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.

Teaching Zambian traditional birth attendants to monitor growth of infants : evaluation of an education program

The high infant mortality in Zambia is largely attributable to malnutrition. It is exacerbated by the inability of mothers to recognise threats to nutritional status and take corrective action. Advice in ‘Health Centres’ is often inaccessible to mothers. The Traditional Birth Attendants (TBAs) work with pregnant women in local communities, and the purpose of this study was to develop and implement an educationprogram in growth monitoring and nutrition for the TBAs and then to evaluate its effects. Twenty five TBAs from two peri-urban areas of Kitwe were enrolled in this pilot study and eighteen completed the program. The researcher developed and taught a program to the TBAs over ten days. A pretest was given before the teaching program to enable the researcher to obtain information about the knowledge and skills of the TBAs. Following the teaching program the TBAs were re-tested, with the same questionnaire. Focus groups were conducted to enable the TBA to provide information on the teaching materials and the education program. The TBAs then returned to their communities and put into practice the skills and knowledge they had learned for six months. Their practice was monitored by a trained Public Health Nurse. The researcher also surveyed 38 pregnant women about their knowledge of growth monitoring and nutrition before the TBAs went into the field to work with their local communities. The same questionnaire used with the pregnant women was administered to 38 new mothers with children aged 0 to 6 months to gain information of their knowledge and skills following the work of the TBAs. The program was evaluated by assessing the extent to which TBAs knowledge and skills were increased, the knowledge and understanding of a selection of their clients and the rates of malnutrition of infants in the area under study. The results from the research clearly indicated that the teaching program on growth monitoring and nutrition given to the selected group of TBAs had a positive effect on their knowledge and skills. It was found that the teaching developed their knowledge, practical skills, evaluative skills. That they were able to give infants’ mothers sound advice regarding their children’s nutrition was revealed by the mother’s increased knowledge and the decrease in numbers of malnourished children in the study areas at the conclusion of the research. The major outcomes from the study are: that Zambian TBAs can be taught to carry out an expanded role; field experience is a key factor in the teaching program; making advice available in local communities is important; and preliminary data on the Zambian experience were generated. Recommendations are: The pilot program should be expanded with continuing support from the Health Department. Similar educational programs should be introduced into other areas of Zambia with support from the Ministry of Health. That in administering a teaching program: Sufficient time must be allocated to practical work to allow poorly educated women to attain the basic skills needed to master the complex skills required to competently reduce faltering in their communities. The teaching materials to illustrate nutritional principles for feeding programs must be developed to suite locally available foods and conditions. Methods of teaching should suit the local area, for example, using what facilities are locally available. The timing of the teaching program should be suitable for the TBAs to attend. This may vary from area to area, for example it may be necessary to avoid times traditionally given to fetching water or working in the fields. For similar reasons, the venue for the teaching program should be suitable to the TBAs. The teachers should go into the TBAs’ community rather than causing disruption of the TBAs’ day by expecting them to go to the teacher. Data should be collected from a larger group of TBAs and clients to enable sophisticated statistical analysis to complement data from this pilot program. The TBAs should be given recognition for their work and achievement. This is something which they asked for. They do not ask for payment, rather acknowledgment through regular follow up and approbation.

To what extent do nurses use research in clinical practice? A systematic review

Background : In the past forty years, many gains have been made in our understanding of the concept of research utilization. While numerous studies exist on professional nurses' use of research in practice, no attempt has been made to systematically evaluate and synthesize this body of literature with respect to the extent to which nurses use research in their clinical practice. The objective of this study was to systematically identify and analyze the available evidence related to the extent to which nurses use research findings in practice.

Methods : This study was a systematic review of published and grey literature. The search strategy included 13 online bibliographic databases: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, EMBASE, HAPI, Web of Science, SCOPUS, OCLC Papers First, OCLC WorldCat, ABI Inform, Sociological Abstracts, and Dissertation Abstracts. The inclusion criteria consisted of primary research reports that assess professional nurses' use of research in practice, written in the English or Scandinavian languages. Extent of research use was determined by assigning research use scores reported in each article to one of four quartiles: low, moderate-low, moderate-high, or high.

Results : Following removal of duplicate citations, a total of 12,418 titles were identified through database searches, of which 133 articles were retrieved. Of the articles retrieved, 55 satisfied the inclusion criteria. The 55 final reports included cross-sectional/survey (n = 51) and quasi-experimental (n = 4) designs. A sensitivity analysis, comparing findings from all reports with those rated moderate (moderate-weak and moderate-strong) and strong quality, did not show significant differences. In a majority of the articles identified (n = 38, 69%), nurses reported moderate-high research use.

Conclusions : According to this review, nurses' reported use of research is moderate-high and has remained relatively consistent over time until the early 2000's. This finding, however, may paint an overly optimistic picture of the extent to which nurses use research in their practice given the methodological problems inherent in the majority of studies. There is a clear need for the development of standard measures of research use and robust well-designed studies examining nurses' use of research and its impact on patient outcomes. The relatively unchanged self-reports of moderate-high research use by nurses is troubling given that over 40 years have elapsed since the first studies in this review were conducted and the increasing emphasis in the past 15 years on evidence-based practice. More troubling is the absence of studies in which attempts are made to assess the effects of varying levels of research use on patient outcomes.

Fundamental elements in examining a child’s right to education : a study of home education research and regulation in Australia

Home education provides valuable educational and developmental opportunities for children. An examination of Australia’s research indicates many best educational practices, including more informed mediation, contextualised learning, and opportunities to exercise autonomy. Key features include learning embedded in communities and program modification in response to students’ needs. Current state and territory legal requirements are examined within the context of this research and Australia’s obligations to international human rights treaties. All jurisdictions accept home education as one way to meet compulsory education requirements. The extent to which respective laws then reflect understanding of home education research and practice varies. Most jurisdictions allow for a variety of educational approaches. Some oversight regulation could however be modified to reflect a better understanding of home education. Consultation with home educators and reference to research would assist the development of more uniform legislation and policy across Australia, and enable better regulatory practice.

An integrated management systems approach to corporate sustainability

Purpose – This paper seeks to describe an integrated management systems (IMS) approach for the integration of corporate sustainability into business processes.
Design/methodology/approach – An extensive review of published literature was conducted. Building on existing research, the paper presents an original framework for structuring the integration of corporate sustainability with existing business infrastructure. The framework is supported by a detailed set of diagnostic questions to help guide the process. Both the framework and the diagnostic questions are based on the “Plan-Do-Check-Act” cycle of continuous improvement.
Findings – The paper highlights the need for a systematic means to integrate sustainability into business processes. Building on that point, the paper illustrates how an IMS approach can be used to structure the entire process of managing, measuring, and assessing progress towards corporate sustainability.
Practical implications – The paper should be of interest to both practitioners and researchers. The framework and diagnostic questions will help guide decision makers through the process of building sustainability into their core business infrastructure. Since the framework and diagnostic questions provide the flexibility to accommodate specific organizational contexts, it is anticipated that they will have wide applicability.
Originality/value – The paper makes several contributions. The framework provides a systematic approach to corporate sustainability that has not been elaborated on in previous publications. The unique set of diagnostic questions provides a means to evaluate the extent to which corporate sustainability has been integrated into an organization.

Identifying the extent, motivations and barriers to outsourcing of accounting services

In this paper we analyse the oursourcing of accounting services. The extent to which firms are currently outsourcing, or considering outsourcing such services, and the motivations and barriers associated with outsourcing are identified. Empirical data from a random sample of accounting firms are used in this analysis. Data indicate that the majority of accounting firms are either currently outsourcing or considering outsourcing and that they exopect the volume of oursourced services to increase. In contrast to the scholarly literature advocating labor arbitrage as the primary driver for organizations choosing to outsource, in this study it was found that the main factors underpinning the decision to outsource were the expediting of service delivary to clients, and to enable the firm to focus on its core competencies.

Insulin sensitivity in response to a single resistance exercise session in apparently healthy individuals

BACKGROUND: Regular resistance exercise completed for a number of weeks has been shown to increase insulin sensitivity and reduce the risk of diabetes-related complications. However, the acute responses to resistance exercise have not been adequately investigated in relation to training frequency.
AIM: To investigate the changes to insulin sensitivity in apparently healthy individuals following a single session of unaccustomed resistance exercise.
SUBJECTS AND METHODS: Ten sedentary, apparently healthy individuals performed a baseline oral glucose tolerance test and maximal strength testing. Participants then performed a single session of moderate-high intensity resistance exercise which was followed by 4 consecutive days of oral glucose tolerance testing, for which participants replicated their initial diet. Mean estimated insulin sensitivity change scores from baseline values and their 95% confidence intervals were compared to the previously determined values for a clinically meaningful change.
RESULTS: Two participants were identified as having hyperinsulinemia and their data were therefore removed from the main analysis. There was a clinically meaningful increase in insulin response (mean >7237 pmol·l⁻¹·120 min⁻¹) on all days following the exercise session and a clinically meaningful increase in glucose response (mean >81 mmol·l⁻¹·120 min⁻¹) on only the 3rd day following exercise. These changes suggest a potentially adverse short-term effect. Additionally, the 2 individuals with hyperinsulinemia displayed more extreme results.
CONCLUSION: These results suggest that insulin sensitivity may be impaired following a single session of unaccustomed resistance exercise for approximately 4 days in healthy untrained, older individuals. Further research is required for individuals with hyperinsulinemia

Methods and technologies to promote information-centered knowledge construction

This alternative event for the 2013 iConference is a combination of lightning talks, a demonstration of an assessment technology for knowledge construction in complex domains, and a hands-on exercise in using the tools discussed. The unifying logic for this presentation is that meaningful learning often involves solving challenging and complex problems that allow for multiple solution approaches and a variety of acceptable solutions. While it is important to prepare students to solve such problems, it is difficult to determine the extent to which various interventions and programs are contributing to the development of appropriate problem-solving strategies and attitudes. Simply testing domain knowledge or the ability to solve simple, single-solution problems may not provide support for improving individual student ability or relevant programs and activities. A reliable and robust methodology for assessing the relevant knowledge constructions of students engaged in solving challenging problems is needed, and that is our focus.

Employing sea-level rise scenarios to strategically select sea turtle nesting habitat important for long-term management at a temperate breeding area

Management strategies to protect endangered species primarily focus on safeguarding habitats currently perceived as important (due to high-density use, rarity or contribution to the biological cycle), rather than sites of future ecological importance. This discrepancy is particularly relevant for species inhabiting beaches and coastal areas that may be lost due to sea-level rise over the next 100 years through climate change. Here, we modelled four sea-level rise (SLR) scenarios (0.2, 0.6, 0.9 and 1.3 m) to determine the future vulnerability and viability of nesting habitat (six distinct nesting beaches totalling about 6 km in length) at a key loggerhead sea turtle (Caretta caretta) rookery (Zakynthos, Greece) in the Mediterranean. For each of the six nesting beaches, we identified (1) the area of beach currently used by turtles, (2) the area of the beach anticipated to become inundated under each SLR, (3) the area of beach anticipated to become unsuitable for nesting under each SLR, (4) the potential for habitat loss under the examined SLR, and (5) the extent to which the beaches may shift in relation to natural (i.e. cliffs) and artificial (i.e. beach front development) physical barriers. Even under the most conservative 0.2 m SLR scenario, about 38% (range: 31–48%) total nesting beach area would be lost, while an average 13% (range: 7–17%) current nesting beach area would be lost. About 4 km length of nesting habitat (representing 85% of nesting activity) would be lost under the 0.9 m scenario, because cliffs prevent landward beach migration. In comparison, while the other 2 km of beach (representing 15% nests) is also at high risk, it has the capacity for landward migration, because of an adjoining sand-dune system. Therefore, managers should strengthen actions on this latter area, as a climatically critical safeguard for future sea turtle nesting activity, in parallel to regularly assessing and revising measures on the current high-use nesting habitats of this important Mediterranean loggerhead population.

Shaping pathways to gambling consumption? An analysis of the promotion of gambling and non-gambling activities from gambling venues

Background: In Australia, venues which provide gambling activities also provide activities that are utilised by families and children. However, there has been limited theoretical or empirical discussion about whether engagement with non-gambling activities may play a role in shaping pathways to current or future engagement in gambling within these environments. We examined marketing tactics for non-gambling and gambling activities in Clubs. Using this data, we propose a conceptual model to test the role of non-gambling activities within gambling environments in shaping gambling attitudes and consumption intentions.

Methods: This study used a mixed method interpretive content analysis to review the marketing activities on the websites of a sample of 65 registered Clubs in New South Wales, Australia. We identified the extent and nature of techniques used to market gambling and non-gambling activities, particularly non-gambling activities directed towards families and children.

Results: Clubs use various marketing tactics to appeal to families and encourage parents to bring their children into venues. We hypothesise that marketing aimed at bringing children and families into gambling environments may play a role in shaping children’s and adults perceptions of these environments and may be influential in the development of a pathway that increases the likelihood that children will continue to visit these environments as adults, and subsequently the extent to which they engage in gambling later in life.

Conclusions: Future research should explore how the presence of family-friendly activities in Clubs and other venues with gambling activities may play a role in shaping future gambling attitudes and behaviours.

‘It should be a big responsibility’: Separated low-income mothers’ evaluation of child support arrangements and the conduct of fathers

The Australian Child Support Scheme was established as a means of ensuring adequate financial support for children of separated parents. However, within the financial transfer of child support exist notions of ‘trust’ and ‘fairness’ based on parents navigating their changed relationship post-separation. Previous research has explored the assessment and outcomes of child support for both payee and payer parents, however little attention has been given to how women evaluate the assessment and outcomes of child support. As such, this research aimed to explore payee mothers’ evaluation of their child support experiences based on the value of their child support assessment and the extent to which these payments were received. Following the methods of constructivist grounded theory, in-depth interviews were conducted with 20 low-income single mothers. Analysis revealed that payee mothers evaluated child support based on the moral assumptions and the rationalities they perceived were underlying payer fathers’ child support compliance. While payee mothers desired arrangements that reflected joint parental financial responsibility, in reality many experienced problematic child support payments, which may ultimately undermine payee parents’ confidence in the Child Support Scheme.

The intoxication defence: toward a better understanding of current doctrine and reform

This article deals with the contentious issue of the extent to which an intoxicated person, particularly one who has become inebriated of his or her own volition, should be permitted to escape liability on the basis that the degree of inebriation was sufficient to preclude the fact-finder from finding a volitional act or omission on the part of the accused and/or that he or she acted with the required mens rea, if any, as defined by the common law or statutory definition of the offence. In addressing this issue, the article embarks upon a thorough analysis of the House of Lords seminal decision in Director of Public Prosecutions v Majewski (1977) AC 443 which, despite some very harsh criticism of late, continues to be the leading authority on the question in the United Kingdom, United States and Australia. As part of this analysis, the article examines and ultimately attempts to resolve the longstanding controversy over what has proved to be the elusive distinction between crimes of basic or general intent and those of specific intent. The article concludes by rejecting the Majewski principles in favour of those enunciated by the High Court of Australia in R v O'Connor (1980) 146 CLR 64; 54 ALJR. In reaching this conclusion, the article notes various legislative and academic proposals for reform as well as statutory reforms in the United Kingdom, United States, Canada and Australia.

Adapting health-risk communication to the specific cultural contexts of diverse populations : an assessment of malaria-treatment programs in Liberia

Drawing on theories of technical communication, rhetoric, literacy, language and culture, and medical anthropology, this dissertation explores how local culture and traditions can be incorporated into health-risk-communication-program design and implementation, including the design and dissemination of health-risk messages. In a modern world with increasing global economic partnerships, mounting health and environmental risks, and cross-cultural collaborations, those who interact with people of different cultures have “a moral obligation to take those cultures seriously, including their social organization and values” (Hahn and Inhorn 10). Paradoxically, at the same time as we must carefully adapt health, safety, and environmental-risk messages to diverse cultures and populations, we must also recognize the increasing extent to which we are all becoming part of one, vast, interrelated global village. This, too, has a significant impact on the ways in which healthcare plans should be designed, communicated, and implemented. Because communicating across diverse cultures requires a system for “bridging the gap between individual differences and negotiating individual realities” (Kim and Gudykunst 50), both administrators and beneficiaries of malaria-treatment-and-control programs (MTCPs) in Liberia were targeted to participate in this study. A total of 105 people participated in this study: 21 MTCP administrators (including designers and implementers) completed survey questionnaires on program design, implementation, and outcomes; and 84 MTCP beneficiaries (e.g., traditional leaders and young adults) were interviewed about their knowledge of malaria and methods for communicating health risks in their tribe or culture. All participants showed a tremendous sense of courage, commitment, resilience, and pragmatism, especially in light of the fact that many of them live and work under dire socioeconomic conditions (e.g., no electricity and poor communication networks). Although many MTCP beneficiaries interviewed for this study had bed nets in their homes, a majority (46.34 percent) used a combination of traditional herbal medicine and Western medicine to treat malaria. MTCP administrators who participated in this study rated the impacts of their programs on reducing malaria in Liberia as moderately successful (61.90 percent) or greatly successful (38.10 percent), and they offered a variety of insights on what they might do differently in the future to incorporate local culture and traditions into program design and implementation. Participating MTCP administrators and beneficiaries differed in their understanding of what “cultural incorporation” meant, but they agreed that using local indigenous languages to communicate health-risk messages was essential for effective health-risk communication. They also suggested that understanding the literacy practices and linguistic cultures of the local people is essential to communicating health risks across diverse cultures and populations.

The Levy Runs Dry: A Legal and Economic Analysis of EU Private Copying Levies

This article provides a legal and economic analysis of private copying levies in the EU, against the background of the Copyright Directive (2001/29), a number of recent rulings by the European Court of Justice and the recommendations presented by mediator Vitorino earlier this year. It concludes that notwithstanding these rulings and recommendations, there remains a lack of concordance on the relevance of contractual stipulations and digital rights management technologies (DRM) for setting levies, and the concept of harm. While Mr Vitorino and AG Sharpston (in the Opinion preceding VG Wort v. Kyocera) use different lines of reasoning to argue that levies raised on authorised copies would lead to double payment, the Court of Justice’s decision in VG Wort v. Kyocera seems to conclude that such copies should nonetheless be levied. If levies are to provide fair compensation for harm resulting from acts of private copying, economic analysis suggests one should distinguish between various kinds of private copies and take account of the extent to which the value said copies have for consumers can be priced into the purchase. Given the availability of DRM (including technical protection measures), the possibility of such indirect appropriation leads to the conclusion that the harm from most kinds of private copies is de minimis and gives no cause for levies. The user value of copies from unauthorised sources (e.g. from torrent networks or cyber lockers), on the other hand, cannot be appropriated indirectly by rightholders. It is, however, an open question in references for preliminary rulings pending at the Court of Justice whether these copies are included in the scope of the private copying exception or limitation and can thus be levied for. If they are not, as currently happens in several EU Member States, legal and economic analysis leads to the conclusion that the scope of private copying acts giving rise to harm susceptible of justifying levies is gradually diminishing.

Are They Really Lost? "True" Status and Reasons for Treatment Discontinuation among HIV Infected Patients on Antiretroviral Therapy Considered Lost to Follow Up in Urban Malawi

INTRODUCTION Patients who are lost to follow-up (LTFU) while on antiretroviral therapy (ART) pose challenges to the long-term success of ART programs. We describe the extent to which patients considered LTFU are misclassified as true disengagement from care when they are still alive on ART and explain reasons for ART discontinuation using our active tracing program to further improve ART retention programs and policies. METHODS We identified adult ART patients who missed clinic appointment by more than 3 weeks between January 2006 and December 2010, assuming that such patients would miss their doses of antiretroviral drugs. Patients considered LTFU who consented during ART registration were traced by phone or home visits; true ART status after tracing was documented. Reasons for ART discontinuation were also recorded for those who stopped ART. RESULTS Of the 4,560 suspected LTFU cases, 1,384 (30%) could not be traced. Of the 3,176 successfully traced patients, 952 (30%) were dead and 2,224 (70%) were alive, of which 2,183 (99.5%) started ART according to phone-based self-reports or physical verification during in-person interviews. Of those who started ART, 957 (44%) stopped ART and 1,226 (56%) reported still taking ART at the time of interview by sourcing drugs from another clinic, using alternative ART sources or making brief ART interruptions. Among 940 cases with reasons for ART discontinuations, failure to remember (17%), too weak/sick (12%), travel (46%), and lack of transport to the clinic (16%) were frequently cited; reasons differed by gender. CONCLUSION The LTFU category comprises sizeable proportions of patients still taking ART that may potentially bias retention estimates and misdirect resources at the clinic and national levels if not properly accounted for. Clinics should consider further decentralization efforts, increasing drug allocations for frequent travels, and improving communication on patient transfers between clinics to increase retention and adherence.