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Debate about the nature of climate and the magnitude of ecological change across Australia during the last glacial maximum (LGM; 26.5–19 ka) persists despite considerable research into the late Pleistocene. This is partly due to a lack of detailed paleoenvironmental records and reliable chronological frameworks. Geochemical and geochronological analyses of a 60 ka sedimentary record from Brown Lake, subtropical Queensland, are presented and considered in the context of climate-controlled environmental change. Optically stimulated luminescence dating of dune crests adjacent to prominent wetlands across North Stradbroke Island (Minjerribah) returned a mean age of 119.9 ± 10.6 ka; indicating relative dune stability soon after formation in Marine Isotope Stage 5. Synthesis of wetland sediment geochemistry across the island was used to identify dust accumulation and applied as an aridification proxy over the last glacial-interglacial cycle. A positive trend of dust deposition from ca. 50 ka was found with highest influx occurring leading into the LGM. Complexities of comparing sedimentary records and the need for robust age models are highlighted with local variation influencing the accumulation of exogenic material. An inter-site comparison suggests enhanced moisture stress regionally during the last glaciation and throughout the LGM, returning to a more positive moisture balance ca. 8 ka.
A fragment of Roman monumental bronze sculpture was discovered near Lincoln in 2015 and reported to the Portable Antiquities Scheme. This note offers identification of the piece as an over-life-size finger, describes comparable examples and similar pieces from the local area, and makes suggestions as to the original form of the sculpture from which it may have derived. The statue's metallurgical characteristics and making, the possible context of display and the circumstances of deposition are also considered.
Sociocultural developmental psychology can drive new directions in gadgetry science. We use autobiographical memory, a compound capacity incorporating episodic memory, as a case study. Autobiographical memory emerges late in development, supported by interactions with parents. Intervention research highlights the causal influence of these interactions, whereas cross-cultural research demonstrates culturally determined diversity. Different patterns of inheritance are discussed.
To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals.
Secondary analysis of publicly available HAI data for calendar year 2013.
We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC).
Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy).
HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs.
Hospital-acquired infection (HAI) data are reported to the public on the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. We previously found that public understanding of these data is poor. Our objective was to develop an improved method for presenting HAI data that could be used on the CMS website.
Randomized controlled trial comparing understanding of data presented using the current CMS presentation strategy versus a new strategy.
A 760-bed tertiary referral hospital.
A total of 61 patients were randomly selected within 24 hours of admission.
Participants were shown HAI data as presented on the CMS Hospital Compare website (control arm) or data formatted using a new method (experimental arm).
No statistically significant demographic differences were identified between study arms. Although 47% percent of participants said a website for comparing hospitals would have been helpful, only 10% had ever used such a website. Participants viewing data using the new presentation strategy compared hospitals correctly 56% of the time, compared with 32% in the control arm (P=.0002).
Understanding of HAI data increased significantly with the new data presentation method compared to the method currently used on the CMS Hospital Compare website. Many participants expressed interest in a website for comparing hospitals. Improved methods for presenting CMS HAI data, such as the one assessed here, should be adopted to increase public understanding.
Public reporting of hospital quality data is a key element of US healthcare reform. Data for hospital-acquired infections (HAIs) are especially complex.
To assess interpretability of HAI data as presented on the Centers for Medicare and Medicaid Services Hospital Compare website among patients who might benefit from access to these data.
We randomly selected inpatients at a large tertiary referral hospital from June to September 2014. Participants performed 4 distinct tasks comparing hypothetical HAI data for 2 hospitals, and the accuracy of their comparisons was assessed. Data were presented using the same tabular formats used by Centers for Medicare and Medicaid Services. Demographic characteristics and healthcare experience data were also collected.
Participants (N=110) correctly identified the better of 2 hospitals when given written descriptions of the HAI measure in 72% of the responses (95% CI, 66%–79%). Adding the underlying numerical data (number of infections, patient-time, and standardized infection ratio) to the written descriptions reduced correct responses to 60% (55%–66%). When the written HAI measure description was not informative (identical for both hospitals), 50% answered correctly (42%–58%). When no written HAI measure description was provided and hospitals differed by denominator for infection rate, 38% answered correctly (31%–45%).
Current public HAI data presentation methods may be inadequate. When presented with numeric HAI data, study participants incorrectly compared hospitals on the basis of HAI data in more than 40% of the responses. Research is needed to identify better ways to convey these data to the public.
Infect. Control Hosp. Epidemiol. 2016;37(2):182–187
Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.
To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.
Systematic evidence synthesis.
Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.
Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.
De-escalation techniques are a recommended non-physical intervention for
the management of violence and aggression in mental health. Although
taught as part of mandatory training for all National Health Service
(NHS) mental health staff, there remains a lack of clarity around
To conduct a systematic review of the learning, performance and clinical
safety outcomes of de-escalation techniques training.
The review process involved a systematic literature search of 20
electronic databases, eligibility screening of results, data extraction,
quality appraisal and data synthesis.
A total of 38 relevant studies were identified. The strongest impact of
training appears to be on de-escalation-related knowledge, confidence to
manage aggression and de-escalation performance (although limited to
artificial training scenarios). No strong conclusions could be drawn
about the impact of training on assaults, injuries, containment and
organisational outcomes owing to the low quality of evidence and
It is assumed that de-escalation techniques training will improve staff's
ability to de-escalate violent and aggressive behaviour and improve
safety in practice. There is currently limited evidence that this
training has these effects.
In this study, we identify the dominant storylines that were embedded in the narratives of younger people with dementia and their nominated family members. By implementing a longitudinal, narrative design underpinned by biographical methods we generated detailed family biographies with five families during repeated and planned research contacts (N=126) over a 12–15-month period between 2009 and 2010. The application of narrative analysis within and between each family biography resulted in the emergence of five family storyline types that were identified as: agreeing; colluding; conflicting; fabricating; and protecting. Whilst families were likely to use each of these storylines at different points and at different times in their exposure to young onset dementia, it was found that families that adopted a predominantly ‘agreeing’ storyline were more likely to find ways of positively overcoming challenges in their everyday lives. In contrast, families who adopted predominantly ‘conflicting’ and ‘colluding’ storylines were more likely to require help to understand family positions and promote change. The findings suggest that the identification of the most dominant and frequently occurring storylines used by families may help to further understand family experience in young onset dementia and assist in planning supportive services.
The migration legislation meets the government's policy aim of strengthening the economy by providing for various temporary and permanent visas that are dependent on the applicant having a successful business or investment history and, for some visas, a willingness to invest and operate in regional areas that are prescribed by Gazette notice.
Permanent visas are divided into two general categories – skilled and business. The skills stream is discussed in the following chapter.
The migration legislation provides a range of visas for temporary workers and business people, and working holiday-makers and students, as well as visas for tourists and people visiting friends and relations. In addition, some temporary visas are issued for special purposes.
Temporary workers and business people can be employer-sponsored or independent. They range from working holiday-makers to those with a need for long-term, but not permanent, residence.
Many visa applicants require a sponsor or nominator, and for many visas, there is a requirement for an assurance of support and/or a social security bond. Nearly all visas have requirements related to members of the family unit of the primary applicant, called ‘secondary criteria’ in Schedule 2, even though, in some cases, those ‘secondary’ people are not included in the visa application. Like all people who have already made a visa application in Australia, they may be refused a second opportunity to make an application. Those matters are canvassed in Chapter 4.
Most visas have application charges, and several of the permanent visas require those payments to be made in two instalments. The second instalment might include a health charge or payment for English language classes. Those payments are set out in the relevant visa class in Schedule 1.
Australia became a signatory to the 1951 United Nations Convention Relating to the Status of Refugees (the Convention) in 1954 and to the 1967 Protocol in 1973. It thereby assumed certain obligations under the Convention, the principal one being to grant asylum to people who fall within the definition of a refugee as set out in Article 1A(2). The process or manner in which asylum is granted is not expressly stipulated in the Convention. It is governed by the Migration Act 1958 (Cth).
The Migration Act 1958 (Cth) provides for visas to be issued on refugee and humanitarian grounds to applicants under the government's humanitarian program. That program is made up of onshore protection for those people already in Australia, whether or not they arrived with temporary visas or without a visa at all, and resettlement in Australia for people in humanitarian need overseas (including those who are classified as refugees by the UN High Commissioner for Refugees (UNHCR) and recommended for resettlement). Previously, both the onshore and offshore visa categories included both permanent and temporary residence visas. Now temporary visas have been abolished.
Article 1A(2) of the Refugee Convention defines a refugee in terms of the reasons why a person fears being persecuted. A refugee must have a well-founded fear of being persecuted ‘for reasons of race, religion, nationality, membership of a particular social group, or political opinion’. After referring to Article 1 of the Convention, Gummow J explained in Applicant A v MIEA:
…[w]hilst as a matter of ordinary usage, a refugee might be one whose flight has been from invasion, earthquake, flood, famine or pestilence, the definition is not concerned with such persons. Accordingly, care is needed in resolving any apparent obscurity in the text of the definition by seeing the definition as reflecting, in a broad sense, humanitarian concerns for displaced persons.
Kirby J commented in the same case that the drafters of the Convention would not have included ‘categories of persecution’ in Article 1A(2) had they intended refugees to be defined as people who feared persecution for any reason.
Migration and Refugee Law: Principles and Practice in Australia is a comprehensive overview of the legal principles governing the entry of people into Australia. This fully revised third edition provides an accessible analysis of the theory and practice of this complex and controversial area of the law. It considers the social and political context of migration and refugee law in devising innovative policies aimed at creating an equitable and rational immigration system. Migration and Refugee Law: Principles and Practice in Australia combines an astute consideration of theory with the creation of practical policy solutions, and is therefore an essential resource for migration lawyers and agents, government employees, students, judicial officers and policymakers.
A defining aspect of national sovereignty is that nation states have the right to determine which people are permitted to come within their geographical borders. Individuals, like nations, appear to be inherently territorial. In addition to this, a defining aspect of many people's personhood (their core identity) is the place where they were born or live.
Despite the disparate range of interests and projects that individuals have and pursue, there are basic goals that communities invariably share. Thus, in Australia, the current generation (building on the work of earlier generations) has committed enormous resources to building state institutions (such as our political and legal system), hospitals, schools, roads and recreational and sporting amenities and facilities.