Boundaries in Action : An Activity-theoretical Study of Development, Learning, and Change in Health Care Organization for Patients with Multiple and Chronic Illnesses

This study examines boundaries in health care organizations. Boundaries are sometimes considered things to be avoided in everyday living. This study suggests that boundaries can be important temporally and spatially emerging locations of development, learning, and change in inter-organizational activity. Boundaries can act as mediators of cultural and social formations and practices. The data of the study was gathered in an intervention project during the years 2000-2002 in Helsinki in which the care of 26 patients with multiple and chronic illnesses was improved. The project used the Change Laboratory method that represents a research assisted method for developing work. The research questions of the study are: (1) What are the boundary dynamics of development, learning, and change in health care for patients with multiple and chronic illnesses? (2) How do individual patients experience boundaries in their health care? (3) How are the boundaries of health care constructed and reconstructed in social interaction? (4) What are the dynamics of boundary crossing in the experimentation with the new tools and new practice? The methodology of the study, the ethnography of the multi-organizational field of activity, draws on cultural-historical activity theory and anthropological methods. The ethnographic fieldwork involves multiple research techniques and a collaborative strategy for raising research data. The data of this study consists of observations, interviews, transcribed intervention sessions, and patients' health documents. According to the findings, the care of patients with multiple and chronic illnesses emerges as fragmented by divisions of a patient and professionals, specialties of medicine and levels of health care organization. These boundaries have a historical origin in the Finnish health care system. As an implication of these boundaries, patients frequently experience uncertainty and neglect in their care. However, the boundaries of a single patient were transformed in the Change Laboratory discussions among patients, professionals and researchers. In these discussions, the questioning of the prevailing boundaries was triggered by the observation of gaps in inter-organizational care. Transformation of the prevailing boundaries was achieved in implementation of the collaborative care agreement tool and the practice of negotiated care. However, the new tool and practice did not expand into general use during the project. The study identifies two complementary models for the development of health care organization in Finland. The 'care package model', which is based on productivity and process models adopted from engineering and the 'model of negotiated care', which is based on co-configuration and the public good.

Preservice early childhood teachers and designers partnering for change at The Lone Pine Koala Sanctuary: An interdisciplinary education and design for sustainability project

This presentation discusses and critiques a current case study of a project in which Early Childhood preservice teachers are working in partnership with Design students to develop principles and concepts for the design and construction of an early childhood centre. This centre, to be built on the grounds of the iconic Lone Pine Koala Sanctuary in Brisbane , focuses on Education for Sustainability (EfS), sustainable design and sustainable business. Interdisciplinary initiatives between QUT staff and students from two Faculties (Education and Creative Industries) have been situated in the real –world context of this project. This practical, authentic project has seen stakeholders take an interdisciplinary approach to sustainability, opening up new ways of thinking about early childhood centre design, particularly with respect to operation and function. Interdisciplinarity and a commitment to genuine partnerships have created intellectual spaces to re-think the potential of the disciplines to be interwoven so that future professionals from different fields might come together to learn from each other and to address the sustainability imperative. The case study documents and explores the possibilities that the Lone Pine project offers for academics and students from Early Childhood and Design to collaboratively inform the Sanctuary’s vision for the Centre. The research examines how students benefit from practical, real world, community-integrated learning; how academic staff across two disciplines are able to work collaboratively within a real-world context; and how external stakeholders experience and benefit from the partnership with university staff and students. Data were collected via a series of focus group and individual interviews designed to explore how the various stakeholders (staff, students, business partners) experienced their involvement in the interdisciplinary project. Inductive and deductive thematic analysis of these data suggest many benefits for participants as well as a number of challenges. Findings suggest that the project has provided students with ‘real world’ partnerships that reposition early childhood students’ identities from ‘novice’ to ‘professional’, where their knowledge, expertise and perspectives are simultaneously validated and challenged in their work with designers. These partnerships are enabling preservice teachers to practice a new model of early childhood leadership in sustainability, one that is vital for leading for change in an increasingly complex world. This presentation celebrates, critiques and problematises this project, exploring wider implications for other contexts in which university staff and students may seek to work across traditional boundaries, thus building partnerships for change.

The role of aesthetic style in the visual communication of climate change

Public apathy on the issue of Anthropogenic Climate Change (ACC) is widespread, with more than half of surveyed Australians and Britons in denial of the phenomenon. While much is known about media influences and strategies such as message framing, there is little in the way of research on the impact of designed visual communication. This study builds knowledge and challenges assumptions by employing a relational approach between ACC visual communications, the professionals producing them, and the members of society that these communications are attempting to influence, contributing knowledge to the fields of graphic design, science communication and social science.

Climate change impacts on northern Australian rangeland livestock carrying capacity: a review of issues

Grazing is a major land use in Australia's rangelands. The 'safe' livestock carrying capacity (LCC) required to maintain resource condition is strongly dependent on climate. We reviewed: the approaches for quantifying LCC; current trends in climate and their effect on components of the grazing system; implications of the 'best estimates' of climate change projections for LCC; the agreement and disagreement between the current trends and projections; and the adequacy of current models of forage production in simulating the impact of climate change. We report the results of a sensitivity study of climate change impacts on forage production across the rangelands, and we discuss the more general issues facing grazing enterprises associated with climate change, such as 'known uncertainties' and adaptation responses (e.g. use of climate risk assessment). We found that the method of quantifying LCC from a combination of estimates (simulations) of long-term (>30 years) forage production and successful grazier experience has been well tested across northern Australian rangelands with different climatic regions. This methodology provides a sound base for the assessment of climate change impacts, even though there are many identified gaps in knowledge. The evaluation of current trends indicated substantial differences in the trends of annual rainfall (and simulated forage production) across Australian rangelands with general increases in most of western Australian rangelands ( including northern regions of the Northern Territory) and decreases in eastern Australian rangelands and south-western Western Australia. Some of the projected changes in rainfall and temperature appear small compared with year-to-year variability. Nevertheless, the impacts on rangeland production systems are expected to be important in terms of required managerial and enterprise adaptations. Some important aspects of climate systems science remain unresolved, and we suggest that a risk-averse approach to rangeland management, based on the 'best estimate' projections, in combination with appropriate responses to short-term (1-5 years) climate variability, would reduce the risk of resource degradation. Climate change projections - including changes in rainfall, temperature, carbon dioxide and other climatic variables - if realised, are likely to affect forage and animal production, and ecosystem functioning. The major known uncertainties in quantifying climate change impacts are: (i) carbon dioxide effects on forage production, quality, nutrient cycling and competition between life forms (e.g. grass, shrubs and trees); and (ii) the future role of woody plants including effects of. re, climatic extremes and management for carbon storage. In a simple example of simulating climate change impacts on forage production, we found that increased temperature (3 degrees C) was likely to result in a decrease in forage production for most rangeland locations (e. g. -21% calculated as an unweighted average across 90 locations). The increase in temperature exacerbated or reduced the effects of a 10% decrease/increase in rainfall respectively (-33% or -9%). Estimates of the beneficial effects of increased CO2 (from 350 to 650 ppm) on forage production and water use efficiency indicated enhanced forage production (+26%). The increase was approximately equivalent to the decline in forage production associated with a 3 degrees C temperature increase. The large magnitude of these opposing effects emphasised the importance of the uncertainties in quantifying the impacts of these components of climate change. We anticipate decreases in LCC given that the 'best estimate' of climate change across the rangelands is for a decline (or little change) in rainfall and an increase in temperature. As a consequence, we suggest that public policy have regard for: the implications for livestock enterprises, regional communities, potential resource damage, animal welfare and human distress. However, the capability to quantify these warnings is yet to be developed and this important task remains as a challenge for rangeland and climate systems science.

Heat transfer with solid liquid phase change initiating at a point in a semi infinite mold

Short-time analytical solutions of temperature and moving boundary in two-dimensional two-phase freezing due to a cold spot are presented in this paper. The melt occupies a semi-infinite region. Although the method of solution is valid for various other types of boundary conditions, the results in this paper are given only for the prescribed flux boundary conditions which could be space and time dependent. The freezing front propagations along the interior of the melt region exhibit well known behaviours but the propagations along the surface are of new type. The freezing front always depends on material parameters. Several interesting results can be obtained as particular cases of the general results.

The climate change risk management matrix for the grazing industry of northern Australia

The complexity, variability and vastness of the northern Australian rangelands make it difficult to assess the risks associated with climate change. In this paper we present a methodology to help industry and primary producers assess risks associated with climate change and to assess the effectiveness of adaptation options in managing those risks. Our assessment involved three steps. Initially, the impacts and adaptation responses were documented in matrices by ‘experts’ (rangeland and climate scientists). Then, a modified risk management framework was used to develop risk management matrices that identified important impacts, areas of greatest vulnerability (combination of potential impact and adaptive capacity) and priority areas for action at the industry level. The process was easy to implement and useful for arranging and analysing large amounts of information (both complex and interacting). Lastly, regional extension officers (after minimal ‘climate literacy’ training) could build on existing knowledge provided here and implement the risk management process in workshops with rangeland land managers. Their participation is likely to identify relevant and robust adaptive responses that are most likely to be included in regional and property management decisions. The process developed here for the grazing industry could be modified and used in other industries and sectors. By 2030, some areas of northern Australia will experience more droughts and lower summer rainfall. This poses a serious threat to the rangelands. Although the impacts and adaptive responses will vary between ecological and geographic systems, climate change is expected to have noticeable detrimental effects: reduced pasture growth and surface water availability; increased competition from woody vegetation; decreased production per head (beef and wool) and gross margin; and adverse impacts on biodiversity. Further research and development is needed to identify the most vulnerable regions, and to inform policy in time to facilitate transitional change and enable land managers to implement those changes.

Action learning in partnership with Landcare and catchment management groups to support increased pasture sowings in southern inland Queensland

The incorporation of sown pastures as short-term rotations into the cropping systems of northern Australia has been slow. The inherent chemical fertility and physical stability of the predominant vertisol soils across the region enabled farmers to grow crops for decades without nitrogen fertiliser, and precluded the evolution of a crop–pasture rotation culture. However, as less fertile and less physically stable soils were cropped for extended periods, farmers began to use contemporary farming and sown pasture technologies to rebuild and maintain their soils. This has typically involved sowing long-term grass and grass–legume pastures on the more marginal cropping soils of the region. In partnership with the catchment management authority, the Queensland Murray–Darling Committee (QMDC) and Landcare, a pasture extension process using the LeyGrain™ package was implemented in 2006 within two Grain & Graze projects in the Maranoa-Balonne and Border Rivers catchments in southern inland Queensland. The specific objectives were to increase the area sown to high quality pasture and to gain production and environmental benefits (particularly groundcover) through improving the skills of producers in pasture species selection, their understanding and management of risk during pasture establishment, and in managing pastures and the feed base better. The catalyst for increasing pasture sowings was a QMDC subsidy scheme for increasing groundcover on old cropping land. In recognising a need to enhance pasture knowledge and skills to implement this scheme, the QMDC and Landcare producer groups sought the involvement of, and set specific targets for, the LeyGrain workshop process. This is a highly interactive action learning process that built on the existing knowledge and skills of the producers. Thirty-four workshops were held with more than 200 producers in 26 existing groups and with private agronomists. An evaluation process assessed the impact of the workshops on the learning and skill development by participants, their commitment to practice change, and their future intent to sow pastures. The results across both project catchments were highly correlated. There was strong agreement by producers (>90%) that the workshops had improved knowledge and skills regarding the adaptation of pasture species to soils and climates, enabling a better selection at the paddock level. Additional strong impacts were in changing the attitudes of producers to all aspects of pasture establishment, and the relative species composition of mixtures. Producers made a strong commitment to practice change, particularly in managing pasture as a specialist crop at establishment to minimise risk, and in the better selection and management of improved pasture species (particularly legumes and the use of fertiliser). Producers have made a commitment to increase pasture sowings by 80% in the next 5 years, with fourteen producers in one group alone having committed to sow an additional 4893 ha of pasture in 2007–08 under the QMDC subsidy scheme. The success of the project was attributed to the partnership between QMDC and Landcare groups who set individual workshop targets with LeyGrain presenters, the interactive engagement processes within the workshops themselves, and the follow-up provided by the LeyGrain team for on-farm activities.

Climate change effects on pasture systems in south-eastern Australia.

Climate change projections for Australia predict increasing temperatures, changes to rainfall patterns, and elevated atmospheric carbon dioxide (CO2) concentrations. The aims of this study were to predict plant production responses to elevated CO2 concentrations using the SGS Pasture Model and DairyMod, and then to quantify the effects of climate change scenarios for 2030 and 2070 on predicted pasture growth, species composition, and soil moisture conditions of 5 existing pasture systems in climates ranging from cool temperate to subtropical, relative to a historical baseline. Three future climate scenarios were created for each site by adjusting historical climate data according to temperature and rainfall change projections for 2030, 2070 mid-and 2070 high-emission scenarios, using output from the CSIRO Mark 3 global climate model. In the absence of other climate changes, mean annual pasture production at an elevated CO2 concentration of 550 ppm was predicted to be 24-29% higher than at 380 ppm CO2 in temperate (C-3) species-dominant pastures in southern Australia, with lower mean responses in a mixed C-3/C-4 pasture at Barraba in northern New South Wales (17%) and in a C-4 pasture at Mutdapilly in south-eastern Queensland (9%). In the future climate scenarios at the Barraba and Mutdapilly sites in subtropical and subhumid climates, respectively, where climate projections indicated warming of up to 4.4 degrees C, with little change in annual rainfall, modelling predicted increased pasture production and a shift towards C-4 species dominance. In Mediterranean, temperate, and cool temperate climates, climate change projections indicated warming of up to 3.3 degrees C, with annual rainfall reduced by up to 28%. Under future climate scenarios at Wagga Wagga, NSW, and Ellinbank, Victoria, our study predicted increased winter and early spring pasture growth rates, but this was counteracted by a predicted shorter spring growing season, with annual pasture production higher than the baseline under the 2030 climate scenario, but reduced by up to 19% under the 2070 high scenario. In a cool temperate environment at Elliott, Tasmania, annual production was higher than the baseline in all 3 future climate scenarios, but highest in the 2070 mid scenario. At the Wagga Wagga, Ellinbank, and Elliott sites the effect of rainfall declines on pasture production was moderated by a predicted reduction in drainage below the root zone and, at Ellinbank, the use of deeper rooted plant systems was shown to be an effective adaptation to mitigate some of the effect of lower rainfall.

Submission for the Inquiry into the Establishment of a Queensland Health Promotion Commission

This submission outlines eight evidence-based recommendations for consideration by the inquiry committee to achieve the goal of improved and sustained health and wellbeing among Queenslanders. For the Queensland Government to be effective in establishing a commission to improve and sustain health and wellbeing, we recommend the eight actions.

Meeting of the Joint Distribution Committee and the Executive Committee of the American Jewish Relief Committee 1918 in New York

Reproduction of a painting of a meeting of the Joint Distribution Committee (representing the American Jewish Relief Committee, the Central Rellief Committee and the People's Relief Committee) and the Executive Committee of the American Jewish Relief Committee, with chairman Felix Warburg, secretary Albert Lucas, stenographer Mrs. F. Friedman, executive director Boris Bogen, comptroller Harriet Lowenstein, associate treasurer Paul Baerwald and treasurer Arthur Lehman; Office of Mr. Felix M. Warburg, 52 William Street, New York

From garamut to mobile phone: Communication change in rural Papua New Guinea

This article presents the attitudinal response of rural villagers in Papua New Guinea to mobile telephony, based on a threshold study made during the early stages of its adoption. The research indicates that the introduction of mobile telecommunications has generally been viewed positively, with mobile phones affording social interaction with loved ones. Nonetheless, negative concerns have been strongly felt, notably financial costs and anxiety about mobile phones aiding in the coordination of extramarital liaisons and criminal activities. The communities investigated previously had scant access to modern communication technologies, some still using traditional means such as wooden slit drums, known locally as garamuts. The expansion of mobile network coverage has introduced into communal village life the capability to communicate dyadically and privately at a distance. Investigation into the adoption of mobile phones thus promotes understanding about traditional means of communication and notions of public and private interactions.

Temperature dependence of the surface conductivity of YBa2Cu3O7−δ accompanying the change in the concentration of dimerized oxygen holes

The intensity of inelastically scattered electrons measured by electron energy loss spectroscopy has been employed to monitor the surface conductivity of YBa2Cu3O6.9 as a function of temperature. The study shows a drastic change in surface conductivity precedes the superconducting transition at 90K. The increase in surface conductivity is accompanied by the formation of dimerized holes in the oxygen derived p-band. This phenomenon is not observed in the non-superconducting YBa2Cu3O6.2.

Mapping the integrity of differential obligations within the United Nations framework convention on climate change

This chapter unpacks public institutional integrity concepts through an examination of differential obligations within the global climate regime.