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Reality of clonidine poisoning in children and adolescents
No full textAim: We aimed to describe the severity of clonidine poisonings in a paediatric population referred to a tertiary toxicology service. Methods: We undertook a retrospective review of all presentations of clonidine poisoning in children or adolescents reported to a tertiary toxicology service from March 2014 to February 2020. Cases were divided into young children (0–6 years), older children (7–11 years) and adolescents (12–17 years). We report clinical effects: bradycardia, hypotension and abnormal Glasgow coma score (GCS), based on standard paediatric observation charts, interventions, length of emergency department stay, proportion admitted to a medical ward or paediatric intensive care unit. Results: We identified 111 clonidine poisonings, 41 young children, 9 older children and 61 adolescents. There were more females in the adolescent group and slightly more males in the younger age groups. The median dose ingested was 13 mcg/kg (interquartile range: 7–38 mcg/kg), which varied across ages. Clonidine alone was ingested in 78 cases (70%) and co-ingestion was more common in adolescents (24/61; 39%). Thirty-seven patients (33%) were admitted and 23 (21%) were admitted to paediatric intensive care unit. Median length of emergency department stay was 16.4 h, longer for adolescents. At least one abnormal observation occurred in 101 of 111 (91%) cases: 76 of 106 (72%) bradycardia, 76 of 110 (69%) hypotension and 4 of 99 (4%) GCS < 9. Thirteen (12%) had severe bradycardia, more common in young children and 23 (21%) had severe hypotension, more common in adolescents. For 27 children (0–11 years) ingesting 5–10 mcg/kg, 3 (11%) had severe bradycardia or severe hypotension and 1 received naloxone (4%). No cases ingesting <5 mcg/kg developed moderate/severe bradycardia or hypotension. Four cases received naloxone with no significant change, two patients got atropine with a transient response. One patient was intubated to facilitate safe inter-hospital transfer. Conclusion: Paediatric clonidine poisoning commonly results in bradycardia, hypotension and decreased GCS, but rarely severe or requiring major interventions. Children ingesting <5 mcg/kg do not require admission
Investigating touchpoint use in omnichannels, and influence of company control on consumer judgements
No full textRetailing is crucial to both economic growth and employment worldwide. It has been estimated that global sales in 2022 will exceed USD27 trillion, representing 31% of the world’s gross domestical product. In addition, the retail sector employs billions of people across the globe. However, the introduction of digital technologies has resulted in changes in the retail environment, which is creating challenges for retailers as well as marketers. Omnichannels have emerged, integrating previously independent sales channels to provide consumers with a more customised, enhanced experience. Meanwhile, touchpoints (i.e. a short episode of direct or indirect contact with a brand or firm) have also been introduced, and digital, mobile and social technologies are used to integrate offline and online options to create new choices for the consumer. Although these touchpoints provide novel ways to engage with products and brands, there is limited understanding, both of consumer perceptions of these touchpoints and of the effects of these perceptions on consumer behaviour in omnichannels. Therefore, this research explores behaviour within omnichannels by considering consumers’ touchpoint choices across their purchase journey. In addition, because consumers can now interact with a range of touchpoints that are under varying degrees of company control (i.e. some directly controlled by the company, and others with shared control through partner organisations, in addition to touchpoints outside the control of the retailer), it also explores the influence of consumers’ perceptions of company control on their judgements. Furthermore, this research examines the believability of a touchpoint to determine whether it explains the degree of usefulness and usage intention a consumer attributes to a touchpoint. Moreover, given that people with high power distance (HPD) have been found to respond differently from those with low power distance (LPD) beliefs to work conditions and other stimuli with varying degrees of authority or autonomy, this research explores whether an individual’s power distance influences the believability of a touchpoint’s message. Considering that the marketing literature has paid limited attention to the touchpoint journey and company control of touchpoints, this research employs two studies and uses qualitative as well as quantitative methods to investigate touchpoint consumer behaviour within the omnichannel. First, to gain knowledge about touchpoint choice and use across the consumer purchase journey, in Study 1, using exploratory research, 52 individual participants were observed as they undertook a purchase task. Touchpoint interactions—more specifically the number, the variety and the order of touchpoint use—were examined. The findings reveal that consumers use both a large number and a wide variety of touchpoints across their purchase journey. On average, they interacted with 30 touchpoints, but only 10 of these were distinct or different, which indicates that they return to previous touchpoints or repeat interactions. Touchpoints were also classified into 23 different categories, and further grouped according to the entity that controls them. This study identified and distinguished between three sources of control—the retailer, a third party and the consumer—each of which has varying degrees of control and connection to the retailer or the company. Study 1 also highlighted how the expansion and the availability of many new touchpoints in the omnichannel have created a shift in control away from the company, given that the findings indicate that a large portion of touchpoints interacted with were outside the retailer’s control. Yet, prior research has not examined consumer perceptions regarding the varying degrees of company touchpoint control and the associated impact on consumer judgements, such as usefulness and usage intention. However, gaining insight on such aspects is important for retailers and marketers because understanding consumer preferences about touchpoint choice may be useful in enhancing and creating more effective omnichannel strategies. Next, in Study 2, the Study 1 results, along with those from the literature, were used to develop hypotheses and a conceptual model was designed to test ‘company control’ as a source variable. The second study comprised three experiments. Experiment 1 examined the influence of company touchpoint control across the three control categories (i.e. retailer/high control, third-party/shared control and independent/low control) on consumer judgements of touchpoint usefulness and usage intention. Experiment 2 extended from the findings of the first experiment and measured the mediating effect of believability, and Experiment 3 examined the moderating effect of power distance beliefs. For all three experiments, data were collected from a randomised sample of consumers aged more than 18 years recruited through the online research company Qualtrics. The key findings across these experiments are as follows: • Higher perceived company control of a touchpoint led to greater attribution of both usefulness and usage intention for that touchpoint. • Believability explains the relationship between company control and consumer judgements. • Consumers with HPD beliefs attributed greater believability to high company control touchpoints, which increased the usefulness and the usage intention of these touchpoints. • LPD beliefs moderated the believability of high company control (retailer) touchpoints, with LPD participants attributing the lowest usefulness and usage intention to retailer touchpoints (high control). In contrast to HPD, LPD participants also attributed higher usefulness and usage intention to independent (low control) and third-party (shared) touchpoints. Thus, through the initial observational study, this research provides foundational insight into the choice, the type and the number of touchpoints used across the broader touchpoint journey. In addition, unlike existing touchpoint and omnichannel studies, Study 2 offers a quantitative perspective that examines novel variables affecting touchpoint choice and judgement within the omnichannel. Significantly, this research contributes to the omnichannel and touchpoint literature by introducing company touchpoint control as a factor that influences the consumer touchpoint choice. It establishes an understanding about the perceived company control of touchpoints, and the impact of the degree of such control on the consumer judgements regarding usefulness and usage intention. This research also demonstrates the novel explanatory role of believability in the relationship between company control and consumer judgements, and the moderating role of power distance in this relationship. From an applied perspective, this research has managerial implications for retailers, marketers and for other organisational decision-makers involved in budgeting, resource allocation and strategic directions. It gives insight into consumer touchpoint choice and behaviour, providing guidance for more effective allocation of resources and better targeted touchpoint marketing strategies. Given the novel understanding gained into the perceptions of company control across different types of touchpoints, it is suggested that companies evaluate where they create their content and identify the most effective way to communicate specific messages to different types of consumers. For example, as touchpoints higher in perceived company control attracted stronger usefulness and usage intention, it is recommended that retailers and marketers focus their efforts in the first instance on touchpoints within their control, such as their own social media, website, physical stores and catalogues. In addition, with believability found to explain positive consumer judgements, and the greatest believability attributed to high company control touchpoints (e.g. retailer touchpoints), it is proposed that marketers and retailers explore likely ways to boost the believability of non-retailer touchpoints. For example, it is suggested that by increasing the perceptions of company involvement through enhancing the retailer’s branding and visual presence on touchpoints outside the retailer’s control (e.g. third-party touchpoints that operate under shared control between the retailer and third-party), believability may also be enhanced as the retailer is more prominent, leading to greater usefulness and usage intention. In addition, because independent touchpoints are perceived as low in company control and appeal to LPD consumers, it is recommended that companies targeting these consumers diversify their touchpoint mix to include a broader range of ‘low company control’ touchpoints. This may include establishing a range of alliances with independent people, such as celebrities or influencers, who are relevant to the specific industry but ‘distant’ to the company market. In addition, when using company-owned touchpoints, believability among LPD individuals may be enhanced by prominently displaying visuals and testimonials from independent people on these retailer touchpoints. In summary, this research offers theoretical contributions to academia and also provides practical implications to guide marketing practitioners and management when building touchpoint and omnichannel strategies
Human intestinal spirochetosis, irritable bowel syndrome, and colonic polyps: A systematic review and meta-analysis
No full textHuman colonic spirochetosis (CS) is usually due toBrachyspira pilosicolior Brachyspira aalborgiinfection. While traditionally considered to be commensal bacteria, there are scattered case reports and case series of gastrointestinal (GI) symptoms in CS and reports of colonic polyps with adherent spirochetes. We performed a systematic review and meta-analysis investigating the association between CS and GI symptoms and conditions including the irritable bowel syndrome (IBS) and colonic polyps. Following PRISMA 2020 guidelines, a systematic search of Medline, CINAHL, EMBASE, and Web of Science was performed using specific keywords for CS and GI disease. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Of 75 studies identified in the search, 8 case–control studies met the inclusion criteria for meta-analysis and 67 case series studies met the inclusion criteria for pooled prevalence analysis. CS was significantly associated with diarrhea (n = 141/127, cases/controls, OR: 4.19, 95% CI: 1.72–10.21, P = 0.002) and abdominal pain (n = 64/65, OR: 3.66, 95% CI: 1.43–9.35, P = 0.007). CS cases were significantly more likely to have Rome III-diagnosed IBS (n = 79/48, OR: 3.84, 95% CI: 1.44–10.20, P = 0.007), but not colonic polyps (n = 127/843, OR: 8.78, 95% CI: 0.75–103.36, P = 0.084). In conclusion, we found evidence of associations between CS and both diarrhea and IBS, but not colonic polyps. CS is likely underestimated due to suboptimal diagnostic methods and may be an overlooked risk factor for a subset of IBS patients with diarrhea
An Association Between Psychological Childbirth Trauma and Hazardous Alcohol Use
No full textHazardous alcohol use is increasing amongst some groups of women, yet little is known about the underlying reasons or gender-specific influences. The purpose of this study was to explore the association between psychological childbirth trauma and women’s hazardous alcohol use. We aimed to identify predictors of hazardous alcohol use given childbirth-related trauma, other life trauma (combat, natural disasters, physical or sexual assault, experiences threatening loss of life or loss of loved ones) and coping motives for drinking, whilst controlling for age, socio-economic status, negative affect and other drinking motives (enhancement and social motives). Australian data from the Why Women Drink survey (N = 301) was analysed. Women who experienced childbirth as traumatic scored higher overall for hazardous drinking and endorsed coping reasons more strongly than those who did not. Analyses of individual differences affecting hazardous drinking revealed coping reasons, rather than trauma itself, as the strongest predictor in a regression model. Other significant predictors included socio-economic status, enhancement of positive emotions and, marginally, negative affect. Findings identified a link between traumatic childbirth and hazardous drinking as a coping strategy. Prospective research is required to characterise predisposing and perpetuating vulnerabilities determining maladaptive coping after traumatic childbirth, and to inform effective interventions
Examining the relationship between organisational factors and residual risk in the mining industry
No full textGlobally, the mining industry continues to experience significant workplace incidents, often with serious and fatal consequences. In Australia, the mining industry is considered a hazardous occupation that experiences episodes of increasing and decreasing alertness with regards to the management of workplace risks leading to a pattern of fatalities and disasters. There is also evidence of substantial investments by mining companies to improve the safety and reliability of their workplace environments. However, despite these investments in improving workplace safety, many stakeholders in the mining industry have warned that the industry should adopt a different approach that recognises the significance of human and organisational factors in risk management activities, otherwise, the situation is unlikely to improve. The failure of risk controls has been identified as a major driver for the current safety performance trend of the Australian mining industry, which is characterised by the occurrence of repeat accidents. Recent state-commissioned reviews focused on the occurrence of fatal accidents in the Australian mining industry have also recommended a consideration of control implementation and effectiveness to support current and future accident prevention strategies. Furthermore, the reviews have also suggested a deliberate focus on organisational factors as a means to broaden the understanding of control implementation and effectiveness in mining workplaces, including the mechanisms of their failure. While considerable research has been done on accident causation in other high-risk industries, there is limited empirical evidence to support the role of organisational factors in risk management activities, which directly impacts the implementation and effectiveness of risk controls in mining workplaces. Consequently, this ethnography examined, through the lens of symbolic interactionism, the impact of organisational factors on risk management practices in mining workplaces. The researcher spent two years immersed in a mining site collecting data through participant observations, in-depth interviews, and document analysis, while interacting with mining employees in their natural settings. Qualitative data analytical strategies were used to inductively examine, analyse, and interpret field data and present findings in the form of a thematic narration. The study confirmed that organisational factors such as leadership, supervision, communication, organisational approach to risk management, learning from incidents, resources allocation, and management decisions play a significant role in determining workers’ perceptions on risk and ultimately how they manage residual risk in the workplace. Organisational factors were found to possess mechanisms through which they influenced the way employees perceived and dealt with workplace risks. In addition, organisational factors were found to be interrelated and their interaction impacted the implementation and effectiveness of risk controls. The ethnography made significant contributions to the understanding of organisational factors as key contributors in the occurrence of workplace incidents in the mining industry. From a risk management perspective, deeper insights were gained regarding the mechanisms of influence for identified organisational factors on residual risk management, including how this influence impacts the implementation and effectiveness of risk controls. Methodologically, the ethnography also demonstrated that workplace culture can be utilised as an illuminating device, through which workplace interactions can be observed and studied to understand their impact on safety and risk management activities. Finally, the ethnography provided some practical implications for improving workplace risk controls in the context of broader workplace safety and risk management and recommended some areas of focus for future research
Community-dwelling rural Thai peritoneal dialysis patients: an explanatory sequential mixed-methods study
No full textThe prevalence of end stage kidney disease (ESKD) is increasing significantly in Thailand and worldwide. Over a decade ago, Thailand launched the PD First Policy to support low-income Thai patients to receive continuous ambulatory peritoneal dialysis (PD). Without treatment, ESKD patients have a shortened lifespan. Effective self-management of chronic conditions such as ESKD can reduce morbidity and mortality and maintain a satisfactory quality of life for the patient. Peritoneal dialysis is recognised as a complex treatment for older PD patients experiencing additional challenges with the self-management of PD related to comorbidities and ageing. Few studies have sought to understand older patients’ experiences of PD self-management, especially in low-income environments, and it has been reported that older Thai PD patients have poorer clinical outcomes than younger PD patients. A mixed-method explanatory sequential study using the participant-selection model was conducted to understand the health-related quality of life, PD clinical outcomes and self-management of older PD patients in rural Thailand. This study recruited 101 older PD patients in the first quantitative phase to investigate health-related quality of life, including physical and mental health and clinical outcomes. The quantitative data revealed that the average age of the study population was 63.63 years, 85.1% had an income below Thailand’s poverty line, 98% had less than three years of education, and approximately 41% received assistance to complete their PD. PD patient participants reported low scores for quality of life measures associated with physical and mental health measures. Forty-nine per cent reported scores on the Geriatric Depression Scale suggestive of depression; most PD patients reported limited difficulty managing their daily activities; however, 12% reported being dependent on one another
23 for washing themselves. Many PD patients presented with pathology results attributed to an increased risk of morbidity and mortality in PD.
Twelve PD patients were selected for the second phase to explore their experiences with self-management based on their scores on the HRQOL measure and their history of peritonitis in the previous year. The families of these older PD patients were also interviewed, as were 11 PD and community nurses. Three themes emerged from the patient and family interviews: PD Support, Managing PD Needs and Living with PD. Four themes emerged from the PD and community nurses: Thailand’s PD First Policy, Providing Support, Family Support and Older People are Different. These interviews demonstrated that the patients and their families experienced difficulties managing PD at home, and the nurses supported these findings. A comprehensive discussion integrating quantitative and qualitative data was conducted to enhance the understanding of older PD patients’ self-management in rural Thailand. This discussion outlined the processes and factors that facilitated and/or were barriers to PD self-management in these patients. Recommendations for future research have been provided in many areas to further examine and improve PD self-management, which will positively impact the quality of life and clinical outcomes of these patients
Field investigations on thermal comfort in university classrooms in New South Wales, Australia
No full textEnsuring thermal comfort in educational buildings is essential for improving students’ learning and productivity performance. This study aims to analyse the thermal comfort level of students and empirically define the preferred and neutral temperatures for higher education students in New South Wales (NSW), Australia. Statistical analyses are carried out based on 154 student responses from three selected classrooms across the summer and winter seasons. Students were requested to complete the ASHRAE questionnaires about their thermal responses during the lecture time, and the indoor thermal conditions were recorded. The results indicate that the mean comfort votes by students were around slightly cool, with 76.9% of comfort votes ranging from -1 (slightly cool) to +1 (slightly warm). The regression analyses show that the neutral and preferred operative temperatures of NSW students were 27.5 °C and 23.7 °C, respectively. The preferred temperature of students is within the ASHRAE comfort range (20.0–26.0 °C). The findings show the applicability of the ASHRAE 55 standard to students in classrooms in climate zone 5, Australia. Increasing the ASHRAE’s minimum acceptable range from 20 °C to 23.7 °C can improve indoor thermal comfort and reduce building energy usage. This study contributes to a better understanding of acceptable indoor temperature in educational buildings in NSW, Australia
Coastal Cliffs Rockfall Analyses And Mitigation Measures Assessment Using Rocfall3: A Case Study Along Shortland Esplanade In Newcastle, NSW (Australia)
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Determining the accuracy of continuous glucose monitoring during periods of acute glycaemic variability in pregnancy
No full textBackground: Guidelines recommend continuous glucose monitoring (CGM) for all ambulatory pregnant women with Type 1 diabetes (T1 DM), and insulin-treated pregnant women with Type 2 diabetes (T2 DM) and hypoglycaemic risk. However, evidence for efficacy and safety of CGM in a hospital setting is lacking. Aim: To determine CGM accuracy and potential clinical risk of using CGM compared to the reference (capillary blood glucose level, capillary BG level) in pregnant women with T1 DM or T2 DM during acute hospitalisation. Method: Prospective cohort study. CGM glucose was compared to paired capillary BG during hospitalisation. This study was conducted at a main tertiary hospital, recruited pregnant women between the 16th and 34th weeks of their pregnancy. Glucose measurement was performed using capillary BG monitoring (Optium Neo H) and CGM systems (Dexcom- G6, Guardian-3, and Abbott-2). Concordance was assessed using paired values distribution, mean absolute relative deviation (MARD), Clarke Error Grid (CEG) Analysis, and the FDA standard for new integrated Contiguous Glucose Monitoring (iCGM) accuracy, stratified by diabetes type and sensor type. Women with T1 DM continued to use their own CGM (Abbott 2, Dexcom G6, or Guardian 3); women with T2 DM were supplied with Abbott 2 CGM.Results: The data set consisted of 1351 paired readings from 26 women with T1 DM and 11 women with T2 DM. MARD was 12.9% overall and 11.9% when the capillary BG were 3.9–10.0 mmol/L. CEG analysis showed 96.9% of paired readings were in low-risk zones A and B, but 2.9% were in higher risk zone D (predominantly CGM false negative for hypoglycaemia). When the reference capillary BG was in the range 3.9–10.0 mmol/l, 99.7% of CGM readings were in zones A and B. Overall, 81.9% of readings were within 20% of the FDA standard, but 5.2% were below FDA requirements.Conclusion: CGM readings were highly correlated with capillary BG readings between glucose levels 3.9-10.0 mmol/l with 99.7% of CGM readings were in zones A and B of Clarke Error Grid Analysis and MARD of 11.9%. Overall, 81.9% of readings were within 20% of the FDA standard, but 5.2% were below FDA requirements, however when the CGM readings were 5.0-7.0 mmol/L 86.6% of CGM readings were within 20% of the capillary BG reference, only 0.5% below the FDA threshold. These findings showed comparable accuracy in inpatient pregnant women to other inpatient groups in recent studies. However, a small proportion of discordant CGM readings were in a zone of high clinical risk. In conclusion and based on the study results, CGM may guide inpatient antenatal diabetes care, but we cannot recommend its non-adjunctive use and critical management decisions (particularly around hypoglycaemia) should be based on capillary BG until greater concordance is established. Currently, a hybrid protocol that combines capillary BG with CGM is a potential future strategy and could be explored pending further technological development. A hybrid protocol could be appropriate for women with hypoglycaemia awareness that will prompt a capillary BG if there is a disconnect between hypoglycaemic symptoms and CGM readings, however this approach has not been assessed.</p
Hear our voices: an Indigenist approach to tourism
No full textIn Australia, all tourism occurs on the unceded lands of Aboriginal and Torres Strait Islander peoples. Indigenous worldviews often position place as Country; not merely land, but a living, all-encompassing entity, woven with kinship, responsibility and care. This contrasts a colonial perspective, which positions place as resource, where place is commodified as a tourism product. These tensions are evident at sites like Uluru in Central Australia, where Indigenous sovereignty has clashed with commercial interests. While the closure of the Uluru climb marked a rare moment of Indigenous agency shaping tourism place narratives, such examples remain uncommon.In fact, Indigenous voices broadly remain underrepresented in tourism decision-making and knowledge creation. Despite calls for meaningful engagement, dominant settler narratives persist in tourism placemaking and promotion. This thesis advocates for an Indigenist approach to tourism – one that centres Indigenous ways of being, doing and knowing. It is both a research project and a deeply personal journey, grounded in my lived experience as a Birpai and Worimi woman, and shaped by the voices of Elders, activists and scholars who have guided me.The thesis presents a stories-led study, exploring Indigenous perspectives on tourism place-making in Muloobinba (otherwise known as Newcastle in New South Wales, Australia). Using a culturally adapted photovoice method, eight Aboriginal community members were engaged as peer-researchers, sharing photographs, stories and yarns that reveal deep, complex connections to place. These were presented as individual narratives and analysed thematically into ten story threads. Together, they expose a disconnect between Indigenous perspectives and tourism representations of Country.This study responds to calls for Indigenous-led research and demonstrates the power ofstories-led inquiry in amplifying community voices. It culminates in the development of a ‘Stories-Led Research Framework’ , co-created with peer-researchers, okering guiding principles for culturally safe engagement. Grounded in an Indigenist paradigm, this framework okers a pathway for embedding Indigenous agency in tourism and beyond.</p