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Stratification of Outpatient Physical Therapy Following Total Knee Arthroplasty: Knee Arthroplasty Physical Therapy Pathways (KAPPA) Trial
No full textBackground:Given the existing and predicted future financial burden associated with total knee arthroplasty (TKA) procedures, it is crucial to critically evaluate the efficacy and economic efficiency of perioperative care, including physical therapy, which features in most TKA rehabilitation protocols. Improvements in clinical outcomes and shorter hospital lengths of stay for patients undergoing TKA bring into question the role of continued outpatient physical therapy postdischarge and whether there is an opportunity for startification of service and further cost savings. Global utilization of outpatient physical therapy following TKA has been reported as high as 85% for supervised physical therapy postdischarge from the acute inpatient hospital setting. However, this widespread use of supervised physical therapy post-TKA contrasts with evidence suggesting noninferior outcomes for a population who undergo unsupervised or self-directed rehabilitation, while also offering greater convenience for patients and potential savings for service providers. Despite the evidence supporting self-directed rehabilitation for individuals post-TKA, there appears to be no established criteria to determine who can successfully self-direct their rehabilitation versus those who would benefit further from outpatient physical therapy.Purpose:The aim of the Knee Arthroplasty Physical Therapy Pathways (KAPPA) trial was to determine if early postoperative criteria can be established to stratify TKA patients into a self-directed rehabilitation or supervised physical therapy pathway without compromising clinical outcomes or patient satisfaction.Methods:Overall, 60 TKA patients were initially allocated to a self-directed, unsupervised protocol for their postoperative rehabilitation. Baseline demographics, along with functional and self-reported outcomes, were assessed preoperatively and at 2 weeks, 6 weeks, and 4 months following surgery. Patients were referred to supervised outpatient physical therapy if they met any of the following Knee Arthroplasty Physical Therapy Pathways (KAPPA) criteria: (1) knee flexion range of motion <90 degrees; (2) knee extension range of motion lacking >10 degrees; or (3) dissatisfaction with the progress of their rehabilitation. Patients in the study who did not meet any of the KAPPA criteria for referral to supervised physical therapy at 2 weeks or 6 weeks following their TKA continued with self-directed rehabilitation at home.Results:At 2 weeks post-TKA, 28 participants met the KAPPA criteria for supervised physical therapy for reasons of knee flexion <90 degrees (61%), a lack of knee extension >10 degrees (36%), or not being satisfied with the progress of their recovery (3%). The remaining 32 participants continued with a self-directed rehabilitation pathway. All outcomes assessed favored the self-directed group at 2 weeks, however, after an average of 4 supervised physical therapy sessions at 4 months there were no longer any differences between the 2 groups.Conclusion(s):Approximately half of the included participants in the KAPPA trial could successfully self-direct their rehabilitation following TKA without supervised physical therapy, while also maintaining excellent clinical and self-reported outcomes. A physical assessment of knee ROM corresponded to all other outcomes when assessed at 2 weeks post-TKA.Implications:The results of the KAPPA trial support the feasibility of self-directed rehabilitation and have established potential early postoperative criteria to indicate who may benefit from referral to supervised physical therapy at 2 weeks post-surgery. Keywords:Total knee arthroplastySupervised physical therapyRehabilitationFunding acknowledgements:This research was supported by Bond University Faculty of Sciences and Medicine Early Career Research Seed Grant.Primary topic:Orthopaedic
Submission to State Development, Infrastructure and Works Committee in relation to the Inquiry into E-mobility safety and use in Queensland
No full textThis submission will deal with the issues around e-mobility safety and use in Queensland, with the following terms of reference: That the State Development, Infrastructure and Works Committee inquire into and report to the Legislative Assembly no later than 30 March 2026 on: 1. Benefits of e-mobility (including both Personal Mobility Devices (PMDs), such as e-scooters and e-skateboards, as well as e-bikes) for Queensland; 2. Safety issues associated with e-mobility use, including increasing crashes, injuries, fatalities, and community concerns; 3. Issues associated with e-mobility ownership, such as risk of fire, storage and disposal of lithium batteries used in e-mobility, and any consideration of mitigants or controls; 4. Suitability of current regulatory frameworks for PMDs and e-bikes, informed by approaches in Australia and internationally; 5. Effectiveness of current enforcement approaches and powers to address dangerous riding behaviours and the use of illegal devices; 6. Gaps between Commonwealth and Queensland laws that allow illegal devices to be imported and used; 7. Communication and education about device requirements, rules, and consequences for unsafe use; and8. Broad stakeholder perspectives, including from community members, road user groups, disability advocates, health and trauma experts, academia, the e-mobility industry, and all levels of governmen
Deciding who decides: An interview study exploring the factors affecting emergency department and intensive care unit health professionals’ understanding and application of the law on end-of-life decision-making
No full textBackground: All health care is underpinned by legal frameworks, including those that regulate who is responsible for healthcare decisions at the end of life. How these frameworks support decision-making in emergency departments (EDs) and intensive care units (ICUs) is underexplored. Objective: The objective of this study was to identify factors that help or hinder healthcare professionals' understanding and application of the law that applies to end-of-life decision-making in the EDs and ICUs in Queensland, Australia. Methods: A descriptive qualitative study based on naturalistic inquiry was undertaken. Participants were healthcare professionals working in the ICUs or EDs of one South East Queensland Hospital and Health Service, responsible for the care of adult patients who had died. Results: Thirteen medical practitioners, 19 registered nurses, and three social workers participated in semistructured interviews. Three themes and eight subthemes were identified in the data. First, the theme the complexity of communication is laid bare at the end of life described the challenges associated with talking about death and dying and the need to reframe conversations where death is inevitable. Next, the theme decision-making has layers highlighted family inclusion in decisions, navigating different perspectives to share decision-making and acknowledging that decision-making is emotionally burdensome. Finally, the theme how the law should apply is uncertain described the difficulties in deciding who should decide, knowing when Advance Health Directives can be relied on, and the need to reduce legal risk. Conclusion:Decision-making at the end of life is complex and challenging. Healthcare professionals charged with leading conversations find them challenging and are mindful of the burdens associated with such decisions. The need to work within the legal framework is acknowledged, but applying the law can be difficult
Pre-operative pain catastrophising and resilience correlate with function and pain outcomes following total knee arthroplasty: A systematic review
No full textBackground: Total knee arthroplasty (TKA) is a common surgical intervention for end-stage knee osteoarthritis, yet up to 20 % of patients report dissatisfaction with surgery. Pre-operative psychological factors may be associated with post-operative outcomes, yet their relationship remains unclear. Objectives: To examine the correlation between pre-operative pain catastrophising and resilience with post-operative outcomes in primary total knee arthroplasty patients. Design: Systematic literature review. Method: Five databases were searched until July 2024. Studies investigating correlations between pre-operative pain catastrophising or resilience and post-operative outcomes were included. Study selection was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Results of individual studies were extracted and described through narrative and tabular synthesis. Study comparisons between pre-operative psychological measures and post-operative outcomes were grouped and reported on. Results: Fourteen studies (2,506 patients) were included. Pain catastrophising showed consistent correlations with post-operative pain intensity and self-reported function in most studies. Lower pre-operative resilience was associated with reduced post-operative self-reported function and physical performance in some studies. However, neither pain catastrophising nor resilience demonstrated correlations with physical performance, analgesic requirements, psychometric outcomes, or length of hospital stay. Conclusions: This review found that pre-operative pain catastrophising consistently correlates with post-operative pain and functional outcomes, while the association with resilience was less conclusive. These findings suggest potential value in pre-operative psychological screening, particularly for pain catastrophising, to identify patients who may benefit from targeted interventions
Transient institutional ownership, costly external finance and corporate cash holdings
No full textWe investigate and robustly show that transient institutional ownership (IO) has a positive effect on the level and value of corporate cash holdings. Further, using a regression discontinuity design exploiting the Russell 1000/2000 index reconstitution as an exogenous shock to transient IO, we show that the effects of transient IO on cash holdings are causal. Additionally, our analysis shows that transient institutions exacerbate debtholder–shareholder conflicts, thereby increasing the cost of debt. Overall, our results suggest that transient institutions make cash holdings more valuable because financing by debt becomes more costly.</p
Sino-Australian Agricultural Trade in 2022–2023
No full text随着工党领袖安东尼·阿尔巴尼斯出任澳大利亚第31 任总理, 中、澳两国在经历了3 年多的冰冻期之后首次出现破冰迹象。阿尔巴尼斯摒弃了前几任政府一直以来对华的敌对态度, 主动改善中澳关系, 加强两国政治、外交、经贸等方面的交流。2022～2023 年, 两国关系重整步伐有所加快。中澳均有意就相关技术性贸易措施等问题进行深入探讨, 两国农产品贸易方面的合作呈现积极向上的趋势。然而冰冻三尺, 非一日之寒, 解冻也并非一朝一夕就能完成的。2022～2023 年, 澳对华农产品出口喜忧参半。小麦、牛肉等农产品的出口表现良好; 葡萄酒、龙虾等出口并未有明显起色, 仍处于触底阶段。展望未来, 随着中澳关系的进一步改善, 两国农产品贸易合作的前景将更加广阔。但是中澳所面临的一系列挑战也是不容忽视的, 尤其是未来关系发展方向, 在很大程度上取决于澳在对华政策上能否保持独立性、积极性和稳定性。As Anthony Albanese was sworn in as the 31st Prime Minister of Australia in May 2022, promising signs emerged that the long-strained Sino-Australian relationship was beginning to recover. The Albanese government departed from the hostile stance adopted by previous administrations and actively sought to improve bilateral ties with China. Notably, in 2022–2023, China and Australia resumed high-level discussions on trade, diplomacy, and security. A key item on the agenda was the removal of trade measures previously imposed by China on Australian agricultural exports. While the process of repairing relations takes time, Australia’s exports of wheat and beef to China increased, although wine, lobster, and other agricultural commodities remained at low levels. Nevertheless, a broader reset is expected in the near future. As bilateral relations continue to improve, opportunities for deeper collaboration in agricultural trade are likely to expand
Real-Time Vehicle Type Detection and Counting for Emission Pollution Monitoring and Traffic Violation Identification
Get PDFIn an urban environment, traffic congestion, automobile emissions, and road safety are significant problems that lead to financial losses and environmental deterioration. Vehicle detection, counting, speed estimation, and pollution monitoring are frequently handled inconsistently by current traffic monitoring systems. This research closes this gap by applying the cutting-edge YOLOv8 deep learning architecture to create an extensive real-time vehicle recognition and counting system. In addition to calculating vehicle speeds and detecting five different types of vehicles and pedestrians, the system also estimates emission rates in real time using traffic data. After evaluation of two YOLOv8 variants (YOLOv8n and YOLOv8s), it was found that YOLOv8s performed better, with 0.936 precision, 0.822 recall, and 0.930 mAP50 for CNG automobiles. With an emission factor ranging from 0.6 to 0.8, real-time pollution monitoring was made possible by calculating vehicle emissions based on both type and speed. In addition, the system has a web application developed with the Flask framework and allows real-time traffic data display, including emission rates, vehicle counts, and speed calculations. The method is effective, as evidenced by the results, where YOLOv8s exceed YOLOv8n in essential metrics, including the miss-classification rate (as low as 0.112) and F1-score (0.875 for CNG). With its unique method of simultaneous vehicle identification, counting, speed estimation, and pollution monitoring, this research could lead to advancements in road safety, traffic management, and emission reduction.</p
‘The mental load carries the weight’: Australian women’s perceptions of their postpartum body image and eating attitudes
No full textThe postpartum period presents physical and psychological changes, often influenced by societal body image ideals. This study explores postpartum women’s experiences with body image and eating behaviours using a qualitative phenomenological approach. Four semi-structured focus groups were conducted with 15 Australian postpartum women. Reflexive thematic analysis identified three key themes: (i) Internal guilt and self-judgement: Mothers are never the priority, mothers deprioritising their needs, (ii) External pressure and support, societal and social influences on postpartum expectations and (iii) Healthy habits and self-compassion, balancing diet, exercise and self-acceptance. Many participants experienced body dissatisfaction driven by societal standards and a desire to reclaim pre-pregnancy bodies, sometimes leading to maladaptive eating behaviours. Social support was both helpful and a source of pressure. This study highlights the complex relationship between postpartum body image and eating attitudes, emphasising the need for holistic healthcare interventions to support maternal well-being, body positivity and healthy eating practices
Working within the school system—Considerations for practice
No full textIntroduction:In Australia, the introduction of school equity funding has broadened the services available in schools to support the educational and wellbeing outcomes for children of low socioeconomic background (LSEB). Eligible schools in New South Wales (NSW), a state where nearly one third of the population of Australia lives, have used this funding to introduce wellbeing programs or hired more specialist teaching and allied health staff. With this emerging role in schools, occupational therapists need to understand the complexities of lower socioeconomic school environments to be able to work within the education system effectively.Objectives: This study aimed to identify facilitators and barriers to school success and wellbeing for children in LSE primary schools.Method: A phenomenological methodology was used to understand the experiences of northern NSW school executives and regional managers working in LSES schools.Results: Three nondiscrete themes emerged from the phenomenological analysis: Theme 1: foundations: time, relationships, high expectations, wellbeing. Theme 2: systems, and staffing: expertise, resources. Theme 3: perpetuation: disruption, disconnect. Combined, the findings demonstrated the complexity of the low socioeconomic school environment, with multiple factors needing to align to support student wellbeing and success.Conclusion: Supporting children of LSEB to experience success and wellbeing at school require effective interdisciplinary partnerships between health and education staff. Occupational therapy services provided in schools do not exist in a vacuum, and models of care that can inform education policy and include school, class, and individual occupational therapy services that may be warranted to improve educational and wellbeing outcomes for children of LSEB
Enhancing medicine information handover at hospital discharge: evaluation of a multifaceted intervention pilot trial
No full textBackground:Hospital pharmacists and doctors should collaborate to prepare discharge medicine handover information and pharmacists and nurses in providing discharge medicine counselling. This pilot trial evaluated a multifaceted intervention that included training hospital doctors to record medicine changes, patient risk stratification, and collaborative doctor and pharmacist discharge medicine reconciliation to improve information handover.Methods:A pilot study was undertaken at two hospitals in Queensland, Australia. Evaluation incorporated an audit of intervention patient discharge medicine information handover with a control cohort and a time-and-motion observation. Eligible general medicine patients ≥65 years were recruited over nine weeks; a randomisation process was followed to select the control group. We aimed to incorporate 50 intervention patient discharges in the audit.Results:Most of the 52 intervention and 50 control patients were male (34/52, 65.5 %; 32/50, 64.0 %); average age was 78.6 (SD = 9.0) and 77.7 (SD = 9.3) years. Medicine reconciliation was completed at the time of discharge for 50/52 (96.2 %) of intervention and 34/50 (68.0 %) of control patients; more electronic discharge summaries of intervention patients included all medicines compared to control patients; pharmacists were involved in all intervention discharges compared to 90.0 % (45/50) of control discharges. Discharge summaries of intervention patients were sent to general practitioners within 4.3 days and 9.2 days for control patients. Time-and-motion observations showed that pharmacist discharge medicine information handover time was reduced by 32 min between intervention and control cohorts.Conclusion:Our study showed that the multifaceted intervention reduced the time required to complete discharge medicine handover information, facilitated patient discharge, and reduced the time-period of sending discharge summaries to general practitioners