320 research outputs found
Only rape! : an examination of the power of ideology and discourse in the policy process with a focus on policy pertaining to refugee women
University of Technology, Sydney. School of Management.During a long career as a policy analyst, I have noticed that government policy often fails to achieve its stated aims. This dissertation seeks to identify why this happens, and how actors external to government can intervene in the policy process and influence policy outcomes. The study focused on policy addressing the needs of refugee women. It involved my taking a leading role in an action research project which lasted for seven years. The aims of the project were to bring about change in government policy and outcomes in relation to refugee women, and to seek a theoretical understanding of the process in which I was involved. The project was undertaken with a small non-government organisation, the Australian National Consultative Committee on Refugee Women and comprised five loops or cycles of action research. It involved working at both local and international levels as links were made between human rights instruments, international law, domestic legislation and refugee policy.
For the purpose of the thesis, policy literature was grouped into three conceptually discrete frameworks, the Rationalist, the Political and the Critical. At each stage of the action research project, writings from three frameworks of policy theory were tested to seek explanations for the activities described. Knowledge gained from theoretical analysis in each reflective phase was applied and used to inform the next stage of research. The outcomes of these five stages produced a theory of policy development and enactment which emerged from the progressive iterative reflections in each of the five cycles.
The theory proposed is that policy often fails to achieve its stated aims because policy actors do not have a discursive understanding of the policy process in which they are involved. It is argued that in order to achieve the level of understanding required to facilitate effective change, it is necessary to take a 'critical distance' from the policy process and identify the ideologically based assumptions which inform it, and how these impact on and shape the social reality of the policy actors involved. It is necessary to understand the power and role of discourse in structuring that reality. In order to bring about change, the discourses which produce and are produced by the policy process have to be challenged and new discourses introduced. The non-government sector can play an active and an informed role by identifying the dynamics driving the process, by using theoretical analysis as a tool to identify and to address the root causes of problems in the policy process, and by realising their power to effect change.
It is argued that the insights gained through the analysis of this action research project have established both guidelines for practice, and theoretical principles which are generalisable to a range of policy domains and policy analysis
Nonocular Melanocytic Neoplasia in Cats: Characterization and Proposal of a Histologic Classification Scheme to More Accurately Predict Clinical Outcome
Nonocular melanocytic neoplasia is considered uncommon in cats yet is routinely encountered in diagnostic pathology and recognized to exhibit a wide variation in biological behavior. Accurate prediction of clinical outcomes is challenging with no widely recognized prognostic criteria. Signalment and tumor location were retrospectively evaluated in 324 cats diagnosed with nonocular melanocytic neoplasia. Histologic features were described in 141 neoplasms and outcome data were available in 79 cases. Immunohistochemistry using Melan-A, PNL-2, cyclooxygenase 2 (COX-2), and E-cadherin was performed in a subset (n = 24). Multivariate analysis identified tumor site, mitotic count, and the presence of intratumoral necrosis to be independent predictors of tumor-related death. On the basis of these findings, we propose a novel histologic grading scheme in which nonocular melanocytic neoplasms involving the lips, oral or nasal mucosa, or nasal planum are considered high grade if they fulfill 1 or both of the following criteria: at least 4 mitoses in 10 high-power fields (HPF) or presence of intratumoral necrosis; those arising elsewhere are considered high grade if they fulfill both of the above criteria. Of 79 tumors with outcome data, 43 (54%) were low grade and 36 (46%) were high grade. The grading system had an 80% sensitivity and 92% specificity for predicting tumor-related death in this population of cats. Median survival for cats with low-grade tumors was not reached, and the median survival was 90 days for those with a high-grade tumor. PNL-2 and Melan-A were sensitive markers for feline nonocular melanocytic neoplasia, and although not significantly associated with prognosis, a large proportion expressed COX-2, suggesting a potential therapeutic role for COX-2 inhibitors
Diagnosis of anaplastic large-cell lymphoma in a dog using CD30 immunohistochemistry
Anaplastic large-cell lymphoma or null-cell lymphoma is a clinical entity reported in people, classified according to the unique appearance of large pleomorphic cells that express CD30. Null-cell lymphoma has also been described in dogs when neither CD3 nor CD79α is expressed by the tumor. We describe a case of lymphoma in the dog in which neoplastic cells did not express routine B- or T-lymphocyte markers on flow cytometry or immunohistochemistry; however, cells immunohistochemically labeled for CD30. The dog in our case died 5 mo after initial presentation, confirming a poor prognosis. Identification of further similar cases in dogs would provide additional prognostic information for this subset of lymphomas. CD30 may also serve as a potential therapeutic target in anaplastic large-cell lymphomas
Clinical challenge of diagnosing non-ventilator hospital-acquired pneumonia and identifying causative pathogens:a narrative review
Non-ventilated hospital-acquired pneumonia (NV-HAP) is associated with a significant healthcare burden, arising from high incidence and associated morbidity and mortality. However, accurate identification of cases remains challenging. At present, there is no gold-standard test for the diagnosis of NV-HAP, requiring instead the blending of non-specific signs and investigations. Causative organisms are only identified in a minority of cases. This has significant implications for surveillance, patient outcomes and antimicrobial stewardship. Much of the existing research in HAP has been conducted among ventilated patients. The paucity of dedicated NV-HAP research means that conclusions regarding diagnostic methods, pathology and interventions must largely be extrapolated from work in other settings. Progress is also limited by the lack of a widely agreed definition for NV-HAP. The diagnosis of NV-HAP has large scope for improvement. Consensus regarding a case definition will allow meaningful research to improve understanding of its aetiology and the heterogeneity of outcomes experienced by patients. There is potential to optimize the role of imaging and to incorporate novel techniques to identify likely causative pathogens. This would facilitate both antimicrobial stewardship and surveillance of an important healthcare-associated infection. This narrative review considers the utility of existing methods to diagnose NV-HAP, with a focus on the significance and challenge of identifying pathogens. It discusses the limitations in current techniques, and explores the potential of emergent molecular techniques to improve microbiological diagnosis and outcomes for patients.</p
Clinical challenge of diagnosing non-ventilator hospital-acquired pneumonia and identifying causative pathogens:a narrative review
Non-ventilated hospital-acquired pneumonia (NV-HAP) is associated with a significant healthcare burden, arising from high incidence and associated morbidity and mortality. However, accurate identification of cases remains challenging. At present, there is no gold-standard test for the diagnosis of NV-HAP, requiring instead the blending of non-specific signs and investigations. Causative organisms are only identified in a minority of cases. This has significant implications for surveillance, patient outcomes and antimicrobial stewardship. Much of the existing research in HAP has been conducted among ventilated patients. The paucity of dedicated NV-HAP research means that conclusions regarding diagnostic methods, pathology and interventions must largely be extrapolated from work in other settings. Progress is also limited by the lack of a widely agreed definition for NV-HAP. The diagnosis of NV-HAP has large scope for improvement. Consensus regarding a case definition will allow meaningful research to improve understanding of its aetiology and the heterogeneity of outcomes experienced by patients. There is potential to optimize the role of imaging and to incorporate novel techniques to identify likely causative pathogens. This would facilitate both antimicrobial stewardship and surveillance of an important healthcare-associated infection. This narrative review considers the utility of existing methods to diagnose NV-HAP, with a focus on the significance and challenge of identifying pathogens. It discusses the limitations in current techniques, and explores the potential of emergent molecular techniques to improve microbiological diagnosis and outcomes for patients.</p
Analysis of caecal mucosal inflammation and immune modulation during Anoplocephala perfoliata infection of horses
Innovation and deadlock in governing disasters and climate change collaboratively - Lessons from the Northern Rivers region of New South Wales, Australia
Both scholars and global policy point to the need for, and effectiveness of, locally-led and collaborative disaster and climate change practices. However, there is a need for analysing how these collaborative approaches are developed and used in practice in different contexts. This paper outlines the use of collaborative approaches by a climate change and disaster community of practice across seven local government areas in the Northern Rivers region, New South Wales, Australia. The region has experienced multiple large-scale flood and bushfire disasters since 2017. This ethnographic study uses established collaborative governance and adaptive governance theoretical frameworks to draw findings from: lived experiences of researchers, 22 interviews with diverse stakeholder groups, in-person and online events and the first author's research diary. The findings indicate that collaborative practice in response to disasters and climate change has resulted in both effective outcomes and multi-dimensional challenges, which have lasting implications for communities across the Northern Rivers region. Three critical leverage points for enhanced collaboration and effectiveness were identified. First, improved use and flow of information such as climate projections and place- and needs-based information. Second, mindset shifts that value community knowledge and contributions, and improved practice through enhancing skills in community development and community-led recovery in disaster and climate change practitioners. Lastly, collectively moving from reactive to proactive responses to climate change and disasters. These insights provide an opportunity for improving the design of community-based risk reduction programs and multi-stakeholder governance arrangements into the future, in the state of New South Wales and beyond
Immunohistochemical characterization of feline lymphoplasmacytic anterior uveitis
OBJECTIVE: To characterize the immune cells present in different forms of feline anterior uveitis. SAMPLES: Eyes were obtained from 49 cats diagnosed with chronic idiopathic lymphoplasmacytic anterior uveitis, 7 cats with feline infectious peritonitis (FIP), and 9 cats euthanized for nonocular disease. METHODS: H&E sections were scored on the level of infiltrate in the anterior uvea. Immunohistochemistry was performed for FoxP3, CD3, and IL-17A, and positive cells were quantified in multiple images of each sample. A generalized estimating equation tested for an association between the level of inflammation and the prevalence of these cell types. RESULTS: Cells stained positive for IL-17A in idiopathic uveitis but not in FIP samples. We found significantly fewer FoxP3+and CD3+cells in low-grade compared with high-grade inflammation in idiopathic uveitis or FIP samples (P values all <.005), but no difference between FIP and high-grade samples. CONCLUSIONS: Idiopathic, but not FIP-associated, uveitis appears to have Th17 cell involvement. The numbers of FoxP3+and CD3+T-cells present appear directly correlated; thus, the severity of disease does not appear directly determined by the numbers of regulatory cells
Enterprise Education Competitions: A Theoretically Flawed Intervention?
The demand for including enterprise in the education system, at all levels and for all pupils is now a global phenomenon. Within this context, the use of competitions and competitive learning activities is presented as a popular and effective vehicle for learning. The purpose of this chapter is to illustrate how a realist method of enquiry – which utilises theory as the unit of analysis – can shed new light on the assumed and unintended outcomes of enterprise education competitions. The case developed here is that there are inherent flaws in assuming that competitions will ‘work’ in the ways set out in policy and guidance. Some of the most prevalent stated outcomes – that competitions will motivate and reward young people, that they will enable the development of entrepreneurial skills, and that learners will be inspired by their peers – are challenged by theory from psychology and education. The issue at stake is that the expansion of enterprise education policy into primary and secondary education increases the likelihood that more learners will be sheep dipped in competitions, and competitive activities, without a clear recognition of the potential unintended effects. In this chapter, we employ a realist-informed approach to critically evaluate the theoretical basis that underpins the use of competitions and competitive learning activities in school-based enterprise education. We believe that our findings and subsequent recommendations will provide those who promote and practice the use of competitions with a richer, more sophisticated picture of the potential flaws within such activities.Peer reviewedFinal Published versio
Information exchange networks for chronic illness care in primary care practices: an observational study
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88018.pdf (publisher's version ) (Open Access)BACKGROUND: Information exchange networks for chronic illness care may influence the uptake of innovations in patient care. Valid and feasible methods are needed to document and analyse information exchange networks in healthcare settings. This observational study aimed to examine the usefulness of methods to study information exchange networks in primary care practices, related to chronic heart failure, diabetes and chronic obstructive pulmonary disease. METHODS: The study was linked to a quality improvement project in the Netherlands. All health professionals in the practices were asked to complete a short questionnaire that documented their information exchange relations. Feasibility was determined in terms of response rates and reliability in terms of reciprocity of reports of receiving and providing information. For each practice, a number of network characteristics were derived for each of the chronic conditions. RESULTS: Ten of the 21 practices in the quality improvement project agreed to participate in this network study. The response rates were high in all but one of the participating practices. For the analysis, we used data from 67 health professionals from eight practices. The agreement between receiving and providing information was, on average, 65.6%. The values for density, centralization, hierarchy, and overlap of the information exchange networks showed substantial variation between the practices as well as between the chronic conditions. The most central individual in the information exchange network could be a nurse or a physician. CONCLUSIONS: Further research is needed to refine the measure of information networks and to test the impact of network characteristics on the uptake of innovations
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