Understanding palliative care: An ethnographic study of three Australian palliative care services

Palliative care commenced in Australia in the early 1980s. Although the value of palliative care has become more widely recognised by the public and other health care professionals, there is still a lack of understanding about what palliative care is and the depth and scope of this specialty area of health care. The research that I present in this thesis is based on examination of palliative care practice in a selection of Australian services, undertaken with the aim of enhancing understanding of Palliative Care. The significance of the research arises from the notion that members of the Australian community should be well informed about health care options available to them. Understanding palliative care and the ability to differentiate palliative care from other end-of-life care is important if people are to make informed decisions about supporting, accessing, and using services appropriate to their needs. An interpretive ethnographic study from a symbolic interactionist perspective was undertaken in three palliative care services, one in each of the major Australian cities of Sydney. Melbourne, and Perth. Each palliative care service had been established for at least ten years, and was part of a larger health care facility. A fourth service, a purpose-built three-year-old unit, was added during the course of the research to provide contrast to the emerging analyses. As an experienced palliative care nurse, I assumed the role of marginal native as the primary research instrument. Data collection was by means of participant observation, formal and informal interviews, and examination of supplementary data sources, with two months spent in each of the three study sites. Interpretations made from ethnographic observation of these Australian palliative care services showed a diversity of practice, best understood within the context of the particular service. The major findings are presented under the headings of Politics, Place, People, and Practice of Palliative Care. Common approaches to provision of care were found in creating an appropriate physical environment for patients, with an underlying mission to make the best of things. Patients cared for in the settings were a similar cohort of middle aged to elderly cancer patients. In general, staff shared expectations of appropriate types of patients and showed discomfort or lack of understanding in caring for non-cancer patients, or patients from non-Australian, non-Christian, and non-English speaking backgrounds. Practice diversity was highlighted by the range of technology used and variations in the availability of social activities for patients in the services. These two: areas in particular warrant further research to examine the outcomes associated with these variations, in terms of survival time, quality of life, and service costs. These findings are particularly relevant at this time when the Australian Government is attempting to enhance access to palliative care. The diversity of practice uncovered in this study suggests that discussions and decisions about allocation of resources and development of services must take into consideration the various interpretations of palliative care services that may exist. The findings also reinforce the need for sound evidence-based studies to examine the impact of variations and the types of populations that might be best served by different types of palliative care support

Testing the tripartite model in young adolescents:Is hyperarousal specific for anxiety and not depress ion?

Background: To clarify the distinction between anxiety and depression, the tripartite model was introduced. According to this model, physiological hyperarousal (PH, i.e. autonomic hyperactivity) is specific for anxiety and not depression. Research on the relation between anxiety, depression and physiological measures representing arousal is lacking. Methods: Parent- and self-reported anxiety and depressive problems were assessed using the CBCL and RCADS. Heart rate (HR), heart rate variability in the low frequency (HRV LF) and respiratory sinus arrythmia (RSA) were used as, indices for autonomic arousal. Results: Parent-reported anxiety was associated with low RSA in supine posture. This association was also found for self-reported anxiety problems, but only in boys. These findings point towards high arousal in anxiety. Self-reported depressive problems were associated with low HRV LF in standing posture and high RSA in supine posture in boys, pointing towards low arousal in depression. However, self-reported depressive problems were also associated with high HR in standing posture and with low HRV LF in supine posture in girls, suggesting high arousal in depression. Limitations: Although HRV LF in standing posture is primarily sympathetically mediated, and HRV LF in supine posture is primarily vagally mediated, the association between HRV LF and sympathetic versus vagal function is not exclusive. Thus, HRV LF measures are merely approaches of high or low arousal. Conclusions: Some evidence was found for hyperarousal in anxiety, but also for hyperarousal in depression. Apparently, the idea of hyperarousal in anxiety arid not in depression is too simple to reflect the more complex reality. (c) 2007 Published by Elsevier B.V.

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

A contemporary examination of workplace learning culture:An ethnomethodology study

Background: Creating and maintaining a sustainable workforce is currently an international concern. Extensive literature suggest that students and staff need to be 'engaged', that is they need to interact with the health team if they are to maximise learning opportunities. Despite many studies since the 1970s into what creates a 'good' learning environment, ongoing issues continue to challenge healthcare organisations and educators. A 'good' learning environment has been an intangible element for many professions as learning is hindered by the complexity of practice and by limitations on practitioners' time available to assist and guide novices. Objectives: This study sought to explore the nature of the learning interactions and experiences in clinical nursing practice that enhance a 'good' workplace learning culture for both nursing students and qualified nurses. Design: An ethnomethodology study. Setting: A range of clinical settings in Victoria and Queensland, Australia. Participants: Students and registered nurses (n. =. 95). Methods: Fieldwork observations were carried out on student nurses and registered nurses, followed by an individual interview with each participant. An iterative approach to analysis was undertaken; field notes of observations were reviewed, interviews transcribed verbatim and entered into NVivo10. Major themes were then extracted. Results: Three central themes: learning by doing, navigating through communication, and 'entrustability', emerged providing insights into common practices potentially enhancing or detracting from learning in the workplace. Conclusions: Students' and registered nurses' learning is constrained by a myriad of interactions and embedded workplace practices, which can either enhance the individual's opportunities for learning or detract from the richness of affordances that healthcare workplace settings have to offer. Until the culture/or routine practices of the healthcare workplace are challenged, the trust and meaningful communication essential to learning in practice, will be achievable only serendipitously.</p

Results from the first ANU-chromasun CPV-T microconcentrator prototype in Canberra

A first prototype of the hybrid CPV-T ANU-Chromasun micro-concentrator (MCT) has been installed at The Australian National University (ANU), Canberra, Australia. The results of electrical and thermal performance of the MCT system, including instantaneou

Towards an Innovative Spectral Splitting Hybrid PV-T Microconcentrator

A hybrid concentrator PV-Thermal (CPV-T) system for delivery of electricity and 150°C hot fluid in a structure suitable for roof-top installation on domestic, commercial, and industrial buildings is being developed by ANU in collaboration with the Unive

“When We Talk about Gender We Talk about Sex”: (A)sexuality and (A)gendered Subjectivities

Gender diversity is seemingly prevalent among asexual people. Drawing on qualitative research, and focusing on agender identities in particular, this article explores why this might be the case. I argue that previous explanations that center biologistic understandings of sexual development, the liberatory potential of asexuality, or psycho-cognitive conflict, are insufficient. Instead, I offer a sociological perspective in which participants’ agender subjectivities can be understood as arising from an embodied meaning-making process where gender was understood to be fundamentally about sexuality. I emphasize the importance of understanding asexuality and agender in the broader structural context, as particular subjectivities were shaped and sometimes necessitated in navigating hetero-patriarchy. However, these entangled understandings of (a)sexuality and (a)gender were sometimes rendered unintelligible within LGBTQ+ discursive communities, where there is often a rigid ontological distinction between gender and sexuality arising from histories of misrecognition and erasure. I complicate this, arguing that already-invisible subjectivities may be made even more invisible by this distinction. The article illustrates the need to empirically explore the meanings of the categories “gender” and “sexuality,” and the relationship between them, rather than siloing them in our methodological and conceptual frameworks

Evolution of the Macondo Well Blowout: Simulating the Effects of the Circulation and Synthetic Dispersants on the Subsea Oil Transport

During the Deepwater Horizon incident, crude oil flowed into the Gulf of Mexico from 1522 m underwater. In an effort to prevent the oil from rising to the surface, synthetic dispersants were applied at the wellhead. However, uncertainties in the formation of oil droplets and difficulties in measuring their size in the water column, complicated further assessment of the potential effect of the dispersant on the subsea-to-surface oil partition. We adapted a coupled hydrodynamic and stochastic buoyant particle-tracking model to the transport and fate of hydrocarbon fractions and simulated the far-field transport of the oil from the intrusion depth. The evaluated model represented a baseline for numerical experiments where we varied the distributions of particle sizes and thus oil mass. The experiments allowed to quantify the relative effects of chemical dispersion, vertical currents, and inertial buoyancy motion on oil rise velocities. We present a plausible model scenario, where some oil is trapped at depth through shear emulsification due to the particular conditions of the Macondo blowout. Assuming effective mixing of the synthetic dispersants at the wellhead, the model indicates that the submerged oil mass is shifted deeper, decreasing only marginally the amount of oil surfacing. In this scenario, the oil rises slowly to the surface or stays immersed. This suggests that other mechanisms may have contributed to the rapid surfacing of oil-gas mixture observed initially. The study also reveals local topographic and hydrodynamic processes that influence the oil transport in eddies and multiple layers. This numerical approach provides novel insights on oil transport mechanisms from deep blowouts and on gauging the subsea use of synthetic dispersant in mitigating coastal damage