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Sprint National Anaesthesia Project 3: A Survey of the Workload Generated by Older Surgical Patients Referred to On‐Call Medical Registrars in Australia
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Livelihood Recovery: Livelihood Approaches for Post-Disaster Reconstruction and Recovery
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Topical, Sustained Release Drug Delivery Platform for the Treatment of Ocular Pain
No full textNeuropathic ocular pain (NOP) is a rare but debilitating neuro-ophthalmological disease with no approved therapies. Patients suffering from NOP are characterised by pain symptoms that are disproportionate to, or that occur in the absence of, established clinical measures of ocular surface disease (OSD), and experience substantial losses in quality of life leading to an increased incidence of suicide. Mounting recognition of NOP as a significant unmet clinical need by the biomedical sector has led to the formation of new biotechnology companies in search of new treatments, such as Australian start-up Foray Therapeutics. Nevertheless, therapeutic development in ophthalmology is associated with several key hurdles, including the lack of alternatives to current in vivo models used for toxicity and mechanistic studies, which have been previously criticised for their poor predictiveness of human clinical outcomes.As part of the NSW Health PhD Partnership Program and industry partnership with Foray Therapeutics, this thesis aims to characterise the unmet need of NOP, contribute to early preclinical development of novel therapies for NOP, and aims to explore new preclinical models of the cornea for their potential use in ophthalmic drug development. In Chapter 2 I present a summary of findings from the Ocular Pain Landscape Assessment provided to Foray, encompassing an in depth evaluation of NOP as a disease entity, its aetiologies and its relation to other OSD markets. The report culminated with a strategic proposal for how to best target NOP during clinical development to maximise the probability of therapeutic benefit. Chapter 3 presents the results of high throughput drug screens of analgesic new chemical entities (NCE) in monolayer primary corneal epithelial cells (pCECs), as a component of early preclinical hit-to-lead identification and lead optimisation drug development purposes. This research was undertaken to assess initial toxicity of NCEs, as well as drug effects on corneal wound healing based on measures of epidermal growth factor receptor (EGFR) signalling. In Chapter 4, I exhibit the development of a new, three-dimensional organotypic in vitro model of the corneal epithelium using pCECs grown at the air-liquid interface (ALI), for potential future use in preclinical ophthalmic toxicity testing. Lastly, Chapter 5 showcases end-to-end development of an ex vivo guinea pig model of corneal sensory nerve activity and provides preliminary evidence of the model's utility for studying analgesic drug effects on nociceptor behaviours.Taken together, this thesis investigated front-of-the-eye drug development, including a timely review of NOP as a clinical and commercial opportunity, and the processes underpinning early drug discovery. In addition, it presented the development of in vitro and ex vivo models of the cornea with potential future utility in ophthalmic therapeutic research.</p
Sexual lives and reproductive health outcomes among persons with disabilities: a mixed-methods study in two districts of Ghana
No full textIntroduction: People with disabilities (PwDs) constitute a large and diverse group within the global population, however, their sexual and reproductive health (SRH) needs are often neglected, particularly in low-and middle-income countries. This may result in adverse outcomes, such as sexually transmitted infections (STIs), unintended pregnancies, and experience of interpersonal violence (IV). This study aimed to assess the factors that influence the sexual lives of PwDs in two districts of Ghana. Methods: A sequential explanatory mixed-methods study design was used to collect data from PwDs. Quantitative data were obtained from 402 respondents using a pretested questionnaire, and qualitative data gathered from 37 participants using in-depth interviews. The quantitative data were analysed using descriptive and inferential statistics, while the qualitative data were analysed using inductive thematic analysis. Results: Most PwDs (91%) reported that they have ever had sex, which was associated with age, disability severity, and household size. The prevalence of poor SRH status, STIs, unintended pregnancy, pregnancy termination, and unsafe abortion were 10.5%, 5.7%, 6.4%, 21.6%, and 36.9% respectively. These outcomes were influenced by education, income, health insurance subscription, and proximity to a health facility. The prevalence of IV was 65%, which was related to disability type and severity. The qualitative data revealed five main themes: curiosity to engage in sexual activities, feelings of despair and insecurity with abled partners, preference for sexual relationships with other PwDs, IV and its perpetrators, and adverse SRH outcomes. Conclusion: The study findings indicate that most adult PwDs have ever had sex and they face various challenges in their sexual lives. They experience multiple forms of abuse and neglect from different perpetrators at different levels of society, which have negative impacts on their well-being. There is a need for comprehensive and inclusive interventions that address the SRH needs of PwDs, as well as the underlying social and structural factors that contribute to their vulnerability. Further research is recommended to explore the perspectives of stakeholders on how to improve the SRH outcomes of PwDs
How Perceptions of Death Interacted with Animal Magic in Antiquity
No full textThe article explores the relationship between death, magic, and animals in ancient Greek, Roman, and Egyptian cultures. It focuses on the use of animals in magical practices and examines how the beliefs about death and the afterlife influenced these practices, and argues that the killing of animals was a common practice in ancient magic and was believed to be necessary to access otherworldly powers and control potential threats from the dead.</p
Evidence-based pedagogy used to teach beginning readers braille in a mainstream setting: A scoping review
No full textBraille literacy enables equal access to learning for students who are blind or have very low vision in a mainstream, inclusive classroom. Teachers need to know which teaching strategies best support the development of braille literacy skills in beginning touch readers. A scoping review following the PRISMA-ScR guidelines was conducted to identify and synthesise the body of literature on braille literacy. The search criteria were peer-reviewed research publications focusing on pedagogy for teaching braille in mainstream Kindergarten to Year 4 settings to beginning readers with vision impairment, without other disabilities, who spoke English as their first language. The publication period searched was from 1975 to 2022. A total of 740 articles were identified. After screening for eligibility using the search criteria, 10 articles were included. A thematic analysis identified the overarching theme of evidence-based pedagogy and the sub-themes of uncontracted and contracted braille, the Learning Environment of the Classroom and Reading Instruction. There was limited research found on evidence-based pedagogy to support the sustained, systematic development of braille literacy in Kindergarten to Year 4 students with vision impairment. The scoping review identified one seminal US study that found braille readers were falling behind their sighted peers as more complex reading skills were not being learned at the same rate. Determining successful evidence-based pedagogy which will support the sustained development of braille literacy skills in developing readers will require a sophisticated research approach involving braille literacy experts and braille readers
Activity and mental well-being in older adults: a compositional data analysis (CoDA)
No full textThis cross-sectional study investigated the relationship between daily time-use compositions of sleep, sedentary behaviour (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) and their associations with mental wellbeing in older adults aged 60–70 years. Using data from 380 community-dwelling participants and a compositional data analysis (CoDA) framework, our study examined how reallocations of time between these activities related to self-reported mental health outcomes, including depression, quality of life (QOL), and social network engagement. Accelerometer-derived estimates of time-use compositions were analysed alongside validated self-report questionnaires to produce a mental health composite score grounded in the dual continua model of mental health. Results indicated that reallocating 20 minutes per day to MVPA from any other behaviour was significantly associated with improvements in mental health composite scores, while reallocating time away from MVPA was associated with poorer mental health composite scores. Sleep and SB showed no direct associations with mental wellbeing, but their effects appeared context dependent. Interestingly, LPA showed no mental health benefit and was negatively associated with QOL. These findings highlight the unique role of MVPA in promoting mental wellbeing in older adults and support the value of compositional methods in generating more precise and actionable public health recommendations for healthy ageing in older adults.</p
The role of the red blood cell in traumatic injury and multiple organ failure
No full textMultiple Organ Failure (MOF) is one of the leading complications following severe traumatic injury. Improvements in resuscitation and trauma practices have resulted in more patients surviving their initial injuries and consequently more patients developing MOF. The aims of this thesis related to how red blood cells (RBCs) could contribute to MOF in the trauma cohort. An observational cohort study of trauma patients admitted to the Intensive Care Unit (ICU) determined ABO blood group was not associated with MOF incidence. The analysis did identify male sex, age and RBC transfusions in the first 24-hours post-injury as variables associated with MOF. Mitochondrial DNA (mtDNA) is a known damage associated molecular pattern that stimulates the innate immune response. Plasma cell-free mtDNA has been associated with poor outcomes from trauma, including MOF. Laboratory studies in this thesis examined RBC-associated mitochondrial DNA (mtDNA) in packed RBC (pRBC) units using qPCR. RBCs from pRBC units were shown to contain mtDNA at high concentrations. RBC-associated mtDNA concentrations were significantly higher than the mtDNA concentrations of pRBC cell-free fraction, healthy patient plasma and trauma patient plasma. The inflammatory contribution of RBC transfusions have previously been underestimated or disregarded as they were presumed to contain low mtDNA concentrations. The findings of this thesis suggest they need to be a consideration in the future. RBCs from pRBC units scavenged purified mtDNA and mtDNA from trauma plasma in a dose-dependent manner, including physiological ranges and far beyond. This finding proposed a potential benefit to RBC transfusions as mediating the inflammatory response post-injury. RBC-associated mtDNA concentrations were significantly higher in trauma patients than stored RBC and were correlated with injury and shock severity. In removing mtDNA from plasma, patients' or transfused RBC likely play an essential role in preventing hyperinflammation following severe injury. Future studies will be essential to further explore the red cell as a novel biomarker of inflammation, predictor of MOF or therapeutic target.</p
Designing fairness in higher education: Balancing meritocracy and equity
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