Narrow Identities

In a world shaped by social media, it is the medium itself that pushes us to share only a fragment of who we are—a carefully curated representation feeding into a black-and-white narrative that influences society’s view of identity. Over time, these partial narratives feed back into our own self-perception, confusing or eclipsing our richer, more nuanced and conflicting selves. In Narrow Identities, vibrant ceramic sculptures symbolize the true breadth of our personality and experiences, while black-and-white crochet elements embody the fragile, woven personas we present online. By juxtaposing these materials, the series highlights the tension between our authentic, multifaceted nature and the diluted images we cultivate and internalise in digital spaces. As we move away from our more authentic, less idealised selves, our ‘narrow identities’ sustain the values of modern life, influencing how we see ourselves and ultimately shaping the ways society comes together

The sexual abuse of adolescent boys in humanitarian emergencies: A qualitative study of how international humanitarian organisations are responding

Background: Over the last decade, public health research has increasingly shown that humanitarian emergencies can negatively impact the wellbeing of adolescents. However, recent studies have largely not addressed the differentiated impact on adolescent boys or how humanitarians are responding. Objective: We sought to understand how humanitarian organisations respond to child sexual abuse against adolescent boys in humanitarian emergencies. Participants and setting: Sixteen humanitarian staff based in Geneva, Switzerland, and 35 humanitarian staff and 52 child protection caseworkers from the Rohingya refugee crisis response in Cox's Bazar, Bangladesh. Methods: We employed a critical ethnographic research design. Between September 2018 and October 2019, we conducted interviews with humanitarians in Geneva, as well as interviews, focus group discussions, and observation of the humanitarian response to the Rohingya refugee crisis in Bangladesh. Results: Sexual abuse of adolescent boys is present in numerous humanitarian emergencies and boys appear to be at risk in certain contexts, including workplaces, streets, and shelters. Humanitarian actors are responding through individualised casework but referrals to services are often limited by the operating environment. The most promising approaches to support survivors are specifically accessible to adolescent boys and provided by services that boys trust. Of note, humanitarian responsibility for adolescent boy survivors appears to be a context-specific negotiation between humanitarian sectors and this may be causing difficulties in the delivery of effective interventions. Conclusion: Humanitarian actors should employ a more systematic approach to supporting adolescent boys that experience child sexual abuse, as an important matter for adolescent rights and health equity

Drug Retention Time of Immunosuppressive Therapy in Behcet’s Uveitis

PURPOSE: Behcet's Disease is a chronic multisystem vasculitis associated with a blinding uveitis. Few comparative studies exist between conventional disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs in Behcet's uveitis (BU). We therefore used drug retention time (DRT), an accepted surrogate measure of pharmacological efficacy and tolerability, to compare these treatments in patients with BU. METHODS: Retrospective chart review of patients who met the revised International Criteria for Behcet's Disease (ICBD) treated at the Royal Victorian Eye and Ear Hospital, Australia, between 1985-2021. DRT was analysed with Kaplan-Meier plots and defined as total time on drug in the first medication-period for each DMARD in each patient. RESULTS: Forty-eight patients (37 males) with median age of 28.6 years were followed-up for a median of 8.0 years. At initial presentation, half had bilateral disease and median logMAR visual acuity was 0.176 (Snellen 6/9) in 62 uveitic eyes (16 anterior uveitis, 11 intermediate, 2 posterior, and 33 panuveitis). Thirty-three patients met ICBD initially. Prescribed corticosteroid-sparing agents were Cyclosporin (N = 24), Mycophenolate (N = 22), Azathioprine (N = 22), Methotrexate (N = 16), and Adalimumab (N = 15). Median DRT was 14.0, 27.4, 8.3, 24.0, and 52.0 months, respectively. DMARDs were discontinued 116 times and adverse effects (N = 37) were the main reason for cessation. Over time, patients were switched from Cyclosporin to Adalimumab earlier in the disease course due to poorer tolerance of adverse events. CONCLUSION: Adalimumab's drug retention time was found to be similar to and possibly better than cDMARDs in patients with BU, who often suffer from vision-threatening disease at first presentation

Patient characteristics and antimicrobial susceptibility profiles of Escherichia coli and Klebsiella pneumoniae infections in international travellers: a GeoSentinel analysis

BACKGROUND: Antimicrobial resistance (AMR) is a global health crisis, with Enterobacterales, including Escherichia coli and Klebsiella pneumoniae, playing significant roles. While international travel to low- and middle-income countries is linked to colonization with AMR Enterobacterales, the clinical implications, particularly the risk of subsequent infection, remain unclear due to limited data. We aimed to characterize E. coli and K. pneumoniae infections in travellers and the antimicrobial susceptibility profiles of their isolates. METHODS: We analysed data on E. coli and K. pneumoniae infections in travellers collected at GeoSentinel sites between 2015 and 2022, focusing on epidemiological, clinical and microbiological characteristics. We defined multi-drug resistance (MDR) as non-susceptibility to agents from at least three drug classes. RESULTS: Over the 8-year period, we included 655 patients (median age 41 years; 74% female) from 57 sites in 27 countries, with 584 E. coli and 72 K. pneumoniae infections. Common travel regions included sub-Saharan Africa, Southeast Asia and South-Central Asia. Urinary tract infections predominated. Almost half (45%) were hospitalized. Among infections with antimicrobial susceptibility data across three or more drug classes, 203/544 (37%) E. coli and 19/67 (28%) K. pneumoniae demonstrated MDR. Over one-third of E. coli and K. pneumoniae isolates were non-susceptible to third-generation cephalosporins and cotrimoxazole, with 38% and 28% non-susceptible to fluoroquinolones, respectively. Travellers to South-Central Asia most frequently had isolates non-susceptible to third-generation cephalosporins, fluoroquinolones and carbapenems. We observed increasing frequencies of phenotypic extended spectrum beta-lactamase and carbapenem resistance over time. CONCLUSIONS: E. coli and K. pneumoniae infections in travellers, particularly those to Asia, may be challenging to empirically treat. Our analysis highlights the significant health risks these infections pose to travellers and emphasizes the escalating global threat of AMR. Enhanced, systematic AMR surveillance in travellers is needed, along with prospective data on infection risk post travel-related AMR organism acquisition

Organisational and policy barriers to transitioning from supported into open employment for people with an intellectual disability

BACKGROUND: People with an intellectual disability prefer more choice with employment options and more community facing roles rather than just traditional supported employment roles. However, data reveal that transition rates from supported to open employment in Australia remain very low and these findings are also found internationally. METHOD: To examine current organisational and policy barriers preventing transition from supported to open employment, a series of 27 in-depth interviews were conducted with people with an intellectual disability, staff from supported employers, and staff from open employers. RESULTS: There were several key policy and organisational barriers identified. These included inflexible funding models and packages, lack of knowledge and experience of open employers, and insufficient training, pathways, and supports for people with an intellectual to make that transition. CONCLUSION: The findings highlight some of the broader policy and program reforms that are required, commencing in school and inclusive of all employer groups

Mechanical power made simple: validating a simplified calculation of mechanical power in preterm lungs

BACKGROUND: The incidence of chronic lung disease is increasing, suggesting a need to explore novel ways to understand ventilator induced lung injury (VILI) in preterm infants. Mechanical power (MP) is a unifying measure of energy transferred to the respiratory system and a proposed determinant of VILI. The gold-standard method for calculating MP (geometric method) is not feasible in the clinical setting. This has prompted the derivation of simplified equations for calculating MP. OBJECTIVE: To validate the agreement between a simplified calculation of MP (MPSimple) and the true MP calculated using the geometric method (MPRef). METHODS: MPSimple and MPRef was calculated in mechanically ventilated preterm lambs (n = 71) and the agreement between both measures was determined using intraclass correlation coefficients (ICC), linear regression, and Bland-Altman analysis. RESULTS: A strong linear relationship (adjusted R2 = 0.98), and excellent agreement (ICC = 0.99, 95% CI = 0.98-0.99) between MPSimple and MPRef was demonstrated. Bland-Altman analysis demonstrated a negligible positive bias (mean difference = 0.131 J/min·kg). The 95% limits of agreement were -0.06 to 0.32 J/min·kg. CONCLUSIONS: In a controlled setting, there was excellent agreement between MPSimple and gold-standard calculations. MPSimple should be validated and explored in preterm neonates to assess the cause-effect relationship with VILI and neonatal outcomes. IMPACT STATEMENT: Mechanical power (MP) unifies the individual components of ventilator induced lung injury (VILI) and provides an estimate of total energy transferred to the respiratory system during mechanical ventilation. As gold-standard calculations of mechanical power at the bedside are not feasible, alternative simplified equations have been proposed. In this study, MP calculated using a simplified equation had excellent agreement with true MP in mechanically ventilated preterm lambs. These results lay foundations to explore the role of MP in neonatal VILI and determine its relationship with short and long term respiratory outcomes

Inpatients' experiences of falls: A qualitative meta-synthesis

OBJECTIVES: Identify and synthesize published qualitative research reporting inpatient experiences of a fall to determine novel insights and understandings of this longstanding complex problem. RESEARCH DESIGN: Qualitative meta-synthesis. METHODS: Online databases were searched to systematically identify published research reporting inpatient experiences of a fall. The included studies were inductively analysed and interpreted then reported as a meta-synthesis. DATA SOURCES: Databases Ovid MEDLINE, Embase, Ovid Emcare, CINAHL Complete, Scopus and ProQuest Dissertations and Theses Global were searched on 3rd August, 2023. RESULTS: From 10 included publications, four new themes of inpatients' experiences of a fall were constructed. Themes one, two and three related to antecedents of patient falls, and theme four related to consequences. Theme one, 'My foot didn't come with me: Physiological and anatomical changes', encompassed patients' experiences of medical conditions, medication, and anatomical changes. These aspects contributed to alterations in balance and strength, and misconceptions of capability in activities of daily (inpatient) living. Theme two, 'I was in a hurry: Help-seeking', encompassed patients' experiences striving for independence while balancing power and control, minimizing their own needs over care of others', and unavailability of support. Theme three, 'I couldn't find the call light: Environment and equipment', encompassed patients' experiences of not being able to reach or use equipment, and environment changes. Theme four, 'It was my fault too: Blame and confidence', encompassed patients' expressions of blame after their fall, blame directed at both themselves and/or others, and impacts on confidence and fear in mobilizing. CONCLUSIONS: Inpatient falls are embedded in a complexity of individual, relational, and environmental factors, yet there are potential ways forward both informed and led by the patient's voice. Strength-based approaches to address the tenuous balance between independence and support may be one opportunity to explore as a next step in complementing the existing multifaceted interventions. IMPACT: Inpatient falls are a complex and costly health safety and quality problem. Despite global initiatives in the prevention of inpatient falls, they remain intractable. This meta-synthesis provides an in-depth exploration of extant qualitative data on patients' experiences of falls in hospitals. Four themes were constructed expressing the inpatients' experiences: physiological and anatomical changes, help-seeking, environment and equipment, and blame and confidence. Novel considerations for future investigation are offered, drawing from self-determination theory and positive psychological interventions. IMPLICATIONS FOR PATIENT CARE: This meta-synthesis elicits new considerations for future interventions based on people's experiences of their fall in hospital, offering healthcare professionals novel directions in fall prevention. REPORTING METHOD: The review was reported according to the Enhancing transparency in reporting the synthesis of qualitative research statement (ENTREQ; Tong et al., 2012). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. REGISTRATION: PROSPERO CRD42023445279

Music therapists’ perceptions of creating safety in the context of trauma with children and adolescents: A qualitative study

Introduction: Ensuring the safety of children and adolescents who have experienced trauma is a paramount consideration in therapeutic practices, yet research specifically addressing this within music therapy is lacking. To bridge this gap, the authors aimed to use semi-structured interviews to investigate how experienced music therapists from diverse cultural backgrounds describe providing safety while working with children and adolescents who experienced trauma. Method: This research employed hermeneutic phenomenology to analyze the perspectives of 18 music therapists representing 11 countries. Their descriptions of cultivating safety and establishing secure environments were shared via online interviews and techniques from Interpretative Phenomenological Analysis (IPA) were used to generate results. Results: Analysis of the interviews revealed four prominent themes delineating the techniques music therapists use in their sessions to foster safety. These themes encompassed various aspects such as establishing a safe space, implementing a semi-structured program, providing opportunities for control and choice, and thoughtfully incorporating music. Collectively, these themes illuminate the approaches music therapists effectively deploy to create safety in their therapeutic sessions. Discussion: The experienced music therapists in this study underscored the importance of attuning to the needs of children and adolescents who have experienced adversity. Newer practitioners may be interested in the ways they described maintaining a delicate balance between openness, flexibility, well-defined boundaries, and a reliable, caring presence. These fundamental elements support the development of safe connections and meaningful engagement, potentially fostering a sense of safety for both therapists and the young people they work with

Generalizability of a Musculoskeletal Therapist Electronic Health Record for Modelling Outcomes to Work-Related Musculoskeletal Disorders

PURPOSE: Electronic Health Records (EHRs) can contain vast amounts of clinical information that could be reused in modelling outcomes of work-related musculoskeletal disorders (WMSDs). Determining the generalizability of an EHR dataset is an important step in determining the appropriateness of its reuse. The study aims to describe the EHR dataset used by occupational musculoskeletal therapists and determine whether the EHR dataset is generalizable to the Australian workers' population and injury characteristics seen in workers' compensation claims. METHODS: Variables were considered if they were associated with outcomes of WMSDs and variables data were available. Completeness and external validity assessment analysed frequency distributions, percentage of records and confidence intervals. RESULTS: There were 48,434 patient care plans across 10 industries from 2014 to 2021. The EHR collects information related to clinical interventions, health and psychosocial factors, job demands, work accommodations as well as workplace culture, which have all been shown to be valuable variables in determining outcomes to WMSDs. Distributions of age, duration of employment, gender and region of birth were mostly similar to the Australian workforce. Upper limb WMSDs were higher in the EHR compared to workers' compensation claims and diagnoses were similar. CONCLUSION: The study shows the EHR has strong potential to be used for further research into WMSDs as it has a similar population to the Australian workforce, manufacturing industry and workers' compensation claims. It contains many variables that may be relevant in modelling outcomes to WMSDs that are not typically available in existing datasets