Withholding and withdrawing life-sustaining treatment in a patient's best interests : Australian judicial deliberations

•Intractable disputes about withholding and withdrawing life-sustaining treatment from adults who lack capacity are rare but challenging. Judicial resolution may be needed in some of these cases. •A central concept for judicial (and clinical) decision making in this area is a patient's “best interests”. Yet what this term means is contested. •There is an emerging Supreme Court jurisprudence that sheds light on when life-sustaining treatment will, or will not, be judged to be in a patient's best interests. •Treatment that is either futile or overly burdensome is not in a patient's best interests. Although courts will consider patient and family wishes, they have generally deferred to the views of medical practitioners about treatment decisions.

Building community capacity for end of life : an investigation of community capacity and its implications for health-promoting palliative care in the Australian Capital Territory

This study identified and examined community-based activities around death, dying and end-of-life care which might reflect a health-promoting palliative care (HPPC) philosophy. This approach is argued to restore community ownership of, and agency in, dying and death through the building of community capacity. However, the enactment of the HPPC approach has not been extensively examined in Australia. Current understandings of community capacity-building relating to end of life are orientated toward service provision. A qualitative interpretive approach was used to engage with local community groups in the Australian Capital Territory with an interest in death, dying and end-of-life care. Data were collected from ten in-depth, semi-structured interviews and thematically analysed. The themes of Practical Support, Respect and Responsiveness and Connection and Empowerment were identified, reflecting community activities initiated in response to the experience of life-limiting illness. Building community capacity offers to restore community agency in end-of-life concerns, while potentially enhancing health service provision through collaborative partnerships. This study indicates an existing community capacity, demonstrated by activities that promote socialisation, peer support and normalisation of death and dying. However, as these activities occur primarily in response to illness, proactive and preparatory interventions in HPPC are a priority.

Informal caring networks for people at end of life: Building social capital in Australian communities

The care of a person living at home near the end of their life is predominantly provided by family carers with the support of health services such as palliative care. In addition, informal caring networks also contribute at times to the support to the dying person and their carer. In this way, these networks can promote social capital in the communities from which they are drawn. This social approach to end of life care enhances community capacity to provide support to those dying at home and their carers. This article examines relevant published literature to explore the conceptual foundations of informal caring networks, examining the place of social capital and community development in the provision of end of life care at home, particularly in the Australian context.

Speaking to the deceased child : Australian Health Professional perspectives in paediatric end-of-life care

Supporting a dying child and family surrounding the child’s death is one of the most significant and challenging roles undertaken by health professionals in paediatric end of life care. An Australian study of parent and health professional constructions of meanings around post mortem care and communication revealed the practice of health professionals speaking to a child after death. This practice conveyed respect for the personhood of the deceased child, recognised the presence of the deceased child, and assisted in involving parents in their child’s post-mortem care. Such findings illuminate an area of end of life care practice that is not often addressed. Talking to a deceased child appeared as a socially symbolic practice that may promote a continued bond between parent and child.

A sunburnt country – storms, surges and sea levels : of insurance and flooding rains

Increasing population pressures and life-style choices are resulting in more people living in areas that are at risk of inundation from rising sea levels and flooding. However, following natural disaster events, such as the 2011 Queensland floods, many Australians discovered they were uninsured. Either their insurance policies did not cover flood; or multiple (and confusing) water-related definitions led them to believe they had cover when they did not. Several theories are analysed to try to explain what is a world-wide underinsurance problem but these do not provide an answer to the problem. This research focuses on uncovering the reasons consumers fail to adequately insure for flood and other water-related events. Recent Australian legislative attempts to overcome insureds’ confusion of water related definitions are examined for this purpose. The authors conclude that Australian and other) legislators should set a maximum premium for a minimum amount of flood and sea related cover; and restrict the building and style of homes in flood prone areas.

University life and Australian homes : three case studies of international Muslim students in Brisbane

Despite a significant increase in enrolments of postgraduate international Muslim students within Australian universities, little is known about their perceptions of life within Australian homes while undertaking their studies. The aim of this study is to investigate the ways in which students’ cultural and religious traditions affect their use of domestic spaces within the homes in which they reside. The research found that participants faced some minor difficulties in achieving privacy, maintaining modesty and extending hospitality while able to perform their daily activities in Australian designed homes. The findings suggest that greater research attention needs to be given to the development of Australian home designs that are adaptable to the needs of a multicultural society. Australian society encompasses diverse cultural customs and requirements with respect to home design, and these are yet to be explored.

Domestic violence (DV) service provision and the architecture of rural life: An Australian case study

This article uses the concept of the architecture of rural life to analyse domestic violence service provision in rural Australia. What is distinctive about this architecture is that it polices the privacy of the rural family. A tight cloak of silence is carved around instances of domestic violence. Imagined threats to rural safety are seen as coming from outsiders (i.e. urban influences or Indigenous), not insiders within rural families. This article draws on key findings from a study conducted in rural New South Wales, Australia. The study interviewed 49 rural service providers working in human services and the criminal justice system. The application of architecture of rural life as a conceptual tool demonstrates challenges with service provision in a rural setting. The main results of this study found that this architecture operates as a silencing form of social control in three distinctive ways. Firstly, shame about being a victim of domestic violence encourages rural women's complicity in remaining silent. Secondly, family privacy maintains a veil of silence that accentuates rural women's social and economic dependency on men. Thirdly, community sanctions act as a deterrent to women seeking help.

Multiple perspectives on quality of life for residents with dementia in long term care facilities: Protocol for a comprehensive Australian study

Background Dementia is a chronic illness without cure or effective treatment, which results in declining mental and physical function and assistance from others to manage activities of daily living. Many people with dementia live in long term care facilities, yet research into their quality of life (QoL) was rare until the last decade. Previous studies failed to incorporate important variables related to the facility and care provision or to look closely at the daily lives of residents. This paper presents a protocol for a comprehensive, multi-perspective assessment of QoL of residents with dementia living in long term care in Australia. A secondary aim is investigating the effectiveness of self-report instruments for measuring QoL. Methods The study utilizes a descriptive, mixed methods design to examine how facility, care staff, and resident factors impact QoL. Over 500 residents with dementia from a stratified, random sample of 53 facilities are being recruited. A sub-sample of 12 residents is also taking part in qualitative interviews and observations. Conclusions This national study will provide a broad understanding of factors underlying QoL for residents with dementia in long term care. The present study uses a similar methodology to the US-based Collaborative Studies of Long Term Care (CS-LTC) Dementia Care Study, applying it to the Australian setting.

Maternal pregravid body mass index and child hospital admissions in the first 5 years of life: results from an Australian birth cohort

Objectives: To examine the association of maternal pregravid body mass index (BMI) and child offspring, all-cause hospitalisations in the first 5 years of life. Methods: Prospective birth cohort study. From 2006 to 2011, 2779 pregnant women (2807 children) were enrolled in the Environments for Healthy Living: Griffith birth cohort study in South-East Queensland, Australia. Hospital delivery record and self-report baseline survey of maternal, household and demographic factors during pregnancy were linked to the Queensland Hospital Admitted Patients Data Collection from 1 November 2006 to 30 June 2012, for child admissions. Maternal pregravid BMI was classified as underweight (<18.5 kg m−2), normal weight (18.5–24.9 kg m−2), overweight (25.0–29.9 kg m−2) or obese (30 kg m−2). Main outcomes were the total number of child hospital admissions and ICD-10-AM diagnostic groupings in the first 5 years of life. Negative binomial regression models were calculated, adjusting for follow-up duration, demographic and health factors. The cohort comprised 8397.9 person years (PYs) follow-up. Results: Children of mothers who were classified as obese had an increased risk of all-cause hospital admissions in the first 5 years of life than the children of mothers with a normal BMI (adjusted rate ratio (RR) =1.48, 95% confidence interval 1.10–1.98). Conditions of the nervous system, infections, metabolic conditions, perinatal conditions, injuries and respiratory conditions were excessive, in both absolute and relative terms, for children of obese mothers, with RRs ranging from 1.3–4.0 (PYs adjusted). Children of mothers who were underweight were 1.8 times more likely to sustain an injury or poisoning than children of normal-weight mothers (PYs adjusted). Conclusion: Results suggest that if the intergenerational impact of maternal obesity (and similarly issues related to underweight) could be addressed, a significant reduction in child health care use, costs and public health burden would be likely.

Spontaneous and episodic volunteers: The legislative, insurance and risk management framework

Baby Boomers are a generation of life long association joiners, but following generations prefer spontaneous and episodic volunteering. This trend is apparent not only during natural disasters, but in most other spheres of volunteering. Legal liability for such volunteers is a growing concern, which unresolved, may dampen civic participation. We critically examine the current treatment of these liabilities through legislation, insurance and risk management.

Developments in termite management in Queensland, Australia: Life after Cyclodienes (Isoptera)

The highly persistent cyclodiene (organochlorine) insecticides (aldrin, dieldrin, chlordane and heptachlor), the main termiticides used in Australia for 30 years, were withdrawn from use in most of Australia on 30 June 1995. Alternative strategies for subterranean termite management in buildings and other structures had been under development, well before this withdrawal. Here we focus on these and subsequent developments in subterranean termite management, relevant to Queensland, including a national survey, relevant building regulations, approvals and changes in the Australian Standards on termite management. Developments including a national training and competency-based-licensing system for pest managers, insurance of dwellings against termite damage and several alternative termite management strategies are discussed. An integrated approach to termite management is the likely direction for the future in Australia, minimising reliance on chemical sprays and drenches. There will be an increased need for physical barriers in improved building design and reliable preventative and remedial treatments involving bait technology. The need for research on termite biology and, in particular, foraging behavior is emphasized yet again.

Feeding mode of Australian infants in the first 12 months of life: An assessment against national breastfeeding indicators

Background: In 2011, Australia published a set of 6 population-level indicators assessing breastfeeding, formula use, and the introduction of soft/semisolid/solid foods. Objectives: This study aimed to report the feeding practices of Australian infants against these indicators and determine the predictors of early breastfeeding cessation and introduction of solids. Methods: Mother–infant dyads (N = 1470) were recruited postnatally in 2 Australian capital cities and regional areas of 1 state between February 2008 and March 2009. Demographic and feeding intention data were collected by self-completed questionnaire at infant birth, with feeding practices (current feeding mode, age of breastfeeding cessation, age of formula and/or solids introduction) reported when the infant was between 4 and 7 months of age, and around 13 months of age. Multiple logistic regression was used to determine the predictors of breastfeeding cessation and solids introduction. Results: Although initiation of breastfeeding was almost universal (93.3%), less than half of the infants were breastfed to 6 months (41.7%) and 33.3% were receiving solids by 4 months. Women who were socially disadvantaged, younger, less educated, unpartnered, primiparous, and/or overweight were most likely to have ceased breastfeeding before 6 months of age, and younger and/or less educated women were most likely to have introduced solid food by 4 months of age. Not producing adequate milk was the most common reason provided for cessation of breastfeeding. Conclusion: The feeding behaviors of Australian infants in the first 12 months fall well short of recommendations. Women need anticipatory guidance as to the indicators of breastfeeding success and the tendency of women to doubt the adequacy of their breast milk supply warrants further investigation.

Evaluation of packaging films to extend storage life of indigenous Australian vegetables and herbs

A study undertaken in Hervey Bay, Queensland, investigated the potential of creating an indigenous agribusiness opportunity based on the cultivation of indigenous Australian vegetables and herbs. Included were warrigal greens (WG) (Tetragonia tetragonioides), a green leafy vegetable and the herb sea celery (SC) (Apium prostratum); both traditional foods of the indigenous population and highly desirable to chefs wishing to add a unique, indigenous flavour to modern dishes. Packaging is important for shelf life extension and minimisation of postharvest losses in horticultural products. The ability of two packaging films to extend WG and SC shelf life was investigated. These were Antimisted Biaxial Oriented Polypropylene packaging film (BOPP) without perforations and Antifog BOPP Film with microperforations. Weight loss, packaging headspace composition, colour changes, sensory differences and microbial loads of packed WG and SC leaves were monitored to determine the impact of film oxygen transmission rate (OTR) and film water vapour transmission (WVT) on stored product quality. WG and SC were harvested, sanitised, packed and stored at 4°C for 16 days. Results indicated that the OTR and WVT rates of the package film significantly (PKLEINERDAN0.05) influenced the package headspace and weight loss, but did not affect product colour, total bacteria, yeast and mould populations during storage. There was no significant difference (PGROTERDAN0.05) in aroma, appearance, texture and flavour for WG and SC during storage. It was therefore concluded that a shelf life of 16 days at 4°C, where acceptable sensory properties were retained, was achievable for WG and SC in both packaging films.

Larval development of estuary perch (Macquaria colonorum) and Australian bass (M. novemaculeata) (Perciformes: Percichthyidae), and comments on their life history

Morphological development of the larvae and small juveniles of estuary perch (Macquaria colonorum) (17 specimens, 4.8−13.5 mm body length) and Australian bass (M. novemaculeata) (38 specimens, 3.3−14.1 mm) (Family Percichthyidae) is described from channel-net and beach-seine collections of both species, and from reared larvae of M. novemaculeata. The larvae of both are characterized by having 24−25 myomeres, a large triangular gut (54−67% of BL) in postflexion larvae, small spines on the preopercle and interopercle, a smooth supraocular ridge, a small to moderate gap between the anus and the origin of the anal fin, and distinctive pigment patterns. The two species can be distinguished most easily by the different distribution of their melanophores. The adults spawn in estuaries and larvae are presumed to remain in estuaries before migrating to adult freshwater habitat. However, larvae of both species were collected as they entered a central New South Wales estuary from the ocean on flood tides; such transport may have consequences for the dispersal of larvae among estuaries. Larval morphology and published genetic evidence supports a reconsideration of the generic arrangement of the four species currently placed in the genus Macquaria.