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Opportunities to improve continuity in medicines management for Aboriginal and Torres Strait Islander people accessing care in South Australian hospitals: Coverage, quality, monitoring and accountability
No full textThis paper proposes that hospital admissions, which are traditionally considered high risk transitions, can be opportunities to strengthen continuity in medicines management (CMM) for Aboriginal and Torres Strait Islander patients and across the healthcare system. There are four key areas of focus in this paper including CMM coverage, CMM quality, health system monitoring of CMM, and health system accountability for CMM to Aboriginal and Torres Strait Islander people and communities. These areas for improvement are justified by the National Agreement on Closing the Gap (The National Agreement), the Guiding Principles to Achieving continuity in medication management, and Continuity in Medication Management: A Handbook for South Australian Hospitals. Other public health services may be able to leverage the National Agreement in similar applications to improve health system performance for Aboriginal and Torres Strait Islander peoples
Effects of a daily, home-based, 5-minute eccentric exercise program on physical fitness, body composition, and health in sedentary individuals
Get PDFPurpose: This study examined the effects of a 4-week home-based bodyweight eccentric exercise program, requiring just 5 min daily, on physical fitness, body composition, and both physical and mental health in sedentary individuals.
Methods: Twenty-two sedentary but healthy individuals (4 men, 18 women; 32–69 years) completed a two-week control period followed by a 4-week intervention. The intervention involved daily exercises consisting of 10 repetitions each of chair squats, chair reclines, wall push-ups, and heel drops, including progressions if necessary. Assessments included isometric mid-thigh pull (IMTP), handgrip (HG) strength, push-up and sit-up endurance, sit-and-reach (S&R) flexibility, 3-min step test (3ST), squat jump (SJ), countermovement jump (CMJ), body composition (via dual-energy X-ray absorptiometry), physical health markers (blood based), and mental wellbeing (SF-36 survey and subjective vitality scale [SVS]). Measurements were taken before (PRE-1), after the control period (PRE-2), and after the 4-week training period (POST).
Results: Adherence to the program was 91±12% (18–28 sessions over 28 days). Intraclass correlation coefficients presented moderate-to-excellent reliability within the control period. No significant changes were observed in body composition, resting heart rate, blood pressure, HG, SJ, CMJ, or blood markers after training. However, significant improvements (p \u3c 0.05) were noted in IMTP (13.0±18.5%), push-up (66.1±86.5%), sit-up (51.1±78.7%), S&R (9.1±20.0%), and 3ST heart rate (4.8±7.1% decrease). Mental health scores improved significantly (SF-36 by 16±29% and SVS by 20±3%, p \u3c 0.05).
Conclusion: The 5-minute daily eccentric exercise routine over 4 weeks significantly improved physical fitness and mental health in sedentary individuals, suggesting even a small dose of daily exercise can be beneficial
Resting energy expenditure and metabolic features in children with septo-optic dysplasia
Get PDFContext: Septo-optic dysplasia (SOD) is a major cause of congenital hypopituitarism and is known to be associated with overweight and obesity in up to 44% of children. Given the role of the hypothalamus in hormonal regulation, we sought to assess the association of resting energy expenditure (REE), appetite and physical activity with SOD. Objective: To characterize REE and other metabolic features in patients with SOD and evaluate relationships with elevated body mass index (BMI). Methods: Children with SOD above 5 years of age attending Perth Children\u27s Hospital participated. A CosMED Q-NRG indirect calorimeter was used to calculate mean measure REE (mREE). This was compared with predictive REE (pREE) based on the Schofield equation to determine mREE/pREE quotient. A BMI z-score \u3e1 was considered elevated. Parents/carers completed a questionnaire about pituitary function, the Hyperphagia Questionnaire and the Sleep Disturbances Scale for Children (SDSC). Results: Twenty-six participants underwent testing (9 female, mean age 12.1 years) with 11 having elevated BMI and 15 with pituitary hormone deficiencies. Mean mREE was 1309 kcal/day (838-1732), mREE/pREE quotient was 88.8% ± 10.1. mREE/pREE quotient was similar in those with elevated BMI compared with normal BMI (83.3% ± 12.5 vs 92.1% ± 7.2, P =. 068). Those with midline defects had a higher mREE/pREE quotient (91.8% ± 8.1 vs 80.4% ± 11.3, P =. 026). Hyperphagia and SDSC scores were similar between BMI groups. Hyperphagia domain scores were higher in children with multiple hypopituitarism, pituitary structural defects, and normal septum pellucidum (P =. 044,. 042, and. 033, respectively). Conclusion: Children with SOD had lower mREE than predicted and hyperphagia scores were higher in those with biochemical or structural pituitary changes, suggesting that hypothalamic dysfunction could drive BMI elevation in SOD. Indirect calorimetry may be used to guide the management of overweight and obesity in SOD
Successful commercialisation in startup accelerator programmes: How different startup ecosystems matter
Get PDFThis study examined the influence of the Western Australian and Iranian startup ecosystem contexts, including the powers and liabilities that determine startups’ commercialisation outcomes. By utilising a theoretical framework based on programme evaluation, explanatory theory building, and critical realism, a cross-contextual comparison study was conducted. The study showed that the context of startup accelerator programmes and the startup ecosystem is an important determinant of commercialisation outcomes. The study revealed factors that impede startup accelerator programme success, including low follow-on investment, ecosystem immaturity, the ineffective agency of the Western Australian and Iranian governments, low levels of talent among startup agents, and the shortcomings of the startup accelerator programmes. The research confirmed that programme evaluation is a suitable theoretical base for the evaluation of startup accelerator programmes by determining what works, for whom, in what context, and why. It extended the existing body of knowledge by developing the change models of the startup accelerator programmes studied in the context of Western Australia and Iran, which can be applied in research on other startup accelerator programmes in different contexts
State of stroke rehabilitation in Australia: A WHO STARS assessment to identify strengths and gaps across policy, practice and funding
Get PDFPurpose of Review: Rehabilitation following stroke is a complex series of assistive and catalytic interventions enabling a survivor to recover and adapt to their stroke. To achieve adaptation, rehabilitation should supplement healthcare across the continuum, however comprehensive evidence on the provision of stroke rehabilitation in Australia is lacking. The aim of this paper was to describe stroke rehabilitation provision, collecting data using the World Health Organisation (WHO) template for rehabilitation information collection (TRIC). Data were analysed descriptively to complete the Systematic Assessment of Rehabilitation Situation (STARS) assessment. Recent Findings: Challenges include inadequacies in reporting and poor data integration between state- and nationally-funded rehabilitation programs and a lack of evidence illustrating continuity of care across rehabilitation settings. Particular gaps in data on stroke rehabilitation in Indigenous populations and a lack of research to date on cultural acceptability of effective interventions were noted. Summary: The economic benefit of improved access to stroke rehabilitation nationally is clear, however achieving this needs collaborative and integrated efforts from multiple stakeholders. Findings will inform the establishment of national priorities to strengthen stroke rehabilitation in Australia
Navigating masculinity construction among the fathers of the nation: Applying Yin-Yang and Wen-Wu Chinese masculinities to U.S. presidential leadership in global health emergencies for global harmony
No full textThe COVID-19 pandemic is much more than a health crisis. It affects all segments of humanity. To world leaders, this pandemic has become a kaleidoscope that can reflect their political leadership and vision. In the United States of America, the president, as the most masculine post in government, is duty-bound to take adequate measures and make consequential policies against public health crises. Moreover, the president’s discursive practice is immediately persuasive in shaping public emotion, social cognition of reality, gender stratification and vice versa. By contrast, Donald Trump and Joe Biden have presented observably divergent responses to this pandemic and their corresponding distinctive leadership styles, which prompted further contemplation of the nexus between their masculinities and presidential leadership styles. The goal-directed inclusion of Barack Obama and his double-edged response to the Ebola outbreak augmented the panorama of presidential masculinities. The relationality of masculinity construction was consequently underscored; fathers of the nation were thus metaphorized.
The limited research on masculinity in relation to U.S. presidential leadership in the West and China further invigorated this study to investigate how the varying masculinities of these three leaders were accordingly constructed through public remarks and presidential discourse. This study integrated Chinese yin-yang and wen-wu masculinity theories to balance and harmonise the imbalanced political leadership during health crises. This study valued the combination of content and discourse analysis to decipher their remarks on Ebola and COVID-19 that have extended to multidimensional correlatives of race, gender, class, and nationality. Grounded on the exhaustive decoding of sampled remarks, this study identified and categorised Obama’s more feminised masculinity, Trump’s cobra-effect masculinity and Biden’s centrist masculinity. Ultimately, this study proposed the emergence of a Global Masculinity Theory to challenge prevailing norms of masculinity, emphasising how Chinese masculinity theories help encourage gender equality and promote global harmony in times of crisis
A roadmap to precision medicine through post-genomic electronic medical records
Get PDFThe promise of integrating Electronic Medical Records (EMR) and genetic data for precision medicine has largely fallen short due to its omission of environmental context over time. Post-genomic data can bridge this gap by capturing the real-time dynamic relationship between underlying genetics and the environment. This perspective highlights the pivotal role of integrating EMR and post-genomics for personalized health, reflecting on lessons from past efforts, and outlining a roadmap of challenges and opportunities that must be addressed to realize the potential of precision medicine
Acknowledging: A classic grounded theory explaining how nurses\u27 employ clinical judgement when complying with early warning system protocols
Get PDFBackground: Recognition and response to clinical deterioration of hospitalised patients is a worldwide health priority area. In response to this concern, international bodies have implemented early warning systems to help clinicians keep people safe and prevent patient deterioration. Registered nurses hold a significant role in managing care provision and utilise early warning system tools to support their clinical judgement when making decisions about patient care. Objective: To generate a theory explaining how registered nurses employ their clinical judgement when complying with an early warning system protocol. Design: Classic grounded theory. Participants: Participants included twenty registered nurses working with early warning systems who are currently employed in a state health care system within Australia. Data were collected via interviews generated from a grand tour question in line with classic grounded theory. Methods: Classic grounded theory methodology and methods were used. This approach facilitated the identification of the participants main concern and supported the generation of a theory explaining how the participants resolved this issue. Results: Analysis of data, including associated field notes and memos, identified participants often experienced unease when complying with an early warning system protocol and employing clinical judgement. The mental discomfort participants voiced in the interviews described internal conflicts that are reflective of the term ‘cognitive dissonance’. How the participants sought to resolve their cognitive dissonance, revealed participants\u27 main concern as: Compliance with early warning systems is sometimes incongruent with nurses\u27 use of clinical judgement. The outcome of this study is a grounded theory that explains how nurses resolve this concern through ‘Acknowledging’. Nurses acknowledge the efficacy of early warning systems, whilst valuing their clinical judgement and the importance of patient safety, through the subcategories of Acting and Pausing. Conclusion: The Theory of Acknowledging explains how nurses overcome their main concern when employing clinical judgement and complying with early warning systems, whilst acknowledging the importance of ensuring patient safety. Reconciling the dissonance caused by trusting their clinical judgement and remaining compliant with early warning systems, enables nurse-led assessment of the patient, promoting patient safety. Tweetable abstract The theory of Acknowledging – How nurses employ clinical judgement when complying with early warning systems @Jusconnor2
Bayesian spatio-temporal modeling of African CO2 emissions (1990–2020): A hierarchical approach to identify determinants, regional trends, and local dynamics
Get PDFAfrica\u27s unique position in global CO2 emissions demands rigorous analysis for effective climate policy development. Despite contributing only 4% to global emissions, the continent faces disproportionate climate impacts while undergoing rapid development and complex economic transitions. Current research lacks extensive continental analysis of the spatial dependencies, temporal evolution of emission patterns, and their key drivers, which is fundamental for evidence-based climate policy and sustainable development strategies. We applied Bayesian hierarchical spatio-temporal modeling to analyze CO2 emissions across African countries (1990–2020), integrating rotated empirical orthogonal function (REOF) analysis with spatial autocorrelation techniques (Local Moran\u27s I and LISA) to capture complex emission patterns. Our hierarchical framework incorporated demographic and environmental predictors, revealing urbanization as the dominant emission driver. Surface temperature and relative humidity showed significant positive associations, while forest cover demonstrated a strong negative relationship. Spatial analysis identified distinct emission clusters, with the first three REOF modes explaining 78% of total variance. Strong positive spatial autocorrelation in North Africa contrasts with negative patterns in Southern regions, suggesting regional development networks could influence emission trajectories. These findings highlight opportunities for low-carbon development during Africa\u27s urbanization phase through integrated urban planning and forest preservation. The spatial dependencies highlight the importance of coordinated regional approaches to emission reduction, providing evidence for targeted climate policies that balance local contexts with regional interdependencies
Developing, implementing, and evaluating the first national Memory and Cognition Clinic Guidelines in Australia
Get PDFINTRODUCTION: A lack of national consensus on the roles and responsibilities of Australian memory and cognition clinics contributes to the large variability seen across services. The introduction of guidelines and a quality assessment framework could facilitate greater harmonization and quality improvements. METHODS: We used a modified Delphi process to develop the guidelines. Pilot clinics completed a self-assessment, case-note audit, and review meeting to evaluate their service against the guidelines. RESULTS: The final guidelines included 160 standards on 14 different topics. Standards around maximum waiting times for an assessment and minimum post-diagnostic care responsibilities were particularly controversial. Seven clinics participated in the pilot. On average, clinics achieved 56% of standards (range of 18% to 87%). DISCUSSION: The Memory and Cognition Clinic Guidelines form the first step toward greater harmonization and quality improvements. Key learnings from the clinics’ feedback included reducing the number of secondary standards and streamlining data collection with the national dementia clinical quality registry. Highlights: We developed and implemented the first national consensus-based best-practice guidelines for memory and cognition clinics in Australia. The guidelines are based on consultation with 125 Australian health professionals and 89 Australians living with dementia and care partners. First-time national agreement on standards around maximum waiting times for an assessment and minimum post-diagnostic care requirements is presented in the guidelines. The guidelines were implemented in seven memory and cognition clinics from five different states. Clinicians\u27 feedback included: reducing the number of secondary standards to increase conciseness and practicability should be considered for future iterations