Ministers, mandarins and diplomats : Australian foreign policy making, 1941-1969

This volume explores key aspects of the development of the Australian Department of External Affairs in the three decades from 1941 to 1969 as it evolved from a small amateur department to a highly professional global operation.

Implementation and evaluation of brief depression and anxiety screening in clients contacting a drug and alcohol service

Introduction and Aims. High prevalence mental health (HPMH) comorbidity is common in clients seeking alcohol and other drug (AOD) treatment yet can remain undetected. Although research has reported on the introduction of screening into AOD services, little research has reported on the processes surrounding the introduction or evaluated its effectiveness.This study reports on the implementation and evaluation of brief anxiety and depression screening within a specialised, publicly funded AOD service in South-East Victoria.
Design and Methods. Study one examined the implementation of standardised HPMH screening with 114 adult clients (Mean age = 35.49, SD = 9.53; 64% male) telephoning an AOD service over a 5 week period. Measures included severity of HPMH problems,AOD use, care plans and referrals. Study two used semistructured interviews with nine staff/managers to evaluate the effectiveness of screening and its impact on service delivery.
Results. Ninety-four per cent of clients were identified at risk of anxiety or depression. Most care plans incorporated counselling, and concurrent referrals commonly involved a general practitioner. Staff and management found systematic screening increased identification and understanding of comorbid issues and enhanced client interaction but impacted on resource requirements.
Discussion and Conclusions. Most AOD treatment seekers were identified HPMH comorbid and care plans generally included counselling.Adjunctive referrals were more common for severely depressed clients. Screening was effective and enhanced client rapport.Evaluations revealed low confidence in treating HPMH issues in-house.Training may increase worker confidence in managing mental health interventions with subclinical cases, enhancing services’ ability to move towards dual diagnosis capability.

On the automated interpretation and indexing of American football

This work combines natural language understanding and image processing with incremental learning to develop a system that can automatically interpret and index American Football. We have developed a model for representing spatio-temporal characteristics of multiple objects in dynamic scenes in this domain. Our representation combines expert knowledge, domain knowledge, spatial knowledge and temporal knowledge. We also present an incremental learning algorithm to improve the knowledge base as well as to keep previously developed concepts consistent with new data. The advantages of the incremental learning algorithm are that is that it does not split concepts and it generates a compact conceptual hierarchy which does not store instances.

Production, properties and processing of American bison (Bison bison) wool grown in southern Australia

American bison grow a thick coat of fibres which assists them to withstand severe climatic conditions. Bison fibre was traditionally used in textiles by native North Americans. This study aimed to quantify the production, fibre attributes and dehairing processing of bison fibre produced from bison grazed in north-eastern Victoria. Three age/sex classes were sampled (n = 16) at seven body positions in spring. The fibre growing area was measured. Fibre was tested for diameter distribution, clean washing yield, proportion of fine fibres <36µm and fine fibre length, and processed by cashmere dehairing. Bison were 12 years of age, liveweights 160450 kg and had mean fibre growing area of 1.4 m². They produced an average 1184 g (range 5301640 g) of fine fibre with mean fibre diameter 18.5µm, clean washing yield 76.5%, wax content 9.8%, suint content 14.5%, clean fine fibre yield 56.4%, fine fibre length 37 mm and fibre curvature was 93/mm. Mid-side fibre had a crimp frequency of 6.5/cm and mean resistance to compression of 6.6 kPa. Fibre had a tenacity of 8.7 cN/tex and an extension of 39.3%. Restricted maximum likelihood mixed model analysis showed age/sex class and sampling site significantly affected all fibre attributes. Finer and longer fibre was produced in anterior sites and in younger bison. Fibre curvature declined 5.3°/mm for each 1-µm increase in mean fibre diameter. Dehaired fibre had a mean fibre diameter of 17.8 µm and mid-length of 28 mm, suitable for woollen spinning. The production by bison of coats containing significant amounts of fibre indicates that careful harvesting of fibre could form an important source of income in bison enterprises.

Characteristics of participants in Australia's Get Healthy telephone-based lifestyle information and coaching service : reaching disadvantaged communities and those most at need

To address increasing rates of overweight and obesity, a population-based telephone intervention was introduced in New South Wales, Australia. The Get Healthy Information and Coaching Service® (GHS) offered participants a 6-month coaching program or detailed self-help information. Determining the population reach of GHS is of public health importance to ensure that the program reaches disadvantaged groups. This paper describes the socio-demographic and risk profile of participants (n = 4828) in the first 18 months of operations, determines how representative they are of the population, assesses changes in participants’ socio-demographic profile and compares ‘information-only’ and ‘coaching’ participants. The results show that GHS users are representative of the adult population in relation to education, employment status, Aboriginal status, fruit and vegetable consumption and alcohol use. However, more female, middle-aged, English-speaking, rural and socially disadvantaged adults participated in GHS. Coaching Participants were more likely to be overweight and to be ex-smokers than the general population. There was substantial variability in GHS recruitment, when mass-reach television advertising was used, participants enrolled from a major city and from more disadvantaged communities. The GHS has broader population reach than many local interventions, but further efforts are needed to increase reach by Aboriginal communities, other minorities and men.

Renal access coordinators' impact on hemodialysis patient outcomes and associated service delivery: a systematic review

Background
Renal access coordinators contribute specifically to dialysis access care for people with chronic and end stage renal disease. Since the introduction of renal access coordinators into Australia in the early 2000s, there have been anecdotal examples of associated improvements in patient outcomes and service delivery; however scant published quantitative evidence exists. Thus, the impact of the implementation of renal access coordinators has not undergone a rigorous review to date.

Objective
The objective of this systematic review was to critically appraise and synthesize the best available evidence related to the impact of renal access coordinators on dialysis patient outcomes and associated service delivery.

INCLUSION CRITERIA

Types of participants
This review considered studies that included renal access coordinators (noting variations of the titles) and adult hemodialysis patients (aged 18 years and over).

Types of intervention(s)
This review considered studies that evaluated the effectiveness of the renal access coordinator. This role typically consists of clinical and administration duties such as providing pre dialysis access coordination, access surveillance patient education and nurse education.

Types of studies
The types of studies considered within this review included experimental and epidemiological study designs. Thus randomized controlled trials (RCT), non-randomized controlled trials, and quasi-experimental, before and after studies, prospective and retrospective cohort studies were considered as were case control studies, analytical cross sectional studies and descriptive cross sectional studies.

Types of outcomes
Patient outcomes considered included: days to first vascular access complication (such as stenosis or thrombosis) and/or primary intervention (such as angioplasty or surgical intervention); percentage of central line insertions (negative); rate of arteriovenous fistula (AVF)/arteriovenous graft (AVG)/central venous catheter (CVC) at start of dialysis (incidence); prevalent rate of AVF/AVG/CVC; time to occlusion of AVF and time from referral to surgery. Service outcomes included: knowledge/up skilling of renal nurses; cannulation skills, ultrasound skills, knowledge of anatomy and physiology and other access related knowledge.

Search strategy
The search strategy aimed to locate published and unpublished studies, utilizing a three-step searching approach. Studies published in English from 1990 to October 2013 were considered for inclusion in this review.

Methodological quality
The studies were assessed by two independent reviewers using the appropriate standardized critical appraisal instruments from the Joanna Briggs Institute.

Data collection
Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute, namely JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI).

Data synthesis
This review aimed to conduct meta-analyses of the findings: however, because of the limitations of the data found, this was not possible and so the findings are presented in a narrative format.

Results
Five studies were identified for inclusion in the review. No RCTs were found, therefore four of the five studies were pre-post intervention cohort studies and one was a prospective quality assurance report. Data were heterogeneous and thus did not allow for meta-analysis. All studies included multidisciplinary teams with variable emphasis on the renal access coordinator role. The pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the hemodialysis population and the quality assurance report measured the difference in patency rates between AVF and AVG. All discussed the role of central coordination as a contributor to the success of vascular access care.

Conclusions
This review found insufficient data to make firm conclusions about the impact that renal access coordinators have on patient outcomes. The results of this review suggest an association between renal access coordinators and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs.

Mothering siblings: Diaspora, desire and identity in American born confused Desi

In this essay we consider the construction of cultural identity, motherhood and the family in ABCD, a film of the Indian diaspora that had its world premiere at the 2001 London Film Festival. This film reads family, apparently within familiar narrative structures such as the U.S.-immigrant story, as portrayed in films like Goodbye, Columbus and My Big Fat Greek Wedding, and the "leaving home" story, as classically portrayed in Pride and Prejudice, where a young person needs to escape from her clueless family. The irritating presence of the mother in the film, and the quickness with which her two children appear to make life-determining decisions following her death, seem to invite discussions of plot and character organized around ideas of individual development, self-improvement and understanding. This is the territory of the desire plot, an account of family history captured for the twentieth century by Freudian-Lacanian readings which position sexual desire within the unconscious history of familial fantasies, understood as vertical and Oedipal. In this territory, mothers and old ladies become, as Mary Jacobus memorably phrased it, little more than "the waste products" of a system in which marriageable women are objects of exchange between men (142) and a mother's death would be expected to grease the wheels of narrative. Identity and narrative are inextricably linked here: a certain understanding of narrative as developmental and teleological paves the way for an understanding of identity as either/or. There are problems, however, in trying to read ABCD as a bildüngsroman structured by what Susan Freidman calls "the temporal plots of the family romance, its repetitions and discontents" (137), rendering the "Indian" characteristics of the plot unreadable, and the apparently self-defeating nature of the characters' choices and behavior, rather pointless. A central [End Page 16] difficulty is that the film both responds to and resists readings based on the Oedipal model of the bildüngsroman with its focus on linear development through time.