The Rise and Decline of Constitutionalism in the Global South: The Case of Indonesia’s Constitutional Court

Studies of constitutionalism in the Global South often chart the rise and achievements of liberal constitutionalism. In this contribution, I suggest that we also need to consider the decline of constitutional democracy as part of studies of constitutionalism in the Global South. Since the book Constitutional Democracy in Indonesia was published, the decline of constitutional democracy in Indonesia has worsened. In this contribution I question the symbolism of the Constitutional Court, examine Indonesia’s place in global scholarship, and demonstrating how the recent 2023 Constitutional Court crisis requires us to reassess the future of constitutional democracy in Indonesi

Multi-objective Food Supply Chain under Uncertainty

The Global Food Supply Chain (GFSC) plays a critical role in ensuring food availability by efficiently managing the distribution of food products. Distribution planning for GFSC is complex and often influenced by economic, political, demographic, environmental, and agricultural factors. Despite numerous works in food supply chains, no study has addressed optimizing global trade dynamics in the face of various deterministic and uncertain disruptions, whether they are happening independently or simultaneously. This thesis has investigated the GFSC distribution network for rice and wheat, proposing various reactive and proactive strategies to mitigate the impacts caused by deterministic and stochastic disruptions. The investigations were done by including various perspectives on the GFSC: The economic perspective which aims to minimize costs for importing countries and maximize revenue for exporting countries, the food security perspective which seeks to minimize the shortages of food products globally, and the environmental perspective, which minimizes the environmental impacts in agricultural practices. Several single-objective and multi-objective mathematical models are presented to address these perspectives. Firstly, an integrated Linear Programming (LP) model is developed to optimize the global flow of rice and wheat among trading partners under ideal conditions. The model was then extended to address potential disruptions in supply and transportation within GFSC, incorporating mitigation strategies such as strategic inventory and product substitution. In addition, a novel heuristic algorithm is proposed, capable of revising the optimal distribution plan in response to single or multiple deterministic disruptions. Applied to the three real-life disruption scenarios, the proposed heuristic effectively mitigated the shortages by 67.5% in the worst-case disruption scenarios and fully eliminated the shortages in all other individual or simultaneous scenarios. To generate proactive plans, the model was extended to deal with many years in the future, projecting GFSC scenarios until 2050. Moreover, the possibility of using alternate modes of transport is considered in this model. To study the effects of stochastic disruptions, real-life disruption situations were simulated using a scenario-based stochastic programming approach and Monte Carlo simulation. Moreover, data required for the approaches are generated using Time Series Analysis and Neural Networks. An Iterated Greedy Approach (IGA) is employed to solve the problem efficiently, accompanied by a decomposition method that clusters countries based on trade dynamics. The decomposition method could significantly reduce the computational time in the scenario-based stochastic problem and decrease the average deviation of the algorithm output from the exact method to 0.23%. Then, the IGA algorithm was employed to construct the distribution and inventory plans for GFSC up to the year 2050. Analysis of results provides crucial managerial insights that recommend effective reactive and proactive strategies for disruption mitigation. The findings emphasized the importance of environmental preservation in the future of GFSC. As a result, this thesis also proposes a multi-objective GFSC model aimed at minimizing both costs and environmental impacts. The multi-objective problem is initially solved using the Epsilon-Constraint method. Then, a Non-dominated Sorting Genetic Algorithm II (NSGA-II) approach was developed to solve the large-scale problems, using an efficient heuristic initialization method that outperforms traditional random initialization. The proposed algorithm was applied to a global case study, cutting down greenhouse emissions by 11.54% without causing any shortages in the network

Randwick Creative Ward

Our proposal, the ‘Randwick Creative Ward’, seeks to develop an upcycled building and fit-out strategy for the sustainable and ‘meanwhile use’ of decanted hospital wards. Australia has an embodied carbon problem. Each square meter of new construction causes greenhouse gas emissions of around 500 – 1,000 kgCO2e. And with around 34 million square metres built per year in Australia, this represents a major contributor to our national emissions. We also have many vacant and under-utilised buildings at the end-of-lifecycle, now under threat of demolition and replacement. These represent a previous investment of millions of tonnes of material, labour, and carbon. While new building structures are a major contributor to embodied carbon, building elements that have shorter lifespans, and are regularly replaced – such as finishes, fit out and furniture – are also major contributors, so any strategy to tackle embodied carbon must consider both. Hospital campuses are a microcosm of these cha llenges, with their vacant and decanted spaces often becoming storage areas for expired medical infrastructure, equipment, and furniture. At the same time, Health & Innovation Precincts are emerging as sites that bring university knowledge and talent into Health. In doing so, they support research startups to evolve and shape future health industries. Co-locating MedTech and creative startups in redundant hospital spaces would further research innovations and support future collaborations between art, design, and health, thus strengthening the creative economy. Refreshing aging health infrastructure benefits staff, patients, and the broader community: an increase in creative and meanwhile studios in cities and neighbourhoods contributes to more activated, vibrant, and healthier environments for all. Our vision, the ‘Randwick Creative Ward’, proposes the re-use long-term vacant hospital spaces to accommodate community, creative and entrepreneurial functions that may change and ebb over time. Using biophilic and wellbeing design principles, the proposal involves re-cladding wards to improve their thermal performance and upcycling existing materials and medical infrastructure, to create inexpensive, simple, and flexible modular fit outs that can be inhabited in multiple ways whilst also reducing waste and embodied emissions. Our concept image shows the transformation of a typical hospital ward at the Randwick Health and Innovation Campus (RHIP) into a MedTech startup and creative studio, promoting social and cultural sustainability. Formerly long dark corridors servicing generic patient bed areas become a metaphoric communal street supporting adjacent light-filled studio spaces. Made of sustainable timber, newly built demountable workstations are located around internal and external windows, to improve thermal efficiencies whilst capitalising on views and daylighting. An inventory of redundant building materials and medical equipment provides the basis for creative repurposing: in our example, former bedside cabinets become bespoke studio tables, Xray light boxes showcase creative works, IV drip holders suspend bespoke neon lighting and expired timber furniture is re-fashioned to create snug workspaces

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. Funding: Bill & Melinda Gates Foundation

Implications for an early intensive blood pressure lowering strategy in patients with acute ischaemic stroke

Background and Objectives: The management of elevated blood pressure (BP) in patients with acute ischaemic stroke (AIS) remains controversial. While large randomised controlled trials, such as the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), have quantified the effects of early intensive BP lowering on functional recovery, further investigations are required to reliably define the balance of risks and benefits in different patient groups. In particular, the INTEnsive ambulance-delivered BP Reduction in hyper-Acute stroke Trial (INTERACT4) aims to define the risks and benefits of intensive BP lowering treatment in the first 2 hours of stroke onset. This thesis explores the effects of early intensive BP lowering to a systolic target of 130-140 mmHg in different time points (<2 hours in the ambulance or <6 hours in hospital) on functional recovery, and injury to the brain and kidney, in AIS patients. It also examines regional differences in BP management to facilitate the uptake of evidence-based recommendations. Methods: These were secondary analysis of the ENCHANTED and INTERACT4 trials, with a focus on functional recovery on the modified Rankin scale, infarct volume assessed on brain imaging, and short-term changes in renal function according to estimations of serum creatinine. Regional differences in antihypertensive treatment were examined in the international multicentre ENCHANTED trial. Results: The findings indicate that intensive BP lowering to a systolic target of 130-140 mmHg is harmful in AIS patients, with worsening of functional recovery and increased mortality when initiated within 2 hours after the onset. However, initiating this treatment within 6 hours in thrombolysed AIS patients is safe according to infarct volume and renal function. There are considerable regional differences in the use of BP lowering treatment in AIS patients. Conclusions: My research has shown that a moderate intensity of BP lowering before reperfusion therapy in AIS patients is harmful and should be avoided. However, this BP lowering treatment after reperfusion therapy does not appear harmful, but more work is required to define whether it provides beneficial effects on functional recovery. Regional differences in the use of BP lowering treatment in AIS translated into differences in BP parameters and needs to be considered in the design and interpretation of trial results. Further research is needed to optimise BP management in AIS

Analysis of extracellular matrix dynamics in renal fibrosis: towards discovering new therapeutic targets and biomarkers

Chronic kidney disease (CKD) affects about 10% of the Australian population and has a broad impact on disability and health costs. The main pathological feature, the most important predictor of CKD progression and, in fact, the silent killer behind that - is tubulointerstitial fibrosis (TIF), the process of scarring of renal tubuli and the surrounding stroma. Despite the disease burden, clinically reliable methods to non-invasively diagnose, prevent, or reverse TIF are to date-absent. This highlights the need for TIF biomarkers and molecular targets. The extracellular matrix (ECM) is a complex protein-rich matter that surrounds the cells. Its excessive accumulation and hardening are the principal characteristics of all fibrotic conditions, including TIF. We hypothesised that ECM could be a new source of biomarkers to early diagnose TIF and assessing ECM remodelling during the development of fibrosis could provide potential therapeutic targets for TIF. Our comprehensive literature analysis provided preliminary evidence supporting our working hypothesis. This project aimed to reveal the protein composition and transcriptional signatures of kidney ECM during the progression and spontaneous recovery of TIF in an animal model of folic-induced fibrosis, by a rational combination of omics technologies and pathophysiology methods. First, we conducted a comprehensive characterisation of ECM proteins of kidneys in healthy mice, with a comparison of two ECM extraction methods in combination with LC-MS/MS, protein identification, and label-free quantification. Next, the ECM dynamics during the initiation, progression, and spontaneous recovery of TIF was explored using the folic acid model. The examination of the animals' blood and kidney tissues by biochemical, histological and immunofluorescence methods confirmed the development of acute kidney injury, progressive TIF and spontaneous recovery in a 40% of animals. Kidney samples from different groups were comparatively analysed using RNAseq and proteomics followed by multi-omics data integration. Omics data were then correlated with pathophysiology findings. As a result, the ECM proteins and gene transcripts, as well as the signalling pathways, which could serve as biomarkers or treatment targets of TIF, were identified. The methodologies can be applied to other research areas and the identified markers might have a role, not only in renal fibrosis but also in other fibrotic disorders

Neighbourhood environments and cognitive health in the longitudinal Personality and Total Health (PATH) through life study: A 12-year follow-up of older Australians

Background: Urban neighbourhood environments may impact older adults’ cognitive health. However, longitudinal studies examining key environmental correlates of cognitive health are lacking. We estimated cross-sectional and longitudinal associations of neighbourhood built and natural environments and ambient air pollution with multiple cognitive health outcomes in Australian urban dwellers aged 60+ years. Methods: The study included 1160 participants of the PATH Through Life study (60+ cohort) who were followed up for 12 years (four assessments; 2001/02 to 2013/15) and with data on socio-demographics, health, cognitive functions and diagnoses, and full residential address. Neighbourhood environmental features encompassed population and street-intersection densities, non-commercial land use mix, transit points, presence of blue space, percentages of commercial land, parkland and tree cover, and annual average PM2.5 and NO2 concentrations. All exposures except for tree cover were assessed at two time points. Generalised additive mixed models estimated associations of person-level average, and within-person changes in, exposures with cognitive functions. Multi-state hidden Markov models estimated the associations of neighbourhood attributes with transitions to/from mild cognitive impairment (MCI). Results: Dense, destination-rich neighbourhoods were associated with a lower likelihood of transition to MCI and reversal to no MCI. Positive cross-sectional and longitudinal associations of non-commercial land use mix, street intersection density and percentage of commercial land were observed especially with global cognition and processing speed. While access to parkland and blue spaces were associated with a lower risk of transition to MCI, the findings related to cognitive functions were mixed and supportive of an effect of parkland on verbal memory only. Higher levels of PM2.5 and NO2 were consistently associated with steeper declines and/or decreases in cognitive functions and worse cognitive states across time. Conclusion: To support cognitive health in ageing populations, neighbourhoods need to provide an optimal mix of environmental complexity, destinations and access to the natural environment and, at the same time, minimise ambient air pollution

The Optimisation of Arteriovenous Fistula Vascular Access Outcomes for Haemodialysis

End Stage Renal Failure, requiring renal replacement therapy, is delivered most commonly via haemodialysis (HD). The gold standard Vascular Access (VA) for HD is the arteriovenous fistula (AVF). However, it can be difficult to establish and maintain a mature AVF. A comprehensive vascular access service model was established with the aim of streamlining AVF care, allowing for the introduction of innovative solutions (over the subsequent years) to AVF pathologies and close observation of AVF experimental outcomes. This service resulted in an improvement in multiple VA outcomes and a reduction in VA expenditure. Innovative solutions focused on improving the reliability of the AVF through addressing known inflow, cannulation zone and outflow AVF pathologies were developed. We implanted an interwoven nitinol stent to approximate the optimal fluid dynamic geometry to treat stenoses of the inflow juxta-anastomosis (JXAS). We found acceptable patency results with no loss of AVFs in the long term results. A dynamic banding (DYBAND) technique was developed to treat excessive AVF inflow, allowing for band adjustment in concert with flow rate measurement, thus achieving the optimal band diameter for every individual AVF. The dysfunctional cannulation zone was addressed with cannulation zone stenting, allowing immediate puncture for dialysis. In a multi-centre study, we found acceptable outcomes and patency of AVFs to 4 years follow up, with a low rate of re-intervention. A pilot study with drug eluting stents in the AVF cannulation zone was performed to improve patency results. Whilst we were able to determine acceptable patency results, cessation of dual antiplatelet therapy in the medium-term post implantation was associated with stent thrombosis, hence limiting widespread adoption. During the study, a meta-analysis (Katsanos et al), determined a significant mortality risk associated with a commonly applied AVF first line therapy, drug eluting balloons (DEB). We performed a meta-analysis and demonstrated no such effect was present in AVF patients receiving a DEB. With increasing confidence from the aforementioned therapies, we combined these treatments as an adjuvant to AVF formation. The study demonstrated that timely, near universal AVF maturation was achieved, with all AVFs maintained utilising a low rate of re-intervention. The methods and results presented in this thesis demonstrates that for incident dialysis dependency, under the supervision of an RVAC, patients can have an AVF formed, matured and maintained for long term access

Generative AI technologies applied to ecosystems and the environment: a scoping review

This report provides a scoping review of the literature on the ways that novel generative artificial intelligence (AI) tools are being applied to living things and other elements of ecosystems and the natural environment. The paper outlines several areas where generative AI is being deployed in new research projects and industry applications. These include animal communication and agriculture and plant cultivation, as well as environmental sustainability, biodiversity, climate change and nature conservation initiatives. The paper also details some of the negative environmental costs and ethical issues associated with the manufacture, training and infrastructure that support generative AI and large language models more generally