Health law : scope, sources and forces

• For the purposes of this chapter, “health law” encapsulates regulation of the medical and health professions, the administration of health services and the maintenance of public health to the extent that it is connected to the provision of health services. • There are diverging views as to whether health law can be regarded as a discrete “area of law”. • Health law draws on other areas of law such as tort law, criminal law and family law. It is also draws upon other disciplines, most notably medical and health ethics. • Social and economic forces have influenced the development and direction of health law, and these forces may become even more influential as the century develops. • The increasingly globalised world has implications for Australia’s health systems and raises questions and creates commitments in respect of the international community. • Technological developments, including in respect of treatment, diagnosis and information management, create ongoing challenges for health law. • Patient rights, human rights and consumerism are increasingly key drivers in the development of health law. • Health law is significant to contemporary Australian society because of the gravity of the topics that fall within its ambit, its social relevance to so many aspects of human existence and endeavour, the important role it plays in protecting the vulnerable, and the extent to which it engages with fundamental principles of justice.

Distribution of forces during fulcrum bending radiographs on adolescent idiopathic scoliosis patients

At the Mater Children’s Hospital, approximately 80% of patients presenting with Adolescent Idiopathic Scoliosis requiring corrective surgery receive a fulcrum bending radiograph. The fulcrum bending radiograph provides a measurement of spine flexibility and a better indication of achievable surgical correction than lateral-bending radiographs (Cheung and Luk, 1997; Hay et al 2008). The magnitude and distribution of the corrective force exerted by the bolster on the patient’s body is unknown. The objective of this pilot study was to measure, for the first time, the forces transmitted to the patient’s ribs through the bolster during the fulcrum bending radiograph.

Settlement geography of African refugee communities in Southeast Queensland : an analysis of residential distribution and secondary migration

Before 2001, most Africans immigrating to Australia were white South Africans and Zimbabweans who arrived as economic and family-reunion migrants (Cox, Cooper & Adepoju, 1999). Black African communities are a more recent addition to the Australian landscape, with most entering Australia as refugees after 2001. African refugees are a particularly disadvantaged immigrant group, which the Department of Immigration and Multicultural Affairs (in the Community Relations Commission of New South Wales, 2006) suggests require high levels of settlement support (p.23). Decision makers and settlement service providers need to have settlement data on the communities so that they can be effective in planning, budgeting and delivering support where it is most needed. Settlement data are also useful for determining the challenges that these communities face in trying to establish themselves in resettlement. There has been no verification of existing secondary data sources, however, or previous formal study of African refugee settlement geography in Southeast Queensland. This research addresses the knowledge gap by using a mixed-method approach to identify and describe the distribution and population size of eight African communities in Southeast Queensland, examine secondary migration patterns in these communities and assess the relationship between these geographic features and housing, a critical factor in successful settlement. Significant discrepancies exist between the primary data gathered in the study and existing secondary data relating to population size and distribution of the communities. Results also reveal a tension between the socio-cultural forces and the housing and economic imperatives driving secondary migration in the communities, and a general lack of engagement by African refugees with structured support networks. These findings have a wide range of implications for policy and for groups that provide settlement support to these communities.

A two-compartment mechanochemical model of the roles of transforming growth factor-beta and tissue tension in dermal wound healing

The repair of dermal tissue is a complex process of interconnected phenomena, where cellular, chemical and mechanical aspects all play a role, both in an autocrine and in a paracrine fashion. Recent experimental results have shown that transforming growth factor-beta (TGF-beta) and tissue mechanics play roles in regulating cell proliferation, differentiation and the production of extracellular materials. We have developed a 1D mathematical model that considers the interaction between the cellular, chemical and mechanical phenomena, allowing the combination of TGF-beta and tissue stress to inform the activation of fibroblasts to myofibroblasts. Additionally, our model incorporates the observed feature of residual stress by considering the changing zero-stress state in the formulation for effective strain. Using this model, we predict that the continued presence of TGF-beta in dermal wounds will produce contractures due to the persistence of myofibroblasts; in contrast, early elimination of TGF-beta significantly reduces the myofibroblast numbers resulting in an increase in wound size. Similar results were obtained by varying the rate at which fibroblasts differentiate to myofibroblasts and by changing the myofibroblast apoptotic rate. Taken together, the implication is that elevated levels of myofibroblasts is the key factor behind wounds healing with excessive contraction, suggesting that clinical strategies which aim to reduce the myofibroblast density may reduce the appearance of contractures.

A lesson in tension yet to be taut : a review

NOBEL prize-winning British writer Harold Pinter is best known for his social commentaries and for dark, sometimes violent "comedies of menace" that capture the cruelty at the heart of human relationships. It has been a while since a Pinter play was on the Brisbane stage, and it is exciting to see one of his lesser known early works, Betrayal, as part of Queensland Theatre Company's session. Betrayal moves backwards from a potentially scandalous moment. In a pub one night, Emma tells Jerry that his best friend Robert is divorcing her. Robert has been unfaithful. And, what's more, Robert now knows about their lengthy affair. What follows is a series of scenes that look back at the stages of that affair and the secrets that have lain unspoken at the heart of their comfortable middle-class lives for so long. Betrayal is characterised by the sparsity of action and language, dark humour, and sudden outbreaks of seemingly excessive cruelty that are a trademark of Pinter's writing for the theatre.

Bubble rise velocity and trajectory in xanthan gum crystal suspension

An experimental set-up was used to visually observe the characteristics of bubbles as they moved up a column holding xanthan gum crystal suspensions. The bubble rise characteristics in xanthan gum solutions with crystal suspension are presented in this paper. The suspensions were made by using different concentrations of xanthan gum solutions with 0.23 mm mean diameter polystyrene crystal particles. The influence of the dimensionless quantities; namely the Reynolds number, Re, the Weber number, We, and the drag co-efficient, cd, are identified for the determination of the bubble rise velocity. The effect of these dimensionless groups together with the Eötvös number, Eo, the Froude number, Fr, and the bubble deformation parameter, D, on the bubble rise velocity and bubble trajectory are analysed. The experimental results show that the average bubble velocity increases with the increase in bubble volume for xanthan gum crystal suspensions. At high We, Eo and Re, bubbles are spherical-capped and their velocities are found to be very high. At low We and Eo, the surface tension force is significant compared to the inertia force. The viscous forces were shown to have no substantial effect on the bubble rise velocity for 45 < Re < 299. The results show that the drag co-efficient decreases with the increase in bubble velocity and Re. The trajectory analysis showed that small bubbles followed a zigzag motion while larger bubbles followed a spiral motion. The smaller bubbles experienced less horizontal motion in crystal suspended xanthan gum solutions while larger bubbles exhibited a greater degree of spiral motion than those seen in the previous studies on the bubble rise in xanthan gum solutions without crystal.

Decoupled trajectory planning for a submerged rigid body subject to dissipative and potential forces

This paper studies the practical but challenging problem of motion planning for a deeply submerged rigid body. Here, we formulate the dynamic equations of motion of a submerged rigid body under the architecture of differential geometric mechanics and include external dissipative and potential forces. The mechanical system is represented as a forced affine-connection control system on the configuration space SE(3). Solutions to the motion planning problem are computed by concatenating and reparameterizing the integral curves of decoupling vector fields. We provide an extension to this inverse kinematic method to compensate for external potential forces caused by buoyancy and gravity. We present a mission scenario and implement the theoretically computed control strategy onto a test-bed autonomous underwater vehicle. This scenario emphasizes the use of this motion planning technique in the under-actuated situation; the vehicle loses direct control on one or more degrees of freedom. We include experimental results to illustrate our technique and validate our method.

Altering heavy vehicle air suspension dynamic forces by modifying air lines

An experimental programme in 2007 used three air suspended heavy vehicles travelling over typical urban roads to determine whether dynamic axle-to-chassis forces could be reduced by using larger-than-standard diameter longitudinal air lines. This paper presents methodology, interim analysis and partial results from that programme. Alterations to dynamic measures derived from axle-to-chassis forces for the case of standard-sized longitudinal air lines vs. the test case where larger longitudinal air lines were fitted are presented and discussed. This leads to conclusions regarding the possibility that dynamic loadings between heavy vehicle suspensions and chassis may be reduced by fitting larger longitudinal air lines to air-suspended heavy vehicles. Reductions in the shock and vibration loads to heavy vehicle suspension components could lead to lighter and more economical chassis and suspensions. This could therefore lead to reduced tare and increased payloads without an increase in gross vehicle mass.

Pressure, oxygen tension and temperature in the periosteal callus during bone healing - An in vivo study in sheep

Adequate blood supply and sufficient mechanical stability are necessary for timely fracture healing. Damage to vessels impairs blood supply; hindering the transport of oxygen which is an essential metabolite for cells involved in repair. The degree of mechanical stability determines the mechanical conditions in the healing tissues. The mechanical conditions can influence tissue differentiation and may also inhibit revascularization. Knowledge of the actual conditions in a healing fracture in vivo is extremely limited. This study aimed to quantify the pressure, oxygen tension and temperature in the external callus during the early phase of bone healing. Six Merino-mix sheep underwent a tibial osteotomy. The tibia was stabilized with a standard mono-lateral external fixator. A multi-parameter catheter was placed adjacent to the osteotomy gap on the medial aspect of the tibia. Measurements of oxygen tension and temperature were performed for ten days post-op. Measurements of pressure were performed during gait on days three and seven. The ground reaction force and the interfragmentary movements were measured simultaneously. The maximum pressure during gait increased (p=0.028) from three (41.3 [29.2-44.1] mm Hg) to seven days (71.8 [61.8-84.8] mm Hg). During the same interval, there was no change (p=0.92) in the peak ground reaction force or in the interfragmentary movement (compression: p=0.59 and axial rotation: p=0.11). Oxygen tension in the haematoma (74.1 mm Hg [68.6-78.5]) was initially high post-op and decreased steadily over the first five days. The temperature increased over the first four days before reaching a plateau at approximately 38.5 degrees C on day four. This study is the first to report pressure, oxygen tension and temperature in the early callus tissues. The magnitude of pressure increased even though weight bearing and IFM remained unchanged. Oxygen tensions were initially high in the haematoma and fell gradually with a low oxygen environment first established after four to five days. This study illustrates that in bone healing the local environment for cells may not be considered constant with regard to oxygen tension, pressure and temperature.

The measurement of applied forces during anterior single rod surgical correction of adolescent idiopathic scoliosis

INTRODUCTION. Following anterior thoracoscopic instrumentation and fusion for the treatment of thoracic AIS, implant related complications have been reported as high as 20.8%. Currently the magnitudes of the forces applied to the spine during anterior scoliosis surgery are unknown. The aim of this study was to measure the segmental compressive forces applied during anterior single rod instrumentation in a series of adolescent idiopathic scoliosis patients. METHODS. A force transducer was designed, constructed and retrofitted to a surgical cable compression tool, routinely used to apply segmental compression during anterior scoliosis correction. Transducer output was continuously logged during the compression of each spinal joint, the output at completion converted to an applied compression force using calibration data. The angle between adjacent vertebral body screws was also measured on intra-operative frontal plane fluoroscope images taken both before and after each joint compression. The difference in angle between the two images was calculated as an estimate for the achieved correction at each spinal joint. RESULTS. Force measurements were obtained for 15 scoliosis patients (Aged 11-19 years) with single thoracic curves (Cobb angles 47˚- 67˚). In total, 95 spinal joints were instrumented. The average force applied for a single joint was 540 N (± 229 N)ranging between 88 N and 1018 N. Experimental error in the force measurement, determined from transducer calibration was ± 43 N. A trend for higher forces applied at joints close to the apex of the scoliosis was observed. The average joint correction angle measured by fluoroscope imaging was 4.8˚ (±2.6˚, range 0˚-12.6˚). CONCLUSION. This study has quantified in-vivo, the intra-operative correction forces applied by the surgeon during anterior single rod instrumentation. This data provides a useful contribution towards an improved understanding of the biomechanics of scoliosis correction. In particular, this data will be used as input for developing patient-specific finite element simulations of scoliosis correction surgery.

Searching for a feminist voice : film festivals and negotiating the tension between expectation and intent

International Film Festivals play a vital role in shaping filmmakers’ careers. This paper presents some initial findings from a current major research project, highlighting the significance of particular festival programming of emerging female directors from developing nations. Some filmmakers showcased at festivals actively privilege the voices of women in their films as a means of commenting on pressing cultural and political issues. Ironically, other filmmakers do not subscribe to the label of “feminist” or “woman filmmaker”, even if their respective films represent a strongly coded woman’s point of view. Tensions also arise inevitably when scrutinising women filmmakers from developing nations within a first world film festival context. The expectations of the researcher, the festival, film critics and audiences inevitably must negotiate with the original intentions of the filmmaker. This paper explores the significance of women filmmakers in attendance at the Brisbane International Film Festival (2009) and the International Film Festival Rotterdam (2010).

The Botanical Gardens X-tension, (Remnant Emergency Artlab)

This film, website and gallery installation shown at UTS Gallery, Sydney, presented a glimpse into the foregrounding process of the REMNANT/EMERGENCY Artlab - held in Sydney in November 2010.

Advanced numerical study of impact forces on railway sleepers under wheel flat

Wheel-rail interaction is one of the most important research topics in railway engineering. It includes track vibration, track impact response and safety of the track. Track structure failures caused by impact forces can lead to significant economic loss for track owners through damage to rails and to the sleepers beneath. The wheel-rail impact forces occur because of imperfections on the wheels or rails such as wheel flats, irregular wheel profile, rail corrugation and differences in the height of rails connected at a welded joint. In this paper, a finite element model for the wheel flat study is developed by use of the FEA software package ANSYS. The effect of the wheel flat to impact force on sleepers is investigated. It has found that the wheel flat significantly increases impact forces and maximum Von Mises stress, and also delays the peak position of dynamic variation for impact forces on both rail and sleeper.