text: The Sydney eScholarship Repository http://ses.library.usyd.edu.au:80 The Sydney eScholarship digital repository system captures, stores, indexes, preserves, and distributes digital research material. 2015-07-29T00:15:33Z Isolation of cells from a Marine Source Responsible for Hemocyanin Biosynthesis http://hdl.handle.net/2123/13617 Title: Isolation of cells from a Marine Source Responsible for Hemocyanin Biosynthesis Authors: Mohd Sairi, Mohd Fareed Abstract: Molluscan rhogocyte cells are known to synthesise the largest respiratory proteins in nature known as hemocyanin. However, attempt to investigate the cells in vitro to understand the hemocyanin biosynthesis is difficult due to the lack of current knowledge on establishing a stable cell culture. Therefore, the aims of this study were to isolate rhogocyte cells from Haliotis laevigata and assessed their characteristics, distribution, capability to grow and synthesise hemocyanin in vitro. Using flow cytometry analysis and simultaneous staining of immunofluorescence and in situ hybridisation strategy, two distinct populations of rhogocyte cells synthesizing type 1 hemocyanin was determined in the mantle tissue. Subsequently, a primary culture of heterogeneous cells was established with different parameters involving basal media, primary growth supplements, secondary growth supplements, growth temperature and seeding density. Cells cultured in MEM result in the highest cell yield compared to other basal media. It is suggested that the presence of vitamin B6 in aldehyde form (pyridoxal) instead of alcohol (pyridoxine) is responsible for promoting the cellular activity. Furthermore, addition of lipimax at 17°C resulted in higher cell-fold increase compared to FBS, knockout serum and hemolymph. Addition of secondary supplements such as amino acids cocktail, lipid concentrate, insulin-transferrin-selenium and vitamin concentrate, however, had no significant impact on the cell growth. On the other hand, evaluation of hemocyanin content using ELISA revealed significant increase of hemocyanin in the media when cells were cultured with lipimax, FBS and knockout serum. However, the hemocyanin content was at the highest concentration only after an hour of culture before decreasing significantly and stabilised around 0.14-0.16 µg/ml in the media. These results suggest that hemocyanin biosynthesis may have an inverse correlation with the cell's growth. 2015-03-31T00:00:00Z Feline clinical biochemistry: new paradigms for interpreting results and comparing analysers http://hdl.handle.net/2123/13616 Title: Feline clinical biochemistry: new paradigms for interpreting results and comparing analysers Authors: Baral, Randolph Matias Abstract: The overall aim of this project was to provide an evidence-based means for comparison of feline biochemical analytes to increase the ability to distinguish between sickness and health of cats and enhance veterinarians' clinical decision-making. Chapter 1, the literature review, has two sections; the first outlines how traditional, population-based reference intervals are generated, followed by a description of subject-based reference limits that are being implemented in human clinical pathology. The second section describes the current approaches for method comparison of analyte values obtained from clinical pathology analysers. Since in-house biochemistry analysers are unable to be calibrated by end-users (such as veterinary hospital staff), any inherent bias in the determination of analyte values cannot be corrected (as it can for commercial laboratory analysers). Bias of in-house biochemistry equipment is well recognised, and Chapter 2 provides the first concurrent assessment of multiple analysers, using a grading system that was devised to assess constant bias and degree of proportional bias. It conclusively demonstrates that results from in-house analysers should not be directly compared to results from others, nor to those determined by commercial laboratory analysers. A potential solution may lie in the ability of correctly generated reference intervals to account for these analysers' inherent bias. Chapter 3 demonstrates that reference intervals provided by in-house biochemistry analyser manufacturers as well as a commercial laboratory do not appear to account for the biases for all analytes and consequently may be inaccurate for local hospital population feline populations. It is now recognised in human clinical pathology, that for many biochemical analytes, traditional population-based reference intervals have limitations, as a significant change in an individual's analyte concentration within the reference limits may still be an important medical indicator for that individual. Conversely, values outside these limits are not always clinically important for an individual. For appropriate analytes, subject-based reference values, often called 'reference change values' are used; these are determined from biological variation data which reflect the inherent physiological variation of these analytes within and between individuals. Chapter 4 defines the biological variation of clinical biochemical analytes in cats, determining which analytes are suited for traditional reference interval interpretation or would be better interpreted with reference change values. The high individuality found for most analytes indicate that subject-based reference values (which are determined and documented) should be used to assess feline plasma biochemistry samples. The generation of biological variation data enabled assessment of precision (repeatability) of in-house analysers in relation to this data, the recognised technique for human clinical pathology. These results are documented in Chapter 5 which found that the precision of results from these in-house and commercial laboratory analysers were generally acceptable, so large differences between repeated results from the same patient are more likely to be due to biological changes rather than analyser variation. Chapter 6 assesses the total error (based on a combination of bias and precision) of values from three in-house biochemistry analysers in relation to a commercial laboratory analyser for feline plasma using multiple quality specifications. This study required an adaptation of method comparison techniques used for human clinical pathology so that these techniques could be used with equipment that is unable to be calibrated. This chapter concludes that in-house analysers provide acceptable results and few clinical decisions would be different based on the results determined by three in-house analysers compared to those determined by the commercial laboratory. The last chapter is a discussion on the impact this research will have on veterinary practice, the projects' limitations and future directions for this avenue of research. 2015-05-23T00:00:00Z Pharmaceuticals, money and the health care organisational field http://hdl.handle.net/2123/13615 Title: Pharmaceuticals, money and the health care organisational field Authors: Lipworth, Wendy Abstract: Using an institutional theory framework, this article discusses the place of the pharmaceutical industry within the health care organizational field, and the wideranging effects the industry has on the other organizations in the field. It then provides a snapshot of the discourse that has emerged about the pharmaceutical industry, and about commercialization and marketization of the health care more generally. This paints a picture of deep ambivalence towards the pharmaceutical industry, both within and between stakeholder groups. The article ends with an effort to explain this ambivalence as the effect of competing institutional logics. This, in turn, points to some suggestions as to how the pharmaceutical industry might be better accommodated within the health care organizational field, without losing sight of the need for ongoing critique of industry behavior. KEYWORDS Pharmaceutical industry, institutional theory, organizational field, institutional logic, commercialization, marketization Description: book chapter 2015-07-23T00:00:00Z Soliton Dynamics in a Grating-Assisted Semilinear Dual Core System with Dispersive Reflectivity http://hdl.handle.net/2123/13614 Title: Soliton Dynamics in a Grating-Assisted Semilinear Dual Core System with Dispersive Reflectivity Authors: Chowdhury, S. A. M. Saddam Abstract: Bragg grating solitons are investigated in a linearly coupled dual core system, in which one core exhibits Kerr nonlinearity and is equipped with a nonuniform Bragg grating with dispersive reflectivity, while the other core is linear and unperturbed. When relative group velocity in the linear core c is zero, the dispersion relation of the linearized system gives rise to two disjoint gaps in the upper and lower halves of the spectrum. When c ≠ 0, the central gap emerges in the linear spectrum. Soliton solutions do not exist in the central gap but they exist as a continuous family of solutions in the upper and lower gaps. The maximum velocity that solitons can possess in this system is limited by c. An interesting property of the soliton solutions is that the presence of dispersive reflectivity may induce sidelobes in solitons' profile, however c tends to counteract the formation of sidelobes. The stability of solitons are determined through numerical simulations and vast stable regions are identified both in the upper and lower gaps. The general trend is that when c 0, as the value of coefficient of coupling between the cores increases, the stable region expands and also the stabilization effect of dispersive reflectivity becomes more prominent. However, soliton stability is affected as c and/or soliton velocity δ becomes larger. The interaction (collision) dynamics of stationary (counter-propagating) solitons are investigated by means of systematic numerical simulations and a variety of outcomes are identified. Of particular interest is the fusion of solitons into a quiescent one through in-phase interactions, which is more observed in the lower gap than in its upper counterpart. It is found that in the presence of sidelobes, interactions of solitons strongly depend on their initial separation. Another noteworthy finding is that solitons can merge into single zero velocity (slow moving) solitons as a result of low velocity in-phase (nearly in-phase) collisions. 2015-03-31T00:00:00Z NGOs and illicit drug policy change in the Russian Federation http://hdl.handle.net/2123/13611 Title: NGOs and illicit drug policy change in the Russian Federation Authors: Zheluk, Andrey Antonovich Abstract: In the decade to 2010, international initiatives directed at changing Russian illicit drug policy gained considerable momentum. However from 2010 official Russian government ambivalence evolved into open hostility directed against foreign ideas and against donor funded NGOs. By 2013, large scale donor-funded programs directed at reducing the social and individual harms associated with illicit drug use became effectively unimplementable in Russia. The main objective of this thesis is to establish if any non-government initiatives directed at illicit drug policy change were politically feasible in Russia between 2010 and 2013. In order to address this overarching objective, I sought to answer the following research questions: 1. What framed the possibilities and limits of political feasibility of drug policy initiatives that relied on international funding sources? 2. What political and other structures framed the feasibility of domestically funded non-government drug policy initiatives? 3. Contemporary Russia has presented unique barriers to the application of conventional methods of researching illicit drug policy. What novel data sources and methods might frame these limits? This thesis examines Russian drug policy from a pragmatic perspective. It examines both internationally and domestically funded civil society actors to identify what worked to influence Russian drug policy in the recent past. This thesis consists of a series of mixed methods exploratory case studies that offer a rich "bottom up" description of the contemporary Russian context. It also describes novel "big data" quantitative Internet search methods as a valid research method to study of complex environments. Against the backdrop of increasing security tensions between Russia and NATO, it proposes mechanisms that may allow future collaboration between donors, researchers, and Russian civil society organisations in a new, largely unknown policy space. 2014-10-29T00:00:00Z The epidemiology of cervictis in sexually transmitted infection clinic populations in Sydney, Australia http://hdl.handle.net/2123/13610 Title: The epidemiology of cervictis in sexually transmitted infection clinic populations in Sydney, Australia Authors: Lusk, Margaret Josephine Abstract: Infectious and non-infectious associations of cervicitis were explored in a prospective cross-sectional study of 550 women at three STI services in Sydney, 2006 to 2010. Associations were compared using three cervicitis case definitions: >30 polymorphonuclear leucocytes/high powered field of cervical Gram stain, yellow discharge or mucopurulent discharge (MCP). Women underwent testing for multiple infections. A prospective observational sub-study assessed the effect of Azithromycin treatment of all cervicitis and non-specific cervicitis (NSC) (cervicitis in the absence of Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) Mycoplasma genitalium (MG), Trichomonas vaginalis (TV)) CT, MG and TV were significantly associated with increased cervicitis risk on multivariate analysis, strongest associations with MCP: CT adjusted Relative Risk (ARR) =2.61 (95% CI 1.57-4.35) p=0.0002, MG ARR =2.25 (95% CI 1.12-4.54) p=0.003, TV ARR=2.86 (95% CI 1.61-5.09) p=0.0003. NG increased cervicitis risk on univariate analysis (RR=3.66 (95% CI 2.02-6.62) p<0.0001). Condom use reduced cervicitis risk by the yellow discharge definition (ARR=0.68 (95% CI 0.50-0.92) p=0.013). Population Attributable Risk% of significant pathogens explained only 23.4% of cervicitis and were: CT 8.5%, NG 3.6%, MG 4.5%, TV 6.7%. Azithromycin treatment showed non-significant reductions in cervicitis persistence for all cervicitis, RR=0.74 (95% CI 0.46-1.21) p=0.235 and NSC, RR=0.60 (95% CI 0.35-1.02) P=0.058 2014-08-29T00:00:00Z The dissemination and expression of the carbapenem- hydrolyzing enzyme blaOXA-23 http://hdl.handle.net/2123/13609 Title: The dissemination and expression of the carbapenem- hydrolyzing enzyme blaOXA-23 Authors: Valenzuela, Jubelle Kristine Abstract: Carbapenems are currently the 'last line' antimicrobial therapeutics prescribed against persistent bacterial infections. Resistance to this class of drug is therefore, clinically significant. Reports of carbapenem resistance, especially in Acinetobacter baumannii and Pseudomonas aeruginosa, are increasing worldwide. Studies have shown that carbapenem resistance can be attributed to altered drug targets; defects in outer membrane proteins, over-expressed efflux mechanisms and or the activity of a carbapenem-hydrolysing enzyme. A retrospective study of the emergence of carbapenem-resistant A. baumannii in Australian hospitals has shown that the activity of a carbapenemase gene, blaOXA-23 was the cause of resistance. The epidemiological study revealed that six related strains of A. baumannii conferred the carbapenem-resistant phenotype. In this epidemic, blaOXA-23 was disseminated by a composite transposon, a mobile genetic element similar to Tn2006. The transposition of Tn2006 is controlled by a transposase encoded by the IS element ISAba1. In addition to transposition, ISAba1 has also been shown to provide a strong promoter for the expression of blaOXA-23. ISAba1 promoter studies demonstrated that the presence of ISAba1-blaOXA-23 in E. coli does not affect susceptibility to carbapenems. This suggests that other factors such as bacterial host's outer membrane permeability may contribute to the carbapenem-resistant phenotype. The effect of the host cell's outer membrane permeability was investigated in P. aeruginosa isolates with outer membrane protein defects. These studies show that P. aeruginosa isolates with specific mutations in outer membrane protein OprD were carbapenem-resistant. The transformation of carbapenemase genes into OprD-defective P. aeruginosa isolates decreased susceptibility to carbapenems. Collectively, carbapenem resistance has been shown to be a complex interaction between host cell permeability, enzyme hydrolysing activity and gene expression. 2010-08-30T00:00:00Z Cytoskeletal dynamics of Cytotoxic T cells during migration in the tumour microenvironment http://hdl.handle.net/2123/13608 Title: Cytoskeletal dynamics of Cytotoxic T cells during migration in the tumour microenvironment Authors: Nino, Jorge Luis Galeano Abstract: Typically, migrating T cells display an elongated polarized shape with a very dynamic leading edge and a uropod in the rear. This 'amoeboid' movement guarantees a fast migration driven by the formation of polarized protrusions at the front. The actomyosin cytoskeleton is responsible for the generation of the forces that are involved in this process. This thesis aims to determine what is the effect of T cell migration when different components of the actomyosin cortex were inhibited using a pharmacological approach. We found that the inhibition of each component of the actomyosin cortex, T cells display different conformation of the actin filaments and produce different type of protrusion. Furthermore, T cell migration is an important feature for the killing and clearance of canner cells. It has been reported that T cells can migrate efficiently in any kind of tissue whilst scanning for cognate antigen. On the other hand, it is known that the tumor microenvironment secretes immunosuppressive cytokines such as TGF-β impairing the antitumor activity of T cells. Therefore, we aim to determine how TGF-β affects the migration behavior of T cells and its consequences in the scanning strategy to search their cognate antigen. 2015-03-31T00:00:00Z Reduction of plasma fibulin-1 predicts poor survival in metastatic colorectal cancer http://hdl.handle.net/2123/13607 Title: Reduction of plasma fibulin-1 predicts poor survival in metastatic colorectal cancer Authors: Huynh, Thien Phuoc Abstract: In Australia, colorectal cancer (CRC) is the second most common diagnosed cancer and the second leading cause of cancer-related deaths. Patients diagnosed with metastatic CRC (mCRC) have a 5-year survival rate of 10%; a drastic reduction from 90% in patients with localised CRC. For patients with mCRC, palliative chemotherapy is the first-line of treatment. Approximately 50% of patients will respond to chemotherapy; and discriminating which patients will respond to therapy prior to starting remains unknown. Therefore, biomarkers are required to predict patient outcomes to aid treatment selection and improve patient survival. Systemic inflammation and extracellular matrix (ECM) remodelling are vital factors in carcinogenesis; mCRC patients with poorer survival tend to have elevated systemic inflammation and excessive ECM remodelling. Fibulin-1 is an ECM protein and plasma glycoprotein which interacts with many ECM proteins to regulate numerous aspects of carcinogenesis. The aim of this thesis was to evaluate the prognostic value of fibulin-1 expression in patients with mCRC and investigate its role in CRC carcinogenesis. To evaluate the prognostic value of fibulin-1 in mCRC, fibulin-1 expression in clinical samples and cell lines were investigated with a variety of techniques, including immunohistochemistry, selective reaction monitoring mass spectrometry, western blotting and qualitative real-time PCR. The functional role of fibulin-1 on migration and angiogenesis was assessed with wound scratch assay and HUVEC tube formation assay, respectively. A reduction of plasma fibulin-1 was associated with elevated systemic inflammation and poorer survival. Differential expression of fibulin-1 was observed in our human colonic fibroblast and CRC cell lines. We were unable to identify differences in migration and angiogenesis according to basal secreted fibulin-1 expression in CRC cell lines. In conclusion, plasma levels of fibulin-1 may serve as a novel prognostic biomarker. 2015-02-24T00:00:00Z Hookworm infection in the Australian sea lion (Neophoca cinerea) http://hdl.handle.net/2123/13606 Title: Hookworm infection in the Australian sea lion (Neophoca cinerea) Authors: Marcus, Alan David Abstract: For the Australian sea lion (Neophoca cinerea), an endangered keystone predator that demonstrates high rates of pup mortality and limited population recovery, an understanding of the role of infectious disease in influencing pup health, and how it may contribute towards shaping population demography, is a key knowledge gap. This thesis investigated the taxonomy, epidemiology, clinical impact, and management of hookworm infection in N. cinerea to address the hypothesis that hookworm infection is a significant cause of disease and mortality in this species. Hookworms collected from N. cinerea pups were identified and described as a novel species (Uncinaria sanguinis). Transmammary transmission in the immediate post-parturient period was implicated as the predominant route leading to patent hookworm infection in pups; however, in contrast to the fundamental role that colony substrate appears to play in shaping the epidemiology of hookworm infection in other otariid hosts, this thesis determined that all N. cinerea pups are infected with U. sanguinis irrespective of the type of colony substrate and that the intensity of hookworm infection appears to be influenced by colony-specific seasonal differences in host behaviour. The clinical impact of hookworm infection in pups was quantified and the occurrence of seasonal patterns in health parameters and the magnitude of colony pup mortality were related to the dynamics of hookworm infection. In addition, the effectiveness of ivermectin to eliminate hookworm infection was investigated. This thesis determined that U. sanguinis is an important cause of disease and mortality in N. cinerea; this thesis contributes towards an improved understanding of the role of infectious disease in influencing the health status and population demography of this endangered species, informing conservation management and providing a solid foundation for further investigations of the effect of disease on the health status of free-ranging species. 2015-06-05T00:00:00Z The effect of post-incident discussion on psychological wellbeing and memory integrity http://hdl.handle.net/2123/13605 Title: The effect of post-incident discussion on psychological wellbeing and memory integrity Authors: Bukalo, Leila Abstract: As a consequence of their work, emergency service personnel, such as fire-fighters, police officers and paramedics are frequently exposed to traumatic events. This can result in an elevated risk of developing Post Traumatic Stress Disorder. To date, studies have indicated that post-trauma early interventions, such as Critical Incident Stress Debriefing, offer no benefit to individuals in terms of recovery from trauma-type symptomatology, and may also have negative effects on an individuals' memory for the event. The present analogue study aimed to investigate what aspects of currently used debriefing procedures may contribute to the negative effects on psychological adjustment and memory integrity observed in the literature. Specifically, the current study examined the effects of differently-focused discussions (emotion, fact, and non-event related) on psychological adjustment and memory integrity, and investigated whether the outcome of these discussions was influenced by the mode of administration (individual, group discussion format). Participants were 177 undergraduate students who viewed a video of a forensic autopsy. Psychological distress was found to decrease for all participants over time, with no significant differences in symptom recovery between conditions. Those who discussed factual information in a group setting incorporated more misinformation into memory; however, these participants reported the most confidence in the accuracy of their memories. Overall, these results suggest that, irrespective of the model of administration, post-trauma discussions in which emotional reactions or factual information are reviewed do not facilitate psychological adjustment compared to non-event related discussions. Furthermore, this study provides a greater understanding of the specific aspects of debriefing that may account for misinformation effects. 2014-08-01T00:00:00Z Research on the Structural Decomposition Analysis of Global Energy And Global Carbon Footprints http://hdl.handle.net/2123/13604 Title: Research on the Structural Decomposition Analysis of Global Energy And Global Carbon Footprints Authors: Lan, Jun Abstract: Greenhouse gas emissions increased by 10.8 Gigagram (Gg) CO2 equivalent in 1990−2010. Significant attention has been dedicated to the increase in emission transfers due to international trade. However, questions remain unanswered about which key sectors are stimulating the increase of CO2 emissions and whether changes in trade conditions have affected global emissions. To address the issue of increased emission transfers due to international trade, I used input-output tables (IOTs) in constant prices extended with CO2 emissions to examine the development of China. I calculated marginal coefficients – in monetary and CO2 terms – that capture the additional (new) technology installed after that year. My work provides a first overview of the magnitude and distribution of these coefficients in recent years across China's rapidly growing economy for which marginal coefficients could be expected to differ greatly from average coefficients and are responsible for the substantial increase in CO2 emissions. To answer the second question regarding which industries and trade conditions are stimulating the increase in CO2 emissions, I first explore the countries and sectors recording an increase or decrease in energy footprints during the decades from 1990-2010. I then highlight the effect of international outsourcing of energy-intensive production processes by decomposing the structural and spatial change in energy footprints. This energy data is then further converted to CO2 emission data to disintegrate total CO2 emissions for each country into contributions from various driving forces acting on the domestic economy and international trade. The results reveal that consumption is outpacing efficiency by accelerating energy consumption and CO2 emissions, and that a world-wide shifting of energy-intensive and emissions-intensive production across borders has happened. 2015-02-01T00:00:00Z The survival and evolution of the smallest galaxies http://hdl.handle.net/2123/13603 Title: The survival and evolution of the smallest galaxies Authors: Webster, David Abstract: The newly discovered low-luminosity galaxies known as ultrafaint dwarfs show little chemical evolution and may therefore retain the signatures of the first stars. This thesis models these galaxies as intrinsically very low-mass systems that formed only a few thousand stars in the early universe. The first part uses hydrodynamical models to determine the lower mass limit for a dwarf galaxy in the face of feedback from its own star formation. Dark matter halos with virial masses greater than 10^6 solar masses are found to retain a large percentage of their baryons following a single supernova event under favourable assumptions regarding radiative cooling, inhomogeneity of the interstellar medium, and position of the supernova. The inclusion of the ionising radiation from a 25 solar mass star prior to the supernova raises this limit to 10^6.5 solar masses. The second part of the thesis uses the first part as a template for the effect of a supernova on 10^7 solar mass systems, allowing extension of the model beyond the first supernova. The model can reproduce the observed chemical abundances of ultrafaint dwarfs (UFDs). Two possible star formation histories are modelled, with continuous star formation fitting the observed abundances better than two-single age bursts. Very metal-poor Damped Lyman-alpha systems (DLAs) at redshifts z = 2-3 are also studied as they may be the precursors to systems similar to the UFDs, but in isolation rather than part of the Milky Way system. However, there are discrepancies in chemical abundances between the DLAs and both the UFDs and the models in this thesis. The 20-metre telescopes to commence operations in the next decade will revolutionise the study of the smallest galaxies, providing chemical abundances for many more stars and a wider range of elements. 2015-01-01T00:00:00Z The use of psychiatric diagnosis on three child and adolescent inpatient units: a qualitative study http://hdl.handle.net/2123/13602 Title: The use of psychiatric diagnosis on three child and adolescent inpatient units: a qualitative study Authors: Kelly, Aidan Abstract: Psychiatric diagnoses are commonly used in both public and mental health professional discourse. They represent and communicate different distressing mental states. Throughout the ages there have been attempts to capture and communicate these states of being. This is what drives psychiatry's desire to refine psychiatric diagnosis. To demonstrate this, I will conduct an analysis of the term 'mental illness', and how psychiatry has sought to define, and also treat it. Different therapeutic models and classification systems are described, and their impact on the area critiqued. Particular focus is given to mental health services for young people in acute care. In these settings, professionals are faced with the most distressed and vulnerable young people in society. They must balance the demands of the job; psychiatric diagnosis is an administrative obligation for every mental health professional, with the danger of labelling a young person with a potentially stigmatizing mental illness. As a result, some professionals (e.g. Koehne, Hamilton, Sands & Humphries, 2012) feel conflicted about using psychiatric diagnosis in their daily practice. This leads to the main project aim; to investigate the role of diagnosis in the clinical work of mental health professionals working in acute child and adolescent care. Finally, the study method is outlined and rationale explained. 2015-03-01T00:00:00Z Post traumatic amnesia in children: sequence of recovery and prediction of outcome http://hdl.handle.net/2123/13601 Title: Post traumatic amnesia in children: sequence of recovery and prediction of outcome Authors: Briggs, Rachel Hilary Abstract: Traumatic brain injury (TBI) is a major cause of death and disability in childhood. Nevertheless, research in this area has predominately been among adults. This adult research has shown that early indicators of TBI severity are predictive of functional outcomes and critical to informing acute and ongoing rehabilitative care. The most commonly used indicators of TBI severity include depth and length of coma and duration of post-traumatic amnesia (PTA). Coma is measured in the moments immediately following the trauma. PTA refers to the period following emergence from coma where a person remains disoriented and amnesic for new events. PTA is typically assessed using a formal measure that involves serial testing from day to day where the patient is required to answer questions pertaining to their person, their current location and the time of day/month/year (referred to as the orientation subscale) and then questions relating to either immediate or delayed recall of facts and information they were provided with the day before (the memory subscale). Initially, testing of PTA is used to monitor patients' cognitive recovery and guides inpatient rehabilitation. Several adult studies have shown that disorientation is generally resolved before amnesia. In contrast, to our knowledge, no published child studies have examined natural sequence of skills recovery during PTA. This is important, as differences in the level of brain maturity and skills mastery at the time of injury, and the timing of skills acquisition in normal development may influence natural sequence of skills recovery in children relative to adults. Moreover, very few studies have examined predictive validity of PTA duration for functional outcomes in children, with only one published study reporting on predictive validity of the most commonly used PTA scale in Australia and United Kingdom – the Westmead PTA Scale (WPTAS), which is the focus of this thesis. Chapter 1 provides a general introduction to traumatic brain injury, the types of ongoing impairments encountered and their relationship to injury severity indices. In Chapter 2, children's natural sequence of skill recovery during PTA is examined in a cohort of 50 children aged 8 to 15 years consecutively admitted to Sydney Children's Hospital with moderate to severe TBI (paper now published in Child Neuropsychology). Assessment of PTA was conducted with the WPTAS. Orientation to time took significantly longer to recover than orientation to person and place, but not memory. This sequence of recovery is similar to the sequence in which they are originally acquired in normal development, with orientation to time and memory emerging later than orientation to person and place in normal development. In Chapter 3, the existing literature on relations between PTA and functional outcomes is explored in a detailed, systematic review (now published in Developmental Medicine and Child Neurology). The review revealed ten papers, which showed that duration of PTA predicts short- and long-term functional outcomes (in intelligence, memory, emotional/behavioural functioning, self-care, mobility and global functioning) in children. Of the ten papers, only three compared PTA with other indices of TBI severity, with PTA the stronger predictor of functional outcome in more than 70% of case. The review also showed only one study to have directly examined the relationship between duration of PTA measured by the WPTAS and functional outcomes in school aged children, with the study restricted to prediction of global functional outcomes at discharge. Finally, Chapter 4 contains a study that examined the validity of the WPTAS for prediction of functional outcomes in a cohort of 55 consecutively admitted children aged 8 to 15 years consecutively admitted to Sydney Children's Hospital with moderate to severe TBI whose PTA was measured by the WPTAS. Longer duration of PTA was strongly related to global and some specific (mobility, mood/behaviour, and cognition/memory/concentration) at the first outpatient follow up. Like in adults, PTA was also found to be a more reliable predictor of cognitive outcomes in children than GCS. In summary, in our studies we were (to our knowledge) the first to demonstrate the natural sequence of skill recovery during PTA and examine the re-acquisition of disrupted abilities during PTA using a developmental framework. In addition, our study showed the duration of PTA measured by the WPTAS is a good predictor of early functional outcomes in school-aged children. 2015-03-01T00:00:00Z Mechanisms of placental evolution: the genetics and physiology of pregnancy in lizards http://hdl.handle.net/2123/13600 Title: Mechanisms of placental evolution: the genetics and physiology of pregnancy in lizards Authors: Griffith, Oliver William Abstract: The placenta is a unique example of a complex organ that has evolved independently more than 115 times in amniotes (birds, reptiles, and mammals). Placentae exchange materials including respiratory gasses, nutrients, and hormones, between the mother and embryo. I aimed to identify the physiological and ecological factors that contribute to the evolution of placentation in vertebrates, focusing on the genetic mechanisms underpinning the evolution of placental functions, and the role of parent-offspring conflict in the evolution of placental traits. Given placentation has evolved independently many times, I assessed whether convergent evolution of placental functions is underpinned by the same genes in mammals and reptiles. I used high throughput sequencing to identify the gene expression patterns that facilitate placental functions in the placentotrophic southern grass skink (Pseudemoia entrecasteauxii).I show that hormone production occurs in the embryonic membranes of amniotes, and the production of growth factors by embryonic placental tissues is an exaptation of ancestrally expressed genes. I show that embryonic hormone production is a mechanism by which embryos can manipulate the function of the placenta, and regulate placental nutrient transport. By investigating the physiology and genetic underpinning of placental functions in reptiles, I provide fundamental data for understanding the evolution of viviparity and placentation in a lineage independent of viviparous mammals. I identify key similarities and differences between reptile and mammal pregnancy that outline the limits to which comparisons between the two lineages can be made. Finally, I show that parent offspring conflict is unlikely to play a role in the evolution of nutrient transport mechanisms in the placenta, but may be a driving force in the shift from lecithotrophic (a reliance on egg yolk for embryonic development) to placentotrophic nutrient provisioning through pregnancy. 2015-04-01T00:00:00Z Adhocratic Humanitarianisms and Ageing Emergencies in Lebanon: from the July 2006 War in Beirut's Southern Suburbs to the Syrian Refugee Influx in Akkar's Villages. http://hdl.handle.net/2123/13599 Title: Adhocratic Humanitarianisms and Ageing Emergencies in Lebanon: from the July 2006 War in Beirut's Southern Suburbs to the Syrian Refugee Influx in Akkar's Villages. Authors: Carpi, Estella Abstract: This thesis explores the ways in which humanitarianism transforms social space through case studies of Beirut's southern suburbs (Dahiye) in response to 2006 July war and the Syrian refugee influx in Akkar (North Lebanon) from war in Syria during 2011-2014. Through the investigation of humanitarian practices, it identifies the (un)declared states of emergency in which the short-term displacement of the Lebanese population cyclically exists alongside ageing refugeehood of Iraqis, Palestinians, and Sudanese in Lebanon. It also explores how humanitarian practice becomes articulated with forms of welfare and development in the form of long-term humanitarianism. Official states of emergency in Lebanon cyclically stimulate the flow of greater amounts of social and economic resources to local citizens through the increasing internationalisation of local welfare. This thesis investigates how transnational humanitarian interventions have produced different macro-political outcomes in Lebanon. In Dahiye, international humanitarian organisations upgraded services from the local to the international through financial support but without wielding de facto power and, therefore, remaining largely technocratic. In Akkar's villages, the practical rescaling of power from the local to the international has paradoxically reinforced fragmented statehoods through their cooperation with the international humanitarian apparatus in the context of a wavering and lax Lebanese state. This phenomenon has been called moralisation of local authorities. In this environment, international humanitarianism ends up functioning as an arm of ethical governance which aims to maintain state and regional order, and avoids confronting the human security of refugees, whose political dimension is constantly tamed by humanitarian policies. This thesis also raises epistemological queries with regards to the ethnographic fluctuation between what humanitarianism actually is on the ground, and how humanitarianism is rather perceived by aid providers and aid (non)recipients in the field. Ultimately, the chronic emergencisation of Lebanese society becomes leverage for preserving international security. The humanitarian strategy of continuously preventing further catastrophes and meeting immediate needs as a way of governing, in an environment of political nihilism, consigns the local as well as the refugee communities in Lebanon to an aprioristic abdication of radical social change. What's Unique About the US Constitution? An Examination of the US Constitution's Influence on the Australian Constitution http://hdl.handle.net/2123/13598 Title: What's Unique About the US Constitution? An Examination of the US Constitution's Influence on the Australian Constitution Authors: Donohoe, Evin 2014-01-01T00:00:00Z 'Us' and Determining Meaning: Intentionality, Social Linguistic Practices, and Singularity http://hdl.handle.net/2123/13597 Title: 'Us' and Determining Meaning: Intentionality, Social Linguistic Practices, and Singularity Authors: Raysmith, Thomas Henry Abstract: This thesis is primarily concerned with answering the two questions 'who are we?' and 'how must we understand our relations to the world and each other, such that knowledge of ourselves and the world is understood as possible?' As will be shown, these two questions and their answers are fundamentally linked. We are those creatures that satisfy certain conditions, conditions which include being able to have objectively correct intentional states and attitudes that are of or about ourselves and the world. Section I begins with a clarification of what is meant by 'we'. It is stipulated that we are to understand the 'we' as including all and only those creatures that are able to treat themselves and others as members of a group, any group. Thus our first question from above becomes 'what does it take to count as an individual that is able to treat herself and others as members of a group, any group?' It will be argued that to be one of us one must be able to have intentional states/attitudes and perform intentional performances that are of or about things, and that this means one must be a creature that takes part in social normative linguistic practices that determine meanings (the contents of intentional states/attitudes/performances) and confer them on to things. Our task then becomes one of accounting for such practices, and thereby also answering our second question from above. In section I.II we will consider Robert Brandom's Inferentialism as a possible candidate for a system that can fulfil this task. It will be argued that this system ultimately founders, but that certain aspects of it, together with an adequate account of conceptual perceptual experiential contents, can fulfil this task. In section II we look to the work of John McDowell for an account of experiential contents. I will argue that his picture is inadequate, but that an adequate account can emerge if we offer a further account of the category of singularity and another of intentional states/attitudes that are of or about singular things and able to play a role in inferential reasoning; both of which, I contend, can be given by taking certain lessons from G. W. F. Hegel. The best way of understanding the relevant lessons from Hegel, however, is to see them as responses to the philosophy Immanuel Kant. Thus section III goes over certain central themes in Kant's work, and in section IV we undertake a study of the key sections of Hegel's system. In section V I bring everything together to explain our completed account of meaning determining practices, which also allows me to explain how we have answered the questions posed at the beginning of the thesis. 2015-01-01T00:00:00Z See Where it Drifts: the Influence of Aboriginal Art on an Australian Ontology of Painting http://hdl.handle.net/2123/13596 Title: See Where it Drifts: the Influence of Aboriginal Art on an Australian Ontology of Painting Authors: French, Hayley Megan Abstract: This thesis examines the influence of Aboriginal contemporary art on an Australian ontology of painting. This investigation is driven by the questions that arise as an emerging artist working in the unfolding discourse of the contemporary, the historical legacy of colonialism, and the unparalleled impact and influence of Aboriginal contemporary art on the Australian artworld. The methodology and concerns of the research have emerged directly from the studio practice and have been examined through both the thesis and studio work. The influence of Aboriginal art on an Australian ontology of painting is addressed through three major areas of impact and intersections between Aboriginal and non-Indigenous art at the core of contemporary Australian painting—the possibility of influence, the idea of landscape and appropriation. The author's work is considered throughout the thesis, in particular as the core case study of influence. The thesis emphasises the important viewpoint of emerging artists in this evolving discourse. A significant part of this research project has been the collection of empirical data: through interviews, exhibitions, research trips to remote art centres and curatorial projects across Australia. The discourse surrounding this field is one that is rapidly developing, and has increased significantly during the research project. The increase in publications and articles not only indicates the significance of this field to current discourse and artistic practice, but also its evolving nature. For this reason the thesis has highlighted literature that has been published in the last five years. 2015-01-06T00:00:00Z Neglected Skies: The Far Eastern Demise of British Naval Supremacy, 1922 – 1942 http://hdl.handle.net/2123/13595 Title: Neglected Skies: The Far Eastern Demise of British Naval Supremacy, 1922 – 1942 Authors: Britts, Angus Abstract: This thesis concludes that Britain's longstanding command of the sea was initially terminated in early April 1942 through the culmination of a two-decade process in which the Royal Navy did not keep pace with the rapid evolution of the air weapon at sea. Whereas it is conceded that British strategic sea power became eclipsed by the United States Navy during the second half of the Second World War, the inability of the Royal Navy to compete effectively with Japan's massed carrier spearhead ended the RN's capacity to dominate the battlefield itself, a reputation the service had enjoyed since the days of Trafalgar. The material examined will demonstrate how the relative neglect of offensive carrier aviation by the British Admiralty in the interwar period, in concert with unfavourable domestic and international circumstances, resulted in Britain entering the war with a fleet far short of optimum operational readiness. Although it shall be concluded that the Royal Navy successfully engaged its European Axis opponents, it remained in a parlous position if forced to confront an opponent that possessed a superior naval air force, which the Eastern Fleet encountered south of Ceylon from 4-9 April 1942 in the form of the Imperial Japanese Navy's Kido Butai (Mobile Force), the most formidable concentration of naval airpower yet seen in modern warfare. 2015-01-01T00:00:00Z Electrical Impedance Tomography as A Radiation-free Alternative Medical Imaging Modality for Pulmonary Embolism Detection http://hdl.handle.net/2123/13594 Title: Electrical Impedance Tomography as A Radiation-free Alternative Medical Imaging Modality for Pulmonary Embolism Detection Authors: Nguyen, Doan Trang Abstract: The diagnosis of Pulmonary Embolism (PE) is an important issue, which currently does not have satisfactory solutions with current imaging modalities such as Computed Tomography Pulmonary Angiogram (CTPA) and Ventilation/Perfusion nuclear scans. Both of these imaging modalities use harmful radiation (X-ray) and CTPA requires the injection of nephrotoxic contrast agents. Furthermore, the patients must be moved to special imaging chambers, which is not optimal for patients who require constant life supporting and/or monitoring devices. A reliable, portable and preferably radiation-free method of imaging would aid significantly in the diagnosis of PE, thus reducing the fatality of this acute condition. Electrical Impedance Tomography (EIT) is a promising medical imaging modality, which typically uses a single ring of external electrodes to image the impedance changes within the body. EIT is portable, non-invasive, radiation free and inexpensive. It can be used for long term monitoring at the bedside with high temporal resolution. Several recent studies showed that pulmonary perfusion could be reliably imaged using EIT with the aid of small bolus of highly conductive fluid (20% NaCl). The presented research explored the application of contrast-enhanced EIT for the evaluation of PE in vivo on a large animal model. The results show that: (1) low concentration saline (3% instead of 20% NaCl) can be effectively utilised as a contrast agent for EIT, (2) perfusion imaging with contrast enhanced EIT during an apnoea with both low and high concentration saline can detect unilateral small segmental PE and (3) with advanced signal processing, perfusion imaging with contrast enhanced EIT without interruption in respiration with low concentration saline can detect unilateral small segmental PE Description: Includes published papers co-authored with others 2015-03-31T00:00:00Z The role of natural regulatory T cells in the regulation of asthma http://hdl.handle.net/2123/13593 Title: The role of natural regulatory T cells in the regulation of asthma Authors: McKnight, Lauren Anne Abstract: Allergic asthma is a chronic inflammatory disease of the airways characterised by Th2 sensitisation and inflammation, which represents a failure of tolerance to environmental antigens. The contribution of thymic "natural" regulatory T cells (nTregs) to the prevention of allergic airway inflammation (AAI) is not well established. We used a mouse model of AAI generated by recombinant allergen HELMCC. A new strategy was developed for the quantification of AAI using multi-colour flow cytometry. CD4+CD25+ MCC-specific nTregs from double transgenic mice were able to prevent the development of AAI when adoptively transferred into host mice prior to sensitisation. The nTregs were antigen-specific and effective even when isolated directly from the thymus. However, they did not suppress AAI in previously sensitised mice, despite accumulating in large numbers in the lungs. Cotransfer of nTregs with naïve MCC-specific cells revealed that nTregs suppressed the late proliferation of responder T cells, prevented their expansion in response to allergen challenge, and reduced the expression of effector cytokines without altering Th2 polarisation. Thus, antigen-specific nTregs potently suppressed the T cell response in AAI, converting it into a response that resembled tolerance. This suggests that nTregs may play an important role in the prevention of allergic asthma. 2014-09-01T00:00:00Z The networking of care in the newborn nurseries of Australia and New Zealand http://hdl.handle.net/2123/13592 Title: The networking of care in the newborn nurseries of Australia and New Zealand Authors: Donoghue, Deborah Anne Abstract: Clinical networks emerged in part, to generate evidence to guide the care of their high-risk populations. For example, the care of the high-risk newborn was changing rapidly necessitating monitoring and assessment of its impact on both short-term and long-term outcomes for these babies. This body of work investigates the elements necessary for a successful and sustained network using the Australian and New Zealand Neonatal Network (ANZNN) as an example. Social network theory proposes that a successful network is underpinned by principles and relationships characterised by flexibility, sustainability and cohesion. Important within the network structure are trust and communication, and the generation of social capital. Each of the five papers in this thesis examined an element of the network in relation to its success and sustainability. They demonstrated that the ANZNN developed and then was sustained by its relationships and the trust developed over 20 years. By establishing a high-quality, ongoing audit process that included a substantive feedback loop to the members, the network created its own social capital which in turn enhanced the evidence base for the care of the newborn. This thesis demonstrates that the clinical network is a successful sustained network due to this remarkable and highly effective loop. Description: Includes published papers co-authored with others 2015-01-30T00:00:00Z Visualizing Evaluative Language in Relation to Constructing Identity in English Editorials and Op-Eds http://hdl.handle.net/2123/13591 Title: Visualizing Evaluative Language in Relation to Constructing Identity in English Editorials and Op-Eds Authors: Almutairi, Bandar Alhumaidi A. Abstract: This thesis is concerned with the problem of managing complexity in Systemic Functional Linguistic (SFL) analyses of language, particularly at the discourse semantics level. To deal with this complexity, the thesis develops AppAnn, a suite of linguistic visualization techniques that are specifically designed to provide both synoptic and dynamic views on discourse semantic patterns in text and corpus. Moreover, AppAnn visualizations are illustrated in a series of explorations of identity in a corpus of editorials and op-eds about the bin Laden killing. The findings suggest that the intriguing intricacies of discourse semantic meanings can be successfully discerned and more readily understood through linguistic visualization. The findings also provide insightful implications for discourse analysis by contributing to our understanding of a number of underdeveloped concepts of SFL, including coupling, commitment, instantiation, affiliation and individuation. 2015-01-01T00:00:00Z Operations of force: NATO, Belgrade and the inflection of Urbicide http://hdl.handle.net/2123/13590 Title: Operations of force: NATO, Belgrade and the inflection of Urbicide Authors: Bobic, Nikolina Abstract: This thesis considers the manner by which the contemporary and inherently flexible concept of 'urbicide' may be inflected and expanded by a focused exploration of one particular urban incursion. The particular focus is on NATO's incursion on Belgrade during 1999 (and beyond). Drawing on connections found in economics, law, media and technology, the research analyses strategies deployed by the military to control the physical and psychological space of Belgrade. NATO's 1999 targeting of Belgrade in Operation Allied Force becomes the means through which to expose more covert manifestations of urbicide. Considering that Belgrade was targeted by NATO at the end of the twentieth century, the urbicide of Belgrade offers perhaps the first insight into the changing modes of urbicide into the twenty-first century. The political context against which Belgrade has been transformed is explored alongside urban, architectural, infrastructural and landscape re-developments. The thesis' findings elaborate and extend the initial position of the thesis that the 1999 bombing of Belgrade has been an attempt to eliminate the historically complex and heterogeneous city of Belgrade. The concluding proposition is that the 1999 urbicide was also an attempt to eliminate Balkanism. The radical potential of Balkanism – specifically through the Yugoslav case – is that it demonstrates alternative ways a society can be set-up – in terms of economics, to urbanism and architecture. The thesis further suggests various models of how societies might interrogate urbicide in order to re-think space and architecture, as well as resist control. 2014-01-01T00:00:00Z Treatment of vaginal candidiasis for the prevention of preterm birth: a systematic review and meta-analysis http://hdl.handle.net/2123/13589 Title: Treatment of vaginal candidiasis for the prevention of preterm birth: a systematic review and meta-analysis Authors: Roberts, Christine L.; Algert, Charles S.; Rickard, Kristen L; Morris, Jonathan M. Abstract: Abstract Background: Recognition that ascending infection leads to preterm birth has led to a number of studies that have evaluated the treatment of vaginal infections in pregnancy to reduce preterm birth rates. However, the role of candidiasis is relatively unexplored. Our aim was to undertake a systematic review and meta-analysis to assess whether treatment of pregnant women with vulvovaginal candidiasis reduces preterm birth rates and other adverse birth outcomes. Methods: We undertook a systematic review and meta-analysis of randomised controlled trials (RCTs) in which pregnant women were treated for vulvovaginal candidias (compared to placebo or no treatment) and where preterm birth was reported as an outcome. Trials were identified by searching the Cochrane Central Register of Controlled Trials, Medline and Embase databases to January 2014. Trial eligibility and outcomes were pre-specified. Two reviewers independently assessed the studies against the agreed criteria and extracted relevant data using a standard data extraction form. Meta-analysis was used to calculate pooled rate ratios (RR) and 95% confidence intervals (CI) using a fixed-effects model. Results: There were 2 eligible RCTs both among women with asymptomatic candidiasis, with a total of 685 women randomised. Both trials compared treatment with usual care (no screening for, or treatment of, asymptomatic candidiasis). Data from one trial involved a post-hoc analysis of a larger trial of treatment of asymptomatic infections in pregnancy (n=586) and the other was a pilot study (n=99). There was a significant reduction in spontaneous preterm births in treated compared with untreated women (meta-analysis RR=0.36, 95%CI 0.17-0.75). No other outcomes were assessed by both trials. Conclusions: This systematic review found two trials comparing treatment of vaginal candidiasis in pregnancy for the outcome of preterm birth. Although the effect estimate provides support for the hypothesis that treatment of asymptomatic candidiasis may reduce 3 the risk of preterm birth, the result needs to be interpreted with caution as the primary driver for the pooled estimate comes from a post-hoc analysis. A prospective trial with sufficient power to answer the clinical question 'does treatment of asymptomatic candidiasis in early pregnancy prevent preterm birth' is warranted. 2015-01-01T00:00:00Z Linkage of four administrative datasets to examine blood transfusion in pregnancy http://hdl.handle.net/2123/13588 Title: Linkage of four administrative datasets to examine blood transfusion in pregnancy Authors: Pattern, Jillian A.; Ford, Jane B. Abstract: Currently collected hospital data records fact of transfusion, but lacks detail on quantity of blood transfused, and timing of transfusions. A number of administrative datasets collect information on blood transfusion including quantity and timing. Linkage of multiple datasources has the potential to give increase the depth of information available for researchers. This study aims to describe the linkage of four administrative datasets to identify transfusions among women giving birth in NSW and to describe the population represented by this linked data. Hospital, birth, blood issue and blood pack databases were linked to identify women receiving red blood cell transfusions in NSW between July 2006 and December 2010. Characteristics of the linked data population are compared with the population of all women giving birth, and births in public hospitals. Between July 2006-December 2010 there were 425,036 births in NSW hospitals, including 235,796 in a population with additional blood issue data available, of which, 4642(2%) received a transfusion. Hospitals supplying blood issue data were more likely to be larger urban or tertiary hospitals, and had a higher risk population than the state overall and public hospitals generally. Linkage of multiple data sources provides additional detail compared with hospital data alone, providing a wealth of data for researchers. The population identified through linkage differs from the overall birthing population, and to a lesser extent from women birthing in public hospitals. In some cases this may affect generalisability of research findings, but in other cases may be beneficial. 2015-07-15T00:00:00Z Prelabor cesarean delivery for twin pregnancies close to term is associated with reduced mortality http://hdl.handle.net/2123/13587 Title: Prelabor cesarean delivery for twin pregnancies close to term is associated with reduced mortality Authors: Roberts, Christine L.; Algert, Charles S.; Nippita, Tanya A.; Bowen, Jennifer R.; Shand, Antonia W. Abstract: Objectives: To examine short and longer term outcomes for twins born at or near term, comparing prelabor cesarean delivery (CD) to birth after trial of labor. Methods: A retrospective cohort of twin pregnancies delivered ≥ 36 weeks gestation from 2000 to 2009. Pregnancies with an antenatal death, lethal anomaly, birthweight discordance ≥25% or birthweight <2000 grams or >4000 grams were excluded. Outcomes included severe hypoxia, stillbirth and neonatal death, and hospital admissions or death during the first 5 years of life. Results: 45.3% of 7099 twin pregnancies were delivered by prelabor CD. Compared to delivery after labor, prelabor CD was associated with significantly reduced risks of adverse infant outcomes including severe birth hypoxia (0.08% vs. 0.75%, RR 0.10, 95% CI 0.04-0.26), neonatal death (0.00% vs. 0.15%, RR 0.05, 95% CI 0.00-0.82), and death up to 5 years of age (0.16% vs. 0.40%, RR 0.41, 95% CI 0.20-0.85). Whereas total mortality for first twins was similar after labor (0.15%) compared to prelabor CD (0.16%), total mortality was four times more common in second twins born after labor (0.64%) compared to second twins born after prelabor CD (0.16%). Conclusions: Twin pregnancies at and beyond 36 weeks who are delivered after labor have increased risks for birth outcomes associated with hypoxia. These risks do not result in increased mortality in the first twin, but second twins have significantly increased mortality up to 5 years of age. However, the absolute mortality rate for relatively uncomplicated twin pregnancies born at or near term is low. 2015-01-01T00:00:00Z Using record linkage to investigate perinatal factors and neonatal thyroid-stimulating hormone http://hdl.handle.net/2123/13586 Title: Using record linkage to investigate perinatal factors and neonatal thyroid-stimulating hormone Authors: Lain, Samantha J.; Roberts, Christine L.; Wilcken, B; Wiley, V; Jack, M M; Nassar, Natasha Abstract: Context: Studies examining the relationship between maternal and infant thyroid parameters have shown conflicting results. Record-linkage provides an opportunity to examine the association between maternal and infant thyroid stimulating hormone (TSH) levels. Objective: To demonstrate the feasibility of record-linkage of newborn screening, laboratory, and birth databases for research by investigating the association between maternal and newborn TSH levels. Design: Record-linkage cohort study Setting and Participants: The records of 2,802 women with first trimester serum TSH concentrations were linked with population-based birth data and newborn screening data (NBS) containing infant TSH levels. Association between moderately high neonatal TSH levels (>5mlU/L) and maternal and infant characteristics were evaluated. The correlation and association between maternal and infant TSH levels were assessed using Pearson's correlation coefficient and multivariable linear regression, respectively. Results: 99.3% of maternal and birth records linked with a NBS record. Mother's country of birth, gestational age (>41 weeks) and lower birth weight were associated with neonatal TSH levels >5mlU/L. Neonatal and maternal first-trimester TSH levels were not correlated, although statistically significant (r=0.05, P=0.008). The association between neonatal TSH and maternal TSH, after adjusting for maternal age, gestational age and age at NBS testing, was also small ( =0.039, P=0.009). Conclusions: Record-linkage is a feasible and cost-efficient way to investigate the association between maternal factors and neonatal hormone levels. First trimester maternal thyroid levels are not correlated with neonatal TSH levels. This method of outcome assessment can be used for future research examining long term outcomes for infants with different newborn screening results. 2015-01-01T00:00:00Z Knowledge, attitude and experience of episiotomy use among obstetricians and midwives in Viet Nam http://hdl.handle.net/2123/13585 Title: Knowledge, attitude and experience of episiotomy use among obstetricians and midwives in Viet Nam Authors: Trinh, Anh T.; Roberts, Christine L.; Ampt, Amanda Abstract: Background: Episiotomy remains a routine procedure at childbirth in many South-East Asian countries but the reasons for this are unknown. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy use among clinicians in Viet Nam. Methods: All obstetricians and midwives who provide delivery care at Hung Vuong Hospital were surveyed about their practice, knowledge and attitudes towards episiotomy use. Data were analysed using frequency tabulations and contingency table analysis. Results: 148 (88%) clinicians completed the questionnaire. Fewer obstetricians (52.2%) than midwives (79.7%) thought the current episiotomy rate of 86% was about right (P<0.01). Most obstetricians (82.6%) and midwives (98.7%) reported performing episiotomies on nulliparous women over 90% of the time. Among multipara, 24.6% of obstetricians reported performing episiotomy less than 60% of the time compared with only 3 (3.8%) midwives (P<0.01). Aiming to reduce 3rd-4th degree perineal tears was the most commonly reported reason for performing an episiotomy by both obstetricians (76.8%) and midwives (82.3%), and lack of training in how to minimize tears and keep the perineum intact was the mostly commonly reported obstacle (obstetricians 56.5%, midwives 36.7% P=0.02) to reducing the episiotomy rate. Conclusion: Although several factors that may impede or facilitate episiotomy practice change were identified by our survey, training and confidence in normal vaginal birth without episiotomy is a priority. 2015-01-01T00:00:00Z Incisional hernia repair after caesarean section: a population based study http://hdl.handle.net/2123/13584 Title: Incisional hernia repair after caesarean section: a population based study Authors: Shand, Antonia W.; Chen, Jian Sheng; Schnitzler, Margaret; Roberts, Christine L Abstract: BACKGROUND Incisional hernias occur at surgical abdominal incision sites but the association with caesarean section (CS) has not been examined. AIM: To determine whether CS is a risk factor for incisional hernia repair. MATERIAL and METHODS: Population-based cohort study in Australia using linked birth and hospital data for women who gave birth from 2000 to 2011. (n=642,578) Survival analysis was used to explore the association between CS and subsequent incisional hernia repair. Analyses were adjusted for confounding factors including other abdominal surgery. The main outcome measure was surgical repair of an incisional hernia. RESULTS: 217,555 women (33.9%) had at least one CS and 1,554 (0.2%) had an incisional hernia repair. The frequency of incisional hernia repair in women who had ever had a caesarean section was 0.47%, compared to 0.12% in women who never had a caesarean section. After controlling for different follow up lengths and known explanatory variables, the adjusted hazard ratio (aHR) was 2.73 (95%CI 2.45-3.06, P <0.001). Incisional hernia repair risk increased with number of caesarean sections: women with two CS had a threefold increased risk of incisional hernia repair, which increased to 6 fold after five CS (aHR=6.29, 95%CI 3.99-9.93, P<0.001) compared to women with no CS. Prior abdominal surgery including other hernia repair also increased the risk of incisional hernia repair (all p<0.001). CONCLUSIONS: There was a strong association between maternal CS and subsequent incisional hernia repair, which increased as the number of CSs increased, but the absolute risk of incisional hernia repair was low. 2015-01-01T00:00:00Z Incidence and outcomes of pregnancy‐associated melanoma in New South Wales http://hdl.handle.net/2123/13583 Title: Incidence and outcomes of pregnancy‐associated melanoma in New South Wales Authors: Bannister-Tyrrell, Melanie; Roberts, Christine L.; Hasovits, Csilla; Nippita, Tanya; Ford, Jane B. Abstract: Background: There is controversy about the interaction between melanoma and pregnancy. There is a lack of Australian data on pregnancy outcomes associated with melanoma in pregnancy, despite Australia having the highest incidence of melanoma in the world. Aims: Describe trends, maternal characteristics and pregnancy outcomes associated with pregnancy‐associated melanoma in New South Wales Materials and Methods: Population‐based cohort study of all births (n=1,309,501) of at least 20 weeks gestation or 400g birthweight in New South Wales, 1994‐2008. Logistic regression was used to analyse the association between melanoma in pregnancy and adverse birth outcomes. Results: 577 pregnancy‐associated melanomas were identified, including 195 diagnosed during pregnancy and 382 diagnosed within 12 months postpartum. The crude incidence of pregnancy‐associated melanoma increased from 37.1 per 100,000 maternities in 1994 to 51.84 per 100,000 maternities in 2008. Adjusting for maternal age accounted for the trend in pregnancy‐associated melanoma. Melanomas diagnosed in pregnancy were thicker (median=0.75mm) than melanomas diagnosed postpartum (median=0.60mm) (p=0.002). Pregnancy‐associated melanoma was associated with increased risk of large for gestational age infant but not preterm birth, planned birth, caesarean section or stillbirth. Parity was inversely associated with pregnancy‐associated melanoma, as women with 3 or more previous pregnancies had 0.59 times the odds of pregnancy‐associated melanoma compared to nulliparous women (95% CI 0.42‐0.84, p=0.003). Conclusions: The incidence of pregnancy‐associated melanoma has increased with increasing maternal age. The observation of thicker melanomas in pregnancy and increased risk of large for gestational age infants may suggest a role for growth‐related pregnancy factors in pregnancy‐associated melanoma. 2015-01-01T00:00:00Z Women's beliefs about the duration of pregnancy and the earliest gestational age to safely give birth. http://hdl.handle.net/2123/13582 Title: Women's beliefs about the duration of pregnancy and the earliest gestational age to safely give birth. Authors: Zhang, LY; Todd, Angela L; Khambalia, Amina; Roberts, Christine L Abstract: Background: American evidence suggests women are not well informed about the optimal duration of pregnancy or the earliest time for safe birth. Similar evidence does not exist in Australia. Aims: To explore pregnant women's beliefs about the duration of pregnancy and the earliest time for safe birth, and to compare the results with US data. Methods: A cross-sectional survey of pregnant women attending antenatal clinics at four public hospitals in Sydney, Australia, included collection of maternal and pregnancy characteristics, and two questions exploring women's beliefs about the duration of pregnancy, and the earliest time for safe birth. Responses were grouped as: late preterm (34-36 weeks), early term (37-38 weeks), and full term (39-40 weeks). Results: Of 784 surveyed women, 52% chose 39-40 weeks as the duration of a full term pregnancy, while for the earliest time for safe birth, 10% chose 39-40 weeks and 57% chose 37-38 weeks. Some maternal characteristics were associated with women's beliefs, including having a medical and/or pregnancy complication, country of birth, level of education, employment status, and attending a tertiary hospital. The associations were different for each question. In comparison with US studies, Australian women were more likely to choose later gestations for both the duration of pregnancy and the earliest time for safe birth. Conclusions: A significant proportion of Australian women believe that full term pregnancy and earliest time for safe birth occur before 39 weeks, suggesting opportunities for antenatal education. 2015-01-01T00:00:00Z Modelling framework of solar assisted dehumidification system to generate freshwater from "Thin air" http://hdl.handle.net/2123/13581 Title: Modelling framework of solar assisted dehumidification system to generate freshwater from "Thin air" Authors: Milani, Dia Abstract: Freshwater scarcity is a major obstacle of growth and prosperity for many nations in the world. Conventional centralised freshwater supply options in general are depleting and the unanticipated social and environmental costs of alternative solutions are emerging. Similar to energy, water sector may also need to explore renewable decentralised freshwater alternatives such as atmospheric moisture as discussed in this thesis. For hot and humid regions, condensed water is unwillingly discharged out of air-conditioning systems and the energy consumed for condensation to full humidity comfort level is wasted. Only a few limited small-scale experimental studies and no systematic modelling have been found in the literature on atmospheric water capture. This thesis works to fill some of this gap by developing an understanding of the fundamental factors that have and continue to challenge the development of technologies for atmospheric water capture. In this thesis, a framework is developed encompassing several modelling elements for assessment of feasibilities of moist air dehumidification technologies for atmospheric water capture. This framework integrates technical, meteorological and economic modelling elements. In the technosphere, detailed models of thermoelectric and absorption cooling are developed as potential dehumidification technologies. These models are interfaced to renewable energy input algorithms, namely solar photo-voltaic (PV) and solar-thermal. Solar energy collection technologies are also part of this framework which includes models of solar PV systems and evacuated tube collectors (ETCs). Studies of such integration of solar-assisted dehumidification and associated analysis for atmospheric water capture are limited in the literature. Fundamental solar energy input models are developed and interfaced to meteorological data to provide geographical location specific analysis. In this way the model framework is generic and applicable to any location on Earth where meteorological data is available. Finally, an economic modelling component completes the framework to provide comprehensive techno-economic assessments of different technologies for atmospheric water capture. This framework therefore provides a tool to support decision making related to feasibilities of different technologies associated with water capture from atmosphere. Along the way to developing the modelling framework, a detailed categorisation of dehumidification systems is established and a model to estimate condensation rates based on local climate data is built. The hurdle of condensation energy requirement is highlighted through simulation results. To alleviate this energy burden, an assessment of renewable solar energy input is then made. Techno-economic challenges for two different climates, Sydney and Abu Dhabi are examined and compared throughout this thesis providing comparisons for water and energy profiles. Several modelling components are developed and presented f or this purpose, requiring implementations in different modelling environments including Matlab, Trnsys, Homer and VBA. Based on the operation principles, dehumidification techniques are categorised into three categories in this thesis (Fig. 2.2). Gas separation membrane technologies were modelled but are not included in this thesis presentation because initial analysis showed they suffer from several key technical drawbacks primarily associated with the sensitivity to fluctuations in feed air temperature and humidity. Technologies in the cooling surfaces category in general use electrical or mechanical power to circulate and compress a refrigerant and cooling down conductive surfaces or coils. This process aims to decrease the temperature of moist air stream below dew point where water vapour molecules start to bond and settle forming the condensation stream. Amongst a wide range of cooling surface techniques, thermoelectric cooler (TEC) devices are attachable to cooling surfaces without using a refrigerant medium. A conceptual TEC dehumidification system is modelled in this thesis targeted at moist air streams with ambient temperature ranges (10-50) C and relative humidity ranges (10-100) %. For large-scale water production, the energy cost is calculated and found to be the major factor contributing to more than 95% of the total cost of generated water. This model is implemented for Sydney and Abu Dhabi case studies by using their annual typical meteorological weather data. This shows the generic nature of the applicability of the model and in this specific comparison confirms the influence of energy consumption over the cost of generated water in those two very different regions. However, lower local utility rates and favourable climatic conditions for dehumidification in Abu Dhabi show significant differentiation in water cost over Sydney. To confront excessive energy demands for atmospheric water capture, the idea of facilitating solar energy via PV panels is examined in this thesis. A comprehensive solar algorithm is developed and implemented to optimise solar collector positioning and for calculating solar penetration ratios for Sydney and Abu Dhabi. As far as the author is aware, this is the first time such optimal position calculation for Sydney and Abu Dhabi is done. It is found that optimal surface tilt angles for Sydney and Abu Dhabi are 32 and 22 respectively, while optimal surface azimuth angles for Sydney and Abu Dhabi are 195 and 16 respectively. This algorithm is generic in its structure allowing such calculation to be executed for any city in the world and is later used in this thesis for calculations associated with a new ETC diffuse at reflector (DFR) model. This thesis also presents a detailed economic model for prediction of utility costs with consideration for CAPEX, OPEX, subsidies and carbon taxation. It is found that investing a $338,000 on a PV array of 100 kW at current utility rates can meet 53% of energy demand of proposed dehumidification system and reduce LCOE by 6 c/kWh in Sydney. Solar PV array at current utility rates to feed proposed dehumidification system is found to be uneconomical for Abu Dhabi. Solar-thermal collectors represent an attractive option for driving refrigeration techniques. Evacuated tube collection technology has progressed significantly over the last few years and this technology is assessed in this thesis as a heat collector for absorption chillers. The role of DFR to improve the performance of ETC is highlighted and modelled. Results showed that DFR can significantly improve ETC performance by an average of 24.1% for Sydney and 22.9% for Abu Dhabi respectively. The optimisation of DFR is therefore an important factor for the enhancement of this solar energy collection technology and the algorithm developed in this thesis is generically applicable across geographical locations. The concept of solar refrigeration is reviewed and investigated for the implementation of sorption refrigeration. Sorption techniques use low-grade heat sources such as solar energy to convert thermal heat into chilling effect. This function is investigated for dehumidification of a moist air stream via cooling coils. A conceptual absorption model is developed in TRNSYS to calculate overall energy demand and water productivity. An ASHRAE algorithm is developed and implemented to cross validate the TRNSYS model. This absorption model was used in an optimisation analysis and showed water productivity improvement of 29% for Sydney and 34% for Abu Dhabi, while energy demand can be reduced by 22% for Sydney and 55% for Abu Dhabi. Unlike Sydney, the cumulative cost of generated water is declining over time in Abu Dhabi reaching $15 /kL. If this system is projected to work during the day only, solar penetration ratio will substantially increase and could meet the entire diurnal load for dehumidification in Abu Dhabi. If the capital cost of developing such system is affordable, absorption model can be further optimised to specifically match local conditions in respect to solar radiation and energy sources where the cost of generated water can economically compete with other conventional sources. In regions such as Abu Dhabi, the idea of having small-scale dehumidification system where the energy demand is mostly met by solar radiation and the volume of generated water is freely controlled and managed by household seems appealing. 2012-01-01T00:00:00Z Eligibility, the ICF and the UN Convention: Australian perspectives http://hdl.handle.net/2123/13580 Title: Eligibility, the ICF and the UN Convention: Australian perspectives Authors: Madden, Rosamond H; Glozier, Nick; Mpofu, Elias Abstract: The UN Convention on the Rights of Persons with Disabilities, in Australia, acts as a philosophical and moral statement and framework guiding integrated and strategic policy across the nation. Broad policy agreement has been reached by governments, and both the government and non-government sectors are developing strategies for implementation or evaluation. There is however a need for a more integrated approach to disability policy and information, reflecting all three components of the Italian project: • legislation and a high level philosophical framework and policy guide; • a technical framework that can underpin specific policies and programs aiming to achieve the major goals; and , • a language and set of tools, relating to both the above, that provide infrastructure for assessment methods and information systems. The International Classification of Functioning, Disability and Health (ICF) is the ideal tool to support the latter two components, consistent with the UN Convention. While the ICF has been used as the basis for national data standards, in population surveys and in the national data collection on disability support services, there is considerable scope for greater use of it, including using all domains of the Activities and Participation and the Environmental Factors component for policy, information and service provision, to advance a disability-inclusive society. Information available from the income support system and from generic services could be enhanced by reference to the ICF components. It would be of significant national value in Australia, especially as a 'continuum of care' is desired, if consistency of concepts and information were expanded across health and social welfare sectors. It would then be possible to obtain consistent data from health, aged care, disability and community services systems about key aspects of health and functioning, building a consolidated picture of access and experience across these sectors. Without attention to all three components of the Italian project and continuing effort to meet the challenges identified in this paper, it will not be possible to determine whether the goals of Australia's National Disability Agreement or the ambitions of the Convention are achieved. 2010-04-01T00:00:00Z SUBMISSION ON THE NATIONAL DISABILITY INSURANCE SCHEME BILL 2012 TO THE SENATE STANDING COMMITTEES ON COMMUNITY AFFAIRS JANUARY 2013 http://hdl.handle.net/2123/13579 Title: SUBMISSION ON THE NATIONAL DISABILITY INSURANCE SCHEME BILL 2012 TO THE SENATE STANDING COMMITTEES ON COMMUNITY AFFAIRS JANUARY 2013 Authors: Faculty of Arts and Sciences; Centre for Disability Research and Policy Abstract: The NDIS is an important and needed reform to Australia's disability system. There is much of merit in the NDIS Bill. Its implementation poses some challenges, to ensure a clear, sustainable and rights-based system, resulting in the outcomes desired by the community. This submission seeks to contribute to the current review of the draft NDIS legislation, and to the design and implementation of the Scheme. We have concentrated on areas where we believe we have something constructive to offer in the timeframe. None of our comments or suggestions implies a need for delay in the Scheme. Our suggestions are framed in the context of the United Nations Convention on the Rights of Person with Disabilities (CRPD), the technical framework of the International Classification of Functioning Disability and Health (ICF) and an entitlement-based service system which supports people's rights to participate in all areas of life and seeks to provide an environment which enables these rights to be exercised. Our main suggestions are as follows: Section 23: Residence criteria should be based on Medicare criteria, to promote the equity of the NDIS in the wider service system. Sections 24, 25, 27: Disability requirements and related rules should be based on an accurate representation of the ICF. Embedding the old linear causal model of disability in the Bill will lead to confusion, inefficiency and challenge. The idea of 'permanent impairment' is not helpful and should be changed. New provisions for these Sections are proposed. Some suggestions about the design of assessment instruments are included. Section 26: Our discussion provides some ideas about why and how additional expert reports may assist the process and the person with disability involved. A medical examination should not become routinely sought and nor should a health condition become part of the eligibility criteria. Long-term cost containment suggestions are made – including developing models which better estimate the costs of reasonable and necessary supports, as the NDIS matures and experience builds. Such measures are needed, to protect the universality and sustainability of the Scheme. Chapter 5 on compensation should be removed and replaced by government-togovernment agreements and compensation reforms, to preserve the primacy and universality of the NDIS, and to avoid the costs of adjustment being borne by individual people with disabilities. National statistics must be published as part of the Agency's responsibilities and as part of its public accountability for outcomes from the Scheme. As recommended by the Productivity Commission, data should be made available for research. Data should be based on the ICF so that it relates to population survey data and data from other sources based on this international standard. Such data must include information on the environment of people and the service system surrounding the ICF. A critical part of the Australian environment is information and communication Submission on NDIS Bill 25 January 2013 2 technologies; at present, however, there are shortfalls in access of Australians with disabilities to digital technologies — a 'disability digital divide'. Nationally, we have little precise idea about the scale, scope, and impact of this digital exclusion. This will affect, but can be remedied by, the administration of the Scheme. There should be at least 3 people on the NDIS Board with experience or knowledge of the provision or use of disability services (Section 127). There are lessons to be learned from international experience, service systems and the wider literature. Implications for the NDIS frameworks, principles and terminology are discussed in our final section. 2013-01-01T00:00:00Z Productivity Commission Inquiry into a National Disability Support Scheme "Treat disability related to injury the same as other disabilities" http://hdl.handle.net/2123/13578 Title: Productivity Commission Inquiry into a National Disability Support Scheme "Treat disability related to injury the same as other disabilities" Authors: Madden, Richard Abstract: The draft report Disability Care and Support contains an exciting vision of improved disability support for all people with disabilities, with provision as an entitlement to every Australian based on their need for support. This vision is strongly supported. It is quite unacceptable in a prosperous and fair society, as exists in Australia in 2011, that social security and universal health insurance provide a wide set of entitlement benefits, but that people with support needs due to disability have heavily rationed benefits, and that families bear the load of support in many cases, often with no or totally inadequate assistance. The Commission's report is a once in a generation opportunity to correct long standing injustices to people with disability and the injured, and to remove the inefficient and inequitable support and compensation systems that have grown up piecemeal over a century or more. The Commission is urged to build on its draft proposals and so provide a base for governments to grasp the opportunity provided for the complete reform that is necessary. 2011-05-01T00:00:00Z Submission to the Productivity Commission on Disability Care and Support 11 May 2011 http://hdl.handle.net/2123/13577 Title: Submission to the Productivity Commission on Disability Care and Support 11 May 2011 Authors: Madden, Ros; Bundy, Anita; Clemson, Lindy; Einfeld, Stewart; Gilroy, John; Glozier, Nick; Kayess, Rosemary; Llewellyn, Gwynnyth; Madden, Richard; Manga, Robert; Mpofu, Elias; Stancliffe, Roger Abstract: The authors of this submission welcome the Productivity Commission (PC) Draft Report and many of the key features of the proposed NDIS including: • the proposal for a scheme to provide long term care and support on an entitlement basis, • many of the accompanying features of the approach outlined, including the no fault basis of provision, the inclusion of aids and equipment, and the recognition of the need to include the full range of support services, • the acknowledgment of unmet demand and the need for significant new funding. Our comments on the draft report are made in the spirit that we endorse the main directions of the proposed scheme, which would be of great benefit to the Australian people, most especially people with disabilities and their families. We sincerely hope that governments will respond positively and promptly to the vision laid out in the Draft Report. We offer constructive criticism to maximise the chances of the scheme's success, in terms of enabling people to access the supports they need, on an equitable basis. In this submission we focus on 5 areas: 1. Eligibility and assessment 2. Assessment Tools 3. Overcoming access and equity barriers for Aboriginal communities 4. Research and Data 5. Governance 2011-05-01T00:00:00Z Submission to the Productivity Commission on Disability Care and Support http://hdl.handle.net/2123/13576 Title: Submission to the Productivity Commission on Disability Care and Support Authors: Madden, Ros; Bundy, Anita; Kayess, Rosemary; Llewellyn, Gwynnyth; Madden, Richard; Manga, Robert; Mpofu, Elias; Stancliffe, Roger Abstract: The authors of this submission welcome: • the proposal for a scheme to provide long term care and support on an entitlement basis, • many of the accompanying features of the approach outlined, including the no fault basis of provision, the inclusion of aids and equipment, and the recognition of the need to include the full range of support services, • the acknowledgment of unmet demand and the need for significant new funding. 2010-01-01T00:00:00Z Submission to the Productivity Commission - National Disability Long term Care and Support Scheme http://hdl.handle.net/2123/13575 Title: Submission to the Productivity Commission - National Disability Long term Care and Support Scheme Authors: Madden, Richard Abstract: This submission encourages and accepts the premises of a National Disability Long‐term Care and Support Scheme (the National Disability Scheme): • No fault • Entitlement based • Support provided in accordance with need for support • Focused on provision of and encouragement for habilitation and rehabilitation • Providing support for services to people with a disability, rather than income support • Integrates people with disabilities in society • Administratively simple and timely The following matters will be addressed • Criteria for the National Disability Scheme should be those set out by Woodhouse in 1973‐4 • Need to set aside provisions of current compensation systems that do not meet the principles of the NDS • Access to Medicare and other community wide health financing systems for all Australians requiring medical, hospital, medicines and other health services • The need for improved funding for habilitation and rehabilitation services • At the commencement of the Scheme, coverage should be limited for people first claiming after age 55 • Funding • Education and training 2010-08-01T00:00:00Z Evaluation of angiogenesis in different dermal regeneration templates, Integra, Pelnac, and Collagen-PCL scaffold, using a novel murine model http://hdl.handle.net/2123/13574 Title: Evaluation of angiogenesis in different dermal regeneration templates, Integra, Pelnac, and Collagen-PCL scaffold, using a novel murine model Authors: Mohaghegh, Mohammad Hassan Abstract: Dermal substitutes are widely used in Plastic surgery for the treatment of partial and full thickness skin defects. Polycaprolactone (PCL) is a promising biomaterial for tissue engineering due to its versatile mechanical properties. In the current study, host cell integration and angiogenesis were evaluated in PCL fabricated with electrospinning and freeze-dry methods and compared with those in Integra and Pelnac, two of the dermal regeneration templates. To this end, a mouse model of non-healing wound that reflected medium and large full-thickness skin injuries in humans was established. This model incorporated a splint around the wound using a rubber grommet. No reduction in the splinted wound was observed until the end of the study. Using this mouse model, Angiogenesis was assessed using IHC for CD146. In collagen-PCL, no CD146 positive cell was detected in freeze-dried PCL and only 26% blood vessels penetration was evident in electrospun PCL. In Integra and Pelnac however, 80% blood vessels penetration was observed. In conclusion, this study proposed a simple model for wound healing studies in human. With regards to the skin substitutes, the results showed that both Integra and Pelnac were superior to collagen-PCL scaffold in terms of stability, angiogenesis and the graft take. 2014-08-31T00:00:00Z Fetal alcohol spectrum disorders in Australia: prevention, diagnosis and intervention http://hdl.handle.net/2123/13573 Title: Fetal alcohol spectrum disorders in Australia: prevention, diagnosis and intervention Authors: Peadon, Elizabeth Marie Abstract: Alcohol consumption in pregnancy is common in Australia. It is one of the few potentially modifiable causes of poor pregnancy and child outcomes including the Fetal Alcohol Spectrum Disorders (FASD). Children with FASD have lifelong physical and neurodevelopmental problems. They are at risk of developing a range of secondary disabilities such as disrupted schooling, mental health issues, drug and alcohol problems, and experiencing trouble with the law. This thesis comprises four studies relating to the prevention, diagnosis and intervention of FASD in Australia. The work is discussed in a series of publications and a submitted manuscript. The first study is a literature review presented as a published monograph. The second study is a national survey of Australian women's knowledge and attitudes regarding alcohol consumption in pregnancy, and their preferred information sources about alcohol use in pregnancy. The third study is an international survey of FASD diagnostic clinics which was conducted to investigate specialist dedicated clinical service provision for the diagnosis and assessment of children with FASD. The final study is a systematic review to evaluate the evidence base for interventions for children with FASD. These studies have informed national prevention strategies and planning for clinical services. 2014-08-28T00:00:00Z Using technology to improve access to emergency mental health care in rural and remote Australia: an evaluation of the Mental Health Emergency Care-Rural Access Program (MHEC-RAP) http://hdl.handle.net/2123/13572 Title: Using technology to improve access to emergency mental health care in rural and remote Australia: an evaluation of the Mental Health Emergency Care-Rural Access Program (MHEC-RAP) Authors: Saurman, Emily Kay Abstract: The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) aims to improve access, safety, and service coordination of specialist emergency mental health care via telehealth technologies. The program was planned and developed in response to the population needs and unique geographic conditions to provide specialist care while maintaining and supporting the role of existing local services. It is the first to provide 24-hour access to a regionally-based team of specialists offering relevant and responsive information, support, and clinical services for all providers, patients, and residents needing emergency care from the rural and remote communities across western New South Wales (NSW), Australia. This evaluation of MHEC-RAP applied a case study methodology and the theory of access to determine whether the program provides accessible specialist emergency mental health care. The five individual studies reported here contribute to the evaluation aims of describing program activity, assessing the provision and experience of emergency mental health care through MHEC-RAP, examining program impact on access, and informing further program development, adaptation, and transferability. This evaluation is the first to examine emergency telepsychiatry use in EDs, to apply the time and motion study method to assess program efficiency, and to present a telepsychiatry model structure that may be adapted or implemented elsewhere. This evaluation offers evidence of a practical telepsychiatry program that is providing accessible emergency mental health care for consumers in communities across western NSW and is changing local practice and perspective. It also enhances the theory of access proposing a modification to the theory with the inclusion of a sixth concept - awareness. The individual study results can be used to guide the continuing development of MHEC-RAP as well as provide insights for program transferability or the development, delivery, and evaluation of other new and existing telepsychiatry services across Australia and abroad. 2015-03-31T00:00:00Z The implementation and evaluation of a community-based salt reduction strategy in Australia http://hdl.handle.net/2123/13571 Title: The implementation and evaluation of a community-based salt reduction strategy in Australia Authors: Land, Mary-Ann Abstract: OBJECTIVE: Salt reduction is a public health priority but there are few studies testing the efficacy of plausible salt reduction programs. METHODS: A multi-faceted, community-based salt reduction program using the Communication for Behavioral Impact framework was implemented in Lithgow, Australia. Single 24hr urinary samples were obtained from a total of 991 individuals, as well as, information about knowledge and behaviours relating to salt. FINDINGS: Mean salt intake fell from 8.8 g/day (SD=3.6g/day) in 2011 to 8.0(3.6) g/day in 2014 (-0.80, 95% confidence interval –1.2 to -0.3;p<0.001). There were significant increases in the proportion of participants that knew the recommended upper limit of salt intake (18% vs. 29%; p<0.001), the importance of salt reduction (64% vs. 78%; p<0.001), reported changing their behaviors to reduce their salt intake by using spices (5% vs. 28%; p<0.001) and avoiding eating out (21% vs. 34%; p<0.001). However, the proportions that checked food labels (30% vs. 25%; p=0.02) fell, as did the numbers avoiding processed foods (44% vs. 35%; p=0.006). CONCLUSION: Implementation of this multi-faceted program was associated with a ~10% reduction in salt consumption. These findings highlight the potential of well-designed health promotion programs to compliment other population-based strategies to bring about much-needed reductions in salt consumption. 2014-12-05T00:00:00Z Human neural precursor cells and iron-oxide nanoparticles: relevance to neurodevelopment and neural repair http://hdl.handle.net/2123/13570 Title: Human neural precursor cells and iron-oxide nanoparticles: relevance to neurodevelopment and neural repair Authors: Eamegdool, Steven Suprakit Abstract: We were able to identify neuroblasts as one of the main candidates involved in phagocytosing apoptotic cells which occurs during the peak of programmed-cell death in early neurogenesis. This biological phenomenon was found to be regulated through the P2X7 scavenger receptor, thus contributing towards a better understanding of the processes involved in the regulation of embryonic neurogenesis. Furthermore, we studied the interactions between nanoparticles and neural precursor cells in order to provide clinically relevant data for future cell transplantation studies and possible use in stem cell therapies. Nanoparticles at low concentrations proved to be viable contrast agents for labelling cells prior to MRI visualisation, however at higher concentrations the cells underwent apoptosis through the ablation of mitochondria function, offering a dual role as an MRI contrast agent or as a target-specific drug delivery vehicle. The biological impacts that nanoparticles had on neural precursor cell mitochondrial function suggests potential mechanisms involved in the pathogenesis of CNS-related diseases and damage, and hence possible therapeutic targets and treatment regimens. Overall, this thesis was able to enhance our understanding of neurodevelopment and neurodegeneration, as well as provide valuable information for future for cell tracking and transplantation studies. 2014-12-09T00:00:00Z Metal-templated synthesis of forward and reverse Fe(III)- or Ga(III)-desferrioxamine E and ringexpanded macrocycles http://hdl.handle.net/2123/13569 Title: Metal-templated synthesis of forward and reverse Fe(III)- or Ga(III)-desferrioxamine E and ringexpanded macrocycles Authors: Lifa, Tulip Abstract: Desferrioxamine E (DFOE) is a macrocyclic trihydroxamic acid-based siderophore that is produced by Streptomyces species for Fe acquisition. Macrocyclic molecules of this class have applications in biomedicine and imaging. This study aimed to synthesize metal-loaded DFOE and analogs using a metal-templated synthesis (MTS) approach from the cognate monomeric fragments. Chapter 2 described the synthesis of forward and retro hydroxamic acids as characterized by NMR, LC-MS and ESI-MS. These hydroxamic acids were subjected to metal templation and cyclization chemistry to synthesize metal-loaded DFOE and analogs. Chapter 3 and 4 described the synthesis of metal-loaded DFOE and ring-expanded macrocyclic analogs as determined by LC-MS and ESI-MS. The LC-MS results suggested that the metal-loaded retro analogs were more lipophilic than the forward isomers. This provides one rational for the predominance in nature of forward hydroxamic acids as effective Fe(III) solubilization agents. Chapter 5 described the synthesis of biotinylated desferrioxamine B (DFOB) using a new form of solid phase organic phase (SPOS) and solution phase chemistry as determined by NMR, LC-MS and ESI-MS. The thesis in total describes new synthetic methodologies to generate macrocyclic siderophore derivatives, and other siderophore adducts. 2015-03-03T00:00:00Z The influence of device and formulation parameters on aerosol electrostatics for pressurised metered dose inhalers http://hdl.handle.net/2123/13568 Title: The influence of device and formulation parameters on aerosol electrostatics for pressurised metered dose inhalers Authors: Chen, Yang Abstract: The aim of this thesis was to investigate the fundamental elements that influence aerosol electrostatic charge and performance of pressurised metered dose inhalers (pMDI). This was achieved by focusing on both physical and chemical parameters of the pMDI system, including orifice materials, geometries and formulation parameters. The electrostatic charges generated from pMDIs were successfully quantified using a modified Electrical Low Pressure Impactor (ELPI) and the magnitude and polarity of aerosol charges were found to be dependent on the actuator materials, nozzle geometries and the formulation used. Triboelectric charging trend was observed with different actuator materials selected from the triboelectric series, when using cone nozzle geometry actuators with drug free and low co-solvent pMDI formulations, respectively. Reversed charge polarities with higher throat deposition were observed with thermoplastic actuators, when curved nozzle geometries were used. The active pharmaceutical ingredients (API) dominated the charge profiles of pMDI formulations over actuator materials and nozzle designs. The studies presented in this thesis have provided valuable information with regards to the relationships between device/formulation parameters (actuator material, nozzle geometries and API) and aerosol electrostatic charge profiles generated from pMDI systems, hence provided fundamental knowledge for the future development of pMDIs and novel electrostatic spray systems. 2015-04-07T00:00:00Z The effect of the Roquin mutation on immunity to mycobacterium tuberculosis infection http://hdl.handle.net/2123/13567 Title: The effect of the Roquin mutation on immunity to mycobacterium tuberculosis infection Authors: Nagalingam, Gayathri Abstract: Mycobacterium tuberculosis is a major cause of mortality and morbidity worldwide. IFN-gamma (IFN-γ) is essential for the control of M. tuberculosis infection and increased expression of the costimulatory molecule, Inducible T cell Costimulator (ICOS) on CD4+ T cells has been found to enhance mycobacteria-specific IFN-γ production in TB patients. ICOS is a marker of T cell activation and is also expressed by T follicular helper (TFH) cells, the role of which in immunity to M. tuberculosis is not well understood. Sanroque (SAN) mice carry a point mutation in the E3 ligase gene, roquin, and display increased ICOS expression on their CD4+ T cells, resulting in enhanced T cell activation and increased numbers of TFH cells. Further, SAN mice also progressively develop autoimmune disease. In this thesis, young SAN mice were utilised to examine whether their increased ICOS expression and higher numbers of TFH cells would improve control of M. tuberculosis infection. SAN mice displayed enhanced control of early M. tuberculosis infection, resulting in delayed bacterial dissemination from the lung. By 8 weeks post infection however, despite the enhanced T cell activation and increased mycobacteria-specific IFN-γ production, the SAN mice were unable to maintain the control of chronic M. tuberculosis infection, with significantly higher bacterial load in the lungs and dysregulated granuloma formation compared with wild type (WT) mice. The mechanisms leading to this increased susceptibility were then investigated. Further findings indicated that the expression of the roquin mutation itself in both T cells and myeloid cells, and potentially non-haematopoietic cells is the cause of increased susceptibility to M. tuberculosis infection and this is independent of the numbers of TFH cells seen in the SAN mice. The role of TFH cells in immunity to intracellular pathogens is not clear. M. tuberculosis infection increases the number of TFH cells in C57Bl/6 mice. To dissect the function of TFH cells in response to M. tuberculosis, we differentiated naïve M. tuberculosis-specific CD4+ T cells in vitro into TFH-like cells producing high IL-21 and low levels of IFN-γ. When these cells were transferred into RAG1-/- mice, which were then infected with M. tuberculosis, they upregulated IFN-γ production, like TH1 cells and controlled M. tuberculosis infection more effectively than the transferred TH0 cells. These data suggest that TFH-like cells retain a degree of plasticity and can modulate their response to infection depending upon the stimuli received. In summary, these data demonstrate that both roquin and TFH cells play important roles in protective immunity against M. tuberculosis infection. 2014-11-03T00:00:00Z Mediating justice: investigating the framing of the 2006 Cole inquiry http://hdl.handle.net/2123/13566 Title: Mediating justice: investigating the framing of the 2006 Cole inquiry Authors: Walsh, Nonee Philomena Abstract: This study analyses the mediation and mediatisation of the Inquiry into certain Australian companies in relation to the UN Oil-for-Food Programme (The Cole Inquiry) which investigated whether breaches of United Nations' trade sanctions by Australia's monopoly wheat exporter, AWB Limited, broke any Australian law. This thesis explores how a political 'framing war' over responsibility for the scandal impacted on media coverage of the Cole Inquiry. Using qualitative methods and news-framing theory the thesis investigates how the Inquiry was reported, how legal and political communicators influenced news reportage and in turn how the media influenced the presentation of the Inquiry process. The study draws on expert interviews, news-framing and transcript analyses, and a case study to document and analyse interactions between the media, lawyers, and strategic communications professionals with a stake in shaping public perceptions of the Cole Inquiry. The study finds that media representations of the Inquiry were not just accurate accounts of legal process, but a co-production involving legal "performers," communications professionals, politicians and journalists. The research illustrates that journalists' professional practices respond to legal process and are shaped by legal communications. It indicates that lawyers appearing at the Inquiry can be seen as "performing" for the media and reacting to media coverage. It extends research on the role of court information officers as a 'bridge' between lawyers and journalists, indicating how such internal strategic communications professionals might also function as frame sponsors. A case study concludes that externally sponsored source material from politicians and political strategists had a marked impact on news journalists' framing of the Cole Inquiry. 2015-01-01T00:00:00Z