Sydney eScholarship
Not a member yet
31878 research outputs found
Sort by
Understanding the Health System Barriers to the Prevention of Mother-to-Child Transmission (PMTCT) of HIV Services in Fiji
No full textAbstract
Introduction: Mother-to-child transmission (MTCT) is the leading cause of HIV in children, yet it is largely preventable with timely care. In low- and middle-income countries, limited infrastructure hinders effective PMTCT programs, leading to avoidable HIV infections.
Objectives: This research examines health system barriers faced by healthcare workers in delivering PMTCT of HIV services in three Fijian divisional hospitals and associated clinics, and their impact on service provision.
Methods: I used both qualitative and 1uantitative approach to examine health system barriers to PMTCT of HIV services. Qualitative data were collected through 58 in-depth interviews with purposively selected healthcare workers from three divisional hospitals and analysed inductively. Quantitative analysis used secondary data from Fiji’s 2021 MICS to assess HIV transmission knowledge among women of reproductive age, employing univariate and logistic regression analyses in STATA/BE 17.
Results: I found that staff shortages, limited training and supplies, workplace tensions, lack of cooperation, and fear of HIV infection hindered PMTCT service quality. Quantitative analysis showed low knowledge of HIV transmission among reproductive-aged women in Fiji. These findings are detailed in separate chapters of the dissertation.
Conclusion: The findings of this thesis underscore the need to address health system barriers to preventing mother-to-child transmission (PMTCT) of HIV in Fiji. Regular monitoring of HIV test supplies and PPE, standardized PMTCT training for all healthcare workers, and improved collaboration between NGO and government staff are essential. Targeted educational campaigns for young women (15–24) in the Western region can also enhance awareness. These insights can guide policymakers and stakeholders in strengthening PMTCT services in Fiji and similar contexts
Understanding the experiences and supporting the challenges of Aboriginal-identified statutory child protection caseworkers in New South Wales
No full textThere is an understanding nationwide that there is a need to improve outcomes and experiences of both Aboriginal children, families and practitioners connected to the Statutory Child protection system.
This study relies on the lived experiences and insights shared by the participants to understand and answer the primary research question: “What are the experiences and support needs of Aboriginal statutory child protection caseworkers in the Department of Communities and Justice New South Wales?”
The research design was underpinned by Critical Race Theory and decolonisation frameworks. The study viewed the participants as the experts of their own experience, from the lens of decolonisation of welfare practices, in turn providing a framework for shared learning and growth of knowledge.
Data was collected through the application of a survey tool and semi-structured interviews between the participants and the researcher, considering the advice of Aboriginal consultants regarding yarning concepts. The purposive sample of participants consisted of 33 people who self-identified as Aboriginal and/or Torres Strait Islander and were currently employed as statutory Child protection caseworkers within NSW. There were 28 participants who completed a survey on the main key thematic areas, and an additional 5 participants who engaged in an interview in place of the survey.
The collation of this information obtained via both the survey results and individual interviews were then transcribed and analysed in terms of emerging themes.The research findings also informed the development of a supervision prompt guide which can be utilised by supervisors of Aboriginal child protection caseworkers.
The research generates new knowledge and reveals examples of both positive support experiences, in addition to findings and examples of Aboriginal practitioner experiences of racism, the lack of culturally safe practices, and marginalisation of Aboriginal child protection caseworkers
The Effect of Dietary Tryptophan Supplementation, and An Oral Tryptophan Challenge, on Urinary Excretion of 5-hydroxyindoleacetic Acid in Domestic Dogs
No full textChronic enteropathic disease, commonly referred to as Inflammatory Bowel Disease (IBD), is a multi-factorial disease that affects a substantial population, including humans and domestic animals. Over the past two decades, it has been postulated that disturbances in serotonin metabolism may be a pathogenic mechanism for IBD in humans. This thesis explores the unique characteristics of IBD in humans, dogs, and cats and examines the literature regarding interrelationships between serotonin dysregulation and IBD. Additionally, it examines the role of tryptophan metabolism as the sole precursor of serotonin synthesis. Our cross-sectional, prospective study explores the possible influence of tryptophan supplementation on serotonin mechanism. Our findings demonstrated a sustained effect on serotonin metabolism following tryptophan loading, though the change in the 5-hydroxyindoleacetic acid to creatinine ratio did not reach statistical significance compared to baseline. Contrary to previous literature, the ratio did not peak at 4 hours post-tryptophan challenge. The second part of the study suggests that using a selective serotonin reuptake inhibitor does not significantly influence the urinary excretion of the serotonin metabolite 5-hydroxyindoleacetic acid in dogs. This study is the first to assess the impact of tryptophan supplementation on serotonin metabolism in dogs, and particularly the impacts of tryptophan supplementation on the excretion of serotonin degradation products in urine. The results provide critical information on potential confounding factors influencing serotonin metabolism in chronic enteropathy in domestic animals. Future prospective studies with a larger sample size are required to compare the serotonin concentrations between dogs with chronic enteropathy and healthy dogs on the tryptophan loading/challenge tests
Deep Learning-Based Cardiovascular Risk Prediction Using Routine Mammograms
No full textAims
This thesis aims to develop an innovative deep learning-based framework for the automated detection and grading of breast arterial calcification (BAC) using routine mammograms. The framework is designed to enhance the assessment of BAC severity and its potential role as an independent predictor of cardiovascular disease (CVD) risk. By leveraging data from a woman’s initial mammographic screening, the model categorizes BAC severity into low, moderate, or high-risk groups for adverse cardiovascular outcomes. This personalized approach seeks to provide a more accurate assessment of cardiovascular risk, thereby enhancing the utility of routine mammographic screenings.
Methods
A U-Net-based deep learning model was developed to segment BAC regions, utilizing two datasets: 1,270 women for training the segmentation model and 9,648 women for assessing cardiovascular outcomes. The initial training phase employed a fully supervised learning approach, refined using a semi-supervised technique with progressive pseudo-labelling. BAC severity was categorized using a four-level grading system absent, mild, moderate, and severe based on tertile thresholds of BAC area or intensity. Regression models assessed associations between BAC and age, diabetes, hypertension, and smoking. Cox Proportional Hazards models calculated adjusted hazard ratios (HR) for BAC grades and cardiovascular outcomes.
Results
The model achieved strong performance (Jaccard 0.602, precision 0.77, F1 0.76, accuracy 0.99). BAC prevalence was 26.96%, increasing with age. Age, diabetes, and hypertension were significant predictors; smoking showed an inverse association. Severe BAC was associated with an adjusted HR of 1.65 (95% CI: 1.30 – 2.10).
Conclusion
This research presents a novel deep learning-based BAC framework, supporting its integration into routine mammography as an additional valuable tool for personalized cardiovascular risk stratification in women
Castaways: Picking up the Pieces of the Plaster Cast Collection of the National Art School, Sydney
No full textIn the late 19th century the National Art School (NAS)in Sydney, purchased plaster casts from the London firm of D. Brucciani. From the original collection only about thirty casts have survived. In 2020 the original objects were added to by the Alexander Murray collection: modern and Australian in its ethos.
The thesis traces the origins and foundation of the NAS cast collection in the context of its history as an academic and technical institution key to the development of artistic education in NSW. It examines casts purchased and produced from the early 1880s to the late 1930s, spanning the leadership of Lucien Henry (1850–1896) and Rayner Hoff (1894–1937). It looks to the social context and debates of a significant period in Australia as the settler-colonial state was challenged to define its national identity.
The thesis argues for the significance of the casts using object biography to recognise their many lives: as valuable pedagogic and aesthetic objects in an art school. In unpacking the relationship between the Brucciani and Murray casts, it demonstrates the unique position of the NAS cast collection, in establishing the importance of Brucciani’s work in an art school and by considering the importance of the Murray collection, situating it as part of Henry’s ethos on the use of Australiana in the arts. The thesis articulates the legacy of these casts in the casting tradition which continues in the practices of the NAS to the present day.
This thesis establishes the NAS casts as a living collection responsive to fluid notions of reception. It builds a detailed catalogue of the casts contextualised by their social interactions and establishes them as part of the school’s life. Ultimately the thesis argues for the importance of the casts as original objects and identifies their changing significance as tools of education and identity to stress their significance as artefacts in their own right: original, produced by the hand of an artist and marked by time
Path models and combinatorial representations of affine Hecke algebras
No full textIn this thesis we explore particular combinatorial representations of affine Hecke algebras with
general parameters. We introduce the combinatorial model of J-folded alcove paths and show
that the matrix entries of our representations are described by these alcove paths. We categorise
which of the representations are bounded and give conjectures connecting the representations
to Kazhdan-Lusztig theory and Opdam’s Plancherel Theorem. Upon specialising to type affine An,
we show that the combinatorial representations form a balanced system of cell representations.
For this type, we prove an asymptotic version of Opdam’s Plancherel Theorem and develop a Janalogue
to the classical Satake isomorphism. Using this asymptotic Plancherel Theorem we
construct a new explicit description of Lusztig’s asymptotic algebra in type affine An in terms of a
ring of specialised matrices formed from the constructed representations
Indicators of quality in NSW public dental services: Enablers and barriers to implementation
No full textQuality measures are essential instruments for evaluating healthcare by providing actionable data to assess care delivery, identify strengths and weaknesses, and monitor various aspects of healthcare performance. Traditionally classified into process, structure, and outcome measures based on Donabedian's framework, these metrics have evolved to encompass seven quality domains, offering a more detailed framework for assessing oral healthcare quality.
This thesis critically examines the status of quality measure implementation and enablers and barriers to the implementation within New South Wales (NSW) public dental services, providing insights into how these factors impact service delivery and overall care quality. The study employs stakeholder interviews to explore the status of implementation as well as enablers and barriers of the quality measures across various quality domains such as accessibility, effectiveness, efficiency, equity, patient-centredness, safety, and timeliness.
The findings highlight several significant enablers that facilitate the implementation of quality measures across multiple domains. These include the Centralised Healthcare Contact Centre, the Priority Oral Health Program (POHP), and the Oral Health Fee for Service Scheme (OHFFSS). Additionally, continuous professional development, mentoring programs, and the Incident Management System+ (IMS+) play a critical role in supporting the effective implementation of quality measures to enhance care delivery and patient outcomes.
The research also highlights several persistent barriers, including limited funding, high staff turnover, resource constraints, and geographic challenges that limit timely and effective services, particularly in rural areas. Cultural and linguistic barriers, combined with low oral health literacy among patients, further complicate the delivery of patient-centred care. Addressing these barriers is essential for improving the quality of public dental services in NSW
Ancient Magic and Christian responses: Augustine and his influence on Isidore of Seville
No full textThe teachings of Augustine of Hippo and Isidore of Seville have a didactic nature with
the main goal to instruct, enlighten, protect, influence, and guide the Christians. This
multifaceted teaching was crucial in an era defined by a constant battle between God
and the demons, whose worship was very frequent. Christian authors utilised polemic against the
seductive practice and reasoning of the magical arts as they sought to protect the faithful. Thus, both
Augustine and Isidore composed manuals which dictate a constant pursuit of clarity and precision for
the clergy, as well as the laity. These works aimed at breaking the supposed barrier and protection of
the dark arts,
promoted by the cultural and political figures of the early Medieval era. Where Isidore of Seville
embraced and furthered the Augustinian though on demonology and magic it will be demonstrated in
the current study
What co-design has taught us about transformative practice and academic development
No full textThis chapter explores lessons about co-design in transformative practice and academic development. Co-design, defined as a purposeful, collaborative, and participatory design process involving multiple stakeholders, has emerged as a pivotal strategy in addressing the challenges of higher education. The Light Touch Program focuses on transformative course design and curriculum development. Through a three-year journey, this study shares insights on the program’s role in enhancing teaching and learning environments, drawing on experiences from educational developers, learning designers, and other stakeholders. The findings underscore three transformative lessons: (1) intentional flexibility is required to meet academics’ diverse needs, (2) co-design facilitates capacity building, and (3) customisable resources accelerate sharing and adoption. These lessons highlight co-design’s potential to foster innovation, adaptability, and inclusive practices in academic settings, contributing to more dynamic and collaborative design processes in higher education
Bridging The Gap: Examining the Accessibility of Essential Medicines and COVID Readiness in the South Pacific Region
No full textThis thesis examines the overall access to medicines in the South Pacific Region (SPR) with the penultimate chapter focusing on the impact of COVID-19. This was primarily achieved by implementing the World Health Organization (WHO) and Health Action International (HAI) methodology in several countries within the SPR. In doing so, several systemic barriers to appropriate medicine access have been identified. For each of which, strategies to navigate these have been offered.
Amidst this body of work are two studies that employed an iteration of the WHO/HAI survey to specifically investigate the access to diabetes-related medicines (specifically insulin) and devices (self-monitoring blood glucose devices (SMBGs)). These studies revealed the stark reality of managing diabetes in the SPR, particularly the extreme costs associated with treatment and a sheer lack of insulin and SMBG access. Suggestions on how best to navigate this situation have been provided throughout. As mentioned, the penultimate chapter addresses the impact COVID-19 has had on the practice of hospital pharmacy in the SPR. Findings were consistent with the broader literature, suggesting that the healthcare system was placed under immense strain due to staff shortages, staff burnout, medication shortages and other logistical challenges. Some recommendations on how to best navigate pandemics in the future have also been provided. By combining updated data with actionable insights, this research provides a comprehensive analysis of medicine accessibility in the SPR, contributing to global discussions on health equity and pandemic preparedness while guiding policy and advocacy efforts in resource-limited settings