Against Rehabilitation; For Reparitive Justice

The difficulties of re-imagining the possible relationships between crime and justice in capitalist societies, and imagining the possible meanings of democracy in societies characterised by gross inequalities of knowledge, and exclusion of the majority from political decisions are well known. One such difficulty stems from the impossible necessity of maintaining stances of both constant reform and constant critique (see Carlen, 2012). Confronted with economic and cultural inequalities which routinely deny ideals of justice and democracy, there can be a temptation to suppress (or bracket-off) troubling knowledge of criminal justice's and democracy's maligned underbellies and instead talk 'as if' criminal justice's ideal play of governance is always and already realised in its rhetoric. In some senses, this 'as if' talk is aspirational and it is difficult to see how it could be otherwise if more just conceptions of criminal justice and more democratic forms of democracy are to be conceived. However, when, as often happens, aspirational criminal justice concepts become routinised and acted upon as if they can be realised without fundamental social change, they become penal imaginaries, part of a taken-for-granted ideological baggage which, because it is taken-for-granted, obstructs critique (see Carlen, 2008). One such penal imaginary is the concept of rehabilitation, a concept which has a long history of justifying almost every kind of non-lethal response to lawbreaking and which is currently being reborn yet again in theories of criminal desistance and anti-prison campaigns as well as in the more invidious rehabilitation industry with its sales of programmes for cognitive reform.

High risk feet in subacute rehabilitation facilities : how many are there?

Background Australian subacute rehabilitation facilities face significant challenges from the ageing population with increased burden of chronic disease. High risk foot complications are a negative consequence of many chronic diseases. With the rapid expansion of subacute services, it seems imperative to investigate the prevalence of foot complications in this population. The primary aim of this study was to quantify the high risk foot complication prevalence in a subacute rehabilitation population. Methods Eligible participants were all adults admitted overnight, over two 4 week periods, into a large Australian subacute rehabilitation facility. Consenting participants underwent a short non-invasive foot examination by a podiatrist. The standard Queensland Health High Risk Foot Form collected data on age, sex, co-morbidities and foot complications. Descriptive statistics, logistic regression and odds ratios were used to determine the prevalence of foot complications and associations with explanatory variables. Results Overall, 85 of 97 eligible participants consented; mean age 80(9) and 71% were female. At least one foot complication was present in 56.5% participants; including 21.2% defined as high risk and 11.8% current foot ulcer. A previous diagnosis of neuropathy increased the risk of presenting with a high risk foot by 13-fold (OR 13.504, p = 0.001). Conclusion This study highlights the significance of foot complications in the subacute population. It appears that one in every two patients present with a foot complication and one in eight with a foot ulcer. It is suggested all patients admitted to subacute rehabilitation services should be screened for foot complications.

A stepped-wedge cluster randomised controlled trial for evaluating rates of falls among inpatients in aged care rehabilitation units receiving tailored multimedia education in addition to usual care : a trial protocol

Introduction Falls are the most frequent adverse event reported in hospitals. Approximately 30% of in-hospital falls lead to an injury and up to 2% result in a fracture. A large randomised trial found that a trained health professional providing individualised falls prevention education to older inpatients reduced falls in a cognitively intact subgroup. This study aims to investigate whether this efficacious intervention can reduce falls and be clinically useful and cost-effective when delivered in the real-life clinical environment. Methods A stepped-wedge cluster randomised trial will be used across eight subacute units (clusters) which will be randomised to one of four dates to start the intervention. Usual care on these units includes patient's screening, assessment and implementation of individualised falls prevention strategies, ongoing staff training and environmental strategies. Patients with better levels of cognition (Mini-Mental State Examination >23/30) will receive the individualised education from a trained health professional in addition to usual care while patient's feedback received during education sessions will be provided to unit staff. Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients. Falls data will be collected by two methods: case note audit by research assistants and the hospital falls reporting system. Cluster-level data including patient's admissions, length of stay and diagnosis will be collected from hospital systems. Data will be analysed allowing for correlation of outcomes (clustering) within units. An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis. Ethics and dissemination The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees. Results The results will be disseminated through local site networks, and future funding and delivery of falls prevention programmes within WA Health will be informed. Results will also be disseminated through peer-reviewed publications and medical conferences.

How neoliberalism and ecological modernization shaped environmental policy in Australia

‘Sustainability’ provides the dominant frame within which environmental policy debate occurs, notwithstanding its divergent meanings. However, how different discourses combine to shape understanding of the environment, the causes of environmental issues, and the responses required, is less clear cut. Drawing primarily on the approach to critical discourse analysis (CDA) developed by Fairclough, this paper explores the way in which neoliberal and ecologically modern discourses combine to shape environmental policy. Environmental scholars have made relatively little use of this approach to CDA to date, despite the significant interest in the discursive aspects of environmental issues, and its wide use in other areas of policy interest. Using the case of environmental policy-making in Victoria, Australia, this paper illustrates how neoliberalism and weak ecological modernization represented sustainability in ways that seriously limited the importance of environmental issues.

Physiotherapists have accurate expectations of their patients’ future health-related quality of life after first assessment in a subacute rehabilitation setting

BACKGROUND Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients' future health states are accurate. METHODS A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists' (n = 23) prediction of patients' discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n = 272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients' cognitive ability. RESULTS Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37-0.57 (58%-83%) across EQ-5D-3L domains in the lower cognition group and 0.53-0.68 (81%-85%) in the better cognition group. CONCLUSIONS Physiotherapists in this subacute rehabilitation setting predicted their patients' discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition.

Applying the ecological model of behavior change to a physical activity trial in retirement communities : description of the study protocol

Objectives To describe the intervention protocol for the first multilevel ecological intervention for physical activity in retirement communities that addresses individual, interpersonal and community influences on behavior change. Design A cluster randomized controlled trial design was employed with two study arms: a physical activity intervention and an attention control successful aging condition. Setting Sixteen continuing care retirement communities in San Diego County. Participants Three hundred twenty older adults, aged 65 years and older, are being recruited to participate in the trial. In addition, peer leaders are being recruited to lead some study activities, especially to sustain the intervention after study activities ceased. Intervention Participants in the physical activity trial receive individual, interpersonal and community intervention components. The individual level components include pedometers, goal setting and individual phone counseling. The interpersonal level components include group education sessions and peer-led activities. The community level components include resource audits and enumeration, tailored walking maps, and community improvement projects. The successful aging group receives individual and group attention about successful aging topics. Measurements The main outcome is light to moderate physical activity, measured objectively by accelerometry. Other objective outcomes included physical functioning, blood pressure, physical fitness, and cognitive functioning. Self report measures include depressive symptoms and health related quality of life. Results The intervention is being delivered successfully in the communities and compliance rates are high. Conclusion Ecological Models call for interventions that address multiple levels of the model. Previous studies have not included components at each level and retirement communities provide a model environment to demonstrate how to implement such an intervention.

Did socio-ecological factors drive the spatiotemporal patterns of pandemic influenza A (H1N1)?

BACKGROUND Pandemic influenza A (H1N1) has a significant public health impact. This study aimed to examine the effect of socio-ecological factors on the transmission of H1N1 in Brisbane, Australia. METHODOLOGY We obtained data from Queensland Health on numbers of laboratory-confirmed daily H1N1 in Brisbane by statistical local areas (SLA) in 2009. Data on weather and socio-economic index were obtained from the Australian Bureau of Meteorology and the Australian Bureau of Statistics, respectively. A Bayesian spatial conditional autoregressive (CAR) model was used to quantify the relationship between variation of H1N1 and independent factors and to determine its spatiotemporal patterns. RESULTS Our results show that average increase in weekly H1N1 cases were 45.04% (95% credible interval (CrI): 42.63-47.43%) and 23.20% (95% CrI: 16.10-32.67%), for a 1 °C decrease in average weekly maximum temperature at a lag of one week and a 10mm decrease in average weekly rainfall at a lag of one week, respectively. An interactive effect between temperature and rainfall on H1N1 incidence was found (changes: 0.71%; 95% CrI: 0.48-0.98%). The auto-regression term was significantly associated with H1N1 transmission (changes: 2.5%; 95% CrI: 1.39-3.72). No significant association between socio-economic indexes for areas (SEIFA) and H1N1 was observed at SLA level. CONCLUSIONS Our results demonstrate that average weekly temperature at lag of one week and rainfall at lag of one week were substantially associated with H1N1 incidence at a SLA level. The ecological factors seemed to have played an important role in H1N1 transmission cycles in Brisbane, Australia.

Performance analysis in team sports : advances from an ecological dynamics approach

Capacity to produce data for performance analysis in sports has been enhanced in the last decade with substantial technological advances. However, current performance analysis methods have been criticised for the lack of a viable theoretical framework to assist on the development of fundamental principles that regulate performance achievement. Our aim in this paper is to discuss ecological dynamics as an explanatory framework for improving analysis and understanding of competitive performance behaviours. We argue that integration of ideas from ecological dynamics into previous approaches to performance analysis advances current understanding of how sport performance emerges from continuous interactions between individual players and teams. Exemplar data from previous studies in association football are presented to illustrate this novel perspective on performance analysis. Limitations of current ecological dynamics research and challenges for future research are discussed in order to improve the meaningfulness of information presented to coaches and managers.

The Use of Ecological Design to Achieve Sustainable Development in Queensland, Australia

This series of technical papers arose out of the action by a private entrepreneur to initiate a process beyond mere regulatory compliance in order to achieve best environmental practice at proposed large new visitor gateways to Australia’s Great Barrier Reef. Because of the complexity of issues involved at such urbanized downstream sites, the range of topics covered is wide – though still only those considered at this juncture to be of management priority. Included on this platform is one introductory paper reviewing the history of environmental management in the field in Queensland, and three papers which seek to appreciate the main techniques by which government contributes to the solutions viz. through the national park, threatened species list, and environmental impact assessment. The history paper was designed to allow the present series to be considered in broad context as well as performance to date. The work emphasizes that much of the fertile land that must be sustained nowadays lies in the province of the private sector, and that the initiative to create any new cost-effective paradigm in ecologically-sustainable practices lies mostly in their hands. In all instances, this strategic approach to large-scale property planning is through ecological design – using field case studies around the immediate biophysical catchment of the development, with attendant focus on the associated legal catchment (the actual development site) and the social catchment (the effective land managers). The first of these has given rise to a document termed a Regional Landscape Strategy, its implementation planned in concert with an Environmental Impact Assessment of the site and with a Strategic Regional Initiative (still being tested in the field) for community engagement. The first document takes into account the aspirations of government as expressed in its broad-scale regional plans.

Consciousness, solidarity and hope as prevention and rehabilitation

This paper grapples with the question of how progressive criminologists might approach working with people who have committed violent or predatory crimes, or are ‘at risk’ of doing so. Progressives have often been uneasy about ‘intervention’ with people who offend: but in the face of the destructiveness of violence, especially in some parts of the world, a posture of simple non-intervention won’t suffice. I suggest three central principles – which I call consciousness, solidarity and hope – that may guide us in developing ways of working with offenders that are both progressive and effective.

Agricultural production and the ecological question

Environmental degradation is a worldwide phenomenon. It is manifested in the clearing of forests, polluted waterways, soil erosion, the loss of biodiversity, the presence of chemicals in the ecosystem and a host of other concerns. Modern agricultural practices have been implicated in much of this degradation. This chapter explores the connections between the form of agricultural production undertaken in advanced nations – so called ‘productivist’ or ‘high-tech’ farming – and environmental degradation. It is argued, first, that the entrenchment of productivist agriculture has placed considerable, and continuing, pressures on the environment and, second, that while there are both new options for a more sustainable agriculture and new policies being proposed to tackle the existing problem, the underlying basis of productivist agriculture remains largely unchallenged. The prediction is that environmental degradation will continue unabated until more dramatic (and possibly less palatable) measures are taken to alter the behaviour of producers and the trajectory of farming and grazing industries throughout the world.

Prevalence of undiagnosed urinary tract infections on admission to a rehabilitation unit

Background Through clinical observation nursing staff of an inpatient rehabilitation unit identified a link between incontinence and undiagnosed urinary tract infections (UTIs). Further, clinical observation and structured continence management led to the realisation that urinary incontinence often improved, or resolved completely, after treatment with antibiotics. In 2009 a small study found that 30% of admitted rehabilitation patients had an undiagnosed UTI, with the majority admitted post-orthopaedic fracture. We suspected that the frequent use of indwelling urinary catheters (IDCs) in the orthopaedic environment may have been a contributing factor. Therefore, a second, more thorough, study was commenced in 2010 and completed in 2011. Aim The aim of this study was to identify what proportion of patients were admitted to one rehabilitation unit with an undiagnosed UTI over a 12-month period. We wanted to identify and highlight the presence of known risk factors associated with UTI and determine whether urinary incontinence was associated with the presence of UTI. Methods Data were collected from every patient that was admitted over a 12-month period (n=140). The majority of patients were over the age of 65 and had an orthopaedic fracture (36.4%) or stroke (27.1%). Mid-stream urine (MSU) samples, routinely collected and sent for culture and sensitivity as part of standard admission procedure, were used by the treating medical officer to detect the presence of UTI. A data collection sheet was developed, reviewed and trialled, before official data collection commenced. Data were collected as part of usual practice and collated by a research assistant. Inferential statistics were used to analyse the data. Results This study found that 25 (17.9%) of the 140 patients admitted to rehabilitation had an undiagnosed UTI, with a statistically significant association between prior presence of an IDC and the diagnosis of UTI. Urinary incontinence improved after the completion of treatment with antibiotics. Results further demonstrated a significant association between the confirmation of a UTI on culture and sensitivity and the absence of symptoms usually associated with UTI, such as burning or stinging on urination. Overall, this study suggests careful monitoring of urinary symptoms in patients admitted to rehabilitation, especially in patients with a prior IDC, is warranted.

Ecological design with respect to the environment of large-scale marina developments in Queensland

Ecological principles have been employed to assist in the sustainability of a suite of 'gateway' marinas currently being developed in Queensland. Tasks included (a) location and fostering of core remnant native vegetation areas, (b) understanding the dynamic patterns of region behaviour using the ecological strategies employed by key flora and fauna species, (c) promoting those native wildlife species best characterising the region, and (d) allocating management actions along elongated buffer zones to the catchment headwaters (rather than only peripheral to the property). The design of infrastructure and its relationship to sustainable landscape development is lacking such a response int eh planning and detailing of new marinas. This paper distinguishes between the practice of landscape ecology and the design of ecological landscapes, offering examples of the principles of the latter in support of the concept of ecological landscape practice.

Ecological consequences of fragmentation and deforestation in an urban landscape : a case study

Landscape change is an ongoing process even within established urban landscapes. Yet, analyses of fragmentation and deforestation have focused primarily on the conversion of non-urban to urban landscapes in rural landscapes and ignored urban landscapes. To determine the ecological effects of continued urbanization in urban landscapes, tree-covered patches were mapped in the Gwynns Falls watershed (17158.6 ha) in Maryland for 1994 and 1999 to document fragmentation, deforestation, and reforestation. The watershed was divided into lower (urban core), middle (older suburbs), and upper (recent suburbs) subsections. Over the entire watershed a net of 264.5 of 4855.5 ha of tree-covered patches were converted to urban land use-125 new tree-covered patches were added through fragmentation, 4 were added through reforestation, 43 were lost through deforestation, and 7 were combined with an adjacent patch. In addition, 180 patches were reduced in size. In the urban core, deforestation continued with conversion to commercial land use. Because of the lack of vegetation, commercial land uses are problematic for both species conservation and derived ecosystem benefits. In the lower subsection, shape complexity increased for tree-covered patches less than 10 ha. Changes in shape resulted from canopy expansion, planted materials, and reforestation of vacant sites. In the middle and upper subsections, the shape index value for tree-covered patches decreased, indicating simplification. Density analyses of the subsections showed no change with respect to patch densities but pointed out the importance of small patches (≤5 ha) as "stepping stone" to link large patches (e. g., ≥100 ha). Using an urban forest effect model, we estimated, for the entire watershed, total carbon loss and pollution removal, from 1994 to 1999, to be 14,235,889.2 kg and 13,011.4 kg, respectively due to urban land-use conversions.