AIDS talk

The observations of Michel Foucault, noted Twentieth Century French philosopher, regarding modern power relations and orders of discourse, form the framework utilized to analyze and interpret the power struggles of AIDS activists and their opponents--the religious and radical right, and the administrative agencies of the 'Liberal' welfare State. Supported by the tools of sociolinguistic inquiry, the analysis highlights the success of a safer sex campaign in Houston, Texas to illustrate the dynamics of cultural and political change by means of discursive transformations initiated by the gay micro-culture. The KS/AIDS Foundation, allied with both the biomedical community and gay entertainment spheres, was successful in conveying biomedical cautions that resulted in altered personal behavior and modified public attitudes by using linguistic conventions consonant with the discourse of the Houston gay micro-culture. The transformation of discursive practices transgressed not only the Houston gay micro-culture's boundaries, but the city boundaries of Houston as well. In addition to cultural and political change, moderate and confrontational gay activists also sought to change the cognitive boundaries surrounding 'the gold standard' for clinical research trials.^ From a Foucauldian perspective, the same-sex community evolved from the subordinated Other to a position of power in a period of five years. Transformations in discursive practices and power relations are exemplified by the changing definitions employed by AIDS policy-makers, the public validation of community-based research and the establishment of parallel track drug studies. Finally, transformations in discursive practices surrounding the issues of HIV antibody testing are interpreted using Foucault's six points of power relations. The Montrose Clinic provides the case study for this investigation. The clinic turned the technical rationalities of the State against itself to achieve its own ends and those of the gay micro-culture--anonymous testing with pre and post test counseling. AIDS Talk portrays a dramatic transformation in discursive practices and power relations that transcends the historical moment to provide a model for future activists. Volume 2 contains copies of fugitive primary source materials largely unavailable elsewhere. Original documents are archived in the Harris County Medical Archives in the Houston Academy of Medicine located in the Texas Medical Center Library, Houston, Texas. ^

Rights at Risk: Refugees in the New South Africa

This thesis seeks to analyze the relationship between public attitudes toward refugees in a refugee receiving state and the realization of the legal rights afforded refugees (de facto rights). I hypothesize that the more negative a host culture is toward refugees, the less refugees are able to realize their rights. Conversely, the more positive a host culture is toward refugees, the more refugees are able to realize their rights. I test the hypothesis through a case study of refugee populations in Cape Town, South Africa, based on research conducted from May to June 2007. The orientation (positive or negative) of the host culture's perceptions toward a refugee group (Independent Variable) is measured through: (1) a coded content analysis of the South African media, (2) a coded content analysis of semi-structured interviews, and (3) an assessment of secondary source public opinion surveys and reports. The realization of refugee rights (Dependent Variable) is operationalized as a function of two rights: (1) the right to personal physical integrity and (2) the right to protection from unlawful detention. These rights are measured by coding (1) media reports and (2) interviews, and by (3) assessing NGO reports and secondary source public opinion surveys. My empirical data shows that the cultural orientation toward refugees is not overwhelmingly negative, and the realization of rights is not conclusively "low." However, the frequency of data coded "negative" and "low" versus "positive" or "high" suggest that South Africans regard refugees somewhat negatively and that rights are not fully realized. This finding is strengthened by the analysis of secondary sources and field notes.

An analysis of the revenue policy -making process of the Texas Legislature

The purpose of this dissertation was to develop a conceptual framework which can be used to account for policy decisions made by the House Ways and Means Committee (HW&MC) of the Texas House of Representatives. This analysis will examine the actions of the committee over a ten-year period with the goal of explaining and predicting the success of failure of certain efforts to raise revenue.^ The basis framework for modelling the revenue decision-making process includes three major components--the decision alternatives, the external factors and two competing contingency theories. The decision alternatives encompass the particular options available to increase tax revenue. The options were classified as non-innovative or innovative. The non-innovative options included the sales, franchise, property and severance taxes. The innovative options were principally the personal and corporate income taxes.^ The external factors included political and economic constraints that affected the actions of the HW&MC. Several key political constraints on committee decision-making were addressed--including public attitudes, interest groups, political party strength and tradition and precedents. The economic constraints that affected revenue decisions included court mandates, federal mandates and the fiscal condition of the nation and the state.^ The third component of the revenue decision-making framework included two alternative contingency theories. The first alternative theory postulated that the committee structure, including the individual member roles and the overall committee style, resulted in distinctive revenue decisions. This theory will be favored if evidence points to the committee acting autonomously with less concern for the policies of the Speaker of the House. The Speaker assignment theory, postulated that the assignment of committee members shaped or changed the course of committee decision-making. This theory will be favored if there was evidence that the committee was strictly a vehicle for the Speaker to institute his preferred tax policies.^ The ultimate goal of this analysis is to develop an explanation for legislative decision-making about tax policy. This explanation will be based on the linkages across various tax options, political and economic constraints, member roles and committee style and the patterns of committee assignment. ^

Impact of air attack in World War II: selected data for civil defense planning.

Division 1 "prepared under Subcontract 669-1 with Stanford Research Institute [by] Lehigh University, the Institute of Research."

Development and evaluation of a youth mental health community awareness campaign - The Compass Strategy

Background: Early detection and treatment of mental disorders in adolescents and young adults can lead to better health outcomes. Mental health literacy is a key to early recognition and help seeking. Whilst a number of population health initiatives have attempted to improve mental health literacy, none to date have specifically targeted young people nor have they applied the rigorous standards of population health models now accepted as best practice in other health areas. This paper describes the outcomes from the application of a health promotion model to the development, implementation and evaluation of a community awareness campaign designed to improve mental health literacy and early help seeking amongst young people. Method: The Compass Strategy was implemented in the western metropolitan Melbourne and Barwon regions of Victoria, Australia. The Precede-Proceed Model guided the population assessment, campaign strategy development and evaluation. The campaign included the use of multimedia, a website, and an information telephone service. Multiple levels of evaluation were conducted. This included a cross-sectional telephone survey of mental health literacy undertaken before and after 14 months of the campaign using a quasi-experimental design. Randomly selected independent samples of 600 young people aged 12 - 25 years from the experimental region and another 600 from a comparison region were interviewed at each time point. A series of binary logistic regression analyses were used to measure the association between a range of campaign outcome variables and the predictor variables of region and time. Results: The program was judged to have an impact on the following variables, as indicated by significant region-by-time interaction effects ( p < 0.05): awareness of mental health campaigns, self-identified depression, help for depression sought in the previous year, correct estimate of prevalence of mental health problems, increased awareness of suicide risk, and a reduction in perceived barriers to help seeking. These effects may be underestimated because media distribution error resulted in a small amount of print material leaking into the comparison region. Conclusion: We believe this is the first study to apply the rigorous standards of a health promotion model including the use of a control region to a mental health population intervention. The program achieved many of its aims despite the relatively short duration and moderate intensity of the campaign.

Standing in front of bulldozers? Explaining policy stability in land use planning

Policy towards planning presents scholars of politics and public policy with a significant puzzle. Since 1947, there has been a surprising level of stability in the system used to plan the use of land. On the other hand, there has been growing evidence that insufficient land has been released for development. The paper considers the question why, in spite of the planning system demonstrably failing to allocate sufficient land, fundamental reform of the system has not been achieved. In answering the question, the paper considers in particular attempts at reform under the Labour governments from 1997 to 2010. It argues that there is an interplay of interests, ideas and institutions: public attitudes, the interests of certain sections of the population, and institutions which are responsive to these attitudes and interests combined to stymie policy reform. As a consequence, radical reform was not achieved, and the paper concludes that attempt to find a technical “fix” to the planning system are unlikely to succeed. A diagnosis recognising the political and distributive nature of the problem will be required.

On the F word:a corpus-based analysis of the media representation of feminism in British and German press discourse, 1990-2009

Research in social psychology has shown that public attitudes towards feminism are mostly based on stereotypical views linking feminism with leftist politics and lesbian orientation. It is claimed that such attitudes are due to the negative and sexualised media construction of feminism. Studies concerned with the media representation of feminism seem to confirm this tendency. While most of this research provides significant insights into the representation of feminism, the findings are often based on a small sample of texts. Also, most of the research was conducted in an Anglo-American setting. This study attempts to address some of the shortcomings of previous work by examining the discourse of feminism in a large corpus of German and British newspaper data. It does so by employing the tools of Corpus Linguistics. By investigating the collocation profiles of the search term feminism, we provide evidence of salient discourse patterns surrounding feminism in two different cultural contexts. © The Author(s) 2012.

Struggles for Citizenship in South Africa

South Africa’s first democratic constitution of 1996, which defines the content and scope of citizenship, emerged out of what the country’s Constitutional Court accurately described as ‘a deeply divided society characterized by strife, conflict, untold suffering and injustice which generated gross violations of human rights, the transgression of humanitarian principles in violent conflicts and a legacy of hatred, fear, guilt and revenge’ (cited in Jagwanth, 2003: 7). The constitution was internationally noteworthy for its expressed protection of women’s and sexual minority rights and its extension of rights of citizenship to socio-economic rights, such as rights of adequate healthcare, housing and education (SAGI, 1996). During South Africa’s first two decades of democracy, the Constitutional Court has proven its independence by advancing citizenship rights on a number of occasions (O’Regan, 2012). The struggle for citizenship was at the heart of the liberation struggle against the apartheid regime and within the complex dynamics of the anti-apartheid movement, increasingly sophisticated and intersectional demands for citizenship were made. South Africa’s constitutional rights for citizenship are not always matched in practice. The country’s high rates of sexual violence, ongoing poverty and inequality and public attitudes towards the rights of sexual minorities and immigrants lag well behind the spirit and letter of the constitution. Nevertheless, the achievement of formal citizenship rights in South Africa was the result of a prolonged and complex liberation struggle and analysis of South Africa demonstrates Werbner’s claim that ‘struggles over citizenship are thus struggles over the very meaning of politics and membership in a community’ (1999: 221). This chapter will begin with a contextual and historical overview before moving onto analyzing the development of non-racialism as a basis for citizenship, non-sexism and gendered citizenship, contestations of white, militarized citizenship and the achievement of sexual citizenship by the Lesbian, Gay, Bisexual and Transgender (LGBT) rights movement. As shall be made clear, all these citizenship demands emerged during the decades of the country’s liberation struggle.

The Reintegration of Sexual Offenders

This paper, presented as the 9th Martin Tansey Memorial Lecture in April 2016, considers current and future approaches to sex offender reintegration. It critically examines the core models of reintegration in terms of risk-based and strengths-based approaches in the criminal justice context as well as barriers to reintegration, chiefly in terms of the community and negative public attitudes. It also presents an overview of new findings from recent empirical research on sex offender desistance, generally referred to the as the process of slowing down or ceasing of criminal behaviour. Finally, the paper presents an optimum vision in terms of re-thinking sex offender reintegration, and what I term ‘inverting the risk paradigm’, drawing out the key challenges and implications for criminal justice as well as society more broadly.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

Comparing professional identities, attitudes, and views in public communication : a study of Chilean journalists and public relations practitioners

Public relations (PR) practitioners’ and journalists’ professional views and attitudes toward each other have been a subject of academic inquiry during the past decades; however, much of this research has focused on Europe and North America. In other regions of the world, for example in Latin America, historical developments and social understandings have led to slightly different conceptualizations of PR and journalism. Using Chile as a case study, this paper reports the results of an examination of Chilean journalists’ and PR practitioners’ professional conceptions. While both groups tend to have somewhat similar views of media relations and see themselves as part of the same profession, there are also important differences which are most likely based on professional socialization processes rather than educational backgrounds or sociodemographic and work related variables. Implications for contextually grounded approaches to the study of PR and journalism are highlighted.

Travel journalists’ attitudes toward public relations : findings from a representative survey

The impact of public relations on emerging fields such as travel journalism has not gained much attention, despite the broader growth of lifestyle journalism, and its particular dependence on PR. This study reports the findings of a representative survey of Australian travel journalists, focusing on their views of PR. Results show that travel journalists are wary of PR, although they believe they can be relatively immune from its influence and see some PR activities as quite useful. Cluster analysis identifies three distinct groups based on their views of PR, which range from a positive attitude to strong criticism. Their backgrounds and differences are explored, pointing to gender, job status, and background in mainstream journalism as main determinants for differences.

Public sector change, person-organization fit, and work attitudes : a mediation model

Organizational change is a typical phenomenon within public sector agencies in OECD countries. An increasing number of studies in the literature examine the implementation of change and its resulting impact on the work attitudes of public sector employees; however, little is known about the extent to which change management processes impact on employees’ work attitudes. This study aims to address this issue by developing a path model underpinned by change management and public service motivation literature. The path model was tested on a sample of 308 managerial and non-managerial public sector employees from the U.S. The results provide further empirical evidence on the types of change initiatives on nursing work and change management processes being implemented. Public sector agencies in the sample implemented a variety of change initiatives such as downsizing, delayering and empowerment. Employees reported two change management processes: the provision of change-related information and participation in change decision making. While the results indicate that change produces change-induced stressors, change information tends to reduce stressors and, subsequently, role stress. The results also indicate that change management processes are associated with higher levels of public service motivation, which is in turn connected to higher levels of person–organization fit. Person–organization fit was found to partially mediate the relationship between public service motivation and job satisfaction in the context of change.

A values analysis of attitudes towards the use of law to prevent obesity: How might these values inform public health law theory and practice?

This thesis asks whether values, like government duty, individual responsibility, community and social justice, influence the way that scholars and research participants think about the use of law to prevent obesity. It explores the way participants speak about values when expressing their support for or against a variety of government regulatory interventions, including taxation, food labelling reforms and advertising restrictions. This research contributes to our understanding of theories of public health law and public health ethics. The qualitative findings also have implications for policy development, in advocating for a variety of government interventions to prevent obesity.