The establishment and development of neurosurgery services in Papua New Guinea

BACKGROUND: Papua New Guinea (PNG) is a developing Pacific Nation of 7.3 million people. Although neurosurgery training was introduced to PNG in the year 2000, it was in 2003 that a neurosurgery service was established. Prior to this time, neurosurgery in PNG was performed by general surgeons, with some assistance from visiting Australian neurosurgeons. Neurosurgical training was introduced to PNG in 2000. The model involved a further 3 years of training for a surgeon who had already completed 4 years of general surgical training. We aim to review the output, outcomes and impact achieved by training the first national neurosurgeon. METHODS: The data on activity (output) and outcomes were collected prospectively from 2003-2012. Ongoing mentoring and continuing professional development were provided through annual neurosurgical visits from Australia. There were serious limitations in the provision of equipment, with a lack of computerized tomographic or MR imaging, and adjuvant oncological services. RESULTS: There were 1618 neurosurgery admissions, 1020 neurosurgical procedures with a 5.74 % overall mortality. Seventy percent of cases presented as emergencies. There were improved outcomes, particularly for head injuries, whilst hydrocephalus was managed with an acceptable morbidity and revision rate. CONCLUSIONS: The training of a neurosurgeon resulted in PNG patients receiving a better range of surgical services, with a lower mortality. The outcomes able to be delivered were limited by late presentations of patients and lack of resources including imaging. These themes are familiar to all low- and middle-income countries (LMICs) and this may serve as a model for other LMIC neurosurgical services to adopt as they consider whether to establish and develop neurosurgical and other sub-specialist surgical services.

Management of obesity: attitudes and practices of Australian dietitians

OBJECTIVE: To document attitudes and current practices of Australian dietitians in the management of overweight and obesity, and to examine their training needs.

DESIGN: Cross-sectional postal survey of a randomly selected sample of members of the Dietitians Association of Australia.

SUBJECTS: 400 dietitians (66% of those surveyed).

MEASURES: Questionnaire-based measures of dietitian's views of obesity, education and training in weight management, definitions and perceptions of success, professional preparedness, approaches to weight management, strategies recommended for weight management, and problems and frustrations experienced.

RESULTS: Dietitians viewed themselves as potential leaders in the field of weight management, and saw this area as an important part of their role. While they considered themselves to be the best-trained professionals in this area, many felt that their training was poor and many were pessimistic about intervention outcomes. Despite this, most dietitians held views that were current, and regularly employed many of the elements of known best practice in management. However, important areas of weakness included: providing opportunities for long-term follow-up; providing a range of management interventions; promoting self-monitoring of diet and exercise; and promoting opportunities for social support.

CONCLUSIONS: This study suggests that training in and advocacy for the management and prevention of overweight and obesity are priority areas for dietitians, and that formal studies to evaluate dietitians' effectiveness in management should be undertaken.

A multi-level approach to planning and scheduling resources for aviation training

This paper describes a multi-level system dynamics (SD) / discrete event simulation (DES) approach for assessing planning and scheduling problems within an aviation training continuum. The aviation training continuum is a complex system, consisting of multiple aviation schools interacting through interschool student and instructor flows that are affected by external triggers such as resource availability and the weather.
SD was used to model the overall training continuum at a macro level to ascertain relationships between system entities. SD also assisted in developing a shared understanding of the training continuum, which involves constructing the definitions of the training requirements, resources and policy objectives. An end-to-end model of the continuum is easy to relate to, while dynamic visualisation of system behaviour provides a method for exploration of the model.
DES was used for micro level exploration of an individual school within the training continuum to capture the physical aspects of the system including resource capacity requirements, bottlenecks and student waiting times. It was also used to model stochastic events such as weather and student availability. DES has the advantage of being able to represent system variability and accurately reflect the limitations imposed on a system by resource constraints.
Through sharing results between the models, we demonstrate a multi-level approach to the analysis of the overall continuum. The SD model provides the school’s targeted demand to the DES model. The detailed DES model is able to assess schedules in the presence of resource constraints and variability and provide the expected capacity of a school to the high level SD model, subjected to constraints such as instructor availability or budgeted number of training systems. The SD model allows stakeholders to assess how policy and planning affect the continuum, both in the short and the long term.
The development of this approach permits moving the analysis of the continuum between SD and DES models as appropriate for given system entities, scales and tasks. The resultant model outcomes are propagated between the continuum and the detailed DES model, iteratively generating an assessment of the entire set of plans and schedule across the continuum. Combining data and information between SD and DES models and techniques assures relevance to the stakeholder needs and effective problem scoping and scaling that can also evolve with dynamic architecture and policy requirements.
An example case study shows the combined use of the two models and how they are used to evaluate a typical scenario where increased demand is placed on the training continuum. The multi-level approach provides a high level indication of training requirements to the model of the new training school, where the detailed model indicates the resources required to achieve those particular student levels.

The establishment of DOHaD working groups in Australia and New Zealand

The evidence underpinning the developmental origins of health and disease (DOHaD) is overwhelming. As the emphasis shifts more towards interventions and the translational strategies for disease prevention, it is important to capitalize on collaboration and knowledge sharing to maximize opportunities for discovery and replication. DOHaD meetings are facilitating this interaction. However, strategies to perpetuate focussed discussions and collaborations around and between conferences are more likely to facilitate the development of DOHaD research. For this reason, the DOHaD Society of Australia and New Zealand (DOHaD ANZ) has initiated themed Working Groups, which convened at the 2014-2015 conferences. This report introduces the DOHaD ANZ Working Groups and summarizes their plans and activities. One of the first Working Groups to form was the ActEarly birth cohort group, which is moving towards more translational goals. Reflecting growing emphasis on the impact of early life biodiversity - even before birth - we also have a Working Group titled Infection, inflammation and the microbiome. We have several Working Groups exploring other major non-cancerous disease outcomes over the lifespan, including Brain, behaviour and development and Obesity, cardiovascular and metabolic health. The Epigenetics and Animal Models Working Groups cut across all these areas and seeks to ensure interaction between researchers. Finally, we have a group focussed on 'Translation, policy and communication' which focusses on how we can best take the evidence we produce into the community to effect change. By coordinating and perpetuating DOHaD discussions in this way we aim to enhance DOHaD research in our region.

Projecting the burden of diabetes in Australia - what is the size of the matter?

OBJECTIVE: To analyse the implications of using different methods to predict diabetes prevalence for the future. APPROACH: Different methods used to predict diabetes were compared and recommendations are made. CONCLUSION: We recommend that all projections take a conservative approach to diabetes prevalence prediction and present a 'base case' using the most robust, contemporary data available. We also recommend that uncertainty analyses be included in all analyses. IMPLICATIONS: Despite variation in assumptions and methodology used, all the published predictions demonstrate that diabetes is an escalating problem for Australia. We can safely assume that unless trends in diabetes incidence are reversed there will be at least 2 million Australian adults with diabetes by 2025. If obesity and diabetes incidence trends, continue upwards, and mortality continues to decline, up to 3 million people will have diabetes by 2025, with the figure closer to 3.5 million by 2033. The impact of this for Australia has not been measured.

Determinants of growth of the flammable grass, Triodia scariosa: consequences for fuel dynamics under climate change in the Mediterranean region of South Eastern Australia

Environmental conditions may influence the presence and strength of competitive interactions between different life forms, thereby shaping community composition and structure, and corresponding fuel dynamics. Woodland and shrubland communities of the Mediterranean climate region of South Eastern Australia contain a varied mixture of herbaceous and woody plants. The ratio of herbaceous to woody plants changes along gradients of temperature, moisture and soil fertility. This study aimed to experimentally examine the relative importance of, and interactions between environmental controls (moisture and soil fertility) on the balance of dominant herbaceous (Triodia scariosa) and woody plants (e.g. Acacia ligulata and Leptospermum coriaceum) and their ultimate effects on fuel and fire regimes. The results suggest that environmental determinants of the growth of T. scariosa are likely to be more important than interactions with shrubs in controlling the distribution of T. scariosa. The growth of T. scariosa was consistently higher under hot temperatures and on the less fertile yellow sands, which dominate the south of the region. The results suggest that there is strong potential for the distribution and abundance of T. scariosa to be altered in the future with changes in temperature associated with climate change. The distribution of soil types across the Mediterranean climate region of South Eastern Australia may be predisposed to favour the southerly expansion of T. scariosa-dominated communities in the future under a warmer climate.

The role of instability rehabilitative resistance training for the core musculature

Neuromuscular training of the spinal stabilizing musculature is relevant for lower back pain prevention and treatment. instability resistance exercises promote cocontractions, increasing joint stability. of greatest importance to joint stability is not necessarily strength or endurance but motor control. dynamic provocative calisthenic exercises may improve core stabilizing functions. higher core muscle activation is possible with stable ground-based exercises. performing resistance exercises on unstable surfaces may have benefits in joint injury prevention and improving balance; however, strength gains could be compromised. higher levels of dynamic stabilization may be recommended with rehabilitation but should only be one component of a periodized plan.

Recreational drug use within the employees of the mariculture and seafood industry in South Australia

A study of recreational drug use among workers in the Port Lincoln mariculture and seafood industries was conducted by self report questionnaire. High rates of cannabis and alcohol use were revealed during the shore based fish farming season. The occupational health and safety implications of these findings in one of Australia's most dangerous industries are significant. Further research could inform the development of industry specific harm minimisation policies.

The performance of the urban water and wastewater sectors in Australia

Substantial structural reform has occurred in the water and wastewater sectors of Australia's major urban centers over the past two decades. This reform has involved the corporatization of government assets and some vertical and horizontal separation. This paper analyses the performance of these sectors since the mid 1990s. In particular, it uses Malmquist Data Envelopment Analysis (DEA) to determine the different levels of productivity and efficiency improvement over this period. The results point to modest, but positive productivity gains in the larger urban centers, independent of industry structure. Further, it highlights the need to consider exogenous factors that can influence productivity outcomes in an industry generally associated with monopoly characteristics and dependent on water sources that are, to varying extents, unpredictable and uncontrollable.

Changes in intravenous fluid use patterns in Australia and New Zealand: evidence of research translating into practice

OBJECTIVES: To describe changes in the use of intravenous (IV) fluid by quantity and type in different regions of Australia and New Zealand. DESIGN, SETTING AND PARTICIPANTS: We conducted a retrospective ecological study examining regional and temporal trends in IV fluid consumption across Australia and New Zealand over the periods 2012-2013 and 2013- 2014, using national proprietary sales data as a surrogate for consumption, and demographic data from the public domain. RESULTS: More than 13.3 million litres of IV fluid were consumed in Australia and New Zealand in 2012-2013, and more than 13.9 million litres in 2013-2014, with colloid solutions accounting for < 2%. There was marked regional variation in consumption of fluids, by volumes and proportions used, when standardised to overall Australian and New Zealand values. There was no significant change in the overall volume of crystalloid solutions consumed but there was a significant decrease (9%; P = 0.02) in the ratio of unbalanced to balanced crystalloid solutions consumed. Consumption of all forms of colloid solutions decreased, with a 12% reduction overall (P = 0.02), primarily driven by a 67% reduction in the consumption of hydroxyethyl starch (HES) solutions. CONCLUSIONS: The amount and type of IV fluid use, as determined by fluid sales, is highly variable across Australia and New Zealand. However, overall use of balanced crystalloid solutions is increasing and the use of HES has decreased dramatically.

"It's just everywhere!" Children and parents discuss the marketing of sports wagering in Australia

OBJECTIVE: To investigate how children and adults recall the content and promotional channels for sports wagering marketing. METHODS: A mixed methods study of 152 parent/child (8-16 years) dyads was conducted at AFL (Australian Football League), NRL (National Rugby League), and soccer sporting sites in New South Wales and Victoria, Australia. Questions related to the frequency of viewing AFL and NRL matches, sports wagering promotions and perceptions of the normalisation of wagering in sport. Descriptive statistics and thematic analysis were used to analyse data. RESULTS: Children recruited from NRL (n=75, 96.2%) and AFL (n=46, 92.0%) sites were significantly more likely to have recalled having ever seen a promotion for sports wagering as compared to children from Soccer sites (n=18, 75.0%) (p<0.05). Children and adults identified seeing sports wagering promotions in similar environments, most commonly on television, and at stadiums. Three-quarters of children (75.0%) and the majority of adults (90.0%) perceived that sports wagering was becoming a normal part of sport. CONCLUSION AND IMPLICATIONS: This research shows that children engaged in particular sports have high awareness of wagering marketing, particularly as seen on television or at sporting matches. Regulation should comprehensively address the placement, quantity and content of wagering marketing aligned with sport to prevent current and/or future gambling harm.

From human capacity development to national capacity development : a report on capacity development in the economic and public sectors of PNG during 2006-2013

This Report concerns capacity development in the economic and public sectors of PNG. In particular, it focuses on the use of advisers to develop the capacity of PNG counterparts in economic and public sector agencies. Such advisers were funded by the Government of Australia and completed or commenced their placements during the period 2006–2013. The research was commissioned by (then) AusAID and commenced in mid-2012. It was completed in mid-2014 under the auspices of Australian Aid, Department of Foreign Affairs & Trade. The project was overseen by the Economic and Public Sector Program administered by Coffey International. The research addressed several research questions about adviser-counterpart placements: What are the advisers’ and counterparts’ views of the success or otherwise of their partnerships in achieving their placements’ stated aims? What approaches were adopted to enable counterparts to learn what was required to fulfil their placements’ aims? What were the main things learned by counterparts? What can be understood from these experiences and how might capacity development be improved? What were the main enablers of and impediments to the success of the placements? What have been the outcomes of the introduction of other modalities of capacity development including short-term consultants, twinning arrangements, targeted training, grants and research? Do these modalities provide increased efficiencies and effectiveness compared to adviser-counterpart placements? What are the main improvements that can be made to ensure the success of future adviser-counterpart placements? What do major stakeholders in PNG conclude from the evidence produced by this study about the impact and success of adviser-counterpart placements? What may be asserted from the evidence of the worth or otherwise of adviser-counterpart placements and other capacity development modalities undertaken since 2006? What suggestions or recommendations may be made for the future?

Voices of dissent: Unpacking Vietnamese international student experience

Purpose – This study examines Vietnamese international students’ experiences with thecampus learning environment by analysing differences in staff and student perceptions.Design/methodology/approach – Two focus groups (N = 12) and ten (10) in-depthinterviews were conducted with Vietnamese students and four (4) in-depth interviews withthe university staff (totalling 26).Findings – The findings show a greater divergence of views between students and staff onteaching and learning than English language proficiency and student support services.These key differences were influenced by students’ prior expectations of their learningenvironment.Research limitations/implications – This study is limited to one group of internationalstudents and to one Australian university.Practical implications – The academics and administrators must have a goodunderstanding of international students’ learning backgrounds and expectations to enhancetheir positive experience; Appropriate teaching skills and practices are essential foracademics to meet the current needs of students. More effective training for internationalstudents to understand the multicultural nature of Australia is also essential.Originality/value – This study contributes to the literature by identifying the experienceof Vietnamese international students in a western university, which is, a relatively underresearchednationality compared to other Asian nationalities such as Chinese and Indian.