula bring exceptional relational skills. The organisation’s capacity to coproduce draws heavily on their skills as cultural brokers and experience in community cultural development practice. The communities Casula works with bring strong cultural knowledge and practice, along with a desire to maintain and preserve these community resources. Casula’s coproduction work also meets external political needs for public services to deliver increased public value as well as a greater diversity in the profile of arts audiences.The key challenge for Casula Powerhouse’s coproduction work is the extent to which it aims for joint delivery of public services through ‘equal and reciprocal’ relationships with the community, or uses coproduction as a tool for community engagement and audience development. Advocates of coproduction in the public sector argue for its value as a means of delivering more effective and efficient public services while at the same time building the skills and capacity of local communities. A critical element of coproduction according to these writers and scholars is the development and delivery of public services through ‘equal and reciprocal’ relationships between providers and users.The value of coproduction for Casula Powerhouse and the Pacifica program is its use as a means of community engagement and audience development. Coproduction is a feature of the components of Pacifica that enable the participation of the community and provide entry points for audiences to engage with contemporary art. Evidence of this approach to coproduction can be seen in the dual ‘stakeholder’ and ‘audience’ role that the community have within the Pacifica program. The community is therefore both a contributor to Pacifica and a beneficiary of this work. The benefits Casula Powerhouse receives from the community’s involvement in Pacifica are greater public value of its work and stronger engagement with communities and audiences.Although coproduction may not be the focus of all aspects of Pacifica, the involvement of Pacific Islander communities in the program results in exhibitions and public programs that are not typical contemporary art gallery offerings. Pacifica is further evidence of Casula Powerhouse’s innovative and entrepreneurial approach to gallery practice. The use of coproduction also ensures Pacifica offers an authentic and distinctive gallery experience.

Uncovering multiple champion roles in implementing new-technology ventures

This article reports the findings of a field study of a new venture electronic network enterprise from a business-to-business perspective. Network theory and the literatures of process innovation management and strategic marketing are used to generate theory about how new venture electronic network enterprises are created, and the roles champions play in their creation. Network champion roles and their relationships with other network participants are not well understood. The case study reveals how (a) network champions have both direct and indirect involvement in creating and commercializing new venture electronic networks, (b) champions within the venture rather than network champions strategically encourage or discourage supplier and buyer firms in joining, and (c) the accumulated knowledge of all champions, rather than the network champion alone, enhances successful implemented strategies. The findings provide researchers with a theoretical understanding of the role of the network champion in creating new ventures. Network champions filling multiple roles appear necessary for the successful creation of new hightech ventures.

Exploring family and community involvement to protect Thai youths from alcohol and illegal drug abuse

Youth substance abuse is widely recognized as a major public health issue in Thailand. This study explores family and community risk and protective factors relevant to alcohol and illegal drug misuse in 1,778 Thai teenagers. Strong family attachment and a family history of antisocial behaviors were strongly associated with nearly all forms of substance abuse, with adjusted odds ratios ranging from 5.05 to 8.45. Community disorganization was strongly associated with self-reported substance use, although involvement in prosocial activities acted as a protective factor. The findings suggest that interventions that promote family cohesion and encourage community involvement may have considerable benefits in reducing substance abuse in Thai adolescents.

Patient participation in pulmonary interventions to reduce postoperative pulmonary complications following cardiac surgery.

BACKGROUND: Clinical interventions aimed at reducing the incidence of postoperative pulmonary complications necessitate patient engagement and participation in care. Patients' ability and willingness to participate in care to reduce postoperative complications is unclear. Further, nurses' facilitation of patient participation in pulmonary interventions has not been explored. OBJECTIVE: To explore patients' ability and willingness to participate in pulmonary interventions and nurses' facilitation of pulmonary interventions. DESIGN: Single institution, case study design. Multiple methods of data collection were used including preadmission (n=130) and pre-discharge (n=98) patient interviews, naturalistic observations (n=48) and nursing focus group interviews (n=2). SETTING: A cardiac surgical ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. PARTICIPANTS: One hundred and thirty patients admitted for cardiac surgery via the preadmission clinic during a 1-year period and 40 registered nurses who were part of the permanent workforce on the cardiac surgical ward. OUTCOME MEASURES: Patients' understanding of their role in pulmonary interventions and patients' preference for and reported involvement in pulmonary management. Nurses' facilitation of patients to participate in pulmonary interventions. RESULTS: Patients displayed a greater understanding of their role in pulmonary interventions after their surgical admission than they did at preadmission. While 55% of patients preferred to make decisions about deep breathing and coughing exercises, three-quarters of patients (75%) reported they made decisions about deep breathing and coughing during their surgical admission. Nurses missed opportunities to engage patients in this aspect of pulmonary management. CONCLUSIONS: Patients appear willing to take responsibility for pulmonary management in the postoperative period. Nurses could enhance patient participation in pulmonary interventions by ensuring adequate information and education is provided. Facilitation of patients' participation in their recovery is a fundamental aspect of care delivery in this context.

Exploring the myths of morphine in cancer: views of the general practice population

Abstract
Background: Morphine is widely used in cancer care, and understanding the concerns and perceptions of patients, family and friends is vital to managing pain and distress effectively. The ‘myths of morphine’ have frequently been discussed in medical literature, yet the extent to which such views are held is not clear. This qualitative project explores the perceptions and attitudes of the wider community towards morphine use in cancer care, to understand this ‘mythology’ according to those who in the future may themselves require its use.
Methods: Semi-structured interviews were held with patients presenting to a metropolitan general practice clinic in Melbourne, Australia. A grounded theory framework underpinned the data collection and thematic analysis undertaken.
Results: Interviewees (15) were aged 24 – 81, with a variety of experiences with cancer care and previous morphine use. Interviewees were highly supportive of morphine use in cancer care, with this attitude founded on the perceived severity of cancer pain and the powerful nature of morphine. They described a number of reasons morphine may be used in cancer care: to treat pain, to enable peace and also as a treatment for cancer.
Conclusion: The public view of morphine to emerge from this study is markedly different from that discussed in the myths of morphine. It is viewed as a medication that has the ability to provide peace and control both pain and the course of cancer. The participants in this study described a wish for greater involvement in pain control decisions, perceiving morphine as a facilitator rather than a barrier to good cancer care.

Demographic risk factors for alcohol-related aggression in and around licensed venues

AIMS: Few studies have examined the role of gender and both area-level and individual socio-economic status (SES) as independent predictors of alcohol-related aggression (ARA) in and around licensed venues. METHODS: The aim of the present study was to investigate the relationship between gender, area-level SES and individual SES (operationalised as occupational category) and ARA in and around licensed venues. The sample comprised 697 men and 649 women aged 16-47, who completed a patron intercept survey as part of a larger study assessing trends in harm and stakeholders' views surrounding local community level interventions in dealing with alcohol-related problems in the night-time economy. RESULTS: Binary logistic regression analyses showed that age, gender, occupational category, area-level SES and level of intoxication at time of interview were all significant predictors of involvement in ARA. Being male doubled the odds of involvement in ARA, while age was a protective factor. Blue collar workers had more than double the odds of ARA involvement of professionals, while those living in the most socio-economically disadvantaged areas were over twice as likely to report experiencing ARA compared to those living in the most advantaged areas. However, assessment of the predictive model by gender revealed that effects of age, occupational category and area-level SES were restricted to male participants, with greater intoxication no longer predictive. CONCLUSIONS: ARA among patrons was significantly more likely to occur among men, those in blue collar occupations, and individuals living in low SES areas, suggesting both individual and area-level disadvantage may play a role in ARA.

Adult education and radical habitus in an environmental campaign: learning in the coal seam gas protests in Australia

Summary: This paper examines the adult learning dimensions of protestors as they participate in a campaign to stop coal seam gas exploration in Gippsland in Central Victoria, Australia. On a global level, the imposition of coal seam gas exploration by governments and mining companies has been the trigger for movements of resistance from environmental groups. They are concerned about the impact of mining on their land, food and water supplies. In central Gippsland a group of ‘circumstantial activists’ comprised of farmers, tree changers and other local residents are campaigning against coal seam gas exploration. This unlikely coalition of environmental action groups has made effective use of a variety of community education strategies. This paper commences by outlining some of the key literature on learning and activism drawing on the education tradition of adult learning. We then draw on key concepts from Bourdieu’s writing on ‘habitus’ and ‘field’ to analyse the data from this research. We outline some of the learning practices of activists; through their involvement in this campaign, and the knowledge and skills they gain as they develop a feel for the game of protest. We argue circumstantial activists learn both formally and informally in the social environment of campaigning. Of particular interest is the role of more experienced activists from Friends of the Earth (FOE), a non-government organisation (NGO), as they pass on knowledge, experience, tactics and strategies to the novice and less experienced activists in this community campaign. We explore some of the contradictions of the protestors’ identification as activists using Bourdieu’s concepts of ‘doxa’ and ‘Ilusio’. The paper concludes by arguing learning in activism is a rich tradition of adult education and practice. However, Bourdieu’s writing on field and habitus makes an added contribution to interpreting the learning that occurs in the social space of a campaign or social movement.

Improving online communication for students in higher education contexts

The study reported here sought to identify Higher Education students’ preferred modes of online communication whilst studying a wholly online research subject at University. The teacher education student participants from an Australian university were required to collaboratively conduct inquiry research projects in groups whilst relying upon computer-mediated communication. How do students communicate as a collaborative research group whilst only meeting online? The data were collected via the use of online pre-test and post-test surveys conducted ‘prior to’ and ‘post’ involvement in the unit of study and descriptive statistical analysis was applied. The findings revealed that important influences affecting students’ choice of communication mode included their own views on the capacity of online communication, their prior experience and the availability and accessibility of the modes. Furthermore, it was found that when given a choice, students preferred the use of asynchronous forms of digital communication to synchronous forms. Recommendations for improving online teaching, learning and research contexts in Universities are provided and the importance of considering blended mode delivery for wholly online units is argued.

Opportunities and challenges in developing a whole-of-government national food and nutrition policy: lessons from Australia's National Food Plan

OBJECTIVE: The present article tracks the development of the Australian National Food Plan as a 'whole of government' food policy that aimed to integrate elements of nutrition and sustainability alongside economic objectives. DESIGN: The article uses policy analysis to explore the processes of consultation and stakeholder involvement in the development of the National Food Plan, focusing on actors from the sectors of industry, civil society and government. Existing documentation and submissions to the Plan were used as data sources. Models of health policy analysis and policy streams were employed to analyse policy development processes. SETTING: Australia. SUBJECTS: Australian food policy stakeholders. RESULTS: The development of the Plan was influenced by powerful industry groups and stakeholder engagement by the lead ministry favoured the involvement of actors representing the food and agriculture industries. Public health nutrition and civil society relied on traditional methods of policy influence, and the public health nutrition movement failed to develop a unified cross-sector alliance, while the private sector engaged in different ways and presented a united front. The National Food Plan failed to deliver an integrated food policy for Australia. Nutrition and sustainability were effectively sidelined due to the focus on global food production and positioning Australia as a food 'superpower' that could take advantage of the anticipated 'dining boom' as incomes rose in the Asia-Pacific region. CONCLUSIONS: New forms of industry influence are emerging in the food policy arena and public health nutrition will need to adopt new approaches to influencing public policy.

Formalising industry feedback in assessment practice for work integrated learning

Work Integrated Learning (WIL) programs, such as co-operative education programs, offer students a learning environment which exists outside the traditional classroom and specific discipline boundaries. This necessitates assessment practices that go beyond traditional practices and relationships. Work placement supervisors are best located to observe the students' learning and development and offer feedback on performance and improvement. An investigation was carried out in order to articulate the role of supervisors and work colleagues in facilitating learning in the workplace environment and their involvement in assessment practices. Interviews were conducted with academics and industry representatives on their perceptions of assessment task validity in terms of professional and generic skill development. A synthesis of the findings formed the basis of the research described in this paper. Key findings highlighted the need for better preparation of industry supervisors as to their role in providing feedback and assessment; better preparation of students for transition from the classroom to the workplace; and the importance of ongoing involvement of the three stakeholders (academic, supervisor and student) to maximise learning and professional development. Recommendations for assessment practices include suggestions on how to involve employers in appraising workplace performance; how to measure the real life application of learning; and the development of generic employability skills. © Common Ground, Kathy Henschke, Joan Richardson.

Australia and Japan after the second world war: constructing new futures in Asia

The subject of my lecture is Australian-Japanese relations since the end of the Second World War, but I’m keen to explore these relations in the context of ideas, efforts and practical results in relation to collaborative and other efforts towards regionalism in the Asia Pacific. My general argument is that, on the one hand, Australian-Japanese relations have developed with a strength that would have been hard to imagine in 1945, and with an important focus on regional growth and security. The incremental steps taken may have been small and at a steady pace but, given the legacy of deep scars resulting from the Second World War and given the limitations on the defence aspects of Japan’s postwar involvement in regional affairs (ie the self defence requirement of the Constitution and the practice of spending not more than one per cent of Gross National Product on defence), these have been very successfully negotiated steps. On the other hand, there are some opportunities for greater joint leadership in the region which may or may not be realized. The incremental steps took place in difficult and changing circumstances; and what I would like to do now is remind us of how many unknowns attached to what might happen in Australian- Japan relationships after the Second World War, partly because there were so many unknowns about how the post-war international order would settle, and partly because Australian-Japanese relations started from such a desperately low point. I will try to walk through some of the key features of different periods, as I see the periodisation logically falling out after the war, and draw some thoughts together in relation to more recent initiatives on regional and bilateral co-operation. My training is as a historian, and that shapes the way this lecture works, and for most of my career I have been an Australian historian of international relations, looking particularly at Australia’s changing role in world affairs, and that is also likely to show in what follows－possibly at the expense of greater detail from Japanese perspectives. But I hope you will understand that, and also the limitations involved in trying to paint with a broad brush on a huge historical canvas.

A systematic review of reliable and valid tools for the measurement of patient participation in healthcare

INTRODUCTION: Patient participation in healthcare is recognised internationally as essential for consumer-centric, high-quality healthcare delivery. Its measurement as part of continuous quality improvement requires development of agreed standards and measurable indicators. AIM: This systematic review sought to identify strategies to measure patient participation in healthcare and to report their reliability and validity. In the context of this review, patient participation was constructed as shared decision-making, acknowledging the patient as having critical knowledge regarding their own health and care needs and promoting self-care/autonomy. METHODS: Following a comprehensive search, studies reporting reliability or validity of an instrument used in a healthcare setting to measure patient participation, published in English between January 2004 and March 2014 were eligible for inclusion. RESULTS: From an initial search, which identified 1582 studies, 156 studies were retrieved and screened against inclusion criteria. Thirty-three studies reporting 24 patient participation measurement tools met inclusion criteria, and were critically appraised. The majority of studies were descriptive psychometric studies using prospective, cross-sectional designs. Almost all the tools completed by patients, family caregivers, observers or more than one stakeholder focused on aspects of patient-professional communication. Few tools designed for completion by patients or family caregivers provided valid and reliable measures of patient participation. There was low correlation between many of the tools and other measures of patient satisfaction. CONCLUSION: Few reliable and valid tools for measurement of patient participation in healthcare have been recently developed. Of those reported in this review, the dyadic Observing Patient Involvement in Decision Making (dyadic-OPTION) tool presents the most promise for measuring core components of patient participation. There remains a need for further study into valid, reliable and feasible strategies for measuring patient participation as part of continuous quality improvement.

Involving people with diabetes and the wider community in diabetes research: a realist review protocol

BACKGROUND: Patient and public involvement in diabetes research is now actively encouraged in different countries because it is believed that involving people with experience of the condition will improve the quality and relevance of the research. However, reviews of patient involvement have noted that inadequate resources, patients' and communities' lack of research knowledge, and researchers' lack of skills to involve patients and communities in research may present significant contextual barriers. Little is known about the extent of patient/community involvement in designing or delivering interventions for people with diabetes. A realist review of involvement will contribute to assessing when, how and why involvement works, or does not work, to produce better diabetes interventions.

METHODS/DESIGN: This protocol outlines the process for conducting a realist review to map how patients and the public have been involved in diabetes research to date. The review questions ask the following: How have people with diabetes and the wider community been involved in diabetes research? What are the characteristics of the process that appear to explain the relative success or failure of involvement? How has involvement (or lack of involvement) in diabetes research influenced the development and conduct of diabetes research? The degree of support in the surrounding context will be assessed alongside the ways in which people interact in different settings to identify patterns of interaction between context, mechanisms and outcomes in different research projects. The level and extent of the involvement will be described for each stage of the research project. The descriptions will be critically reviewed by the people with diabetes on our review team. In addition, researchers and patients in diabetes research will be asked to comment. Information from researcher-patient experiences and documents will be compared to theories of involvement across a range of disciplines to create a mid-range theory describing how involvement (or lack of involvement) in diabetes research influences the development and conduct of diabetes research.