Complexities of medicines safety: communicating about managing medicines at transition points of care across emergency departments and medical wards

To explore how health professionals, patients and family members communicate about managing medicines across transition points of care in two Australian public hospitals.

Pandemic (H1N1) Influenza 2009 and Australian emergency departments : implications for policy, practice and pandemic preparedness

Objective: To describe the reported impact of Pandemic (H1N1) 2009 on EDs, so as to inform future pandemic policy, planning and response management.

Methods: This study comprised an issue and theme analysis of publicly accessible literature, data from jurisdictional health departments, and data obtained from two electronic surveys of ED directors and ED staff. The issues identified formed the basis of policy analysis and evaluation.

Results: Pandemic (H1N1) 2009 had a significant impact on EDs with presentation for patients with ‘influenza-like illness’ up to three times that of the same time in previous years. Staff reported a range of issues, including poor awareness of pandemic plans, patient and family aggression, chaotic information flow to themselves and the public, heightened stress related to increased workloads and lower levels of staffing due to illness, family care duties and redeployment of staff to flu clinics. Staff identified considerable discomfort associated with prolonged times wearing personal protective equipment. Staff believed that the care of non-flu patients was compromised during the pandemic as a result of overwork, distraction from core business and the difficulties associated with accommodating infectious patients in an environment that was not conducive.

Conclusions: This paper describes the breadth of the impact of pandemics on ED operations. It identifies a need to address a range of industrial, management and procedural issues. In particular, there is a need for a single authoritative source of information, the re-engineering of EDs to accommodate infectious patients and organizational changes to enable rapid deployment of alternative sources of care.

Cultural equality and its soft power against terrorism

This book is a collection of papers originally presented at a workshop entitled 'After Nine Eleven: Ethics in the Time of Terror' hosted by Monash University on 24 June 2005. The workshop participants included members of the Ethics of War and Peace (EWAP) working group which was inaugurated at the first Oceanic Conference on International Studies in July 2004. EWAP provides a cross-disciplinary forum for scholars and non-academic professionals to exchange and debate ideas on topics including the ethics of armed intervention, the Just War, pacifist ethics, international humanitarian law, ethics in the military profession, and the relationship between law, ethics and politics.

The chapters within this book examine themes including 'lesser evils' and 'dirty hands' in the fight against terrorism, the ethics of intelligence gathering, humanitarian intervention, terrorism and the North-South divide, cultural equality as a response to terrorism, human rights and counterterrorism legislation, and the ethics of defending against 'bioterrorism'. 

Contributors include Alex Bellamy and Richard Devetak (University of Queensland), Baogang He (Deakin University), Christopher Michaelsen (Office for Democratic Institutions and Human Rights, Organization for Security and Co-operation in Europe), Jeremy Moses (University of Canterbury), Christian Enemark and Hugh Smith (University of New South Wales, Australian Defence Force Academy).

Neoconservatism, US-China conflict, and Australia's 'great and powerful friends' dilemma

Following its time-honoured 'great and powerful friends' foreign policy tradition, Australia has been cultivating close ties simultaneously with the United States and China. Yet, as a rivalry between the two powers apparently looms large, Australia faces an acute dilemma. While the rise of China and the question of Taiwan are often cited as main causes of US-China discord, this article argues that the American neoconservative policy on China, underpinned by a belief in both military strength and moral clarity, is integral to this growing competition and is, by extension, partly responsible for the emergence of Australia's predicament. To avoid such a difficult choice, the article suggests that Australia should strive to curb the policy influence of neoconservatism both in the United States and at home by pursuing a more independent foreign policy, making clear its strategic postures on US-China relations, and helping establish a trilateral strategic forum between Australia, the United States, and China.

The interface of acute and aged care: the role of the nurse in provincial area

Objective: This study was to investigate issues that arose from pre-admission to post-discharge, for people in Toowoomba, Queensland over the age of 65 admitted to an acute facility. This paper concentrates on a significant concern that emerged from the latge amount of data collected during this project, that is, the role of the nurse in the continuum of health care involving elderly people.

Method: The study involved a multi-site, multi-agency and multi-method (qualitative and quantitative) approach. Data was collected from regional service providers, the Department of Health and Aged Care (DHAC), the Australian Bureau of Statistics (ABS), Home and Community Care (HACC), the Aged Care Assessment Team (ACAT), elderly people who had been discharged from regional hospitals and their carers, residents of regional aged care facilities, area health professionals and elderly regional hospital inpatients.

Results: The data indicated that nurses in this provincial area currently play a limited role in preadmission planning, being mostly concerned with elective surgery, especially joint replacements. While nurses deliver the majority of care during hospitalisation, they do not appear to be cognizant of the needs of the elderly regarding post-acute discharge.

Conclusion: The recent introduction of the model of nurse case management in the acute sector appears to be a positive development that will streamline and optimise the health care of the elderly across the continuum in the Toowoomba area. The paper recommends some strategies, such as discharge liaison nurses based in Emergency Departments and the expansion of the nurse case management role, which would optimise care for the elderly person at the interface of care.

Modelling the relationship between defense spending and economic growth for the Fiji Islands

The goal of this paper is to examine the nexus between GDP and military expenditure. We model this relationship within a multivariate framework by including exports in the model. We use the recently developed bounds testing approach to cointegration and find that there is a long run relationship among the variables when GDP is the endogenous variable. Normalizing on GDP and using four different estimators, we find that in the long run both military expenditure and exports have a positive impact on GDP. Finally, using the Granger causality test, we find that there is evidence for military expenditure Granger causing exports and exports Granger causing GDP, implying that military expenditure indirectly Granger causes GDP in the short run. In the long run, we find that both military expenditure and exports Granger cause GDP for Fiji. Our findings are consistent with the Keynesian school of thought, leading us to derive some policy implications.

The inadequacy of Western media theory in third world internal conflicts : the case of military censorship in Sri Lanka

Research on media production and on media effects under military censorship has centred primarily on cross-border conflicts being waged by Western regimes. There is a noticeable void in understanding internal conflicts, particularly so within the Asian region. To help address this lacuna, we content-analyse Sri Lankan newspaper samples of two critical military campaigns within the Sri Lankan separatist conflict to gain insight into an Asian internal conflict within the context of military censorship and culture. We discover that supposedly stringent censorship regulations and the rules of the official communication systems have almost no effect on Sri Lankan newspapers, which demonstrate a unique talent to circumvent these strictures. During these bloody internal conflicts, the Sri Lankan press enjoyed freedom of expression, flaunted social responsibility and their watchdog instincts, and, most interestingly for us, demonstrated the failure of the Western propaganda model and other theoretical perspectives. The importance of understanding cultural dimensions before theorizing media behaviour in order to obtain a more rational understanding of the sociology of media is posited by this study. We conclude with discussion of a new model of media censorship which has more relevance in Asian internal conflicts.

A panel data analysis of the military expenditure-external debt nexus : evidence from six middle eastern countries

While a number of studies examine the nexus between military expenditure and economic growth, little consideration has been give to the effect of military expenditure on external debt. This article examines the impact of military expenditure and income on external debt for a panel of six Middle Eastern countries - Oman, Syria, Yemen, Bahrain, Iran, and Jordan - over the period 1988 to 2002. The Middle East represents an interesting study of the effect of military expenditure on external debt because it has one of the highest rates of arms imports in the world and it is one of the most indebted regions in the world. The study first establishes whether there is a long-run relationship between military expenditure, income, and external debt in the six countries using a panel unit root and panel cointegration framework and then proceeds to estimate the long-run and short-run effects of military expenditure and income on external debt. The study finds that external debt is elastic with respect to military expenditure in the long run and inelastic with respect to military expenditure in the short run. For the panel of six Middle Eastern countries, in the long run a 1% increase in military expenditure results in between a 1.1 % and 1.6% increase in external debt, while a 1% increase in income reduces external debt by between 0.6% and 0.8%, depending on the specific estimator employed. In the short run, a 1% increase in military expenditure increases external debt by 0.2%, while the effect of income on external debt is statistically insignificant.

History of contact and change in the Goroka Valley, Central Highlands of New Guinea, 1934-1949

The thesis traces the interaction of the Goroka Valley people with European and coastal New Guinean intruders during the pacification stage of contact and change. In this 15 year period the people moved from a traditional subsistence culture to the threshold of a modern, European-influenced technological society. The contact experiences of the inhabitants of the Valley and the outsiders who influenced them are examined, using both oral and documentary sources. A central theme of this study is the attempts by Europeans and their coastal New Guinean collaborators to achieve the pacification of a people for whom warfare has been described as 'the dominant orientation'. The newcomers saw pacification as being inextricably linked with social, economic and religious transformation, and consequently it was pursued by patrol officers, missionaries and soldiers alike. Following an introductory chapter outlining the pre-contact and early-contact history of the Goroka Valley people, there is a discussion of the causes of tribal fighting in Highlands communities and two case studies of violent events which, although occurring beyond the Goroka Valley, had important consequences for those who lived within its bounds. The focus then shifts to the first permanent settlement of the agents of change -initially these were coastal New Guinean evangelists and policemen - and their impact on the local people. A period of consolidation is then described, as both government and missions established a permanent 'European presence in the Valley'. This period was characterised by vigorous pacification coupled with the introduction of innovations in health and education, agriculture, technology, law and religion. The gradual transformation of Goroka Valley society as a result of the people's interaction with the newcomers was abruptly accelerated in 1943, when many hundreds of Allied soldiers occupied the Valley in anticipation of a threatened Japanese invasion. Village life was disrupted as men were conscripted as carriers and labourers and whole communities were obliged to grow food to assist the Allied war effort. Those living close to military airfields-and camps were subject to Japanese aerial attacks and the entire population was exposed to an epidemic of bacillary dysentery introduced by the combatants. However the War also brought some positive effects, including paradoxically, the almost total cessation of tribal fighting, the construction of an ail-weather airstrip at Goroka which ensured its future as a town and administrative and commercial centre, and the compulsory growing of vegetables, coffee, etc, which laid the foundations for a cash economy and material prosperity. The final chapter examines the aftermath of military occupation, the return of civil administration and the implementation of social and economic policies which brought the Goroka Valley people into the rapid-development phase of contact. By 1949 Gorokans were ready to channel their aggressive energies into commercial competitiveness and adopt a cash-crop economy, to accept the European rule of law, to take advantage of Western innovations in medicine, education, transport and communications, to seek employment opportunities at home and in other parts of the country and to modify their primal world view with European religious and secular values. A Stone Age people was in process of being transformed into a modern society.

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

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

Export quality : representing Fijian bodies and the economy of war

Fijian bodies have become a valuable commodity in the economy of war. Remittances from workers overseas are Fiji’s largest income – exceeding that of tourism and sugar export. This essay examines historical and contemporary representations of the black male body that perpetuate the exploitation of Fijians by inscribing the Fijian male body as warrior, criminal and protector. Taking a multidisciplinary approach informed by sociology, cultural theory, Pacific studies, visual culture, feminist and post-colonial theory, my practice is the vehicle through which I address issues of neocolonial commodification of Fijian bodies. Through an analysis of my own staged photographs and vernacular images taken by Fijians working for private security military companies and British and US armies, I hope to challenge audiences to consider their own perceptions of Fijian agency and subjectivity. By theorising the politicisation of the black body and interrogating colonial representations of blackness, I argue that we can begin to create links between the historical and contemporary exploitation of Fijians and that at the essence of both is an underlying racial hierarchy and economic requirement for cheap and, arguably, expendable labour.

Metaphors, stigma and the ‘Alzheimerization’ of the euthanasia debate

This paper reports the findings of an unobtrusive research inquiry investigating the possible use and misuse of Alzheimer’s disease in public policy debate on the legalization of euthanasia. The component of the study being reported identified the problematic use of five key metaphors: the Alzheimer metaphor, which in turn was reinforced by three additional metaphors – the epidemic metaphor, the military metaphor, and the predatory thief metaphor; and the euthanasia metaphor. All metaphors were found to be morally loaded and used influentially to stigmatize Alzheimer’s disease and mediate public opinion supporting the legalization of euthanasia as an end-of-life ‘solution’ for people with the disease. It is contended that, in the interests of promoting intellectual honesty and giving proper recognition to the extraordinary complexity of the issue, the problematic use and influence of metaphoric thinking in the public debate about Alzheimer’s disease and euthanasia needs to be made transparent, questioned and challenged.