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With just ‘three days to inform the next three budgets’, here’s how Chalmers’ roundtable kicked off
No full textNovel Clinical Assessment of Visual, Vestibular, Somatosensory, and Autonomic Function:Establishing Test Re-Test Reliability in a Healthy Population
No full textIntroduction: Maintaining balance is a complex process involving the integration of information from the visual, vestibular, and somatosensory (VVS) systems, along with autonomic nervous system (ANS) function. Traditional assessments of these systems are often expensive, limited to specialised settings or focus on overall balance outcomes, potentially overlooking deficits in the individual systems. This study aimed to evaluate the test-retest reliability of a novel, fully portable clinical assessment tool designed to provide objective measures for individual components of the VVS system and ANS function. Methods: Twenty-eight participants (aged 20–88 years), with no comorbidities and meeting Australian physical activity guidelines, completed the protocol twice. The novel clinical assessment tool comprised of two systems: (1) a virtual reality-type headset incorporating eye-tracking to evaluate visual-vestibular function (smooth pursuit and voluntary saccades), and autonomic function (pupil light reflex); and (2) the Active Movement Extent Discrimination Apparatus (AMEDA) for somatosensory function. Reliability was assessed using two-way mixed-effects model (consistency type, single rater) Intraclass Correlation Coefficients (ICC 3,1) calculated in R-studio. The standard error of measurement (SEM) and minimal detectable change (MDC) was also calculated. Bland-Altman plots were utilised to visualise the agreement between two test repeats. Results: Each metric demonstrated at least moderate to good test re-test reliability: left and right AMEDA (ICC = 0.69 and 0.75), smooth pursuit (ICC = 0.67), voluntary saccades (ICC = 0.53), autonomic response delay (ICC = 0.80), parasympathetic function (ICC = 0.86), and sympathetic function (ICC = 0.89). Discussion: This study supports the reliability of a new, fully portable clinical assessment tool to assess VVS and ANS function. By demonstrating the reliability of this new streamlined tool for evaluating the VVS and ANS systems, the findings of this study has the potential to enhance clinical practice and research in falls prevention and balance rehabilitation.</p
Democratic Resilience in Retreat:Australia’s Response to the 2002 Bali Bombings
No full textThis article takes democratic resilience as a means of exploring the quality of public dialogue following a violent extremist attack. Drawing on the normative theory of deliberative democracy, it argues that democratic resilience requires meaningful deliberations in the public sphere following extremist attacks. It focuses on the responses of political leaders and news media in Australia regarding the aftermath of the 2002 Bali bombings in Indonesia and asks whether and to what extent these responses fostered democratic resilience. A critical discourse analysis of these responses suggests that although the initial political discourse emphasised democratic values and multiculturalism, this rhetoric did not translate into practice. The initial messages of harmony and tolerance were lost in subsequent discourses of national unity, national sacrifice and collective responsibility, which emphasised an ‘us versus them’ narrative, and reinforced racial prejudices. As a result, the public sphere lacked the reflective and inclusive dialogue needed to foster democratic resilience.</p
Beyond the Hit:Muscle and Vascular Tissue Responses to Contact Exposure in Collision Sports—A Narrative Review
No full textContact events in rugby codes such as tackling, running into contact, scrums, rucks, and contact with the playing surface may expose athletes to muscle damage known as impact-induced muscle damage. These repetitive impacts to muscle tissue have the potential to diminish muscle force production and delay recovery following contact-focused training and match-play. Repetitive exposure to contacts may also affect the surrounding vascular and neuronal tissues, an area that has received little attention in the collision sports. Depending on the severity and duration of tissue damage, repetitive contact exposure without sufficient recovery or noticeable adaptation may predispose collision sport athletes to impaired performance and long-term health complications. The aim of this narrative review is to provide a conceptual framework for understanding the physiological implications of contact exposure in collision sports. We examine the current understanding of impact-induced muscle damage (IIMD), how it differs from exercise-induced muscle damage (EIMD), and its relationship with contact exposure in collision sports. Drawing on both experimental animal models of contusion injury and limited human observational research, we explore the effects of repeated contact exposure on the microvasculature and its implications for both athletic performance and player welfare. To account for all tissues that may be affected by impacts, including muscle, nerve, vascular, connective tissue, skin, other organs and bones, we recommend impact-induced tissue damage (IITD) as the preferred descriptor rather than IIMD. Finally, we discuss the concept of contact adaptation and provide recommendations for future research on IITD in collision sports.</p
Validating adverse events in administrative healthcare data in ireland:a retrospective chart review study
No full textBACKGROUND: Pneumonia, urinary tract infections, pressure ulcers and delirium are adverse events that affect older inpatients. Accurate administrative data are key to improving patient safety and healthcare quality. The aim of the study was to validate Hospital In-Patient Enquiry (HIPE) data on the occurrence of pneumonia, urinary tract infections, pressure ulcers and delirium in older patients discharged from an acute hospital in Ireland through retrospective chart review.METHODS: A cohort of one thousand randomly selected admissions of inpatients aged over 65 from a university, tertiary hospital in 2022 were reviewed using a two-stage retrospective chart review. The researchers, healthcare professionals and patient representatives co-produced a study-specific chart review protocol and data collection instrument. HIPE data were validated by comparing the chart review data to the HIPE data. Since HIPE only codes the presence of the respective adverse event once, the comparisons between the HIPE data and the chart review data were carried out at admission level.RESULTS: Of the 1,000 admissions reviewed, 231 (23.1%) contained at least one adverse event. At event level, 373 adverse events were identified including 133 pressure ulcers in 71 admissions, 101 delirium episodes in 100 admissions, 84 pneumonia episodes in 79 admissions and 55 urinary tract infections in 52 admissions. Of the 302 adverse events found in chart review on admission level, 96 (31.8%) of these were coded in the HIPE data and flagged by the Hospital Acquired Diagnosis indicator. Compared with chart review data, the overall sensitivity of the administrative data was low, and the specificity was high. The positive predictive values varied, and the negative predictive values were generally high. In HIPE data, 42 adverse events were found that were not identified in the chart review.CONCLUSIONS: The results demonstrate that HIPE data may not accurately represent these specific adverse events as experienced by older patients. Improving the accuracy of these data may facilitate benchmarking of adverse events across hospitals and countries and provide opportunities for improvements in patient safety.</p
The influence of gender norms on post-migration men's sexual and reproductive health:A scoping review
Get PDFMigration exposes people to unfamiliar gender roles and sexual views, influencing the ways they care for their sexual and reproductive health (SRH). Migrant men’s health is overlooked in care and research, prohibiting culturally responsive care that acknowledges these changing beliefs. Thus, we aimed to synthesise the available evidence on the ways pre-established gender norms impact a man’s SRH in the setting of migration to a high-income country. We aimed to investigate how refugee and migrant men viewed gender and gender roles in their countries of resettlement and how they experience their SRH in this country. We systematically searched scientific databases and grey literature (published between 2000–2023), using a search strategy covering four major topics: CALD/migrants, men, gender and SRH. Two reviewers independently screened the titles and abstracts of 7,840 articles and reviewed the full text of 180 articles. Thematic analysis of 36 articles revealed three key themes: (a) depleted masculinity, (ii) sex and sexuality, and (iii) accessing SRH care in a new country, all influencing how migrant men viewed masculinity, engaged in SRH services and approached sexual relationships. Further, navigating new cultural norms and gendered expectations often resulted in feelings of depleted masculinity, impacting men’s wellbeing, intimate relationships and confidence to seek SRH care after migration. We found that migrant men largely carried pre-established beliefs of sex and gender roles from their home country to their host country. This had mainly negative repercussions on their relationships and SRH behaviours post-migration and should be acknowledged in future research and interventions.</p
Theorising digital practices
Get PDFHistorically, research about young children and digital technologies is informed by technological determinist thinking seeking to understand the impact of technologies on young children. As digital society is increasingly understood to interface social practices with technologies, questions of impact become harder to sustain theoretically. In this chapter, practice theory and critical constructivism are identified and explained leading to a cultural study of technologies. Practices are interpreted as what people do, say and how they relate to material and non-material affordances in their world as motivated by what they want to do or achieve. Critical constructivism explains how design and use values are mediated by people in situ so that technologies are never value-neutral but always in a state of social formation over time. Directing attention to the practices that comprise how people engage with technologies via their social formation comprises a cultural study of technologies.</p
Bridging the Gap between Microstructurally Resolved Computed Tomography-Based and Homogenised Doyle-Fuller-Newman Models for Lithium-Ion Batteries
Get PDFLithium-ion batteries (LIB) are synonymous with the modern age of electrification, yet advances in battery design, manufacturing, and chemistry are still urgently needed. Mathematical modelling plays an important role in understanding LIB performance and can provide physics informed design directions, optimisation and explain outcomes. We present an exploration and detailed comparison of the commonly used homogenised Doyle-Fuller Newman (DFN) model and X-ray computed tomography (CT) based microstructural model for LIBs, along with experimental data. We provide insights into the relative benefits of each model and highlight why they are important to battery technology development. We compare two common cathode chemistries, lithium nickel manganese cobalt oxide (NMC), and lithium iron phosphate (LFP), and investigate discharge current density. The DFN and CT-based models show good agreement for averaged LIB metrics, such as the voltage response and active material utilization, demonstrating that homogenised, computationally inexpensive models are an essential basis for battery design and optimisation. The CT-based microstructural model provides further insight into localised particle and electrode dynamics, considering heterogeneities that are a source of battery degradation. Qualitatively, the models also compare well with experimental secondary ion mass spectrometry mapping of the Li concentration in the active particles across the electrode thickness.</p
A Digital Alert Feedback System (Aged Care Electronic Dashboard Information Tool, ACED-IT) to Enhance Quality Nursing Care:Participatory Action Research
Get PDFAims: Develop and simulate test a digital alert dashboard drawing from existing data to support nurses, care workers and managers in residential aged care. Design: Participatory action research, co-designing for an Australian 64-bed residential site. Methods: Qualitative data were collected through focus groups and analysed using reflective thematic analysis. Results: Nursing-theory and evidence-based Nursing Data Domain Standards (NDDS) were developed to support internal triaging of fundamental and clinical care in a non-clinical environment. A co-designed retrospective digital alert dashboard (Aged Care Electronic Dashboard Information Tool—ACED-IT) representing the Standards was created and tested. Twenty aged care nurses, care workers and managers found it had promise in enhancing quality of care, improving resident health and reducing adverse events. Conclusions: Maximising efficient use of resident-level data with a system that empowers nurse decision-makers is crucial to support effective care design and harm prevention. Implications for the Profession and/or Patient Care: ACED-IT has the potential to improve visibility of resident needs, support staff to adjust their workflow based on in-house triage, enhance supervision of staff and quality of care and reduce preventable complications. Impact: Digital systems that enable nursing care escalation and triaging for early intervention are needed in residential aged care settings. The co-designed system was perceived by registered nurses, care workers and managers to have the potential to improve care quality and efficiency. Using an evidence-informed nursing framework to identify day-to-day care indicators can be widely implemented by government regulators, software providers and residential care providers on an international scale to improve resident experience. Reporting Method: This study adhered to the relevant EQUATOR guidelines, specifically the COREQ (Consolidated Criteria for Reporting Qualitative Research) Checklist. Patient or Public Contribution: A member of the public participated in the Advisory Group, observed and contributed to the co-design process and reviewed the manuscript.</p
Greenhouse gas emissions associated with anaesthetic gases in Australia, 2002–2022: a retrospective descriptive analysis
Get PDFObjectivesTo assess changes in greenhouse gas emission rates associated with the use of anaesthetic gases (desflurane, sevoflurane, and isoflurane) in Australian health care during 2002–2022, overall and by state or territory and hospital type.Study designRetrospective descriptive analysis of IQVIA anaesthetic gases purchasing data.SettingAll Australian public and private hospitals, 1 January 2002 – 31 December 2022.Main outcome measuresAbsolute carbon dioxide equivalent (CO2e) emissions and CO2e emissions rate per 100 000 population by gas and year, overall and by state/territory and hospital type (public or private).ResultsThe overall emissions rate increased from 74 t CO2e per 100 000 population in 2002 to 328 t CO2e per 100 000 population in 2012, most rapidly during 2002–2004 (annual percentage change [APC], 51%; 95% confidence interval [CI], 38–62%). The rate then declined to 83 t CO2e per 100 000 population in 2022, most rapidly during 2017–2022 (APC, –21%; 95% CI, –23% to –20%). Patterns of emissions rate change were similar for all states and territories. More units of sevoflurane than of desflurane or isoflurane were purchased each year throughout 2002–2022, but desflurane provided the largest proportion of total emissions from anaesthetic gases during 2002–2022: 33% in 2002, 88% in 2013, and 68% in 2022. Mean emission rates per 100 000 population during 2002–2022 were highest for South Australia/Northern Territory (276 t CO2e per year) and lowest for Victoria/Tasmania (196 t CO2e per year). The desflurane emissions rate was consistently higher for private than public hospitals; it declined for public hospitals during 2009–2018 (APC, –8%; 95% CI, –10% to –5%) and 2018–2022 (APC, –43%; 95% CI, –48% to –37%), but for private hospitals only during 2017–2022 (APC, –20%; 95% CI, –24% to –17%).ConclusionsIn Australia, the CO2e emissions rate for anaesthetic gases increased during 2002–2008 but declined during 2017–2022, at first primarily in public hospitals. Continuing to reduce the use of anaesthetic gases, particularly desflurane, will advance the decarbonisation of clinical practice in Australian health care