Public use and perceptions of emergency departments: A population survey

Objectives To inform demand management strategies aimed at reducing congestion in EDs by: (i) identifying public use of EDs, decision-making and reasons; and (ii) measuring acceptance of alternative care models. Methods A cross-sectional telephone survey of a random sample of Queensland population aged 18 years or older residing in a dwelling unit in Queensland that could be contacted on a land-based telephone service was conducted. One person per household was selected according to a predetermined algorithm to ensure sex and regional balance were interviewed. The main outcome measures were: ED use, attitudes towards ED staff and services, and alternative models of care. Results The final sample included a total of 1256 respondents (response rate = 40.3%). Twenty-one per cent attended EDs in the preceding 12 months. The decision to attend was made by patients (51%), health and medical professionals (31%), and others (18%). The main reasons included perceived severity of the illness (47%), unavailability of alternative services (26%) and better care (11%). Most respondents agreed with more flexible care models of service delivery including incentives for general practitioners (90%), private health insurance coverage for ED use (89%), and enhanced roles for paramedics and nurses. Conclusions Main reason for attending ED is perceived severity of illness, followed by lack of alternative care. The majority of both consumers and the public are in favour of more flexible care models. However, further research is necessary to detail those alternatives and to test and validate their effectiveness.

Bangarra Dance Theatre: Copyright law and Indigenous culture

This article considers the artistic and legal practices of Bangarra Dance Theatre in a case study of copyright law management in relation to Indigenous culture. It is grounded in the particular local experience, knowledge and understanding of copyright law displayed by the performing arts company. The first part considers the special relationship between Bangarra Dance Theatre and the Munyarrun Clan. It examines the contractual arrangements developed to recognise communal ownership. The next section examines the role of the artistic director and choreographer. It looks at the founder, Carole Johnson, and her successor, Stephen Page. The third part of the article focuses on the role of the composer, David Page. It examines his ambition to set up a Indigenous recording company, Nikinali. Part 4 focuses upon the role of the artistic designers. It looks at the contributions of artistic designers such as Fiona Foley. Part 5 deals with broadcasts of performances on television, film, and multi-media. Part 6 considers the collaborations of Bangarra Dance Theatre with the Australian Ballet, and the Sydney Organising Committee for the Olympic Games. The conclusion considers how Bangarra Dance Theatre has played a part ina general campaign to increase protection of Indigenous copyright law.

Confirmatory factory analysis of the Neck Disability Index in a general problematic neck population indicates a one-factor model

BACKGROUND CONTEXT: The Neck Disability Index frequently is used to measure outcomes of the neck. The statistical rigor of the Neck Disability Index has been assessed with conflicting outcomes. To date, Confirmatory Factor Analysis of the Neck Disability Index has not been reported for a suitably large population study. Because the Neck Disability Index is not a condition-specific measure of neck function, initial Confirmatory Factor Analysis should consider problematic neck patients as a homogenous group. PURPOSE: We sought to analyze the factor structure of the Neck Disability Index through Confirmatory Factor Analysis in a symptomatic, homogeneous, neck population, with respect to pooled populations and gender subgroups. STUDY DESIGN: This was a secondary analysis of pooled data. PATIENT SAMPLE: A total of 1,278 symptomatic neck patients (67.5% female, median age 41 years), 803 nonspecific and 475 with whiplash-associated disorder. OUTCOME MEASURES: The Neck Disability Index was used to measure outcomes. METHODS: We analyzed pooled baseline data from six independent studies of patients with neck problems who completed Neck Disability Index questionnaires at baseline. The Confirmatory Factor Analysis was considered in three scenarios: the full sample and separate sexes. Models were compared empirically for best fit. RESULTS: Two-factor models have good psychometric properties across both the pooled and sex subgroups. However, according to these analyses, the one-factor solution is preferable from both a statistical perspective and parsimony. The two-factor model was close to significant for the male subgroup (p<.07) where questions separated into constructs of mental function (pain, reading headaches and concentration) and physical function (personal care, lifting, work, driving, sleep, and recreation). CONCLUSIONS: The Neck Disability Index demonstrated a one-factor structure when analyzed by Confirmatory Factor Analysis in a pooled, homogenous sample of neck problem patients. However, a two-factor model did approach significance for male subjects where questions separated into constructs of mental and physical function. Further investigations in different conditions, subgroup and sex-specific populations are warranted.

Automatic population HARDI white matter tract clustering by label fusion of multiple tract atlases

Automatic labeling of white matter fibres in diffusion-weighted brain MRI is vital for comparing brain integrity and connectivity across populations, but is challenging. Whole brain tractography generates a vast set of fibres throughout the brain, but it is hard to cluster them into anatomically meaningful tracts, due to wide individual variations in the trajectory and shape of white matter pathways. We propose a novel automatic tract labeling algorithm that fuses information from tractography and multiple hand-labeled fibre tract atlases. As streamline tractography can generate a large number of false positive fibres, we developed a top-down approach to extract tracts consistent with known anatomy, based on a distance metric to multiple hand-labeled atlases. Clustering results from different atlases were fused, using a multi-stage fusion scheme. Our "label fusion" method reliably extracted the major tracts from 105-gradient HARDI scans of 100 young normal adults. © 2012 Springer-Verlag.

Automatic clustering and population analysis of white matter tracts using maximum density paths

We introduce a framework for population analysis of white matter tracts based on diffusion-weighted images of the brain. The framework enables extraction of fibers from high angular resolution diffusion images (HARDI); clustering of the fibers based partly on prior knowledge from an atlas; representation of the fiber bundles compactly using a path following points of highest density (maximum density path; MDP); and registration of these paths together using geodesic curve matching to find local correspondences across a population. We demonstrate our method on 4-Tesla HARDI scans from 565 young adults to compute localized statistics across 50 white matter tracts based on fractional anisotropy (FA). Experimental results show increased sensitivity in the determination of genetic influences on principal fiber tracts compared to the tract-based spatial statistics (TBSS) method. Our results show that the MDP representation reveals important parts of the white matter structure and considerably reduces the dimensionality over comparable fiber matching approaches.

'There is nothing that identifies me to that place’: Indigenous Women’s Perceptions of Health Spaces and Places

This chapter provides an overview of the gendered realities of Indigenous men’s and Indigenous women’s lives and gendered Indigenous health perspectives. It offers the nurse some examples of the role of the nurse in working within gendered Indigenous health care.

Indigenous gendered health perspectives

Indigenous gendered health perspectives. In O. Best & B. Fredericks (eds).Yatdjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care. Cambridge University Press: Melbourne, pp.74-86.

Indigenous ways with literacies: Transgenerational, multimodal, placed, and collective

This research describes some of the salient features of Indigenous ways of working with multimodal literacies in digital contexts of use that emerged within an Indigenous school community with the oversight of Aboriginal Elders. This is significant because the use of multimodal literacy practices among a growing number of Indigenous school community groups has not been an emphasis of multimodal literacy research to date. Furthermore, authentic examples of Indigenous multimodal texts are often difficult to locate within Euro-centric educational systems of postcolonial countries. The research was conducted over a full year with students from middle and upper primary (aged 8.5–12.5 years) in an Indigenous Independent school in South-East Queensland, Australia. The project applied participatory research methods in which the research agenda was negotiated with the cultural community. Indigenous ways of multimodal literacy practices emerged as transgenerational, multimodal, placed, and collective. The findings have implications for teachers and researchers to re-envisage Indigenous ways of multimodal literacy practices in the digital age.

Projecting excess emergency department visits and associated costs in Brisbane, Australia, under population growth and climate change scenarios

The direct and indirect health effects of increasingly warmer temperatures are likely to further burden the already overcrowded hospital emergency departments (EDs). Using current trends and estimates in conjunction with future population growth and climate change scenarios, we show that the increased number of hot days in the future can have a considerable impact on EDs, adding to their workload and costs. The excess number of visits in 2030 is projected to range between 98–336 and 42–127 for younger and older groups, respectively. The excess costs in 2012–13 prices are estimated to range between AU$51,000–184,000 (0–64) and AU$27,000–84,000 (65+). By 2060, these estimates will increase to 229–2300 and 145–1188 at a cost of between AU$120,000–1,200,000 and AU$96,000–786,000 for the respective age groups. Improvements in climate change mitigation and adaptation measures are likely to generate synergistic health co-benefits and reduce the impact on frontline health services.

Dementia and the population health approach: Promise, pitfalls and progress. An Australian perspective

The increasing prevalence of dementia in Australia (and worldwide) over the next few decades poses enormous social, health and economic challenges. In the absence of a cure, strategies to prevent, delay the onset of, or reduce the impact of dementia are required to contain a growing disease burden, and health and care costs. A population health approach has the potential to substantially reduce the impact of dementia. Internationally, many countries have started to adopt population health strategies that incorporate elements of dementia prevention. The authors examine some of the elements of such an approach and barriers to its implementation. International dementia frameworks and strategies were reviewed to identify options utilized for a population health approach to dementia. Internationally and nationally, dementia frameworks are being developed that include population health approaches. Most of the frameworks identified included early diagnosis and intervention, and increasing community awareness as key objectives, while several included promotion of the links between a healthy lifestyle and reduced risk for dementia. A poor evidence base (especially for illness prevention), diagnostic and technical limitations, and policy and implementation issues are significant barriers in maximizing the promise of population health approaches in this area. The review and analysis of the population health approach to dementia will inform national and jurisdictional policy development.

Interventions targeting the elderly population to reduce emergency department utilisation: A literature review

Objective High utilisation of emergency department (ED) among the elderly is of worldwide concern. This study aims to review the effectiveness of interventions targeting the elderly population in reducing ED utilisation. Methods Major biomedical databases were searched for relevant studies. Qualitative approach was applied to derive common themes in the myriad interventions and to critically assess the variations influencing interventions’ effectiveness. Quality of studies was appraised using the Effective Public Health Practice Project (EPPHP) tool. Results 36 studies were included. Nine of 16 community-based interventions reported significant reductions in ED utilisation. Five of 20 hospital-based interventions proved effective while another four demonstrated failure. Seven key elements were identified. Ten of 14 interventions associated with significant reduction on ED use integrated at least three of the seven elements. All four interventions with significant negative results lacked five or more of the seven elements. Some key elements including multidisciplinary team, integrated primary care and social care often existed in effective interventions, while were absent in all significantly ineffective ones. Conclusions The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.

A right of resale? Indigenous art under the hammer

This week, Sotheby's sold the late Clifford Possum Tjapaltjarri's painting, Warlugulong. The auction-house's spokesman, Tim Klingender, was enthusiastic about the high price commanded by the art work: "The painting was a really great painting and it deserved to make a really fantastic price, and it made that price."

Travelling bones: The repatriation of Indigenous ancestral remains

In the album Journey, Archie Roach -- the Australian Indigenous singer-songwriter hailing from Mooroopna in Victoria - has a melancholy song called ‘Travell’n Bones.' It is about the repatriation of Indigenous ancestral remains to their rightful home. This Chapter considers the legal, ethical, and cultural conflicts over Australian indigenous remains being held in museums, in Australia, the United Kingdom, the European Union, and the United States. James Nason comments: ‘The explosion of legal and extra legal attention on issues of cultural property and heritage was born of the frustration and anger of indigenous peoples whose rights and perspectives about cultural property and heritage issues had been largely absent and essentially unwanted by the museum of community.' Part I focuses upon disputes in Australia involving the repatriation of Indigenous Australian remains. In Bropho v HREOC, there was controversy over a cartoon, mocking the repatriation of the remains of Yagan, an Indigenous warrior, to Western Australia. There was a discussion about the operation of the Racial Discrimination Act 1975 (Cth), and the exemptions available from the operation of the regime. Part II considers the efforts by The Te Papa Tongarewa - the Museum of New Zealand - to repatriate Maori and Moriori ancestral remains to New Zealand, and to iwi communities of origin. The conclusion considers the relevance of the United Nations Declaration on the Rights of Indigenous Persons 2007, and issues raised by ventures such as the Genographic Project.

Disjecta: Material representations of an Indigenous and immigrant cultural legacy

This practice-led research explores family history and the on-going influence of cultural legacy on the individual and the artist. Homi Bhabha theorises that identity vacillates through society, shifting and changing form to create disjunctive historical spaces – spaces of slippage that allow for new narratives and understandings to occur. Using the notion of disjuncture that became apparent in this research, the practice outcomes seek to visualise my families' sometimes-occulted history at the intersection of euro-centric and Indigenous ideologies. Researched archival materials, government documents, interviews, collected objects and family photo-albums became primary source data for studio-based explorations. Scanners, glitch apps and photo-hacking were used to navigate through these materials, providing opportunities for photographic punctum and creating metaphors for the connections and disconnections that shape our sense of self.