Consensus building in a local context for the AHP-GDM with the individual numerical scale and prioritization method

The methodology for selecting the individual numerical scale and prioritization method has recently been presented and justified in the analytic hierarchy process (AHP). In this study, we further propose a novel AHP-group decision making (GDM) model in a local context (a unique criterion), based on the individual selection of the numerical scale and prioritization method. The resolution framework of the AHP-GDM with the individual numerical scale and prioritization method is first proposed. Then, based on linguistic Euclidean distance (LED) and linguistic minimum violations (LMV), the novel consensus measure is defined so that the consensus degree among decision makers who use different numerical scales and prioritization methods can be analyzed. Next, a consensus reaching model is proposed to help decision makers improve the consensus degree. In this consensus reaching model, the LED-based and LMV-based consensus rules are proposed and used. Finally, a new individual consistency index and its properties are proposed for the use of the individual numerical scale and prioritization method in the AHP-GDM. Simulation experiments and numerical examples are presented to demonstrate the validity of the proposed model.

Evaluation of the Living 4 Life project : a youth-led, school-based obesity prevention study

The Living 4 Life study was a youth-led, school-based intervention to reduce obesity in New Zealand. The study design was quasi-experimental, with comparisons made by two cross-sectional samples within schools. Student data were collected at baseline (n = 1634) and at the end of the 3-year intervention (n = 1612). A random-effects mixed model was used to test for changes in primary outcomes (e.g. anthropometry and obesity-related behaviours) between intervention and comparison schools. There were no significant differences in changes in anthropometry or behaviours between intervention and comparison schools. The prevalence of obesity in intervention schools was 32% at baseline and 35% at follow-up and in comparison schools was 29% and 30%, respectively. Within school improvements in obesity-related behaviours were observed in three intervention schools and one comparison school. One intervention school observed several negative changes in student behaviours. In conclusion, there were no significant improvements to anthropometry; this may reflect the intervention’s lack of intensity, insufficient duration, or that by adolescence changes in anthropometry and related behaviours are difficult to achieve. School-based obesity prevention interventions that actively involve young people in the design of interventions may result in improvements in student behaviours, but require active support from leaders within their schools.

The new wilderness: A practice-led model for arts based enquiry

The New Wilderness is a practice-led, multidisciplinary arts project first piloted by artists, writers, teachers and academics from Geelong, Deakin University and Courthouse ARTS Centre in 2013. In a series of workshops run by artists, and working to specific themes, the project provided a platform for participants to explore and respond creatively to change in the community; it culminated in a large-scale installation at Courthouse ARTS Centre’s main gallery. Our paper positions the project as a able to cut across convention, empowering young artists to respond to ‘big questions’ of relevance to the changing material, spatial and social relations within their communities. In questioning and seeking to transform communities into sustainable media, economic, environmental and social ecologies, this emergent model begins with a localised focus, which is designed to travel across time and place, and pedagogical frameworks. The paper positions Geelong as a community under radical transformation in its economic foundations and demographics. As artists and academics living and working in the region we see it as an experimental ground for investigations into a series of provocations that mirror the shape of the paper we intend to give. The provocations, as outlined in the workshops, might also be envisaged as new relations to:Object – From consumable to unusable to play. In revisiting the first iteration of The New wilderness in 2013 we discuss the ‘superfictional’ (Hill, 2000) enquiry that participants were asked to engage with. Its premise described Geelong as an abandoned, post-apocalyptic site. Participants were asked to imagine themselves as a group of future explorers and excavate objects from the city’s old tip. In unearthing their choices and re-presenting the objects in the gallery the participant was prompted to analyse site, situation, object and process as phenomena for ‘being’ or ‘telling stories’, providing insights into wider realms of cultural experience (Ellis, Adams and Bochner, 2010). Parallel to this ‘autoethnographic’ reflection our paper uses the philosopher Giorgio Agamben’s analysis of consumer and material culture. He traces the subject’s relation to objects from use-value, to exchange-value and in the era of extreme capitalism, to pure exhibition-value. He searches for ways that the objects produced in our material culture can be ‘profaned’ (Agamben, 2007). Space – From the material to the spatial to the situation. We are interested in how objects and the practices they elicit can be ‘profaned’ by their situation (Agamben, 2007; Wark, 2103). To profane, according to Agamben, is to open up the possibility that the object loses its exhibition-value to ‘a special form of negligence’ (Agamben). He uses the example of the child’s ability to insinuate any object into a new logic of play (Agamben). Like the objects excavated for The New Wilderness they could be from a variety of spheres – business, household, industry, health etc… The child, like the artist, reconstitutes, reorders and assembles new relations between things. In reflecting on the first New Wilderness project the paper correlates the creative response of the participant (student, child, artist) with the occupier. The Occupy Movement, which took up residence in many of the world’s cities’ financial districts in 2011, used a number of strategies commensurate with both Agamben’s notion of profanation and McKenzie Wark’s reading of the Situationist International’s use of détournement - as a strategy that releases objects and subjects back into the field of play (Wark, 2013). The field was taken by the occupy movement to be the space in which they occupied – capitalism, its logic and its practices, were, for a short time, redundant in the occupied field. The New Wilderness conceptualises the city as a localised field, from which its discarded objects can be ‘profaned’ or, repurposed, to reflect on shared histories, responsibilities, pedagogies and future action. Subject: self/other– As much as we propose New Wilderness to be a pedagogical initiative we see it as personal, critical and political. In the themed workshops, designed to elicit personal responses to the object and the site, which culminated in a multi-disciplinary installation, performance and/or text based work, participants were encouraged to think critically, and importantly, collectively. Through the four workshops run in the first iteration of the project participants were asked to re-consider their material value-systems, much as the occupy movement was trying to do, and like the occupiers, participants were empowered to be agents of change. Our paper reflects on the practical outcomes and the conceptual, political and pedagogical strategies embedded in The New Wilderness project. The paper affords us the additional opportunity to imagine a life for it in other geographical, socio-economic and educational situations. Merinda Kelly and Cameron Bishop, 2013Bio: Merinda Kelly is a sculptor and installation artist, educator and PhD student at Deakin University. Her research interests include Visual Culture, Practice Led Research, the Ontology of Art, and Autoethnography. Her most recent work includes the Pop Archaeology' and the Globo-Touro Projects.Bio: Dr Cameron Bishop is an artist and academic working in Visual Arts at Deakin University. He exhibits regularly and has written a number of journal articles and book chapters. His research has focused on the philosophical and postcolonial dimensions of space and subjectivity and more recently has evolved into an active interest in strategic interventions into space and practice.

Preventing tobacco use and harm: what is evidence based policy?

The majority of tobacco users commence in early to mid-adolescence. Tobacco smoking can be characterised as a chronic, relapsing disorder. While risk increases with amount smoked, there is no safe level of use (i.e., all use is risky). Duration of use is the most important predictor of premature death with the majority of excess morbidity and mortality avoidable if people quit before middle age. Investment in initiatives that reduce smoking among pregnant women and those at risk of cardiovascular disease provide quickest returns -in reduced health care episodes and expenditure.  Measures that successfully reduce smoking among parents probably reduce smoking uptake by children, and high levels of smoking among both children and parents appear to be associated with higher levels of illicit drug use.
The evidence base for pharmcotherapies in the treatment of tobacco dependence is very strong. Population-level initiatives such as tax increases, mass media-led campaigns and smoke-free policies are all highly cost-effective in reducing population-smoking levels, including among children and young people.
Australian tobacco control initiatives have been based on "social ecology" conceptualisations of the problem, which acknowledge the pivotal role of the media in shaping social values, and public and political opinion.
Broad social change, as well as more focused prevention and cessation initiatives, has drawn heavily on research findings from the behavioural sciences. Considerable effort (mainly, in Australian, in the NGO sector) has gone into documenting policy inputs and monitoring impact and outcome measures.
This chapter discusses why conceptualising tobacco-related harm from legal, economic and social policy perspectives should also help build support for tobacco control policy among academic and practising economists and lawyers, and in the business, welfare and government sectors.

Impact of an empowerment-based parent education program on the reduction of youth suicide risk factors

Purpose: To evaluate the impact of parent education groups on youth suicide risk factors. The potential for informal transmission of intervention impacts within school communities was assessed.

Methods: Parent education groups were offered to volunteers from 14 high schools that were closely matched to 14 comparison schools. The professionally led groups aimed to empower parents to assist one another to improve communication skills and relationships with adolescents. Australian 8th-grade students (aged 14 years) responded to classroom surveys repeated at baseline and after 3 months. Logistic regression was used to test for intervention impacts on adolescent substance use, deliquency, self-harm behavior, and depression. There were no differences between the intervention (n = 305) and comparison (n = 272) samples at baseline on the measures of depression, health behavior, or family relationships.

Results: Students in the intervention schools demonstrated increased maternal care (adjusted odds ratio [AOR] 1.9), reductions in conflict with parents (AOR .5), reduced substance use (AOR .5 to .6), and less delinquency (AOR .2). Parent education group participants were more likely to be sole parents and their children reported higher rates of substance use at baseline. Intervention impacts revealed a dose-response with the largest impacts associated with directly participating parents, but significant impacts were also evident for others in the intervention schools. Where best friend dyads were identified, the best friend’s positive family relationships reduced subsequent substance use among respondents. This and other social contagion processes were posited to explain the transfer of positive impacts beyond the minority of directly participating families.

Conclusions: A whole-school parent education intervention demonstrated promising impacts on a range of risk behaviors and protective factors relevant to youth self-harm and suicide.

Evaluation of phenomenological findings in IS research : a study in developing web-based IS

This paper presents a phenomenological investigation of project managers’ experiences with the implementation of web-based employee service systems (ESS), a domain that has witnessed sharp growth in Australia in recent times. The rich, multidimensional account of project managers’ experiences with the implementation of ESS revealed the social obstacles and fragility of intraorganizational relationships that demanded a cautious and tactful approach. While arriving at such findings usually concludes the cyclical process of phenomenological study, Information Systems (IS) research usually demands some independent assessment of the empirical discovery, which led us to conducting a further study focusing on the evaluation of the collected and packaged project managers’ experience. This phenomenological evaluation is in the focus of this paper. By means of a small case study, this project engaged a number of professional teams to reflect upon the previously captured problem-solving experience and determine its applicability, usefulness and relevance in developing new web-based ESS products and services.

A pHMM-ANN based discriminative approach to promoter identification in prokaryote genomic contexts

The computational approach for identifying promoters on increasingly large genomic sequences has led to many false positives. The biological significance of promoter identification lies in the ability to locate true promoters with and without prior sequence contextual knowledge. Prior approaches to promoter modelling have involved artificial neural networks (ANNs) or hidden Markov models (HMMs), each producing adequate results on small scale identification tasks, i.e. narrow upstream regions. In this work, we present an architecture to support prokaryote promoter identification on large scale genomic sequences, i.e. not limited to narrow upstream regions. The significant contribution involved the hybrid formed via aggregation of the profile HMM with the ANN, via Viterbi scoring optimizations. The benefit obtained using this architecture includes the modelling ability of the profile HMM with the ability of the ANN to associate elements composing the promoter. We present the high effectiveness of the hybrid approach in comparison to profile HMMs and ANNs when used separately. The contribution of Viterbi optimizations is also highlighted for supporting the hybrid architecture in which gains in sensitivity (+0.3), specificity (+0.65) and precision (+0.54) are achieved over existing approaches.

Evidence based drug therapy : are optimal doses and multiple medication therapies realistic in patients with chronic heart failure

Background: Chronic Heart Failure (CHF) has a high mortality and morbidity. Large scale randomised controlled trials have proven the benefits of beta blockade and ACE inhibitors in reducing mortality in patients with CHF and expert guidelines mandate their use. In spite of these recommendations, important therapies are under-prescribed and under-utilised.

Method: 1015 consecutive patients enrolled in CHF management programs across Australia were surveyed during 2005-2006 to determine prescribing patterns in heart failure medications. These patients were followed-up for a period of 6 months.

Results: The survey revealed that beta blockers were prescribed to 80% of patients (more than 85% were on sub-optimal doses) and 70% were prescribed Angiotensin converting enzyme (ACE) inhibitors (approximately 50% were on sub-optimal dose). 19% of patients were prescribed Angiotensin receptor blockers (ARBs). By 6 months <25% of the patients who were on sub-optimal dose beta blockers or ACE inhibitors at baseline, had been up-titrated to maximum dose (p<0.0001). In CHF programs, were nurses were able to titrate medications, 75% of patients reached optimal dose of beta blockers compared to those programs with no nurse-led medication titration, where only 25% of patients reached optimal dose (p<0.004). When examining optimal dosage for any two of these mandatory medications, less patients were on optimal therapy. Beta blockers and ACE inhibitors, were both prescribed in combination in 60% of patients. While beta blockers and ARBs were prescribed to 15% of patients.

Conclusion: Whilst prescribing rates for a single medication strategy of beta blockers, or ACE inhibitors were greater than 70%, an increase in dosage of these medications and utilisation of proven combination therapy of these medications was poor. It is suggested that clinical outcomes for this cohort of patients could be further improved by adherence to evidence-based practice, ESC guidelines, and optimisation of these medications by heart failure nurses in a CHF program. On the basis of these findings and in the absence of ready access to a polypill, focussing on evidence-based practice to increase utilisation and optimal dosage of combination medication therapy is critical.

A controlled trial of internet-based cognitive-behavioural therapy for panic disorder with face-to-face support from a general practitioner or email support from a psychologist

Background: Panic disorder (PD) is one of the most common anxiety disorders seen in general practice, but provision of evidence-based cognitive-behavioural treatment (CBT) is rare. Many Australian GPs are now trained to deliver focused psychological strategies, but in practice this is time consuming and costly.

Objective: To evaluate the efficacy of an internet-based CBT intervention (Panic Online) for the treatment of PD supported by general practitioner (GP)-delivered therapeutic assistance.

Design: Panic Online supported by GP-delivered face-to-face therapy was compared to Panic Online supported by psychologist-delivered email therapy.

Methods: Sixty-five people with a primary diagnosis of PD (78% of whom also had agoraphobia) completed 12 weeks of therapy using Panic Online and therapeutic assistance with his/her GP (n = 34) or a clinical psychologist (n = 31). The mean duration of PD for participants allocated to these groups was 59 months and 58 months, respectively. Participants completed a clinical diagnostic interview delivered by a psychologist via telephone and questionnaires to assess panic-related symptoms, before and after treatment.

Results: The total attrition rate was 20%, with no group differences in attrition frequency. Both treatments led to significant improvements in panic attack frequency, depression, anxiety, stress, anxiety sensitivity and quality of life. There were no statistically significant differences in the two treatments on any of these measures, or in the frequency of participants with clinically significant PD at post assessment.

Conclusions: When provided with accessible online treatment protocols, GPs trained to deliver focused psychological strategies can achieve patient outcomes comparable to efficacious treatments delivered by clinical psychologists. The findings of this research provide a model for how GPs may be assisted to provide evidence-based mental healthcare successfully.

Therapist-assisted, internet-based treatment for panic disorder: can general practitioners achieve comparable patient outcomes to psychologists

Background: Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors or general practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes.
Objective: The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists.
Methods: Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up).
Results: Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F₁,₈₂ = 9.13, P = .00) and environmental (F₁,₈₂ = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (χ²₁ = 4.40, P = .02, N = 96).
Conclusions: This study provides evidence that Internet-based interventions are an effective adjunct to existing mental health care systems. Consequently, this may facilitate and enhance the delivery of evidence-based mental health treatments to increasingly large segments of the population via primary care systems and through suitably trained health professionals.

Developing a web-based information resource for palliative care : an action-research inspired approach

Background : General Practitioners and community nurses rely on easily accessible, evidence-based online information to guide practice. To date, the methods that underpin the scoping of user-identified online information needs in palliative care have remained under-explored. This paper describes the benefits and challenges of a collaborative approach involving users and experts that informed the first stage of the development of a palliative care website.

Method : The action research-inspired methodology included a panel assessment of an existing palliative care website based in Victoria, Australia; a pre-development survey (n = 197) scoping potential audiences and palliative care information needs; working parties conducting a needs analysis about necessary information content for a redeveloped website targeting health professionals and caregivers/patients; an iterative evaluation process involving users and experts; as well as a final evaluation survey (n = 166).

Results : Involving users in the identification of content and links for a palliative care website is time-consuming and requires initial resources, strong networking skills and commitment. However, user participation provided crucial information that led to the widened the scope of the website audience and guided the development and testing of the website. The needs analysis underpinning the project suggests that palliative care peak bodies need to address three distinct audiences (clinicians, allied health professionals as well as patients and their caregivers).

Conclusion : Web developers should pay close attention to the content, language, and accessibility needs of these groups. Given the substantial cost associated with the maintenance of authoritative health information sites, the paper proposes a more collaborative development in which users can be engaged in the definition of content to ensure relevance and responsiveness, and to eliminate unnecessary detail. Access to volunteer networks forms an integral part of such an approach.

The effects of an area-based intervention on the uptake of maternal and child health assessments in Australia : a community trial

Background
Recognition of the importance of the early years in determining health and educational attainment and promotion of the World Health Organization Health for All (HFA) principles has led to an international trend towards community-based initiatives to improve developmental outcomes among socio-economically disadvantaged children. In this study we examine whether, Best Start, an Australian area-based initiative to improve child health was effective in improving access to Maternal and Child Health (MCH) services.

Methods
The study compares access to information, parental confidence and annual 3.5 year Ages and Stages visiting rates before (2001/02) and after (2004/05) the introduction of Best Start. Access to information and parental confidence were measured in surveys of parents with 3 year old children. There were 1666 surveys in the first wave and 1838 surveys in the second wave. The analysis of visiting rates for the 3.5 year Ages and Stages visit included all eligible Victorian children. Best Start sites included 1,739 eligible children in 2001/02 and 1437 eligible children in 2004/05. The comparable figures in the rest of the state were and 45, 497 and 45, 953 respectively.

Results
There was a significant increase in attendance at the 3.5 year Ages and Stages visit in 2004/05 compared to 2001/02 in all areas. However the increase in attendance was significantly greater at Best Start sites than the rest of the state. Access to information and parental confidence improved over the course of the intervention in Best Start sites with MCH projects compared to other Best Start sites.

Conclusion
These results suggest that community-based initiatives in disadvantaged areas may improve parents' access to child health information, improve their confidence and increase MCH service use. These outcomes suggest such programmes could potentially contribute to strategies to reduce child health inequalities.

Traversing theory and transgressing academic discourses : arts-based research in teacher education

Pre-service teacher education is marked by linear and sequential programming which offers a plethora of strategies and methods (Cochran-Smith & Zeichner, 2005; Darling Hammond & Bransford, 2005; Grant & Zeichner, 1997). This paper emerges from a three year study within a core education subject in preservice teacher education in Australia. This ‘practitioner’ research (Zeichner, 1999) engaged the problematics of authentic and meaningful learner-centred teaching and learning through an arts-based curriculum. Over the period of the study, two hundred and eighty pre-service teachers participated in a ‘dialogical performance’ (Conquergood, 2003) of pedagogy about curriculum and assessment through the construction of art about curriculum and assessment. The possibilities of an arts-based pedagogy in pre-service education were affirmed by the research. An enacted epistemological move by the teacher educators led to similar shifts by the students. This opened a space for the reappearance of learner through engagements with identities, positionings and agency. This was an act of ‘putting theory to work’ (Lather, 2006, 2007) and invoked transgressive practices of academic discourses.

Effectiveness of a community-based osteoporosis education and self-management course : a wait list controlled trial

Summary : Osteoporosis is an increasing burden on individuals and health resources. The Osteoporosis Prevention and Self-Management Course (OPSMC) was designed to assist individuals to prevent and manage osteoporosis; however, it had not been evaluated in an Australian setting. This randomised controlled trial showed that the course increased osteoporosis knowledge.
Introduction and hypothesis : Osteoporosis is a major and growing public health concern. An OPSMC was designed to provide individuals with information and skills to prevent or manage osteoporosis, but its effectiveness has not previously been evaluated. This study aimed to determine whether OPSMC attendance improved osteoporosis knowledge, self-efficacy, self-management skills or behaviour.
Materials and methods : Using a wait list randomised controlled trial design, 198 people (92% female) recruited from the community and aged over 40 (mean age = 63) were randomised into control (n = 95) and intervention (n = 103) groups. The OPSMC consists of four weekly sessions which run for 2 h and are led by two facilitators. The primary outcome were osteoporosis knowledge, health-directed behaviour, self-monitoring and insight and self-efficacy.
Results : The groups were comparable at baseline. At 6-week follow-up, the intervention group showed a significant increase in osteoporosis knowledge compared with the control group; mean change 3.5 (p < 0.001) on a measure of 0–20. The intervention group also demonstrated a larger increase in health-directed behaviour, mean change 0.16 (p < 0.05), on a measure of 0–6.
Conclusion : The results indicate that the OPSMC is an effective intervention for improving understanding of osteoporosis and some aspects of behaviour in the short term.