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Healthy Country: Re-writing the book on Australia
Get PDFThe path to reconciliation must be underpinned by truth. Without truth, we can only build a flawed future for our continent and our people. The narrative of modern Australia is based on a lie. The lie that this continent was unoccupied at the time of the British Invasion – a terra nullius. This lie pervades the very fabric of our nation and is causing serious harm to its people and its very health. Right now, Australia is facing enormous environmental challenges that threaten the health of Country across our continent. Finding solutions to these challenges is critical if we hope to live sustainably over the long-term.
While climate change is placing ever increasing pressures on human and natural systems, many of the challenges we face – such as species loss and catastrophic bush fires – began long before the onset of anthropogenic climate change. In this talk, I will highlight and then dispel the series of myths upon which modern Australia’s identity is built. This identity shapes the way we attempt to manage our environments and is, in many instances, doing more harm than good. I will draw upon a range of data sources to demonstrate that cultural factors are as equally important as climate change. I urge that we seek to understand the truth of Country so that harmful myths, such as “Wilderness”, do not continue to result in the neglect of Country that needs care. We need, instead, to understand how our landscapes have been shaped by Aboriginal people for tens of thousands of years if we are to succeed in our efforts to mitigate catastrophic bush fires and biodiversity loss. It is by reconciling with these truths that we will return health to Country and its people
\u27The Aboriginal standards for the conduct of research - changing the paradigm at Telethon Kids Institute\u27
Get PDFThe Telethon Kids Institute launched the \u27Guidelines for the Standards for the Conduct of Aboriginal Health Research\u27 in July 2022. These guidelines were developed over seven years before being launched during NAIDOC week 2022, when the theme was \u27Get Up! Stand Up! Show Up!\u27. Our Aboriginal communities\u27 voices are at the centre of the work at Telethon Kids Institute, where the health of Aboriginal children is everybody\u27s business. Implementing ‘The Standards’ is fundamental in challenging and changing the way research is being done in our communities. The framework it provides ensures our ways of knowing, doing, and being are at the heart of change in Aboriginal Health research
SMEs tax minimization as shared responsibility
No full textPrevailing criticism of tax minimization strategies is impacting contemporary business decisions. While extant research has focused on an alleged ‘moral’ shift among large accounting firms and corporates, little is known about tax responsibilities in the context of small and medium-sized enterprises (SMEs). Thus, we examine the following research question: How do SMEs and tax accountants perceive responsibility within the context of taxation? Our empirical investigation involves semi-structured interviews with accountants and their SME clients in Italy. Our findings point to an entanglement of legal, economic, ethical, and philanthropic responsibilities enacted in mundane tax strategy work. We propose a model of ‘shared responsibility’, aiming to clarify the complementary role of SMEs, tax accountants, and state actions in the curtailment of public funding, ultimately affecting the survival of all actors involved. Our work contributes to growing scholarship on business taxation as a form of social responsibility by emphasizing the shared nature of such responsibility, as well as showing how a current reliance on reputational risks to incentivise more responsible tax behaviour is ill suited to the SME conte
Visualising the modern housewife: US occupier women and the home in the allied occupation of Germany, 1945-1949
No full textThousands of Allied women arrived in occupied Germany after the Second World War as the wives of military and civilian men working in the occupation apparatus. Yet rarely have these women been seen as active agents of occupier power and knowledge. One way of understanding their role, or how it was imagined, is through images and textual representations. With a focus on the early years of occupation (1945–1949) and visual representations of US wives, this article examines the occupation household that was serviced by occupied domestic workers, in turn drawing comparisons to imperial contexts. Visual cues in selected photographs and caricatures suggest a presumed superior occupier modernity that was both performative and educative, mediated by a class-like asymmetrical relationship. These representations have been divided into three key themes: economic modernity, as through consumerism; domestic modernity in the home; and modern gender and family relations. Here, occupier women’s bodies were contrasted against the occupied to signify the power, prestige and modernity of her nation as an occupying power, in turn revealing both the shape of everyday power relations in the home and the paradoxical aims of the occupation itself
Harmony Day 2024
No full textHarmony Day is an Australian Government program that centers on the message that “Everyone belongs”, reinforcing the importance of inclusiveness to all Australians. Since 1999, thousands of Harmony Day events have been staged in childcare centers, schools, community groups, churches, businesses and federal, state and local government agencies across Australia
Evaluation of the accuracy of diagnostic coding and clinical documentation for traumatic heterotopic ossification diagnoses in Western Australian hospitals
No full textBackground: Traumatic heterotopic ossification (tHO) refers to the pathological formation of ectopic bone in soft tissues that can occur following burn, neurological ororthopaedic trauma. As completeness and accuracy of medical diagnostic coding can vary based on coding practices and depend on the institutional culture of clinical documentation, it is important to assess diagnostic coding in that local context. To the authors’ knowledge, there is no prior study evaluating the accuracy of medical diagnostic coding or specificity of clinical documentation for tHO diagnoses across Western Australia (WA) trauma centres or across the full range of inciting injury and surgical events.
Objective: To evaluate and compare the clinical documentation and the diagnostic accuracy of ICD-10-AM coding for tHO in trauma populations across 4 WA hospitals.
Results: HO-specific M61 ICD-10-AM codes failed to identify more than a third of true tHO cases, with a high prevalence of non-specific HO codes (19.4 %) and cases identified via manual chart review (25.4 %). The sensitivity of M61 codes for correctly diagnosing tHO after burn injury was 50 %. ROC analysis showed that M61 ICD-10-AM codes as a predictor of a true positive tHO diagnosis were a less than favourable method (AUC=0.731, 95 % CI=0.561–0.902, p = 0.012). Marked variability in clinical documentation for tHO was identified across the hospital network.
Conclusion: Coding inaccuracies may, in part, be influenced by insufficiencies in clinical documentation for tHO diagnoses, which may have implications for future research and patient care. Clinicians should consistentl
Hypomineralization disorder in tropical Southeast Asia during the agricultural revolution: Analysis of morbidity and mortality
No full textThis paper presents evidence for hypomineralization disorders (rickets and osteomalacia) in non-adults at Man Bac, a Neolithic site from northern Vietnam dated to 4000–3500BP, contributing to the well-described disease burden at the site that includes scurvy, treponemal disease, thalassemia, and malaria. Forty-four non-adults (\u3c20 years of age-at-death) were assessed for macroscopic and radiographic evidence for hypomineralization disorders. Differential diagnosis was completed using traditional methods and three-level standardized criteria to combat the challenges of overlapping pathological features between hypomineralization disorder and the other diseases already diagnosed at the site. In addition, a diagnostic certainty approach was applied to investigate the impact of lesion ambiguity on our findings. Kaplan–Meier and Fishers exact tests were applied to assess age-at-death-related epidemiological patterns of hypomineralization disorder and co-morbid relationships with scurvy, thalassemia, and treponemal disease. Almost 50% of the non-adult assemblage presented with evidence for hypomineralization disorder, which was associated with decreased survivorship in childhood. Potential epidemiological relationships between scurvy and hypomineralization disorders, and thalassemia and hypomineralization disorders are described. The former relationship may be due to the likelihood of the introduction of rice resulting in multi-micronutrient deficiency, including vitamin C and calcium deficiency, and cultural attitudes to sunlight. The latter relationship may relate to the pathophysiology of thalassemia that can result in secondary osteomalacia possibly contributing to the development of hypomineralization disorder in the thalassemic non-adults. The findings are significant as they present possible approaches for diagnosis of disease embedded within complex disease burdens where individuals are likely suffering from co-morbidities
Early ambulation impacts on quality-of-life outcomes positively after lower limb burn injury: A group trajectory analysis
No full textIntroduction: Despite the challenges of providing burn care throughout the 2.5MKm2 jurisdiction of Western Australia, early intervention after injury remains a key premise of the multidisciplinary model of care applied by the State Adult Burn Unit (SABU) team. In particular, contemporary guidelines support the facilitation of early ambulation after lower limb burn and skin grafting. Thus, this study aimed to evaluate the association between the timing of ambulation after burn and surgery on quality of life (QoL) outcomes.
Methods: Data from 1707 lower limb burn patients aged ≥ 18, admitted to the SABU between February 2011- December 2019, were included. Self-reported QoL longitudinal outcomes were assessed using the Short Form 36 and Burn Specific Health Scale Brief. Three recovery trajectories were defined according to their QoL outcome responses, mapped out to one year. Early ambulation was defined as occurring within 48 h of acute burn or surgery, as per SABU routine practice.
Results: Early ambulation was shown to have a positive association to the higher QoL trajectory group (\u3e 75% of cohort), though not statistically significant for the Physical Component (PCS) and Mental health Component (MCS) summary scores of the SF36; however, ambulation pathway was associated with adjusted long-term BSHS-B QoL outcomes. The least favorable trajectory of long-term recovery of the physical aspects of QoL was seen in those with higher TBSA and complications and increasing age and comorbidities. In contrast, the mental health components of QoL were robust to all those factors, apart from pre-existing comorbidities.
Conclusion: Early ambulation after lower limb burn, and surgery, was positively associated with early and long-term QoL outcomes. Recovery trajectory is strongly indicated by where the patient journey begins after early acute care. The optimal physical QoL recovery trajectory was shared by those who were younger with reduced TBSA; complications; and, comorbidities whereas the mental health QoL trajectories were only impacted by comorbidities
Hot avulsion versus argon plasma coagulation for the management of the non-ensnarable polyp: A multicenter, randomized controlled trial
No full textBackground and aim: Snare resection of nonlifting colonic lesions often requires supplemental techniques. We compared the success rates of neoplasia eradication using hot avulsion and argon plasma coagulation in colonic polyps when complete snare polypectomy had failed.
Methods: Polyps that were not completely resectable by snare polypectomy were randomized to argon plasma coagulation or hot avulsion for completion of resection. Argon plasma coagulation was delivered using a forward shooting catheter, using a nontouch technique (flow 1.2 L, 35 watts). Hot avulsion was performed by grasping the neoplastic tissue with hot biopsy forceps and applying traction away from the bowel wall while using EndoCut I or soft coagulation for avulsion. Surveillance colonoscopies were performed at 6, 12, and 18 months.
Results: From November 2013 to July 2017, 59 patients were randomized to argon plasma coagulation (28) or hot avulsion (31). The median age was 69 (60-75), with 46% being female. The median residual tissue size was 10 mm (6-12). The residual adenoma rate at 6 months (hot avulsion 6% vs argon plasma coagulation 21% P = 0.09) and 18 months was not different between the groups (6.6% vs 3.6% P = 0.25). One patient in the argon plasma coagulation arm was diagnosed with metastatic cancer of likely colorectal origin despite benign histology in the original polypectomy specimen, supporting the importance of tissue acquisition.
Conclusion: Both hot avulsion and argon plasma coagulation are effective and safe modalities to complete resection of non-ensnarable colonic polyps
Identification of distinct immune signatures in inclusion body myositis by peripheral blood immunophenotyping using machine learning models
No full textObjective: Inclusion body myositis (IBM) is a progressive late‐onset muscle disease characterised by preferential weakness of quadriceps femoris and finger flexors, with elusive causes involving immune, degenerative, genetic and age‐related factors. Overlapping with normal muscle ageing makes diagnosis and prognosis problematic.
Methods: We characterised peripheral blood leucocytes in 81 IBM patients and 45 healthy controls using flow cytometry. Using a random forest classifier, we identified immune changes in IBM compared to HC. K‐means clustering and the random forest one‐versus‐rest model classified patients into three immunophenotypic clusters. Functional outcome measures including mTUG, 2MWT, IBM‐FRS, EAT‐10, knee extension and grip strength were assessed across clusters.
Results: The random forest model achieved a 94% AUC ROC with 82.76% specificity and 100% sensitivity. Significant differences were found in IBM patients, including increased CD8+ T‐bet+ cells, CD4+ T cells skewed towards a Th1 phenotype and altered γδ T cell repertoire with a reduced proportion of Vγ9+Vδ2+ cells. IBM patients formed three clusters: (i) activated and inflammatory CD8+ and CD4+ T‐cell profile and the highest proportion of anti‐cN1A‐positive patients in cluster 1; (ii) limited inflammation in cluster 2; (iii) highly differentiated, pro‐inflammatory T‐cell profile in cluster 3. Additionally, no significant differences in patients\u27 age and gender were detected between immunophenotype clusters; however, worsening trends were detected with several functional outcomes.
Conclusion: These findings unveil distinct immune profiles in IBM, shedding light on underlying pathological mechanisms for potential immunoregulatory therapeutic development