Across the great divide : Ankersmit's aesthetic gap and representative democracy

This thesis is an exploration of an aesthetic approach to political theory. In particular, I examine the concept of representative democracy in terms of philosophical aesthetics. Drawing inspiration from F.R. Ankersmit's Aesthetic Politics: Political Philosophy Beyond Fact and Value, I argue that there is a necessary 'distance' between citizens and their government, that, if ignored, can have totalitarian consequences. Understanding this distance, also known as the 'aesthetic gap,' requires an exploration of the notion of perspective. Ultimately, once both citizens and government begin to comprehend their particular perspectives, the question of what it means to be represented in a democratic regime becomes comprehensible. This awareness leads to interesting implications for the role of the political representative, and about the relationship between citizens and their governor

Topological states of matter and noncommutative geometry

This thesis examines topological states of matter from the perspective of noncommutative geometry and KK-theory. Examples of such topological states of matter include the quantum Hall e ect and topological insulators. For the quantum Hall e ect, we consider a continuous model and show that the Hall conductance can be expressed in terms of the index pairing of the Fermi projection of a disordered Hamiltonian with a spectral triple encoding the geometry of the sample's momentum space. The presence of a magnetic eld means that noncommutative algebras and methods must be employed. Higher dimensional analogues of the quantum Hall system are also considered, where the index pairing produces the `higher-dimensional Chern numbers' in the continuous setting. Next we consider a discrete quantum Hall system with an edge. We show that topological properties of observables concentrated at the boundary can be linked to invariants from a boundary-free model via the Kasparov product. Hence we obtain the bulk-edge correspondence of the quantum Hall e ect in the language of KK-theory. Finally we consider topological insulators, which come from imposing (possibly anti-linear) symmetries on condensed-matter systems and studying the invariants that are protected by these symmetries. We show how symmetry data can be linked to classes in real or complex KK-theory. Finally we prove the bulk-edge correspondence for topological insulator systems by linking bulk and edge systems using the Kasparov product in KKO-theory

Should Police and Crime Commissioners be abolished? The Commissioners respond

This week the report of the Independent Police Commission, led by the former Metropolitan Police Commissioner John Stevens and commissioned by the Labour Party, was published. One of its key proposals was for the abolition of the post of Police and Crime Commissioner, introduced in 2012 to establish a new form of democratic oversight of the police. In this post we ask serving Commissioners to respond to the proposal

Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation

BACKGROUND: In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. OBJECTIVE: We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. METHODS: We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. RESULTS: Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. CONCLUSIONS: This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability

Integrating testing for sexually transmissible infections into annual health assessments for Aboriginal and Torres Strait Islander young people: a cross-sectional analysis

Background In the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16–29 years in Aboriginal Community Controlled Health Services between 2018 and 2020. Methods Using routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test. Results Of the13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20–24 years (OR 1.2, 95% CI 1.1–1.4) and 25–29 years (OR 1.1, 95% CI 1.0–1.2) compared to 16–19 years and patients residing in very remote (OR 4.2, 95% CI 3.7–4.8), remote (OR 2.4, 95% CI 2.1–2.8), and regional areas (OR 2.5, 95% CI 2.2–2.8) compared to metropolitan areas. There was no association with patient sex. Conclusions Integration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women

Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012–2019)

Background:Many people survive critical illness with the burden of new or worsened mental health issues and sleep disturbances. We examined the frequency of psychotropic prescribing after critical illness, comparing critical care to non-critical care hospitalised survivors, and whether this varied in important subgroups.Methods:This retrospective cohort study included 23,340 critical care and 367,185 non-critical care hospitalised adults from 2012 through 2019 in Lothian, Scotland, who survived to discharge.Results:One-third of critical care survivors (32 7527/23,340) received a psychotropic prescription within 90 days after hospital discharge (25 14hypnotics; 4mania medicines). In contrast, 1554,589/367,185) of non-critical care survivors received a psychotropic prescription (12 5hypnotics; 2mania medicines). Among patients without psychotropic prescriptions within 180 days prior to hospitalisation, after hospital discharge, the critical care group had a higher incidence of psychotropic prescription (10.3 1610/15,609) compared with the non-critical care group (3.2 9743/307,429); unadjusted hazard ratio (HR) 3.39, 95 3.22–3.57. After adjustment for potential confounders, the risk remained elevated (adjusted HR 2.03, 95 1.91–2.16), persisted later in follow-up (90–365 days; adjusted HR 1.38, 95 1.30–1.46), and was more pronounced in those without recorded comorbidities (adjusted HR 3.49, 95 3.22–3.78).Conclusions:Critical care survivors have a higher risk of receiving psychotropic prescriptions than hospitalised patients, with a significant proportion receiving benzodiazepines and other hypnotics. Future research should focus on the requirement for and safety of psychotropic medicines in survivors of critical illness, to help guide policy for clinical practice

Neurolinguistic programming: a systematic review of the effects on health outcomes

BACKGROUND: Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers. AIM: To evaluate the effects of NLP on health-related outcomes. DESIGN AND SETTING: Systematic review of experimental studies. METHOD: The following data sources were searched: MEDLINE, PsycINFO, ASSIA, AMED, CINAHL, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups. RESULTS: Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4-20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain. CONCLUSION: There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes

Players, Characters, and the Gamer's Dilemma

Is there any difference between playing video games in which the player's character commits murder and video games in which the player's character commits pedophilic acts? Morgan Luck's “Gamer's Dilemma” has established this question as a puzzle concerning notions of permissibility and harm. We propose that a fruitful alternative way to approach the question is through an account of aesthetic engagement. We develop an alternative to the dominant account of the relationship between players and the actions of their characters, and argue that the ethical difference between so-called “virtual murder” and “virtual pedophilia” is to be understood in terms of the fiction-making resources available to players. We propose that the relevant considerations for potential players to navigate concern (1) attempting to make certain characters intelligible, and (2) using aspects of oneself as resources for homomorphic representation.Peer reviewe

Sustaining sexual and reproductive health through COVID-19 pandemic restrictions: qualitative interviews with Australian clinicians

Background. The sexual and reproductive health care of people with HIV and those at risk of HIV has largely been delivered face-to-face in Australia. These services adapted to the coronavirus disease 2019 (COVID-19) pandemic with a commitment to continued care despite major impacts on existing models and processes. Limited attention has been paid to understanding the perspectives of the sexual and reproductive health care workforce in the research on COVID-19 adaptations. Methods. Semi-structured interviews were conducted between June and September 2021 with 15 key informants representing a diverse range of service settings and professional roles in the Australian sexual and reproductive health sector. Inductive themes were generated through a process of reflexive thematic analysis, informed by our deductive interest in clinical adaptations. Results. The major adaptations were: triage (rapidly adapting service models to protect the most essential forms of care); teamwork (working together to overcome ongoing threats to service quality and staff wellbeing), and the intwined themes of telehealth and trust (remaining connected to marginalised communities through remote care). Despite impacts on care models and client relationships, there were sustained benefits from the scaleup of remote care, and attention to service safety, teamwork and communication. Conclusions. Attending to the experiences of those who worked at the frontline of the COVID-19 response provides essential insights to inform sustained, meaningful system reform over time. The coming years will provide important evidence of longer-term impacts of COVID-19 interruptions on both the users and providers of sexual and reproductive health services

Remote Aboriginal-led primary care services integrate testing for sexually transmitted infections into comprehensive annual preventive health assessments in regions with highest prevalence

Top Abstracts of the Joint Australasian Sexual Health and HIV & AIDS Conferences, Held 29 August-1 September 2022 at the Sunshine Coast Convention Centre