The knowledge translation pathway for timely diagnosis of dementia

There has been significant debate about the value of screening for dementia, and the need for early diagnosis. Options include Gene testing, early risk assessment, screening, case finding and review when a patient or carer identify that they have symptoms. This paper is not focused on these early approaches to identifying people with dementia. It is focused on the period when a patient or a carer has recognised that there are some memory problems and they are seeking assistance with a diagnosis or explanation in relation to memory loss.

Found in translation : debating the abstract elements of cultures through actor training styles

While the synthesis of acting methodologies in intercultural acting has been discussed at length, little discussion has focussed on the potential of diverse actor training styles to affect performance making and audience reception. This article explores a project where the abstract elements of the British and American cultures were translated in rehearsal and in production through the purposeful juxtaposition of two differing actor training styles: the British ‘traditional’ approach and the American Method. William Nicholson’s Shadowlands was produced by Crossbow Productions at the Brisbane Powerhouse in 2010. Nicholson’s play contains a discourse on the cultural cringe of British – American relations. As a research project, the production aimed to extend and augment audience experience of the socio-cultural tensions inherent in the play by juxtaposing two seemingly culturally inscribed approaches to acting. Actors were chosen who had been trained under a traditional conservatoire approach and the American Method. A brief overview of these acting approaches is followed by a discussion centred on the project. This article analyses how from the casting room to the rehearsal room to the mise en scene and into the audience discussions, cultural issues were articulated, translated and debated through the language of acting.

Lost in translation?

The vast majority of research in the psychology of reproduction and infancy ultimately aims to improve the health and well-being of individuals in meaningful ways. Despite diversity in topics of study, research in our field can support improved planning of health and social services and the development and implementation of policy, practice guidelines and programmes to enhance the experiences of women, men and children. Research published in the current issue demonstrates this practical utility. In this issue of the journal Chin, Hall and Daiches’ meta-synthesis of fathers’ experiences of the transition to parenthood and Bradley and Slade’s review of fathers’ mental health problems following the birth of a child legitimate men’s role in the maternity care system and provide a robust basis for the development of health policies and programmes that can address their needs. Together, their findings highlight the importance of improved tailoring of antenatal education (practical accessibility and content relevance) for fathers, and opportunities for postnatal reflection, debriefing, and support...

A profile of Australian travel journalists' professional views and ethical standards

Despite significant changes in mainstream journalism in recent decades, journalistic fields beyond the news have been little explored. In an attempt to contribute to a deeper understanding of such fields, this article examines the role perceptions of 85 Australian travel journalists. By viewing travel journalism as a distinct field of practice that is affected by a unique mix of influences, this study identifies five dimensions of practitioners’ role perceptions. These relate to travel journalists’ views of themselves as Cultural Mediators, Critics, Entertainers, Information Providers and Travellers. In addition, the study examines in some depth the ethical standards of travel journalists. Determinants of these views and standards are explored. The study argues that, in light of travel journalists’ increasingly important role in reporting about foreign places, more remains to be done to promote travel stories that show a deeper understanding of other cultures and which contain a more critical appraisal of destinations.

Recontextualising policy discourses : a Bernsteinian perspective on policy interpretation, translation, enactment

This paper contributes to critical policy research by theorising one aspect of policy enactment, the meaning making work of a cohort of mid-level policy actors. Specifically, we propose that Basil Bernstein’s work on the structuring of pedagogic discourse, in particular, the concept of recontextualisation, may add to understandings of the policy work of interpretation and translation. Recontextualisation refers to the relational processes of selecting and moving knowledge from one context to another, as well as to the distinctive re-organisation of knowledge as an instructional and regulative or moral discourse. Processes of recontextualisation necessitate an analysis of power and control relations, and therefore add to the Foucauldian theorisations of power that currently dominate the critical policy literature. A process of code elaboration (decoding and recoding) takes place in various recontextualising agencies, responsible for the production of professional development materials, teaching guidelines and curriculum resources. We propose that mid-level policy actors are crucial to the work of policy interpretation and translation because they are engaged in elaborating the condensed codes of policy texts to an imagined logic of teachers’ practical work. To illustrate our theoretical points we draw on data; collected for an Australian research project on the accounts of mid-level policy actors responsible for the interpretation of child protection and safety policies for staff in Queensland schools.

A new national women's health policy : legal, ethical and policy initiatives to support women's health

In 1989 the first National Women's Health Policy was launched in Australia. Now, 20 years later, the Federal Government has announced plans for the development of a new National Women's Health Policy to address the health needs of Australian women. The Policy will be based on five principles: gender equity; health equity between women; a focus on prevention; an evidence base for interventions; and a life course approach. This editorial examines the role for law in the development of a new National Women's Health Policy. It considers the relevance of regulatory frameworks for health research in supporting an evidence base for health interventions and analyses the requirement in the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research for "fair inclusion" of research participants. The editorial argues for a holistic approach to women's health that includes regulatory frameworks for research, identification of funding priorities for research, and the need for a dedicated government department or agency to promote women's health.

Managing Ethical Dilemmas

This chapter reviews almost a decade of research and writing undertaken by the authors into ethical dilemmas faced by leaders in a number of different operational contexts, including schools, universities and the public sector. The importance of this body of work is emphasised by one of our research participants who argued that ethical dilemmas were the 'bread and butter' of what leaders do. The chapter comprises four main sections. The first section overviews key theoretical aspects as background to the chapter, including relevant discussions about ethics and ethical decision-making. The second section synthesises the research findings from our work in the three contexts noted above, drawing out a set of learnings that contribute to better understandings of the nature, complexities and challenges of ethical dilemmas. This section is followed by a discussion of an explanatory conceptual model of ethical dilemmas that was developed initially from the literature and confirmed by our research. The model reminds us of some of the critical issues at play in ethical dilemmas, and some of the consequences and implications for organisational culture building they can generate. By way of a short scenario, the final section provides a theory-to-practice illustration of an ethical dilemma in action. A set of recommendations, drawn from the ideas of school leaders who have worked with this and similar dilemmas, is offered as a way forward to better understanding and resolution of such dilemmas so prevalent in our schools today.

Digital culture : blurred boundaries and ethical considerations

The Weberian sense of work and life suggests that working is something around which the rest of life flows. Moreover, work life and domestic life have been defined as separate for most people based on physical structures. That is, being physically in a building at work limited your ability to interact with those who are not nearby – not part of work. As such, social conventions regarding the uses of media at work have become part of our cultural sensibilities – we “know” it is not proper to have romantic discourse over the office phone, much less romance during work! Doing so becomes news. Yet, despite the construction of such distinctions, these workspaces and places have always been difficult to render as such. For example, one might consider the relatively recent development of teleworking from the 1980s or the “putting out system”[1] which dates back to the 1400s – both requiring work in the home. The papers in this special issue draw our attention to some of the ethical issues raised by the growing pervasiveness of information and communications technologies (ICTs) in our everyday lives and the fact that it is becoming increasingly difficult to make distinctions between being somewhere (like work) and being away from some things (like one’s friends, social interests and other parts of life that are not integrated into this space or place [2] )...

Female genital cutting : An overview of Australian legal principles, ethical controversies, and medical, legal and social challenges

Female genital cutting (also often called female genital mutilation, or female circumcision) is a cultural practice that originated thousands of years ago. Female genital cutting has various forms, some of which are more invasive than others, but all of which produce health, legal and social consequences for those involved. Due to patterns of immigration in Australia, especially since the 1990s, there are women in Australia who have experienced female genital cutting. There may be some families, or some parents, who still hold a cultural commitment to female genital cutting. As a result, female genital cutting presents complex legal, ethical, medical and social challenges in contemporary Australian society. Medical practitioners and other health and welfare workers may encounter women who have experienced genital cutting and who require treatment for its sequelae. Currently, legislative frameworks for female genital cutting vary across states and territories, including the penalties for conducting it, and for removing a child for the purpose of conducting it outside Australia. This presentation provides an overview of the history, nature and consequences of the various forms of female genital cutting, and of the major Australian legal principles, ethical controversies, and medical, legal and social challenges in this field.

Ethical values in emergency medical services: A pilot study

Background Ambulance professionals often address conflicts between ethical values. As individuals’ values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. Objectives To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals’ value profiles in Spain and Sweden. Methods The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. Ethical considerations This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. Findings Spanish professionals favoured justice and Swedish professionals’ rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. Discussion Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals’ moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer’s professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. Conclusion A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally – especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care.

Voluntary palliated starvation : A lawful and ethical way to die?

Increasingly, individuals want control over their own destiny. This includes the way in which they die and the timing of their death. The desire for self-determination at the end of life is one of the drivers for the ever-increasing number of jurisdictions overseas that are legalising voluntary euthanasia and/or assisted suicide, and for the continuous attempts to reform state and territory law in Australia. Despite public support for law reform in this field, legislative change in Australia is unlikely in the near future given the current political landscape. We argue that there may be another solution which provides competent adults with control over their death and to have any pain and symptoms managed by doctors, but which is currently lawful and consistent with prevailing ethical principles. ‘Voluntary palliated starvation’ refers to the process which occurs when a competent individual chooses to stop eating and drinking, and receives palliative care to address pain, suffering and symptoms that may be experienced by the individual as he or she approaches death. In this article, we argue that, at least in some circumstances, such a death would be lawful for the individual and doctors involved, and consistent with principles of medical ethics.

Can we do better? Researchers' experiences with ethical review boards on projects with later life as a focus

The goal of this study was to describe researchers' experiences in submitting ethical proposals focused on older adult populations, including studies with persons with dementia, to ethical review boards. Ethical approval was granted for an online survey. Researchers were recruited via listservs and snowballing techniques. Participants included 157 persons (73% female) from Australia and the United States, with a mean age of 46 (±13). Six main issues were encountered by researchers who participated in this survey. In descending order, these included questions regarding: informed consent and information requirements (61.1%), participants' vulnerability, particularly for those with cognitive impairments (58.6%), participant burden (44.6%), data access (29.3%), adverse effects of data collection/intervention (26.8%), and study methodology (25.5%). An inductive content analysis of responses revealed a range of encounters with ethical review panels spanning positive, negative, and neutral experiences. Concerns voiced about ethical review boards included committees being overly focused on legal risk, as well as not always hearing the voice of older research participants, both potential and actual. Respondents noted inability to move forward on studies, as well as loss of researchers and participant groups from gerontological and clinical research as a result of negative interactions with ethics committees. Positive interactions with the committees reinforced researchers' need to carefully construct their research approaches with persons with dementia in particular. Suggested guidelines for committees when dealing with ethics applications involving older adults include self-reflecting on potential biases and stereotypes, and seeking further clarification and information from gerontological researchers before arriving at decisions.

Treatment for gender dysphoria in children : the new legal, ethical and clinical landscape

- Gender dysphoria is a condition in which a child's subjectively felt identity and gender are not congruent with her or his biological sex. Because of this, the child suffers clinically significant distress or impairment in social functioning. - The Family Court of Australia has recently received an increasing number of applications seeking authorisation for the provision of hormones to treat gender dysphoria in children. - Some medical procedures and interventions performed on children are of such a grave nature that court authorisation must be obtained to render them lawful. These procedures are referred to as special medical procedures. - Hormonal therapy for the treatment of gender dysphoria in children is provided in two stages occurring years apart. Until recently, both stages of treatment were regarded by courts as special medical treatments, meaning court authorisation had to be provided for both stages. - In a significant recent development, courts have drawn a distinction between the two stages of treatment, permitting parents to consent to the first stage. In addition, it has been held that a child who is determined by a court to be Gillick competent can consent to stage 2 treatment. - The new legal developments concerning treatment for gender dysphoria are of ethical, clinical and practical importance to children and their families, and to medical practitioners treating children with gender dysphoria. Medical practitioners should benefit from an understanding of the recent developments in legal principles. This will ensure that they have up-to-date information about the circumstances under which treatment may be conducted with parental consent, and those in which they must seek court authorisation.