Genetics and public health - evolution, or revolution?

During the 19th and early 20th century, public health and genetics shared common ground through similar approaches to health promotion in the population. By the mid-20th century there was a division between public health and genetics, with eugenicists estranged and clinical genetics focused on single gene disorders, usually only relevant to small numbers of people. Now through a common interest in the aetiology of complex diseases such as heart disease and cancer, there is a need for people working in public health and genetics to collaborate. This is not a comfortable convergence for many, particularly those in public health. Nine main concerns are reviewed: fear of eugenics; genetic reductionism; predictive power of genes; non-modifiable risk factors; rights of individuals compared with populations; resource allocation; commercial imperative; discrimination; and understanding and education. This paper aims to contribute to the thinking and discussion about an evolutionary, multidisciplinary approach to understanding, preventing, and treating complex diseases.

The boundary lubrication of chemically grafted and cross-linked hyaluronic acid in phosphate buffered saline and lipid solutions measured by the surface forces apparatus

High molecular weight hyaluronic acid (HA) is present in articular joints and synovial fluid at high concentrations; yet despite numerous studies, the role of HA in joint lubrication is still not clear. Free HA in solution does not appear to be a good lubricant, being negatively charged and therefore repelled from most biological, including cartilage, surfaces. Recent enzymatic experiments suggested that mechanically or physically (rather than chemically) trapped HA could function as an “adaptive” or “emergency” boundary lubricant to eliminate wear damage in shearing cartilage surfaces. In this work, HA was chemically grafted to a layer of self-assembled amino-propyl-triethoxy-silane (APTES) on mica and then cross-linked. The boundary lubrication behavior of APTES and of chemically grafted and cross-linked HA in both electrolyte and lipid 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC) solutions was tested with a surface forces apparatus (SFA). Despite the high coefficient of friction (COF) of μ ≈ 0.50, the chemically grafted HA gel significantly improved the lubrication behavior of HA, particularly the wear resistance, in comparison to free HA. Adding more DOPC lipid to the solution did not improve the lubrication of the chemically grafted and cross-linked HA layer. Damage of the underlying mica surface became visible at higher loads (pressure >2 MPa) after prolonged sliding times. It has generally been assumed that damage caused by or during sliding, also known as “abrasive friction”, which is the main biomedical/clinical/morphological manifestation of arthritis, is due to a high friction force and, therefore, a large COF, and that to prevent surface damage or wear (abrasion) one should therefore aim to reduce the COF, which has been the traditional focus of basic research in biolubrication, particularly in cartilage and joint lubrication. Here we combine our results with previous ones on grafted and cross-linked HA on lipid bilayers, and lubricin-mediated lubrication, and conclude that for cartilage surfaces, a high COF can be associated with good wear protection, while a low COF can have poor wear resistance. Both of these properties depend on how the lubricating molecules are attached to and organized at the surfaces, as well as the structure and mechanical, viscoelastic, elastic, and physical properties of the surfaces, but the two phenomena are not directly or simply related. We also conclude that to provide both the low COF and good wear protection of joints under physiological conditions, some or all of the four major components of joints—HA, lubricin, lipids, and the cartilage fibrils—must act synergistically in ways (physisorbed, chemisorbed, grafted and/or cross-linked) that are still to be determined.

Sources, perceived usefulness and understanding of information disseminated to families who entered home quarantine during the H1N1 pandemic in Victoria, Australia: a cross-sectional study

Background Voluntary home quarantine of cases and close contacts was the main non-pharmaceutical intervention used to limit transmission of pandemic (H1N1) 2009 influenza (pH1N1) in the initial response to the outbreak of the disease in Australia. The effectiveness of voluntary quarantine logically depends on affected families having a clear understanding of what they are being asked to do. Information may come from many sources, including the media, health officials, family and friends, schools, and health professionals. We report the extent to which families who entered home quarantine received and used information on what they were supposed to do. Specifically, we outline their sources of information; the perceived usefulness of each source; and associations between understanding of recommendations and compliance. Methods Cross-sectional survey administered via the internet and computer assisted telephone interview to families whose school children were recommended to go into home quarantine because they were diagnosed with H1N1 or were a close contact of a case. The sample included 314 of 1157 potentially eligible households (27% response rate) from 33 schools in metropolitan Melbourne. Adjusting for clustering within schools, we describe self-reported 'understanding of what they were meant to do during the quarantine period'; source of information (e.g. health department) and usefulness of information. Using logistic regression we examine whether compliance with quarantine recommendations was associated with understanding and the type of information source used. Results Ninety per cent understood what they were meant to do during the quarantine period with levels of understanding higher in households with cases (98%, 95% CI 93%-99% vs 88%, 95% CI 84%-91%, P = 0.006). Over 87% of parents received information about quarantine from the school, 63% from the health department and 44% from the media. 53% of households were fully compliant and there was increased compliance in households that reported that they understood what they were meant to do (Odds Ratio 2.27, 95% CI 1.35-3.80). Conclusions It is critical that public health officials work closely with other government departments and media to provide clear, consistent and simple information about what to do during quarantine as high levels of understanding will maximise compliance in the quarantined population.

Viewpoints, creativity and embodied learning : developing perceptual and kinaesthetic skills in non-dancers studying undergraduate university drama

Viewpoints are a structural approach to training and directing for theatre. Originating from the innovative, inventive and exploratory approach of Mary Overlie and the self- confessed scavenger approach of Anne Bogart, Viewpoints offers a practical philosophy of working. As a training approach it begins with a disciplined engagement  of the body in space and time. The tangible elements of the Viewpoints provide a set of tasks on which the student can focus, thus freeing the imagination and spirit to  create. Yet at the same time the systematic logic of Viewpoints supports novice practitioners to begin to question their perception, invest in creative practice that demands action and exploration, and to deconstruct, re-organise and rebuild scores and sequences in the pursuit of theatre that is visceral and visual. This essay reports on undergraduate student experiences of learning Viewpoints. It interrogates the demands of embodied learning of the movement/structural system on non- ancers and examines student-actor experiences of embodied learning from multiple of subject positions – observer/participant/creator/reflector/actor.  

In defence of parole : why parole is essential to community safety

This article discusses recent moves to make parole harder to obtain for prisoners serving sentences, and explains why this is disastrous and counter-productive to public safety

Bollywood’s Australian yarn

 It’s 101 years since the birth of Bollywood, the world’s largest and most vibrant movie industry and, of course, that’s more than enough time to mature and alter, to grow arms and legs. For some time, but since the 1990s particularly, the connections between Australia and Bollywood have really taken hold. So sit back and enjoy a cinematic journey that’s sure to entertain. As a genre Bollywood has grown and developed over a period of 100 years, coloured by India’s history, politics, socio-economic conditions, culture, sensibilities, dreams, fantasies, hopes and expectations. The ever-increasing presence of the Indian diaspora in different parts of the world has helped to realise what we might think of as Bollywood’s cultural diplomacy project. Various Australian state tourism bodies have since supported Indian productions and used Bollywood stars as ambassadors to promote Australia as a welcoming nation. The 1996 film Indian has been credited for featuring the first appearance of kangaroos in Indian cinema. But I have noticed that as early as 1974, a Hindi film Majboor made first reference to Australia and its iconic boxing kangaroo. It featured Bollywood superstar Amitabh Bachchan with a poster captioned: ‘Just hop, skip and jump every Thursday to Perth Sydney’. Australia is now a hot destination for Bollywood as well as regional language film-makers, with a successful foray of films from Soldier (1998) to Bhaag Milkha Bhaag (2013). Over the past two decades, Australian films such as Holy Smoke! (1999), The Waiting City (2009), Save Your Legs! (2012), feature India, not just as a background location but as an integral part of the plot. Bollywood’s influence on Australia can be gauged by the direction of Australian film careers. Be it the Indian-Australian actress Pallavi Sharda (Besharam) or Australia’s bowling sensation Brett Lee (Asha and Friends), Mary Ann Evans – AKA Fearless Nadia, Louise Lightfoot, Tom Cowan, Bob Christo, Tania Zaetta (Salaam Namaste), Nicholas Brown (Kites), Tabrett Bethell (Dhoom 3), Rebecca Breeds (Bhaag Milkha Bhaag), Kristina Akheeva (Yamla Pagla Deewana 2), Emma Brown Garett (Yamala Pagla Deewana), Vimala Raman (Mumbai Mirror), Anusha Dandekar (Delhi Belly), and Maheep Sandhu (Shivam). In this paper I would focus on the journeys and stories of actors, chiefly Fearless Nadia, Bob Christo, and Pallavi Sharda; and also compare a few Bollywood films, particularly Kya Kehna (2000) and Salaam Namaste (2005) made on same theme but set in India and Australia respectively, to show how Australia as has been presented as sexually liberating, visually romantic, and fantastical land of beaches and beauties.

Salt intake assessed by 24 h urinary sodium excretion in a random and opportunistic sample in Australia

The gold standard method for measuring population sodium intake is based on a 24 h urine collection carried out in a random population sample. However, because participant burden is high, response rates are typically low with less than one in four agreeing to provide specimens. At this low level of response it is possible that simply asking for volunteers would produce the same results.

Managing women with acute physiological deterioration: student midwives performance in a simulated setting

OBJECTIVE: Midwives' ability to manage maternal deterioration and 'failure to rescue' are of concern with questions over knowledge, clinical skills and the implications for maternal morbidity and, mortality rates. In a simulated setting our objective was to assess student midwives' ability to assess, and manage maternal deterioration using measures of knowledge, situation awareness and skill, performance. METHODS: An exploratory quantitative analysis of student performance based upon performance, ratings derived from knowledge tests and observational ratings. During 2010 thirty-five student, midwives attended a simulation laboratory completing a knowledge questionnaire and two video, recorded simulated scenarios. Patient actresses wearing a 'birthing suit' simulated deteriorating, women with post-partum and ante-partum haemorrhage (PPH and APH). Situation awareness was, measured at the end of each scenario. Applicable descriptive and inferential statistical tests were, applied to the data. FINDINGS: The mean total knowledge score was 75% (range 46-91%) with low skill performance, means for both scenarios 54% (range 39-70%). There was no difference in performance between the scenarios, however performance of key observations decreased as the women deteriorated; with significant reductions in key vital signs such as blood pressure and blood loss measurements. Situation, awareness scores were also low (54%) with awareness decreasing significantly (t(32)=2.247, p=0.032), in the second and more difficult APH scenario. CONCLUSION: Whilst knowledge levels were generally good, skills were generally poor and decreased as the women deteriorated. Such failures to apply knowledge in emergency stressful situations may be resolved by repetitive high stakes and high fidelity simulation.

Dietary salt intake and discretionary salt use in two general population samples in Australia: 2011 and 2014

The limited Australian measures to reduce population sodium intake through national initiatives targeting sodium in the food supply have not been evaluated. The aim was, thus, to assess if there has been a change in salt intake and discretionary salt use between 2011 and 2014 in the state of Victoria, Australia. Adults drawn from a population sample provided 24 h urine collections and reported discretionary salt use in 2011 and 2014. The final sample included 307 subjects who participated in both surveys, 291 who participated in 2011 only, and 135 subjects who participated in 2014 only. Analysis included adjustment for age, gender, metropolitan area, weekend collection and participation in both surveys, where appropriate. In 2011, 598 participants: 53% female, age 57.1(12.0)(SD) years and in 2014, 442 participants: 53% female, age 61.2(10.7) years provided valid urine collections, with no difference in the mean urinary salt excretion between 2011: 7.9 (7.6, 8.2) (95% CI) g/salt/day and 2014: 7.8 (7.5, 8.1) g/salt/day (p = 0.589), and no difference in discretionary salt use: 35% (2011) and 36% (2014) reported adding salt sometimes or often/always at the table (p = 0.76). Those that sometimes or often/always added salt at the table and when cooking had 0.7 (0.7, 0.8) g/salt/day (p = 0.0016) higher salt excretion. There is no indication over this 3-year period that national salt reduction initiatives targeting the food supply have resulted in a population reduction in salt intake. More concerted efforts are required to reduce the salt content of manufactured foods, together with a consumer education campaign targeting the use of discretionary salt.

Interprofessional collaborative practice across Australasia: an emergent and effective community of practice

Individuals involved in fostering interprofessional collaborative practice in health are employed in the education, practice and political arenas. While the need to innovate and develop optimal training and practice is not new, the uniqueness of interprofessional collaborative practice is that it exists across professional backgrounds and transcends traditional hierarchies (entry-level to senior practitioners). As such, alternate models of support are required to assist champions to progress learning and innovation. One such model is a group of educators and practitioners networking across Australasia, resulting in the Australasian Community of Interprofessional Collaborative Practice (ACoIPCP). ACoIPCP is a lively community of practice (CoP) group across Australia and New Zealand, which is abreast of current activity in the relevant arenas and provides members with an avenue to share information and, therefore, respond appropriately to changes in the environment. Membership includes likeminded individuals who work in the area of interprofessional collaboration from a broad range of perspectives in both health education and practice. This paper describes the development of ACoIPCP and its aims, activities and achievements. By developing a community of practice framework in a cross-organisational environment, ACoIPCP members have been able to support one another, share resources, seek feedback and learn with and from one another to foster interprofessional collaborative practice within educational, clinical and political settings. Information about the processes and outcomes of ACoIPCP may provide guidance to others interested in facilitating learning and innovation through a community of practice model.

Building a better mousetrap (Exergame) to increase youth physical activity

Although exergames have been demonstrated to induce moderate levels of physical activity (PA) if played as designed, there is conflicting evidence on use of exergaming leading to increased habitual PA. Exergames have increased PA in some home and school studies, but not others. Exergames have been used in community centers to good effect, but this has not generally been validated with research. PA from exergames may be enhanced by innovative use of sensors, "fun"-enhancing procedures, tailored messaging, message framing, story or narrative, goal setting, feedback, and values-based messaging. Research is needed on PA-enhancing procedures used within exergames for youth to provide a firmer foundation for the design and use of exergames in the future.

Single-room usage patterns and allocation decision-making in an Australian public hospital: a sequential exploratory study

AIMS AND OBJECTIVES: The aims are to (1) measure occupancy rates of single and shared rooms; (2) compare single room usage patterns and (3) explore the practice, rationale and decision-making processes associated with single rooms; across one Australian public health service.

BACKGROUND: There is a tendency in Australia and internationally to increase the proportion of single patient rooms in hospitals. To date there have been no Australian studies that investigate the use of single rooms in clinical practice.

DESIGN: This study used a sequential exploratory design with data collected in 2014.

METHODS: A descriptive survey was used to measure the use of single rooms across a two-week time frame. Semi-structured interviews were undertaken with occupancy decision-makers to explore the practices, rationale decision-making process associated with single-room allocation.

RESULTS: Total bed occupancy did not fall below 99·4% during the period of data collection. Infection control was the primary reason for patients to be allocated to a single room, however, the patterns varied according to ward type and single-room availability. For occupancy decision-makers, decisions about patient allocation was a complex and challenging process, influenced and complicated by numerous factors including occupancy rates, the infection status of the patient/s, funding and patient/family preference. Bed moves were common resulting from frequent re-evaluation of need.

CONCLUSION: Apart from infection control mandates, there was little tangible evidence to guide decision-making about single-room allocation. Further work is necessary to assist nurses in their decision-making.

RELEVANCE TO CLINICAL PRACTICE: There is a trend towards increasing the proportion of single rooms in new hospital builds. Coupled with the competing clinical demands for single room care, this study highlights the complexity of nursing decision-making about patient allocation to single rooms, an issue urgently requiring further attention.

Walker Evans: documentary detachment, narrative sequences and telling juxtapositions

This paper will re-examine the long established position of Evans as the quintessential detached documentary style photographer. I propose that is only part of the story. Evans was the inventor of the clinically detached and knowing ‘documentary style’. However, we will see that his magazine portfolios and his portfolios in book form; function quite differently. I will argue they employ a surprisingly engaged pictorial narrative form that echoes his personal scrapbook arrangements of magazine cuttings, and international magazine tropes of the time. Evans arranges his otherwise detached documents in satirical juxtapositions and telling sequences. I will argue that the Vitruvius of the vernacular is after all, also an engaged and engaging storyteller.