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Settler teachers’ engagement with first nations content in the Australian curriculum
No full textSituated in the curriculum space created by the recent enhancements to First Nations content is the opportunity for teachers to better connect with First Nations perspectives. Using constructivist theory methodology and drawing on two studies, a small qualitative school-based study of teachers who teach in the early years of schooling, and a large-scale study of professional development across two Australian states, the paper explores teachers’ preparedness to teach First Nations content. The tenets of critical literacy frame the discussion and are positioned as reflective tools that can be used to support the ‘settler teacher’ in self-reflection. Audio-recorded transcripts of planning sessions, a teacher survey, comments from feedback forms and researcher memos form the data sets. Findings from the study necessitate discursive practices for the development of teacher knowledge, dispositions, and confidence, and highlight the imperative for teacher critical self-reflection
Role of neoadjuvant peptide receptor radionuclide therapy in unresectable and metastatic gastro-entero-pancreatic neuroendocrine neoplasms: A scoping review
No full textPeptide receptor radionuclide therapy (PRRT) is an established therapy for metastatic neuroendocrine neoplasms (NEN). The role of PRRT as a neoadjuvant treatment prior to surgery or other local therapies is uncertain. This scoping review aimed to define the landscape of evidence available detailing the utility of PRRT in the neo-adjuvant setting, including the clinical contexts, efficacy, and levels of evidence. A comprehensive literature search of PUBMED, SCOPUS, and EMBASE through to December 2022 was performed to identify reports of PRRT use as neoadjuvant therapy prior to local therapies. Observational studies and clinical trials were included. A total of 369 records were identified by the initial search, and 17 were included in the final analysis, comprising 179 patients treated with neoadjuvant PRRT. Publications included case reports, retrospective cohort series and a phase 2 trial. Definitions of unresectable disease were variable. Radioisotopes used included 177Lu (n = 142) and 90Y (n = 36), used separately (n = 178) or in combination (n = 1). A combination of PRRT with chemotherapy was also explored (n = 2). Toxicity data was reported in 11/17 studies. Survival analysis was reported in 3/17 studies. Surgical resection following PRRT was reported for both the primary tumor (n = 71) and metastases (n = 12). Resection rates could not be calculated as not all publications reported whether resection was completed. Published literature exploring the use of PRRT in the neoadjuvant setting is mostly limited to case reports and retrospective cohort studies. From these limited data there is reported to be a role of PRRT in neoadjuvant setting in the literature. However, the low quality of evidence precludes any definite conclusion on the grade of disease, site of primary, isotope used or use of concomitant chemotherapy that can benefit from this application. Further prospective studies will require collaboration between multiple centers to gain sufficient high-quality evidence
The gendered framing of language impairments in criminalised young people
No full textYoung people whose language performance does not meet socially expected standards are overrepresented in the criminal justice system. Pragmatic language skills encompass the social aspects of language, which include constructing narratives, the rules of conversations, turn-taking, topic management, and non-verbal communication. Current research on pragmatic language impairments in criminalised young people – that is, on their symptomatic difficulties with social communication and language – remains inconclusive. The purpose of this study is to uncover the perceptions and framing of pragmatic language impairments in a sample of studies involving boys and girls from Australia and the United States. Drawing on content analysis of a sample of pertinent research, we expose the deeply gendered framing of pragmatic language performance and associated behaviours of criminalised young people. We demonstrate that available studies often represent female participants’ problematised use of pragmatic language as a personal choice, thus locating the problem within the individual and responsibilising girls and young women. However, for male participants, current research often presents problematised use of pragmatic language as a consequence of institutional failures. We argue that this gendered framing has political implications for criminalised young people and future research
Beyond conventional critique in education: embracing the affirmative
No full textThis article provides new insight into the potentialities of critique. Drawing on posthuman critical theory and the Spinozan concept of power to act, we explore the limits of critique that centrally depends on making explicit power relations that are frequently hidden. Set within the context of inequalities surrounding sexuality, gender and mental health, this exploration involves two Australian government schools and critique as practised. The interdependence of affective, discursive and material relations as they play into these inequalities is shown. Affect and material forces emerge as constitutive aspects of critique with the capacity to address these inequalities and do so in generative ways. Critique presents as more than exposing power structures and power manifests as potentialising, as well as normalising. The argument is made that we might with profit move beyond human-centred and exclusively critical modes of critique. A de-centering of human subjects and re-centering of human and more-than-human relations augments received views of critique and reflects the immanent and productive power to act that underpins it. In bringing an enacted ontology of power to bear, what counts as critique is complex relational positioning with both criticality and affirmation at its core
Quality of Refractive Error Care in Cambodia: An Unannounced Standardized Patient Study
No full textPURPOSE: Quality-of-care in refractive error services is essential, as it directly affects vision outcomes, wellbeing, educational attainment, and workforce participation. In Cambodia, uncorrected refractive error is a leading cause of mild and moderate vision impairment in adults. We evaluated the quality of refractive error care in Cambodia by estimating the proportion of prescribed and dispensed spectacles appropriate for people's refractive error needs and factors associated with spectacle quality. METHODS: A cross-sectional protocol was employed with 18 Khmer-speaking adult participants observing testing procedures in 156 optical services across six provinces in 2022. A total of 496 dispensed spectacles were assessed against spectacle quality indicators. RESULTS: The analysis revealed that 35.1% of dispensed spectacles were of optimal quality. The most common error observed in sub-optimal spectacles was the presence of horizontal prism outside of tolerance limits. The study also found that 44.0% of emmetrope visits involved unnecessary prescription spectacle recommendations, and 18.3% of written prescriptions did not correspond with dispensed spectacles. Sex differences were observed, with men predominantly providing refractive error care and women more likely to be unnecessarily recommended prescription spectacles. CONCLUSION: The findings highlight the importance of prioritizing quality-of-care in refractive error services. A key recommendation is to consider regulatory mechanisms to ensure optical services employ appropriately qualified staff. Additionally, efforts should be made to eliminate unnecessary prescriptions -- especially for emmetropes and females -- standardize written prescriptions, ensure consistent pupil distance measurements, reduce reliance on autorefraction, and address the gender imbalance in the refractive error workforce
Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta-Analysis
No full textOBJECTIVE: We wanted to determine if higher compliance with American College of Sports Medicine (ACSM) exercise prescription guidelines influences exercise outcomes in knee osteoarthritis (OA). METHODS: We conducted a systematic review. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase up to January 4, 2024, for randomized controlled trials evaluating resistance and/or aerobic exercise for knee OA. Interventions were classified as higher compliance (meeting ≥60% of ACSM guideline recommendations for frequency, intensity, and duration) or lower compliance (meeting <60% of recommendations). Effects on pain and function were evaluated via meta-analysis, stratified by compliance. RESULTS: Twenty-five trials (3,290 participants) evaluated combined resistance and aerobic programs, with no differences in outcomes between those with higher and lower compliance (standardized mean difference [SMD] pain: -0.38 [95% confidence interval (CI) -0.59 to -0.17] vs -0.31 [95% CI -0.45 to -0.16], respectively; SMD function: -0.43 [95% CI -0.64 to -0.21] vs -0.36 [95% CI -0.58 to -0.14]). Sixty-six trials (5,231 participants) evaluated resistance exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.60 [95% CI -0.81 to -0.39] vs -0.93 [95% CI -1.27 to -0.59]; SMD function: -0.64 [95% CI -0.83 to -0.44] vs -0.85 [95% CI -1.20 to -0.49]). Twelve trials (958 participants) evaluated aerobic exercise, with no differences between interventions with higher and lower compliance (SMD pain: -0.79 [95% CI -1.20 to -0.38] vs -1.00 [95% CI -2.52 to 0.53]; SMD function: -0.83 [95% CI -1.27 to -0.38] vs -0.76 [95% CI -2.02 to 0.50]). CONCLUSION: Higher or lower compliance with ACSM exercise prescription guidelines did not influence exercise outcomes. Given there was substantial heterogeneity and many publications were at risk of bias, our results should be interpreted with caution
Prenatal opioid exposure and the early life epigenome: results from ECHO
No full textBACKGROUND: Prenatal opioid exposure has been associated with adverse child health outcomes. Changes to the epigenome provide a plausible mechanism through which effects may be elicited. We investigated whether prenatal opioid exposure was associated with locus-specific changes in umbilical cord blood DNA methylation (DNAm) and gestational epigenetic age. METHODS: We leveraged data from the Environmental influences on Child Health Outcomes cohort. Prenatal opioid data was obtained from maternal self-report and/or medical record data. DNAm measures were generated from blood biospecimens collected at birth. Linear regression models tested associations between prenatal maternal opioid exposure and epigenetic outcomes in crude and fully adjusted models. RESULTS: We tested the association between prenatal opioid exposure and cord blood DNAm at 15 CpG sites in 385 (n = 25 exposed, n = 360 unexposed) individuals from three cohorts. We identified a single CpG site (cg14303187) that was nominally associated with prenatal opioid exposure (p = 0.02, β = -0.012; 95% CI, -0.023 to -0.0012). No significant associations between exposure and gestational epigenetic age were found (n = 716 individuals from eight cohorts; n = 29 exposed, n = 687 unexposed). CONCLUSIONS: We identified a nominally significant association between prenatal opioid exposure and DNAm at one CpG site. Future studies should continue investigating the effect of this exposure on the epigenome
The epidemiology of mental and substance use disorders in Australia 2020–22: Prevalence, socio-demographic correlates, severity, impairment and changes over time
No full textOBJECTIVE: Mental and substance use disorders are the leading causes of disability worldwide. Contemporary estimates of prevalence, severity and impairment are essential for service planning. This study provides estimates of prevalence, severity, impairment and demographic correlates of mental and substance use disorders in 2020-22 and changes in prevalence since 2007. METHODS: Data were from the two Australian National Surveys of Mental Health and Wellbeing conducted in 2020-22 (N = 15,893) and 2007 (N = 8841). Descriptive statistics report prevalence of lifetime and 12-month mental and substance use disorder by sex and age, proportion of people with each mental disorder by levels of severity (mild, moderate and severe) and mean days out of role by mental disorder class (mood, anxiety, substance use). Logistic regression analyses examined demographic correlates of mental disorder class and assessed changes over time. RESULTS: The lifetime prevalence of any mental or substance use disorder in 2020-22 was 40.2%. The 12-month prevalence was 20.2% (mood disorder - 7.4%, anxiety disorder - 15.7% and substance use disorder - 3.1%). Mood disorders were associated with significant impairment. The prevalence of mental disorders has changed over time, with mood and anxiety disorders increasing and substance use disorders decreasing. These changes were most evident among young adults. CONCLUSION: Mental disorders are common in Australia. Impairment associated with mental disorders remains significant. Particular focus should be paid to young adults aged 16-25 years who have shown the largest increases in anxiety and mood disorder prevalence over the past 13 years
Evaluating the cost-effectiveness of levofloxacin therapy for household contacts of multidrug-resistant tuberculosis in Vietnam
No full textBackground: Multidrug-resistant tuberculosis (TB) threatens global TB control, on account of poor treatment outcomes, high treatment toxicity and costs. Recent trials demonstrated the effectiveness of six-months of levofloxacin (6Lfx) to prevent TB disease among high-risk contacts. However, the cost-effectiveness of this strategy has not previously been evaluated. Methods: The VQUIN study was a double-blinded randomised control trial in Vietnam assessing the effectiveness of 6Lfx in household contacts of multidrug resistant/rifampicin resistant TB (MDR/RR-TB) to prevent progression to TB disease. Incorporating in-trial costs and effectiveness outcomes from the VQUIN trial, we developed a closed cohort, decision-analytic Markov model to assess the cost effectiveness of 6Lfx versus placebo in a cohort exposed to MDR/RR-TB in Vietnam. Findings: Over a 20-year time horizon, the provision of 6Lfx preventative therapy to household contacts of people infected with MDR/RR-TB was found to gain a total of 40.1 QALYs per 1000 population and save US$23,145 per 1000 population, indicating the strategy was cost saving. MDR/RR-TB cases averted over 20 years was 19.9 per 1000 population treated with 6Lfx, and the number of deaths averted was 3.2 per 1000 people treated. Interpretation: 6Lfx therapy is a cost-saving strategy to reduce the incidence of active disease in household contacts of MDR/RR-TB in a resource-limited setting. Funding: National Health and Medical Research Council Project Grant ( #1081443). GJF was supported by a NHMRC Leadership Fellowship (Level 1) ( #2007920)
Gender identity and mental health inequalities 2001-2022: population-level evidence from an Australian cohort study
No full textBACKGROUND: Trans, non-binary and gender-diverse (TGD) people experience poorer mental health relative to cisgender populations. However, we know little on how TGD mental health inequalities are changing over time. With newly available information on gender identity within Australia's largest longitudinal household survey, we aimed to provide the first nationally representative estimates of temporal trends in TGD mental health inequalities. METHODS: We used the 2001-2022 Household, Income and Labour Dynamics in Australia Survey, a national probability sample of Australian adults. Using questions about sex at birth and gender identity, asked in the 2022 wave, we compared temporal trends in mental health among TGD and cisgender respondents. Mental health was measured using the five-item Mental Health Inventory (MHI). Adjusting for age, income and other observable characteristics, we calculated annual population-weighted estimates of mean MHI Scores for TGD and cisgender respondents and corresponding TGD mental health inequalities. RESULTS: Across the 22-year period, TGD respondents consistently reported poorer mental health than cisgender respondents. Prior to 2010, differences in MHI Scores were more variable, but TGD MHI Scores were generally lower than cisgender respondents. From 2010 onwards, there was a trend of widening inequalities, with TGD-cisgender MHI inequalities ranging from -5.1 (95% CI -10.6, 0.3) in 2010 to -7.6 (95% CI -10.8, -4.4) in 2022, indicating clinically relevant differences in mental health. Effects were driven by younger populations. CONCLUSION: TGD-cisgender mental health inequalities are increasing in Australia, with inequalities more apparent between 2010 and 2022. Policy action and greater protections for gender-diverse Australians are urgently needed