Medicine & Health

Publication Search Results

Now showing 1 - 10 of 17
  • (2021) Gupta, Medhavi
    Thesis
    Globally, drowning is the second largest cause of death by injury in children aged 1-14 years old. Risk factors for child drowning include poor supervision, lower socioeconomic status, poor swimming and rescue skills, and the proximity of open water near homes. These are more prevalent in low-and middle-income countries(LMICs). The WHO has developed recommended interventions for drowning prevention in rural LMIC contexts, such as the provision of supervised childcare to prevent access to nearby water bodies. This thesis explores the process of developing and evaluating drowning prevention programs in two high-risk LMIC regions: the Sundarbans in India and the Barishal Division in Bangladesh. As no previous research on drowning burden and prevention has been conducted in India, the main aims were to: (1) Identify the burden of child drowning in the Sundarbans, and (2) identify implementation strategies for drowning prevention programs. Conversely, drowning prevention programs have been implemented in Bangladesh, but evaluation of their implementation remains. The Anchal program provides supervised childcare to younger children, while SwimSafe provides swim training to older children. The main aims in Bangladesh were to: (1) Understand implementation implications and best practices, and (2) understand the impact of gender norms on implementation. The findings from the Sundarbans mortality survey showed a significant burden of drowning, with a rate of 243.8/100 000 for 1-4-year-old children, and 38.8/100 000 for 5-9-year-old children. Common circumstances were the lack of effective adult supervision, no physical barriers against water, and proximity of open water to homes. Findings from the analysis of relevant government policy and interviews with community-based stakeholders identified three existing government programs that could be leveraged for the implementation of drowning interventions. In Bangladesh, the mixed-methods process evaluation of the Anchal program showed that while the program was acceptable in the community, geographical barriers to access, cultural beliefs and inadequate resources reduced attendance, limiting effectiveness. The gender analyses of both Anchal and SwimSafe programs revealed opportunities to ensure equitability. Fewer older girls enrolled in SwimSafe classes compared to boys due to cultural concerns. Female community-based staff found that employment in the programs improved social status, physical mobility and access to resources.

  • (2022) Patterson, Kate
    Thesis
    3D computer generated biomedical animations can help audiences understand and contextualise scientific information that can be challenging to communicate due to resolution and complexity. Biomedical animators bring together multiple sources of authentic scientific data, to translate abstract information into a visual form through storytelling and visualisation. The field of biomedical animation has emerged from a long history of science visualisation and science-art endeavours, and despite there being rich discourse in the fields of data visualisation and science communication, the academic literature in the field of biomedical animation is limited, and focussed on the technical methods for visualisation, or the role these animations play in scientific research, rather than the processes through which they are created. However, as the field matures, there is a need for a deeper understanding of the creative process, and the field is now poised to expose and characterise these aspects, particularly from the perspective of the practitioner. This practice-based research project aims to expose and characterise both the visible and invisible factors that influence my personal process of creating a biomedical animation, and the tacit dimensions that influence orchestrated design choices. This research project employs a multi-method and reflective practice approach with disciplined capture and documentation of critical moments of self-reflection, that ultimately comprise the data for analysis. Thematic analysis was then used to analyse the data, and to identify themes that could contribute to frameworks that represent my personal process(es) in creating 3D biomedical animations. This has allowed me to identify and contextualise my creative process both in terms of my personal and professional position as well as within the field more broadly. I am now able to better advocate for the intangible and often undervalued aspects of my creative practice, and can articulate how a hierarchical decision matrix that considers multiple inputs contributes to my creative process. These insights will also be relevant to others in the field of biomedical animation and in the field of design more broadly, who may gain a deeper insight into their own processes of working and ways of exploring creative practice.

  • (2022) MacGibbon, James
    Thesis
    HIV pre-exposure prophylaxis (PrEP) is a recent, yet significant, development in HIV prevention. This mixed-methods research followed PrEP’s introduction in Australia, and examined how gay, bisexual and queer (GBQ) men in relationships have adapted to and incorporated PrEP in their sex practices, relationships, and everyday lives. As PrEP raises the prospect of having condomless sex both within and outside primary relationships without risking HIV infection, this research revisited the concept of negotiated safety (Kippax et al., 1997) to explore how HIV-negative GBQ men practice and negotiate safe sex in the era of biomedical HIV prevention. Quantitative data were collected in two national cross-sectional survey projects, The Gay Community Periodic Surveys (GCPS; 2013–2018) and the PrEPARE Project (2013–2021). The GCPS analysis showed a rapid shift away from relationship agreements in which condomless sex is only sanctioned between regular partners. The PrEPARE Project analysis found that men in relationships who used PrEP were more likely to have spoken and non-monogamous agreements, and to have partners that also used PrEP, compared to men in relationships who did not use PrEP. Qualitative data were generated using semi-structured, in-depth interviews conducted between January and August 2019 with 26 GBQ men in Sydney, Melbourne and Perth. Thematic analysis of these data identified new shared meanings and social practices that were enabled or mediated by PrEP, with an analytic focus on complexity, situatedness, contingency and relationality. Participant accounts illustrated diverse sexual practices and views about risk, but most participants adopted PrEP due to perceived HIV risk from casual sex rather than sex with their primary partners. PrEP complicated views about what counted as ‘safe sex’ and revealed changing understandings and practices of intimacy, pleasure, trust and risk. There was, however, an enduring narrative of individual responsibility to practice effective HIV prevention. Participants diverged in how they discussed and disclosed sexual practices with their primary and casual partners, revealing tensions about what disclosures were believed to be necessary or expected. Together, these quantitative and qualitative data collected as PrEP use became more common refocus attention on the practicality and complexity of relationship agreements among GBQ men.

  • (2022) Aung, Htein Linn
    Thesis
    With widespread access to combination anti-retroviral therapy (cART) and HIV suppression, life expectancy among people living with HIV (PLHIV) is increasing more than ever. According to UNAIDS, there were 8.1 million older PLHIV (i.e., 50 years of age and over) in 2020 globally. Although HIV-associated dementia has become rare in the cART era, mild neurocognitive impairments remain prevalent among PLHIV (~30% in virally suppressed). With aging, there is an increasing concern that HIV may precipitate neurocognitive abnormal aging because HIV is associated with increased markers of aging (e.g., immunosenescence and hyper-coagulopathy) and multiple age and HIV-related comorbidities (e.g., cardiovascular diseases). Importantly, these comorbidities occur at an earlier age and at a higher rate among PLHIV compared to age-matched HIV-negative persons. Earlier, more severe and more rapidly progressing neurocognitive impairment would have major public health consequences for the millions of PLHIV and the healthcare system. The overarching aim of this PhD thesis is to determine whether having chronic stable HIV infection and suppressive ART is associated with abnormal cognitive aging including premature cognitive aging (HIV and age synergistically/addictively lead to much lower cognitive performance at a younger age compared to controls), accentuated cognitive aging (HIV and age synergistically/addictively lead to much greater prevalence and severity of neurocognitive impairment), and/or accelerated cognitive aging (HIV and age synergistically/ addictively lead to much more rapid progression of neurocognitive impairment). To address these questions, we used a range of scientific methodologies including a systematic review, and several types of advanced statistical analyses using national and international longitudinal cohort data. First, to contextualise the potential public health consequences of cognitive aging in PLHIV, we conducted a narrative review of the burden of established dementia risk factors among PLHIV. We identified that the burden of several major dementia risk factors is much greater among PLHIV than in the general population. Second, we conducted the first-ever systematic review evaluating the current evidence for premature, accentuated and accelerated cognitive aging among PLHIV. We determined moderate evidence for premature cognitive aging and strong evidence for accelerated cognitive aging, while accentuated cognitive aging had not been optimally assessed. Lastly, addressing the previous literature major limitations (low sample size, cross-sectional study design, low proportion of older PLHIV, and inadequate controls/norms), we quantified the profiles of cognitive aging in four longitudinal studies of PLHIV. We demonstrated robust trends for premature cognitive aging among PLHIV compared to age-matched HIV-negative persons. We also demonstrated that older PLHIV had a higher risk for both neurocognitive impairment and neurocognitive decline compared to younger PLHIV, while controlling for normative age effect. These results are indicative of both accentuated and accelerated aging, although our research identified the need for longer-term studies using very large sample size to assess these trends especially in PLHIV older than 70+. Based on these findings, we discussed implications for clinical practice and future research directions.

  • (2023) Stirling, Robert
    Thesis
    In Australia, there is no standardised approach to measuring performance of alcohol and other drug (AOD) treatment services. Non-government organisations (NGOs) that provide AOD treatment in Australia manage contracts from multiple funding sources, with performance measures varying between funders. They have reported a high reporting burden and inconsistent expectations from different funders to demonstrate accountability. The primary aim of this thesis was to establish a list of performance measures that are acceptable to service users, treatment providers, and funders; explore approaches to improve implementation of performance measures; and make recommendations to funders of non-government AOD treatment. The research approach involved three phases: 1) an assessment by three independent raters of existing measures used in contracts against best practice; 2) focus groups with service users, treatment providers, and funders (n=10 focus groups) to identify the most important performance measures among diverse stakeholders and explore the challenges associated with implementation; 3) a Delphi process with a purposeful sample of service users, treatment providers, and funders to prioritise a core set of performance measures. Phase One found over 500 unique measures used in contracts for AOD treatment services, with most not adhering to best practice. Further, the majority were output and process measures. In Phase Two, focus groups identified that access, outcome, and experience measures were the most important measurement types across all stakeholder groups, with structural measures also important to service users. In Phase Three, 17 performance measures reached consensus. In contrast to Phase One, the final set were mostly outcome, access, and structural measures (n= 11/17) with only one measure each for output and process. Further, key findings from the focus groups highlighted that identification of measures is only part of a robust performance measurement system. Support systems for collecting, analysing, interpreting, and reporting performance data are also needed. At the policy-level, implementation of the final set of measures can improve accountability of public funds, and support the collection of standardised performance-related data to inform funding decisions and treatment planning. At the practice-level, the measures have the potential to reduce reporting burden, improve organisational efficiency, and inform quality improvement initiatives.

  • (2023) Sazzad, Hossain
    Thesis
    Prisons are a hotspot for blood-borne virus transmission. To control outbreaks of these infections, it is essential to have an in-depth understanding of risk behaviours of inmates and the impact of existing control measures, and also to apply sensitive methods for detection of new infections occurring within prisons. This thesis describes studies in these three domains to understand the spread of hepatitis C infection in the prisons in New South Wales (NSW). The clinical data and blood samples for this work originated from two prospective studies conducted in the NSW prisons: the Hepatitis C Incidence and Transmission Study in prisons (HITS-p) (2005- 2014; n=590) and the Surveillance and Treatment of Prisoners with Hepatitis C (SToP-C) (2015-2019; n=3691). The first study identified a high rate of incident infections in an at-risk cohort and documented outcomes (spontaneous clearance, chronic infection, and re-infection or superinfection), while the second study demonstrated the impact of scale up of direct acting antiviral (DAA) treatment in reducing incidence – that is treatment as prevention. The first project utilised qualitative data obtained from audiotaped interviews with inmates in the HITS-p study to understand contexts and concerns regarding violence and HCV transmission in prison. Concerns regarding violence were identified at the individual level during blood contact; triggering factors such as drug debt were identified at the network level; racial influence at the community level; and legislation such as delayed parole for violence impacted at the policy level. For the subsequent projects near-full length HCV genomes for genotypes 1a and 3a cases from both cohorts were sequenced with Oxford Nanopore Technology (ONT) using previously published protocols. A total of 211 genotype 1a sequences and 282 genotype 3a sequences were generated. Of these, 28 1a and 63 3a sequences were from samples collected within 6 months of the estimated date of infection and are hence referred to as acute infection sequences. Acute infection sequences from samples collected during 2005 – 2015 (the pre-DAA era) and 2016-2019 (the post-DAA era) were used to model the temporal evolution in the size of infected population using previously published Bayesian evolutionary analysis methods. The effective population size modelled with the genotype 3a infection samples, demonstrated a 21% reduction in the size of infected population in 2019 compared to 2014. By contrast, the trend in the genotype 1a samples was static. The SToP-C sequences (from both acute and chronically infected subjects) were used to identify molecularly related infections (clusters), before within-host viral variants were further characterised within these clusters to identify likely direct transmission events (defined as phylogenetic intermingling of within-host variants between two or more subjects). For genotype 1a, there were 131 sequences which formed 51 clusters, and for genotype 3a, 140 sequences formed 61 clusters. Each cluster had 2-4 sequences. Among these, 41 genotype 1a and 39 genotype 3a clusters were analysed for minor variants. Evidence of a direct transmission of a within-host variant was observed in only one cluster. Subjects in 45 (40%) clusters were from the same prison providing preliminary epidemiological support for the transmissions. These studies highlight the high-risk context for HCV transmissions in the prison setting, and the utility of molecular epidemiological tools for surveillance in this closed setting.

  • (2022) Watfern, Chloe
    Thesis
    There are studios all over the world where neurodiverse artists work together in a supportive way. This thesis is an inquiry into how art works in two of these organisations—Studio A in Sydney, Australia, and Project Art Works in Hastings, UK. It draws from traditions of narrative inquiry and ethnography to understand the lived experiences of the people at the heart of these studios, and the role that art has played in their storied lives. As such, the thesis contributes to knowledge in three ways: 1) It documents the important practices of makers and organisations whose work has not yet received significant critical or academic attention. It explores the dimensions of these practices that hold potential for reshaping normative understandings of both art and disability; 2) It conceptualises the role of art as a point of connection between neurodiverse people, and as a way of coming to express and understand lived experience. It maps the resonances across different fields that help articulate empathic encounters with and through art; 3) It demonstrates, through its written form, an ecological mode of creative inquiry that resists reductionism—an inquiry that is, like the practices it studies, embodied and relational. It interrogates the value, and ethical implications, of this mode of research. To contribute to knowledge in this way, the thesis assembles many forms of pre-existing knowledge, including the lived experience of its subjects, and the academic literature preceding it. It is grounded in an ecological understanding of cognition, informed by theories that help situate thought in the world, as a dynamic system of relationships between self, others, and the environment. It draws links between disability aesthetics, care ethics, and an ecological approach to empathy, through detailed insights into the social and aesthetic dynamics operating in the work of the two studios. These insights were built up over three years of fieldwork, including over one hundred interviews, and hundreds of hours spent looking, listening, and making alongside artists in the studio. This thesis is an invitation to enter the world of the studios, and of some of the people who work there. It offers a way of paying attention to art, and to other people, that is attuned to the senses, and that allows us to be comfortable with not knowing—or, knowing differently. It argues that this is a practice of ethical importance, in a world where both disability and art are still poorly understood.

  • (2022) Sudewo, Anindita
    Thesis
    In recent years, major changes have affected the national response to HIV with people who inject drugs in Indonesia. These include changes in international HIV funding, the dissolution of the National AIDS commission, and a “war on drugs” declared by the Indonesian president in 2015. Set in this national context, this thesis examines the production of HIV risk for men and women who inject drugs in Indonesia; the factors that influence their engagement in harm reduction and HIV testing, treatment and care services; and the everyday strategies and actions instigated by people who inject drugs to enhance health and wellbeing. This study adopted a qualitative study design, and involved in-depth interviews with 36 men and women who inject drugs, and 10 key informants in community-based organisations (CBOs) and government health services. Key findings pertain to the production of HIV risk for people who inject drugs within micro-level social and physical spaces, influenced by macro-level stigmatising community values and criminalising policies; socio-ecological influences that inhibit their engagement in harm reduction and HIV services, including insular lifestyles associated with drug use and stigmatisation within interpersonal relationships with families and friends; the loss of critical community-based support services; and the shift of HIV care to formal government health services perceived as unsafe, with operations constrained by national policies. Yet, people who inject drugs also demonstrate a range of strategies – with support of people in injecting networks, families, CBOs and health services – that enable them to navigate and negotiate restrictive social, physical and policy environments to seek health and wellbeing. This thesis contributes to an emerging scholarship in social science approaches to public health in Indonesia. It draws on an analytic framework that recognises the interpersonal, institutional and contextual influences on people’s health and wellbeing, as well as the important action that HIV affected communities take to enhance their own lives in challenging contexts. The conclusions argue for the adoption of HIV and harm reduction practices and policies that cater to the complex lives of people who use drugs, and help overcome their everyday experiences of criminalisation and stigmatisation that produce risk and inhibit engagement in appropriate support services.

  • (2022) Ahmed-Cox, Aria
    Thesis
    Cancer persists as a major public health concern with poor survival rates for aggressive tumours. Nanotechnology offers opportunities to develop delivery vehicles (nanoparticles) which can improve drug efficacy in cancer cells while reducing collateral toxicity caused by many current therapies. A key challenge in the clinical translation of therapeutic nanoparticles stems from the complexities of drug delivery; namely a need for greater understanding of how the biophysical characteristics of nanoparticles affects their tumour penetration and cell uptake. This thesis sought to address this challenge, developing advanced imaging and analysis methodologies to evaluate nanoparticle uptake and efficacy in quantitative cell models. We initially investigated the capability of rapid fluorescence lifetime imaging microscopy to measure nanoparticle cellular uptake. Results showcased the ability of this emerging quantitative imaging approach to track and quantify changes in nanoparticle dynamics on a second time scale, localising significant changes in nanoparticle lifetime with uptake across extracellular and nuclear boundaries in live cells. Broadening our study into tumour models which recapitulate key elements of the tumour microenvironment, glioblastoma, neuroblastoma and non-small cell lung cancer cells were grown as 3D spheroids and used to study the penetration kinetics of nanoparticles with confocal microscopy. The development of rigorous analysis methods enabled direct evaluation of nanoparticle kinetics. Subsequent study by lightsheet microscopy and real-time force imaging cytometry identified that nanoparticle uptake was influenced not only by nanoparticle size but also the stiffness and density of the cell model. Applying these analyses to functionalised nanoparticles for brain cancer delivery, we identified that lactoferrin coated nanoparticles (Lf-NP) had enhanced penetration kinetics. Low-density lipoprotein receptor (LRP1), for which lactoferrin is a key ligand, was shown to be highly expressed on the blood-brain barrier (BBB) and in glioblastoma. Following, in vitro models identified that Lf-NP could cross the BBB, and drug-loaded iterations of these nanoparticles were revealed to have elevated efficacy against glioblastoma cells. Collectively, these findings showcase methods to systematically visualise and quantify nanoparticle tumour cell uptake and highlight functionalised drug-loaded nanoparticles for further investigation in brain cancer.

  • (2022) Overton, Kristen
    Thesis
    Addressing antimicrobial resistance (AMR) as a purely medical problem fails to recognise the sociological factors that drive the misuse of antimicrobials. Antimicrobial use is shaped by the local social, cultural, political and economic context. There is now widespread recognition that addressing AMR requires an understanding of the social factors that underpin our use and prescription of antimicrobials. Sociological and anthropological explorations of the global antimicrobial crisis have thus far disproportionately focused on economically wealthier nations. This is despite the recognition of economically poorer nations as sites of considerable, escalating, and often unregulated, antimicrobial use. This thesis examines the social dynamics of antimicrobial use in the Indian context through ethnographic observations and 100 qualitative interviews with doctors, community health practitioners, pharmacists, pharmacy employees and community members in Hyderabad, India. Using a constructivist grounded theory approach to data collection and analysis, the focus is on gaining an understanding of how enduring and emerging inequalities, infective risk and uncertainty, labour risks and precarious work, improvisation and self-medication, and informal and formal pharmaceutical economies shape antimicrobial use in India. Using a critical sociological lens, I explore: the dynamics of biopolitics and risk; the pharmaceuticalisation of everyday life and the vested interests therein; the economies of healthcare and antimicrobial use, including commodification and privatisation; and the vulnerability and structural violence associated with the use of antimicrobials. Knowledge of the social dynamics driving antimicrobial use can then in the future be used to inform policies and programs aimed at optimising antimicrobial use in India, appropriately tailoring them to context, rather than continuing with pan-national approaches that do little to accommodate considerations of the Global South.