''That was then...but this is now'' : Historical perspectives on intercountry adoption and domestic child adoption in Australian public policy

This paper brings historical perspectives to bear on the ambivalent and contradictory position of adoption in Australian public policy. It examines the divergent histories of Australian domestic and intercountry adoption (ICA) since the mid-1970s and the impact of these histories on adoption policy in Australia. It identifies tendencies in contemporary ICA to repeat elements of pre-reform era domestic adoption. In particular, it is argued that the resistance of ICA to the move to openness in local adoption has been an unacknowledged driver of ICA for many Australian families. We offer corrective readings of the rise of ICA in relation to domestic adoption and conclude by offering alternatives for adoption policy which better align the two kinds of adoption, focusing on the needs of children, as distinct from the desires of adult

Mental Reinstatement of Context: Do individual differences in mental time travel and eyewitness occupation influence eyewitness performance over different delay intervals?

The Cognitive Interview is a memory-enhancing interview protocol designed to optimize the access and retrieval of eyewitness memories. Its Mental Reinstatement of Context (MRC) component requires interviewees to mentally reconstruct the crime event they witnessed. Individual differences in mental time travel (MTT) relate to the extent to which a person mentally re-experiences personal events from his or her past. Individual differences in MTT have been found to predict correct recall of a simulated crime event under immediate MRC recall conditions. To explore the relationship between MTT and performance under MRC conditions further, the present study presented a simulated crime video to 30 police officers and 26 members of the public. Eyewitness recall was tested under MRC conditions either immediately or one week later. Participants’ general MTT and also MTT relating specifically to the crime video itself was measured via self-report. Less correct information and more confabulations were produced after one week but delay had no effect on the amount of incorrect information reported. No difference in recall was found between police officers and members of the public. Better quality MTT relating to the crime video was found to be a positive predictor of the amount of information correctly recalled under immediate conditions but not after one week. General MTT scores did not predict correct recall under either delay condition. Interviewers need to be aware that, due to individual differences, some witnesses may perform better under the MRC component than others

Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET.

BACKGROUND: It is unclear whether beta-blocker therapy should be reduced or withdrawn in patients who develop acute decompensated heart failure (HF). We studied the relationship between changes in beta-blocker dose and outcome in patients surviving a HF hospitalisation in COMET. METHODS: Patients hospitalised for HF were subdivided on the basis of the beta-blocker dose administered at the visit following hospitalisation, compared to that administered before. RESULTS: In COMET, 752/3029 patients (25%, 361 carvedilol and 391 metoprolol) had a non-fatal HF hospitalisation while on study treatment. Of these, 61 patients (8%) had beta-blocker treatment withdrawn, 162 (22%) had a dose reduction and 529 (70%) were maintained on the same dose. One-and two-year cumulative mortality rates were 28.7% and 44.6% for patients withdrawn from study medication, 37.4% and 51.4% for those with a reduced dosage (n.s.) and 19.1% and 32.5% for those maintained on the same dose (HR,1.59; 95%CI, 1.28-1.98; p<0.001, compared to the others). The result remained significant in a multivariable model: (HR, 1.30; 95%CI, 1.02-1.66; p=0.0318). No interaction with the beneficial effects of carvedilol, compared to metoprolol, on outcome was observed (p=0.8436). CONCLUSIONS: HF hospitalisations are associated with a high subsequent mortality. The risk of death is higher in patients who discontinue beta-blocker therapy or have their dose reduced. The increase in mortality is only partially explained by the worse prognostic profile of these patients

Improving chlamydia knowledge should lead to increased chlamydia testing among Australian general practitioners: a cross-sectional study of chlamydia testing uptake in general practice

Female general practitioners (GPs) have higher chlamydia testing rates than male GPs, yet it is unclear whether this is due to lack of knowledge among male GPs or because female GPs consult and test more female patients

Sorption-Desorption Behavior of Atrazine on Soils Subjected to Different Organic Long-Term Amendments

Sorption of atrazine on soils subjected to three different organic amendments was measured using a batch equilibrium technique. A higher K(F) value (2.20 kg(-1)(mg L(-1))(-)N) was obtained for soil fertilized with compost, which had a higher organic matter (OM) content. A correlation between the K(Foc) values and the percentage of aromatic carbon in OM was observed. The highest K(Foc) value was obtained for the soil with the highest aromatic content. Higher aromatic content results in higher hydrophobicity of OM, and hydrophobic interactions play a key role in binding of atrazine, On the other hand, the soil amended with farmyard manure had a higher content of carboxylic units, which could be responsible for hydrogen bonding between atrazine and OR Dominance of hydrogen bonds compared to hydrophobic interactions can be responsible for the lower desorption capacity observed with the farmyard manure soil, The stronger hydrogen bonding can reduce the leaching of atrazine into drinking water resources and runoff to rivers and other surface waters

Diagnosis and Management of Iliac Artery Endofibrosis: Results of a Delphi Consensus Study

Objective Iliac endofibrosis is a rare condition that may result in a reduction of blood flow to the lower extremity in young, otherwise healthy individuals. The data to inform everyday clinical management are weak and therefore a Delphi consensus methodology was used to explore areas of consensus and disagreement concerning the diagnosis and management of patients with suspected iliac endofibrosis. Methods A three-round Delphi questionnaire approach was used among vascular surgeons, sports physicians, sports scientists, radiologists, and clinical vascular scientists with experience of treating this condition to explore diagnosis and clinical management issues for patients with suspected iliac artery endofibrosis. Analysis is based on 18 responses to round 2 and 14 responses to round 3, with agreement reported when 70% of respondents were in agreement. Results Initially there was agreement on the typical symptoms at presentation and the need for an exercise test in the diagnosis. Round 3 clarified that duplex ultrasound was a useful tool in the diagnosis of endofibrosis. There was consensus on the most appropriate type of surgery (endarterectomy and vein patch) and that endovascular interventions were inadvisable. The final round helped to inform aspects of the natural history and post-operative surveillance. Progression of the disease was likely with continued exercise but cessation may prevent progression. Surveillance after surgery is generally recommended yearly with at least a clinical assessment. Conclusions There is broad agreement about the presenting symptoms and the investigations required to confirm (or exclude) the diagnosis of iliac endofibrosis. There was consensus on the surgical approach to repair. Disagreement existed about the specific diagnostic criteria that should be applied during non-invasive testing and about post-operative care and resumption of exercise

Do Baseline Executive Functions Mediate Prospective Memory Performance under a Moderate Dose of Alcohol?

Prospective memory (PM) is memory for delayed intentions. While deleterious effects of acute doses of alcohol on PM have been documented previously using between-subjects comparisons, the current study adopted a single blind placebo-controlled within-subjects design to explore whether the extent to which alcohol-related impairments in PM are mediated by executive functions (EFs). To this end, 52 male social drinkers with no history of substance-related treatment were tested using two parallel versions of a clinical measure of PM (the Memory for Intentions Test; Raskin et al., 2010), and a battery of EF measures. Testing took place on two occasions, with the order of administration of the alcohol and placebo conditions being fully counterbalanced. Overall, PM was worse under alcohol and participants showed deficits on five of the six subscales making up the clinical test. Hierarchical multiple regression analyses demonstrated that EFs did not predict PM performance decrements overall but did predict performance when time cues were presented and when verbal responses were required. Phonemic fluency was the strongest of the EF predictors; a greater capacity to gain controlled access to information in long-term memory predicted a smaller difference between placebo- and alcohol-related performance on both the time cue and verbal response scales. PM is crucial to compliance with, and response to, both therapy programs and alcohol harm prevention campaigns. The results indicate that individual differences in cognitive function need to be taken into account when designing such interventions in order to increase their effectiveness

The management and outcomes of placenta accreta, increta, and percreta in the UK:a population-based descriptive study

OBJECTIVE: To describe the management and outcomes of placenta accreta, increta, and percreta in the UK.DESIGN: A population-based descriptive study using the UK Obstetric Surveillance System (UKOSS).SETTING: All 221 UK hospitals with obstetrician-led maternity units.POPULATION: All women diagnosed with placenta accreta, increta, and percreta in the UK between May 2010 and April 2011.METHODS: Prospective case identification through the monthly mailing of UKOSS.MAIN OUTCOME MEASURES: Median estimated blood loss, transfusion requirements.RESULTS: A cohort of 134 women were identified with placenta accreta, increta, or percreta: 50% (66/133) were suspected to have this condition antenatally. In women with a final diagnosis of placenta increta or percreta, antenatal diagnosis was associated with reduced levels of haemorrhage (median estimated blood loss 2750 versus 6100 ml, P = 0.008) and a reduced need for blood transfusion (59 versus 94%, P = 0.014), possibly because antenatally diagnosed women were more likely to have preventative therapies for haemorrhage (74 versus 52%, P = 0.007), and were less likely to have an attempt made to remove their placenta (59 versus 93%, P &lt; 0.001). Making no attempt to remove any of the placenta, in an attempt to conserve the uterus or prior to hysterectomy, was associated with reduced levels of haemorrhage (median estimated blood loss 1750 versus 3700 ml, P = 0.001) and a reduced need for blood transfusion (57 versus 86%, P &lt; 0.001).CONCLUSIONS: Women with placenta accreta, increta, or percreta who have no attempt to remove any of their placenta, with the aim of conserving their uterus, or prior to hysterectomy, have reduced levels of haemorrhage and a reduced need for blood transfusion, supporting the recommendation of this practice.</p

Intensified partner notification and repeat testing can improve the effectiveness of screening in reducing Chlamydia trachomatis prevalence: a mathematical modelling study.

BACKGROUND The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a cluster randomised controlled trial designed to assess the effectiveness of annual chlamydia testing through general practice in Australia. The trial showed that testing rates increased among sexually active men and women aged 16-29 years, but after 3 years the estimated chlamydia prevalence did not differ between intervention and control communities. We developed a mathematical model to estimate the potential longer-term impact of chlamydia testing on prevalence in the general population. METHODS We developed an individual-based model to simulate the transmission of Chlamydia trachomatis in a heterosexual population, calibrated to ACCEPt data. A proportion of the modelled population were tested for chlamydia and treated annually at coverage achieved in the control and intervention arms of ACCEPt. We estimated the reduction in chlamydia prevalence achieved by increasing retesting and by treating the partners of infected individuals up to 9 years after introduction of the intervention. RESULTS Increasing the testing coverage in the general Australian heterosexual population to the level achieved in the ACCEPt intervention arm resulted in reduction in the population-level prevalence of chlamydia from 4.6% to 2.7% in those aged 16-29 years old after 10 years (a relative reduction of 41%). The prevalence reduces to 2.2% if the proportion retested within 4 months of treatment is doubled from the rate achieved in the ACCEPt intervention arm (a relative reduction of 52%), and to 1.9% if the partner treatment rate is increased from 30%, as assumed in the base case, to 50% (a relative reduction of 59%). CONCLUSION A reduction in C. trachomatis prevalence could be achieved if the level of testing as observed in the ACCEPt intervention arm can be maintained at a population level. More substantial reductions can be achieved with intensified case management comprising retesting of those treated and treatment of partners of infected individuals

Development, Implementation, and Evaluation of a ‘Virtual Patient’ with Chronic Low Back Pain: An Education Resource for Physiotherapy Students

Background: The management of chronic pain is inherently multidisciplinary, requiring collaboration across health and care professions because pain is multidimensional, involving psychological, social, biomedical, cultural, and environmental factors. However, pain education has often focused more on biomedical aspects, limiting the capacity of professionals to deliver integrated, person-centred care. Shifting pain education away from biomedically driven curricula may better prepare graduates for meaningful consultations and biopsychosocial care. Objective: This manuscript reports the development and pilot evaluation of a virtual patient simulation designed to help physiotherapy students develop person-centred pain assessment skills. Methods: We developed and piloted a virtual patient with complex pain scenarios for physiotherapy students. To evaluate the simulation, students completed a self-reported questionnaire assessing their ability, self-confidence in person-centred assessment skills, and their attitudes and beliefs regarding the simulation. Results: Frequency and confidence in person-centred inquiry ranged from 100% to 16.3%, depending on the complexity of information. Inductive thematic analysis revealed four themes: (1) Environmental factors &amp; preferences—students’ preference for the learning environment; (2) Learning experience—including engagement, feedback, discussions, and a ‘safe’ space for building confidence; (3) Professional development—insights into person-centred inquiry, personal biases, and emotional challenges; (4) Limitations—including the desire for more complexity, and technical challenges noted. Conclusions: The development of this virtual patient simulation enabled healthcare students to engage with a multidimensional perspective on pain, fostering skills essential for biopsychosocial pain assessment and patient-centred care. Although designed and piloted with physiotherapy students, this model holds potential for broader application across healthcare disciplines