The Anonymous Portrait

1. 'MotherDaughter', Six works, 75 cm x 75 cm each, watercolour and ink wash, charcoal, graphite, photocopy transfer, on Arches 300gsm 2. 'MotherDaughter II'. One work made up of 15 images, 30 cm x 37 cm each, watercolour and ink wash, charcoal, graphite, eye-shadow powders, photocopy transfer, on Arches 300gsm. 3. 'MotherSon'. One work made up of 15 images, 30 cm x 37 cm each, black and coloured photocopy transfers, on Arches 300gsm. 4. 'MotherSon II'. One work made up of 8 60 cm x 40.5 cm each, black and coloured photocopy transfers, on Arches 300gsm. 5. 'MotherSon III'. One work made up of 6 images, 60 cm x 40.5 cm each, black and coloured photocopy transfers, on Arches 300gsm. 6. 'FatherDaughter'. One work made up of fourteen images, 37.5 cm x 52.5 cm each, ink and watercolour wash, photocopy transfer, charcoal and graphite, on Arches 300gsm. 7. 'his/ her'. Twenty-six bound books, 25 cm x 23 cm x 1.5 cm each when closed, letterpress text and facial imprints (eye-shadow powders), charcoal, on Magnani Velata Arvorio 210gsm. 7. 'Closed Book'. Ten books comprising 10 to 12 drawings, 16.5 cm x 8 cm each image, photocopy transfer, charcoal, on Arches 300gsm.

Philosophy of childhood: the foundational childhood needs and wellbeing

 The foundational needs of children and wellbeing have been examined through the India chakra system. This new needs theory assists in the understanding children’s basic needs as well as a way to diagnose the unmet needs of children. The model has applications for psychological and education systems as well as parenting.

Associations between socioeconomic status and primary total knee joint replacements performed for osteoarthritis across Australia 2003-10: data from the Australian Orthopaedic Association National Joint Replacement Registry

Relatively little is known about the social distribution of total knee joint replacement (TKR) uptake in Australia. We examine associations between socioeconomic status (SES) and TKR performed for diagnosed osteoarthritis 2003-10 for all Australian males and females aged ≥30 yr.

Hepatitis C virus treatment in the 'real-world': how well do 'real' patients respond?

Background: Published clinical trials of the treatment of HCV are largely multicentre prospective pharmaceutical trials. Patients in clinical trials tend to have more favorable outcomes than patients in the 'real-world', due to strict patient selection and differences in treatment conditions and available resources. Objectives: To assess the outcomes of Hepatitis C infected patients treated at the Barwon Health Liver Clinic with combination Pegylated interferon (PEG-IFN) and Ribavirin (RBV) therapy and to determine factors associated with a treatment response. Methods: Retrospective review of patients who received treatment for Hepatitis C at our institution's Liver Clinic from January 2001-September 2011. Patient demographics, comorbidities, treatment-related parameters and side effects were extracted from medical records and analyzed. Results: A total of 190 patients (120 male, 70 female) with a mean age of 42.8 years (range 20-68 years) commenced treatment. The most common genotype was genotype 3 (48.9%), followed by genotype 1 (42.6%). 150 of 190 patients (78.9%) completed treatment and had end of treatment data available. 107 of 182 patients, (58.8%) for whom sustained virologic response (SVR) rate data was available achieved an SVR. Overall response rates were; 46.9%, 68.8% and 62.4% in genotypes 1, 2 and 3 respectively. The response rate was significantly lower in 29 patients with documented cirrhosis (20.7%). Age, diabetes and alcohol abuse did not predict treatment response in our cohort. Side effects reported in 81.6% of patients included general malaise, hematological disturbance and psychiatric issues, and necessitated cessation of therapy in 16 patients (8.4%) and dose reduction in 26 patients (13.7%). Conclusions: Response rates to combination PEG-IFN and RBV therapy at our institution are comparable to other 'real-world' and pharmaceutical registration trials. Side effects of combination therapy were prominent but resulted in fewer discontinuations of therapy compared to pharmaceutical trials.

Impact of high-sensitivity cardiac troponin I assays on patients presenting to an emergency department with suspected acute coronary syndrome

 Objective: To determine whether introduction of high-sensitivity cardiac troponin I (hscTn-I) assays aff ected management of patients presenting with suspected acute coronary syndrome (ACS) to the emergency department (ED) of a tertiary referral hospital. Design, patients and setting: A retrospective analysis of all patients presenting to the Geelong Hospital ED with suspected ACS from 23 April 2010 to 22 April 2013 -2 years before and 1 year after the changeover to hscTn-I assays on 23 April 2012. Main outcome measures: Hospital admission rates, time spent in the ED, rates of coronary angiography, rates of percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABGS), rates of discharge with a diagnosis of ACS, and rates of inhospital mortality. Results: 12 360 consecutive patients presented with suspected ACS during the study period; 1897 were admitted to Geelong Hospital in the 2 years before and 944 in the 1 year after the changeover to hscTn-I assays. Comparing the two patient groups, there was no statistically signifi cant diff erence in allhospital admission rates (95% CI for the diff erence, - 3.1% to 0.3%; P = 0.10) or proportion of patients subsequently discharged with a diagnosis of ACS (95% CI for the diff erence, - 2.3% to 5.4%; P = 0.43). After the changeover, the median time patients spent in the ED was 11.5% shorter (3.85 h v 4.35 h; 95% CI for the diff erence, - 0.59 to - 0.43; P < 0.001) and the proportion of admitted patients undergoing coronary angiography was higher (53.4% v 45.2%; 95% CI for the diff erence, 4.3 to 12.0 percentage points; P < 0.001), but there was no statistically signifi cant rise in the proportion of patients who had invasive treatment (PCI and/or CABGS) (95% CI for the diff erence, - 0.4% to 6.3%; P = 0.08). Inhospital mortality rates from ACS did not change signifi cantly (95% CI for the diff erence, - 1.5% to 0.8%; P = 0.43). Conclusion: The introduction of hscTn-I assays appeared to be associated with more rapid diagnosis, resulting in less time spent in the ED, without a change in hospital admission rates. A higher proportion of patients had coronary angiographies after the changeover, but there was no signifi cant change in rates of invasive treatment or inhospital mortality.

Health cosmopolitanism: melding universality and difference – the case of childbirth in post-conflict Timor Leste

ABSTRACTThis study will consider the case of TBAs (traditional birth attendants) under the health cosmopolitan banner. Fifteen interviews with health administrators, obstetricians, midwives, traditional birth attendants and women in Timor Leste, provide evidence : (1) that the WHO (1992) directive to dismiss the inclusion of TBAs within the formal maternity care system has been precipitous (2) that TBAs could, with adequate training in emergency obstetric techniques and hygienic practices, assist in meeting MDG No 5, and (3) that TBAs may assist in sustaining hybrid cosmologies and serving other cultural aims. Although Millennium Development Goals embrace the idea of the universal right to health, a human rights framework remains abstract and legalistic. I argue that health cosmopolitanism offers a more inclusive lens. Applied to maternity care it shifts childbirth to a central focus of government policy, obliges all nations to contribute international aid yet recognises the interpretation of complex needs at the local level. It defines a philosophy of care that is person-centred (not professional or institution-centred), ensures equal access to quality care (based not on ability to pay or other obstacles such as geographical distance) and choice of carer and modality (Western, traditional or hybrid). It underlines the argument here that TBAs trained in emergency obstetric care and hygiene and funded by international agencies would ensure every woman has a known carer, plus choice of location, modality and provider. Health cosmopolitanism thus embraces universality, individual autonomy, reciprocal respect and global responsibility.

Singh v The Queen: A Path Toward Confusion, Redundancy and Doctrinal Inconsistency

In Walkington v The Queen, the English Court of Criminal Appeal enunciated criteria fordetermining whether a building contains parts thereof for purposes of ss 76 and 77 of the CrimesAct 1958 (Vic): burglary and aggravated burglary respectively. In Singh v The Queen, the VictorianCourt of Appeal was confronted with a situation in which a trespassory entry had been made into abuilding that, according to the principles enunciated in Walkington, did not consist of any part orparts. Recognizing that there was scant evidence with which to prove that the accused’s entry hadbeen accompanied by an intention to commit one of the crimes specified in ss 76 and 77, the courtnonetheless affirmed the applicant’s conviction for aggravated burglary under s 77. In so doing,the court reaffirmed its earlier decision in The Queen v Chimirri which held that a trespassoryentry into a building results in continuing trespass for as long as the accused remains in thebuilding. In Chimirri, it was further held that if an accused forms an intention to commit one ofthe specified crimes subsequent to the initial trespassory entry and enters a part of the buildingwith that intention, he or she has committed burglary, aggravated burglary, or both by virtueof the continuing trespass doctrine. The discussion to follow will demonstrate that the court’sreasoning in both Chimirri and Singh is not only flawed, but flies in the face of the very passagesfrom the judgment of Lane LJ in Walkington that were quoted with apparent approval in Singh.The discussion will further demonstrate that the continuing trespass doctrine adds nothing of valueto the law of burglary as it existed prior to Chimirri and Singh; rather, its only effect is to addconfusion and uncertainty to what had been a settled area of the law.

FRAX (Aus) and falls risk: Association in men and women

Purpose: The WHO fracture risk prediction tool (FRAX®) utilises clinical risk factors to estimate the probability of fracture over a 10-year period. Although falls increase fracture risk, they have not been incorporated into FRAX. It is currently unclear if FRAX captures falls risk and whether addition of falls would improve fracture prediction. We aimed to investigate the association of falls risk and Australian-specific FRAX. Methods: Clinical risk factors were documented for 735 men and 602 women (age 40-90. yr) assessed at follow-up (2006-2010 and 2000-2003, respectively) of the Geelong Osteoporosis Study. FRAX scores with and without BMD were calculated. A falls risk score was determined at the time of BMD assessment and self-reported incident falls were documented from questionnaires returned one year later. Multivariable analyses were performed to determine: (i) cross-sectional association between FRAX scores and falls risk score (Elderly Falls Screening Test, EFST) and (ii) prospective relationship between FRAX and time to a fall. Results: There was an association between FRAX (hip with BMD) and EFST scores (. β=. 0.07, p<. 0.001). After adjustment for sex and age, the relationship became non-significant (. β=. 0.00, p=. 0.79). The risk of incident falls increased with increasing FRAX (hip with BMD) score (unadjusted HR 1.04, 95% CI 1.02, 1.07). After adjustment for age and sex, the relationship became non-significant (1.01, 95% CI 0.97, 1.05). Conclusions: There is a weak positive correlation between FRAX and falls risk score, that is likely explained by the inclusion of age and sex in the FRAX model. These data suggest that FRAX score may not be a robust surrogate for falls risk and that inclusion of falls in fracture risk assessment should be further explored.

Restoration of self-awareness of hypoglycemia in adults with long-standing type 1 diabetes: hyperinsulinemic-hypoglycemic clamp substudy results from the HypoCOMPaSS trial.

OBJECTIVE: Impaired awareness of hypoglycemia (IAH) and defective counterregulation significantly increase severe hypoglycemia risk in type 1 diabetes (T1D). We evaluated restoration of IAH/defective counterregulation by a treatment strategy targeted at hypoglycemia avoidance in adults with T1D with IAH (Gold score ≥4) participating in the U.K.-based multicenter HypoCOMPaSS randomized controlled trial. RESEARCH DESIGN AND METHODS: Eighteen subjects with T1D and IAH (mean ± SD age 50 ± 9 years, T1D duration 35 ± 10 years, HbA1c 8.1 ± 1.0% [65 ± 10.9 mmol/mol]) underwent stepped hyperinsulinemic-hypoglycemic clamp studies before and after a 6-month intervention. The intervention comprised the HypoCOMPaSS education tool in all and randomized allocation, in a 2 × 2 factorial study design, to multiple daily insulin analog injections or continuous subcutaneous insulin infusion therapy and conventional glucose monitoring or real-time continuous glucose monitoring. Symptoms, cognitive function, and counterregulatory hormones were measured at each glucose plateau (5.0, 3.8, 3.4, 2.8, and 2.4 mmol/L), with each step lasting 40 min with subjects kept blinded to their actual glucose value throughout clamp studies. RESULTS: After intervention, glucose concentrations at which subjects first felt hypoglycemic increased (mean ± SE from 2.6 ± 0.1 to 3.1 ± 0.2 mmol/L, P = 0.02), and symptom and plasma metanephrine responses to hypoglycemia were higher (median area under curve for symptoms, 580 [interquartile range {IQR} 420-780] vs. 710 [460-1,260], P = 0.02; metanephrine, 2,412 [-3,026 to 7,279] vs. 5,180 [-771 to 11,513], P = 0.01). Glycemic threshold for deterioration of cognitive function measured by four-choice reaction time was unchanged, while the color-word Stroop test showed a degree of adaptation. CONCLUSIONS: Even in long-standing T1D, IAH and defective counterregulation may be improved by a clinical strategy aimed at hypoglycemia avoidance.

Trafficking and protection: theorising reintegration and defining success

Grounded upon research in Cambodia, a theory of ‘reintegration’ is proposed for victims of sex-trafficking and benchmarks for assessing success. Drawing upon a cosmopolitan conception of shared vulnerability, it is argued that a life lived with dignity chiefly depends upon access to either modernist or traditional forms of reciprocal recognition.

The effect of surgical timing on the outcome of patients with neck of femur fracture

Aims: To investigate the effect of surgical timing (in hours versus after hours and weekdays versus weekends) on the outcome of patients with neck of femur fracture. Methods: Patients who were admitted to a single tertiary referral hospital for surgical management of femoral neck fractures over a continuous period from 1/11/2002 to 12/7/2012 were identified from medical records and the operating theatre database. Results: A consecutive series of 2334 patients were included in the study. Of the patients who underwent surgery during the weekday and during usual hours, 18 % (207/1135) experienced an adverse event, compared to 16 % (193/1199) outside of these times. The difference between the two groups was not significant (p = 0.17). The same conclusion was made for the comparison between those who had surgery during the week with those who had surgery on the weekend (17 %, 267/1546 and 17 %, 133/788, respectively, p > 0.05). The proportion of patients who underwent surgery during hours that experienced an adverse event was significantly higher than those undergoing surgery out of hours (18 %, 327/1789 and 13 %, 73/545, respectively, p = 0.0081). When adjusted for age, ASA score and pre-operative stay, there was no statistical difference between those different sub-groups. Conclusions: There was no difference in the rates of adverse events between patients who had surgery during hours and weekdays with those who had surgery after hours or weekends. The careful selection of patients with appropriate hospital staff, resources and adequate theatre access, surgery during after hours and weekends may be safely considered to prevent a delay in surgical treatment for patient with neck of femur fracture.

The epidemiology of incident fracture from cradle to senescence

To reduce the burden of fracture, not only does bone fragility need to be addressed, but also injury prevention. Thus, fracture epidemiology irrespective of degree of trauma is informative. We aimed to determine age-and-sex-specific fracture incidence rates for the Barwon Statistical Division, Australia, 2006-2007. Using radiology reports, incident fractures were identified for 5342 males and 4512 females, with incidence of 210.4 (95 % CI 204.8, 216.2) and 160.0 (155.3, 164.7)/10,000/year, respectively. In females, spine (clinical vertebral), hip (proximal femoral) and distal forearm fractures demonstrated a pattern of stable incidence through early adult life, with an exponential increase beginning in postmenopausal years for fractures of the forearm followed by spine and hip. A similar pattern was observed for the pelvis, humerus, femur and patella. Distal forearm, humerus, other forearm and ankle fractures showed incidence peaks during childhood and adolescence. For males, age-related changes mimicked the female pattern for fractures of the spine, hip, ribs, pelvis and humerus. Incidence at these sites was generally lower for males, particularly among the elderly. A similar childhood-adolescent peak was seen for the distal forearm and humerus. For ankle fractures, there was an increase during childhood and adolescence but this extended into early adult life; in contrast to females, there were no further age-related increases. An adolescent-young adult peak incidence was observed for fractures of the face, clavicle, carpal bones, hand, fingers, foot and toe, without further age-related increases. Examining patterns of fracture provides the evidence base for monitoring temporal changes in fracture burden, and for identifying high-incidence groups to which fracture prevention strategies could be directed.

Evolving epidemiology of injecting drug use-associated infective endocarditis: a regional centre experience

INTRODUCTION AND AIMS: Injecting drug use (IDU) is a major risk factor for infective endocarditis (IE). An understanding of the epidemiology of IE and IDU is vital for delivery of health care for this disease. Our aim was to examine the rates of IDU-associated IE (IDU-IE) in a single centre over the last 12 years. DESIGN AND METHODS: Retrospective analysis of two cohorts of consecutive patients (n = 226) admitted with IE from 2002 to 2013. Numbers of cases and rates of IE were compared between two cohorts (2002-2006 and 2009-2013). Rate ratios were calculated using Poisson distributions. Poisson regression was used to examine relationship over time. RESULTS: One hundred thirty cases of endocarditis were seen in the first observation period (6 IDU-IE) and 96 in the second observation period (15 IDU-IE). The estimated incidence rate of IE had fallen from 10.1 to 6.45 per 100, 000 person-years [rate ratio 0.64, 95% confidence interval (CI) 0.48, 0.85]. In contrast, the estimated incidence rate of IDU-E has risen from 0.48 to 0.79 per 100, 000 person-years (rate ratio 1.65, 95% CI 0.59, 4.57). Incidence rate regression suggests that the number of IDU-IE cases is expected to increase by a factor of 1.25 (95%CI 1.09-1.44) for each increase of 1 year. DISCUSSION AND CONCLUSIONS: Over the last decade, there has been a decrease in incidence rate and total number of cases of IE but a rise in rate and number of cases of IDU-IE. This may indicate increasing IDU or increased rates of endocarditis in intravenous drug users in this region. This finding may inform health-care planning in the area.

Pluralist risk cultures: the sociology of childbirth

Western medical approaches to childbirth typically locate risk in women’s bodies,making it axiomatic that ‘good’ maternity care is associated with medically trainedattendants. This logic has been extrapolated to developing societies, like Vanuatu, anIsland state in the Pacific, struggling to provide good maternity care in line with theWorld Health Organization’s Millennium Development Goals. These goals include thereduction of maternal mortality by two-thirds by 2015, but Vanuatu must overcomechallenging hurdles – medical, social and environmental – to achieve this goal.Vanuatu is a hybridised society: one where the pre-modern and modern coincide inparallel institutions, processes and practices. In 2010, I undertook an inductive study of30 respondents from four main subcultures – women living in outer rural communitieswith limited access to Western-trained health workers; women from inner urbancommunities with ease of access to medical clinics; traditional birth attendants whoare formally untrained but highly specialised and practised mainly in remote communities;and Western-trained medical clinicians (obstetricians and midwives). I invitedall the participants to comment on what constituted a ‘good birth’. In this article, Ishow that participants interpreted this variously according to how they believed theuncertainties of childbirth could be managed. Objectivist approaches that define risk asan objective reality amenable to quantifiable measurement are thus rendered inadequate.Interpretivist approaches better explain the reality that social actors not only findrisk in different sites but gravitate towards different practices, discourses and individualsthey can trust especially those with whom they feel a strong sense of community.Strategies are, therefore, formed less through scientific rationality but according tofeelings and emotions and the lived experience. The concept of risk cultures conveysthis complexity; they are formed around values rather than calculable rationalities. Riskcultures form self-reflexively to manage contingent circumstances.

Mixed feelings: Anglo-Indians and the distribution of the sensible in Indian cinema

Hollywood, and various regional cinemas in India typically represent Mixed-Race Anglo-Indians as a degenerate community marked by lax morals, alcoholism, and indolence. These stereotypical tropes typically generate indignant protests from members of this miniscule Indian community, and debates about the representation of Anglo-Indians focus on the injustices propagated by such stereotypes. This paper rethinks Anglo-Indian representation in cinema by drawing on Jacques Rancière’s concept of ‘the distribution of the sensible,’ which provides a cartography for understanding how one’s various identity assignations structure sensory experience. In other words those who are marginalized have ways of seeing and hearing from those occupy normative or dominant subject positions, and these differences are best approached in terms of neo-Kantian aesthetic judgment. It also argues, with Rancière, that ‘inequality’ is built into the distribution of the sensible. Drawing on a number of Indian and Hollywood films — including Aparna Sen’s 36 Chowringhee Lane (1981) Anjan Dutt’s Bada Din (1998) Ismail Merchant’s Cotton Mary (2000), Bow Barracks Forever (2004) and Harry McClure’s Going Away (2013) — the paper contends that Rancière’s ‘distribution of the sensible’ allows us to think through a politics that is connected to ‘aesthetic judgement’ as well as a politics of differentiation that informs our understanding of the function of minoritarian characters in narrative cinema.