Newness Against the Grain: Democratic emergence in organisational and professional practice

What is the nature of democratic innovation in a performative culture? The purpose of this chapter is to help answer this question by giving conceptual substance to the notion of democratic emergence as a specific kind of innovation in the context of contemporary governance trends. It is argued that the performative governance which is the product of these trends is not invulnerable to challenge because of deficiencies in the capacity of managerialism and performative governance to improve services, and the creative spaces for agency and initiative created by the valuing of entrepreneurialism and innovation. The chapter draws on existing conceptual work on democratic approaches to school organisation and innovation, relevant literature on entrepreneurialism, and offers a brief insight into an example of democratic innovation in practice

Decreasing Post-Operative Ventilator Time in the Cardiovascular Surgical Patient: A Nursing Education Quality Initiative

Extended mechanical ventilation times after open heart surgery can contribute to complications prolonging recovery and length of stay, as well as increasing mortality. Standardized staff education of immediate post-open-heart recovery and ventilator weaning protocols, combined with the use of ABCDE and VAP bundles can reduce these complications. At Hospital X during summer of 2022, the average length of time patients remained mechanically ventilated after open heart surgery increased. After an initial needs survey was distributed to nursing staff, a set of novel QR codes was created to simplify and centralize training for staff in the ICU to facilitate early extubation and mobility, as well as increase adherence to standards of care. As a result, average post operative ventilator times showed a downward trend and staff reported increased confidence in their skills. In addition, QR codes have led to an electronic resource of protocols that could be updated as needed. Use of QR codes can be extended to other areas of education and patient care

Psychosocial correlates in treatment seeking gamblers: Differences in early age onset gamblers vs later age onset gamblers

Background Age of onset is an important factor in the development and trajectory of psychiatric disorders; however, little is known regarding the age of onset in relation to disordered gambling in treatment seeking samples in the UK. Utilising a large residential treatment seeking gambler cohort, the current study examined the relationship between age of gambling onset and a range of variables thought to be associated with disordered gambling. Method Data were collected from 768 gamblers attending residential treatment for disordered gambling. Individuals were grouped per the age they started gambling as either a child (≤12), adolescent (13–15), or young adult/adult (≤16). Data were analysed using linear, backward stepwise, and multinomial logistic regressions to identify significant relationships between age of onset and variables of theoretical significance. Results Results indicate the younger age of gambling onset was associated with increased gambling severity. Those who began gambling at an earlier age were more likely to have abused drugs or solvents, committed an unreported crime, been verbally aggressive and experienced violent outbursts. They are less likely to report a positive childhood family environment and are more likely to have had a parent with gambling and/or alcohol problems. Discussion Gamblers who began gambling at an earlier age experience negative life events and exhibit some antisocial behaviors more than later onset gamblers, indicating that when addressing gambling behavior, it is important to consider the developmental trajectory of the disorder, rather than merely addressing current gambling behavior. However, the direction of the relationship between gambling and significant variables is in some instance unclear, indicating a need for further research to define causality

Vulvoplasty in NSW 2001-2013: A population-based record-linkage study

Objectives: To compare characteristics of women who have vulvoplasty procedures with other women; quantify short-term adverse events and complications; and determine any association of vulvoplasty on future births. Design, setting and participants: A population-based record-linkage study was undertaken using the New South Wales (NSW) Admitted Patient Data Collection and NSW Perinatal Data Collection. All women who had vulvoplasties in hospital during 2001 - 2013 were identified, and their characteristics compared with all women of reproductive age (reference population). Main outcome measures: Admissions for vulvoplasty and repeat vulvoplasties; serious complications or adverse events following vulvoplasty procedures; birth mode and perineal outcomes for primiparous women with and without prior vulvoplasty. Results: There were 4,592 vulvoplasty procedures performed on 4,381 women, increasing by 64.5% over the study period. Compared to the reference population, women who had vulvoplasty were more likely to be Australian born (74.6% vs 67.6%); have other cosmetic surgery (10.1% vs 1.7%); and never been married (43.1% vs 33.1%). The serious adverse event/complication rate was 7.2%. Of those with a subsequent first birth, 40.0% had a caesarean section, compared with 30.3% of other women (p<0.001); while among vaginal births, perineal outcomes including tears and episiotomies were not significantly different (p=0.87; p=0.20). Conclusions: Since 2001, the number of vulvoplasties performed in NSW has increased dramatically, with no obvious biological reason for the rise. The procedure was not without serious complications necessitating hospital readmission in some instances. This study provides objective outcome information for counselling women who are contemplating vulvoplastyNHMR

Environmental Policy Update 2012: Development Strategies and Environmental Policy in East Africa

The seven chapters that comprise this report explore ways to integrate sustainability goals and objectives into Ethiopia's current development strategies

The impact of first birth obstetric anal sphincter injury on the subsequent birth: a population-based linkage study

Background With rising obstetric anal sphincter injury (OASI) rates, the number of women at risk of OASI recurrence is in turn increasing. Decisions regarding mode of subsequent birth following an OASI are complex, and depend on a variety of factors. We sought to identify the risk factors for OASI recurrence from first and subsequent births, and to investigate the effect of OASI birth factors on planned caesarean for the second birth. Methods Using two linked population datasets from New South Wales, Australia, we selected women giving birth between 2001 and 2011 with a first birth OASI and a subsequent birth. Multivariable logistic regression was used to identify the association of first and second birth factors with OASI recurrence, and to determine which factors were associated with a planned pre-labour caesarean at the second birth. Results Of 6,380 women with a first birth OASI who proceeded to a subsequent birth, 75.4% had a vaginal second birth, 19.4% a pre-labour caesarean, and 5.2% an intrapartum caesarean. The OASI recurrence rate of 5.7% was significantly higher than the first birth OASI rate of 4.5% (p<0.01). Following adjustment for first and second birth factors, risk factors for recurrence included diabetes at first birth (adjusted odds ratio (aOR) 1.82), and birthweight at second birth ≥4.0kg (aOR 2.34); second birth at 37-38 weeks was associated with decreased odds of OASI (aOR 0.56). First birth factors associated with planned caesarean at second birth included epidural, spinal or general anaesthetic (aOR 1.88); birthweight ≥4.0kg (aOR 1.68); while factors associated with decreased likelihood included Asian country of birth (aOR 0.73), and maternal age< 25 years (aOR 0.81). Conclusions Compared with previous reports, the low OASI recurrence rate (approximately one in twenty) potentially indicates that appropriate decisions are being made about subsequent mode of delivery following first birth OASI. This assertion is supported by evidence of different risk profiles for women who have planned caesareans compared with planned vaginal births.Dr Albert S McKern Research Scholarship; Australian Research Council Future Fellowship (FT12010069); Australian National Health and Medical Research Council Senior Research Fellowship (1021028)

Ethanol consumption in mice: relationships with circadian period and entrainment

A functional connection between the circadian timing system and alcohol consumption is suggested by multiple lines of converging evidence. Ethanol consumption perturbs physiological rhythms in hormone secretion, sleep and body temperature, and conversely, genetic and environmental perturbations of the circadian system can alter alcohol intake. A fundamental property of the circadian pacemaker, the endogenous period of its cycle under free-running conditions, was previously shown to differ between selectively bred High- (HAP) and Low- (LAP) Alcohol Preferring replicate 1 mice. To test whether there is a causal relationship between circadian period and ethanol intake, we induced experimental, rather than genetic, variations in free-running period. Male inbred C57Bl/6J mice and replicate 2 male and female HAP2 and LAP2 mice were entrained to light:dark cycles of 26 h or 22 h or remained in a standard 24 h cycle. Upon discontinuation of the light:dark cycle, experimental animals exhibited longer and shorter free-running periods, respectively. Despite robust effects on circadian period and clear circadian rhythms in drinking, these manipulations failed to alter the daily ethanol intake of the inbred strain or selected lines. Likewise, driving the circadian system at long and short periods produced no change in alcohol intake. In contrast with replicate 1 HAP and LAP lines, there was no difference in free-running period between ethanol naïve HAP2 and LAP2 mice. HAP2 mice, however, were significantly more active than LAP2 mice as measured by general home-cage movement and wheel running, a motivated behavior implicating a selection effect on reward systems. Despite a marked circadian regulation of drinking behavior, the free-running and entrained period of the circadian clock does not determine daily ethanol intake

Trends and patterns in UK treatment seeking gamblers: 2000–2015

Background and aims Gambling is an activity that for some can become disordered, with severe negative consequences. Existing literature does little to inform us regarding changing gambling habits of treatment seeking gamblers; the current study sought to measure trends and patterns in UK treatment seeking gambler behaviour and demographics over a 15-year period. Methods Case files for 768 gamblers seeking residential treatment with the Gordon Moody Association (GMA) were analysed, collected between 2000 and 2015. Case files comprised initial assessment questionnaires, demographic data, current gambling behaviour, mental and physical health status, and a risk assessment. Chi-squared analyses were used to measure change in categorical distribution. Results Prevalence of different forms of gambling identified as problematic have changed over time: Fixed Odds Betting Terminals (FOBTs), sports betting, and poker have become more common; horse and dog racing, and the National Lottery have become less common. Online gambling has also increased over time. In more recent years, gamblers are also more likely to have attempted suicide, to report a co-occurring mental health disorder, and to start treatment having already been prescribed medication. Discussion and conclusions This is the first study to demonstrate that UK treatment seeking gambler behaviour has changed over time; major changes relate to the forms of gambling engaged in problematically, and the mental health of disordered gamblers. Whilst much media focus is directed towards one form of gambling, this should not detract focus from other forms and associated disorders, and the impact of the legislative environment

The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis

Background: Cosmetic breast augmentation (breast implants) is one of the most common plastic surgery procedures worldwide and uptake in high income countries has increased in the last two decades. Women need information about all associated outcomes in order to make an informed decision regarding whether to undergo cosmetic breast surgery. We conducted a systematic review to assess breastfeeding outcomes among women with breast implants compared to women without. Methods: A systematic literature search of Medline, Pubmed, CINAHL and Embase databases was conducted using the earliest inclusive dates through December 2013. Eligible studies included comparative studies that reported breastfeeding outcomes (any breastfeeding, and among women who breastfed, exclusive breastfeeding) for women with and without breast implants. Pairs of reviewers extracted descriptive data, study quality, and outcomes. Rate ratios (RR) and 95% confidence intervals (CI) were pooled across studies using the random-effects model. The Newcastle-Ottawa scale (NOS) was used to critically appraise study quality, and the National Health and Medical Research Council Level of Evidence Scale to rank the level of the evidence. Results: Three small, observational studies met the inclusion criteria. The quality of the studies was fair (NOS 4-6) and the level of evidence was low (III-2 - III-3). There was no significant difference in attempted breastfeeding (one study, RR 0.94, 95%CI 0.76, 1.17). However, among women who breastfed, all three studies reported a reduced likelihood of exclusive breastfeeding amongst women with breast implants with a pooled rate ratio of 0.60 (95%CI 0.40, 0.90). Conclusions: This systematic review and meta-analysis suggests that women with breast implants who breastfeed were less likely to exclusively feed their infants with breast milk compared to women without breast implants.NHMRC, Dr Albert McKern Research Scholarshi