Closing the (service) gap: exploring partnerships between Aboriginal and mainstream health services

Background: Although effective partnerships between Aboriginal and mainstream health services are critical to improve Aboriginal health outcomes, many factors can cause these partnerships to be tenuous and unproductive. Understanding the elements of best practice for successful partnerships is essential. Methods: A literature review was conducted in 2009 using keyword searches of electronic databases. Sourced literature was assessed for relevance regarding the benefits, challenges, lessons learnt and factors contributing to successful Aboriginal and mainstream partnerships. Key themes were collated. Results: Although there is much literature regarding general partnerships generally, few specifically examine Aboriginal and mainstream health service partnerships. Twenty-four sources were reviewed in detail. Benefits include broadening service capacity and improving the cultural security of healthcare. Challenges include the legacy of Australia’s colonial history, different approaches to servicing clients and resource limitations. Recommendations for success include workshopping tensions early, building trust and leadership. Conclusion: Although successful partnerships are crucial to optimise Aboriginal health outcomes, failed collaborations risk inflaming sensitive Aboriginal–non-Aboriginal relationships. Factors supporting successful partnerships remind us to develop genuine, trusting relationships that are tangibly linked to the Aboriginal community. Failure to invest in this relational process and push forward with ‘business as usual’ can ultimately have negative ramifications on client outcomes. What is known about the topic? Partnerships between different health services have long been recognised as beneficial for broadening service capacity and using resources more effectively to improve client care. The current policy climate particularly recognises partnerships between Aboriginal and mainstream services as offering multiple benefits for improving the cultural and clinical capacity of health service delivery to Aboriginal clients. Yet many challenges face these arrangements, including tensions stemming from historical and current race relations, different ways of working and ongoing Aboriginal disadvantage. What does this paper add? Although partnerships between Aboriginal and mainstream services are strongly advocated for, there is a paucity of research on the challenges in these arrangements and practical suggestions on how to make such partnerships genuinely successful. This paper analyses the results from research, case studies, reports and reviews to identify the factors that challenge and enhance partnerships between Aboriginal and mainstream health services. The collation of this information also enables indicators of best practice to be presented. What are the implications for practitioners? Although there are considerable challenges for Aboriginal and mainstream health services entering into partnerships, this paper offers health service practitioners and managers a summary of lessons learnt and a ‘checklist’ of best practice indicators to assist them in developing, implementing and sustaining a successful collaborative arrangement

Visual feedback-dependent modulation of arousal, postural control, and muscle stretch reflexes assessed in real and virtual environments

IntroductionThe mechanisms regulating neuromuscular control of standing balance can be influenced by visual sensory feedback and arousal. Virtual reality (VR) is a cutting-edge tool for probing the neural control of balance and its dependence on visual feedback, but whether VR induces neuromodulation akin to that seen in real environments (eyes open vs. closed or ground level vs. height platform) remains unclear.MethodsHere we monitored 20 healthy young adults (mean age 23.3 ± 3.2 years; 10 females) during four conditions of quiet standing. Two real world conditions (eyes open and eyes closed; REO and REC) preceded two eyes-open virtual ‘low’ (ground level; VRL) and ‘high’ (14 m height platform; VRH) conditions. We measured arousal via electrodermal activity and psychosocial questionnaires rating perceived fear and anxiety. We recorded surface electromyography over the right soleus, medial gastrocnemius, and tibialis anterior, and performed force plate posturography. As a proxy for modulations in neural control, we assessed lower limb reflexive muscle responses evoked by tendon vibration and electrical stimulation.ResultsPhysiological and perceptual indicators of fear and anxiety increased in the VRH condition. Background soleus muscle activation was not different across conditions; however, significant increases in muscle activity were observed for medial gastrocnemius and tibialis anterior in VRH relative to REO. The mean power frequency of postural sway also increased in the VRH condition relative to REO. Finally, with a fixed stimulus level across conditions, mechanically evoked reflexes remained constant, while H-reflex amplitudes decreased in strength within virtual reality.DiscussionNotably, H-reflexes were lower in the VRL condition than REO, suggesting that these ostensibly similar visual environments produce different states of reflexive balance control. In summary, we provide novel evidence that VR can be used to modulate upright postural control, but caution that standing balance in analogous real and virtual environments may involve different neural control states

Lafayette in Hamilton: History in Art

Lin-Manuel Miranda’s Hamilton, based on historian Ron Chernow’s award-winning biography of the nation’s first Treasury Secretary, quickly became a cultural phenomenon after opening on Broadway in 2015 and introduced a new generation to the medium and magic of musicals. This thesis discusses how Hamilton portrays the Marquis de Lafayette, a Frenchman who fought in the American Revolution. It compares the character presented in Hamilton with the historical figure of Lafayette and considers the historical accuracy of the portrayal. The thesis also looks at historical musicals and how they have employed history in their composition. Ultimately, I find that Hamilton’s portrayal of Lafayette is effective in engaging a broad audience with history even if it is not completely historically accurate. The balance of accuracy and engagement make it possible for Hamilton to reach a broad audience while still offering historical value

Influence of virtual heights on dynamic postural control

Fear of falling and fall risk are strongly related. As such, falls are a leading cause of injury among older adults. Therefore, there is a need to study how balance is influenced by fear and fear related factors. Previous research has shown that when healthy young adults are exposed to a postural threat, by standing at the edge of an elevated support surface, their postural control is altered in both static and dynamic situations. While responses to support surface rotations have been studied in a high postural threat scenario [Carpenter et al., 2004b], the effects of threat on dynamic responses to support surface translations, a more ecologically valid type of perturbation, have not yet been investigated. This is due to several safety and feasibility issues that preclude translating individuals at height. Virtual reality (VR) has been established as an effective means for simulating height-related postural threat and can therefore be used to avoid the limitations associated with translating subjects at physical height. The purpose of this study was to examine the influence of fear and anxiety on postural reactions to surface translations during exposure to virtual heights. Twenty-one healthy young adults experienced support surface translations in the forward and backward directions, while immersed in a low and then high height virtual environment. Postural responses were significantly affected by height. Specifically, muscle activity in the lower leg and arm, and COP peak displacements, were earlier and larger in response to backward perturbations. No changes were observed in the responses to forward perturbations. In conclusion, virtual heights significantly altered neuromuscular responses to translational perturbations. Virtual height was capable of eliciting responses similar to real height, and thus may be used as an alternative method in investigating fear and anxiety related balance deficits in populations with a known fear of falling.Education, Faculty ofKinesiology, School ofGraduat