Picturing a golden age: September and Australian Rules

In two Australian coming-of-age feature films, Australian Rules and September, the central young characters hold idyllic notions about friendship and equality that prove to be the keys to transformative on-screen behaviours. Intimate intersubjectivity, deployed in the close relationships between the indigenous and nonindigenous protagonists, generates multiple questions about the value of normalised adult interculturalism. I suggest that the most pointed significance of these films lies in the compromises that the young adults make. As they reach the inevitable moral crisis that awaits them on the cusp of adulthood, despite pressures to abandon their childhood friendships they instead sustain their utopian (golden) visions of the future

Applying Participatory Health Research Elements in Rural End-of-Life Research: Reflections on Conducting In-Depth Interviews With Participants on Sensitive Topics

Gegenstand des Forschungsprojekts "Living Loving Dying" war es, die Versorgung am Lebensende und die Trauerbewältigung für Sterbende und ihre Angehörigen in ländlichen Regionen zu verbessern. Teilnehmende waren Personen, die Sterbende begleitet hatten und in Gebieten mit geringer Einwohner*innenzahl und in relativer geografischer Isolation lebten. Die Datenerhebung zu derart sensitiven Themen mit Menschen, die immer noch von Tod und Trauer betroffen waren, erforderte die Nutzung entsprechen sensitiver Methoden. Wichtig ist auch, dass diese Menschen sicher sein können, dass ihre Stimme gehört wird und dass sie zu positiven Veränderungen für andere beitragen können. Vor diesem Hintergrund haben wir sie gebeten, als Community-Partner*innen an der Studie teilzunehmen, für die wir ein deskriptives qualitatives Design gewählt und partizipative Elemente in die Datenerhebung mittels teilstrukturierter Interviews einbezogen haben. Dabei war die nicht-hierarchische Beziehung zwischen uns Forschenden und den Partner*innen von herausragender Bedeutung gerade angesichts dieser vulnerablen Gruppe. In dem Beitrag reflektieren wird die pragmatischen und ethischen Erwägungen des Methodeneinsatzes für die ländliche Lebensende-Forschung.The "Living Loving Dying" research project aimed to improve end of life and bereavement care for people caring and dying in rural areas. The data were provided by people who had experienced caring for someone until his/her death, while living in an area of low population and geographical isolation. Undertaking data collection on such a sensitive topic, from people still vulnerable from the impacts of death and grief, requires the use of particularly sensitive research methods. It is also important that participants feel their voices are heard and that they are contributing to positive change for others. In view of this we positioned people to participate as community-partners and utilized a descriptive qualitative design with participatory elements in the data collection method of in-depth, semi structured interviewing. The non-hierarchical relationship between researchers and community-partners were key influences for using participatory elements in this research with a vulnerable population. In this article we reflect on the pragmatic and ethical considerations that the application of this method has for rural end-of-life research

Relative age effects on academic achievement in the first ten years of formal schooling: A nationally representative longitudinal prospective study

The effects of school starting age and relative age effects (RAEs) have generated much interest from parents, teachers, policymakers, and educational researchers. Our 10-year longitudinal study is based on a nationally representative (N = 4,983) prospective sample from the Longitudinal Study of Australian Children. The primary outcomes are results from the high-stake, Australia-wide National Assessment Program-Literacy and Numeracy tests in Years 3, 5, 7, and 9, controlling for demographic characteristics (gender, socioeconomic status, school type, and childhood cognition measured before the start of kindergarten). We evaluated how direct and mediated RAEs vary over the first 10 years of schooling for these longitudinal data. Results revealed significant RAEs in primary school years for both numeracy and literacy test outcomes. Effects were large in primary school years but declined in secondary school years. Although the direct effects of RAEs declined over time, there continued to be significant indirect effects over the whole 10-year period. RAEs in primary school had enduring effects that were mediated through the effects of earlier achievement. We juxtapose our results with previous RAE research on achievement and a range of other noncognitive outcomes where the RAEs are enduring into adolescence and even adulthood. We position our research within this broader research literature and discuss implications for educational policy, practice, theory, and future research

Bridging the evidence gap: A review and research protocol for outdoor mental health therapies for young Australians

Internationally, over 60% of all lifetime cases of mental health disorders are identified as emerging by 25 years of age. In Australia, young people (aged 16–24 years) report the highest prevalence of mental health problems. Acceptability of mainstream services for young people is a concern, particularly for clients 18–25 years, heterosexual males and certain marginalised communities. With unaddressed distress in young people a precursor to poor, potentially lifelong mental ill-health trajectories, the provision of acceptable, and accessible mental health services remains a critical system imperative. Outdoor therapies, such as outdoor talking therapies, present an option for increasing the breadth of mental health interventions available to young people. Reported benefits of outdoor therapies include improved self-esteem and confidence, positive and negative affect, stress reduction and restoration, social benefits, and resilience. As outdoor therapies draw on multidisciplinary skillsets, this modality has the potential to expand services beyond existing workforce capacities. However, there are evidence gaps that must be addressed before mainstreaming of this treatment modality can occur. Here we overview the existing evidence base for outdoor talking therapies, as a form of outdoor mental healthcare, to determine their appropriateness as an effective and efficient treatment modality for young people with psychological distress in Australia and elsewhere. We then propose a research protocol designed to determine the acceptability, efficacy and efficiency of ‘outdoor talking therapies’. Our aim is to help address identified youth mental healthcare service shortages in Australia, and potentially support the health of our mental healthcare workforce

City-size bias in knowledge on the effects of urban nature on people and biodiversity

The evidence base for the benefits of urban nature for people and biodiversity is strong. However, cities are diverse and the social and environmental contexts of cities are likely to influence the observed effects of urban nature, and the application of evidence to differing contexts. To explore biases in the evidence base for the effects of urban nature, we text-matched city names in the abstracts and affiliations of 14 786 journal articles, from separate searches for articles on urban biodiversity, the health and wellbeing impacts of urban nature, and on urban ecosystem services. City names were found in 51% of article abstracts and 92% of affiliations. Most large cities were studied many times over, while only a small proportion of small cities were studied once or twice. Almost half the cities studied also had an author with an affiliation from that city. Most studies were from large developed cities, with relatively few studies from Africa and South America in particular. These biases mean the evidence base for the effects of urban nature on people and on biodiversity does not adequately represent the lived experience of the 41% of the world’s urban population who live in small cities, nor the residents of the many rapidly urbanising areas of the developing world. Care should be taken when extrapolating research findings from large global cities to smaller cities and cities in the developing world. Future research should encourage research design focussed on answering research questions rather than city selection by convenience, disentangle the role of city size from measures of urban intensity (such as population density or impervious surface cover), avoid gross urban-rural dualisms, and better contextualise existing research across social and environmental contexts

Clinical laboratory reference values amongst children aged 4 weeks to 17 months in Kilifi, Kenya: A cross sectional observational study

Reference intervals for clinical laboratory parameters are important for assessing eligibility, toxicity grading and management of adverse events in clinical trials. Nonetheless, haematological and biochemical parameters used for clinical trials in sub-Saharan Africa are typically derived from industrialized countries, or from WHO references that are not region-specific. We set out to establish community reference values for haematological and biochemical parameters amongst children aged 4 weeks to 17 months in Kilifi, Kenya. We conducted a cross sectional study nested within phase II and III trials of RTS, S malaria vaccine candidate. We analysed 10 haematological and 2 biochemical parameters from 1,070 and 423 community children without illness prior to experimental vaccine administration. Statistical analysis followed Clinical and Laboratory Standards Institute EP28-A3c guidelines. 95% reference ranges and their respective 90% confidence intervals were determined using non-parametric methods. Findings were compared with published ranges from Tanzania, Europe and The United States. We determined the reference ranges within the following age partitions: 4 weeks to <6 months, 6 months to less than <12 months, and 12 months to 17 months for the haematological parameters; and 4 weeks to 17 months for the biochemical parameters. There were no gender differences for all haematological and biochemical parameters in all age groups. Hb, MCV and platelets 95% reference ranges in infants largely overlapped with those from United States or Europe, except for the lower limit for Hb, Hct and platelets (lower); and upper limit for platelets (higher) and haematocrit(lower). Community norms for common haematological and biochemical parameters differ from developed countries. This reaffirms the need in clinical trials for locally derived reference values to detect deviation from what is usual in typical children in low and middle income countries

Pandemic gardening: A narrative review, vignettes and implications for future research

There is a significant amount of evidence highlighting the health, wellbeing and social benefits of gardening during previous periods of crises. These benefits were also evident during the COVID-19 pandemic. This paper presents a narrative review exploring gardening during the early stages of the COVID-19 pandemic to understand the different forms of gardening that took place during this crisis and key elements of this activity. Research about gardening during the pandemic focused on food (in)security and disrupted food systems, the health and wellbeing benefits of gardening, and the social dimensions of gardening. We offer three vignettes of our own research to highlight key insights from local, national and international perspectives of gardening during the pandemic. The paper’s conclusion outlines how researchers, policy makers and public health practitioners can harness what has been learned from gardening during the pandemic to ensure these benefits are more widely available and do not exacerbate already entrenched health inequalities in society

Pandemic gardening: A narrative review, vignettes and implications for future research

There is a significant amount of evidence highlighting the health, wellbeing and social benefits of gardening during previous periods of crises. These benefits were also evident during the COVID-19 pandemic. This paper presents a narrative review exploring gardening during the early stages of the COVID-19 pandemic to understand the different forms of gardening that took place during this crisis and key elements of this activity. Research about gardening during the pandemic focused on food (in)security and disrupted food systems, the health and wellbeing benefits of gardening, and the social dimensions of gardening. We offer three vignettes of our own research to highlight key insights from local, national and international perspectives of gardening during the pandemic. The paper’s conclusion outlines how researchers, policy makers and public health practitioners can harness what has been learned from gardening during the pandemic to ensure these benefits are more widely available and do not exacerbate already entrenched health inequalities in society

Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2):a multicentre observational cohort study

Background: Cerebral microbleeds are a potential neuroimaging biomarker of cerebral small vessel diseases that are prone to intracranial bleeding. We aimed to determine whether presence of cerebral microbleeds can identify patients at high risk of symptomatic intracranial haemorrhage when anticoagulated for atrial fibrillation after recent ischaemic stroke or transient ischaemic attack. Methods: Our observational, multicentre, prospective inception cohort study recruited adults aged 18 years or older from 79 hospitals in the UK and one in the Netherlands with atrial fibrillation and recent acute ischaemic stroke or transient ischaemic attack, treated with a vitamin K antagonist or direct oral anticoagulant, and followed up for 24 months using general practitioner and patient postal questionnaires, telephone interviews, hospital visits, and National Health Service digital data on hospital admissions or death. We excluded patients if they could not undergo MRI, had a definite contraindication to anticoagulation, or had previously received therapeutic anticoagulation. The primary outcome was symptomatic intracranial haemorrhage occurring at any time before the final follow-up at 24 months. The log-rank test was used to compare rates of intracranial haemorrhage between those with and without cerebral microbleeds. We developed two prediction models using Cox regression: first, including all predictors associated with intracranial haemorrhage at the 20% level in univariable analysis; and second, including cerebral microbleed presence and HAS-BLED score. We then compared these with the HAS-BLED score alone. This study is registered with ClinicalTrials.gov, number NCT02513316. Findings: Between Aug 4, 2011, and July 31, 2015, we recruited 1490 participants of whom follow-up data were available for 1447 (97%), over a mean period of 850 days (SD 373; 3366 patient-years). The symptomatic intracranial haemorrhage rate in patients with cerebral microbleeds was 9·8 per 1000 patient-years (95% CI 4·0–20·3) compared with 2·6 per 1000 patient-years (95% CI 1·1–5·4) in those without cerebral microbleeds (adjusted hazard ratio 3·67, 95% CI 1·27–10·60). Compared with the HAS-BLED score alone (C-index 0·41, 95% CI 0·29–0·53), models including cerebral microbleeds and HAS-BLED (0·66, 0·53–0·80) and cerebral microbleeds, diabetes, anticoagulant type, and HAS-BLED (0·74, 0·60–0·88) predicted symptomatic intracranial haemorrhage significantly better (difference in C-index 0·25, 95% CI 0·07–0·43, p=0·0065; and 0·33, 0·14–0·51, p=0·00059, respectively). Interpretation: In patients with atrial fibrillation anticoagulated after recent ischaemic stroke or transient ischaemic attack, cerebral microbleed presence is independently associated with symptomatic intracranial haemorrhage risk and could be used to inform anticoagulation decisions. Large-scale collaborative observational cohort analyses are needed to refine and validate intracranial haemorrhage risk scores incorporating cerebral microbleeds to identify patients at risk of net harm from oral anticoagulation. Funding: The Stroke Association and the British Heart Foundation

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research