ANU Research Publications
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The Australian National University's Research Publications collection is an online location for collecting, preserving and disseminating the scholarly output of the University. This service allows members of the University to share their research with the wider community. ANU Open Research accepts journal articles, conference papers, book chapters, working or technical papers and other forms of scholarly communication.
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Item Open Access Socioeconomic factors, medication subsidisation and the use of preventativecardiovascular disease medications in Australia.(Swansea University, UK, 2022) Paige, Ellie; Banks, Emily; Agostino, Jason; Brieger, David; Page, Karen; Joshy, Grace; Barrett, Eden; Korda, RosemaryObjectives Cardiovascular disease (CVD) events are highly preventable through appropriate treatment and disproportionally affect socioeconomically disadvantaged individuals. This study quantified the relationship of socioeconomic factors to dispensing and persistent use of lipid- and blood pressure-lowering medication following hospital admission for a major CVD event (myocardial infarction, ischaemic stroke/transient ischaemic attack). Approach Data from 8,285 people with major CVD events aged ≥45 years from the Australian 45 and Up Study with linked medication dispensing data were used. Modified Poisson regression was used to estimate relative risks (RRs) for combined lipid- and blood pressure-lowering dispensing at three-months following hospital discharge and for 12-month persistent use, in relation to education, income, and level of medication subsidisation. Results Overall, 56% were dispensed guideline-recommended medications at three months and 37% persistently used them across 12 months. After adjusting for demographic factors, type of CVD and history of CVD hospitalisation, RRs for lowest (no educational qualifications) compared to highest education level (university degree) were 1.14 (95% CI: 1.06, 1.22) for medication dispensing and 1.15 (1.02, 1.29) for persistent medication use; 1.14 (1.06, 1.22) and 1.17 (1.04, 1.32) respectively for lowest (<$20,000) versus highest (≥$70,000) household pre-tax income; and 1.25 (1.17, 1.33) and 1.28 (1.15, 1.43) respectively for those receiving highest versus lowest subsidisation. There was little to no evidence of a relationship of income and education to medication use after adjustment for medication subsidisation. Conclusions While preventive medication use is sub-optimal, subsidisation is substantially associated with increased use and accounts for most of the relationship with socioeconomic position, suggesting medication subsidy schemes are working in the intended directionItem Embargo Faultlines and contact zones: A new forum for Migration Studies(Oxford University Press, 2018) Gamlen, Alan; Betts, Alexander; Delano, Alexandra; Lacroix, Thomas; Paoletti, Somerville; Sigona, Nando; Vargas-Silva, CarlosMigration studies is entering a new era. The intellectual roots of the field stretch back at least to the nineteenth century, since which time it has focused on the drivers of human mobility and the processes of adaptation that follow. But never before has it drawn such sustained attention from so many researchers across such a broad range of backgrounds. Migration is becoming an increasingly visible and important element of human experience, and more than ever before, migration studies is becoming a distinctive and integrated field of scholarship, with its own approaches and institutions. This journal is being established to help galvanize the field still further. It aims to provide an interdisciplinary forum for leading research that develops the core concepts, data, and methods needed by migration scholars in the twenty-first century and beyond. It has several specific priorities.Item Embargo Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study(Elsevier B.V, 2017) Jetton, Jennifer; Boohaker, L; Sethi, Sidharth; Wazir, Sanjay; Rohatgi, S; Soranno, D; Chishti, A; Woroniecki, R; Mammen, C; Swanson, J; Kent, Alison; Fletcher, JefferyBackground Findings from single-centre studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, because of the small sample size of those studies, few inferences can been made regarding the independent associations between AKI, mortality, and hospital length of stay. We aimed to establish whether neonatal AKI is independently associated with increased mortality and length of hospital stay. Methods We did this multicentre, multinational, retrospective cohort study of critically ill neonates admitted to 24 participating neonatal intensive care units (NICUs) in four countries (Australia, Canada, India, USA) between Jan 1 and March 31, 2014. We included infants born or admitted to a level 2 or 3 NICU and those who received intravenous fluids for at least 48 h. Exclusion criteria were admission at age 14 days or older, congenital heart disease requiring surgical repair within 7 days of life, lethal chromosomal anomaly, death within 48 h of admission, inability to determine AKI status, or severe congenital kidney abnormalities. We defined AKI as an increase in serum creatinine of 0·3 mg/dL or more (≥26·5 μmol/L) or 50% or more from the previous lowest value, or a urinary output of less than 1 mL/kg per h on postnatal days 2–7. We used logistic regression to calculate crude odds ratios (ORs) and associated 95% CIs for the association between AKI and likelihood of death. We used linear regression to calculate the crude parameter estimates and associated 95% CIs for the association between AKI and length of hospital stay. Multivariable logistic and linear regression models were run to account for potential confounding variables. We additionally created regression models stratified by gestational age groups (22 weeks to <29 weeks, 29 weeks to <36 weeks, and ≥36 weeks). This study is registered with ClinicalTrials.gov, number NCT02443389. Findings We enrolled 2162 infants, of whom 2022 (94%) had data to ascertain AKI status. 605 (30%) infants had AKI. Incidence of AKI varied by gestational age group, occurring in 131 (48%) of 273 of patients born at 22 weeks to less than 29 weeks, 168 (18%) of 916 patients born at 29 weeks to less than 36 weeks, and 306 (37%) of 833 patients born at 36 weeks or older. Infants with AKI had higher mortality than those without AKI (59 [10%] of 605 vs 20 [1%] of 1417 infants; p<0·0001), and longer length of hospital stay (median 23 days [IQR 10–61] vs 19 days [9–36]; p<0·0001). These findings were confirmed in both crude analysis of mortality (OR 7·5, 95% CI 4·5–12·7; p<0·0001 for AKI vs no AKI) and length of stay (parameter estimate 14·9 days, 95% CI 11·6–18·1; p<0·0001) and analysis adjusted for multiple confounding factors (adjusted OR 4·6, 95% CI 2·5–8·3; p<0·0001 and adjusted parameter estimate 8·8 days, 95% CI 6·1–11·5; p<0·0001, respectively). Interpretation Neonatal AKI is a common and independent risk factor for mortality and increased length of hospital stay. These data suggest that AKI might have a similar effect in neonates as in paediatric and adult patients. Strategies designed to prevent AKI and treatments to reduce the burden of AKI, including renal support devices designed for neonates, are greatly needed to improve the outcomes of these vulnerable infants.Item Embargo The epidemiology of tuberculosis in the Australia Capital Territory, 2006-2015(National Centre for Disease Control, 2017) Jones, Belinda; Johnston, Vanessa; Appuhamy, Ranil; Kaczmarek , Marlena; Hurwitz, MarkAim To review the epidemiology of tuberculosis (TB) in the Australian Capital Territory (ACT) over a 10 year period. Methods: A retrospective analysis of the ACT TB notif ication data from 1 January 2006 to 31 December 2015 was conducted. Results Over the 10 year study period there were 171 TB notifications in the ACT, with an increasing trend in the number of notifications over time. The median age of cases was 36 years (range 14 to 91 years) and 53.8% of cases were male. Most TB cases (84.2%) were born overseas. Among Australian-born cases the most common risk factor for acquiring TB was close/household contact with a known case of TB (30.8%). The most common risk factor in the overseas-born population was past travel or residence in a high-risk country (86.9%). Of all the TB cases notif ied, 82.4% successfully completed treatment. Conclusion There was an increasing trend in the number of TB notifications in the ACT over the study period. The highest rate of TB notifications remained in the overseas-born population; with other studies suggesting this is commonly due to reactivation of latent tuberculosis infection (LTBI). As Australia starts working towards TB elimination, options for the screening and management of LTBI, especially in high risk populations, need to be explored.Item Embargo Evidence Summary: Pressure Injuries: Preventing heel pressure injuries with prophylactic dressings(Cambridge Publishing, 2017) Haesler, EmilyHeels are a common anatomical location in which PIs occur. Due to their small surface area and minimal tissue protection over the bony prominence, interface pressure at the heel is high when an individual is lying in bed, particularly when that individual has reduced mobility1 (Level 3.c evidence). There is evidence to indicate that suspending the heels using a foam cushion block2 or heel suspension boots2-4 reduces the incidence of heel PIs (Level 1.c evidence).Item Embargo Evidence Summary: Pressure Injuries: Preventing heel pressure injuries with positioning(Cambridge Publishing, 2017) Haesler, EmilyHeels are a common anatomical location in which PIs occur. Due to their small surface area and minimal tissue protection over the bony prominence, interface pressure at the heel is high when an individual is lying in bed, particularly when that individual has reduced mobility1 (Level 3c evidence). There is evidence to indicate that suspending the heels using a foam cushion block2 or heel suspension boots2-4 reduces the incidence of heel PIs (Level 1c evidence).Item Embargo Evidence Summary: Pressure Injuries: Preventing medical device related pressure injuries(Cambridge Publishing, 2017) Haesler, EmilyMedical device related pressure injuries occur from the use of devices designed and applied to the body for diagnostic purposes or for the delivery of treatment. The MDRPI occurs as a result of ongoing pressure on the skin from the device or from fixations used to secure the device.1 Individuals in intensive care setting2-6 and children/neonates7-12 are at particular risk of developing a MDRPI (Levels 1, 2, 3 and 4 evidence). Interventions designed to reduce interface pressure and protect the skin, such as regularly repositioning the device (Level 5b evidence), alternating devices (Level 1c evidence), moisturising the skin (Level 1c evidence), and applying a prophylactic dressing (Levels 1, 2 and 4 evidence), are effective in reducing the risk of MDRPI.Item Embargo Evidence Summary: Wound Management Low ResourceCommunities - Potato Peel Dressings(Cambridge Publishing, 2017) Haesler, EmilyWhat is the best available evidence regarding sterile potato peel dressings for wound management?Item Embargo Evidence Summary: Single modality management of lymphoedema: Exercise(Cambridge Publishing, 2017) Haesler, EmilyWhat is the best available evidence on the effectiveness of exercise regimens in managing lymphoedema?Item Embargo Evidence summary: Wound management low resource communities - Aloe vera for wound healing(Cambridge Publishing, 2017) Haesler, EmilyAloe vera is a succulent plant that has traditionally been used for natural wound healing. The leaves contain a gel substance that is harvested, then stabilised and sterilised with heat, before application to a wound (generally a burn) (Level 5.b evidence). Despite its wide spread use as a cost effective agent for wound management, there is minimal evidence on the efficacy of aloe vera in wound healing. The evidence identified for this summary included efficacy of aloe vera for healing partial thickness burns, diabetic ulcers, leg ulcers, surgical wounds, biopsy sites7 and stage >=2 pressure injuries (Level 1.b to 4.c evidence). The findings were contradictory; however, aloe vera was not inferior to contemporary wound care products, particularly for burn management. The different aloe vera products used, or the high risk of bias observed in most trials, may account for inconsistent findings. Safety reviews indicate that risks of using aloe vera products in wound management are low (Level 5.b evidence).Item Embargo Dwell time and risk of central-line-associated bloodstream infection in neonates(W B Saunders Co, 2017) Sanderson, E; Yeo, Kee Thai; Wang, A Y; Callander, I; Bajuk, Barbara; Bolisetty, S; Lui, Kei; Bowen, J; Sedgley, S; Carlisle, Hazel; Kent, Alison; Smith, JBackground: Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). Aim: To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. Methods: The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). Findings: There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan–Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12–20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. Conclusion: There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.Item Open Access Developing a systems thinking guide for enhancing knowledge mobilisation in prevention research(Sax Institute, 2022) Irving, Michelle J.; Pescud, Melanie; Howse, E; Haynes, Abby; Rychetnik, LucieKnowledge mobilisation aims to increase research impact in policy and practice. ‘Mobilising’ knowledge implies a social interaction and involves an iterative, collaborative process. We argue that this process is strengthened when underpinned by systems thinking. Previous research has integrated systems thinking with knowledge mobilisation. We built on this to develop an applied tool to support prevention researchers seeking to incorporate systems thinking into their knowledge mobilisation work. We refer to this tool as the ‘systems thinking guide for knowledge mobilisation’. Our guide was developed through a stepwise process that included: 1) An inductive thematic synthesis of previous research in this area; 2) Reflexive deliberation to identify critical focus areas, drawing on the synthesis and the authors’ experiences of applying systems approaches to knowledge mobilisation; 3) Development of a set of questions designed for end users to consider against the backdrop of their own research and contexts; 4) Trialling these questions through a series of workshops; and 5) Revision based on user feedback. The proposed systems thinking guide includes 13 questions and 18 subquestions to help researchers frame their knowledge mobilisation strategies using a systems perspective. Our next steps are applying this guide to other research projects and reviewing and reporting on its implementation and real-world use. In the meantime, we invite other research teams to test this tool and contribute constructive feedback on its usefulness and potential further development.Item Embargo Re-thinking Bias in the Age of Automation(The Law Book Company, 2019) Lim, SarahThis article explores the applicability of the rule against bias to administrative decisions made wholly by automated systems, questioning the ability of Australia's administrative law system to adapt to increasing digitalisation and automation of government processes. By examining the behaviour and characteristics of neural networks, this article demonstrates the ways in which bias may infuse the decisions of predictive automated systems. It subsequently reveals the difficulties courts will likely face in transposing the rule against bias to automated decision-makers, thus advocating the use of alternative grounds of judicial review to remedy defective decisions. Ultimately, the relevancy and reasonableness grounds; despite their similarly human focus, are identified as the most amenable to judicial modification.Item Embargo Cover Image, Volume 9, Issue 4 WIREs RNA(John Wiley & Sons Ltd., 2018) Shirokikh, Nikolay; Preiss, ThomasThe cover image, by Nikolay E. Shirokikh and Thomas Preiss, is based on the Overview Translation initiation by capdependent ribosome recruitment: Recent insights and open questions, DOI: 10.1002/wrna.1473.Item Open Access Of pregnancies complicated by small for gestational age babies at term, what proportions have placental findings with implications for future pregnancies or neonatal outcomes? [Online](Taylor & Francis Group, 2019) Orefice, Roberto; Kent, Alison; Sethna, Farah; Dahlstrom, JaneBackground: Small for gestational age (SGA) is a term to define any baby born with birth weight <10th centile. SGA can be associated with a number of placental pathology findings, which may influence maternal outcomes, neonatal neurodevelopment, and future pregnancies. Aims: To identify the proportion of term pregnancies complicated by SGA with placental findings that may have implications for future pregnancies or neonatal outcomes. Method: A retrospective review between 2011 and 2015 of babies and placentas born at term with SGA histopathological findings were categorized as to whether they had a high recurrence rate and where the long-term neurodevelopmental outcome may affect the neonate. Results: Six hundred and ninety-eight babies were identified as SGA. Only 335 (47.8%) placentas were sent for histopathological assessment. Of these, 60 (17.9%) had histopathological findings associated with high recurrence rates and 68 (20.2%) had findings associated with potential adverse neonatal outcomes. Conclusions: Of those placentas sent for examination between 17.9% and 20.2% had findings associated with either high recurrence rates or findings that may benefit from neonatal follow-up. Under 50% of pregnancies complicated by SGA at term had a placental examination, resulting in a significant number of potential important clinical consequences being missed.Item Embargo Surgical Technique for Establishment of a Multiple-Organ Ischemia and Reperfusion (I/R) Injury Model in Rat(Gavin Publishers, 2018) Smith, Paul; Yang, Yongliang; Weiss, Steven; Dai, Jin; Li, RachelAnimal models of ischemia/reperfusion (I/R) injury have been widely applied to the study of myocardial, liver, renal and skeletal muscle ischemia, I/R injury and drug efficacy. However, these require large numbers of experimental animals and human resources in performing the surgical procedures. Animal models described for experimental research regarding multiple-organ I/R injury are relatively sparse. Therefore, there is a clear potential to evaluate the drugs for protection against I/R injury of multiple organs in an established multiple organ I/R injury animal model. Here we provide useful information for medical researchers who are learning the surgical process of establishing I/R injury animal models. We demonstrate a novel multiple-organ procedure for both skeletal muscle I/R injury and kidney I/R injury in a rat model. The surgical process is described from an anesthetized animal to the completion of reperfusion, including detailed descriptions of each step throughout the procedure. It should also be noted that this video guide is focused towards procedures conducted in rodent models. Modifications of the described procedures are applicable to other animal models.Item Embargo Going virtual: how can technology play a role in supporting students with mental health problems?(BACP (British Association for Counselling and Psychotherapy), 2018) Farrer, Lou; Gulliver, AmeliaLou Farrer and Amelia Gulliver describe the evolution of anonline "clinic" for university students, and outline the potential benefits of such initiatives for hard-to-reach students as well as those with chronic mental health issues.Item Embargo Editorial: Special Issue in Honour of Justice John Basten(The Law Book Company, 2022) Groves, Matthew; Weeks, GregItem Embargo Editorial: Vale The Hon Sir Francis Gerard Brennan AC KBE GBS QC(The Law Book Company, 2022) Groves, Matthew; Weeks, GregJustice John Basten formally retired as a Judge of the Supreme Court of New South Wales and Judge of Appeal in April 2022, appointments that he had held since 2 May 2005. Although his Honour will remain an Acting Judge of Appeal, this is an appropriate time to celebrate the career of one of Australia’s foremost thinkers on administrative law.Item Embargo Editorial: The State of the AAT(The Law Book Company, 2022) Groves, Matthew; Weeks, GregThe Administrative Appeals Tribunal (AAT) is one of the cornerstones of our system of administrative review. It is a body designed to review the decisions of government. It is also one that has suffered badly at the hands of government.