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Co-designing research with people who have a stoma- Understanding support needs that facilitate positive adjustment
No full textBackgroundStoma surgery involves creating an opening (stoma) on the abdomen to divert faeces or urine. A stoma may be required in response to inflammatory bowel diseases, cancer or abdominal trauma. This body-altering surgery is confronting and potentially stigmatising, resulting in a complex adjustment process for patients (termed ostomates), both physically and psychologically. Adjusting to a stoma is important for ostomates so that a resumption of usual interpersonal, social, employment and leisure activities can be enabled.Evidence to date about what promotes adjustment after stoma surgery is minimal. Few studies have quantified predictors of adjustment or the effectiveness of adjustment-promoting interventions. Qualitative research is similarly scant, leaving a lack in understanding of barriers and enablers to adjustment and experiences of interventions which target adjustment support. These gaps in knowledge leave little to guide the stoma nurse seeking to provide a research-based approach to meeting their patients’ needs. A key knowledge gap relates to the role of peer support, support groups and other nurse-led adjustment-focused supports.The aims of this PhD study were to:1.explore the experiences of people who have a stoma (ostomates) and who attend a stoma peer support group; and2.identify important supports that exist currently and identify gaps in support that ostomates require to facilitate adjustment.The objective of this PhD study was to:• inform the ongoing care of new ostomates from a person-centred perspective.MethodsThis qualitative study used the participatory approach of co-design. The emergent two-phased approach was designed so that the first phase (focus group study) would inform the second phase (patient interview study), enabling a deep understanding of the focus area. The study was underpinned by Roy’s Adaptation Theory which advances a response-based conception of adaptation.The first phase involved three ostomate focus groups which sought to ascertain the benefits and barriers of attending a nurse-led stoma support group. The second phase (a patient interview study), built on the results yielded by Phase 1, utilised a co-design approach. Phase 1 participants were invited to be trained as co-researchers to work alongside the PhD candidate. Three participants joined as co-researchers, and the patient interview study was then undertaken together. Data from both study phases were analysed using Braun and Clarke’s six step thematic analysis approach.FindingsBoth study phases revealed previously unknown knowledge. The first phase (focus group study) shed light on the benefits of attending a nurse-led peer support group. Three themes and six sub-themes were derived, and findings suggested that ostomates benefit principally in terms of learning, support and connectedness. The second phase (patient interview study) identified key enablers and barriers to accessing peer support groups. Adjustment was found to be enhanced by the presence of a role model while physical recovery and ongoing oncology care were found to be barriers to the level of involvement ostomates had with supports. The results of both study phases highlighted the significance of the stomal therapy nurse (STN) throughout the continuum of care for ostomates beyond the initial follow-up, and for an undefined length of time afterwards.The successful use of a co-design approach established that ostomates want to be involved in research about themselves – an important finding for future research. Co-design was understood by both consumer researchers and researchers as valuing the lived experience of the ostomate and benefiting both the researcher and the researched.ConclusionThis research contributes to the evidence on adjustment to a stoma. Key recommendations derived from the research will guide clinicians in providing support to ostomates to promote their adjustment. The timing of the provision of adjustment-promoting interventions, such as peer support groups, needs to be considered as physical recovery from surgery and oncological commitments proved to be barriers to accessing this method of support. Collaborating with ostomates by co-designing research is important as it provides opportunities for both researchers and ostomates to learn from each other, facilitating meaningful research outcomes.This unique study has highlighted the presence of the STN as a key adjustment-promoting factor. Group peer support via a nurse-led support group also positively influenced adjustment after stoma surgery. Stoma nurses need to access facilitation training so they can learn the skills required to facilitate support groups and embed this into their model of care. The establishment of a formalised peer support program in Australia is necessary to enable equal access for everyone having stoma surgery.</p
Frailty in older adults admitted to hospital: outcomes from the Western Sydney Clinical Frailty Registry
No full textObjectives: To examine baseline frailty and its association with rehospitalisation and mortality within 12 months among older adults enrolled in the Western Sydney Clinical Frailty Registry. Design: Prospective observational cohort study. Setting and participants: 592 adults admitted to an acute geriatric medicine service in NSW, Australia, were included in this study. Methods: The Western Sydney Clinical Frailty Registry is a study of adults admitted to acute geriatric wards in a 570-bed two-site district general hospital in Western Sydney, NSW, Australia. Recruitment began in April 2020 and is ongoing. Each participant is recruited while an inpatient and followed up for 12 months, including baseline visits and three-, six- and 12-month follow-ups via telephone interviews. The primary outcome of this study was rehospitalisation and/or mortality at 12 months. Results: Median age 82 years; half the cohort were classified as mild-moderately frail, and 21% were classified as severely frail. A total of 134 participants died (22.6%) within the 12-month follow-up period. Increased cumulative incidence of first rehospitalisation and/or death during the first 12 months post-discharge was significantly associated with higher modified Charlson comorbidity (p </p
Follow the labour process: Constructing explanations and making a difference through multi-sited ethnographic methods
No full textThis Exchanges commentary adds to recent dialogue in economic geography on how methodological approaches, explanatory goals and political standpoints intersect. Drawing lessons from collaborative projects that have sought to understand the concrete, place-based experiences of labouring in industries amidst capitalist and environmentally induced restructuring, we describe and advocate for a multi-sited ethnographic approach that we call ‘following the labour process’. We highlight three recurring challenges for researchers adopting such an approach to building explanations that purposefully centre labour: (1) developing and maintaining different relationships, (2) making sense of difference and (3) making a difference. Multi-sited following illuminates moral and political aspects of commodity relations, prompting reflection on the ethics of research engagement and knowledge production. While requiring engagement in/across different, interconnected sites, multi-sited ethnographic following can help yield rich empirical insights capable of deepening scholarly explanations, engaging diverse audiences and articulating normative viewpoints.</p
Peer coaches to improve type 2 diabetes mellitus outcomes through patient activation and self-management in India
No full textBackground: Type 2 diabetes mellitus (T2DM) stands as a significant public health concern, not only in India but globally, ranking among leading non-communicable diseases with high mortality rates. Effectively managing T2DM requires the adoption of crucial self-management behaviors, encompassing medication adherence, a healthy diet, blood glucose monitoring, regular physical activity, and footcare. Recognizing the pivotal role of self-management in controlling T2DM, the concept of patient activation has been introduced to empower individuals in taking charge of their health. Patients with higher levels of activation demonstrate a greater propensity for engaging in self-care behaviors, achieving improved clinical outcomes, and incurring lower healthcare costs. In tandem with patient activation, peer coaches have emerged as valuable assets in providing support to individuals managing diabetes. The collaborative synergy between patient activation and peer coaching holds considerable potential for optimizing T2DM management. Despite the global significance of these strategies, there is limited information about the impact of patient activation driven diabetes self-management interventions delivered by peer coaches, specifically in the context of Indian hospital settings. This study was an attempt to fill this knowledge gap.Methodology: This was a mixed-methods study, conducted in three phases across nine government hospitals in New Delhi, India. Phase I was a cross-sectional study which included a large cohort of diabetes patients. Phase II assessed the effect of patient activation driven diabetes self-management intervention delivered by peer coaches. Phase III was a qualitative study, which explored the feasibility, acceptability and sustainability of the self-management intervention. Data for Phases I and II were collected using self-administered questionnaires. Data for Phase III were collected using semi-structured interviews.Results: Phase I involved 326 patients living with T2DM in New Delhi, India. Results revealed the majority of participants were females aged 45–65 years of age. Over half were low educated, had caregivers and were mainly relatives. Clinical data analyses showed that more than half had uncontrolled HbA1c level and the majority of participants were either obese or overweight. In terms of patient activation, almost half of the participants were at level 1 (not activated), one third were at level 2 (low activated) and about a quarter were at level 3 (highly activated). In relation to self-management, participants showed a moderate adherence to healthy diet and exercise; however, they struggled in managing blood sugar testing and footcare. Regression analyses revealed that diabetes self-management behaviors were significant predictors of diabetes clinical data. Similarly, patient activation was a significant predictor of self-management behaviors. Phase II involved examining the impact of patient activation driven intervention delivered by peer coaches among 65 individuals living with T2DM. It showed substantial improvements in glycemic control, exercise and diet self-management behaviors. However, marginal progress was observed in blood sugar testing, footcare and medication adherence. Phase III, post-intervention interviews with patients, doctors and peer coaches, showed they found the intervention feasible, acceptable and sustainable.Conclusion: This study significantly contributes to the existing body of evidence supporting the effectiveness of self-management interventions and the pivotal role of peer support in enhancing diabetes care. Our finding showed that patient activation can be used as a reliable driver of diabetes self-management. In the same vein, our data revealed that peer coaches can offer reliable support of diabetes care in community settings. Peer coaches played instrumental roles in supporting and empowering participants to actively engage in diabetes care which highlighted the potential of peer support interventions. Participating patients, doctors and peer coaches highlighted the viability and acceptability of the intervention and its potential for broader implementation. Moving forward, these findings suggest that interventions emphasizing patient activation and peer coaching could be instrumental in shaping the future landscape of diabetes care in India and in similar healthcare settings.</p
Phytoliths as indicators of palaeoenvironmental change during the Middle Pleistocene Transition, in the So’a Basin, Flores
No full textExcavations in the So’a Basin, central Flores, have provided some of the earliest evidence of hominin activity in Wallacea. Stone tool evidence suggest that the likely ancestors of the small-bodied Homo floresiensis had reached the island over 1 million years ago. Understanding the paleoenvironmental context of the arrival of genus Homo across the Wallace Line is crucial to understand the evolutionary context of Homo floresiensis.The world of this early hominin, was in flux, undergoing climate shifts and major ecological change, driven by the Middle Pleistocene Transition (MPT). Observed between 1.2 and 0.7 Ma, the MPT is known to have led to the strengthening of global monsoon systems, as well as the increased intensity and duration of glacial cycles. The effect of these climate shifts on the small insular ecosystem of Flores is uncertain, obscured by a ~400 ka gap in the fossil record. In an effort to generate much needed palaeoenvironmental data for the So’a Basin during the MPT, phytolith analysis was conducted on 22 sediment samples from Tangi Talo and Mata Menge which provide a record of local vegetation spanning from >1.27 to >0.65 Ma.The results of this study are in agreement with previous paleoenvironmental research, concluding that vegetation during the Early Pleistocene was likely more forested, with a significant expansion of grassland occurring after 1.27 Ma and ending prior to 1 Ma. It is likely that the increasingly arid and seasonal conditions generated by the MPT enabled the spread of tropical grasses and a great reduction in the presence of woody taxa in the So’a Basin. It is likely that savannah-like conditions predominated in the So’a Basin by the time of hominin arrival. These conditions remain relatively stable with no significant vegetation shifts recorded in the phytolith assemblages following 1 Ma. After this period savannah with a nearby forests and wetland component persisted through the basin.Overall, this study finds phytoliths to be very well preserved in the So’a Basin. There is significant potential for their application in archaeological and paleontological research in future.</p
Interface Regulation by Functional Additives Towards Highly Stable Zn Batteries in Aqueous Electrolyte
No full textAqueous zinc batteries have emerged as highly promising route for large-scale energy storage applications due to their inherent safety, higher energy density, lower raw material costs, simpler manufacturing processes, and non-toxicity. Despite these advantages, challenges such as Zn dendrite formation, hydrogen evolution side reactions, and Zn metal anode corrosion hinder their practical implementation. These challenges are intrinsically linked to Zn deposition behavior, which is influenced by the critical interfaces adjacent to the Zn electrode. To address these problems, here the interface between the Zn electrode and the aqueous electrolyte has been effectively regulated using electrolyte additive strategies to enhance the electrochemical performance of Zn batteries. Succinic acid (SA) was identified as a viable and cost-effective additive that significantly improves the reversibility and cycling stability of aqueous Zn batteries by altering the solvation structure of Zn ions and preferentially adsorbing onto the Zn anode surface. This approach results in Zn anodes in a 2 m ZnSO4 electrolyte containing 0.1 m SA exhibiting remarkable improvements, with Zn||Zn symmetric cells achieving a cycle life of 5500 hours and Zn||Cu cells demonstrating an average Coulombic efficiency of approximately 99.7% over 1300 cycles. Further advancements were made with a novel aqueous electrolyte composed of 1 m ZnSO4 and 0.1 m SS (sodium sulfanilate) additive, where abundant amino groups of SS molecules promoted the uniform Zn deposition and inhibited corrosion, leading to long-term cycling stability of over 1000 hours at 1 mA cm-2 and 1 mAh cm-2 and high Coulombic efficiency (CE) of Zn plating/stripping in Zn||Cu cells. Additionally, a low-cost strategy utilizing a very small amount of pyridine electrolyte additive leveraged results in dendrite-free and homogeneous Zn deposition through a unique electrostatic repulsion mechanism during the Zn plating/stripping process. This enables a remarkable cycling stability in Zn||Zn symmetrical cells for over 2000 hours at 1 mA cm-2 and 1 mAh cm-2, with superior performance even at high current densities and capacities. The full batteries with an Al0.1V2O5·1.5 H2O (AIVO) cathode achieved a lifespan of 800 cycles, significantly surpassing the conventional electrolytes. Therefore, these findings offer a scalable electrolyte additive strategy for developing advanced dendrite-free Zn anodes and high-performance aqueous Zn batteries, paving the way for their potential applications in large-scale energy storage systems. </p
Development and performance investigation of low activation medium entropy alloy FeCr<sub>2</sub>VW<sub>x</sub> via arc melting for fusion applications
No full textHigh-entropy alloys (HEAs) are a novel class of metal alloys composed of five or more metal elements, with each primary element's concentration ranging from 5% to 35%. Due to their outstanding mechanical properties, creep resistance, high oxidation resistance, and irradiation durability, HEAs are considered ideal candidate materials for structural components in nuclear reactors. This study aims to design a medium-entropy alloy (MEAs) consisting of high-melting-point, low-activation alloy elements as a potential nuclear structural material. Alloy samples were fabricated using arc melting. The microstructure, phase characterization, mechanical properties, and oxidation resistance of the arc-melted low-activation medium-entropy alloys were investigated. Additionally, annealing heat treatment was employed to optimize the mechanical properties of the samples.Firstly, thermodynamic calculations were employed to guide alloy design. Feasibility analysis was then performed on newly designed low-activation medium-entropy alloys produced by arc melting. These materials were manufactured using arc melting, and their microstructure and mechanical properties were studied. The results indicated that a developed MEA FeCr2VW0.1 composition displayed a similar microstructure to FeCr2V. The prepared FeCr2VW0.1 showed improved mechanical properties compared to FeCr2V. First-principles calculations based on density functional theory (DFT) and theoretical strength calculations confirmed that the inclusion of W in MEAs based on FeCr2V significantly enhanced Solid State Strengthening (SSS) and Precipitate Strengthening (PS) of the investigated alloy, in line with experimental results.Building upon the feasibility manufacturing study, the microstructure of arc-melted low-activation medium-entropy alloys with varying W contents was characterized, and their mechanical properties were tested at room temperature and high temperatures. The studied FeCr2VWx (x = 0, 0.1, 0.3) medium-entropy alloys exhibited a dual-phase microstructure composed of body-centered cubic (BCC) phases. With further W addition, the microstructure of the FeCr2VW0.5 sample featured additional W-rich phases. Compression tests conducted at both room temperature and high temperature revealed an improvement in the compression performance of MEA with the introduction of W. These compression properties are comparable to existing low-activation refractory high-entropy alloys. The excellent high-temperature performance is attributed to the enhanced precipitation and solid solution strengthening effects post W addition.After confirming the excellent mechanical properties of the novel low-activation medium-entropy alloys, their oxidation resistance was studied. Oxidation kinetics studies demonstrated that different FeCr2VWx (x = 0, 0.1, 0.3, 0.5) medium-entropy alloys followed a parabolic kinetic trend at 650°C in air. Compared to the traditional nuclear material P91 steel, FeCr2VWx MEAs exhibited superior oxidation resistance. Additionally, the addition of W further enhanced their oxidation resistance. Finally, the mechanical properties of the fabricated structures were optimized through post-annealing treatment. Solid solution annealing treatment at 1200°C refined the microstructure of the low-activation medium-entropy alloy samples. Samples subjected to post-annealing treatment at 1200°C displayed a more uniform elemental distributions, larger grain sizes, and an appropriate combination of precipitates, resulting in improved mechanical properties.Based on the outcomes of this study, it can be concluded that the designed low-activation medium-entropy alloys are viable. They exhibit mechanical properties comparable to existing low-activation refractory high-entropy alloys and superior oxidation resistance compared to traditional nuclear materials. Furthermore, subsequent annealing treatment effectively enhanced the comprehensive mechanical properties of the alloys. The outstanding resistance of MEA to high temperatures, along with its high strength and resistance to oxidation, positions it as a promising candidate for applications in the nuclear energy sector, critical component manufacturing in aerospace, and the marine chemical industry. These results in the study provide valuable insights for the future development and microstructure engineering of novel MEAs, as well as optimizing the mechanical properties of MEAs.</p
Shifting Gears: An Economic Geography Analysis of Australia's Downstream Automotive Sector
No full textThis report examines the restructuring of Australia's automotive sector, focusing on the shift from domestic manufacturing to a post-production, import-based market, and the growth of the aftermarket sector. It presents data collected from a multi-year project which investigated the spatial and economic aspects of restructuring the automotive sector, with a specific focus on the repair and maintenance industry and the changing requirements of the workforce. The report identifies the significant contribution of aftermarket automotive sales and services to the economy, and flags a growing skills shortage as the market turns increasingly to electric vehicles (EVs).</p
“Food is the Glue”: Community Centres in the Illawarra and Shoalhaven Use Food as a Gateway to Supporting Wellbeing & Connection
No full textThis evidence brief presents a comparative analysis of the "Let's Talk About Food" survey results, examining the differing responses from individuals who engaged through community centres versus those who responded online or via postal methods. Community centres act as key referral hubs, linking individuals with a wide network of support that extends beyond immediate food relief. The data presented highlights that people attending community centres experience a higher severity of food insecurity (73% of adults and 73% of children), poorer diets and deal with more serious health issues than the wider community. Despite these challenges, they report a higher level of community support— likely a reflection of their direct engagement with these centres. The pivotal role of community centres in supporting individuals facing these challenges is highlighted, demonstrating that “food is the glue”. Despite being under-resourced in their efforts to provide food relief, community centres find that food paves the way for connecting people to other critical support services, including healthcare, employment resources, education, and mental health care. In response to these findings, the Illawarra Shoalhaven Food Futures Taskforce was established, bringing together stakeholders from local government, community organisations, health services, and food relief agencies to collaborate on integrated strategies addressing food insecurity and its associated health impacts across the region.</p
Community Perspectives on Local Food in the Illawarra and Shoalhaven
No full textThe "Let’s Talk About Food" survey, conducted with over 700 households in the Illawarra and Shoalhaven regions, aimed to explore residents' thoughts on locally produced food, their participation in urban agriculture initiatives, and their shopping habits for local foods. Key findings reveal residents highly value the freshness, quality, and community benefits of local food but face barriers such as cost, limited availability, and lack of accessibility. There is substantial dissatisfaction with the availability of farmers markets and community gardening spaces in the region. This report proposes recommendations to improve the availability, affordability, and accessibility of local food through targeted initiatives that strengthen community engagement and the local food economy.</p