Why we need a population-based approach to clinical indicators for cancer: a case study using microscopic confirmation of lung cancer in Queensland

An important function of clinical cancer registries is to provide feedback to clinicians on various performance measures. To date, most clinical cancer registries in Australia are located in tertiary academic hospitals, where adherence to guidelines is probably already high. Microscopic confirmation is an important process measure for lung cancer care. We found that the proportion of patients with lung cancer without microscopic confirmation was much higher in regional public hospitals (27.1%) than in tertiary hospitals (7.5%), and this disparity remained after adjusting for age, sex and comorbidities. The percentage was also higher in the private than in the public sector. This case study shows that we need a population-based approach to measuring clinical indicators that includes regional public hospitals as a matter of priority and should ideally include the private sector.

Media Literacy through Arts Education in Australia

Media arts has been included as one of five Arts subjects for the new Australian Curriculum and will become mandatory learning for all Australian children from pre-school to year six, and elective for children in years seven to twelve. While media education has historically been associated with English curriculum in Australia, it has also occurred through the Arts since at least the 1960s and creative practice has almost always been included as an aspect of official media curricula. This chapter investigates the possibilities for creative and critical learning enabled through media arts by discussing the media learning of one primary school student. This chapter investigates the possibilities for creative and critical learning enabled through the inclusion of media arts in the curriculum. Media arts has been included as one of five Arts subjects for the new Australian Curriculum and will become mandatory learning for all Australian children from pre-school to year six, and elective for children in years seven to twelve. Media education has historically been associated with English curriculum in Australia due to its development through the critical reading tradition. However, media literacy education in secondary schools has also occurred through the Arts since at least the 1960s and creative practice has almost always been included as an aspect of official media curricula. This chapter investigates the media learning of one primary school student, to consider the nature of creative learning and how this relates to the ���critical��� aspects of media arts curriculum. We undertook this work as part of a large research project that has been investigating the relationship between digital media and traditional literacy outcomes in a primary school.

Recruitment and results of a pilot trial of vitamin D supplementation in the general population of Australia

Context: The benefits of high serum levels of 25-hydroxyvitamin D [25(OH)D] are unclear. Trials are needed to establish an appropriate evidence base. Objective: We plan to conduct a large-scale trial of vitamin D supplementation for the reduction of cancer incidence and overall mortality and report here the methods and results of a pilot trial established to inform its design. Design: Pilot D-Health was a randomized trial carried out in a general community setting with 12 months intervention and follow-up. Participants: Participants were 60- to 84-yr-old residents of one of the four eastern Australian states who did not have any vitamin D-related disorders and who were not taking more than 400 IU supplementary vitamin D per day. A total of 644 participants were randomized, and 615 completed the study (two persons withdrew because of nonserious adverse events). Interventions: The interventions were monthly doses of placebo or 30,000 or 60,000 IU vitamin D3. Main Outcomes: The main outcomes were the recruitment rate and changes in serum 25(OH)D. Results: Ten percent of those approached were recruited. At baseline, the mean 25(OH)D was 42 nmol/liter in all three study arms. The mean change in 25(OH)D in the placebo group was 0.12 nmol/liter, compared with changes of 22 and 36 nmol/liter in the 30,000- and 60,000-IU groups, respectively. Conclusions: The D-Health pilot has shown that a large trial is feasible in Australia and that a dose of 2000 IU/d will be needed to ensure that a large proportion of the population reaches the target serum 25(OH)D level. Copyright �� 2012 by The Endocrine Society.

Detaining the usual suspects : charting the use of segregated settings in New South Wales government schools, Australia

In this paper, we examine the increase in segregated placements in the New South Wales government school sector. Using disaggregated enrolment data, we point to the growing over-representation of boys in special schools and classes; particularly those of a certain age in certain support categories. In the discussion that follows, we question the role of special education in the development of new and additional forms of being ���at risk.��� In effect, we invert the traditional concept by asking: Who is at risk of what? In focusing on the containment of risk, are modern practices of diagnosis and segregation perpetuating risks that already disproportionately affect certain groups of individuals? Do these perceptions of and responses to risk in local schools now place these students at greater personal risk of school failure and a future marked by social exclusion? And, finally, is that risk worth the cost?

I sang Amazing Grace for about 3 hours that day : understanding Indigenous Australians��� experience of seclusion

Research shows that Indigenous Australians suspicion and fear of being ���locked up��� may influence mental health service avoidance. Given this, the aim of this study was to explore, by qualitative analysis of in depth interviews (N = 3), how three Indigenous people experienced the controversial practice of seclusion Hans-Georg Gadamer���s phenomenology guided analysis of the material, and allowed narrated experiences to be understood within their cultural and historical context. Participants viewed seclusion negatively: police involvement in psychiatric care; perceptions of being punished and powerless; occasions of extreme use of force; and lack of care were prominent themes throughout the interviews. While power imbalances inherent in seclusion are problematic for all mental health clients, the distinguishing factor in the Indigenous clients��� experience is that seclusion is continuous with the discriminatory and degrading treatment by governments, police and health services that many Indigenous people have experienced since colonisation. The participants��� experiences echoed Goffman���s (1961) findings that institutional practices act to degrade and dehumanise clients whose resulting conformity eases the work of nursing staff. While some nurses perceive that seclusion reduces clients��� agitation (Meehan, Bergen & Fjeldsoe, 2004; Wynaden et al., 2001), one must ask at what cost to clients��� dignity, humanity and basic human rights.

Assessment of applicability and transferability of evidence-based antenatal interventions to the Australian indigenous setting

There is a need for public health interventions to be based on the best available evidence. Unfortunately, well-conducted studies from settings similar to that in which an intervention is to be implemented are often not available. Therefore, health practitioners are forced to make judgements about proven effective interventions in one setting and their suitability to make a difference in their own setting. The framework of Wang et al. has been proposed to help with this process. This paper provides a case study on the application of the framework to a decision-making process regarding antenatal care in Aboriginal and Torres Strait Islander communities in Queensland. This method involved undertaking a systematic search of the current available evidence, then conducting a second literature search to determine factors that may affect the applicability and transferability of these interventions into these communities. Finally, in consideration of these factors, clinical judgement decisions on the applicability and transferability of these interventions were made. This method identified several interventions or strategies for which there was evidence of improving antenatal care or outcomes. By using the framework, we concluded that several of these effective interventions would be feasible in Aboriginal and Torres Strait Islander communities within Queensland.

A comparison of Chinese and Australian early childhood mathematics

In the 21st century mathematics proficiency is synonymous with a numerate citizenry. In the past few decades young children���s ability to reason mathematically and develop mathematical proficiencies has been recognised. This paper explores the history of early childhood mathematics (ECME) that may explicate differences in Chinese and Australian contexts. Results of this review established that China and Australia are diametrically positioned in ECME. Influencing each countries philosophies and practices are their cultural beliefs. ECME in China and Australia must be culturally sustainable to achieve excellent outcomes for young children. Ongoing critique and review is necessary to ensure that ECME is meeting the needs of all teachers and children in their particular context. China and Australia with their rich contrasting philosophies can assist each other in their journeys to create exemplary ECME for the 21st century.

Combined expression of KLK4, KLK5, KLK6, and KLK7 by ovarian cancer cells leads to decreased adhesion and paclitaxel-induced chemoresistance.

OBJECTIVE: Chemoresistance is a critical feature of advanced ovarian cancer with only 30% of patients surviving longer than 5 years. We have previously shown that four kallikrein-related (KLK) peptidases, KLK4, KLK5, KLK6 and KLK7 (KLK4-7), are implicated in peritoneal invasion and tumour growth, but underlying mechanisms were not identified. We also reported that KLK7 overexpression confers chemoresistance to paclitaxel, and cell survival via integrins. In this study, we further explored the functional consequenses of overexpression of all four KLKs (KLK4-7) simultaneously in the ovarian cancer cell line, OV-MZ-6, and its impact on integrin expression and signalling, cell adhesion and survival as contributors to chemoresistance and metastatic progression. METHODS: Quantitative gene and protein expression analyses, confocal microscopy, cell adhesion and chemosensitivity assays were performed. RESULTS: Expression of ��5��1/��v��3 integrins was downregulated upon combined stable KLK4-7 overexpression in OV-MZ-6 cells. Accordingly, the adhesion of these cells to vitronectin and fibronectin, the extracellular matrix binding proteins of ��5��1/��v��3 integrins and two predominant proteins of the peritoneal matrix, was decreased. KLK4-7-transfected cells were more resistant to paclitaxel (10-100 nmol/L: 38-54%), but not to carboplatin, which was associated with decreased apoptotic stimuli. However, the KLK4-7-induced paclitaxel resistance was not blocked by the MEK1/2 inhibitor, U0126. CONCLUSIONS: This study demonstrates that combined KLK4-7 expression by ovarian cancer cells promotes reduced integrin expression with consequently less cell-matrix attachment, and insensitivity to paclitaxel mediated by complex integrin and MAPK independent interactions, indicative of a malignant phenotype and disease progression suggesting a role for these KLKs in this process.

Survival, sublethal injury and recovery of environmental Burkholderia pseudomallei in soil subjected to desiccation

Environmental Burkholderia pseudomallei isolated from sandy soil at Castle Hill, Townsville, in the dry tropic region of Queensland, Australia, was inoculated into sterile-soil laboratory microcosms subjected to variable soil moisture. Survival and sublethal injury of the B. pseudomallei strain were monitored by recovery using culture-based methods. Soil extraction buffer yielded higher recoveries as an extraction agent than sterile distilled water. B. pseudomallei was not recoverable when inoculated into desiccated soil but remained recoverable from moist soil subjected to 91 days desiccation and showed a growth response to increased soil moisture over at least 113 days. Results indicate that endemic dry tropic soil may act as a reservoir during the dry season, with an increase in cell number and potential for mobilization from soil into water in the wet season.

Understanding Indigenous Australian women���s social and emotional wellbeing and wellness through yarning

This paper explores Indigenous Australian women���s understanding of wellness, through the lens of social and emotional wellbeing. The authors use a ���yarning��� approach to explore how wellness is important to Indigenous women who live in North Brisbane (Australia). They discuss the benefits of yarning and its strength as a methodology for conducting research and building activism within Indigenous Australian communities. They argue that, for Indigenous Australian women, wellness is linked to a sense of wholeness and strongly related to the feeling of connection that women get from meeting together and having time for women���s business. They describe the way that their research project developed into a community summit focused on Indigenous women���s wellness.

Juveniles in detention in Australia, 1981-2008

The Australian Institute of Criminology���s (AIC���s) national Juveniles in Detention Monitoring Program was established to contribute to the evidence base on juvenile detention in Australia, with a particular focus on Indigenous juveniles. Findings date back to 1981 and have been reported annually. This report provides an overview of the numbers and rates of juveniles in detention in Australia since 1981 and juveniles in detention for the financial year 2007���08. As with the AIC���s previous report on juveniles in detention (Taylor 2009), it also provides contextual information on young people sentenced in the children���s courts. The collation of data for these reports is supported by statutory juvenile justice agencies in each of Australia���s jurisdictions, as well as the NSW Department of Corrective Services. As described in more detail in this report, the Australian Institute of Health and Welfare (AIHW) administers the Juvenile Justice National Minimum Data Set and also reports annually on juveniles in detention. Given this development, the AIC is conducting a review of the Juveniles in Detention Monitoring Report in 2010���11, to ensure that AIC���s research and monitoring does not duplicate the AIHW���s work and that it makes a useful contribution to the field and enables more in-depth analysis of key issues.

Returning to the practices of our ancestors? Reconsidering Indigenous justice and the emergence of restorative practices

Restorative practices have often been considered both as emerging from the customs of Indigenous peoples, and ways of responding to crime that might be most suitable for Indigenous individuals and communities. This paper, which consists of two parts, will reconsider these claims from a critical perspective. The first part of the paper draws on my Ph.D. research on the emergence of restorative justice in Western criminal justice systems. It will argue that although many advocates of restorative justice uncritically and unproblematically accept that restorative practices emerged from the customs of Indigenous peoples, the relationship between Indigenous justice customs and the emergence of restorative justice is much more nuanced than proponents imply. The paper will examine, therefore, the legitimating rationalities associated with the diverse historical ���truths��� obscured in advocates��� accounts of the role of Indigenous customs and the emergence of restorative justice. The second section draws on the findings of recent research undertaken at the Australian Institute of Criminology, and will present data on the numbers of Indigenous juveniles who participate in restorative conferences in each jurisdiction. These data will be used to elucidate the disparity between the rhetoric or ���promise��� of restorative justice, and its apparent impact in relation to Indigenous juveniles. This paper will conclude with a consideration of the continued relevance of restorative justice for Indigenous young people in Australia.

An evidence-informed strategy to prevent osteoporosis in Australia

Osteoporosis imposes a tremendous burden on Australia : 1.2 million Australians have osteoporosis and 6.3 million have Osteopenia. In the 2007-08 financial year, 82000 Australians suffered fragility fractures, of Which >17000 were hip fractures. In the 2000-01 financial year, direct costs were estimated at $1.9 billion per year and an additional $5.6 billion on indirect costs. Osteoporosis was designated a National Health Priority Area in 2002; however, implementation of national plans has not yet matched the rhetoric in terms of urgency. Building healthy bones throughout life, the Osteoporosis Australia strategy to prevent osteoporosis throughout the life cycle, presents an evidence-informed set of recommendations for consumers, health care professionals and policymakers. The strategy was adopted by consensus at the Osteoporosis Australia Summit in Sydney, 20 October 2011. Primary objectives throughout the life cycle are: to maximise peak bone mass during childhood and adolescence to prevent premature bone loss and improve or maintain muscle mass, strength and functional capacity in healthy adults to prevent and treat osteoporosis in order to minimise the risk of suffering fragility fractures, and reduce falls risk, in older people. The recommendations focus on three affordable and important interventions to ensure people have adequate calcium intake, vitamin D levels and appropriate, physical activity throughout their lives. Recommendations relevant to all stages of life include: daily dietary calcium intakes should be consistent with Australian and New Zealand guidelines serum levels of vitamin D in the general population should be above 50 nmol/L in winter or early spring for optimal bone health regular weight-bearing physical activity, Muscle strengthening exercises and challenging balance/ mobility activities should be conducted in a safe environment.