Reform and resistance: an indigenous perspective on proposed changes to the Aboriginal Heritage Act 1972 (WA)

This article provides a critical analysis of some of the seven proposals put forward to regulate and amend the Aboriginal Heritage Act 1972. Reference is made throughout to Aboriginal heritage legislation in other Australian jurisdictions. We do not mean to suggest any of this legislation is ideal, as we are aware that Indigenous people throughout Australia have concerns about the level of protection being given to their heritage. We are seeking to show, however, that many of the measures that have been introduced in other jurisdictions—some of which have been criticised as being inadequate by the local Aboriginal people—do not exist at all in Western Australia (‘WA’)

Nursing Students\u27 Lived Experiences surrounding Medication Administration

Medication errors are abounding and the complexity of medication administration creates an environment where health care providers are at risk for making errors. This environment includes nursing students learning medication administration. Coupled with a rigid, protocol-driven pedagogy, nursing students may be placed in a learning experience counterproductive to accuracy. Previous studies have focused on causes and perceptions of medication errors looking for the delineation between safe and unsafe practice. In doing so, past research may have narrowed the path of discovery needed to diminish medication errors. In addition, research regarding the lived experience of nursing students while they are learning medication administration is limited. Two designs were used for this study. First, using a critical feminist perspective, a mid-range theory of nursing lens distortion is proposed regarding the oppression caused by the socially-constructed phenomenon of perfectibility and its distorting influence on the development of a nursing lens. Subsequently, an interpretive phenomenological study was conducted to approach the reality of how nursing practice and practice wisdom is learned during medication administration. A purposive sample of 13 students attending an entry-level masters nursing program was analyzed using the interpretive phenomenological method by Benner. Paradigm cases, thematic analysis, and exemplars were identified from the narrative accounts. Four paradigm cases emerged revealing a student-clinical instructor-staff nurse triad where power relations themes either promoted or inhibited learning medication administration. Exemplars of student feelings, meaning of medication administration, and solutions for improvement further revealed the students\u27 experiences. A portion of the thematic analysis examined a student medication error revealing a destructive learning aftermath. Themes describing the sociopolitical context, including the rights of medication administration, are also examined. Discussion using the mid-range theory of nursing lens distortion and the Perfectibility Model further illustrated the experiences. Exploring such experiences offered insight into educational pedagogies that inhibited and promoted accuracy. The phenomenon of medication errors was exposed in a contemporary context revealing a complexity that requires more than a list of rights, or ineffective preparatory actions when learning medication administration. Opportunities for academia and practice are further explored

A service evaluation of parent adherence with dysphagia management therapy guidelines: Reports from family carers supporting children with complex needs in Greece

Purpose: Many children with complex needs exhibit eating, drinking and/or swallowing disorders (dysphagia). These children often have associated learning needs, and require assistance from carers for daily tasks such as eating and drinking. The aim of this study was to identify which strategies to manage dysphagia were challenging for family carers, and reasons for any non-adherence. Method: In this service evaluation researchers observed carers during mealtimes, and investigated carer opinions of strategies used to minimise the risks of dysphagia. Eight children with complex needs aged 3.4 - 7.5 years and their primary family caregiver participated. Results: Adherence with speech and language pathologists’ dysphagia recommendations overall was over 50% in all but one case. For specific strategies, the highest adherence was observed for diet modifications of foods (89%), communication during the mealtime (83%), amount of food to present (81%) and the pacing of fluids and foods (81%). Lower levels of adherence were identified in relation to postural management (58%), environmental changes (58%), utensils (56%) and preparatory strategies (49%). Conclusion: Adherence with use of strategies to support mealtimes was over 50% in all but one case. Findings suggest that support is essential in order to promote safe mealtimes, reduce family carers’ stress and increase knowledge, confidence and adherence in implementing dysphagia guidelines in the family home

The future of returning genetic test results for psychiatric conditions

Background: Genome-wide association studies are rapidly advancing our understanding of the genetic architecture of complex psychiatric conditions. In order to use findings from these studies for enhanced clinical prediction, we need to gain a better understanding of the issues surrounding the return of complex genetic results. Methods: We review the current literature on genetic literacy in the population, the public’s interest in receiving genetic test results for psychiatric conditions, how individuals react to and interpret their genetic results for psychiatric conditions, and gaps in our knowledge that will be critical to address before returning genetic results for psychiatric conditions. Results: We find that in hypothetical scenarios genetic test results indicating increased risk for a psychiatric condition lowers an individual’s confidence to control behavior, reduces self-agency, and negatively impacts affect. Individuals may believe that a change in behavior is important, but there is little evidence that genetic test results indicating increased risk for a psychiatric condition are associated with behavior change. The negative impact of results indicating an increased risk may stem from common misconceptions of complex disorders that exist in approximately 25% to 35% of individuals studied. Conclusions: Individuals with these misunderstandings about the role of genetic factors in complex disorders may have a belief in genetic determinism, the idea that behaviors and characteristics are determined solely by one’s genetic information. Regardless of one’s genetic knowledge, a majority of people are interested in receiving genetic feedback for psychiatric conditions, highlighting a need for effective communication of these genetic test results.https://scholarscompass.vcu.edu/gradposters/1069/thumbnail.jp

Key Considerations for Accountability and Gender in Health Systems in Low- and Middle-Income Countries

This article poses questions, challenges, and dilemmas for health system researchers striving to better understand how gender shapes accountability mechanisms, by critically examining the relationship between accountability and gender in health systems. It raises three key considerations, namely that: (1) power and inequities are centre stage: power relations are critical to both gender and accountability, and accountability mechanisms can transform health systems to be more gender-equitable; (2) intersectionality analyses are necessary: gender is only one dimension of marginalisation and intersects with other social stratifiers to create different experiences of vulnerability; we need to take account of how these stratifiers collectively shape accountability; and (3) empowerment processes that address gender inequities are a prerequisite for bringing about accountability. We suggest that holistic approaches to understanding health systems inequities and accountability mechanisms are needed to transform gendered power inequities, impact on the gendered dimensions of ill health, and enhance health system functioning.Open Society Foundations, Vozes Desiguais/Unequal Voices, Future Health Systems consortium, the Impact Initiative and Health Systems Globa

Design of the low-speed NLF(1)-0414F and the high-speed HSNLF(1)-0213 airfoils with high-lift systems

The design and testing of Natural Laminar Flow (NLF) airfoils is examined. The NLF airfoil was designed for low speed, having a low profile drag at high chord Reynolds numbers. The success of the low speed NLF airfoil sparked interest in a high speed NLF airfoil applied to a single engine business jet with an unswept wing. Work was also conducted on the two dimensional flap design. The airfoil was decambered by removing the aft loading, however, high design Mach numbers are possible by increasing the aft loading and reducing the camber overall on the airfoil. This approach would also allow for flatter acceleration regions which are more stabilizing for cross flow disturbances. Sweep could then be used to increase the design Mach number to a higher value also. There would be some degradation of high lift by decambering the airfoil overall, and this aspect would have to be considered in a final design

Understanding communication of health information: a lesson in health literacy for junior medical and physiotherapy students

Healthcare professional students should be engaged in best practice regarding communication with patients, including using good quality patient information leaflets (PILs) on health behaviours. A cross-sectional survey of 337 junior medical and physiotherapy students investigated the readability, health psychology theory content, and quality and reliability ratings of nine international PILs on smoking. Estimates of readability, theory content and quality/reliability ratings varied considerably across PILs. Importantly, additional theory-based content, as proposed by students, had no detrimental effect on readability scores. Results are discussed with regard to their potential for improving interactions between future healthcare providers and service users

Exercise induced skeletal muscle metabolic stress is reduced after pulmonary rehabilitation in COPD

SummaryIn COPD, skeletal muscle ATP resynthesis may be insufficient to meet demand during exercise due to excessive anaerobic and reduced oxidative (mitochondrial) energy production, leading to metabolic stress. We investigated the effect of outpatient pulmonary rehabilitation (PR) on the metabolic response (measured by exercise-induced accumulation of plasma ammonia) and determined whether this response predicted functional improvement following PR.25 subjects with stable COPD [mean (SD) age 67 (8)years and FEV1 47 (18)% predicted] performed maximal cycling ergometry before and after PR. Plasma ammonia was measured at rest, during exercise and 2 min post-exercise.Following PR, there were significant increases in peak cycle WR and ISWT performance (Mean (SEM) changes 13.1 (2.0) W and 93 (15) m respectively, p < 0.001). Mean (SEM) rise in plasma ammonia was reduced at peak (Pre vs Post-PR: 29.0 (4.5) vs 20.2 (2.5) μmol/l, p < 0.05) and isotime (Pre vs Post-PR: 29.0 (4.5) vs 10.6 (1.7) μmol/l, p < 0.001) exercise. Improvements in exercise performance after PR were similar among subgroups who did versus those who did not show a rise in ammonia at baseline.The results suggest that muscle cellular energy production was better matched to the demands of exercise following PR. We conclude that a pragmatic outpatient PR programme involving high intensity walking exercise results in significant adaptation of the skeletal muscle metabolic response with a reduction in exercise-related metabolic stress. However, the outcome of PR could not be predicted from baseline metabolic response

Reflections from Research in Gender and Ethics: Building Stronger Health Systems (RinGs)

Gender analysis is an important component of health systems research (HSR) as it reveals how power relations create inequalities in health system needs, experiences, and outcomes among women, men, and people of other genders. Various challenges must be overcome to successfully mainstream gender into health systems practice and research

Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

Introduction: Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue. Objective: To investigate if SPACE for COPD employed upon hospital discharge would reduce readmission rates at 3 months, compared with usual care. Methods: This is a prospective, single-blinded, two-center trial (ISRCTN84599369) with participants admitted for an exacerbation, randomized to usual care or SPACE for COPD. Measures, including health-related quality of life and exercise capacity, were taken at baseline (hospital discharge) and at 3 months. The primary outcome measure was respiratory readmission at 3 months. Results: Seventy-eight patients were recruited (n=39 to both groups). No differences were found in readmission rates or mortality at 3 months between the groups. Ten control patients were readmitted within 30 days compared to five patients in the intervention group (P>0.05). Both groups significantly improved their exercise tolerance and Chronic Respiratory Questionnaire (CRQ-SR) results, with between-group differences approaching statistical significance for CRQ-dyspnea and CRQ-emotion, in favor of the intervention. The “Ready for Home” survey revealed that patients receiving the intervention reported feeling better able to arrange their life to cope with COPD, knew when to seek help about feeling unwell, and more often took their medications as prescribed, compared to usual care (P<0.05). Conclusion: SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days