Australian Society Research Articles

The NDIS at ten years: designing an equitable scheme for the next decade.

The NDIS at ten years: designing an equitable scheme for the next decade.

Issue Information

Immunology & Cell BiologyVolume 101, Issue 4 p. 273-277 Issue InformationFree Access Issue Information First published: 03 April 2023 https://doi.org/10.1111/imcb.12527AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume101, Issue4April 2023Pages 273-277 Journal of the Australian and New Zealand Society for Immunology RelatedInformation

Practice Variation in Proximal Phalangeal Fracture Management.

Background: Practice variation may indicate a lack of evidence to guide management. This study investigated the preferences of operative management of proximal phalangeal fractures in Australian hand surgeons, as well as factors that may account for variations. Methods: An electronic survey of all members of the Australian Hand Surgery Society was performed. Surgeon demographic factors and surgical preferences were investigated. Three common proximal phalangeal fracture configurations were presented as cases. Potential predictors of management were explored. Results: A total of 51.9% of active hand surgeons responded. Orthopaedic surgeons were more comfortable with lateral plating and intramedullary screw fixation, while plastic surgeons preferred Kirschner wire (K-wire) fixation. Junior surgeons were more likely to believe that intramedullary screw fixation produced superior results. 53.0% of surgeons in a tertiary environment believed that adequate hand therapy was key (compared to 17.0% of clinicians in a secondary hospital). Conclusions: There is significant practice variation and a lack of standards in the management of a common clinical problem, as well as a lack of consensus on the evidence underpinning common fixation methods. Further research is needed. Level of Evidence: Level IV (Therapeutic).

Autologous fat grafting: current state of clinical practice in the Australian setting

**Objective**: This study aimed to gather and present systemic data about current fat grafting practice in Australia. We knew prior to the study that data for Australian fat grafting is limited, so we sought information from distinct sources. Part 1 aimed to present fat grafting data available from the Australian Breast Device Registry (ABDR). Part 2 aimed to present the details of current fat grafting practice by Australian plastic and reconstructive surgeons. **Methods**: In part 1, fat grafting data from the ABDR from its inception in 2012 to 2020 was collected and summarised. In part 2, a comprehensive survey about all aspects of fat grafting practice was distributed to surgeon members of the Australian Society of Plastic Surgeons (ASPS). **Results**: Part 1. The ABDR recorded an 8.4 per cent and 6.0 per cent increase in fat grafting at the time of breast device insertion surgery from 2012 to 2020 for reconstructive and aesthetic procedures respectively. Fat grafting with breast device insertion, in previously irradiated breast tissue, increased from 0 per cent to 17.4 per cent in the same period. Part 2. One in five of all surgeons of the Australian Society of Plastic Surgeons completed the survey. Our survey demonstrated that fat grafting is highly heterogeneous with respect to donor site selection, harvest technique, processing technique, number of sessions required and volumetric follow-up. **Conclusion**: Our study is the first attempt to present national data on fat grafting. It demonstrates clearly that uptake of autologous fat grafting for breast reconstruction and aesthetic procedures is rapidly increasing Australia-wide. It demonstrates that procedural variables of fat grafting are not standardised among Australian plastic surgeons. This indicates that further clinical data relating to patient demographics, procedural variables and outcomes are vital to ensure patient safety, health resource management and to inform best practice guidelines.

Towards a hermeneutics of the postmodern transnational space: the case of contemporary Australian literature

The work analyses the “spatial turn” in recent Australian literature, which has led to a new transnational orientation in many contemporary Australian narratives. To do so, it frames literary production in terms of spatial cognition and analyses spatiality and cognition as presented by several scholars in several realms. This theoretical introduction is followed by a more practical examination of recent Australian literary works and changes. Their features show that they are moving ahead of the postcolonial label and influence into a less ideologised position. They are in tune with the new deterritorialisation of the world, and the critical cognitive approach can provide insightful realisations bridging the gap between the actual world and its fictional representation. Finally, these examples and appreciations of the transnational are returned to theoretical ground to demonstrate that space and place, with their variants, are not only useful to (cognitive) literary studies, but to any socio-cultural approach. One of the key uses in this spatial turn towards the transnational lies in the apprehension of space-place as a pathway. It also speaks to the mobility of Australian society and its cultural productions.

Projecting the Health and Economic Burden of Cardiovascular Disease Among People with Type 2 Diabetes, 2022-2031.

The aim was to project the health and economic outcomes of cardiovascular disease (CVD) among people with type 2 diabetes from Australian public healthcare and societal perspectives over the next decade. A dynamic multistate model with yearly cycles was developed to project cardiovascular events among Australians with type 2 diabetes aged 40-89 years from 2022 to 2031. CVD risk (myocardial infarction [MI] and stroke) in the type 2 diabetes population was estimated using the 2013 pooled cohort equation, and recurrent cardiovascular event rates in the type 2 diabetes with established CVD population were obtained from the global Reduction of Atherothrombosis for Continued Health (REACH) registry. Costs and utilities were derived from published sources. Outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total healthcare costs, and total productivity losses. The annual discount rate was 5%, applied to outcomes and costs. Between 2022 and 2031, a total of 83,618 non-fatal MIs (95% uncertainty interval [UI] 83,170-84,053) and 58,774 non-fatal strokes (95% UI 58,458-59,013) were projected. Total years of life lived and QALYs (discounted) were projected to be 9,549,487 (95% UI 9,416,423-9,654,043) and 6,632,897 (95% UI 5,065,606-7,591,679), respectively. Total healthcare costs and total lost productivity costs (discounted) were projected to be 9.59 billion Australian dollars (AU$) (95% UI 1.90-30.45 billion) and AU$9.07 billion (95% UI 663.53 million-33.19 billion), respectively. CVD in people with type 2 diabetes will substantially impact the Australian healthcare system and society over the next decade. Future work to investigate different strategies to optimize the control of risk factors for the prevention and treatment of CVD in type 2 diabetes in Australia is warranted.

Survival of multiple arterial grafting in diabetic populations: a 20-year national experience.

Diabetics may have diminished survival after coronary artery bypass grafting even with multiple arterial revascularization. We compared multi-arterial versus single-arterial grafting (SAG) survival in diabetic and non-diabetic patients undergoing primary isolated bypass surgery. This is a retrospective analysis of the Australian and New Zealand Society of Cardiac-Thoracic Surgical Database from June 2001 to January 2020. Patients were classified as having either single or multiple arterial grafting irrespective of the number of venous grafts. The end points were long-term all-cause mortality and 30-day clinical outcomes, which was compared in 1:1 propensity score-matched patients. Cox regression model was used to assess interactions between diabetes and the treatment effect of multi-arterial grafting, reported as hazard ratios (HRs) and confidence intervals (CIs). Short-term outcomes were compared with McNemar's paired t-test. From 69 624 patients, matching generated 17 474 non-diabetic and 10 989 diabetic patient pairs. At a median [interquartile range] of 5.9 [3.2-9.6] years postoperative, mortality was significantly lower after multi-arterial grafting for both diabetic (HR, 0.83; 95% CI, 0.76-0.90, P < 0.001) and non-diabetic (HR, 0.88; 95% CI, 0.82-0.95; P < 0.001) cohorts than SAG. The incidence of 30-day myocardial infarction was significantly higher in single than multiple arterial grafting for both cohorts (diabetic, P = 0.029; non-diabetic, P < 0.001). The interaction analysis suggested an insignificant effect of diabetes (P = 0.55) on the observed survival advantage. Further stratification by diabetic management generated consistent results. Multi-arterial grafting was associated with improved overall survival compared to SAG for both non-diabetic and diabetic patients.

The Inculcative Power of Australian Cadet Corps Uniforms in the 1900s and 1910s

The Inculcative Power of Australian Cadet Corps Uniforms in the 1900s and 1910s

The High Road to the Near North: Origins and Development of Sinology in Australia

AbstractThe development of Sinology in Australia was contingent upon, and serves as a lens through which to view, a number of transformations to Australian society in the middle decades of the twentieth century, as the country sought independence from the “Mother Country,” Great Britain, and reoriented itself towards Asia. These include Australia's first forays into independent international diplomacy and the introduction of the Ph.D. degree and postgraduate research in the university system—culminating in the first Australian postgraduate work on China in the 1950s. While government support has always been crucial to the enterprise, from the early years until today scholars have defended the Chinese humanities against the utilitarian “national interest” proclivities of governments. Adopting a broad definition of Sinology, one which encompasses post-war trends in “Chinese Studies,” this article surveys the universities that have been important to Sinology, the scholars who worked in them and the ongoing challenges to the discipline.

Association of Perioperative Cryoprecipitate Transfusion and Mortality After Cardiac Surgery

BackgroundCryoprecipitate is often transfused in patients undergoing cardiac surgery. However, its safety and effectiveness remain uncertain. MethodsThis study was a propensity score–matched analysis of data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. The study included adults undergoing cardiac surgery between 2005 and 2018 across 38 sites. The association between perioperative cryoprecipitate transfusion and clinical outcomes was estimated, with a primary outcome of operative mortality. ResultsOf 119,132 eligible patients, 11,239 (9.43%) patients received cryoprecipitate. The median cumulative dose was 8 U (interquartile range, 5-10 U). After propensity score matching, we matched 9055 cryoprecipitate recipients to 9055 control subjects. Postoperative cryoprecipitate transfusion was associated with reduced operative mortality (odds ratio [OR], 0.82; 99% CI, 0.69-0.97; P = .002) and long-term mortality (hazard ratio, 0.92; 99% CI, 0.87-0.97; P = .0042). It was also associated with a reduction in acute kidney injury (OR, 0.85; 99% CI, 0.73-0.98; P = .0037) and all-cause infection (OR, 0.77; 99% CI, 0.67-0.88; P < .0001). These findings were observed despite increased rates of return to the operating room (OR, 1.36; 99% CI, 1.22-1.51; P < .0001) and cumulative 4-hour postoperative chest tube output (adjusted mean difference in mL, 97.69; 99% CI, 81.65;113.74; P < .0001). ConclusionsIn a large, multicenter cohort study and after propensity score matching, perioperative transfusion of cryoprecipitate was associated with reduced operative and long-term mortality.

O professor de História como historiador público

Educators have long been aware of the role that schools, and specific school subjects, play in nation-building, including the ways in which national consciousness is perceived to be shaped within the classroom. This makes the historical narratives that future history teachers mobilise of particular interest to researchers. This paper draws on research from the Remembering Australia’s Past (RAP) project conducted with pre-service History teachers from the University of Newcastle, who studied history at school during the period of the ‘history wars’ (Clark, 2008). Drawing on a methodology developed by Létourneau (2006), 97 pre-service History teachers (consisting of 27 males and 70 females, the overwhelming majority of whom identified as either or both European and Anglo-Celtic) were asked to “Tell us the history of Australia in your own words.” The participants were given 45 minutes to write their personal account of the nation’s past. The analysis of the stories of the nation collected from the pre-service teachers, reveal that they have largely adopted popular discourses circulating in contemporary Australian society, demonstrating that our pre-service History teachers are successful consumers of public history in general, and the dominant discourses of Australia’s past in particular; and that given the opportunity, it is these dominant discourses that they readily mobilise. This underscores the importance of engaging public history directly in the classroom, in order to assist pre-service history teachers to deconstruct the narratives ‘truths’ they have inherited and taken for granted.

Transnational suburbia: suburban settings in Australian video games

ABSTRACT Video games with suburban settings offer distinctive experiences of quotidian environments. This article examines how Australian games set in homes or verdant residential neighbourhoods contribute to a global circulation of ideas about suburban life. It contributes to understanding the relationship between Australian games and Australian society by showing how gameworlds that represent everyday spatial environments exist at intersections of the global and the local. By using suburbia as a focal point for demonstrating how Australian games can be read on both international and local levels, the article explores an alternative to a cultural nationalist approach. The Australian games examined are Rumu (Robot House, 2017), Roombo: First Blood (Samurai Punk, 2019), Mars Underground (Moloch Media, 2019), Moving Out (SMG Studio and DevM Games, 2020), Untitled Goose Game (House House, 2020) and Unpacking (Witch Beam, 2021). This article argues that by positioning suburbia as both familiar and foreign, games offer experiences of virtual travel and exploration that contribute to re-imagining everyday environments. While addressing universal themes such as moving house and domestic labour, these games can also be understood in relation to Australian cultural traditions and contexts.

Issue Information

Immunology & Cell BiologyVolume 101, Issue 3 p. 179-182 Issue InformationFree Access Issue Information First published: 01 March 2023 https://doi.org/10.1111/imcb.12526AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume101, Issue3March 2023Pages 179-182 Journal of the Australian and New Zealand Society for Immunology RelatedInformation

Australian Atherosclerosis Society Position Statement on Lipoprotein(a): Clinical and Implementation Recommendations.

This position statement provides guidance to cardiologists and related specialists on the management of adult patients with elevated lipoprotein(a) [Lp(a)]. Elevated Lp(a) is an independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease (CAVD). While circulating Lp(a) levels are largely determined by ancestry, they are also influenced by ethnicity, hormones, renal function, and acute inflammatory events, such that measurement should be done after accounting for these factors. Further, circulating Lp(a) concentrations should be estimated using an apo(a)-isoform independent assay that employs appropriate calibrators and reports the results in molar units (nmol/L). Selective screening strategies of high-risk patients are recommended, but universal screening of the population is currently not advised. Testing for elevated Lp(a) is recommended in all patients with premature ASCVD and those considered to be at intermediate-to-high risk of ASCVD. Elevated Lp(a) should be employed to assess and stratify risk and to enable a decision on initiation or intensification of preventative treatments, such as cholesterol lowering therapy. In adult patients with elevated Lp(a) at intermediate-to-high risk of ASCVD, absolute risk should be reduced by addressing all modifiable behavioural, lifestyle, psychosocial and clinical risk factors, including maximising cholesterol-lowering with statin and ezetimibe and, where appropriate, PCSK9 inhibitors. Apheresis should be considered in patients with progressive ASCVD. New ribonucleic acid (RNA)-based therapies which directly lower Lp(a) are undergoing clinical trials.

International students, intersectionality and sense of belonging: a note on the experience of gay Chinese students in Australia

ABSTRACT This essay considers the experience of international students, contemplating their identity and agency in Australian society. Thinking through the potential experience of gay Chinese students, we argue that the community of international students is not homogenous. Working with and against the literature on studentification, we suggest more consideration should be given to the social and personal experience of students, not just their economic contribution to placemaking. The fluidity and dynamism of gay Chinese students’ identities reveals how geography plays an important role in shaping intersectionality. In this essay, we also question the generalised image of ‘Asian’ identity that is often used in academic approaches, and argue that geographers could make valuable contributions to the debate of intersectionality, by grounding the analysis in specific geographical contexts.

Trends in the incidence, surgical management and outcomes of type B aortic dissections in Australia over the last decade.

This study aims to investigate the incidence and in-hospital outcomes of surgical repair for type B aortic dissection (TBAD) in Australia. Data were obtained from the Australasian Vascular Audit (AVA) and the Australian Institute of Health and Welfare (AIHW). The former is a total practice audit mandated for all members of the Australian and New Zealand Society for Vascular Surgery (ANZSVS) while the latter is an independent government agency which records all healthcare data in Australia. All cases of TBAD which underwent surgical intervention (endovascular or open repair) between 2010 and 2019 were identified using prospectively recorded data from the AVA (New Zealand data was excluded). The primary outcomes were temporal trends in procedures and hospital mortality; secondary outcomes were complications and risk factors for mortality. All admissions and procedures for, and hospital deaths from, TBAD in Australia were identified in AIHW datasets using the relevant diagnosis and procedure codes, with age-standardized rates calculated for the period 2000-01 to 2018-19. A total of 567 cases of TBAD underwent vascular surgical intervention (AVA data, Australia). Of these, 96.3% were treated by endovascular repair. There was an increase in the annual procedure number from 45 in 2010 to 88 in 2019. In-hospital mortality was 4.8% for endovascular repair and 19% for open repair (p = 0.021). From 2000-01 to 2018-19, the age-standardized procedure rates for TBAD (Australia) doubled, the proportion of admitted patients undergoing a procedure rose from 28% to 43%, and in-hospital deaths fell by 25%. There has been an increasing incidence of vascular surgical intervention for TBAD in Australia. The majority of patients received endovascular therapy while the mortality from surgically managed TBAD appears to be falling.

Teaching Simulations Supported by Artificial Intelligence in the Real World

Video conferencing has enabled synchronous communication in a classroom and created multi-sensory content to stimulate learners. Artificial intelligence involves complex equations that are better taught using a constructive pedagogy where students experiment with alternative ways of solving the same problem. Multiple-choice questions have high reliability and can easily reveal student skill levels in a quick way. The Australian Computer Society accreditation exercise ensures that the content for each subject serves as a flexible template for teaching. The geographical extent of the country requires the presence of multiple subordinate campuses affiliated to a main campus. Following the concept of strands, it was also necessary to show continuity in learning and assessments between the first- and second-year subjects. Student feedback for subjects with artificial intelligence-based simulations showed that several students found it difficult to understand lectures and assignments. Hence, to measure student learning, we introduced a Kahoot quiz during the recess of each lecture that students could join through their mobile phones from different campuses. Software project management is challenging for students with vision or attention-related disorders. We taught them how to use charts to visually observe variables and narrow down possible relationships before performing in-depth analysis. One of the main purposes of education is employability. Hence, greater context to real world industry examples was introduced into lectures.

Home language use and shift in Australia: Trends in the new millennium.

The 25 million Australians today are identified with more than 300 ancestries. People's home language use and shift patterns had demonstrated great variations as more immigrants from Asia-Pacific regions entered Australia. The ethnolinguistic composition of Australia's population had undergone substantial changes in the last few decades. Based on the statistics from Australian censuses, the present paper aims to analyze the changes of people's home language use and the shift patterns in the new Millennium. Five sets of census data released by Australian Bureau of Statistics were adopted as the secondary data source and descriptive analysis was conducted to disclose the dynamic picture of different home languages in Australia after 2000. The results suggest that the number of home language speakers in Australia has soared up quickly in the last two decades and great variations have been found between the traditional European migrant groups and the newly Asian arrivers. Mandarin has overtaken Italian and Greek to become the most populous home language other than English used in Australia since 2011 and great regional differences were also found to exist among different states and territories. Moreover, the ranking order of different home language speakers had changed considerably as compared with that in the last century. The language shift rates of different language communities and their cross-tabulations with generations, gender, age, and duration of residence in the latest available censuses after 2000 also revealed diverse developmental directions. The findings give us a glimpse of the current status of different home languages in Australia and help us to identify the potential factors impacting the shifting trends of different language communities. A better understanding of the language needs of different migrant communities may further help policymakers set more effective plans to accommodate an increasingly diverse Australian society.

Current patterns of care in low-risk thyroid cancer-A national cross-sectional survey of Australian thyroid clinicians.

De-escalated treatment of hemithyroidectomy without radioactive iodine (RAI) is now accepted for patients with low-risk, well-differentiated thyroid cancer (WDTC). The benefit of long-term follow-up care remains controversial. This study aims to describe parameters associated with less than total thyroidectomy, and discharge from specialist follow-up in patients with low-risk WDTC in Australia. An online survey was distributed to Australian members of Endocrine Society of Australia, Australian and New Zealand Endocrine Surgeons, and Australian Society of Otolaryngology, Head and Neck Surgery. Clinicians completed a survey of management and follow-up care preferences for four clinical vignettes (all low-risk WDTC). 119 clinicians (48% endocrinologists, 55% male) answered at least one question. The majority (59%) of respondents recommended less than total thyroidectomy and omission of RAI in patients with WDTC <2 cm. Most (62%) would discharge a patient with micropapillary thyroid cancer within 1 year following total thyroidectomy. In contrast, for WDTC 1-4 cm, >90% of clinicians would continue specialist follow-up for at least 5 years. The majority of clinicians felt that patients experienced disproportionate fear of recurrence and were reassured by follow-up. After multivariable analysis, clinicians who participated in multidisciplinary teams (MDTs) were more likely to choose de-escalated care for both initial treatment (p = .005) and follow-up care (>5 years, p = .05). Clinician attitudes captured by this survey reflect recent changes in guidelines towards hemithyroidectomy for low-risk WDTC, particularly amongst MDT attendees. There is a need to further examine the impact of de-escalated care on fear of recurrence and quality of life in thyroid cancer survivors.

Novelties from the Joint EANM/SNMMI/ANZSNM Guidelines on Immunotherapy.

In the past decade, the implementation of immunotherapy with checkpoint inhibitors has determined a major change in the management of oncological patients. The challenges associated to the new therapeutic regimen have promoted adapted criteria for response assessment to interpret imaging findings and atypical patterns of response. Parallel to the new morphological criteria, also 18fluoro-deoxyglucose positron emission/computed tomography imaging has required novel approaches and specific guidelines on how to perform, interpret, and report the scan in patients with solid tumors under immune checkpoint inhibitors therapy. A summary of the novelties related to the new joint international European Association of Nuclear Medicine (EANM)/Society of Nuclear Medicine and Molecular Imaging (SNMMI)/Australian and New Zealand Society of Nuclear Medicine (ANZSNM) guidelines on immunotherapy is provided herein to elucidate most critical aspects in image interpretation.