The natural death of the Supreme Judicial Commission of Bangladesh and the consequent patronage appointments to the Bench: advocating the establishment of an Independent Judicial Commission

In order to strengthen the constitutional process of appointment of judges in Superior Courts, Bangladesh established a Supreme Judicial Commission in 2008 by promulgating an Ordinance. This Ordinance was neither promulgated in pursuance of any provisions of the Constitution nor by introducing any amendment to the provisions of the Constitution. The recommendations of the Commission were not given binding force on the executive. The power of the executive to accept or reject the candidates recommended by the Supreme Judicial Commission at his pleasure defeated the very objective of establishing the Commission for appointing the most competent and suitable persons as judges of the superior courts in Bangladesh. However, following the general elections held on 29 December 2008, the newly elected Government of Bangladesh Awami League dispensed with the Supreme Judicial Commission by not placing the Supreme Judicial Commission Ordinance before the parliament for its approval. This resulted in restoring the previous system of appointing judges on the satisfaction of the executive, which has resulted in patronage appointments. Thus, the establishment of an independent judicial commission in Bangladesh is an imperative necessity for strengthening the independence and impartiality of the judiciary.

The establishment of the Judicial Appointments Commission in Malaysia to improve the constitutional method of appointing the judges of the superior courts : a critical study

The Judicial Appointments Commission was established in Malaysia in 2009 to ensure unbiased selection of judicial candidates for the consideration of the Prime Minister, who has the final say regarding the appointment of judges to the superior courts. But the provisions concerning Prime Minister’s power to appoint the majority of the members of the Commission and his unfettered power of removing four of the five appointed members without assigning any reason, have calculatedly been devised for ensuring the selection of judicial candidates having right political patronage in accordance with the covert wishes of the Prime Minister. Furthermore, the Prime Minister’s power of rejecting the Commission’s recommendations of multiple candidates renders the undertaking of a lengthy process of selection unproductive and useless. Thus the Judicial Appointments Commission has become a superfluous body with an ineffective modus operandi to attain the stipulated objectives of improving and complementing the constitutional method of appointing judges to the superior courts. Since the Federal Constitution of Malaysia has not empowered the Parliament to enact a law providing for the establishment of a Judicial Appointments Commission, it also appears that the Judicial Appointments Commission Act 2009 is an invalid piece of legislation.

A discrete choice experiment to examine the preferences of patients with cancer and their willingness to pay for different types of health care appointments

BACKGROUND: This study sought to understand the preferences of patients with cancer and the trade-offs between appointment attributes using discrete choice experiment (DCE). METHODS AND STUDY DESIGN: Patients with cancer at 3 hospitals completed a self-administered DCE. Each scenario described 6 attributes: expertise of health care professionals (HCPs), familiarity of doctors with patients' medical history, waiting time, accompaniment by family/friends, travel time, and out-of-pocket costs. Patient preferences were estimated using logistic regression. Willingness to pay (WTP) estimates were derived from regression coefficients. RESULTS: Of 512 patients contacted, 185 returned the questionnaire. The mean age was 61 years, and 60% of respondents were female. The mean time since cancer diagnosis was 34 months, 90% had received treatment; and 61% had early-stage disease. The most important attributes were expertise and familiarity of doctors with patients' medical history; distance traveled was least likely to influence patient preferences. The WTP analysis estimated that patients were willing to pay $680 (95% CI, 470-891) for an appointment with a specialist, $571 (95% CI, 388-754) for doctors familiar with their history, $422 (95% CI, 262-582) for shorter waiting times, $399 (95% CI, 249-549) to be accompanied by family/friends, and $301 (95% CI, 162-441) for shorter traveling times. Male patients had a stronger preference for accompaniment by family/friends. The expertise of HCP was the most important attribute for patients regardless of geographic remoteness. CONCLUSIONS: Our study can assist the development of patient-centered health care models that improve patient access to experienced HCPs, support the role of primary care providers during the cancer journey, and educate patients about the roles of non-oncology HCPs to cope with increasing demand for cancer care.

Obesity impacts on general practice appointments

Objective: To quantify the impact of obesity on the number of visits to both primary and secondary care teams.

Research Methods and Procedures: The adult populations of 80 general practices throughout the United Kingdom were classified according to their BMI. We undertook a cross-sectional survey of computer-generated and handwritten records of 6150 obese people (BMI ≥ 30 kg/m2) and 1150 normal weight (BMI = 18.5 to 24.9 kg/m2) control subjects over an 18-month retrospective period.

Results: Obese patients made significantly more visits to the general practitioner (GP), practice nurse (PN), and hospital outpatient units than normal weight patients (all p < 0.001), and they were admitted to the hospital more often (p = 0.034). For both GP and PN visits, the relationship remained after adjusting for age, sex, social deprivation category, country, and number of comorbidities. Among obese patients, there was an increasing relationship between frequent GP visits (at least four appointments) and greater BMI, which remained significant after adjustment had been made for age, sex, deprivation, country, and number of comorbidities.

Discussion: The human resource burden to general practice is significantly higher in the obese population than in the normal weight population, even when adjusted for confounding factors. The increase in prevalence of obesity will continue to put pressure on GP and PN time unless appropriate action is taken.

You can't say no to the Beauty and the Beast : Shrek and ideology

In 2002 the Australian Prime Minister John Howard announced that we are living in 'the post-feminist stage of the debate.' As Anne Summers documents in The End of Equality: Work, Babies and Women's Choices in Twenty-First Century Australia (2003), Howard cut funding for childcare, for the Office of the Status of Women, and for the Human Rights and Equal Opportunity Commission. He abolished the Register of Women in the Office of the Status of Women for government appointments, the Women's Statistical Unit in the Australian Bureau of Statistics, and the Women's Bureau in the Department of Employment, Education, Training and Youth Affairs. Special services for women, given the achievement of gender equality, were obviously no longer required.

Understanding women's breast screening behaviour: a study carried out in South East London, with women aged 50-64 years

Objective To understand low uptake of breast cancer screening through exploring the personal reasoning underlying women's attendance or non-attendance, and identifying differences between those who attend and those who decline.

Design Cross-sectional survey.

Setting Community and home environments of women eligible for breast screening aged 50—64 years, living in South East London. Method Structured, self-completed or assisted-completion questionnaires.

Results The decision to attend or decline screening is rational and personally justifiable, engaging factors linked to emotions and attitude. Attitudes about breast screening and perceived personal importance of breast screening are the strongest predictors of attendance and non-attendance. There are differences between ethnic groups in perceptions of breast screening. Regular attendance at screening is associated with ethnicity, although consistent avoidance of mammography is not. Inconvenience is an important factor in missing appointments, and tends to be prolonged rather than specific to the time or day of the pre-booked invitation. GP and health worker advice are good persuaders towards attendance. Pain and anxiety during mammography are notable dissuaders against re-attending.

Conclusion Appropriate service provision requires consideration of local factors, as well as the medical needs of the population eligible for breast screening. Lay perceptions of potential personal costs of attending or not attending breast screening are important for guiding health promotion. Information providers should consider the language needs of a culturally and educationally mixed community. Health care professionals are well placed to encourage uptake of breast screening through disseminating information that promotes attendance, both within and outside the breast screening service.

Teacher education for rural communities : a focus on 'incentives'

In Australia we face a national crisis in attracting and retaining teachers and other professionals with regard to rural areas. In response to this difficulty in ‘staffing the empty schoolhouse’ (Roberts 2004), the majority of state  education departments have initiated some form of rural incentive scheme designed to attract teachers to rural schools. This paper argues that such  schemes have little chance of success unless teachers taking up such  incentives have actually been prepared for teaching in nonmetropolitan   schools. Although many universities claim to prioritise rural and regional  education and community development as part of their vision statements, in reality relatively few education providers reflect this rhetoric in their practice  and only a handful have made direct links to such state-based schemes in  pre-service teacher education, or initiated their own rural incentives. A  preliminary study into pre-service preparation and rural incentive schemes, as part of a three-year ARC Discovery Grant, indicates that, nationally, the  majority of Faculties and Schools of Education have no easily accessible or  advertised incentive programs to encourage students to undertake a rural  practicum. Nor do many reflect rural education in their course-work.

This paper will introduce the ‘TERRAnova’ project, and then discuss findings of the preliminary work to date that has focussed on identifying incentives and their significance. Drawing on evidence collected from websites from   Australian Universities representing all pre-service teacher education programs in the nation, we argue that few Faculties and Schools appear to  see it necessary or desirable to provide students with links to information  about particular state-based rural funding opportunities. We show how some, either directly or indirectly, imply the importance of a rural practicum, and that  a few teacher education programs provide written advice to students who  are considering taking up a rural practicum. It is unclear, however, whether  follow-up advice is provided, so that the impact and effectiveness of such advice on students’ experiences and willingness to take rural education   seriously can be questioned. Our analysis so far indicates that it is the regional universities which are more likely to address rural education needs, and on this basis we question the metro-centricity of teacher education practice more broadly and suggest ways of expanding the options of teachers in their initial teaching appointments.

Supporting beginning rural teachers : lessons from successful schools

Across Australia and internationally, the vexed problem of staffing rural school remains a major issue affecting the educational outcomes of many rural students and their families. TERRAnova, (New Ground’ in Teacher Education for Rural and Regional Australia), is the name of a large Australian Research Council funded (2008-2010) project involving: a national study of pre-service preparation and rural incentive schemes offered by both University and State government agencies, a longitudinal study of beginning teachers who take up rural appointments and a study of communities where teacher retention is high. In 2008 calls for nominations for rural schools with high rates of retaining beginning teachers were sought (over three years), and twenty-four of nearly fifty nominated schools were selected as case studies. Each case study has involved researchers from the TERRAnova team travelling and staying as close to the community nominated as possible. Numerous teaching staff, parents and community members were invited to be interviewed and their recordings were transcribed. Five of these case studies have now been completed, and this paper examines common themes derived from the strategies that support beginning teachers in these rural communities. Key factors emerging to date from the data relate to particular models of rural school leadership, ongoing teacher learning and mentoring, and school support and innovative community practices.

Board structure and firm performance : evidence from India's top companies

Manuscript Type: Empirical

Research Question/Issue: This paper investigates the relationship between internal governance structures and financial performance of Indian companies. The effectiveness of boards of directors, including board composition, board size, and aspects of board leadership including duality and board busyness are addressed in the Indian context using two theories of corporate governance: agency theory and resource dependency theory.

Research Findings/Insights: The study used a sample of top Indian companies taking into account the endogeneity of the relationships among corporate governance, corporate performance, and corporate capital structure. The study provides some support for aspects of agency theory as a greater proportion of outside directors on boards were associated with improved firm performance. The notion of separating leadership roles in a manner consistent with agency theory was not supported. For instance, the notion that powerful CEOs (duality role, CEO being the promoter, and CEO being the only board manager) have a detrimental effect on performance was not supported. There was some support for resource dependency theory. The findings suggest that larger board size has a positive impact on performance thus supporting the view that greater exposure to the external environment improves access to various resources and thus positively impacts on performance. The study however failed to support the resource dependency theory in terms of the association between frequency of board meetings and performance. Similarly the results showed that outside directors with multiple appointments appeared to have a negative effect on performance, suggesting that "busyness" did not add value in terms of networks and enhancement of resource accessibility.

Theoretical/Academic Implications: The two theories of corporate governance, namely agency and resource dependence theory, were each only partially supported, by the findings of this study. The findings add further to the view that no single theory explains the nexus between corporate governance and performance.

Practitioner/Policy Implications: This study demonstrates that corporate governance measures utilized in developed economies related to boards of directors have some synergies and relevance to emerging economies, such as India. However, the nature of business structures in India, for example the large number of family businesses, may limit the generalizability of the findings and signals the need for further investigation of these businesses. The evidence related to multiple appointments of directors suggests that there may be support for restricting the number of directorships held by any one individual in emerging economies, given that the "busyness" of directors was negatively associated with firm performance.

Lived experience of gay men caring for others with HIV/AIDS : living, loving and dying in the era of HIV/AIDS

This thesis explored gay male carers’ experience of caring for their partner, brother or friend who had HIV/AIDS. Through using phenomenological methodology (van Manen, 1990), the day-to-day caring experiences were uncovered. The data gathered were then analysed through a nursing ‘lens’, with the concept of stigma as an anchoring point. The dual stigmas of homophobia and AIDS phobia impacted on the daily lives of these men as they cared for their loved one. The research identified six themes. These were: 1) the relationship; 2) coping with HIV and AIDS; 3) the corporal impact of HIV/AIDS; 4) experiences of carers including the absence of others; 5) living daily with the virus: Demands of people living with HIV/AIDS (PLWHA); and 6) saying goodbye, but wanting to keep the memory alive. The caring these men undertook, for which they were frequently unprepared, was intensive and complex, but because of their commitment and love they battled on. Because of a sense of shame associated with AIDS phobia on the part of the PLWHA, the carer often had to undertake this care in isolation, without support from family, friends or home health care agencies. The carers struggled with not only the demands of day-to-day care, but also with non-acceptance from family, both of the nature of the relationship with their partner and of their homosexuality. Family members were forced, often with great difficulty, to acknowledge the close commitment the men had to each other. Recognition that one had a terminal disease, HIV/AIDS was also required. The fear of potential transmission was high among carers, friends and family members. Notably, there was an absence of blame on the part of the carer towards his partner for contracting HIV/AIDS. The physical decline and marking of the body further stigmatised the PLWHA, which added to carers’ burdens. They endeavoured to minimise the physical decline in their partner, so he could continue to pass as healthy, and attempted to make the day-to-day living as normal as possible. The methods of combating weight loss and opportunistic infections meant frequent medical appointments, complex intensive medical procedures and help with personal care, which was undertaken at home largely without support from health care staff. Carers frequently struggled also with their partner’s denial of being ill. One strategy all carers used was to escape with their partners from their everyday life in Melbourne and attempt metaphorically to leave the HIV/AIDS behind; this was a time when they could rekindle their life together as it was before HIV/AIDS came into their lives. Some carers chose to holiday without their partner, to give themselves a break from the day-to-day caring, while others planned and took holidays with their partner. The decline of the health in the PLWHA meant that family members had to recognise and accept both the nature of the relationship and the presence of the disease. This recognition and acceptance often came only when the partner was very ill, even at the point of dying. Carers and their partners discussed the potential use of euthanasia, as a means of ending the final phase of life with some dignity. One carer and his partner used euthanasia, despite its illegal status. The main concern for all carers was providing comfort and a reduction in the pain associated with HIV/AIDS for the partner. The widespread grief associated with HIV/AIDS was evident amongst these carers. All had known other gay men who had died, some carers own partner had died, or was about to die. There was an overwhelming sense of grief, which at times was repressed as a means of coping day-to-day. All carers felt it was important and necessary to remember those lost to HIV/AIDS through the various public memorials, as they did not want their partner to be just another faceless person lost to this disease. This phenomenological study of carers’ experience highlights the need for health care workers to be aware of the differing strategies that gay men use to cope with HIV/AIDS. While it may seem that the carers are coping with care of their partner, the outer façade is not always an accurate portrayal of the true situation. Health care workers should enquire as to the assistance these carers need from health care services in order to continue to care for their loved one. Such assistance can be the simple recognition of the partner and acceptance of them as part of the PLWHA’s network; this inclusion and acceptance is half the battle.

Client-reported reasons for non-engagement in drug and alcohol treatment

Introduction and Aims.To examine client-reported reasons for missed early appointments at a drug and alcohol treatment service and to compare characteristics of those who missed appointments with those who attended. Design and Methods. Clients who missed a first or second appointment between 1 May and 31 August 2007 at a public community-based outpatient treatment facility were invited to participate in a semistructured telephone interview.This consisted of an open-ended question asking the reason(s) for nonattendance, followed by a questionnaire of items for therapeutic alliance and service satisfaction, perceived impact of substance use and previous treatment experience, mostly rated on Likert scales. Database information on demographic and clinical variables was gathered for all clients who were accepted for treatment within the study time frame. Characteristics of those who missed a first or second appointment (n = 66) were compared with those who attended at least their first two appointments (n = 97). Results. Of clients who missed their appointments, 80.6% provided reasons for nonattendance, which included extraneous factors (50.0%), service shortcomings (29.7%), no further need for service (16.2%) and motivational ambivalence (4.1%). They generally had high ratings of therapeutic alliance and service satisfaction and identified their substance use as having a negative impact on their lives. Clients who missed appointments were more likely to be male, unmarried and have a history of polysubstance use. Discussion and Conclusions. Extraneous issues relating to the client may be a dominant obstacle in early treatment engagement. Efforts to overcome these issues may therefore improve early engagement.

The utility of the Mood Disorders Questionnaire as a screening tool in a methadone maintenance treatment program

Objective. Comorbid mental illness amongst methadone maintenance therapy clients may be common and screening may be warranted. The Mood Disorders Questionnaire (MDQ) is a screening tool for bipolar disorder that has been validated in other treatment settings. Its utility for patients with substance use disorders is assessed in this study.

Methods. Clients of a methadone maintenance program were invited to complete the MDQ when they attended a public Drug and Alcohol Service for their regular scheduled appointments. Information about their history of substance use was also collected.

Results. Eighty clients (43 females, 37 males) aged 35 8.0 years (mean SD) participated in the study. Seventy-four clients completed the MDQ of which 36 (48.6%) obtained a positive screen. A check of client fi les suggested that only three of the 74 participants had a current working diagnosis of bipolar disorder. These three participants had screened positive on the MDQ.

Conclusions. There was a high prevalence of manic symptoms reported by participants, suggesting that screening for bipolar disorder in this population may be warranted. However, there is a risk of false positives with the MDQ, as it does not clearly differentiate between symptoms of mania and drug intoxication.

Methodological reflections on using pilot data from fracture patients to develop a qualitative study

Background: Qualitative studies are particularly valued for their exploratory nature but, like other research methods, they do require careful planning to ensure rigorous study design. Our objective was to undertake a pilot study to inform the development of a larger qualitative study.

Results: We conducted a series of brief interviews with out-patients in a hospital setting. The interviews were designed to elicit superficial information about whether (and how) post-fracture osteoporosis investigation and/or treatment were being initiated among patients receiving treatment or follow-up for a current or recent fracture. We used thematic analysis to identify key themes in the data that related to the broader research questions. We analysed data obtained from 11 out of a total of 12 interviews conducted. Participants were male and female, aged 19-83 years of age (median age 57 years). Participants attended 2-8 medical appointments to seek treatment and follow up for a current or recent fracture. The following four overarching themes emerged from thematic analysis of the data: fracture event, referral pathway, osteoporosis investigation and/or treatment, and communication by health practitioners and staff.

Conclusions: This pilot study was necessarily tentative and exploratory in nature, but provided a helpful snapshot of some typical experiences in the public health system following fracture. Several themes emerged for consideration in the design of the main study. Despite its critics, theoretical sampling and saturation continue to provide sustainable methods for ensuring that relevant themes and categories are covered in sufficient depth and breadth, appropriate to the needs of the study.

Web health portal to enhance patient safety in Australian healthcare systems

The use of a web Health Portal can be employed not only for reducing health costs but also to view patient's latest medical information (e.g. clinical tests, pathology and radiology results, discharge summaries, prescription renewals, referrals, appointments) in real-time and carry out physician messaging to enhance the information exchanged, managed and shared in the Australian healthcare sector. The Health Portal connects all stakeholders (such as patients and their families, health professionals, care providers, and health regulators) to establish coordination, collaboration and a shared care approach between them to improve overall patient care safety. The paper outlines a Health Portal model for designing a real-time health prevention system. An application of the architecture is described in the area of web Health Portal.