Find it yourself! A brief course in the use of books and libraries under the contract system,

Mode of access: Internet.

Uncompensated care in a competitive environment : whose problem is it? : proceedings, September 13-14, 1984.

Mode of access: Internet.

The Ledgewood-Bonair Landslide toe and where did it go? A case study in littoral sediment budgets from a deep-seated landslide in Island County, Washington

On the morning of March 27th, 2013, a small portion of a much larger landslide complex failed on the western shoreline of central Whidbey Island, Island County, Washington. This landslide, known as the Ledgewood-Bonair Landslide (LB Landslide), mobilized as much as 150,000 cubic meters of unconsolidated glacial sediment onto the coastline of the Puget Sound (Slaughter et al., 2013, Geotechnical Engineering Services, 2013). This study aims to determine how sediment from the Ledgewood-Bonair Landslide has acted on the adjacent beaches 400 meters to the north and south, and specifically to evaluate the volume of sediment contributed by the slide to adjacent beaches, how persistent bluff-derived accretion has been on adjacent beaches, and how intertidal grain sizes changed as a result of the bluff-derived sediment, LiDAR imagery from 2013 and 2014 were differenced and compared to beach profile data and grain size photography. Volume change results indicate that of the 41,850 cubic meters of sediment eroded at the toe of the landslide, 8.9 percent was redeposited on adjacent beaches within 1 year of the landslide. Of this 8.9 percent, 6.3 percent ended up on the north beach and 2.6 percent ended up on the south beach. Because the landslide deposit was primarily sands, silts, and clays, it is reasonable to assume that the remaining 91.1 percent of the sediment eroded from the landslide toe was carried out into the waters of the Puget Sound. Over the course of the two-year study, measurable accretion is apparent up to 150 meters north and 100 meters south of the landslide complex. Profile data also suggests that the most significant elevation changes occurred within the first two and half months since the landslides occurrence. The dominant surficial grain size of the beach soon after the landslide was coarse-sand; in the years following the landslide, 150 meters north of the toe the beach sediment became finer while 100 meters south of the toe the beach sediment became coarser. Overall, the LB Landslide has affected beach profile and grain size only locally, within 150 meters of the landslide toe.

The template: A cooperative approach to evaluating community rehabilitation services

This article describes a workshop and consultation process utilized by four community rehabilitation services and other stakeholders. This process led to the development of an evaluation Template upon which to plan a service evaluation. The Template comprises a number of guiding questions within three broad domains. These are, the people domain (pertaining to the client, their disability, their family and service context), the program domain (pertaining to the service and its activities), and the perspective domain (pertaining to the broader social and community context). It is suggested that the Template, the process by which it was developed, and the guidelines for its use will have relevance to rehabilitation managers, administrators, and others involved in evaluation of community rehabilitation services.

Developing New Tourism Services: Dinosaurs a New Drive Tourism Resource for Remote Areas

This paper examines issues encountered when developing new tourism services generally, and specific aspects relating to the development of remote area dinosaur fossil fields for tourism. It studies two sites, one in the USA and one in Australia. Access to both sites is by minor roads, and both sites are characterised by long drives separating the sites from small communities that offer limited infrastructure and few other attractions for visitors. In both areas, however, tourism is seen as one of the few possible ways to sustain existing communities in the face of declining primary-industry-based employment. In general, tourists visiting these areas are on touring holidays of two weeks’ duration or more where the attraction is the general attributes of the region as well as to a lesser extent their interest in dinosaur fossils. These provide a potential resource for remote-region economic development through commodification as a new tourism attraction. Development of dinosaur fossil finds as a tourism resource is conceptualised here as new service development. Developing new tourism services, especially in remote regions, is challenging and has not been well examined in the tourism literature. The new service development process used in this case study first examines the characteristics of the existing tourists travelling through the region. The characteristics of a number of potential market segments currently interested in dinosaur fossils were then examined and contrasted with the existing market. This is conceptualised on a specialist-generalist spectrum of interest in fossils. A study of the tourist service features associated with dinosaur fossil tourism in remote regions of the USA was conducted, leading to the identification of a number of possible incremental development opportunities. The paper then takes a strategic approach to examining potential new tourism service development related to dinosaur fossils in remote regions of Queensland, Australia. In particular, it describes use of information about existing services in similar regions as the basis for ideas about development as well as comparison between existing and potential markets.

The sense of belonging to a neighbourhood: can it be measured and is it related to health and well being in older women?

This study investigates the sense of belonging to a neighbourhood among 9445 women aged 73-78 years participating in the Australian Longitudinal Study on Women's Health. Thirteen items designed to measure sense of neighbourhood were included in the survey of the older women in 1999. Survey data provided a range of measures of demographic, social and health-related factors to assess scale construct validity. Factor analysis showed that seven of the items loaded on one factor that had good face validity and construct validity as a measure of the sense of neighbourhood. Two of the remaining items related to neighbourhood safety and comprised a factor. A better sense of neighbourhood was associated with better physical and mental health, lower stress, better social support and being physically active. Women who had lived longer at their present address had a better sense of belonging to their neighbourhood, as did women living in non-urban areas and who were better able to manage on their income. Feeling safe in the neighbourhood was least likely in urban areas, increased in rural townships, and was most likely in rural and remote areas. Older women living alone felt less safe, as did women who were less able to manage on their income. This study has identified two sets of items that form valid measures of aspects of the social environment of older women, namely the sense of neighbourhood and feelings of safety. These findings make a contribution to our understanding of the relationship between feelings of belonging to a neighbourhood and health in older women. (C) 2004 Elsevier Ltd. All rights reserved.

IS/IT outsourcing practices of small- and medium-sized manufacturers

Firms began outsourcing information system functions soon after the inception of electronic computing. Extant research has concentrated on large organizations and large-valued outsourcing contracts from a variety of different industries. Smaller-sized firms are inherently different from their large counterparts. These differences between small and large firms could lead to different information technology/information system (IT/IS) items being outsourced and different outsourcing agreements governing these arrangements. This research explores and examines the outsourcing practices of very small through to medium-sized manufacturing organizations. The in-depth case studies not only explored the extent to which different firms engaged in outsourcing but also the nuances of their outsourcing arrangements. The results reveal that all six firms tended to outsource the same sorts of functions. Some definite differences existed, however, in the strategies adopted in relation to the functions they outsourced. These differences arose for a variety of reasons, including size, locality, and holding company influences. The very small and small manufacturing firms tended to make outsourcing purchases on an ad hoc basis with little reliance on legal advice. In contrast, the medium-sized firms often used a more planned initiative and sought legal advice more often. Interestingly, not one of the six firms outsourced any of their transaction processing. These findings now give very small, small-, and medium-sized manufacturing firms the opportunity to compare their practices against other firms of similar size.

Paediatric outreach services

Paediatric outreach services are provided in Australia and overseas to regional and rural communities. More recently telehealth services have been established to support the delivery of paediatric services and clinical management at distant sites. It is suggested that with the large distances separating centres in Australia that a combination of telehealth clinics and outreach visits may provide the most efficient means of delivering paediatric specialty and subspecialty care to these centres.

Getting the run around: accessing services for children with developmental co-ordination disorder

Background Accessing services for children with developmental co-ordination disorder (DCD) is frequently difficult for parents who have to navigate both health and education systems to find a diagnosis and appropriate interventions. Method A qualitative study design incorporating a phenomenological perspective was utilized to understand the nature of the experiences of these parents in attempting to access support for their children with DCD. Twelve parents, whose children attended the Kids Skills Clinic at the University of Western Ontario and were identified as having DCD, were interviewed by the second author. Interviews were transcribed verbatim and analysed using constant comparative method. Member checking, peer checking and code-recoding were carried out to enhance rigour in data analysis. Results A number of themes emerged focusing on the common problems experienced leading to occupational therapy referral. Parents' journeys to seek and access services for their children with DCD were characterized by a sense of maternal knowing, experience of frustration, trivialization of the problem, a sense of 'going it alone', and 'getting the run around'. Conclusions Implications for health and educational professionals working with children, in terms of recognition of DCD and referral for services, are described.

Public and private psychiatry: Can they work together and is it worth the effort?

Objective: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems. Method: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area. Results: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors. Conclusions: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

Routine measurement of outcomes in Australia's public sector mental health services

OBJECTIVE: This paper describes the Australian experience to date with a national 'roll out' of routine outcome measurement in public sector mental health services. METHODS: Consultations were held with 123 stakeholders representing a range of roles. RESULTS: Australia has made an impressive start to nationally implementing routine outcome measurement in mental health services, although it still has a long way to go. All States/Territories have established data collection systems, although some are more streamlined than others. Significant numbers of clinicians and managers have been trained in the use of routine outcome measures, and thought is now being given to ongoing training strategies. Outcome measurement is now occurring 'on the ground'; all States/Territories will be reporting data for 2003-04, and a number have been doing so for several years. Having said this, there is considerable variability regarding data coverage, completeness and compliance. Some States/Territories have gone to considerable lengths to 'embed' outcome measurement in day-to-day practice. To date, reporting of outcome data has largely been limited to reports profiling individual consumers and/or aggregate reports that focus on compliance and data quality issues, although a few States/Territories have begun to turn their attention to producing aggregate reports of consumers by clinician, team or service. CONCLUSION: Routine outcome measurement is possible if it is supported by a co-ordinated, strategic approach and strong leadership, and there is commitment from clinicians and managers. The Australian experience can provide lessons for other countries.

Fixing the system? The experience of service users of the quasi-market in disability services in Australia

A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, service users experienced inadequate service supply, service cutbacks, and an increased emphasis on cost subsidisation and assessment processes. Additionally, few consumers felt that individualised funding arrangements had personally delivered the benefits which the quasi-market model and associated policy paradigm had indicated that they should receive. For many consumers, the notion of consumer 'choice' around service provision was fictitious and they felt that any efficiency gains were at the agency level, largely at the consumers' cost. It is concluded that there appears to be no particular benefit to service users of quasi-market reforms, particularly in policy contexts where service delivery systems are historically under-funded.