A systematic policy approach to changing the food system and physical activity environments to prevent obesity

As obesity prevention becomes an increasing health priority in many countries, including Australia
and New Zealand, the challenge that governments are now facing is how to adopt a systematic
policy approach to increase healthy eating and regular physical activity. This article sets out a
structure for systematically identifying areas for obesity prevention policy action across the food
system and full range of physical activity environments. Areas amenable to policy intervention can
be systematically identified by considering policy opportunities for each level of governance (local,
state, national, international and organisational) in each sector of the food system (primary
production, food processing, distribution, marketing, retail, catering and food service) and each
sector that influences physical activity environments (infrastructure and planning, education,
employment, transport, sport and recreation). Analysis grids are used to illustrate, in a structured
fashion, the broad array of areas amenable to legal and regulatory intervention across all levels of
governance and all relevant sectors. In the Australian context, potential regulatory policy
intervention areas are widespread throughout the food system, e.g., land-use zoning (primary
production within local government), food safety (food processing within state government), food
labelling (retail within national government). Policy areas for influencing physical activity are
predominantly local and state government responsibilities including, for example, walking and
cycling environments (infrastructure and planning sector) and physical activity education in schools
(education sector). The analysis structure presented in this article provides a tool to systematically
identify policy gaps, barriers and opportunities for obesity prevention, as part of the process of
developing and implementing a comprehensive obesity prevention strategy. It also serves to
highlight the need for a coordinated approach to policy development and implementation across
all levels of government in order to ensure complementary policy action.

Service migration in autonomic service oriented grids

The introduction of Web services into grids helped to address their two main obstacles to be embraced by business and industry, heterogeneity and useability. However, many problems are still open, e.g., grid reconfiguration, reliability and computing optimization. We argue here that a mechanism that could help solving these problems is Web Service migration, a part of automatic and transparent brokerage. Web service migration presents a number of new requirements not addressed in traditional process migration, being the outcome of Web services specific configuration of hosts and application servers, and availability of Web services / resources state. In this paper we report on our study into the development of a Web service migration facility focused on providing migration of services in a Service Oriented Grid environment. We present a novel approach to Web service migration, embodied in a System Management Broker, which is transparent, interoperable and flexible. We take the requirements of Web services into consideration when discovering suitable destination hosts and match services to suitable grid resources which are able to fulfil the needs of the service. We discuss a number of experiments conducted with different types of grid and Web service applications to highlight the feasibility and effectiveness of our migration facility and demonstrate how our facility significantly improves Service Oriented Grids.

Housing service officers : agents of the state or customer service officers?

Staff employed in the Victorian Office of Housing are invariably required to exercise discretion in their day-to-day work managing housing assets and providing services to public housing tenants. Policies specify processes but they never cover all situations and do not provide guidance on competing objectives. For example, preparing a property for reletting is a process with protocols and budget constraints. However, staff can make procedural variations that compy with policy. These variations, generally learnt from peers on the job, often result in budget over runs, but do result in improved properties for new tenants. Discretion is being exercised in balancing housing asset, budget control and tenant service objectives. A housing officer sums up the enduring tension in balancing objectives in the question and statement:’ Am I an agent of the state or a customer service officer? Because I can’t be both’. Organisationally these tensions are spoken about as ‘management issues’, ‘policy reengineering’ and ‘unrealistic understandings’. Using data from an ethnographic study in the Victorian Office of Housing, the paper addresses the question: ‘What do we know about the way in which front line housing officers manage competing objectives in their daily work and how might this knowledge be usefully used in the development of operational policy?’ The paper will explore the way in which complex administrative rules are used as a device to align staff to the Office of Housing objectives and limit the exercise of discretion by frontline staff. Against the background of this analysis the paper will consider the limitations of rule making and the extent to which other organisational strategies might be important for improvements in service provision in a context of constrained resources and limited resources.

Guideline for the non-surgical management of hip and knee osteoarthritis

Introduction: Chronic disease is a major public health burden on Australian society. An increasing proportion of the population has risk factors for, or at least one, chronic disease, leading to increasing public health costs. Health service policy and delivery must not only address acute conditions, it must also effectively respond to the wide range of health and public service requirements of people with chronic illness.^1,2 Strong primary health care policy is an important foundation for a successful national health delivery system and long term management of public health, and is linked to practical outcomes including lower mortality, decreased hospitalisation and improved health outcomes.¹ National strategic health policy has recently given increased recognition to the importance of chronic disease management, with the Australian Federal Government endorsement of a number of initiatives for the prevention (or delay in onset), early detection and evidence based management of chronic disease, including osteoarthritis.^1,3
Chronic musculoskeletal conditions, including arthritis, account for over 4% of the national disease burden in terms of disability adjusted life years. Over 6 million Australians (almost one-third of the population) are estimated to have a chronic musculoskeletal disease; chronic musculoskeletal disease represents the main cause of long term pain and physical disability. In Australia, osteoarthritis is self reported by more than 1.4 million people (7.3% of the population4) and is the tenth most commonly managed problem in general practice.5 This number is set to rise as the elderly population grows. Osteoarthritis exerts a significant burden on the individual and the community through reduction in quality of life, diminished employment capacity and an increase in health care costs. For further details, refer to the Evidence to support the National Action Plan for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis: Opportunities to improve health-related quality of life and reduce the burden of disease and disability (2004).⁶
As such, federal government health policy has identified arthritis as a National Health Priority Area and adopted a number of initiatives aimed at decreasing the burden of chronic disease and disability; raising awareness of preventive disease factors; providing access to evidence based knowledge; and improving the overall management of arthritis within the community.4 In 2002, all Australian health ministers designated arthritis and musculoskeletal conditions as Australia’s seventh National Health Priority Area. In response, a National Action Plan was developed in 2004 by the National Arthritis and Musculoskeletal Conditions Advisory Group (NAMSCAG).6 The aim of this document was to provide a blueprint for national initiatives to improve the health related quality of life of people living with osteoarthritis, rheumatoid arthritis and osteoporosis; reduce the cost and prevalence of these conditions; and reduce the impact on individuals, their carers and their communities within Australia. The National Action Plan was developed to complement both the National Chronic Disease Strategy – which is broader – and the National Service Improvement Framework for Osteoarthritis, Rheumatoid Arthritis and Osteoporosis, in addition to other national and state/ territory structures.

How do school day activity patterns differ with age and gender across adolescence?

Purpose
A knowledge of how young people use their time could be instrumental in informing health interventions, modeling consumer behaviors, and planning service delivery. The aim of the present study was to describe age- and gender-related patterns in the self-reported use of time on school days in a large sample of Australian children and adolescents aged between 10 and 18 years.

Methods
A single, detailed use-of-time diary for a school day was collected from 6024 Australians aged 10–18 from several state and regional surveys conducted in the states of South Australia (SA) and Victoria between 2001 and 2006. Time–use profiles were analyzed for a range of active and sedentary state behaviors.

Results
Boys reported higher physical activity levels (PALs), moderate-to-vigorous physical activity (MVPA), and sports than girls. There were no differences in free play, and girls used more active transport. All activity-related variables decreased with age, except active transport, which peaked at 14–15 years. Boys exhibited higher levels of screen time, whereas girls had higher levels of passive transport. Screen time and its components (television, videogames, and computer use) peaked in the peripubertal years.

Conclusion
Age- and gender-related patterns of time use vary greatly within adolescence. This may reflect a mix of biological and social factors.

Boundary crossers, communities, and health : exploring the role of rural health professionals

Boundary crossers understand the culture and language of community and health service domains and have the trust of both. Rural health professionals living within the communities they serve are ideally placed to harness community capacity so as to influence community-level determinants of health. We analyse five case studies of rural health professionals acting as boundary crossers against indicators of capacity for communities and external agents such as health services working in partnership. A more explicit evidence base for inclusion of community health development in the jobs of rural health professionals is needed.

Strategic significance of the island state of Sri Lanka

The study is focused on an analysis of the major diplomatic documents from the mid eighteenth century to the present as regards Sri Lanka, or Ceylon as it was known till 1972. The objectives of the study are to identify the issues underlying these diplomatic documents. These include the political and strategic factors and other subsidiary issues like trade and commerce relevant at the time these treaties, agreements, and proposed treaties were formulated. It is also a geopolitical study as it relates to Sri Lanka's geographical position in the Indian Ocean, and her possession of the Trincomalee Harbour on its east coast, which is one of the great natural harbours of the world. Over the centuries this harbour has had significant strategic value for naval deployments. The case study of the eighteenth and nineteenth centuries studies the diplomatic documents against the political and strategic background for the French Revolution and actions of Napoleon, and the Anglo/French rivalry, spreading from Europe to North America and Asia. In the twentieth century the environment for studying the place of Sri Lanka in the Indian Ocean was created by the Russian Revolution, the failure to keep the peace of Versailles after World War I, the conflict and horrors of World War II which led to the disintegration of European colonial empires in Asia and Africa, and the tensions generated by the Cold War. A study of the documents would reveal that in international relations what matters is the ability of a party to promote its interests, and this depends on its power. This realist approach contrasts to the idealist approach where policies are based on moral and ethical principles. For the realist the states should follow to protect their interests and to survive. To achieve this is to strive for a ‘balance of power’. To do so is to form a favourable alliance system. As the documents examined cover a period from the mid-eighteenth century to the later part of the twentieth century, they reflect the changing technologies that have had an influence on naval and military matters. For example, this period witnessed great changes in technology of energy utilized to propel warships, from wind, to steam, to fuel and finally to nuclear power. These changes had an influence in determining strategic policies involving weapon systems and communications within a global and regional setting. The period covered was the beginning of the process described a ‘globalisation’. Its idea is not unique to this century; there were many attempts, in various times of history, to integrate societies within a global context. Viewed in this light, the Anglo-French rivalry of the eighteenth and nineteenth centuries was the indication of a global naval strategy, in which Sri Lanka was a major factor in the Indian Ocean region. This process was associated with the phenomena called the ‘expansion of Europe’. It covered all the oceans of the world and in the nineteenth and twentieth centuries led to the founding of the largest maritime empire the world has ever seen: The British Empire. After World War I, the British naval strength (the basis of the British Empire) and her consequent position as a great power, was challenged by other powers like the United States of America and Japan. After World War II, the US Navy was supreme: and there was a close alliance between Britain and the USA. The strength of the US/British alliance was based on the navy and its bases, which were spread throughout the globe; to project power, and act as deterrence and balancing force. Sri Lanka, due to her strategic position, was a part of this evolving process, and was tied to a global strategy (with its regional connotations) from the eighteenth century to the present.

New educational service products : tertiary EC/EB education - the Asia-Pacific region

Electronic Commerce (EC) / Electronic Business (EB) has been (and is expected to continue to be) a dynamic, rapidly evolving area of technology, requiring skilled people with up-to-date knowledge and skills. The global community has required (and still requires) tertiary academic programs to prepare and train these people quickly. In the late nineties, following a tidal wave of tertiary EC program development in the United States, new tertiary programs began to appear in the Asia-Pacific (AP) region to satisfy this need, over a very short period of time. This research project aims to examine whether the development and effectiveness of tertiary EC/EB educational programs can be enhanced through employing a particular marketing paradigm. Four regions - Australia, New Zealand, Hong Kong SAR and the Republic of Singapore — were selected from the AP region, for this study. Based on a review of marketing literature, an inductive approach is adopted to build a model for new educational service product offerings. I also provide a description and comprehensive analysis of EC/EB education, and explore the model empirically, examining how it applies to the way EC education programs have been developed, to date. Essentially, this project consists of two major activities: theory building and theory testing – and is divided into three parts. Part 1: Preliminary study – literature review for theory building. This section of the thesis provides a literature review of the domains of curriculum development, EC/EB program development and management, EC/EB component models and new service product development. Part 2 : Understanding the marketplace – quantitative analysis. This section comprises five major surveys which provide an understanding of EC/EB education. Part 3 : In-depth analysis – qualitative research for theory testing. This section discusses the results of the multiple case studies of EC/EB degree programs undertaken over a five year period. The results of this project highlight both theoretical and practical aspects of the topic. In terms of the theoretical aspect, I provide a contribution to existing theory concerning the planning and development of new tertiary education programs. Research into academic course development in the past has tended to assume that all program development is pedagogically based and influenced. There is an assumption that people only develop academic programs and academic courses for pedagogic reasons. What this research project has done is to suggest that there are, in fact, many possible reasons for developing new programs and that, although these reasons might be pedagogic in nature, they can also be industry-focased, and market-oriented in the following ways: -the university is shaping the way it is perceived by the public – that is, the market; -the university is highlighting where its expertise lies. This led me to a form of new service product development consistent with the new image of the university. There is a clear need for diverse models for program development which accommodate the dynamic roles of modern universities. My research project develops such a model based on conditions in the Asia-Pacific region, and discusses findings arising from the overall project, which can be used to improve new educational program offerings in future, in both the Asia-Pacific and, I suggest, in other regions. This potential use of my findings highlights the practical contribution made by the research Project.

Anycast services and its applications

Anycast in next generation Internet Protocol is a hot topic in the research of computer networks. It has promising potentials and also many challenges, such as architecture, routing, Quality-of-Service, anycast in ad hoc networks, application-layer anycast, etc. In this thesis, we tackle some important topics among them. The thesis at first presents an introduction about anycast, followed by the related work. Then, as our major contributions, a number of challenging issues are addressed in the following chapters. We tackled the anycast routing problem by proposing a requirement based probing algorithm at application layer for anycast routing. Compared with the existing periodical based probing routing algorithm, the proposed routing algorithm improves the performance in terms of delay. We addressed the reliable service problem by the design of a twin server model for the anycast servers, providing a transparent and reliable service for all anycast queries. We addressed the load balance problem of anycast servers by proposing new job deviation strategies, to provide a similar Quality-of-Service to all clients of anycast servers. We applied the mesh routing methodology in the anycast routing in ad hoc networking environment, which provides a reliable routing service and uses much less network resources. We combined the anycast protocol and the multicast protocol to provide a bidirectional service, and applied the service to Web-based database applications, achieving a better query efficiency and data synchronization. Finally, we proposed a new Internet based service, minicast, as the combination of the anycast and multicast protocols. Such a service has potential applications in information retrieval, parallel computing, cache queries, etc. We show that the minicast service consumes less network resources while providing the same services. The last chapter of the thesis presents the conclusions and discusses the future work.

New teachers, professional knowledge and educational reform in New Zealand

This thesis examines the professional knowledge of new secondary school teachers in New Zealand, their negotiation of multiple discourses encountered in policy and practice, and their processes of professional identity formation. It is also a study of policy reform. In New Zealand, as elsewhere, recent educational and social reforms have brought about major changes to the way education is managed and implemented. These reforms emphasise market ideologies promoting consumer choice and responsibility, while measuring and monitoring quality and effectiveness. At the same time, the reforms attempt to alleviate social inequality. Teachers' negotiation of an accountability culture and the dominant equity policies is a major focus of this study. The study draws upon group interviews held with nine new teachers during the first two years of their teaching careers. The group interviews were designed to elicit extended narratives from individual teachers, as well as promote more interactive dialogue and reflections within the groups. Because the interviews were conducted at different points in their early careers, the study also has a longitudinal element, allowing insight into how teachers' views are formed or changed during an intense period of professional learning. Analysis of the teachers' narratives is informed by poststructural and feminist understandings of identity and knowledge and by a methodological orientation to writing as a method of enquiry. The thesis develops three main types of discussion and sets of arguments. The first examines new teachers' negotiation of the 'macro' context of teacher knowledge formation that is, their negotiation of an educational policy environment that juxtaposes an equity agenda with accountability controls. In order to historically situate these dilemmas, the particular political, social and educational context of New Zealand is examined. It is argued that teachers negotiate competing political and conceptual debates about social justice, equity and difference, and that this negotiation is central to the formation of professional knowledge. The analysis illustrates ways in which teachers make sense of equity discourses in educational policy and practice, and the apparent contradictions that arise from placing tight accountability standards on schools and teachers to achieve associated equity goals. The second type of discussion focuses on teachers' negotiation of the 'micro' dimension of professional knowledge, looking closely at the processes and practices that form professional identity. Against stage or developmental models of teacher identity, it is argued that professional identity is formed in an ongoing, uneven and fluid manner and is socially and discursively situated/embedded. It is further argued that professional knowledge and identity are entwined and that this relationship is most usefully understood through analysis of the discursive practices that frame teachers' working lives and through which teachers work out who they are or should become and what and how they (should) think. This analysis contributes new perspectives to debates in teacher education about teacher preparation and the knowledge required of teachers in current 'new times'. The final cluster of arguments brings together these macro and micro aspects of professional knowledge and identity with a case study of how new teachers negotiated a recent educational reform of senior secondary school qualifications in New Zealand. This reform has had a significant impact on secondary schools and on the way teachers, and New Zealanders in general, think about education, achievement and success. It was found that this reform significantly challenged new teachers to question their beliefs about assessment and justice in education, and what counts as success. This case study draws attention to the tensions between equity, academic excellence and standards-based assessment, and contributes to understanding how teacher professional knowledge forms both in the context of a specific educational policy reform and in relation to educational reform in general. This study contributes new knowledge to the formation of teacher professional knowledge and identity in an educational climate of change in New Zealand. The findings offer new insights for teacher educators, policymakers and schools into how teachers build, shape and sustain professional knowledge; how they juggle contradictions between a desire for justice, policy imperatives and teacher education rhetoric; the self-constructed, but contingent nature of professional knowledge and identity; and the urgency to address identity formation as part of teacher education and to take account of the dynamic ways in which identities form. These matters need to be articulated in teacher education both pre-service and in-service in order to address teacher retention and satisfaction, and teachers' commitment to equity reform in education.

Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services

Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services.

Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account 'second-filter criteria' of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia.

Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment.

Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.

Chronic disease self-management programs : perspectives on enablers and barriers to GP and patient engagement

Aims & rationale/Objectives : Chronic disease self-management programs (CDSMP) are increasingly being integrated into the health system to improve the care of people with chronic conditions. Despite activity at both policy and program levels, GPs as the 'gatekeepers' to the health system have generally not been well informed or engaged in this process. This study, in collaboration with 3 Victorian Divisions of General Practice, sought both GP and patient perspectives on enablers and barriers to engagement in self-management programs.
Methods : Interviews were conducted with GPs (n=20) and consumers (n=45) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.
Principal findings : Lack of education/information and uncertainty about the effectiveness of self-management programs were key barriers for both GP and patient engagement. Programs that were sustainable and utilised existing community resources were viewed as enablers to increase uptake. GP and patient preferences for disease specific or generic CDSMP differed.
Discussion : Outcomes from the recent Council of Australian Governments' meeting suggest that self-management will be a centerpiece in forthcoming chronic disease initiatives. International evidence has highlighted the need for GP and patient engagement as critical in ensuring the recruitment of a critical mass of individuals to participate in CDSMP to ensure the sustainability of such initiatives. Insight from this study indicates that GPs and patients are not well informed about self-management, have different preferences to current policy trends and identifies several other barriers which need to be addressed if CDSMP are to be successful.
Implications : Identification of barriers and enablers of GP and patient engagement in self-management is essential in shaping current policy initiatives and delivery of future programs. This is supported by international evidence which indicates strongly that GP engagement in particular is crucial to the success of these programs.
Presentation type : Paper

Justice-based service recovery in a service guarantee context

Although many service organisations have committed resources to developing service guarantee programmes, empirical research assessing their influence of consumers' post purchase evaluations is limited. This thesis addresses this deficiency in the guarantee literature by adapting and extending an established model of perceived justice and consumer satisfactionto the service guarantee context.

Descartes on the human soul : philosophy and the demands of Christian doctrine

By the 17th century Catholic orthodoxy had defined a range of propositions concerning the human soul as revealed by God and verifiable by natural reason. The writings of Rene Descartes display a consistent adherence to these orthodox propositions. The conclusion presents him as ultimately unsuccesful in convincing his contemporaries that his philosophy provided the rational demonstration of the key soul doctrines and that he was worthy of the title "Christian philosopher"