Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis

BACKGROUND: Acute respiratory exacerbations (AREs) cause morbidity and lung function decline in children with chronic suppurative lung disease (CSLD) and bronchiectasis. In a prospective longitudinal cohort study, we determined the patterns of AREs and factors related to increased risks for AREs in children with CSLD/bronchiectasis. METHODS: Ninety-three indigenous children aged 0.5 to 8 years with CSLD/bronchiectasis in Australia (n = 57) and Alaska (n = 36) during 2004 to 2009 were followed for > 3 years. Standardized parent interviews, physical examinations, and medical record reviews were undertaken at enrollment and every 3 to 6 months thereafter. RESULTS: Ninety-three children experienced 280 AREs (median = 2, range = 0-11 per child) during the 3-year period; 91 (32%) were associated with pneumonia, and 43 (15%) resulted in hospitalization. Of the 93 children, 69 (74%) experienced more than two AREs over the 3-year period, and 28 (30%) had more than one ARE in each study year. The frequency of AREs declined significantly over each year of follow-up. Factors associated with recurrent (two or more) AREs included age < 3 years, ARE-related hospitalization in the first year of life, and pneumonia or hospitalization for ARE in the year preceding enrollment. Factors associated with hospitalizations for AREs in the first year of study included age < 3 years, female caregiver education, and regular use of bronchodilators. CONCLUSIONS: AREs are common in children with CSLD/bronchiectasis, but with clinical care and time AREs occur less frequently. All children with CSLD/bronchiectasis require comprehensive care; however, treatment strategies may differ for these patients based on their changing risks for AREs during each year of care.

Mathematical modeling for improved greenhouse gas balances, agro-ecosystems, and policy development: Lessons from the Australian experience

If the land sector is to make significant contributions to mitigating anthropogenic greenhouse gas (GHG) emissions in coming decades, it must do so while concurrently expanding production of food and fiber. In our view, mathematical modeling will be required to provide scientific guidance to meet this challenge. In order to be useful in GHG mitigation policy measures, models must simultaneously meet scientific, software engineering, and human capacity requirements. They can be used to understand GHG fluxes, to evaluate proposed GHG mitigation actions, and to predict and monitor the effects of specific actions; the latter applications require a change in mindset that has parallels with the shift from research modeling to decision support. We compare and contrast 6 agro-ecosystem models (FullCAM, DayCent, DNDC, APSIM, WNMM, and AgMod), chosen because they are used in Australian agriculture and forestry. Underlying structural similarities in the representations of carbon flows though plants and soils in these models are complemented by a diverse range of emphases and approaches to the subprocesses within the agro-ecosystem. None of these agro-ecosystem models handles all land sector GHG fluxes, and considerable model-based uncertainty exists for soil C fluxes and enteric methane emissions. The models also show diverse approaches to the initialisation of model simulations, software implementation, distribution, licensing, and software quality assurance; each of these will differentially affect their usefulness for policy-driven GHG mitigation prediction and monitoring. Specific requirements imposed on the use of models by Australian mitigation policy settings are discussed, and areas for further scientific development of agro-ecosystem models for use in GHG mitigation policy are proposed.

Lung disease in indigenous children

Children in indigenous populations have substantially higher respiratory morbidity than non-indigenous children. Indigenous children have more frequent respiratory infections that are, more severe and, associated with long-term sequelae. Post-infectious sequelae such as chronic suppurative lung disease and bronchiectasis are especially prevalent among indigenous groups and have lifelong impact on lung function. Also, although estimates of asthma prevalence among indigenous children are similar to non-indigenous groups the morbidity of asthma is higher in indigenous children. To reduce the morbidity of respiratory illness, best-practice medicine is essential in addition to improving socio-economic factors, (eg household crowding), tobacco smoke exposure, and access to health care and illness prevention programs that likely contribute to these issues. Although each indigenous group may have unique health beliefs and interfaces with modern health care, a culturally sensitive and community-based comprehensive care system of preventive and long term care can improve outcomes for all these conditions. This article focuses on common respiratory conditions encountered by indigenous children living in affluent countries where data is available.

Authorisation management in business process environments: An authorisation model and a policy model

This thesis provides two main contributions. The first one is BP-TRBAC, a unified authorisation model that can support legacy systems as well as business process systems. BP-TRBAC supports specific features that are required by business process environments. BP-TRBAC is designed to be used as an independent enterprise-wide authorisation model, rather than having it as part of the workflow system. It is designed to be the main authorisation model for an organisation. The second contribution is BP-XACML, an authorisation policy language that is designed to represent BPM authorisation policies for business processes. The contribution also includes a policy model for BP-XACML. Using BP-TRBAC as an authorisation model together with BP-XACML as an authorisation policy language will allow an organisation to manage and control authorisation requests from workflow systems and other legacy systems.

Digital literacy in theory, policy and practice: Old concerns, new opportunities

The increasing ubiquity and use of digital technologies across social and cultural life is a key challenge for educators engaged in helping students develop a range of literacies useful for school and beyond. Many young people's experience of communication and participation is now shaped by almost constant engagements with digital technologies and media, as well as with global digital cultures. This increasing access and use has given many young people the opportunity to engage deeply with global media cultures via popular music, television and film franchises, the worldwide computer games industry, or countless other subcultures that connect fans and interested others from around the world via the internet. 'Digital literacy' is often the term associated with the ability to traverse these, and other, online and offline worlds; the notion has long been synonymous with the idea that digital technologies now mediate perhaps a majority of our social interactions. These forms of engagement with the world have important implications for educators and school systems which have historically recognised only a very narrow set of legitimate literacies.

You're hot, then you're cold: Creative industries policy making in Australia

Much compelling evidence has emerged over the last two decades demonstrating the importance of Australia’s creative industries. In 2014, the Australian Bureau of Statistics confirmed that culture is ‘big business’ in this country. Yet despite this, interest by policy makers at all levels of government has been intermittent, at best. This chapter gives a brief history of policy development, and offers a number of reasons for why policy and politics have not focussed more resolutely on Australia’s creative economy. It finishes with a discussion of Australia’s ‘unfinished agenda’, one which demands attention not only by government, but also industry and higher education, if we are to properly meet both the challenges and opportunities before us.

Valuing Indigenous heritage through multimodal literacy

The study on which this presentation is based focuses on the particular ways in which students’ counter-narratives about race were embedded in multimodal and digital design in the development of a digital cultural heritage. The multimodal texts were analysed as a site for students’ views of Indigenous oppression in relation to the colonial powers and ownership of the land in Australian history. In this presentation, Kathy will demonstrate how pedagogies that explore counter-narratives of cultural heritage in the official curriculum can encourage students to reframe their own racial identity, while challenging dominant white, historical narratives of colonial conquest, race, and power. In the second part of this session, Indigenous Principal, John Davis and teachers from HymbaYumba Community Hub will provide a school-based, Indigenous panel to inspire educators with authentic ways to embed Indigenous knowledge in the curriculum.

Submission to the draft Migration Assurance Policy - Improving the transition to the fixed-line national broadband network review

The rights of individuals to self-determination and participation in social, political and economic life are recognised and supported by Articles 1, 3 and 25 of the International Covenant on Civil and Political Rights 1966.4 Article 1 of the United Nations’ Human Rights Council’s Resolution on the Promotion and Protection of Human Rights on the Internet of July 2012 confirms individuals have the same rights online as offline. Access to the internet is essential and as such the UN: Calls upon all States to promote and facilitate access to the Internet and international cooperation aimed at the development of media and information and communications facilities in all countries (Article 3) Accordingly, access to the internet per se is a fundamental human right, which requires direct State recognition and support.5 The obligations of the State to ensure its citizens are able, and are enabled, to access the internet, are not matters that should be delegated to commercial parties. Quite simply – access to the internet, and high-speed broadband, by whatever means are “essential services” and therefore “should be treated as any other utility service”...

The bias and assumptions in the Aboriginal and Torres Strait Islander Education Action Plan

This presentation argues that “genuine” engagement and consultation is required where Indigenous voice is included within the policy development process for “true” progress to be achieved. With the ever increasing engagement of Aboriginal and Torres Strait Islander people in the decision making processes of Indigenous education, it is anticipated that there will be provision of opportunities for better outcomes and a greater acceptance of the policy within community (Department of Prime Minister and Cabinet, 2014). This presentation is derived from a larger project where the Aboriginal and Torres Strait Islander Education Action Plan (MCEECDYA, 2011) was critically analysed using Fairclough’s (2001) Critical Discourse Analysis framework and Rigney’s (1999) Indigenist Research Principles. Within this study, the underlying assumptions and bias identified within the policy and how it positions Aboriginal and Torres Strait Islander people were articulated. The major findings that emerged from the data included: - a) the homogenous grouping of Aboriginal and Torres Strait Islander people; - b) the maintenance of the prevalent dominant ideology within policy, and finally; - c) the expectation by the power elite of increased engagement and connections by Aboriginal and Torres Strait Islander peoples without consideration of the detrimental effects of past policies and reforms.

A critical analysis of the Aboriginal and Torres Strait Islander Education Action Plan

This study involves the analysis of one of the most recent Indigenous Education policies, the Aboriginal and Torres Strait Islander Education Action Plan 2010-2014 (MCEECDYA, 2011). It examines how the language used within policy positions Aboriginal and Torres Strait Islander peoples. Articulating Rigney's (1999) Indigenist Research Principles with Fairclough's (2001) Critical Discourse Analysis provides a platform for critical dialogues about policy decision-making. In doing so, this articulation enables and emphasises the need for potential policy revision to contribute to the Aboriginal and Torres Strait Islander struggle for self-determination.

Governance and regional planning outcomes: Using governance indicators to support a policy implementation approach

Regional planning faces numerous decision making uncertainties related to the complex interdependencies between urban and regional centres. Questions about how to achieve sustainable planning solutions across regions are a key uncertainty and relate to a lack of information about the actual achievement of outcomes as proposed by the objectives of a plan. Regional plan implementation and its impact on environmental, social and economic outcomes have been little explored within Australian urban and regional planning research. Despite a desire to improve the conditions across Australian regions, ambiguity persists regarding the results of regional planning efforts. Of the variables affecting regional planning, scholars argue that governance has a significant impact on achieving outcomes (see Pahl-Wostl 2009). In order to better analyse the impact of governance, we propose a set of governance indicators to examine decisions across regional planning institutions and apply this to governance models across Queensland’s regions. We contend that these governance indicators can support a more rigorous assessment of the impacts of governance models on plan implementation and outcomes. We propose that this is a way to better understand the relationship between planning and outcomes across urban and regional areas.

Drink driver rehabilitation and new developments

Drink driving continues to be a major public health concern. Significant reductions in road fatalities have been achieved due largely to the Safe Systems Approach to road safety. However, serious injury due to road trauma has increased in most Australian jurisdictions. Some subgroups of drink drivers such as young drivers and Indigenous drink drivers are vulnerable to road trauma and have been less responsive to countermeasures based on the deterrence philosophy. Drink driving rehabilitation programs that use a combination of deterrence, education and social control models have been moderately successful in reducing recidivism. However, most of these programs do not adequately address alcohol related health concerns or the needs of drink drivers in remote and rural areas. Scant attention has also been given to the use of brief online drink driving interventions. The ‘Under the Limit’ (UTL) drink driving rehabilitation program has recently been revised to ensure that its content is contemporary, relevant and evidenced based. CARRS-Q has also developed a brief online program that targets first time convicted drink drivers who have a BAC under 0.15g/100mL and a culturally sensitive program that targets Aboriginals and Torres Strait Islanders living in rural and remote areas. These new developments will be discussed in the context of the most effective road safety educational policy and practice.

What’s law got to do with it?: Medical negligence, causation and the use of policy

In a medical negligence context, and under the causation provisions enacted pursuant to Civil Liability Legislation in most Australian jurisdictions, the normative concept of “scope of liability” requires a consideration of whether or not and why a medical practitioner should be responsible for a patient’s harm. As such, it places a limit on the extent to which practitioners are deemed liable for a breach of the duty of care owed by them, in circumstances where a legal factual connection between that breach and the causation of a patient’s harm has already been shown. It has been said that a determination of causation requires ‘the identification and articulation of an evaluative judgement by reference to “the purposes and policy of the relevant part of the law”’: Wallace v Kam (2013) 297 ALR 383, 388. Accordingly, one of the normative factors falling within scope of liability is an examination of the content and purpose of the rule or duty of care violated – that is, its underlying policy and whether this supports an attribution of legal responsibility upon a practitioner. In this context, and with reference to recent jurisprudence, this paper considers: the policy relevant to a practitioner’s duty of care in each of the areas of diagnosis, treatment and advice; how this has been used to determine an appropriate scope of liability for the purpose of the causation inquiry in medical negligence claims; and whether such an approach is problematic for medical standards or decision-making.

Cough and ARI outcomes in urban Indigenous Children

Aim To identify cough epidemiology and outcomes in urban Indigenous children Methods An ongoing prospective cohort study of Indigenous children aged <5 years registered with at an urban Indigenous primary health care centre, Brisbane. Detailed baseline data are collected and, children are followed monthly for 12 months to capture ARI events. Children who develop cough as a symptom at any time over the 12 months have weekly follow-up for four weeks to ascertain cough outcomes. Results To date, 118 children have been enrolled (535 child-months of observation); Respiratory illnesses accounted for 23 (19 %) of overall reported reasons for presentation, however respiratory symptoms were present in 41 (35%) of all visits; a dry cough in 22 (18%), wet cough in 31 (26%). To date, 99 ARI’s have been recorded with an incidence of 18.4 episodes/100 child months. Seventeen children (14.4%) had persistent cough at day 28. Conclusion This is the first study to comprehensively describe the incidence and outcomes of cough in urban Indigenous children. Early data suggest respiratory illnesses are the most common illnesses for which these children seek medical advice and there is a high prevalence of wet cough.