Working the iceberg : a staffroom morality play

This play comes from a research project about how teachers understand and sustain their work in challenging secondary school classrooms. The research asked “How DO teachers work in these classrooms?” not “How SHOULD they?” In the play you meet three teachers who speak candidly about their principles, priorities and vulnerabilities to a pre-service teacher as they move between classes and staffroom. These are real people, real quotes and real feelings taken from real interview data, not idealised guidelines for ‘best practice’. Rather than templates for practice, the play offers a variety of models, issues and food for thought to discuss in teacher education programs. The project was interested in the moral dynamics of classrooms created under the Council of Australian Governments’ 2009 Compact with Young Australians, a policy move that required students to be ‘earning or learning till 17’ across all Australian states. By removing the unemployment benefit for this age group, and tying school attendance to family welfare entitlements, these policies effectively raised the minimum school-leaving age. The risk in this well-intended policy move is that a lack of suitable job opportunities will keep young people at school longer than they want to be there. The effects of this ‘earning or learning’ policy will impact some communities, schools and classrooms much harder than others. The title uses the metaphor of an iceberg to refer to the complex community-school relations that lie below classroom interactions. The idea of a morality play in the play’s title refers back to a medieval form of popular play that used characters to instruct the audience in virtues and values. In the same way, this play seeks to bring to the surface and embody the different moral principles that can inform teacher’s work. The research involved classroom ethnographies of classes for 16 to 17 years olds in non-academic pathways. Eight different teacher/ class combinations were sampled across 2 high schools, 2 TAFE colleges and I hybrid TAFE/school program in three towns experiencing chronic youth unemployment. Their timetabled lessons were observed across 3 to 4 weeks and the teachers and some students were interviewed in each site. The project was funded by an ARC Discovery Early Career Award, 2012-214.

Religion and life satisfaction: Evidence from Germany

We examined the association between religious involvement and life satisfaction using data drawn from the 2003, 2007, and 2011 waves of the German Socio-Economic Panel. Our study provides evidence of an association between attendance at religious services and life satisfaction for respondents residing in West Germany. While social networks partially mediate this relationship for West Germany, there appears to be a remaining direct impact of attendance on life satisfaction. On the contrary, we find no evidence of an association between attendance at religious services and life satisfaction for respondents residing in East Germany.

Depression in Working Adults: Comparing the Costs and Health Outcomes of Working When Ill

Objective Working through a depressive illness can improve mental health but also carries risks and costs from reduced concentration, fatigue, and poor on-the-job performance. However, evidence-based recommendations for managing work attendance decisions, which benefit individuals and employers, are lacking. Therefore, this study has compared the costs and health outcomes of short-term absenteeism versus working while ill (“presenteeism”) amongst employed Australians reporting lifetime major depression. Methods Cohort simulation using state-transition Markov models simulated movement of a hypothetical cohort of workers, reporting lifetime major depression, between health states over one- and five-years according to probabilities derived from a quality epidemiological data source and existing clinical literature. Model outcomes were health service and employment-related costs, and quality-adjusted-life-years (QALYs), captured for absenteeism relative to presenteeism, and stratified by occupation (blue versus white-collar). Results Per employee with depression, absenteeism produced higher mean costs than presenteeism over one- and five-years ($42,573/5-years for absenteeism, $37,791/5-years for presenteeism). However, overlapping confidence intervals rendered differences non-significant. Employment-related costs (lost productive time, job turnover), and antidepressant medication and service use costs of absenteeism and presenteeism were significantly higher for white-collar workers. Health outcomes differed for absenteeism versus presenteeism amongst white-collar workers only. Conclusions Costs and health outcomes for absenteeism and presenteeism were not significantly different; service use costs excepted. Significant variation by occupation type was identified. These findings provide the first occupation-specific cost evidence which can be used by clinicians, employees, and employers to review their management of depression-related work attendance, and may suggest encouraging employees to continue working is warranted.

But how do we know they watched it? Adapting to the flipped classroom conundrum

Those who teach film and media need to use screen content to illustrate their subjects. For example, students want illustrations to accompany lectures on film or television genres. Our experience has been that student access to the film and television screen content underpinning a study of genres is not only desirable but is, in fact, crucial for effective teaching and learning outcomes. Not so long ago, a screening during or at the completion of a lecture was the expected method by which educators delivered screen content to illustrate their teaching. Even if student attendance fluctuated from week to week a quick head count confirmed that a certain number of students were physically present. It was assumed that this physical attendance encouraged students to reflect upon and contextualize the material post lecture. While simply attending a lecture will not translate into actual student learning, it does demonstrate a willingness by students to engage with the course content by making a commitment to attend a scheduled and recurring lecture and screening program. However, as flipped classroom models gain acceptance in educational institutions, this traditional lecture-screening model is giving way to online, off-site, and student-controlled mechanisms for screen content delivery and viewing. Nevertheless, care should be taken when assessing how online delivery translates into student engagement and learning. As Junco (2012) points out, “it’s not the technology that generates learning, but the ways in which the technology are used.” Discussed, debated, and embraced to varying degrees by educators, there remains no definitive model for the flipped classroom – although many models involve ‘flipping’ content and knowledge acquisition (including viewing films and television shows) from scheduled on-campus classes to online material viewed by students in advance of an on-campus lecture or class. The classroom or tutorial room then becomes a space to problem-solve, engage in collaborate learning, and advance and explain concepts. From an institutional perspective, the flipped classroom model could deliver an additional benefit beyond immediate pedagogical concerns. Tucker (2012) suggests through the flipped classroom model “all aspects of instruction can be rethought to best maximize the scarcest learning resource — time.” The narrative most often associated with this shift is that the move to online content delivery of lecture and cinematic / televisual material may also provide educators with more time to do other work such as engage in research, plan strategies to empower students. Experimentation with the flipped classroom model is playing out in various educational institutions. Yet several core concerns remain — one of these concerns is the crucial question of whether an online/digital flipped approach is more effective for student engagement and learning than the traditional lecture-screening mode for screen content delivery. Some urge caution in this regard, arguing that “new technology isn’t always supported by change management and professional development to ensure that digital isn’t just a goal within itself, but actually helps to transform education” (Fleming cited in Blain 2014). The most fundamental concern remains how do lecturers, instructors, and tutors know students have watched the films and television shows associated with a subject? The remainder of this discussion deals with these concerns, and possible solutions offered, through an analysis of the Film, Television and Screen Genres subject at the Queensland University of Technology (QUT) in Brisbane, Queensland.

Religion, spirituality, and mental health and social behaviour in young adulthood: A longitudinal study

Background The concept spirituality appears to be gaining increasing attention for its potential relationship to mental health, despite there being an absence of consensus on what spirituality is or whether it can be distinguished from religion (or religiousness) in operational terms. Spirituality is a term that is embraced within secular and non-secular contexts alike. As a consequence, spirituality as a concept encompasses forms of religiosity that are embedded in traditional religion and those that have little or no connection to traditional religious teachings. The emergence of religious/spiritual beliefs that depart from traditional religious thought represents one key feature of widespread religious change in contemporary societies. Non-traditional religious/spiritual beliefs need to be viewed within this context and thus be differentiated from traditional religious/spiritual beliefs when investigating connections between religion, spirituality, and mental health. Aims The current study seeks to compare the mental health of those whose beliefs are rooted in religious tradition with those whose beliefs deviate from traditional religious thought. The two main objectives of this study are: (1) to determine the extent to which religious background predicts endorsement of traditional and non-traditional religious/spiritual beliefs and church attendance in young adulthood, and; (2) to determine whether differential relationships exist between current religiosity, religious background, and mental health in young adulthood, and whether any observed differences are attributable to other characteristics of respondents like sociodemographic factors and health-risk behaviours. Methods Data were derived from the Mater-University of Queensland Study of Pregnancy, a longitudinal, prospective study of maternal and child health from the prenatal period to 21 years post-delivery. Religiosity was assessed among the study children in young adulthood from three items measured at the time of the 21-year follow-up. Religious background was assessed from information provided by the study mothers in earlier phases of the study. Young adult responses to items included in the Young Adult Self Report (Achenbach, 1997) were used to assess cases of anxiety/depression and externalising behaviour, and delusional ideation was assessed from their responses to the 21-item Peters et al. Delusions Inventory (PDI) (Peters & Garety, 1996). Results Belief in a spiritual or higher power other than God was found to be positively related to anxiety/depression, disturbed ideation, suspiciousness and paranormal ideation, high total PDI scores, as well as antisocial behaviour in young adulthood, regardless of gender. These associations persisted after adjustment for potential confounders. By contrast, young adults who maintain a traditional belief in God appear to be no different to those who reject this belief in regard to anxiety/depression. Belief in God was found to have no association with antisocial behaviour for males, but was observed to have a weak negative relationship with antisocial behaviour for females. This association failed to reach statistical significance however, after adjustment for other religious/spiritual and social characteristics. No associations were found between young adult belief in God and disturbed, suspicious or paranormal ideation, although a positive relationship was identified for high total PDI scores. Weekly church attendance was observed to reduce the likelihood of antisocial behaviour in young adulthood among males, but not females. Religious ideation was found to more prevalent among young adults who attend church on either a weekly or infrequent basis. No long-term effects on anxiety/depression or antisocial behaviour were evident from maternal belief in God, church attendance or religious affiliation in the young adults’ early lives. However, maternal church attendance predicted religious ideation in young adulthood. Offspring of mothers affiliated with a Pentecostal church in the prenatal period appear to have a high rate of religious ideation and high total PDI scores. Paranormal ideation in young adulthood appears to have no association with maternal religiosity in a young adult’s early life. Conclusion The findings from this study suggest that young adults who endorse non-traditional religious/spiritual beliefs are at greater risk for poorer mental health and aberrant social behaviour than those who reject these beliefs. These results suggest that a non-traditional religious/spiritual belief system involves more than mere rejection of traditional religious doctrine. This system of belief may be a marker for those who question the legitimacy of established societal norms and values, and whose thoughts, attitudes and actions reflect this position. This possibility has implications for mental health and wellbeing at both an individual and a societal level and warrants further research attention.

Improving wound management for residents in Residential Aged Care Facilities: National dissemination and implementation of the evidence based Champions for Skin Integrity Program

Overview The incidence of skin tears, pressure injuries and chronic wounds increases with age [1-4] and therefore is a serious issue for staff and residents in Residential Aged Care Facilities (RACFs). A pilot project funded in Round 2 of the Encouraging Best Practice in Residential Aged Care (EBPRAC) program by the then Australian Government Department of Health and Ageing found that a substantial proportion of residents in aged care facilities experienced pressure injuries, skin tears or chronic wounds. It also found the implementation of the evidence based Champions for Skin Integrity (CSI) model of wound care was successful in significantly decreasing the prevalence and severity of wounds in residents, improving staff skills and knowledge of evidence based wound management, increasing staff confidence with wound management, increasing implementation of evidence based wound management and prevention strategies, and increasing staff awareness of their roles in evidence based wound care at all levels [5]. Importantly, during the project, the project team developed a resource kit on evidence based wound management. Two critical recommendations resulting from the project were that: - The CSI model or a similar strategic approach should be implemented in RACFs to facilitate the uptake of evidence based wound management and prevention - The resource kit on evidence based wound management should be made available to all Residential Aged Care Facilities and interested parties A proposal to disseminate or rollout the CSI model of wound care to all RACFs across Australia was submitted to the department in 2012. The department approved funding from the Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) at the same time as the Round 3 of the Encouraging Better Practice in Aged Care (EBPAC) program. The dissemination involved two crucial elements: 1. The updating, refining and distribution of a Champions for Skin Integrity Resource Kit, more commonly known as a CSI Resource Kit and 2. The presentation of intensive one day Promoting Healthy Skin “Train the Trainer” workshops in all capital cities and major regional towns across Australia Due to demand, the department agreed to fund a second round of workshops focussing on regional centres and the completion date was extended to accommodate the workshops. Later, the department also decided to host a departmental website for a number of clinical domains, including wound management, so that staff from the residential aged care sector had easy access to a central repository of helpful clinical resource material that could be used for improving the health and wellbeing of their older adults, consumers and carers. CSI Resource Kit Upgrade and Distribution: At the start of the project, a full evidence review was carried out on the material produced during the EBPRAC-CSI Stage 1 project and the relevant evidence based changes were made to the documentation. At the same time participants in the EBPRAC-CSI Stage 1 project were interviewed for advice on how to improve the resource material. Following this the documentation, included in the kit, was sent to independent experts for peer review. When this process was finalised, a learning designer and QUT’s Visual Communications Services were engaged to completely refine and update the design of the resources, and combined resource kit with the goal of keeping the overall size of the kit suitable for bookshelf mounting and the cost at reasonable levels. Both goals were achieved in that the kit is about the same size as a 25 mm A4 binder and costs between $19.00 and $28.00 per kit depending on the size of the print run. The dissemination of the updated CSI resource kit was an outstanding success. Demand for the kits was so great that a second print run of 2,000 kits was arranged on top of the initial print run of 4,000 kits. All RACFs across Australia were issued with a kit, some 2,740 in total. Since the initial distribution another 1,100 requests for kits has been fulfilled as well as 1,619 kits being distributed to participants at the Promoting Healthy Skin workshops. As the project was winding up a final request email was sent to all workshop participants asking if they required additional kits or resources to distribute the remaining kits and resources. This has resulted in requests for 200 additional kits and resources. Feedback from the residential aged care sector and other clinical providers who have interest in wound care has been very positive regarding the utility of the kit, (see Appendix 4). Promoting Healthy Skin Workshops The workshops also exceeded the project team’s initial objective. Our goal of providing workshop training for staff from one in four facilities and 450 participants was exceeded, with overwhelming demand for workshop places resulting in the need to provide a second round of workshops across Australia. At the completion of the second round, 37 workshops had been given, with 1286 participants, representing 835 facilities. A number of strategies were used to promote the workshops ranging from invitations included in the kit, to postcard mail-outs, broadcast emailing to all facilities and aged care networks and to articles and paid advertising in aged care journals. The most effective method, by far, was directly phoning the facilities. This enabled the caller to contact the relevant staff member and enlist their support for the workshop. As this is a labour intensive exercise, it was only used where numbers needed bolstering, with one venue rising from 3 registrants before the calls to 53 registrants after. The workshops were aimed at staff who had the interest and the capability of implementing evidence-based wound management within their facility or organisation. This targeting was successful in that a large proportion (68%) of participants were Registered Nurses, Nurse Managers, Educators or Consultants. Twenty percent were Endorsed Enrolled Nurses with the remaining 12% being made up of Personal Care Workers or Allied Health Professionals. To facilitate long term sustainability, the workshop employed train-the-trainer strategies. Feedback from the EBPRAC-CSI Stage 1 interviews was used in the development of workshop content. In addition, feedback from the workshop conducted at the end of the EBPRAC-CSI Stage 1 project suggested that change management and leadership training should be included in the workshops. The program was trialled in the first workshop conducted in Brisbane and then rolled out across Australia. Participants were asked to complete pre and post workshop surveys at the beginning and end of the workshop to determine how knowledge and confidence improved over the day. Results from the pre and post surveys showed significant improvements in the level of confidence in attendees’ ability to implement evidence based wound management. The results also indicated a significant increase in the level of confidence in ability to implement change within their facility or organisation. This is an important indication that the inclusion of change management/leadership training with clinical instruction can increase staff capacity and confidence in translating evidence into practice. To encourage the transfer of the evidence based content of the workshop into practice, participants were asked to prepare an Action Plan to be followed by a simple one page progress report three months after the workshop. These reports ranged from simple (e.g. skin moisturising to prevent skin tears), to complex implementation plans for introducing the CSI model across the whole organisation. Outcomes described in the project reports included decreased prevalence of skin tears, pressure injuries and chronic wounds, along with increased staff and resident knowledge and resident comfort. As stated above, some organisations prepared large, complex plans to roll out the CSI model across their organisation. These plans included a review of the organisation’s wound care system, policies and procedures, the creation of new processes, the education of staff and clients, uploading education and resource material onto internal electronic platforms and setting up formal review and evaluation processes. The CSI Resources have been enthusiastically sought and incorporated into multiple health care settings, including aged care, acute care, Medicare Local intranets (e.g. Map of Medicine e-pathways), primary health care, community and home care organisations, education providers and New Zealand aged and community health providers. Recommendations: Recommendations for RACFs, aged care and health service providers and government  Skin integrity and the evidence-practice gap in this area should be recognised as a major health issue for health service providers for older adults, with wounds experienced by up to 50% of residents in aged care settings (Edwards et al. 2010). Implementation of evidence based wound care through the Champions for Skin Integrity model in this and the pilot project has demonstrated the prevalence of wounds, wound healing times and wound infections can be halved.  A national program and Centre for Evidence Based Wound Management should be established to: - expand the reach of the model to other aged care facilities and health service providers for older adults - sustain the uptake of models such as the Champions for Skin Integrity (CSI) model - ensure current resources, expertise and training are available for consumers and health care professionals to promote skin integrity for all older adults  Evidence based resources for the CSI program and similar projects should be reviewed and updated every 3 – 4 years as per NH&MRC recommendations  Leadership and change management training is fundamental to increasing staff capacity, at all levels, to promote within-organisation dissemination of skills and knowledge gained from projects providing evidence based training Recommendations for future national dissemination projects  A formal program of opportunities for small groups of like projects to share information and resources, coordinate activities and synergise education programs interactively would benefit future national dissemination projects - Future workshop programs could explore an incentive program to optimise attendance and reduce ‘no shows’ - Future projects should build in the capacity and funding for increased follow-up with workshop attendees, to explore the reasons behind those who are unable to translate workshop learnings into the workplace and identify factors to address these barriers.

Mandatory naptimes in child care and children's nighttime sleep

Objectives To examine the relationship between mandatory naptimes in child care and children's nighttime sleep duration, both concurrently and 12 months later once in school. Methods A sample of 168 children (50-72 months; 55% males) attending licensed child care centers were observed across their morning and throughout their scheduled naptime. Mandatory naptime was determined as the period in which children were not permitted any alternative activity except lying on their bed. Teachers reported each child's napping in child care. Nighttime and total sleep duration was reported by parents at 2 time points, in child care and in the second semester of their first school year. General linear models were used to examine group differences in sleep duration between children experiencing 0 to 60 minutes and >60 minutes of mandatory naptime, adjusting for key confounders. Path analysis was conducted to test a mediation model in which mandatory naptime is associated with nighttime sleep duration through increased napping in child care. Results Children who experienced >60 minutes of mandatory naptime in child care had significantly less nighttime sleep than those with 0 to 60 minutes of mandatory naptime. This difference persisted at 12-month follow-up, once children were in school. Napping in child care mediated the relationship between mandatory naptime and duration of nighttime sleep. Conclusions Exposure to mandatory naptimes of >60 minutes in child care is associated with decreased duration of nighttime sleep that endures beyond child care attendance. Given the large number of children who attend child care, sleep practices within these settings present an important focus for child health.

Where do ED patients come from?

A lack of access to primary care services, decreasing numbers of general practitioners (GPs) and free of charge visits have been cited as factors contributing to the rising demand on emergency departments. This study aims to investigate the sources of patients' referrals to emergency departments and track changes in the source of referral over a six-year period in Queensland. Data from Queensland Emergency Departments Information Systems were analyzed based on records from 21 hospitals for the periods 2003–04 to 2008–09. The emergency department data were compared with publicly available data on GPs services and patients attendance rates. In Queensland, the majority of patients are self-referred and a 6.6% growth between 2003–04 and 2008–09 (84.4% to 90% respectively) has been observed. The number of referrals made by GPs, hospitals and community services decreased by 29.4%, 40%, 42% respectively during the six-year period. The full-time workload equivalent GPs per 100,000 people increased by 4.5% and the number of GP attendances measured per capita rose by 4% (4.25 to 4.42). An examination of changes in the triage category of self-referred patients revealed an increase in triage category 1-3 by 60%, 36.2%, and 14.4% respectively. The number of self-referred patients in triage categories 4–5 decreased by 10.5% and 21.9% respectively. The results of this analysis reveal that although the number of services provided by GPs increased, the amount of referrals decreased, and the proportion of self-referred patients to emergency departments rose during the six-year period. In addition, a growth in urgent triage categories (1–3) has been observed, with a decline in the number of non-urgent categories (4–5) among patients who came directly to emergency departments. Understanding the reasons behind this situation is crucial for appropriate demand management. Possible explanations will be sought and presented based on patients' responses to an emergency department users' questionnaire.

Audience response systems can facilitate communal course feedback

Background At Queensland University of Technology (QUT), the Bachelor of Radiation Therapy course evaluation has previously suffered from low online survey participation rates. A communal instantaneous feedback event using an audience response system (ARS) was evaluated as a potential solution to this problem. The aims of the project were to determine the extent to which this feedback event could be facilitated by ARS technology and to evaluate the impact the technology made on student satisfaction and engagement. Methods Students were invited to a timetabled session to provide feedback on individual study units and the course overall. They provided quantitative Likert-style responses to prompts for each unit and the course using an ARS as well as anonymous typed qualitative comments. Data collection was performed live so students were able to view collective class responses. This prompted further discussion and enabled a prospective action plan to be developed. To inform future ARS use, students were asked for their opinions on the feedback method. Results Despite technological difficulties, student evaluation indicated that all responders enjoyed the session and the opportunity to view the combined responses. All students felt that useful feedback was generated and that this method should be used in the future. The student attendance and response rates were high, and it was clear that the session had led to the development of some insightful qualitative feedback comments. Conclusions: An ARS contributed well to the collection of course feedback in a communal and interactive environment. Students found it enjoyable to use, and it helped to stimulate useful qualitative comments

Disciplining the screen through education: The Royal Commission into the moving picture industry in Australia

In this article, we investigate the complex relationship between concerns about children and young people’s exposure to cinema in 1920s Australia and the use of film in education. In part, the Royal Commission into the Moving Picture Industry in Australia aimed to ‘ascertain the effect and the extent of the power of film upon juveniles’ and Commissioners spoke to educationalists, psychologists, medical professions, police officers and parents to gain insight into the impacts of movies on children. Numerous issues were canvassed in the Commission hearings such as exposure to sexual content, ‘excesses’ in film content, children’s inability to concentrate at school following cinema attendance and the influence of cinema on youth crime. While the Commission ultimately suggested it was parents’ role to police children’s engagements with cinema, it did make recommendations for restricting children’s access to films with inappropriate themes. Meanwhile, the Commission was very positive about film’s educational role stating that ‘the advantage to be gained by the use of the cinematograph as an adjunct to educational methods should be assisted in every possible way by the Commonwealth’. We draw on the Commission’s minutes of evidence, the Commission report and newspaper articles form the 1920s to the 1940s to argue that the Commission provides valuable insight into the beginnings of the use of screen content in formal schooling, both as a resource across the curriculum and as a specific focus of education through film appreciation and, later, broader forms of media education. The article argues debates about screen entertainment and education rehearsed in the Commission are reflected today as parents, concerned citizens and educators ponder the dangers and potential of new media technologies and media content used by children and young people such as video games, social media and interactive content.

Postprocedural effects of gastrointestinal endoscopy performed as a day case procedure in children : implications for patient and family education

A prospective design that included a survey tool, nursing care records, and telephone interview was used to determine postprocedural effects experienced by children and families following gastrointestinal endoscopy performed as a day procedure. One hundred twenty-one children attending a pediatric gastroenterology unit for endoscopy under general anesthesia participated in the study. Physical symptoms, day care/school attendance, behavioral issues, and economic factors in the 72 hours post procedure were identified. Over half the children (n = 69, 57%) experienced pain in the hospital post procedure. Pain was reported by 73 children (60%) at home on the day of the procedure, by 55 children (45%) on Day 1 post procedure, and by 37 children (31%) on Day 2 post procedure. The throat was the most common site of pain. Nausea or vomiting was experienced by 37 children (31%) at some time following their procedure but was not associated with procedure type, age, or fasting time. Over half the children (n = 53, 51%) who usually attended day care or school did not attend the day following their procedure. Twenty-four parents (40%) who would normally have worked on the day after the procedure did not attend employment. These findings have been used to improve the preprocedural information and discharge management of patients treated in a pediatric gastroenterology ambulatory setting. © The Society of Gastroenterology Nurses & Associates 2007. All Rights Reserved.

A critical analysis of the Aboriginal and Torres Strait Islander Education Action Plan

This study involves the analysis of one of the most recent Indigenous Education policies, the Aboriginal and Torres Strait Islander Education Action Plan 2010-2014 (MCEECDYA, 2011). It examines how the language used within policy positions Aboriginal and Torres Strait Islander peoples. Articulating Rigney's (1999) Indigenist Research Principles with Fairclough's (2001) Critical Discourse Analysis provides a platform for critical dialogues about policy decision-making. In doing so, this articulation enables and emphasises the need for potential policy revision to contribute to the Aboriginal and Torres Strait Islander struggle for self-determination.

The functional liminality of the not-dead-yet students, or, how public schooling became compulsory: A glancing history

This paper redefines the focus for narrating histories of education in the USA through a ‘glancing history’. It highlights the important role played by ‘not-dead-yet students’ who occupied a liminal place on the scale of life in late nineteenth- and early twentieth-century. Traditional histories of education have been more singularly focused on the advent and dynamics of public schooling, ignoring the functionality of such child subjects to public schooling’s existence. This paper argues that public schools as historical objects cannot be understood outside of a broader trinary system of prior institutions that were established for ‘delinquent’ and ‘special’ children. These prior institutions facilitated the formation of ‘the public’ in public schooling less in opposition to ‘the private’ and more in consonance with ‘the human’. The existence of prior institutions enabled the enforcement of compulsory attendance legislation. Compulsory attendance legislation, in place across all existing states by 1918, was concerned more with the conditions for exclusion and exemption than with compelling attendance. Thus, at the most immediate level, this paper historicizes some of the discursive and hence institutional events that linked an array of tutelary complexes by the early 1900s, and which enabled such legislation. This part of the argument extends the notion of institution to consider broader places of confinement and systematicity. It examines the prior practice of reservation and slavery systems, and the efficacy they lent to further institutionalized segregation in the USA. At a second level, the narrative reflects on how such a narration has become possible. It considers how histories of education can currently be rethought and rewritten around the notion of dis/ability, historicizing the formation of dis/ability as identity categories made noticeable in part (and circularly) through the crystallization of a segregated but linked common schooling system. The paper thus provides a counter-memory against dominant economic foundationalist and psychomedical accounts of schooling’s past. It documents both ‘external’ conditions of possibility for public schooling’s emergence and ‘internal’ effects that emerged through the experiences of confinement

General practitioner utilisation amongst urban Aboriginal and Torres Strait Islander children aged less than 5 years

Aim There are limited studies documenting the frequency and reason for attendance to primary health care services in Australian children, particularly for urban Aboriginal and Torres Strait Islander children. This study describes health service utilisation in this population in an urban setting. Methods An ongoing prospective cohort study of Aboriginal and Torres Strait Islander children aged <5 years registered with an urban Aboriginal and Torres Strait Islander primary health care centre in Brisbane, Australia. Detailed demographic, clinical, health service utilisation and risk factor data are collected by Aboriginal researchers at enrolment and monthly for a period of 12 months on each child. The incidence of health service utilisation was calculated according to the Poisson distribution. Results Between 14 February 2013 and 31 October 2014, 118 children were recruited, providing data for 535 child-months of observation. Ninety-one percent of children were Aboriginal, 4% Torres Strait Islander and 5% were both Aboriginal and Torres Strait Islander. The incidence of presentations to see a doctor for any reason was 43.9 episodes/100 child months (95%CI 38.4 – 49.9) The most common reasons for presentation were for immunisations (23%), respiratory illnesses (19%) and for Australian Government funded Indigenous child health check (16%). The primary health services used, for majority of these visits were Aboriginal and Torres Strait Islander specific medical services (61%). Conclusions Within a cultural-specific service for an urban Aboriginal and Torres Strait Islander people, there is a high frequency of childhood attendance at for primary health care services. Well-health checks and respiratory illnesses were the most common reasons. The high proportion of visits for well child services suggests a potential for opportunistic health promotion, education and early interventions across a range of child health issues.

Questions about multidisciplinary teams

Multidisciplinary care (MDC) involves health professionals from a range of disciplines working together as a team (a multidisciplinary team – MDT) to deliver comprehensive care that addresses as many of a patient's needs as possible. Writing in 2011, Wilcoxon and others concluded: ‘Multidisciplinary care is accepted as best practice in cancer treatment planning and care.’ Yet their report (of the national audit of multidisciplinary cancer care in Australia) indicated that two-thirds of the surveyed hospitals did not have a MDT. Further, they found that where teams did exist, one-third of patients were not told that their case would be discussed by the team; the MDT-recommended treatment plan was not included in the patient’s record one-quarter of the time; and less than 1 per cent of teams reported routine attendance by the tumour-specific minimum core team. There is sparse case authority as to the potential medico-legal consequences of MDC by MDTs. This article raises five questions about legal aspects of MDC for consideration. The questions are not limited to cancer care, as MDTs are increasingly used in other areas of medicine.