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Community health navigators in Australian general practice: an implementation study
Get PDFBackground Patient health navigators have an emerging role in assisting people to connect with health and social care services especially those experiencing language and communication barriers. A challenge with navigator programs is sustaining their implementation. This study evaluated the implementation and sustainability of bilingual community navigators (BCNs) in multilingual general practices in Sydney and their impact on patient access. The hypothesis was that the use of bilingual navigators within multilingual practices would be acceptable and feasible, improve patient access to appropriate care and staff workload, and reduce health inequities. Methods Patient referral information was collected and analysed descriptively. Interviews were conducted with practice staff, patients, and navigators after 10-week placements and analysed thematically using Normalisation Process Theory. Results A total of 110 patients were referred to navigators who assisted with booking appointments, accessing community resources, and translating and explaining information. Interviews were undertaken with four navigators, three patients, three carers, and four GPs. Practice participants could see the benefits of the BCNs and were motivated to engage with them, especially with GP endorsement. However, not all understood the navigator competencies and roles. In some practices, the population needs and the scheduling of appointments and staff routines could have aligned better, which constrained referrals and continued navigator involvement. Conclusions This study demonstrates the potential role of navigators in addressing navigation challenges experienced by culturally and linguistically diverse patients in general practice. More effort is needed to tailor attachments to the unique needs of the patient population and practice schedule. Sustainability requires ongoing funding and broad institutional support
Links between hail hazard and climate modes of variability across Australia
Get PDFHailstorms are destructive and dangerous phenomena that can cause large losses, motivating better understanding of their occurrence. As climate modes of variability influence temperature and moisture and hence convective instability, they offer predictive skill for hail conditions. Here, we examine relationships between hail-prone days across Australia and the El Niño–Southern Oscillation (ENSO), Indian Ocean Dipole (IOD), and Southern Annular Mode (SAM). Hail-prone days were identified using a hail proxy applied to European Centre for Medium-Range Weather Forecasts Reanalysis v5 (ERA5) data from 1979 to 2022. Hail-prone day anomalies were correlated with strength-of-mode indices. Broad areas of the country's interior show increased hail-prone days during La Niña, negative IOD, and positive SAM in spring. The relationship with IOD and SAM is significant in winter for Brisbane and to some extent for Sydney, reversing sign in summer. Anomalies increase over Western Australia's south during El Niño and positive IOD in spring. Our work highlights potential connections between climate modes and hail-prone conditions, investigates meteorological factors behind the observed correlations, and helps us understand annual variability to improve seasonal prediction
Soft Conductive Stitching of Carbon Fibre Reinforced Composites for Electrical Conductivity Enhancement
Get PDFCarbon fibre reinforced polymer (CFRP) has become dominant in aerospace structural materials due to its lightweight and high specific strength. However, its low electrical conductivity, particularly in the through-thickness direction, limits its application in areas requiring conductive structures, such as lightning strike protection (LSP), electromagnetic interference (EMI) shielding, and structural health monitoring. Stitching has emerged as a low-cost and effective method to enhance the interlaminar fracture toughness and can be used to increase electrical conductivity of the composites by incorporating conductive materials, thereby promoting the multifunctionality of the structural composites. Nonetheless, the primary concern is the potential reduction in the in-plane mechanical strength. Additionally, comprehensive studies investigating both the electrical and mechanical performance of stitched composites remain limited. This work aims to address these gaps by conducting an in-depth study using soft conductive yarns to enhance electrical conductivity while maintaining sufficient mechanical strength. The study first focused on investigating the effects of stitching parameters, including yarn type and stitch density on electrical and mechanical properties. One of the silver-coated low-stiffness yarns significantly improved electrical conductivity and mode I interlaminar fracture toughness. The study demonstrated that a marginal reduction of tensile strength can be achieved by adjusting the stitching density. Hence, both electrical and mechanical can be tailored to meet specific requirements.
The effects of stitch parameters were further investigated the electrical and mechanical properties by implementing the silver-coated yarn stitching in a grid pattern due to the potential to provide uniform deformation distribution and reduce anisotropy of in-plane properties. High-voltage impulse testing was also conducted to evaluate the effectiveness of stitched composites for lightning strike protection (LSP) applications. At the highest stitch density (smallest grid size), the stitched composites offered similar protection under high-voltage condition to commercial metallic mesh materials. However, the specimen with the smallest grid size exhibited the greatest reduction in in-plane mechanical properties compared to baseline composites. To further enhance electrical conductivity while retaining mechanical strength, surface modification was integrated with lower stitch-density composites. In this study, a thin silver-coated carbon fibre veil was combined with stitching to provide more conductive paths on the surface. After high-voltage testing, integrating a conductive veil with stitching showed residual flexural strength comparable to metallic mesh composites. This approach allowed the stitched composites to achieve high conductivity and fracture toughness while retaining sufficient mechanical strength for LSP application without the necessity of very small grid stitching. This work provides new contributions on the impact of stitching parameters using soft conductive yarns on the electrical and mechanical performance of the composites, which is essential for developing structural composite design for applications where current dissipation is significant. Additionally, critical stitch parameters for protecting composites under the high-voltage conditions were obtained. A novel approach using an integrated silver-carbon conductive layer together with the conductive stitching revealed that the primary lightning strike protection mechanism was attributed to current dissipation from the strikes’ impact location to the conductive yarns. This developed design of the through-thickness reinforcement method offers the advantage over conventional lightning strike protection materials by improving delamination resistance, reducing the potential of galvanic corrosion associated with traditional copper materials, and highlighting the multifunctionality of the stitched composites for electrical applications. The developed composites have the potential for lightning strike protection while maintaining sufficient structural capability for aerospace and automotive applications
Aristotelian Battle Ethics: An examination of the utility of Aristotelian Virtue Ethics for the Australian Army at the tactical level of war.
Get PDFThe future battlespace will evolve and accelerate, impacted by the convergence of technology, culture and competition, complicating tactical level command, planning and decision-making. The manifesting evolutions are likely to overwhelm and fracture current approaches used by the Australian Army to overcome ethical and intellectual friction. Currently, the ethical, moral, and intellectual framework the Australian Army uses is unlikely to address the complexities of
future tactical problem sets. This is because it is an amalgamation of approaches that potentially duplicates process, disrupts action, and prevents tactical innovation in battle. The Army should embrace an approach that enables excellence of character and cultivates ethical and intellectual attributes. The alternative to the current doctrinal or alternative approaches is the integration of Virtue Ethics, as Aristotle advocates, which focuses on the fundamental character and motivations of an individual’s behaviour, and involves rationally pursuing excellence as a goal in and of itself. This thesis examines the utility of Aristotelian Virtue Ethics as a framework for command, planning and decision-making at the tactical level of war via a synthesis of virtue ethics and key doctrinal warfighting concepts to overcome moral and intellectual friction. The objective is to provide combatants with intellectual and ethical skills to ensure they are prepared to overcome the dangers and complexity of future tactical battlefields
Stress-Related Brain Alterations in Chronic Pain
No full textBackground: Stress symptoms are commonly experienced by people with chronic pain. Although stress and chronic pain are associated with similar effects on brain morphology, the present study aims to clarify the relationship between stress severity, chronic pain, and brain morphology. Methods: Fifty-two people with chronic pain and 38 pain-free healthy controls (HC) underwent T1-weighted magnetic resonance imaging. Severity of stress symptoms was measured using the civilian version of the posttraumatic stress disorder checklist (PCL-C). A series of multiple linear regressions determined the main effects of group, stress symptom severity (PCL-C total score and symptom-specific scores) and their interaction on grey matter volume of selected regions of interest. Results: The interaction term was significantly associated with variations in grey matter volume in the left and right putamen, the left middle cingulate cortex (MCC) and the right posterior insula. Results showed significantly smaller left and right putamen when reporting higher stress levels, and significantly larger left MCC and right posterior insula at lower stress levels in people with chronic pain compared to HCs. In addition, increasing stress severity was significantly associated with larger left and right putamen in HCs, and significantly associated with smaller left MCC and right posterior insula in people with chronic pain. Conclusions: Severity of stress moderated chronic pain-related grey matter alterations. More severe stress, especially avoidance, was associated with smaller left MCC, a core region of the “pain matrix”. The MCC is strongly linked with the somatosensory network and critical for empathy, especially toward pain-related stimuli. Significance: To our knowledge, this is the first study to show that stress severity differentially impacts grey matter integrity in people with chronic pain compared to pain-free healthy controls. Briefly, our results indicate that higher levels of stress were associated with larger putamen and right posterior insula in pain-free participants, potentially reflecting mechanisms of resilience to trauma in this group. Higher levels of stress, especially avoidance symptoms, were associated with smaller left middle cingulate cortex, a region with strong links to the somatosensory network and critical for empathy, especially toward pain-related stimuli
MultifocAL COntact Lenses for Myopia
Get PDFThis thesis evaluates the efficacy of the Acuvue Oasys for Presbyopia (AOP; Johnson & Johnson Vision Care, USA) soft contact lens (SCL) in controlling progressive myopia in children, compared to the FDA-approved MiSight 1-Day (CooperVision, USA) CL over one-year in the MultifocAL Contact Lenses for Myopia (MALCOLM) trial, designed as a contralateral eye, non-inferiority study. Secondary objectives involved assessing methods for measuring treatment adherence and Vision-Related Quality-of-Life (VR-QoL) to explore their association with myopia progression.
The AOP power profile was characterised using high resolution instrumentation, confirming its theoretical potential for myopia control. Interim analysis showed that myopia progression, defined by axial length and spherical equivalent refraction, in eyes fitted with the AOP was non-inferior to those fitted with MiSight 1-Day. The study design presented no barriers to recruitment, and study outcomes demonstrated high clinical acceptability of both CL designs.
Evaluation of methods measuring treatment adherence found implementation rates were the highest in retrospective questions, followed by text-message surveys and CL label counting. While text-message surveys were preferred for daily wear, retrospective questions were favoured for weekly wear. Moderate to high weekly and daily adherence was found supporting the study outcomes of high clinical acceptability of both lens designs.
Pediatric Refractrive Error Profile 2 (PREP2) and Pediatric Eye Questionnaire (PedEyeQ) were incorporated into the MALCOLM trial to assess VR-QoL in children while they were undergoing CL treatment. Psychometric evaluation of the PREP2 survey revealed limitations in measurement precision but confirmed its validity for the measurement of VR-QoL in myopic children. VR-QoL remained stable or improved with CL wear, demonstrating wearing two different myopic control SCL contralaterally did not adversely impact QoL and supporting these two lens designs for myopia control in children.
Evaluation of secondary, safety/dispensing and exploratory outcomes of the MALCOLM trial found no reduction in monocular or binocular visual function after fitting with contralateral eye lens use. No associations were observed between treatment adherence and myopia progression, even with VR-QoL as a covariate. Nonetheless, further research is needed to explore the underlying mechanisms driving myopia control outcomes beyond adherence and VR-QoL
Power and the passion: assessing statistical power with simulations to optimise monitoring of a threatened lizard
Get PDFContext Effective ecological surveying is a crucial component of the conservation management of cryptic and threatened species. Ensuring that a survey design has adequate statistical power to confidently detect changes is often overlooked. The pygmy bluetongue (Tiliqua adelaidensis) is an endangered species likely to benefit from increased survey optimisation and structured monitoring efforts across its fragmented and limited distribution. Aims We compared multiple quadrat sizes on simulated populations of T. adelaidensis at varying densities to evaluate sample sizes and detection rates required to achieve optimal statistical power and assess the ideal quadrat size and number for detecting population changes at Tiliqua Nature Reserve, South Australia. Methods We employed power analyses to assess the number of 30 × 30-m, 50 × 50-m, and 100 × 100-m quadrats required to detect 10%, 25%, and 50% declines in a simulated population of T. adelaidensis. On the basis of these analyses, we conducted the first site-wide monitoring survey for this species at Tiliqua Nature Reserve and, with the assistance of volunteer citizen scientists, surveyed 25 50 × 50-m quadrats over 5 days, achieving the expected sample size required to detect changes in the population size and estimate population densities for the site. Key results Our results suggested that 50 × 50-m quadrats were comparable or had significantly higher statistical power than did other quadrat sizes within the survey area and during the sampling period. Conclusions This study demonstrated that 50 × 50-m quadrats were the most effective survey strategy for detecting significant population declines of the endangered T. adelaidensis at Tiliqua Nature Reserve. This quadrat size balances survey effort and statistical power, providing a reliable method for long-term monitoring. Implications The optimised survey design using 50 × 50-m quadrats provides a robust framework for annual monitoring at Tiliqua Nature Reserve and is likely to be a viable method for other properties. This approach to determining survey effort can be applied to similar conservation efforts for other cryptic and threatened species, ensuring more effective use of resources and timely detection of population changes to inform conservation actions
Whatever It Takes: Parents' Perspectives of Patient-Derived Xenograft Mouse Models for Poor Prognosis Childhood Cancer
No full textPURPOSEPatient-derived xenograft (PDX) models are used in precision medicine to identify treatments that may be more effective for an individual patient's molecular tumor profile. We explored parents' perspectives of using personalized PDX mouse models to potentially guide treatment recommendations for their child enrolled in Precision Medicine for Children with Cancer (PRISM), a precision medicine trial for poor prognosis cancer.METHODSWe report on interview data collected from a mixed-methods study examining families' experiences of PRISM. We interviewed 57 parents about their understanding and perceptions of the use of PDXs in PRISM. We analyzed quantitative data using linear models and Fisher-Freeman-Halton exact tests and qualitative data via inductive content analysis.RESULTSOverall, 83% of participants deemed PDXs acceptable. This is despite 51% of participants being aware that PDXs were a part of PRISM and the majority having little-To-no understanding of the technology. Of the 14 potential advantages/disadvantages of PDXs presented, participants rated that "accessing the right drug more quickly"as most important and "testing will involve harming animals"as least important. Several parents had concerns around animal models although some preferred mouse models over zebrafish as they felt that mice were more human-like and thus more valid. Participants expressed that they would sacrifice an unlimited number of mice for their child, yet only 63% endorsed a willingness to use up to 1,000 mice per patient. Willingness to use more mice appeared to be associated with parents' sense of urgency for a cure and perceived likelihood of benefit for their child. Regardless, most participants (96%) indicated that the number of mice used in PRISM would not have affected their decision to participate.CONCLUSIONOur study indicates that despite having minimal knowledge, parents consider the use of PDX mouse models in precision oncology to be acceptable
Non-Contact Sensing for Protected Cropping
Get PDFProtected cropping systems offer a controlled environment for optimized plant growth, but traditional sensing techniques for monitoring plant health and crop quality are often invasive, costly, and labor-intensive. This thesis explores innovative, non-contact sensing methodologies to address key challenges in plant water management and crop quality assessment within protected cropping. By leveraging advancements in millimeter-wave (mmWave) radar and near-infrared (NIR) spectroscopy, this work provides practical, scalable solutions for sustainable agricultural practices.
The research is structured around three key contributions. First, Leafeon, a novel system using mmWave radar, is introduced for accurate and low-cost sensing of leaf water content. The system demonstrates high sensitivity and reliability, enabling precise water management without physical plant contact. Second, MotionLeaf applies mmWave radar to monitor fine-grained multi-leaf damped vibrations, providing a unique and cost-effective method to detect plant water stress dynamically. This approach extends the capabilities of traditional monitoring systems by focusing on plant movement patterns as indicators of hydration levels. Third, SweetFruit employs NIR spectroscopy to measure the sugar content of fruits in a non-contact and cost-efficient manner, presenting a valuable tool for quality control in protected cropping systems.
The findings from these studies collectively showcase the potential of non-contact sensing technologies to enhance precision agriculture in protected cropping environments. This thesis not only advances the state-of-the-art in agricultural sensing but also paves the way for scalable, data-driven farming solutions that can improve water efficiency and crop quality while reducing operational costs.
The work concludes by outlining future research directions and discussing the broader implications of adopting non-contact sensing technologies in sustainable agriculture
Understanding digital capabilities and their impacts on Australian agri-food supply chain resilience: Engineering vs. socio-ecological thinking
Get PDFMany agri-food supply chains (SCs) are vulnerable to sudden disruptions (i.e., shocks), which can have devastating impacts. SC member firms’ digital capabilities (as routinized and integrated resource bundles) have the potential to address these challenges, yet their nature and differentiated impacts on engineering versus socio-ecological resilience are not well understood in the present literature. The purpose of this study is to address these gaps. First, a comprehensive taxonomy of five digital capabilities (labelled LogisticsTech, SecureData, ClientValue, InsightDecision, and InnovateTech) is developed, along with a set of nine resilience criteria/sub-criteria useful for resiliency evaluation. This was achieved through using a narrative literature review, a content analysis, validated by a Delphi study, and semi-structured interviews. Second, the relative impacts of these capabilities on resilience are assessed through pairwise comparison, network analysis, and system dynamics modelling across six Australian agri-food SCs (Grains, Red Meat, Dairy, Horticulture, Seafood, and Wine). The study findings reveal that Australian agri-food SC members’ digital capabilities play distinct but interconnected roles in enhancing resilience, with their impact varying across persistence (engineering), adaptation, and transformation (socio-ecological) over different time frames. LogisticsTech is crucial for short-term, while SecureData safeguards long-term persistence. Moreover, InsightDecision supports immediate adaptation, ClientValue facilitates long-term adaptation, and InnovateTech drives systemic transformation and future-ready SCs. The study offers strategic insights for managers and policymakers to align digital technology adoption with resilience objectives