text: Sydney eScholarship Community: http://hdl.handle.net/2123/2740 2015-07-07T19:45:57Z Analysis of the Federal Health Budget and Related Provisions 2015-16 http://hdl.handle.net/2123/13528 Title: Analysis of the Federal Health Budget and Related Provisions 2015-16 Authors: Russell, Lesley; Menzies Centre for Health Policy Abstract: This analysis looks at the health and related provisions in the Australian Government's 2015-16 Budget. This is done in the light of current and past strategies, policies, programs and funding, and is supported, where possible, by data drawn from Medicare, the Pharmaceutical Benefits Scheme, reports and published papers. 2015-07-07T00:00:00Z (Re)Moralizing the suicide debate http://hdl.handle.net/2123/13523 Title: (Re)Moralizing the suicide debate Authors: Fitzpatrick, S.J. Abstract: Contemporary approaches to the study of suicide tend to examine suicide as a medical or public health problem rather than a moral problem, avoiding the kinds of judgements that have historically characterised discussions of the phenomenon. But morality entails more than judgement about action or behaviour, and our understanding of suicide can be enhanced by attending to its cultural, social, and linguistic connotations. In this work, I offer a theoretical reconstruction of suicide as a form of moral experience that delineates five distinct, yet interrelated domains of understanding – the temporal, the relational, the existential, the ontological, and the linguistic. Attention to each of these domains, I argue, not only enriches our understanding of the moral realm, but provides a heuristic for examining the moral traditions and practices which constitute contemporary understandings of suicide. Keywords: Suicide; philosophy; social values; humanities 2014-04-01T00:00:00Z Medicine's inconvenient truth: The placebo/nocebo effect http://hdl.handle.net/2123/13522 Title: Medicine's inconvenient truth: The placebo/nocebo effect Authors: Arnold, MH; Finniss, DG; Kerridge, I Abstract: Placebo and nocebo effects are often regarded by clinicians as either a quaint reminiscence from the pre-therapeutic era, or simply as a technique for establishing the efficacy of therapeutic interventions within the locus of evidence-based practice. However, neither of these explanations sufficiently account for their complexity or their persistence and impact in clinical medicine. Placebo and nocebo effects are embedded in the very fabric of therapeutic relationships and are both a manifestation and outcome of the rituals that characterise clinical practice. They are also a stark reminder of the many personal and environmental factors, including the attitudes, beliefs and expectations of both doctor and patient, that shape the outcomes of health professional-patient interactions. We describe how recent biological and neuropsychiatric data have clarified the operation of placebo and nocebo effects in clinical practice – demonstrating the ability of the therapeutic context to modulate endogenous biological processes in a targeted manner. This, in turn, illustrates the potent philosophical and sociocultural aspects of medical praxis. Keywords: placebo; nocebo; context effect; medical therapeutics; medical practice; medical ethics 2014-04-01T00:00:00Z Indigenous Provisions in the 2015-16 Budget http://hdl.handle.net/2123/13476 Title: Indigenous Provisions in the 2015-16 Budget Authors: Russell, Lesley Abstract: This analysis looks at the Indigenous provisions in the 2015-16 federal Budget. This is done in the light of current and past strategies, policies, programs and funding, and is supported, where this is possible, by data and information drawn from government agencies, reports and published papers. Similar analyses from previous budgets are available on the University of Sydney e‐scholarship website.The opinions expressed are solely those of the author who takes responsibility for them and for any inadvertent errors. This work does not represent the official views of the Menzies Centre for Health Policy. 2015-06-23T00:00:00Z Propaganda or cost of innovation? The high price of new drugs http://hdl.handle.net/2123/13445 Title: Propaganda or cost of innovation? The high price of new drugs Authors: Ghinea, N; Kerridge, I; Lipworth, W Abstract: Ever wonder how much it costs to develop a new drug? The independent, non-profit research group, The Tufts Center for the Study of Drug Development, estimates US$2.6 billion, almost double the centre's previous estimate a decade ago. But how accurate is this figure? While the details of the study remain a secret, a press release, slideshow and background document on the Tufts website provide some insight into how this figure was calculated. Interestingly, only slightly more than half of this cost is directly related to research and development (R&D). US$1.2 billion are "time costs" – returns that investors might have made if their money wasn't tied up in developing a particular drug. As expected, these costings have attracted the attention of policymakers, consumer advocates and critics of big pharma. In the New England Journal of Medicine, Harvard University Professor of Medicine Jerry Avorn questions several assumptions underpinning the Tufts costing – particularly the unverifiable claim that up to 80% of compounds are abandoned at some point during development. Description: The Conversation article 2015-06-16T00:00:00Z Conflicting rights: How the prohibition of human trafficking and sexual exploitation infringes the right to health of female sex workers in Phnom Penh, Cambodia http://hdl.handle.net/2123/13428 Title: Conflicting rights: How the prohibition of human trafficking and sexual exploitation infringes the right to health of female sex workers in Phnom Penh, Cambodia Authors: Maher, L; Dixon, C; Phlong, P; Mooney-Somers, Julie; Stein, Ellen; Page, K Abstract: While repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced anti-trafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers' human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia's AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers. 2015-06-11T00:00:00Z How we can increase Australia's organ donation rate http://hdl.handle.net/2123/13427 Title: How we can increase Australia's organ donation rate Authors: Bendorf, A; Newson, A.J.; Kerridge, I Abstract: The Australian government has commissioned a private consultancy to review the country's poor organ donation rates. While the review may make some interesting observations, the answer to increasing the rate is already clear: we need to better manage patients nearing brain death. In 2008, the Rudd Labor government allocated A$136 million to create a nationwide government body called the Organ and Tissue Authority (OTA), and charged it with increasing Australia's low deceased organ and tissue donation rates. The initiative failed. After initially increasing rates to our highest-ever of 16.9 deceased organ donors per million population (pmp) in 2013, the rate fell again to 16.1 in 2014. And our year-to-date projections point to a further decrease in this rate for 2015. Even though there has been a small relative increase in the number of people who have received transplants – 56.3 transplants pmp in 2008 to 58.9 transplants in 2014 – this 4.6% increase has cost more than A$250 million. And Australia's donation rate remains in the bottom half of developed countries, with a rate less than half that of world-leading Spain. The OTA's failure to achieve higher donation levels or to maintain its early improvements raises questions about its strategic approach. We believe there are three key areas where its approach differs from world's best practice. Description: The Conversation article 2015-06-12T00:00:00Z Joe Hockey's medical research fund is nothing more than a distraction http://hdl.handle.net/2123/13423 Title: Joe Hockey's medical research fund is nothing more than a distraction Authors: Mayes, C; Kaldor, J; Carter, SM; Little, M; Kerridge, I Abstract: Health is a basic requirement for an individual to lead a good life. Without health you have nothing; when we are sick, it's difficult to work, to care for others, to participate in the things we enjoy. We seek treatment so we can get back to our normal lives. Because health is so important to our wellbeing, there is widespread agreement— including among ethicists —that a fair and accessible healthcare system is something that we should pursue. And although the Australian healthcare system is far from perfect, it has provided universal access to healthcare for almost 40 years. A universal healthcare system – one that is open to everyone, whether or not they can afford to pay – is a basic feature of a good and just society. Tony Abbott and Joe Hockey want us to panic about a "budget emergency", including the idea that our current health system is unsustainable. Rising healthcare costs pose a challenge to governments everywhere. But this is not a new problem, and will not bring about economic or social catastrophe any time soon. This amplified threat is being used to justify measures that are now well known: introducing co-payments for GP fees; disestablishing Medicare Locals; transferring health agencies to the department of health with reduced funding; and stripping $80bn in funding from the states, particularly in health and education. This will not only force the states to increase their own goods and services taxes, but reduce the public services they can afford to provide. It will end universal access to health care, make Medicare a mere "safety net", overwhelm hospitals, and increase the inequities that are increasingly a feature of Australian society. Description: newsletter article 2014-05-23T00:00:00Z The First Shared Online Curriculum Resources for Veterinary Undergraduate Learning and Teaching in Animal Welfare and Ethics in Australia and New Zealand http://hdl.handle.net/2123/13422 Title: The First Shared Online Curriculum Resources for Veterinary Undergraduate Learning and Teaching in Animal Welfare and Ethics in Australia and New Zealand Authors: Johnson, J; Collins, T; Degeling, C; Fawcett, A; Fisher, AD; Freire, R; Hazel, S; Hood, J; Lloyd, J; Phillips, C; Stafford, K; Tzioumis, V; McGreevy, PD Abstract: The need for undergraduate teaching of Animal Welfare and Ethics (AWE) in Australian and New Zealand veterinary courses reflects increasing community concerns and expectations about AWE; global pressures regarding food security and sustainability; the demands of veterinary accreditation; and fears that, unless students encounter AWE as part of their formal education, as veterinarians they will be relatively unaware of the discipline of animal welfare science. To address this need we are developing online resources to ensure Australian and New Zealand veterinary graduates have the knowledge, and the research, communication and critical reasoning skills, to fulfill the AWE role demanded of them by contemporary society. To prioritize development of these resources we assembled leaders in the field of AWE education from the eight veterinary schools in Australia and New Zealand and used modified deliberative polling. This paper describes the role of the poll in developing the first shared online curriculum resource for veterinary undergraduate learning and teaching in AWE in Australia and New Zealand. The learning and teaching strategies that ranked highest in the exercise were: scenario-based learning; a quality of animal life assessment tool; the so-called 'Human Continuum' discussion platform; and a negotiated curriculum. Keywords: animal ethics; animal welfare; online curriculum resources; learning and teaching; scenarios; quality of life assessment 2015-01-01T00:00:00Z What is it like to be a doctor in immigration detention centres? http://hdl.handle.net/2123/13420 Title: What is it like to be a doctor in immigration detention centres? Authors: Chan, A; Kerridge, I Abstract: I am often asked questions about my work as a general practitioner in the Christmas Island and Nauru immigration detention centres. Are the conditions as bad as they say? Is the health care adequate? Are they genuine refugees? What are the people like? I often don't know what to say, and wonder whether my answers are ever sufficient. Words often seem inadequate to describe what I saw, or the ways in which my experience continues to impact upon me. Are the conditions bad? Absolutely. Imagine tents at a grungy music festival, but without the festivity and enclosed by wire. Imagine a world that has a 500m radius and is characterized by bleakness and oppressive humidity. And then imagine living there, for months on end, with no purpose or direction, unable to leave and not being told if you ever will. Is the health care adequate? Definitely not. But arguably this is impossible to provide in such remote and underdeveloped centres, where the primary purpose is not health but segregation and isolation. Are they genuine refugees? I have no idea because I never asked, and as a doctor who sat beside Ahmed, or Leila, or Antony I didn't really need to know. So what are "they" like? And what is it like to be their doctor? As a practitioner working in a detention centre you see many shocking departures from the ordinary – men with their lips sewn closed with thread from a blanket, women drinking from bottles of shampoo, children with weeping sores and no shoes, people hurting themselves to express their pain. In each case you try and do what you can to treat both the physical consequences of living in harsh environments and the mental anguish caused by losing hope. Description: newsletter article 2014-09-16T00:00:00Z Festschrift for Simon Chapman - Introduction by Mike Daube http://hdl.handle.net/2123/13395 Title: Festschrift for Simon Chapman - Introduction by Mike Daube Authors: Daube, Mike; Chapman, Simon Abstract: A Festschrift to celebrate the career of Simon Chapman AO was introduced by Professor Mike Daube AO, Professor of Public Policy, Curtin University. 2015-05-21T00:00:00Z Global Tobacco Control : Achievements and Challenges - Kenneth Warner - University of Michigan http://hdl.handle.net/2123/13394 Title: Global Tobacco Control : Achievements and Challenges - Kenneth Warner - University of Michigan Authors: Warner, Kenneth Abstract: Dr Kenneth Warner is Avedis Donabedian Distinguished University Professor of Public Health at the University of Michigan. 2015-05-21T00:00:00Z The Rewards and Challenges of Academic Supervision - Associate Professor Julie Leask http://hdl.handle.net/2123/13393 Title: The Rewards and Challenges of Academic Supervision - Associate Professor Julie Leask Authors: Leask, Julie Abstract: Associate Professor Julie Leask is a social scientist specialising in immunisation and is an NHMRC Career Development Fellow. 2015-05-21T00:00:00Z Public Health Advocacy - Professor Mike Daube http://hdl.handle.net/2123/13392 Title: Public Health Advocacy - Professor Mike Daube Authors: Daube, Mike Abstract: Professor Mike Daube: Advocacy and the Public interest. 2015-01-21T00:00:00Z How Research can influence Health Policy - The Honorable Nicola Roxon http://hdl.handle.net/2123/13391 Title: How Research can influence Health Policy - The Honorable Nicola Roxon Authors: Roxon, Nicola Abstract: How Research can and does influence Government Health Policy development. 2015-05-21T00:00:00Z Defending Renewable Energy from Pseudoscience and Quackery - Simon Holmes a Court http://hdl.handle.net/2123/13390 Title: Defending Renewable Energy from Pseudoscience and Quackery - Simon Holmes a Court Authors: Holmes a Court, Simon Abstract: The struggle for Science and rational thought in Energy Industry policy. 2015-05-21T00:00:00Z Shining a light - Norman Swan interviews Simon Chapman AO http://hdl.handle.net/2123/13389 Title: Shining a light - Norman Swan interviews Simon Chapman AO Authors: Chapman, Simon; Swan, Norman Abstract: An extract of an interview with Dr Norman Swan, Medical Journalist, Radio National, ABC. 2015-05-26T00:00:00Z Values in breast cancer screening: an empirical study with Australian experts http://hdl.handle.net/2123/13349 Title: Values in breast cancer screening: an empirical study with Australian experts Authors: Parker, Lisa; Rychetnik, L; Carter, SM Abstract: Objective: To explore what Australian experts value in breast screening, how these values are conceptualised and prioritised, and how they inform experts' reasoning and judgement about the Australian breast-screening programme. Design: Qualitative study based on interviews with experts. Partic ipants: 33 experts, including clinicians, programme managers, policymakers, advocates and researchers selected for their recognisable influence in the Australian breast-screening setting. Setting: Australian breast-screening policy, practice and research settings. Results: Experts expressed 2 types of values: ethical values (about what was good, important or right) and epistemological values (about how evidence should be created and used). Ethical values included delivering benefit, avoiding harm, promoting autonomy, fairness, cost effectiveness, accountability, professionalism and transparency. Epistemological values informed experts' arguments about prioritising and evaluating evidence methodology, source population and professional interests. Some values were conceptualised differently by experts: for example, delivering benefit could mean reducing breast cancer mortality, reducing all-cause mortality, reducing mortality in younger women, reducing need for aggressive treatment, and/or reassuring women they were cancer free. When values came into conflict, experts prioritised them differently: for example, when experts perceived a conflict between delivering benefits and promoting autonomy, there were differences in which value was prioritised. We explain the complexity of the relationship between held values and experts' overall views on breast cancer screening. Conclusions: Experts' positions in breast screening are influenced by evidence and a wide range of ethical and epistemological values. We conclude that discussions about values should be a regular part of breast-screening review in order to build understanding between those who hold different positions, and provide a mechanism for responding to these differences. 2015-01-01T00:00:00Z Facebook as a recruitment tool for adolescent health research: A systematic review http://hdl.handle.net/2123/13348 Title: Facebook as a recruitment tool for adolescent health research: A systematic review Authors: Amon, Krestina L; Campbell, Andrew J; Hawke, Catherine; Steinbeck, Katharine Abstract: BACKGROUND: Researchers are increasingly using social media to recruit participants to surveys and clinical studies. However, the evidence of the efficacy and validity of adolescent recruitment through Facebook is yet to be established. OBJECTIVE: To conduct a systematic review of the literature on the use of Facebook to recruit adolescents for health research. DATA SOURCES: Nine electronic databases and reference lists were searched for articles published between 2004 and 2013. STUDY ELIGIBILITY CRITERIA: Studies were included in the review if: 1) participants were aged 10 to 18 years, 2) studies addressed a physical or mental health issue, 3) Facebook was identified as a recruitment tool, 4) recruitment details using Facebook were outlined in the methods section and considered in the discussion, or information was obtained by contacting the authors, 5) results revealed how many participants were recruited using Facebook, and 6) studies addressed how adolescent consent and/or parental consent was obtained. STUDY APPRAISALS AND SYNTHESIS METHODS: Titles, abstracts, and keywords were scanned and duplicates removed by 2 reviewers. Full text was evaluated for inclusion criteria, and 2 reviewers independently extracted data. RESULTS: The search resulted in 587 publications, of which 25 full-text papers were analyzed. Six studies met all the criteria for inclusion in the review. Three recruitment methods using Facebook was identified: 1) paid Facebook advertising, 2) use of the Facebook search tool, and 3) creation and use of a Facebook Page. CONCLUSIONS: Eligible studies described the use of paid Facebook advertising and Facebook as a search tool as methods to successfully recruit adolescent participants. Online and verbal consent was obtained from participants recruited from Facebook. 2014-01-01T00:00:00Z Testosterone and its effects on human male adolescent mood and behavior: A systematic review http://hdl.handle.net/2123/13347 Title: Testosterone and its effects on human male adolescent mood and behavior: A systematic review Authors: Duke, Sally-Anne; Balzer, Ben W.R; Steinbeck, Katharine S Abstract: Purpose: During human puberty, there is an approximate 30-fold increase in testosterone production in boys. This increase is often linked to changes in mood and behavior in adolescence such as aggression, an increase in risk taking, and depression. The aim of this systematic review was to determine what evidence exists on the effects of endogenous testosterone on behavior and mood in males during adolescence. Methods: The following databases were searched: MEDLINE, Pre-MEDLINE, Education Resources Information Centre, PsycINFO, EMBASE, Scopus, and Web of Science. Only human studies were included. The study is community based, and the participants were healthy male adolescents within the age range of 9e18 years. Studies were required to have a validated mood and/or behavior assessment contemporaneous with a timed testosterone measurement. Results: A total of 27 studies met the inclusion criteria of which only one was a longitudinal study. The remaining 26 studies were cross sectional in their analysis. As a variety of measurement tools were used, no meta-analysis was possible. Most studies focused on aggression. The one longitudinal study looking at testosterone and aggression showed little relationship with concurrent changes in aggression. Most of the cross-sectional studies of adolescent males observed relationships between aggression and testosterone levels. With respect to other behaviors and moods and/or affect, no consistent relationships with testosterone were observed in cross-sectional studies. Conclusions: This systematic review concludes that there are insufficient longitudinal data of high methodological quality to currently confirm that changing testosterone levels during puberty are significantly associated with mood and behavior in adolescent males. To discount these findings is to risk apportioning blame inappropriately and missing other important diagnoses in adolescent males. 2014-01-01T00:00:00Z The effects of estradiol on mood and behavior in human female adolescents: a systematic review http://hdl.handle.net/2123/13346 Title: The effects of estradiol on mood and behavior in human female adolescents: a systematic review Authors: Balzer, Ben, W.R; Duke, Sally-Anne; Hawke, Catherine; Steinbeck, Katharine S Abstract: Mood disorders and health risk behaviors increase in adolescence. Puberty is considered to contribute to these events. However, the precise impact of pubertal hormone changes to the emergence of mood disorders and risk behaviors is relatively unclear. It is important that inappropriate attribution is not made. Our aim was to determine what is known about the effect of endogenous estradiol on human adolescent girls' mood and behavior. The databases searched were MEDLINE, Embase, PsycINFO, Education Resources Information Center (ERIC), Pre-MEDLINE, Web of Science, and Scopus for all dates to October 2014. For inclusion, contemporaneous hormone and mood or behavioral assessment was required. Data were extracted following a template created by the authors. Fourteen studies met our inclusion criteria. There was some consistency in findings for mood and estradiol levels, with associations between estradiol and depression and emotional tone and risk taking. Results were less consistent for studies assessing other mood and behavioural outcomes. Most studies were cross-sectional in design; assay methodologies used in older studies may lack the precision to detect early pubertal hormone levels. Conclusion: Three longitudinal and several cross-sectional studies indicate potential associations between estradiol and certain mood or affective states, especially depression and mood variability though there are insufficient data to confirm that the rise in estradiol during puberty is causative. We believe that it is important for health professionals to take care when attributing adolescent psychopathology to puberty hormones, as the current data supporting these assertions are limited. 2015-01-01T00:00:00Z Text messaging is a useful reminder tool http://hdl.handle.net/2123/13344 Title: Text messaging is a useful reminder tool Authors: Balzer, B.W; Kelly, P.J; Hazell, P; Paxton, K; Hawke, C; Steinbeck, K.S Abstract: Introduction Longitudinal studies of adolescents must be 'adolescent-friendly', to collect data and to encourage maintenance in the study cohort. Text messaging may offer a feasible means to do both. Methods Adolescents in the Adolescent Rural Cohort, Hormones and Health, Education, Environments and Relationships (ARCHER) study (n=342) are sent automated text messages every 3 months, prompting biological specimen collection. Results A total of 99.2% of participants (or their parents) owned a mobile phone, of which 89.1% of participants responded to text messages and 97.3% of intended urine samples were collected. The average time to provide a urine sample after prompting correlated with time to reply to Short Message Service (SMS). Conclusions This study shows SMS can be used effectively in longitudinal research involving adolescents and is feasible and useful as a reminder tool for regular biological specimen collection. 2014-01-01T00:00:00Z "You can help people": Adolescents' Views on Engaging Young People in Longitudinal Research http://hdl.handle.net/2123/13337 Title: "You can help people": Adolescents' Views on Engaging Young People in Longitudinal Research Authors: Cooper Robbins, Spring C; Hawsthorne, M; Paxton, K; Hawke, C; Skinner, S.R; Steinbeck, K Abstract: We sought to discover adolescents' thoughts about participation in longitudinal research and identify recruitment and retention strategies that were meaningful to them. We conducted seven focus groups with 10–15-year-olds in two large rural centers in New South Wales, Australia, and all focus groups were digitally recorded, transcribed, and analyzed. Adolescents discussed factors salient to their involvement in focus groups, as well as factors that may influence involvement in a longitudinal study. At the outset of the focus groups, adolescents had a positive view of "research," but were reluctant to engage in research that involved biologic samples. Effective recruitment of adolescents requires an appreciation of motivators, and time and resources to extend potential participants' understanding. 2012-01-01T00:00:00Z Hygiene http://hdl.handle.net/2123/13336 Title: Hygiene Authors: Hooker, C Abstract: Hygiene is defined in current English dictionaries as "the science of health." This definition, though formally correct, hides a long history of change in the word's use, from its holistic classical meaning of "individual regimens to preserve health" to its nineteenth-century connotations of "social medicine" (including lethal eugenics programs), to its current limited construal as "personal cleanliness" or "germ removal." For more than 2,500 years of use in many different lands, concepts of hygiene have been integral to personal identity, shaping sense of self through boundary maintenance and spirituality. Description: dictionary entry 2005-01-01T00:00:00Z Medicalization of Eating and Feeding http://hdl.handle.net/2123/13319 Title: Medicalization of Eating and Feeding Authors: Mayes, C Abstract: A variety of developments over the past century have produced the conditions in which eating and feeding are transformed from practices embedded in social or cultural relations into explicit medical practices. The rise of medical science, expansion of the pharmaceutical and food industries, escalating concern over diet‐related diseases and conditions, and growing anxiety over infant and childhood development have contributed to a process of medicalization. Medicalization is a sociological concept that analyses the expansion of medical terminology, interventions, or practitioners into areas of the life that were previously considered outside the medical sphere. For instance, under‐eating has previously been defined using theological language, as an act of fasting demonstrating a saintly character. Such practices are now understood through medical terms of anorexia nervosa, malnutrition, or general diagnoses such as "eating disorders not otherwise specified." Individuals engaged in under‐ or over‐eating practices are increasingly defined by medical concepts (anorexia nervosa and obesity) and treated in medical spaces (hospitals, clinics, or rehabilitation centres) through medical interventions (pharmaceuticals, surgery, psychotherapy, or dietary regimens). Likewise, infant feeding (breast or formula) is understood as a practice that requires monitoring and instruction from medical practitioners. Further, eating in general is progressively invested with medical significance. Foods and diets are touted as possessing a therapeutic or health enhancing capacity that indicates an individual's or population's present and future health. Due to the high regard for, and influence of, medical science in the West, medicalization studies primarily focus on Western contexts. Medicalization does have an impact on non‐Western societies and the developing world, however its influence emanates from Western biomedicine, industries, and policies. There is important work to be done in examining the process of medicalization in non‐Western contexts, however this article is limited to the Western context ( Hunt, 1999). To analyse the medicalization of eating and feeding it is important to first sketch the theoretical and historical background of medicalization as a sociological concept. The relationship between eating and medicine is extensive. In order to focus the discussion, three examples are used – under‐eating, over‐ eating and infant feeding. This background focuses the analysis of the forces driving the medicalization of eating and feeding. Finally, in elaborating the influences and consequences of the medicalization of eating and feeding, some of the central ethical implications are identified and discussed Description: reference article 2014-04-10T00:00:00Z Power and control in interactions between journalists and health-related industries – the view from industry. http://hdl.handle.net/2123/13283 Title: Power and control in interactions between journalists and health-related industries – the view from industry. Authors: Morrell, B; Lipworth, W; Forsyth, R; Jordens, C; Kerridge, I Abstract: The mass media is a major source of health information for the public, and as such the quality and independence of health news reporting is an important concern. Concerns have been expressed that journalists reporting on health are increasingly dependent on their sources – including representatives of industries responsible for manufacturing health-related products – for story ideas and content. Many critics perceive an imbalance of power between journalists and industry sources, with industry being in a position of relative power, however the empirical evidence to support this view is limited. The analysis presented here – which is part of a larger study of industry-journalist relationships – draws on in-depth, semi-structured interviews with representatives of health-related industries in Australia to inductively examine their perceptions of power relations between industry and journalists. Participants painted a picture in which journalists, rather than themselves, were in a position to control the nature, extent, and outcome of their interactions with industry sources. Our results resonate with the concept of "mediatisation" as it has been applied in the domain of political reporting. It appears that, from the perspective of industry representatives, the imposition of media logic on health-related industries may inappropriately influence the information that the public receives about health-related products. KEYWORDS: journalism, ethics, power, public health, qualitative research 2014-01-01T00:00:00Z Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers. http://hdl.handle.net/2123/13282 Title: Why do smokers try to quit without medication or counselling? A qualitative study with ex-smokers. Authors: Smith, Andrea L; Carter, SM; Chapman, S; Dunlop, S; Freeman, B Abstract: Objective When tobacco smokers quit, between half and two-thirds quit unassisted: that is, they do not consult their general practitioner (GP), use pharmacotherapy (nicotine-replacement therapy, bupropion or varenicline), or phone a quitline. We sought to understand why smokers quit unassisted. Design Qualitative grounded theory study (in-depth interviews, theoretical sampling, concurrent data collection and data analysis). Participants 21 Australian adult ex-smokers (aged 28–68 years; 9 males and 12 females) who quit unassisted within the past 6 months to 2 years. 12 participants had previous experience of using assistance to quit; 9 had never previously used assistance. Setting Community, Australia. Results Along with previously identified barriers to use of cessation assistance (cost, access, lack of awareness or knowledge of assistance, including misperceptions about effectiveness or safety), our study produced new explanations of why smokers quit unassisted: (1) they prioritise lay knowledge gained directly from personal experiences and indirectly from others over professional or theoretical knowledge; (2) their evaluation of the costs and benefits of quitting unassisted versus those of using assistance favours quitting unassisted; (3) they believe quitting is their personal responsibility; and (4) they perceive quitting unassisted to be the 'right' or 'better' choice in terms of how this relates to their own self-identity or self-image. Deep-rooted personal and societal values such as independence, strength, autonomy and self-control appear to be influencing smokers' beliefs and decisions about quitting. Conclusions The reasons for smokers' rejection of the conventional medical model for smoking cessation are complex and go beyond modifiable or correctable problems relating to misperceptions or treatment barriers. These findings suggest that GPs could recognise and respect smokers' reasons for rejecting assistance, validate and approve their choices, and modify brief interventions to support their preference for quitting unassisted, where preferred. Further research and translation may assist in developing such strategies for use in practice. 2014-04-30T00:00:00Z Privacy in the context of 're-emergent' infectious diseases. http://hdl.handle.net/2123/13281 Title: Privacy in the context of 're-emergent' infectious diseases. Authors: Denholm, J; Kerridge, I Abstract: James is a 31-year-old information technology worker who has been referred to you by the Department of Health for tuberculosis (TB) screening. A work colleague, Susan, has been recently diagnosed with pulmonary tuberculosis, and those working in the office are potentially at risk of having been infected. Contacts may have contracted latent tuberculosis infection (LTBI), which does not have immediate symptoms but can develop into active disease at some future stage. If LTBI is identified during screening, treatment can be provided to prevent active TB developing, most commonly with the anti-tuberculosis medication isoniazid. James is aware that someone at his workplace has had TB. Susan, however, has not told others of her diagnosis and has asked the Department of Health not to notify them of her identity. James, therefore, is not able to provide you with information about the extent of his contact with the sick person and is frustrated that he has not been told who it is. You are aware of Susan's identity, including details of her medical treatment, as you have been caring for her during a recent hospital stay. You are also aware that Susan has a drug-resistant strain of TB, and isoniazid (the standard preventive therapy) would be ineffective for people infected due to their contact with her. During her stay, Susan had no visitors and was adamant that she did not want anyone to know about her diagnosis. Before he agrees to have further screening, James wants to know how likely he is to have contracted TB—information that is difficult to offer him without a detailed discussion about the extent of contact he has had with Susan over the past few months. Further, if screening did suggest that James has contracted latent tuberculosis, the standard preventive therapy would need to be changed for an alternative. Explaining the rationale for an alternative treatment would mean disclosing to James that you are aware of Susan's identity, which you are reluctant to do given both her wishes and James' evident frustration with his lack of information. Keywords: Tuberculosis, Contact tracing, Privacy, Public health, Clinical ethics Description: case study 2014-04-27T00:00:00Z Integrating research- and relationship-based approaches in Australian health promotion practice http://hdl.handle.net/2123/13267 Title: Integrating research- and relationship-based approaches in Australian health promotion practice Authors: Klinner, Christiane; Carter, SM; Rychetnik, L; Li, V; Daley, M; Zask, A; Lloyd, B Abstract: We examine the perspectives of health promotion practitioners on their approaches to determining health promotion practice, in particular on the role of research and relationships in this process. Using Grounded Theory methods, we analysed 58 semi-structured interviews with 54 health promotion practitioners in New South Wales, Australia. Practitioners differentiated between relationship-based and research-based approaches as two sources of knowledge to guide health promotion practice. We identify several tensions in seeking to combine these approaches in practice and describe the strategies that participants adopted to manage these tensions. The strategies included working in an evidence-informed rather than evidence-based way, creating new evidence about relationship-based processes and outcomes, adopting 'relationship-based' research and evaluation methods, making research and evaluation useful for communities, building research and evaluation skills and improving collaboration between research & evaluation and program implementation staff. We conclude by highlighting three systemic factors which could further support the integration of researchbased and relationship-based health promotion practices: (1) expanding conceptions of health promotion evidence, (2) developing 'relationship-based' research methods that enable practitioners to measure complex social processes and outcomes and to facilitate community participation and benefit, and (3) developing organisational capacity. KEYWORDS: qualitative research, health promotion practice, community participation, research & evaluation 2014-01-01T00:00:00Z Black-market lottery: organ donation and the international transplant trade http://hdl.handle.net/2123/13266 Title: Black-market lottery: organ donation and the international transplant trade Authors: Bendorf, A Abstract: Estimates suggest more than two million people worldwide would benefit from an organ transplant. While the donation rates vary greatly between countries, the contrast between the increasing numbers of people in need and the inadequate numbers of organs being donated mean many will die while they wait. Last night, ABC's Four Corners screened Tales from the Organ Trade, an HBO documentary that highlights the desperation that links the world's poor, who sell their organs, together with first-world recipients who buy them on the black market. While accurate statistics are difficult to find, some suggest that up to 15% of the world's transplants are performed using illegally obtained organs via an international black market web of organ brokers. The brokers bring recipients and donors together with transplant surgeons working out of fly-by-night medical clinics. The process is unregulated, illegal and the risks to both donor and recipient are high. The documentary raises challenging questions about this illegal trade in organs that sometimes benefits both the donor and recipient and other times imperils the well-being of both. There are, no doubt, many more untold horror stories. While some experts argue the sale of organs should be regulated and legalised, most medical professionals strongly discourage their patients from travelling overseas to undergo organ transplants because they have significantly poorer outcomes than those who receive transplants here. So, with Australia widely regarded as a world leader in transplantation outcomes, what would compel anyone to consider such a risky proposition? And why would anyone participate in exploitation like this? Description: The Conversation article 2014-03-04T00:00:00Z Five myths about organ donation in Australia http://hdl.handle.net/2123/13265 Title: Five myths about organ donation in Australia Authors: Bendorf, A Abstract: Australia has some of the world's highest organ transplant success rates, but, for almost two decades, our deceased organ donation rates have been among the lowest in the developed world. In other words, when it comes to organs, we're no good at finding them but we're the best in the world at transplanting them. Recent well-publicised increases in organ donation rates have raised expectations that Australia can sustain meaningful improvement, but the cumulative effect of the increases has moved national performance up from the bottom third of the world's developed countries and into the bottom half. There's still only a very limited supply of organs available for those who desperately need them and each year people die waiting for a life-saving transplant. For many years now, enormous attention (and funding) has been devoted to finding ways of raising the organ donation rate. Between 1989 and 2008, more than 20 public and government-led initiatives were launched to address issues believed to be its cause. Unfortunately, they've proved ineffective and cumulatively resulted not in an increase in donation, but a decline of around 20%. These failures illustrate misunderstandings about what the country can do to raise its organ donation rates. The idea that Australia is somehow fundamentally different to world leading donor countries, for instance, and incapable of matching their success in organ donation is false. A number of misconceptions lead to such conclusions, and they constitute five myths about organ donation. Description: The Conversation article 2012-02-20T00:00:00Z A Week Can be a Long Time in Mental Illness http://hdl.handle.net/2123/13264 Title: A Week Can be a Long Time in Mental Illness Authors: Ryan, C; Callaghan, Sascha Abstract: An erosion of the Mental Health Act is worrying. The safeguards on our human rights hang by a slender thread. In July last year, everyone in NSW had one such safeguard cut away. Its removal, by a simple bureaucratic manoeuvre, will be hard felt by anyone unfortunate enough to become severely mentally ill. Mental illness can happen to anyone. Severe depression, for example, affects one person in 10 and can strike at any age. The NSW Mental Health Act gives psychiatrists extraordinary powers to lock up and medicate people with severe mental illness, even when the affected person refuses all treatment. These powers are important. They can and do save lives. But, like any extraordinary power, there is always a risk that they might be abused. To make abuse less likely the Mental Health Act only allows a person to be held on a psychiatrist's order for a very short time and demands that the order be quickly and automatically reviewed by an independent tribunal. How quickly? The phrase in the Act is "as soon as practicable". Until July last year "as soon as practicable" was interpreted as within about a week - usually within a few days. Of course, many felt that even a few days was a long time, if you were in a psychiatric hospital and believed you shouldn't be there. However, most people accepted that within about a week was a pretty reasonable definition for "as soon as practicable". It was the definition used for more than 50 years and the system seemed to work very well. In July last year though, everything changed. The Mental Health Review Tribunal took over the independent reviews from magistrates, and the president of the Tribunal, Greg James, advised hospitals that although the Act said that these reviews should happen "as soon as practicable", in some cases people should be made to wait in detention for at least two weeks before their automatic review. Description: newsletter article 2011-08-20T00:00:00Z When a mother's rights clash with the needs of her unborn child. http://hdl.handle.net/2123/13255 Title: When a mother's rights clash with the needs of her unborn child. Authors: Callaghan, Sascha Abstract: The recent report of case of a pregnant woman who refused life-saving cancer treatment while heavily pregnant has once again ignited debate within the community about how we should resolve conflicts between a mother's rights and those of her unborn child. The facts of the case, which occurred in 2009 but was reported in the Journal of Internal Medicine this month, were that a young woman presented to hospital with acute promyelocytic leukaemia and pre-eclampsia, requiring urgent treatment. Her doctors recommended that she receive chemotherapy combined with blood products so that her body could tolerate the cancer treatment, but because of her Jehovah's Witness faith, she refused. She remained steadfast in this decision even though she was told she might die as a result. To further complicate matters, she was nearly 27 weeks pregnant at the time. As her illness progressed her fetus died in utero, and the woman herself died from multiple organ failure just short of two weeks after her admission. The controversy which has emerged centres on the rights of women to refuse medical treatment when to do so will endanger the lives of their fetuses. Description: newspaper commentary 2015-04-09T00:00:00Z Exhibition Catalogue: Growing Up with Cancer: Self-portraits by young people growing up with cancer. http://hdl.handle.net/2123/13254 Title: Exhibition Catalogue: Growing Up with Cancer: Self-portraits by young people growing up with cancer. Authors: Lewis, P; Jordens, C; Mooney-Somers, Julie; Kerridge, I Abstract: Growing Up with Cancer (GUWC) is an innova�ve project using research and crea�ve prac�ce to understand the experience of having cancer during adolescence and young adulthood. Funded through an Australian Research Council Linkage Grant, it brought together researchers, ar�sts, advocates and clinicians at the Centre for Values, Ethics and the Law in Medicine at the University of Sydney, the University of Newcastle, the Children's Hospital at Westmead, and Canteen. During 2010 and 2011, 27 young people par�cipated in interviews about the impact of cancer on the transi�on from adolescence to adulthood. Of these, 19 collaborated with ar�st Kris Smith or worked on their own, to produce a self-portrait that represented them and their experience of growing up. Twenty two self-portraits are represented in this exhibi�on, including one suite of music. A cancer diagnosis and treatment had ongoing and complex social and personal consequences for these young people. Life did not turn out the way they imagined. These beau�ful, poignant, strong, funny, and thought-provoking images shout at us to pay a�en�on. We acknowledge and celebrate the crea�ve expression of these young people's experiences of growing up with cancer. Description: exhibition catalogue 2012-01-01T00:00:00Z Guidelines on Collaborative Research and Authorship http://hdl.handle.net/2123/13253 Title: Guidelines on Collaborative Research and Authorship Authors: The Centre for Values, Ethics and the Law in Medicine (VELiM) Abstract: Collaboration can be one of the best things about academic life and one of the most difficult. The difficulties mostly appear when academics try to publish together. Guidelines cannot cover all contingencies or always fix authorship troubles. But there are things they can do. They can articulate the virtues and values that we think are important in research and publication and they can provide principles and processes for action. This guideline was developed at the Centre for Values, Ethics and the Law in Medicine (VELiM) at the University of Sydney, Australia. It is intended to support researchers in collaborative projects to assign authorship and resolve authorship disputes. It sets out nine principles, a process for having a conversation and reaching agreement, and a process for dealing with disputes. Publication ethics are important in sole authorship. However the processes described here apply only to collaborative authorship. As collaborative authorship is more common in the sciences and social sciences, these guidelines may be less relevant to the humanities. But whenever researchers collaborate, irrespective of their disciplinary background, the principles articulated in these guidelines will apply Description: guidelines collaboratively created by VELiM 2011-08-16T00:00:00Z "'Suicidology as a Social Practice': A Reply to Tom Widger." http://hdl.handle.net/2123/13242 Title: "'Suicidology as a Social Practice': A Reply to Tom Widger." Authors: Fitzpatrick, S; Hooker, C; Kerridge, I Abstract: In recent years, a growing body of critical literature has emerged that challenges the dominant norms and practices of mainstream suicidological research. Concerns over epistemology and methodology, the (political) rationales that determine how suicide is researched and responded to, and the lack of measurable advances in knowledge and prevention, are, for a growing number of scholars, symptoms of a more widely felt paradigm crisis in contemporary suicide research. Tom Widger (2015) crystallises the incommensurability between the globalising paradigm of 'scientific' suicidology and the meanings and nuances of self-inflicted death in specific cultural contexts, extending the concerns raised by our article 'Suicidology as a Social Practice' (2014). While recent debates have largely focused on issues of methodological pluralism as a way of moving suicidology forward, Widger questions the degree by which any study of suicide can truly subvert the suicidological paradigm when it produces both the subject and object involved. As he says, the very concept of suicide is suicidological. 2015-03-25T00:00:00Z Growing Up with Cancer Project (2010) What's it like having to deal with cancer AND with growing up? http://hdl.handle.net/2123/13241 Title: Growing Up with Cancer Project (2010) What's it like having to deal with cancer AND with growing up? Authors: Mooney-Somers, Julie; Lewis, P Abstract: The transition from childhood to adulthood is a period of promise and growth that encompasses every facet of life. It leads to an independent conception of one's place in the world. Cancer severely disrupts this development and can turn a young person's world upside down. Cancer illness, hospitalisation and treatment impact on psychosocial well-being at this critical stage, which can have a prolonged impact on the lives of young cancer survivors. These young people need services that are developmentally appropriate, and recognise the impact of cancer on the development of identity and the transition to adulthood. CanTeen, the Australian Organisation for Young People Living with Cancer, has made significant headway in this area with the establishment of Youth Cancer Services in major cancer centres across Australia. The services provide specialist treatment for both the medical and psychosocial needs of young people with cancer. We also realise the importance of raising community awareness of these needs, and are delighted to be involved in the Growing Up with Cancer project and this exhibition. The project is a bold undertaking that has enabled young people who have experienced cancer to create self-portraits that communicate the issues they face as they negotiate cancer during this significant stage of life. 2010-01-01T00:00:00Z No, you don't have to finish all your antibiotics http://hdl.handle.net/2123/13136 Title: No, you don't have to finish all your antibiotics Authors: Gilbert, GL Abstract: Most people believe – and have been told by health professionals – that it's essential to finish a course of antibiotics to prevent antibiotic resistance. But this advice is not only wrong, it could actually be harmful. The idea that you have to take all the antibiotics you're prescribed is based on the assumption that all the bacteria causing the infection have to be killed, so the surviving minority don't become resistant. In fact, for most otherwise healthy people, significantly reducing, but not necessarily totally eliminating, the bacteria causing the infection allows the body's natural defences to take over and mop up the remaining few. Some important caveats There are some special circumstances when it's important to kill all the bacteria – when the patient's normal defences are damaged for any reason, for instance, or when the infection is in a site that's relatively inaccessible to antibiotics and the white blood cells that kill bacteria. This can be in the middle of an abscess or cavity filled with pus (as in tuberculosis infection), on a foreign body, such as a prosthetic heart valve, or in dead tissue that can't be removed (as in osteomyelitis or infection of the bone). Obviously, stopping antibiotics before a serious infection is cured will risk a relapse. That's what happened to Albert Alexander, the London policeman who was one of the first people to be treated with penicillin by Howard Florey in 1941. Description: The Conversation article 2015-04-17T00:00:00Z Prenatal testing, cancer risk and the overdiagnosis dilemma http://hdl.handle.net/2123/13135 Title: Prenatal testing, cancer risk and the overdiagnosis dilemma Authors: Newson, A.J.; Carter, SM Abstract: In March, US company Sequenom revealed that its MaterniT21 non-invasive prenatal test (NIPT) has detected potential cancer in some pregnant women (see BioNews 793). As well as receiving information about their fetus, around 40 of the 400,000 or so women who have had this test have been informed that they may have cancer. One example of this was Dr Eunice Lee, who had investigations following an abnormal NIPT result that identified a 7cm colorectal tumour, which was then surgically removed. This is a good thing, right? Women in the prime of their lives receiving information that may catch a cancer early. But, we suggest, it is not this simple. So-called liquid biopsies lead to ethical issues that go beyond the matter of using a test for one thing and finding out about something else. They are also a prime example of the problem of overdiagnosis. Before diving into this particular biopsy pool, we need to think carefully about what might be under the surface. Overdiagnosis is hard to define, but, loosely, an overdiagnosis is a correct diagnosis that doesn't benefit a patient. It occurs when a test finds something that, if left alone, would regress, or never become symptomatic. Although in practical terms the line between false positives and overdiagnosis can be blurry, the conceptual distinction is this: an overdiagnosis is a correct diagnosis that doesn't benefit, while a false positive is an incorrect test result: a finding that is not actually true. Both can lead to harm, such as having unnecessary medical interventions. They also consume valuable and often scarce health resources. We know neither the extent of overdiagnosis nor the false-positive rate for suspected cancer detection following NIPT. The latter will be measurable soon enough, but pinning down rates of overdiagnosis will be difficult. Description: newsletter article 2015-04-13T00:00:00Z Dental and Oral Health http://hdl.handle.net/2123/13134 Title: Dental and Oral Health Authors: Leeder, Stephen; Russell, Lesley Abstract: Tooth and gum diseases affect the lives of many Australians; their job opportunities may be restricted, productivity and self-esteem reduced, speech impeded, and the pain, discomfort and difficulties with eating affect their health and quality of life. 2007-09-01T00:00:00Z Trends in New South Wales infant hospital admission rates in the first year of life: population-based study http://hdl.handle.net/2123/13108 Title: Trends in New South Wales infant hospital admission rates in the first year of life: population-based study Authors: Lain, Samantha J.; Roberts, Christine L.; Bowen, J.R.; Nassar, Natasha Abstract: Objective: To examine the trends in hospital admissions in the first year of life and identify whether changes in maternal and infant risk factors explain any changes Design: Population-based study using de-identified linked health data. Participants: All 788,798 liveborn infants delivered in New South Wales from 2001 to 2009 with a linked birth and hospital record. Main outcome measures: The number of infants readmitted to hospital at least once, up to one year of age, per 100 livebirths each year; changes in maternal and infant risk factors were assessed using logistic regression. Results: The number of infants admitted to hospital up to age one decreased 10.5%, from 18.4 per 100 births in 2001 to 16.5 in 2009. Fifty five per cent of this decrease could be explained by changes in factors that are associated with likelihood of hospitalisation; length of stay during the birth admission, maternal age and maternal smoking. The rate of admissions for jaundice and feeding difficulties increased significantly over the study period, while admissions for infections decreased. Conclusions: There has been a decrease in the rate of infants admitted to hospital in the first year of life, which can be partly explained by increasing maternal age, decreasing maternal smoking and a shift to shorter length of hospital stay at birth. Improved maternal and neonatal care in hospital and increased postnatal support at home may have contributed to reduced risk of readmission. The introduction of government policies may explain the rest of the decrease. 2014-01-01T00:00:00Z Trends and recurrence of stillbirths in NSW http://hdl.handle.net/2123/13099 Title: Trends and recurrence of stillbirths in NSW Authors: Patterson, Jillian A.; Ford, Jane B.; Morris, Jonathan; Roberts, Christine L. Abstract: Objective: To examine the trend in stillbirth rates adjusted for the trends in the maternal risk profile, and to use local data to estimate the stillbirth recurrence risk. Methods: Linked hospital, birth and perinatal death review data were used to identify risk factors and stillbirths among women giving birth to singletons in NSW between 2001 and 2009. Logistic regression models were developed to predict stillbirth rates based on the changes in the maternal population. Results: Between 2001 and 2009 there were 3449 stillbirths (4.4 per 1000 births), with no significant change in rate overall (p=0.6) or across older gestational age categories (26-33 weeks p=0.67, >=34 weeks p=0.36), and a slight increase at <26 weeks (p=0.01). However, when changes in the maternal population were taken into account, there was a significant increase in stillbirths at <26 weeks (p<0.001). Women with a stillbirth in a first pregnancy were at increased risk of stillbirth in their second pregnancy (4.3 95% CI (2.4,7.7)). Conclusion: There has been no decline in the stillbirth rate in NSW in recent years, which at late gestations may be accounted for by changes in the maternal population. At early gestations, there has been an increase in stillbirths where a decrease in rate may be expected based on the maternal population. Implications: Further focus on addressing risk factors for stillbirths is needed to ensure continued progress is made in reducing stillbirths. 2014-08-01T00:00:00Z Is there a problem with the status quo? Debating the need for standalone ethical guidelines for research with people who use alcohol and other drugs http://hdl.handle.net/2123/13096 Title: Is there a problem with the status quo? Debating the need for standalone ethical guidelines for research with people who use alcohol and other drugs Authors: Olsen, A; Mooney-Somers, Julie Abstract: In 2011, the Australian National Health and Medical Research Council (NHMRC) initiated an inquiry to determine whether there is a need for expanded ethical guidance in the form of a discrete guidance document for alcohol and other drug (AOD) research. An issues paper was developed to frame the inquiry. AOD researchers, Human Research Ethics Committees and others were invited to discuss whether there are distinctive ethical issues facing researchers and Human Research Ethics Committees in the AOD setting. Based on the public submissions, the NHMRC recommended that no AOD research-specific guidance is required. The inquiry and the NHMRC decision were not widely publicized, and we feel there is a need for further discussion. In order to do so, we have analysed the public inquiry submissions and described the central themes. Few submissions in the inquiry explicitly agreed AOD research warrants a specific guidance framework. Most were concerned that the NHMRC issues paper unfairly targeted people who use drugs as complex research participants. The inquiry highlights tensions around research governance and ethics review boards dealing with illicit and stigmatised behaviours. While we agree that a specific guidance framework for AOD research is not needed and could potentially be harmful and restrictive, we are concerned that the wholesale rejection of a guidance framework has closed the door to much needed debate. There remains, we argue, a need for alternative strategies and tools to support ethical research, inform and streamline institutional ethics approval, and engage and protect participants. Keywords: ethics; research; guideline; drug; Human Research Ethics Committee 2014-01-01T00:00:00Z The Medical Innovation Bill: Still more harm than good http://hdl.handle.net/2123/13095 Title: The Medical Innovation Bill: Still more harm than good Authors: Richards, B; Porter, G; Lipworth, W; Lysaght, T Abstract: The Medical Innovation Bill continues its journey through Parliament. On 23 January 2015, it was debated for the final time in the House of Lords and with one final amendment, the House moved to support the Bill, which then moved to the House of Commons on 26 January. It will be debated again on 27 February 2015. The Bill's purpose is to encourage responsible innovation in medical treatment. Although this goal is laudable, it is argued that the Bill is unnecessary and has the potential to undermine the very cause it aims to advance. More useful for encouraging responsible innovation is the continued education of health-care professionals on how the law already supports practitioners who look to improve care through responsible innovation. 2015-01-01T00:00:00Z Mandatory influenza immunisation of health-care workers http://hdl.handle.net/2123/13094 Title: Mandatory influenza immunisation of health-care workers Authors: Gilbert, GL; Kerridge, I; Cheung, P Abstract: Seasonal influenza imposes an enormous but poorly defined burden of excess deaths, hospital admissions, and health-care costs, and often spreads within health-care facilities. Hospital patients with influenza are a potential source of infection for health-care workers that are not immunised, with attack rates among health-care workers of 18–24%.1 Unfortunately, health-care workers infected with influenza often continue to work, despite symptoms, with potentially devastating consequences for high-risk patients, including those who are very young, elderly, or immunocompromised—for example, patients receiving bone-marrow transplants have a high risk of pneumonia and death from influenza.2 Trivalent subunit influenza vaccines are 70–90% effective3 and safe, with mild side-effects in less than 10% of recipients.4 Immunisation of health-care workers can reduce exposure to, and illness and death from, influenza among patients in long-term care facilities5 even with modest uptake rates6 (at an estimated cost of £51–405 per life-year saved), as well as reducing infection and absenteeism among health-care workers that have been immunised (with estimated savings of £12 per vaccinee).5 In a bone-marrow-transplant unit in the USA, increasing immunisation uptake from 12% to 58% among health-care workers, was associated with a reduction in nosocomial influenza infections from 14 to 4 cases per 10 000 patients days.7 Despite this evidence and recommendations by major health authorities for yearly immunisation of health-care workers,8 uptake is often poor (less than 30%). Immunisation uptake rarely exceeds 60%, even when vaccine is free and easily accessible,5 and 9 which is inadequate to protect the most vulnerable patients, many of whom are unimmunised because of immunosuppression or comorbidities. Uptake can be increased by various interventions, including staff education, active promotion, incentives, declination forms, clinical leadership, and provision of free vaccine at convenient locations, such as mobile carts,8 and 10 but increases are often modest and difficult to sustain over successive seasons 2010-01-01T00:00:00Z 'When good evidence is not enough: the role of context in bowel cancer screening policy in New Zealand'. http://hdl.handle.net/2123/13093 Title: 'When good evidence is not enough: the role of context in bowel cancer screening policy in New Zealand'. Authors: Flitcroft, K; Gillespie, J; Carter, SM; Trevena, L; Salkeld, G Abstract: Bowel cancer is a serious health problem in developed countries. Australia, the United Kingdom (UK) and New Zealand (NZ) reviewed the same randomised controlled trial evidence on the benefits and harms of population-based bowel cancer screening. Yet only NZ, with the highest age standardised rate of bowel cancer mortality, decided against introducing a bowel cancer screening programme. This case study of policy making explores the unique resource, ethical, institutional and political environments in which the evidence was considered. It highlights the centrality of context in assessing the relative worth of evidence in policy making and raises questions about the suitability of knowledge utilisation strategies. 2011-01-01T00:00:00Z WHAT FACTORS CONTRIBUTE TO HOSPITAL VARIATION IN OBSTETRIC TRANSFUSION RATES? http://hdl.handle.net/2123/13090 Title: WHAT FACTORS CONTRIBUTE TO HOSPITAL VARIATION IN OBSTETRIC TRANSFUSION RATES? Authors: Patterson, Jillian A.; Roberts, Christine L.; Isbister, James P.; Irving, David O.; Nicholl, Michael C.; Morris, Jonathan M.; Ford, Jane B. Abstract: Background & Objectives: To explore variation in red blood cell transfusion rates between hospitals, and the extent to which this can be explained. A secondary objective was to assess whether hospital transfusion rates are associated with maternal morbidity. Materials & Methods: Linked hospital discharge and birth data were used to identify births (N=279,145) in hospitals with at least 10 deliveries per annum between 2008-2010 in New South Wales, Australia. To investigate transfusion rates, a series of random effects multilevel logistic regression models were fitted, progressively adjusting for maternal, obstetric and hospital factors. Correlations between hospital transfusion and maternal, neonatal morbidity and readmission rates were assessed. Results: Overall, the transfusion rate was 1.4% (hospital range 0.6 to 2.9) across 89 hospitals. Adjusting for maternal casemix, reduced the variation between hospitals by 26%. Adjustment for obstetric interventions further reduced variation by 8% and a further 39% after adjustment for hospital type. At a hospital level, high transfusion rates were moderately correlated with maternal morbidity (0.56, p=0.01) and low Apgar scores (0.54, p=0.002), but not with readmission rates (0.18, p=0.28). Conclusion: Both casemix and practice differences contributed to the variation in transfusion rates between hospitals. The relationship between outcomes and transfusion rates was variable, however low transfusion rates were not associated with worse outcomes. 2015-01-01T00:00:00Z Women's expectations and experiences in maternity care: how do women conceptualise the process of continuity? http://hdl.handle.net/2123/13087 Title: Women's expectations and experiences in maternity care: how do women conceptualise the process of continuity? Authors: Jenkins, M. G.; Ford, Jane B.; Forsyth, R; Morris, Jonathan M.; Roberts, Christine L.; Todd, Angela Abstract: Objective: to gain an understanding of how women conceptualise continuity of maternity care. Design: a qualitative study involving in-depth semi-structured interviews and thematic analysis. Setting: a range of urban and rural public hospitals in New South Wales, Australia. Participants: 53 women aged 18-44 years (median age 27 years) receiving maternity care in 2011 - 2012. Findings: responses from women suggested five types of continuity: continuity of staff, continuity of relationship, continuity of information, continuity across pregnancies, and continuity across locations. The types of continuity differed by parity and location. Conclusion and implications for practice: continuity of maternity care has a variety of meanings to women. If healthcare providers are to commit to providing woman-centred maternity care it is important to recognise the diversity of women's experiences, and ensure that systems of care are flexible and appropriate to women's circumstances and needs. 2014-05-01T00:00:00Z Women's expectations and experiences of maternity care in NSW - what women highlight as most important http://hdl.handle.net/2123/13074 Title: Women's expectations and experiences of maternity care in NSW - what women highlight as most important Authors: Jenkins, Mary G.; Ford, Jane B.; Morris, Jonathan M.; Roberts, Christine L. Abstract: Background Although surveys have identified that women are generally highly satisfied with maternity care provision, those aspects of care that women highlight as most important for achieving satisfaction and a satisfactory maternity care experience have not been reported. The aim of this study was to investigate how women understand and experience their maternity care and to report which aspects of care women highlight as most important. Methods This large qualitative study explored women's expectations and experiences of maternity care provision. In-depth semi-structured interviews were conducted with 53 women experiencing maternity care in a range of tertiary, regional, rural, remote hospitals and midwife-led practices in the state of New South Wales, Australia during 2011 to 2012. Included in the interview schedule was the question 'What 3 aspects would you see as most important for delivery of maternity care?' Descriptive analyses of entire transcripts and responses to the question on most important aspects of care were undertaken. Results Descriptive analyses of women's responses identified 5 important aspects of care: woman-focused care, staff qualities, systems and facilities, family-focused care and continuity of care/information. First-time mothers were more likely to identify woman-focused care, staff qualities and continuity of care/information as important 3 aspects than multiparous mothers. Urban and regional mothers highlighted staff qualities as having greater importance for satisfaction with their care while rural and particularly remote women nominated systems and facilities as important. Conclusions Our study showed that women from a range of settings are more concerned with staff and relational issues than facilities. Differences in perceptions among primiparous versus multiparous women, at different stages of pregnancy and among women from rural and remote compared to urban settings highlight the need to include women with a diversity of experience when trying to understand the aspects of maternity care most important to women. 2014-09-01T00:00:00Z Variation in hospital caesarean rates among nulliparae at term is unexplained and unrelated to maternal or neonatal outcome: a population based cohort study http://hdl.handle.net/2123/13073 Title: Variation in hospital caesarean rates among nulliparae at term is unexplained and unrelated to maternal or neonatal outcome: a population based cohort study Authors: Nippita, Tanya; Lee, Yuen Li; Patterson, Jillian; Ford, Jane; Morris, Jonathan; Nicholl, Michael; Roberts, Christine L. Abstract: OBJECTIVE To explore variation in hospital caesarean rates for nulliparous women; determine whether casemix, labour and delivery, and hospital factors explain the variation and examine the association between hospital caesarean rates and outcomes. DESIGN Population-based cohort study. SETTING New South Wales, 2009-2010. POPULATION Nulliparous women with singleton cephalic live births at term. METHODS Random effects multilevel logistic regression models using linked hospital discharge and birth data. MAIN OUTCOME MEASURES Prelabour, and intrapartum caesarean rates following spontaneous labour or labour induction; maternal and neonatal severe morbidity rates. RESULTS Of 67,239 nulliparous women, 4,902 (7.3%) had prelabour caesareans, 39,049 (58.1%) had spontaneous labour and 23,288 (34.6%) had induction of labour. Overall, there were 18,875 (28.1%) caesareans, with labour inductions twice as likely to end in an intrapartum caesarean than spontaneous labour (34.0% versus 15.5%). Variation in caesarean rates for term nulliparae 3 After adjusting for casemix, labour and delivery, and hospital factors, the overall variation in caesarean rates decreased by 78% for prelabour caesareans; for intrapartum caesarean by 52% following spontaneous labour and by 9% following labour induction. However, adjusting for labour and delivery practices increased the unexplained variation in intrapartum caesareans. The rates of severe maternal and neonatal morbidity were not significantly different across caesarean rate quintile groups, except for women in spontaneous labour, where the hospitals in the lowest caesarean quintile had the lowest neonatal morbidity rate. CONCLUSIONS Differences in clinical practice were substantial contributors to variations in intrapartum caesarean rates. Strategies aiming at lowering the caesarean rate should not adversely affect maternal or neonatal outcome. 2015-04-01T00:00:00Z


text:
Now that the madness and chaos that was Black Friday 2011 is behind us, it's time to gear up for the next big spending day…Cyber Monday!
How did Cyber Monday get its start anyway?
We all know it's the most popular online shopping day of the year…but how did it get that way?
Did people not get all their shopping done on Black Friday?
Did you know that, out of those people who did their holiday shopping online, a staggering 70 percent of them did their shopping at work?
Check out some more amazing Cyber Monday facts & figures below.

subset: commoncrawl


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This profile for Waynesville Hardware Inc is located in Waynesville, GA. Waynesville Hardware Inc industry is listed as Ret Hardware. There are no officers listed for this company.
Jack Cathcart served as the Owner
Lillie Cathcart was the Chief Financial Officer of Waynesville Hardware Inc.
Key roles for Waynesville Hardware Inc
Jack Cathcart
Owner, President, Chief Executive Officer
Lillie Cathcart
Chief Financial Officer, Secretary
Comprehensive Insight Plus Report
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|The D&B Comprehensive Insight Plus Report for Waynesville Hardware Inc combines D&B's proprietary statistical scoring with business, payment and financial information all in one report.
US Company Profile Report
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|The D&B U.S. Company Profile contains basic information such as address and telephone number, executive names and titles, line of business and SIC codes, D-U-N-S Numbers, organization status, and year and location of incorporation for Waynesville Hardware Inc.


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I would like to split a binary file into smaller files based on pattern 'xÚ' (it's 78 DA in hexadecimal), so when there's an 'xÚ' in the file the splitter script splits and pastes the content into a new file until another 'xÚ' can be found. The newly created files should start as 'xÚ'.
FreeBSD AWK, GREP, sh preferred.


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Beyonce Previews 'Live at Roseland' DVD With 'End of Time' Performance (VIDEO)
The first is a performance of her epic song End of Time, in which Beyonce shows off a number of epic dance moves and costume changes as fans rock out to the incredibly catchy tune. (Seriously, why wasn't this released as a single?)
The second clip features a performance of the ballad I Was Here, which features behind-the-scenes footage of her incredible career trajectory, from child singer to a married woman with a baby on the way.
Check out the clips now, then sound off: Will you buy the DVD on Nov. 29?