Recover : A seven-element concept for evaluating recovery

In recent years empirical investigations into service recovery have examined the impact of firm’s recovery attempt on consumers’ post-purchase decisions. However, these measurements tended to be based on one or two outcomes ignoring the complexity of post purchase behavior. As such, there exist limited empirical studies of multiple consumer outcomes. This paper considers the need to examine the impact of service recovery processes using multiple customer-based factors. Seven outcome issues are identified and described in this paper that relate to the essence of a positive after-service affiliations of customer with the service provider.

Assessment of indigenous older peoples ’ needs for home and community care in remote central Australia

The Home and Community Care (HACC) program in Australia provides services which supports older people to live at home. Individual HACC organisations are generally responsible for initial assessment of eligibility and need of clients presenting for services. This paper reports on a project which aimed to develop an understanding of the various approaches to assessment of client needs in Central Australia. The majority of clients in this geographical area are indigenous. The project was initiated in recognition of the primary importance of assessment in determining service access and service delivery and of the particular challenges faced by service providers in remote areas. This paper discusses key project findings including the client group and services provided, initial needs assessment and care planning processes. Evident inconsistencies in practice reflect a variety of complex contextual factors. Staff in remote areas have an inadequate knowledge base to draw upon to assist them with assessment and care planning decisions, and further research and professional development is required.

Mental illness and substance use : an Australian perspective

This paper presents a review of the literature of service trends and practice recommendations for management of those with the dual diagnosis of mental illness and substance abuse. The method for the review was to search bibliographical data bases and hand held literature published in English between 1990 and 2007. Using the search terms dual diagnosis, and co-morbidity and mental illness, 93 abstracts were selected and reviewed. The authors concluded that a collaborative approach to care with better integration of drug and alcohol services within mental health would benefit clients with a dual diagnosis. Improved education to enhance the assessment and diagnosis of this client group is also considered essential for clinicians in both mental health and alcohol and drugs services.

The measurement of the number, uniqueness, and valence of brand associations across three product categories

The research reported in this paper investigated the measurement of brand associations across three product categories. Brand associations had not been tested previously across all three categories of fast-moving consumer good, service, and durable in the one study. A free association method was used to generate brand associations for a fast-moving consumer good (shampoo), a service (banks) and a durable good (cars). The findings indicate that the first brand a respondent recalled has the greatest number of positive, unique and total brand associations. In addition, the findings indicated that durable goods have the highest number of associations, and the greatest number of unique and favourable brand associations. Further, banks and financial services had the fewest positive associations, which may have reflected attitudes to banks at the time of the research. These findings have implications for the manner in which respondents use information to recall brands, and how they process brand information when faced with a cue. Respondents use a depth and breadth of brand associations to generate brand information.

Second Life and the role of educators as regulators

Regulation, governance and harms stemming from the use of virtual worlds and other Massive Multi Media Online Role Playing Games (MMMORPGs) in higher education, are poorly understood and under-researched issues. Second Life, developed by Linden Labs, provides users with a series of generic ‘terms of service’ and codes of conduct, yet place the bulk of responsibility on individual users or groups to report misbehaviour or develop their own behavioural codes, enforcement procedures and punishments suited to their particular needs. There is no guidebook to assist users in the processes of risk identification and management. As such, the various benefits of MMMORPG technologies could be offset by the risks to users and user-groups from a range of possible harms, including the impact of actual or perceived violence within teaching and learning settings.

While cautioning against the direct translation of real-world regulatory principles into the governance of virtual worlds, this paper suggests theoretical and practical guidance on these issues can be taken from recent criminological developments. Using Lawrence Lessig’s (1999) landmark work on cyber-regulation as a starting point, this paper examines the literature on video-game violence to illustrate the need for educators show awareness of both real and perceived risks in virtual worlds as a core element of an emerging educational pedagogy. We identify how the multiple roles of the virtual-world educator become useful in framing this pedagogy to improve student learning, to dispel myths about the risks of immersive technologies and advocate for their adoption and acceptance in the educational community.

Introducing active support in the United States : staff training developments and research directions

Aim: Active Support, an evidence-based intervention developed in the UK and tested in Australia, enables direct support professionals to engage people with high support needs in meaningful and rewarding every day activities. This paper outlines the practical details of adapting the Active Support curriculum for service providers in the US and outlines an evaluation methodology that will inform both service delivery and future developments of Active Support.

Method: Active Support curricula developed in the UK and Australia were adapted for implementation the US.Train-the-trainer activities were conducted in early 2008 in three group homes serving 12 people with intellectual or developmental disabilities. A formative evaluation process was used to identify changes in the materials and training design needed to support a randomized controlled trial of the intervention in 20 small group homes.

Results: Modifications in the delivery of training are needed to account for differences in scheduling patterns and high turnover rates in US group homes, and to adjust British/Australian terminology to the U.S. context.

Conclusions: The translation of active support into the U.S. context requires modifications to support successful implementation. Research is planned to document the success of the modified curriculum in improving outcomes for persons with disabilities.

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.

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.

Quality of occupational health provision: two rating scales and their determinants

Background To develop quality scales for occupational health services (OHSs) and describe and explain variation in quality across the UK university sector.

Methods Analysis of data from a national survey, to which 93 of 117 (79%) UK universities responded, and from the Higher Education Statistics Agency. Two quality scales were generated, one from the 1985 International Labour Organization recommendations on OHSs and one from clinicians’ perceptions (good, adequate, poor) about their OHS. The determinants examined were number of university staff, type of OHS (in-house, contracted, none/other), number of full-time equivalent occupational health doctors and nurses and OHS leadership (doctor, nurse, other).

Results There was wide variation in quality and a correlation (r = 0.65) between scales. In-house service, increasing service size and leadership by a doctor or nurse were determinants of higher quality; size of the university was not statistically significant after taking account of these factors.

Conclusions Some university OHSs may not be structured or operated to promote the highest quality of service. Inspection of individual quality scale items may be informative. These scales may be applicable in other employment sectors.

NGOs, enterprise and rural development

Non-Government Welfare Organisations (NGOs) in rural areas have traditionally relied upon the state for a large part of their revenue which in turn provides the state with the capacity to impose strict monitoring and evaluation. However the tightening of state funding has either forced NGOs to stretch their own resource to the limit or to become more enterprising and innovative in their desire to provide people with access to an ever increasing range of community-based services and opportunities for connection with their local communities. The term that is often used for these new approaches is ‘social enterprise’ that has been defined as a business with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or the community, rather than being driven by the need to maximise profit for shareholders and owners’ . It is most often seen as an interface between public and private sector, being part of neither but engaging closely with both through partnerships, stakeholding and joint ventures as well as through complex trading and contracting relationships.

Such broad definitions however do not give much guidance to how particular NGOs can shift to a social enterprise model and still remain within their chosen missions. It is the very processes of re-imagining and reforming their enterprise that is a vital element in moving to a successful social enterprise practice. Accordingly this project focuses on two NGOs in different parts of the world (Brophy Family and Youth Services in Warrnambool. Australia and Aberdeen Foyer in Aberdeen, Scotland) that have developed (and are developing) new ways of approaching their roles as service providers and early intervention agents for youth in their local areas. Since both organisations have faced (and are facing) issues associated with depleting state allocated resources they are attempting to break new ground in the ways in which they redevelop their work with youth. Both agencies are leading the way in developing a broader approach that draws together disparate element of a social enterprise model. The project analyses the processes used by these two agencies to develop as social enterprises and how likeminded agencies can use the model for capability enhancement.

Enablers and barriers to accessing mental health services for adults with high prevalence psychological disorders in South West Victoria

Knowing what services are available and how to access them can be challenging in rural areas. The aim of the South West Mental Health Mapping project was to identify the level, accessibility and effectiveness of mental health services for high prevalence psychological disorders amongst the adult population in the South West region of Victoria. This study includes data from a number of sources: regional records of the number and location of health professionals; a telephone survey of 1297 people in five Local Government Areas in the region; and a social network analysis of contact points. Additional qualitative interviews and surveys were conducted with 25 service recipients and 37 health professionals to identify issues from different perspective. This paper will focus on the social network analysis of the project. It highlights the relative prominence of each type of service provider within the overall network. The social network map shows the centrality of the General Practitioner and the wide range of agencies that become involved in supporting people with mental health issues. The discussion identifies primary contact points for people seeking help and places of referral. The main barrier acknowledged by people requiring assistance was lack of knowledge about where to go for help. Enablers included Medicare Better Access funded schemes. The findings show that there is a reasonable range of mental health professionals across the region, although there are challenges with recruitment and retention of staff. Even with available services, a major problem is communicating this information to potential consumers

Examining the development of the Victorian Certificate of Applied Learning and its implications for schools and teacher education in Australia

The Victorian Certificate of Applied Learning (VCAL) is a very successful senior secondary school qualification introduced in the Australian state of Victoria in 2002. Applied learning in the VCAL engages senior students in a combination of work-based learning, service-learning, and project-based learning and aims to provide them with the skills, knowledge, and attitudes to make informed choices regarding pathways to work and further education. The program has enjoyed rapid growth and its system-wide adoption by Victorian secondary schools, Technical and Further Education (TAFE) institutions, Registered Training Organizations (RTOs), and Adult and Community Education (ACE) providers has broadened significantly the range of senior schooling pathway options for young people. This paper will examine reasons for developing an applied learning senior secondary certificate and its rapid growth in Victoria since 2002. The authors draw on a number of case studies to profile the unique nature of applied learning in the VCAL, including its dimensions of service learning, work-based learning, and project-based learning. These case studies are also used to discuss a number of implications that have emerged from the use of applied learning in the VCAL, including approaches to teaching and assessment that will support applied learning and the development of new partnerships between VCAL providers and community partners. Finally, the paper considers significant implications the VCAL has created for teacher education in Victoria by discussing the new Graduate Diploma of Education (Applied Learning) developed by Deakin University.

Elevated intracardiac angiotensin II leads to cardiac hypertrophy and mechanical dysfunction in normotensive mice

Introduction
Angiotensin II (Ang II) is known to induce cardiac growth and modulate myocardial contractility. It has been reported that elevated levels of endogenous Ang II contribute to the development of cardiac hypertrophy in hypertensives. However, the long-term functional effects of cardiac exposure to Ang II in normotensives is unclear.

A recently developed transgenic mouse (TG1306/1R), in which cardiac-specific overproduction of Ang II produces primary hypertrophy, provides a new experimental model for investigation of this phenotype. The aim of the present study was to use this model to investigate whether there is a functional deficit in primary hypertrophy that may predispose to cardiac failure and sudden death. We hypothesised that primary cardiac hypertrophy is associated with mechanical dysfunction in the basal state.

Methods
Normotensive heterozygous TG1306/1R mice harbouring multiple copies of a cardiac-specific rat angiotensinogen gene were studied at age 30—40 weeks and compared with age-matched wild-type littermates. Left ventricular function was measured ex vivo in bicarbonate buffer-perfused, Langendorffmounted hearts ( at a perfusion pressure of 80 mmHg, 37°C) using a fluid-filled PVC balloon interfaced to a pressure transducer and digital data acquisition system.

Results
There was no difference in the mean (±SEM) intrinsic heart rate of TG1306/1R and wild-type control mice (357.4±11.8 vs. 367.5±20.9 bpm, n=9 & 7). Under standardised end-diastolic pressure conditions, TG1306/1R hearts exhibited a significant reduction in peak developed pressure (132.2±9.4 vs. 161.5±3.1 mmHg, n=9 & 7, p<0.05) and maximum rate of pressure development (3566.7±323.7 vs. 4486.3±109.4 mmHg, n=9 & 7, p<0.05). TG1306/1R mice show a significant correlation between incidence of arrhythmia and increasing heart size (Spearman's correlation coefficient 0.61).

Conclusion
These data demonstrate that chronic in vivo exposure to elevated levels of intra-cardiac Ang II is associated with significant contractile abnormalities evident in the ex vivo intact heart. Our findings suggest that endogenous overproduction of cardiac Ang II, independent of changes in blood pressure, is sufficient to induce ventricular remodelling that culminates in impaired cardiac function which may precede failure.

Investigation of overweight and obesity management in a rural primary health care setting

Background : The rural region of interest has one main central medical clinic and several smaller outlying clinics. The services available for weight management include dietetic services, community-based groups and bariatric surgery. At present, no formal area specific referral pathway exists for the treatment of overweight and obesity.
Aims & rationale/Objectives : To investigate general practitioners':
- assessment practices and experiences with overweight and obese clients
- experience of different treatment options for overweight and obesity
- perceived barriers to overweight and obesity management.
Methods : A self-administered survey will be sent to general practitioners within the region of interest. The survey was designed to investigate current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management. Participants will also be offered a brief interview to discuss the following topics; Usefulness of NHMRC's Overweight and Obesity Guidelines; barriers and frustrations of weight management, GP's and dietitian's roles in overweight and obesity treatment.
Principal findings : It is expected the principal findings will include details about methods used to determine overweight and obesity; factors considered when selecting patients for treatment; favoured treatment options of GPs; perceived barriers and frustrations of managing overweight and obese patients.
Discussion : Overweight and obesity are significant health issues in Australia, with recent data indicating more than 60% of Australian adults are affected (NHMRC, 2003). Studies have also suggested that the prevalence of overweight and obesity is higher in rural populations (Coulson, 2005). GPs have been recognised as an important contributor in the treatment of overweight and obesity (Campbell, 2000). There have been guidelines produced to assist GPs, however the extent to which guidelines are utilised or their perceived effectiveness have not yet been investigated.
Implications : It is thought that an investigation into current methods of assessing overweight and obesity; treatment options; and perceived barriers to successful weight management will provide valuable information to inform primary health care service provision and future quality improvement directions.
Presentation type : Poster
Session theme : Primary health care delivery

Research indepedence matters for practitioners and researchers in the addictions

As governments, industry bodies, and other interest groups become more adept at influencing the conduct and dissemination of research, it is increasingly important that the alcohol and other drug (AOD) sector maintains and protects the integrity of its evidence base. This commentary discusses the level and type of influence being exerted on the research process by different interest groups within the field. It explores the impact and influence of funding bodies, other interest groups, and social systems on addiction and recovery using relevant examples to identify questions for practitioners and researchers to consider when encountering interested parties in their day-to-day practice. Ultimately, it is service users and clinicians at the "front line" of recovery who have the most to lose from research findings that have been unduly influenced. The best protection against bias in these forms is to practice critical self-reflection and to keep openly and honestly debating those things that we find most challenging.