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Immune checkpoint inhibitor therapy for advanced cutaneous squamous cell carcinoma in Australia : a retrospective real world cohort study
No full textObjectives: To review the outcomes of immune checkpoint inhibitor (ICI) treatment of advanced cutaneous squamous cell carcinoma (CSCC) outside clinical trials. Study design: Retrospective observational study; review of patient records in fifteen Australian institutions. Setting, participants: All Australian adults with locally advanced or metastatic CSCC not amenable to curative surgery or radiotherapy treated with ICIs, 5 May 2017 – 23 May 2022, through a cemiplimab compassionate access scheme (Therapeutic Goods Administration Special Access Scheme) or who personally covered the cost of pembrolizumab prior to the start of the access scheme. Main outcome measures: Best overall response rate (ORR) according to standardised assessment criteria using the hierarchy: Response Evaluation Criteria in Solid Tumors (RECIST 1.1), the modified World Health Organization clinical response criteria, and the Positron Emission Tomography Response Criteria (PERCIST 1.0); overall and progression-free survival. Results: A total of 286 people with advanced CSCC received ICI therapy during May 2017 – May 2022 (cemiplimab, 270; pembrolizumab, 16). Their median age was 75.2 years (range, 39.3–97.5 years) and 232 were men (81%); median follow-up time was 12.2 months (interquartile range, 5.5–20.5 months). Eighty-eight people (31%) were immunocompromised, 27 had autoimmune disease, and 59 of 277 (21%) had ECOG performance scores of 2 or 3. The ORR was 60% (166 of 278 evaluable patients): complete responses were recorded for 74 (27%) and partial responses for 92 patients (33%). Twelve-month overall survival was 78% (95% confidence interval [CI], 72–83%); progression-free survival was 65% (95% CI, 58–70%). Poorer ECOG performance status was associated with poorer overall survival (per unit: adjusted hazard ratio [aHR], 3.0; 95% CI, 2.0–4.3) and progression-free survival (aHR, 2.4; 95% CI, 1.8–3.3), as was being immunocompromised (overall: aHR, 1.8; 95% CI, 1.1–3.0; progression-free: aHR, 1.8; 95% CI, 1.2–2.7). Fifty-five people (19%) reported immune-related adverse events of grade 2 or higher; there were no treatment-related deaths. Conclusion: In our retrospective study, the effectiveness and toxicity of ICI therapy were similar to those determined in clinical trials. Our findings suggest that ICIs could be effective and well tolerated by people with advanced CSCC who are ineligible for clinical trials
Local LGBTQ+ Legacies: Uncovering Migrant and Multicultural Contributions to Sydney's LGBTQ+ History
Get PDFUp till now, there has been limited exploration of how LGBTQ+ people of migrant and multicultural backgrounds have contributed to Sydney’s queer history. This resource has three key aims: first, to provide an overview of what is currently known about such contributions; second, to explore the narratives of individuals who have made contributions through primary research; third, to offer directions for future research to expand what is currently known about migrant and multicultural contributions. This resource aims to foster ongoing work that expands our understandings of, and approaches to LGBTQ+ history to better encapsulate the diversity of communities
Putting seed traits into pellets : using seed mass data to improve seed encapsulation technology for native plant revegetation
No full textPoor seedling emergence often limits the success of direct seeding in ecological restoration. New techniques for maximising seed use efficiency and seedling emergence are needed to help meet global targets for nature repair in the UN Decade on Restoration. Extruded pellets are widely used in agriculture and represent a promising advancement in seed-based restoration. However, extruded pellets must be optimised for diverse suites of native species that possess a range of seed sizes and morphotypes. We investigated how seed mass affects the performance of native plant seeds (total % seedling emergence) when encapsulated in extruded pellets designed for revegetation. Two glasshouse trials were undertaken using seeds from 30 native Australian plant species. In Trial 1, we encapsulated seeds in the centre of pellets and determined the relationship between seed mass and emergence. In Trial 2, we encapsulated seeds nearer the periphery of pellets and determined whether the position of seeds (central vs. peripheral) affected emergence for a subset of 10 small-seeded species. In both trials, emergence from pellets was compared to an optimal, bare-seeded control to identify any barriers to seed encapsulation under well-watered conditions. In Trial 1, when seeds were centrally encapsulated, emergence was generally higher for bare-seeded controls relative to pelleted seeds. However, seed mass predicted emergence when seeds were encapsulated in the pellet centre (R2 = 0.32, p = 0.002), such that larger-seeded species tended to have higher emergence than smaller-seeded species. In Trial 2, encapsulating seeds nearer the pellet periphery (relative to the centre) resulted in an average 28-fold increase in emergence for all 10 small-seeded species. For half of the small-seeded species trialled, emergence from the pellet periphery was equivalent to that of bare-seeded controls. Synthesis and applications: Collectively, our results demonstrate: (1) a positive relationship between seed mass and emergence under central-encapsulation, and (2) that emergence can be significantly improved for small-seeded species when seeds are positioned nearer the pellet periphery. Translation of these findings into practice can help optimise emergence outcomes for native species with different sized seeds and nuanced germination requirements
Sleep spindle architecture associated with distinct clinical phenotypes in older adults at risk for dementia
No full textSleep spindles are a hallmark of non-REM sleep and play a fundamental role in memory consolidation. Alterations in these spindles are emerging as sensitive biomarkers for neurodegenerative diseases of ageing. Understanding the clinical presentations associated with spindle alterations may help to elucidate the functional role of these distinct electroencephalographic oscillations and the pathophysiology of sleep and neurodegenerative disorders. Here, we use a data-driven approach to examine the sleep, memory and default mode network connectivity phenotypes associated with sleep spindle architecture in older adults (mean age = 66 years). Participants were recruited from a specialist clinic for early diagnosis and intervention for cognitive decline, with a proportion showing mild cognitive deficits on neuropsychological testing. In a sample of 88 people who underwent memory assessment, overnight polysomnography and resting-state fMRI, a k-means cluster analysis was applied to spindle measures of interest: fast spindle density, spindle duration and spindle amplitude. This resulted in three clusters, characterised by preserved spindle architecture with higher fast spindle density and longer spindle duration (Cluster 1), and alterations in spindle architecture (Clusters 2 and 3). These clusters were further characterised by reduced memory (Clusters 2 and 3) and nocturnal hypoxemia, associated with sleep apnea (Cluster 3). Resting-state fMRI analysis confirmed that default mode connectivity was related to spindle architecture, although directionality of this relationship differed across the cluster groups. Together, these results confirm a diversity in spindle architecture in older adults, associated with clinically meaningful phenotypes, including memory function and sleep apnea. They suggest that resting-state default mode connectivity during the awake state can be associated with sleep spindle architecture; however, this is highly dependent on clinical phenotype. Establishing relationships between clinical and neuroimaging features and sleep spindle alterations will advance our understanding of the bidirectional relationships between sleep changes and neurodegenerative diseases of ageing
'It's time to make your way home' : implications of the COVID-19 pandemic for multicultural policies in Australia
No full textGovernments around the world acted in response to the COVID-19 pandemic through lockdowns and border closures that had specific impacts on temporary residents (migrants, asylum seekers and refugees). In Australia, there were differential responses across states and territories, and a critical distinction made at Federal government level between permanent residents and citizens as compared to temporary migrants. The result has been the continued Othering of certain groups of Australians of culturally and linguistically diverse backgrounds as well as migrants and refugees on the basis of racial characteristics and visa status. This paper will consider the period where arguably multicultural policies were ‘on hold’ by investigating the timeline leading up to major policy decisions and the immediate and longer-term after-effects during the COVID-19 pandemic. Arguably the way in which multicultural communities were treated has shown the superficial nature of multicultural policies in Australia and the lack of more solid foundations in support of what now demographically constitutes a majority of the country's population. Drawing on secondary data analysis, the paper will outline the distance these actions have put between political leaders and multicultural communities, and queries the implications for a sustained commitment to multicultural policies in an era of temporary migration
The potential for digital health to reframe the role of compassion in patient experience innovation
No full textGiven the opportunities afforded by digital health, this chapter clarifies the relationship between compassionate care and digital health and, in doing so, makes a case for compassionate digital health. It demonstrates how, despite the increasing ubiquity of digital health and the decline of compassion, digital health has the potential to foster compassionate care. Digital health is arguably the most significant opportunity to improve health outcomes, make healthcare more accessible, reduce its cost and improve patient experience innovation, creating enthusiasm and unease in equal measure. The chapter explicates the associated implications for scholars, healthcare professionals, policymakers as well as patients and carers. The relationship between digital health and compassion is paradoxical. On the one hand, the widespread adoption of digital health may enhance compassionate care, while on the other hand, there is the potential for a detrimental impact on compassionate care
WHS (Wound Healing Society) guidelines update : diabetic foot ulcer treatment guidelines
No full textEducating the educated : the impact of educational interventions on knowledge, attitudes and confidence of healthcare professionals in caring for patients with intellectual disability : a systematic review
No full textBackground: The attitudes, perceptions and inherent biases of healthcare professionals (HCPs) have the potential to influence and inform health outcomes of people with intellectual disability. This review aimed to identify what educational interventions have been conducted to improve the attitude, knowledge, and confidence of HCPs in caring for people with intellectual disability. Method: A systematic literature review was conducted using Medline, ERIC and PsycINFO. Inclusion criteria included: articles published after 1980 in English, quantitative and mixed methods studies. Results: Of 1444 articles yielded, 10 met the inclusion criteria. Studies predominantly included doctors and nurses. Almost half (40%) of the studies reported interventions that were effective in changing perceived confidence and attitudes, while 60% achieved improvement in knowledge or skills based on Kirkpatrick classification. Conclusions: Training is valuable in improving knowledge, broadening perspectives, and increasing confidence in managing people with intellectual disability but there are limited studies in this area
[In Press] Personal care workers' intention to stay in residential aged care : an integrative review
No full textAim: To identify key factors that influence personal care workers' (PCW) intention to stay in residential aged care (RAC). Background: PCWs are the ‘backbone’ of providing direct care in RAC settings. The well-being of older people hinges upon their dedication an commitment; thus, enhancing their intention to stay is a priority to reduce turnover and ensure continuity of care. Methods: Six databases were searched for articles focusing on factors influencing PCWs' intention to stay in RAC. Studies were independently assessed for quality using the Joanna Briggs Institute Methodology for systematic review tools. Reporting of the results followed the PRISMA guidelines. Findings: Eight articles published between 2010 and 2022 were included. The key issues were categorized as: (a) sociodemographic characteristics; (b) psychological factors; (c) workplace factors and (d) job satisfaction. Older age, being married and immigration status were positively associated with intention to stay. Work stress and burnout contributed towards demotivation, while a supportive and engaging organizational culture that recognized workers' contributions and provided appropriate remuneration and benefits, enhanced job satisfaction and retention. Conclusion: This review affirms the complexity of the decision making process influencing workers' intention to stay. A comprehensive understanding of the interplay of these factors and the personal and sociocultural challenges faced by PCWs is essential to design strategies to provide support and enhance job satisfaction and retention. Implications for Aged Care: This review showed that support from the organization is critical in improving PCWs' intention to stay in aged care. Given the interconnectedness of a range of key factors, decision-makers need to address modifiable factors holistically. Including PCWs in planning retention strategies could be the missing link in tailoring interventions towards workforce retention
The City, the River and the Museum: Ways of Knowing the Parramatta/Burramatta River
Get PDFParramatta is the furthest navigable point inland on the Parramatta River, and also the point at which the river becomes freshwater. Aboriginal people once fished from bark canoes on the river, and the river continues to be a place of Aboriginal cultural significance. The river was also an important transport corridor between Sydney and Parramatta, and most of the Parramatta River was once swimmable. By the 1950s, however, a lack of regulation and rapid industrial development caused substantial pollution and degradation of the water quality. Today, there are growing calls and initiatives to restore Parramatta River's significance as the green heart of the city. The arrival of the Powerhouse Parramatta – scheduled to open in 2025 – is a catalyst for this development. This publication is the result of a symposium held at Western Sydney University in November 2023 which brought together researchers, scientists, policy makers, artists, activists, community members and museum workers to focus on different aspects of the Parramatta River as a central feature of Parramatta's growing role as the Central River City in Greater Sydney