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SDG 5

Economic Analysis of Improving Cold Tolerance in Rice in Australia
03 November 2005
University of Sydney

Singh, Rajinder;Brennan, John P;Farrell, Tim;Williams, Robert;Lewin, Laurie;Mullen, John

The occurrence of low night temperatures during reproductive development is one of the factors most limiting rice yields in southern Australia. Yield losses due to cold temperature are the result of incomplete pollen formation and subsequent floret sterility. Researchers have found that in 75% of years, rice farmers suffer losses between 0.5 and 2.5 t/ha. Research is being undertaken to identify overseas rice varieties, that are cold tolerant under the local weather conditions and by using those genotypes as parent material, develop cold tolerance varieties of rice. A yield simulation model was used to measure reduction in losses due to cold at different minimum threshold temperatures, while the SAMBOY Rice model was used to measure the costs and returns of a breeding program for cold tolerance. The results of the economic analysis reveal that new cold tolerant varieties would lead to significant increase in financial benefits through reduction in losses due to cold, and an increase in yield from the better use on nitrogen by the cold tolerant varieties. The returns to investment on the research project are estimated to be high.
Oöcyte markets: global tissue economies and women’s reproductive work in embryonic stem cell research
05 September 2006
University of Sydney

Waldby, Catherine

Somatic Cell Nuclear Transfer (SCNT) research, otherwise known as therapeutic cloning, requires large numbers of research oöcytes, placing pressure on an already limited supply. In the UK, Canada, Australia, Singapore and most of Western Europe, oöcytes are made available through modestly reimbursed donation, and, due to the onerous nature of donation, the existing demand for reproductive oöcytes far outstrips availability. SCNT research will place this system under even greater pressure. This paper investigates the growth in a global market for oöcytes, where transnational IVF clinics broker sales between generally poor, female vendors and wealthy purchasers, beyond the borders of national regulation, and with little in the way of clinical or bioethical scrutiny. It considers the possible impact that SCNT research will have on this global market, and suggests some ways to improve the protection, security and power of vendors.
Feminine sexual subjectivities: Bodies, agency and life history
12 March 2009
University of Sydney

Bryant, Joanne;Schofield, Toni

The relationship between discourse, sex and the body has attracted sustained interest from scholars in sociology and cultural studies over the last twenty years. It is only recently, however, that sociological analyses of sexuality have begun to explore the specificity of the body and its relationship to human agency. This work suggests that, far from serving as a passive surface upon which sexual scripts are inscribed, the body in sexual action is itself a dynamic force in generating sexual subjectivities. This is related to the way that the praxeological aspects of sex are always corporeal and that corporeality is indivisibly related to individual agency. The specific configuration of sexual practices is central to the making of sexual identities. Indeed, it is through such a configuration that the sexual subject is brought into being. Yet human agency is a central feature of the process, rendering it a project that develops over time. Such an idea is particularly relevant to feminists who are concerned with the way that feminine sexual subjectivity can be theorised as active and desiring. This paper explores the way in which the body is implicated in sex practice and the making of active feminine sexual subjectivities. In doing so, it draws on qualitative data collected from life history interviews with eighteen women.
Journal of Digital Research & Publishing Semester 1 2010 (1pm class)
16 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Refolding the fold: the complete representation of actuality in digital culture (Sonia Therese Chan) // Mind over media? A philosophical view on user-generated media and social identity (Romina Cavagnola) // Outsiders looking in: How everyday bloggers are gaining access to the elite fashion world (Tiana Stefanic) // New media revolution: personal ads expand to the Internet (David James Misner) // Online publishing: (Anime) Fan fiction and identity (Nicola Santilli) // The practicality of magazine websites (Emma Turner) // A Cultural Historical Approach to Virtual Networking (Kate Fagan) // How social media is changing public relation practices (Katharina Otulak) // The 3D evolution after AVATAR: Welcome to 3D at homes (Jaeun Yun) // The interaction between technology, people and society —In the case of Happy Farm (Chen Chen) // Technical solutions to business challenges: the Content Management System of today (Bujuanes Livermore) // Hidden Consumerism: ‘Advergames’ and preschool children. Parents give the thumbs up? (Kathryn Lewis) // Google’s library of Alexandria: The allure and dangers of online texts (Leila Chacko) // Google’s Taking on China:an Ingenious Publicity Campaign (Junying Cui) // Redifining Glamour: Capturing Queer Subculture on TheNightBloomers.com (Ron O’Berst) // Patient Advocates in the Internet Age: a threat to traditional notions of authority in health care? (Allison Jones) // Fashion Blogs: the new menber in fashion industry (Chi Zhang) // Twitter Wave Will Drown The World? (Jie He) // The influence of cultural differences on electronic commerce (Yuan Shen).
Journal of Digital Research & Publishing Semester 1 2010 (7pm class)
17 February 2012
University of Sydney

nan

The Journal of Digital Communication and Culture is a publication created by students of ARIN6912 Digital Research and Publishing. This unit of study is part of the Master of Digital Communication and Culture taught by the Digital Cultures Program in the School of Letters, Art, and Media. For more information contact Chris Chesher (chris.chesher@sydney.edu.au). CONTENTS (TITLE/AUTHOR): Lost online: TV series as multi-author, multi-platform metafictions (César Albarrán Torres) // Join the Group: Facebook (Marta Conejo Sobrino) // Is Twitter making news more interpersonal? (Ella Pong) // Love or Lies: Deception in internet dating (Bridget Slater) // To be or not to be: T.Sina in China (Jin Xing) // Cyberbullying and the “Net Generation” (Annie Chiv) // The rise of social media and the creation of a new digital divide (Allen Liu) // Building the Wheel: Popular Education in the Digital Era (Dan O’Reilly-Rowe) // Publishers Attempt To Reconnect With Readers (Kim Kooren) // Blooks: A New Era of Literature? (Amanda Lansdowne) // The ‘Death of the Author’ and the birth of the reader? (Tamsin Lloyd) // Crisis Communications and New Media (Tom Champion) // The Influence of Online Reviews (Amy Fong) // I Blog. You Buy. (Miren Mendoza) // ‘Will 2020 still be a Great Year to be a Fashion Blogger?’ (Kate Pagett) // The Necessity for Social Media Plans in Business Strategies (Alicia Fong Yee Shum)
The role of prolactin in fish reproduction
05 August 2013
University of Sydney

Whittington, Camilla M.;Wilson, Anthony B.

Prolactin (PRL) has one of the broadest ranges of functions of any vertebrate hormone, and plays a critical role in regulating aspects of reproduction in widely divergent lineages. However, while PRL structure, mode of action and functions have been well-characterised in mammals, studies of other vertebrate lin- eages remain incomplete. As the most diverse group of vertebrates, fish offer a particularly valuable model system for the study of the evolution of reproductive endocrine function. Here, we review the cur- rent state of knowledge on the role of prolactin in fish reproduction, which extends to migration, repro- ductive development and cycling, brood care behaviour, pregnancy, and nutrient provisioning to young. We also highlight significant gaps in knowledge and advocate a specific bidirectional research method- ology including both observational and manipulative experiments. Focusing research efforts towards the thorough characterisation of a restricted number of reproductively diverse fish models will help to provide the foundation necessary for a more explicitly evolutionary analysis of PRL function.
Regulating Women: The ‘Mass Media’ of Early Modern Society?
03 January 2014
University of Sydney

O'Brien, Karen

People in early modern England went to great lengths in court to protect themselves from the wrath of the female tongue and crimes of speech increased fourfold in England between 1580 and 1680. This paper explores legal attempts to regulate and censor the speech of women. It examines the processes of cultural transmission in Cheshire as represented in petitions and court documents during the decade of 1660 to 1670 and charts the attempts of ruling bodies to regulate the behaviour of ‘unruly’ women to prevent them from informing the community at large through issuing prohibitive petitions and by publishing them. Evidence of censorship of the female voice is derived from hundreds of manuscripts from the Chester Consistory Courts and Quarter Sessions Courts. These archival sources have been closely read and organised and the readership is respectfully invited to enter the fascinating world of Nantwich townsfolk as they are brought to life - larger than life, on this historical canvas, as the intricacies of their lives and the attempts to censor female behaviour unfold during an investigation of their actions, language and private lives.
Selling sex in unsafe spaces: Sex work risk environments in Phnom Penh, Cambodia
07 July 2014
University of Sydney

Maher, L;Mooney-Somers, Julie;Phlong, P;Couture, MC;Stein, E;Evans, J;Cockroft, M;Sansothy, N;Nemoto, T;Page, K

Background The risk environment framework provides a valuable but under-utilised heuristic for understanding environmental vulnerability to HIV and other sexually transmitted infections among female sex workers. Brothels have been shown to be safer than street-based sex work, with higher rates of consistent condom use and lower HIV prevalence. While entertainment venues are also assumed to be safer than street-based sex work, few studies have examined environmental influences on vulnerability to HIV in this context. Methods As part of the Young Women's Health Study, a prospective observational study of young women (15-29 years) engaged in sex work in Phnom Penh, we conducted in-depth interviews (n = 33) to explore vulnerability to HIV/STI and related harms. Interviews were conducted in Khmer by trained interviewers, transcribed and translated into English and analysed for thematic content. Results The intensification of anti-prostitution and anti-trafficking efforts in Cambodia has increased the number of women working in entertainment venues and on the street. Our results confirm that street-based sex work places women at risk of HIV/STI infection and identify significant environmental risks related to entertainment-based sex work, including limited access to condoms and alcohol-related intoxication. Our data also indicate that exposure to violence and interactions with the police are mediated by the settings in which sex is sold. In particular, transacting sex in environments such as guest houses where there is little or no oversight in the form of peer or managerial support or protection, may increase vulnerability to HIV/STI. Conclusions Entertainment venues may also provide a high risk environment for sex work. Our results indicate that strategies designed to address HIV prevention among brothel-based FSWs in Cambodia have not translated well to street and entertainment-based sex work venues in which increasing numbers of women are working. There is an urgent need for targeted interventions, supported by legal and policy reforms, designed to reduce the environmental risks of sex work in these settings. Future research should seek to investigate sex work venues as risk environments, explore the role of different business models in mediating these environments, and identify and quantify exposure to risk in different occupational settings. Keywords: sex work; risk; environment; vulnerability; HIV; STI; young women; entertainment; Cambodia
Making decisions in the mechanistic, probabilistic and scientific domains of medicine: a qualitative study of medical practitioners
07 August 2014
University of Sydney

Little, M;Gordon, J;Markham, P;Lipworth, W;Kerridge, I

Rationale, aims and objectives: To find out how medical practitioners perceive the processes of decision-making in the context of the individual patient and to examine the importance of decision- making in the development and identity of medical practitioners throughout their clinical lives and to suggest how these perceptions might influence medical pedagogy. Method:A qualitative study of medical practitioners of varying ages and specialties, using loosely structured biographical interviews that were read to determine the different ways in which decisions were constructed and recalled and the impact these decisions were felt to have onboth the decision-maker and othersfor whom the decision was salient. Results: Personal decisions about career choice were important because they shaped the life of the practitioner and made a significant impact on those around them. Professional decisions were made in the domains of the mechanistic and probabilistic scientific world of medicine and in the domain of human relationships, emotions and suffering. There was often a tension between the different domains and the context of the life-world often modified decisions that might logically have been determined by evidence-based medicine and its bio-knowledge. Conclusions: Decisions had a strong effect on the development of identity within the field of practice. Individuals came to see themselves as doctors who made certain kinds of decisions of immediate relevance to the individual patient. Teaching medical students and graduates how to apply evidence to their decisions and how to use formal computational decision aids may well have a useful place in pedagogy, but the impact of decision-making on the lives of doctors and their individual patients deserves at least equal emphasis. Keywords Bio-knowledge, decisions, identity, life-world, personal development
Managing scientific uncertainty in health legislation
11 August 2014
University of Sydney

Lipworth, W

Legislation and regulation are one means of controlling biomedical research and its clinical applications. This is seldom a one-off process since biomedical science evolves rapidly, dynamically and often unpredictably, and legislative and regulatory reviews are often required in response to the emergence of apparently new ethical and legal issues. In recent years, there have been several reviews of Australian biomedical legislation including the Australian Law Reform Commission’s “Inquiry into the Protection of Genetic Information in Australia” (“the ALRC Inquiry”) released in 2003 1, and the Legislative Review of the Prohibition of Human Cloning Act 2002 and the Research Involving Human Embryos Act 2002, (“the Lockhart Review”) which was released in December 2005 2. The ALRC Inquiry was a response to developments in genetic research, particularly genetic epidemiological research involving powerful new techniques such as microarrays (gene chips). The Lockhart Review was concerned with developments in stem cell research, including the use of embryos produced in the course of assisted reproductive technology (ART) and through cloning. These two reviews, when juxtaposed, highlight the key elements—both recurring and review-specific—of biomedical legislative review.
"It looks after me”: how older patients make decisions about analgesics for osteoarthritis
29 August 2014
University of Sydney

Milder, T;Lipworth, W;Williams, K;Ritchie, J;Day, R

Objective: To explore the key motivators behind selection of analgesics (non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and complementary medications (CMs)) by patients with osteoarthritis (OA). Methods: A qualitative study, in which in-depth semi-structured interviews were conducted with 15 OA patients, recruited from four general practices in Sydney, Australia. Patients were aged 65 or above, and were currently taking, or had recently taken, an NSAID for osteoarthritis. Results: Three key themes emerged from the data: reliance, routine and pill load. Reliance: Patients were strongly reliant upon NSAIDs because they consistently satisfied their needs. By contrast, they were much less reliant upon paracetamol because of uncertainty or scepticism about its effectiveness. They were not reliant upon CMs but were willing to take them indefinitely because they were perceived as being without risk. Routine and pill load: Many patients took an NSAID, as well as CMs as part of a ‘daily routine’. By contrast, patients had difficulty developing a routine around using paracetamol at the recommended maximum dose because of the implicit frequency of dosing required and an aversion to the associated ‘pill load’. Conclusion: The results highlight the importance of exploring the perceptions and preferences of patients with regard to analgesics for OA. Clinician advice regarding analgesia for OA should take account of the possible reliance of the patient upon an NSAID, their medicine routines, and their potential concern about the pill load associated, in particular, with paracetamol.
Beyond evidence: reappraising use of CA-125 as post-therapy surveillance for ovarian cancer
03 September 2014
University of Sydney

Harnett, P;Kerridge, I;Jordens, C;Hobbs, K;Mason, C;Morrell, B

omen who have completed primary chemotherapy for ovarian cancer commonly have serial assessment of the serum tumour marker cancer antigen 125 (CA-125).1 This practice has been based on the proven utility of CA-125 in diagnostic algorithms and as a marker of response to therapy. Serial CA-125 assessment is also used because there is evidence that in women who have completed treatment for ovarian cancer, the serum CA-125 rises 2–6 months before symptoms or signs of relapse develop. The assumption underlying this and other similar studies is that serial monitoring of CA-125 would enable early diagnosis and treatment of relapse. This would thus lead to delay or reduction of cancer-related symptoms, psychological reassurance and, in theory, improved survival. Some studies have suggested that CA-125 may have some benefit in post-treatment surveillance. However, many others have demonstrated that although a rising CA-125 level is highly predictive of relapse, surveillance monitoring of CA-125 levels after remission from primary chemotherapy confers little benefit over standard clinical examination and does not improve duration of survival or quality of life.
Condom negotiation across different relationship types by young women engaged in sex work in Phnom Penh, Cambodia
17 September 2014
University of Sydney

Maher, L;Mooney-Somers, Julie;Phlong, P;Couture, MC;Phal, S;Bates, A;Sansothy, N;Page, K

Cambodia’s 100% Condom Use Programme is credited with an increase in consistent condom use in commercial sexual interactions and a decrease in HIV prevalence among female sex workers (FSWs). There has been little improvement in condom use between FSWs and non-commercial partners, prompting calls for more innovative approaches to increasing condom use in these relationships. To understand why condoms are used or not used in sexual interactions involving FSWs we examined condom negotiation across different types of relationship. We conducted 33 in-depth interviews with young (15 to 29 years) women engaged in sex work in Phnom Penh. There was an important interplay between the meanings of condom use and the meanings of women’s relationships. Commercial relationships were characterised as inherently risky and necessitated condom use. Despite a similar lack of sexual fidelity, sweetheart relationships were rarely construed as risky and typically did not involve condom use. Husbands and wives constructed their sexual interactions with each other differently, making agreement on condom use difficult. The lack of improvements in condom use in FSWs’ non-commercial sexual relationships needs to be understood in relation to both sex work and the broader Cambodian sexual culture within which these relationships take place. Keywords: Female sex workers; condoms; sexually transmitted infections; HIV; Cambodia Introduction
A complex negotiation: Women’s experiences of naming and not naming premenstrual distress in couple relationships
22 September 2014
University of Sydney

Mooney-Somers, Julie;Perz, J;Ussher, JM

Recent research has demonstrated the importance of family relationships in women’s experience of premenstrual changes, and their construction of these changes as ‘PMS’. However, the discursive process by which women take up the subject position of ‘PMS’ sufferer through the explicit naming of ‘PMS’ to an intimate partner has received little research attention. Drawing on 60 individual interviews with Australian women, conducted between 2004 and 2006, we examined accounts of naming ‘PMS’ in intimate relationships, women’s explanations for naming or not naming, and their experiences of their partner naming them as premenstrual. The analysis process identified an overarching theme of naming ‘PMS’, which was made up of three themes: naming to explain; ‘PMS’ becoming the only explanation for distress; and ‘PMS’ as not a legitimate explanation for distress. The findings suggest that clinicians need to be aware of women’s complex, and often ambivalent, experiences of naming ‘PMS’ within their relationships, when working with women, and couples, seeking treatment or support for premenstrual distress. Premenstrual distress; PMS; relationships; cultural construction; Positioning Theory
Sex as commodity: Single and partnered men’s subjectification as heterosexual men
22 September 2014
University of Sydney

Mooney-Somers, Julie;Ussher, JM

Drawing on a discursive analysis of individual and group interviews with heterosexual men, this paper examines how men take up and resist discourses of sexuality and gender to (re)produce a recognisable heterosexual subjectivity. We being by exploring the commodification of sex in men’s accounts, and the various practices men undertake to obtain sex. We then draw on differences that emerged between single men and partnered men’s accounts, to argue that the contexts in which men (re)produce sexual subjectivity have significant implications for how they negotiate the discursive positions available to them. Three themes are explored in this section. In ‘just sex’, single men work to fix the meaning of the sex they are pursuing/having, thus resisting alternative meanings offered by women. In ‘more than just sex’, single men articulate a romantic discourse where sex is part of an emotional relationship. Finally, in ‘accounting for the lack of sex’ partnered men undertook work to remain recognisable as heterosexual men in the absence of sex. This paper explores the difficulties, dilemmas and ambivalences produced by the project of subjection, and how men resolve or accommodate them. Keywords: men, heterosexuality, subjectification, relationships, discourse analysis.
Structural elements in achieving legislative tobacco control in NSW, 1955-95: political reflections and implications.
31 October 2014
University of Sydney

Hooker, C;Chapman, Simon

Objective: To analyse structural factors revealed by politicians that shaped legislation on tobacco control in New South Wales, 1955-1995. Methods: Parliamentary debates and other records were collected. Open-ended interviews were conducted with 17 of the Members of Parliament (MPs) and health advocates who were significantly involved, and analysed for structural elements. Results: Tobacco industry lobbying had a significant but limited influence on policymaking, being exerted largely through social interactions with executives and based on concerns for the economic impacts on third parties. MPs saw health advocates’ chief functions as (1) generating community concern about the issue and support for control measures, and (2) bringing any new information to political attention, providing pro-control arguments and data through the media. Factors that delayed tobacco control policies included: the conservative stance of Premiers and major parties, commitments to unanimous federal action, and rivalry between parties. Factors that facilitated control policies included: reforms that gave the Legislative Council increased power, the use of Parliamentary committees, and backbencher and grass roots support. Conclusions: Tobacco control policy and legislation has been the product of political structures that gave power to those MPs in the least powerful positions – minor parties, Members of the Legislative Council (MLCs), backbenchers, women and party rank and file – rather than to major parties and their executives. Implications: Advocates should make the most of their access points to the political process, providing information, arguments and support to interested backbenchers, party and parliamentary health committees, the health ministers’ conference, minor parties and independents, and demonstrating public opinion in favour of further control.
Preconception testing and screening: Has the HGC covered all the bases?
10 November 2014
University of Sydney

Newson, A.J.

Has the Human Genetics Commission (HGC)'s recent report on population-wide preconception genetic testing and screening (1) convincingly demonstrated that this practice raises 'no specific ethical, legal or social principles' that would make population screening unacceptable? In BioNews 606, I critiqued Dr Callum MacKellar's commentary on the report (2). At the end of my commentary, I alluded to issues I think the HGC didn't address in enough depth. This doesn't mean that preconception screening is unacceptable, but we should pay more attention to these issues before introducing population-wide preconception screening. I'm concerned about three things. First, the HGC has adopted an 'apple pie' version of reproductive autonomy, viewing this concept as an intrinsic good (an issue Dr MacKellar also recognises). Second, the Commission has failed to justify why it has decided to offer screening to mature school students. Third, the HGC has glossed over the implications of communicating screening results to family members. The HGC states that 'respect for reproductive autonomy implies that a range of reproductive options should be available' (p1). They claim their proposals for population screening in young people are an extension of screening pregnant women that will increase choice and enhance reproductive autonomy. This seems to suggest that reproductive autonomy is an inherent good. I don't wish to underplay the right of women or couples to make informed and free decisions before and during pregnancy. But there is significant debate in bioethics and social science about the nature of and appropriate limits to reproductive autonomy, for example the myriad discussions over how women's decisions are influenced. The HGC report seems not to recognise these nuances.
Choice, autonomy and eugenics: Thoughts on the HGC's report on preconception genetic testing and screening
10 November 2014
University of Sydney

Newson, A.J.

As highlighted in BioNews, in early April 2011 the UK's Human Genetics Commission (HGC) published a report supporting preconception genetic testing and screening (1). Preconception screening, which can be broadly described as identifying carriers of genetic mutations to inform reproductive decision-making for the person tested or his/her relatives, is well established in some jurisdictions but relatively unknown in the UK. The proposals outlined in the report could be argued to be merely an extension of established principles of genetic testing in pregnancy to those who are not yet pregnant. The rationale for this extension is that it will increase people's options and choices, enhancing reproductive autonomy. But large-scale screening of young people previously unaware of such testing will give rise to new issues. This means Dr Callum MacKellar was right to question the ethics of screening in his recent BioNews Commentary. But I think that Dr MacKellar hasn't quite hit the mark with his criticism. His concerns can be divided into two broad areas: (i) whether preconception testing is eugenic; and (ii) that preconception testing necessarily entails selecting against children. Taking his first concern, Dr MacKellar does not explicitly state whether he believes the report's recommendations will lead to eugenic practices, although he does seem to imply they may contravene some EU legal instruments if put into practice. But if such an interpretation is sound, it would also mean most current prenatal diagnosis also amounts to such a contravention. It may be more helpful to examine what might be wrong with 'negative eugenics' (that is, discouraging couples from having a particular child).
Free fetal DNA for non-invasive prenatal diagnosis (NIPD): ethical aspects
10 November 2014
University of Sydney

Newson, A.J.;Deans, Z

Dr Phillipa Brice's accompanying commentary highlights how non-invasive testing of free fetal DNA (ffDNA) in pregnancy could transform women's experiences of antenatal screening and prenatal diagnosis. NIPD is already available for foetal sex, rhesus D blood type and some Mendelian inheritance such as achondroplasia, with tests for aneuploidy detection and Down syndrome being developed. These tests will not pose a risk to the pregnancy and could provide women and couples with definitive information earlier than current methods. The advantages over 'traditional' prenatal screening and diagnosis seem obvious - so is NIPD ethically problematic? Unsurprisingly, a pithy 'yes' or 'no' answer to this question is impossible and would undermine the opportunity for a rich and important discussion of how the ethics of NIPD might depart from 'traditional' testing in pregnancy. But in short, expectations are that NIPD can be conducted ethically if the right conditions are in place, and it is laudable that those working in this field are liaising so closely with ethicists to address emerging concerns as this technology develops.(1) An initial question is whether this technology gives rise to any new ethical questions over and above existing screening, diagnostic or assisted reproductive technologies. Existing debates in prenatal diagnosis, such as the disability rights critique, will continue to be relevant and may be exacerbated. So too will issues of the 'seriousness' threshold for offering PND and the routinisation of testing. Whilst NIPD does not depart too far from these existing issues, there may be important changes to the moral landscape of testing. If offered widely (for suitable conditions), NIPD will effectively become a screening test with a definitive outcome, akin to HIV (human immunodeficiency virus) testing in pregnant women, but one that may lead to termination. We need to decide which method of consent is appropriate and be mindful that a major justification for declining prenatal diagnosis (risk to the pregnancy) will be removed. Overall termination rates may also increase. Women will need sound and unbiased information about NIPD and will require time to reflect before deciding about testing.
Paternity testing: how to progress
10 November 2014
University of Sydney

Newson, A.J.

If statements on paternity testing websites are to be believed, the decision to have a paternity test is a straightforward process for the curious father. Send away for a free, no-obligation kit, post it back with your samples and your results will be available (by phone, mail or online) within 5 days - all for around £119. Yet for most men, the decision to take a paternity test will be much more difficult. A father may have endured years of doubt about his child's paternity before deciding to find out for sure. And once the decision to take the test has been made, many fathers may be unprepared for the emotional, legal and financial fallout from the results. The wide availability, technical simplicity and non-invasiveness of modern testing may also blind families to the devastation that non-paternity may bring. Although paternity testing in Britain is regulated by a voluntary code of practice that does account for ethical issues, the recent study published by a team at the Liverpool John Moores University further highlights the need for more research into how a finding of 'parental discrepancy' impacts not only fathers and children but the broader family. At present, findings of non-paternity are assumed to have a devastating impact, one that could destroy families, but the empirical validity of these assumptions remains unknown. We also need a broader debate on the value of this knowledge. While some believe that 'ignorance is bliss', others argue that our lives are better if we obtain all accessible knowledge about ourselves. This age-old debate about the value of knowledge is unlikely to be solved any time soon, but those commissioning paternity tests should be encouraged to think about their own attitudes towards the meaning of paternity. For many fathers, knowledge of biological kinship is fundamental to the parent-child relationship: some groups have even called for compulsory paternity testing at birth, arguing that this is the simplest and least-heartbreaking solution.
How to draw the line between ‘good’ and ‘bad’ reasons to die
12 November 2014
University of Sydney

Callaghan, Sascha

A Senate inquiry into legalising voluntary euthanasia for terminally ill people has recommended a conscience vote on the proposed bill after technical matters, such as what constitutes a “terminal illness”, are clarified. While this is an important step forward in grappling with the idea of the “right to die”, drawing a line at terminal illness for this purpose will be difficult. What’s more, restricting the right to die to people who are terminally ill is very different to what most of us think of as justifiable euthanasia. Research shows more than 82% of Australians support voluntary euthanasia where “a hopelessly ill patient, experiencing unrelievable suffering, with absolutely no chance of recovering” asks for help to end their life. This description covers terminal illnesses as well as other incurable conditions causing great suffering in which death may not be imminent.
Dynamics and Ethics of Comprehensive Preimplantation Genetic Testing. A Review of the Challenges
12 November 2014
University of Sydney

Hens, K;Dondorp, W;Handyside, AH;Harper, J;Newson, A.J.;Pennings, G;Rehmann-Sutter, C;de Wert, G

BACKGROUND: Genetic testing of preimplantation embryos has been used for preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). Microarray technology is being introduced in both these contexts, and is to be expected that also whole genome sequencing of blastomeres will become possible. The amount of extra information such tests will yield may prove to be beneficial for embryo selection, but also raise various ethical issues. We present an overview of the developments and an agenda-setting exploration of the ethical issues. METHODS: The paper is a joint endeavour by the presenters at an explorative 'campus meeting' organized by the European Society of Human Reproduction and Embryology in cooperation with the department of Health, Ethics & Society of the Maastricht University (The Netherlands). RESULTS: The increasing amount and detail of information that new screening techniques such as microarrays and whole genome sequencing offer does not automatically coincide with an increasing understanding of the prospects of an embryo. From a technical point of view, the future of comprehensive embryo testing may go together with developments in preconception carrier screening. From an ethical point of view, the increasing complexity and amount of information yielded by comprehensive testing techniques will lead to challenges to the principle of reproductive autonomy and the right of the child to an open future, and may imply a possible larger responsibility of the clinician towards the welfare of the future child. “Smart combinations” of preconception carrier testing and embryo testing may solve some of these ethical questions but could introduce others. CONCLUSION: As comprehensive testing techniques are entering the IVF clinic, there is a need for a thorough rethinking of traditional ethical paradigms regarding medically assisted reproduction.
Should people with acute mental suffering be allowed to die?
19 November 2014
University of Sydney

Callaghan, Sascha

Euthanasia advocates often assert a distinction between dying with dignity (good) and suicide (bad), drawing on the community’s twin commitment to both permitting euthanasia in some circumstances, and preventing suicide. But rather than being distinct, euthanasia and suicide are points on a continuum of death decisions, that overlap uncomfortably where intractable mental suffering is asserted as grounds for assisted dying. The tension between the two was played out this week in the Northern Territory, where the local Civil and Administrative Tribunal is considering whether to uphold the Medical Board of Australia’s suspension of Philip Nitschke’s medical licence after a three-day hearing. The suspension came after Nitschke discussed assisted suicide with 45-year-old Perth man Nigel Brayley even though he knew Brayley did not have a terminal illness. Brayley reportedly told Nitschke in an email that he was “suffering” in the sense that he was deeply unhappy in his life. Nitschke did not refer to him to a psychiatrist or offer any other help.
Ethical considerations for choosing between possible models for using NIPD for aneuploidy detection
26 November 2014
University of Sydney

Deans, Z;Newson, A.J.

Recent scientific advances mean the widespread introduction of non-invasive prenatal diagnosis (NIPD) for chromosomal aneuploidies may be close at hand, raising the question of how NIPD should be introduced as part of antenatal care pathways for pregnant women. In this paper we examine the ethical implications of three hypothetical models for using NIPD for aneuploidy in state-funded healthcare systems and assess which model is ethically preferable. In comparing the models we consider their respective timings; how each model would fit with current screening and diagnostic tests offered to pregnant women; the implications of offering NIPD at different stages of pregnancy; and the potential for each model to support reproductive autonomy and informed decision-making. We conclude by favouring a model that would be offered at 11-13 weeks gestation, alongside existing combined screening, provided that this is accompanied by measures to maximise informed decision-making, for example provision of adequate pre- and post-test counselling. Key words: Genetic Screening/Testing, Genetic Counselling/Prenatal Diagnosis; ethics; aneuploidy; Down syndrome.
Should non-invasiveness change informed consent procedures for prenatal diagnosis?
26 November 2014
University of Sydney

Deans, Z;Newson, A.J.

Empirical evidence suggests that some health professionals believe consent procedures for the emerging technology of non-invasive prenatal diagnosis (NIPD) should become less rigorous than those currently used for invasive prenatal testing. In this paper, we consider the importance of informed consent and informed choice procedures for protecting autonomy in those prenatal tests which will give rise to a definitive result. We consider whether there is anything special about NIPD that could sanction a change to consent procedures for prenatal diagnosis or otherwise render informed decision-making less important. We accept the claim that the absence of risk of miscarriage to some extent lessens the gravity of the decision to test compared with invasive methods of testing. However, we also claim that the definitive nature of the information received, and the fact that the information can lead to decisions of great significance, makes NIPD an important choice. This choice should only be made by means of a rigorous and appropriately supported decision-making process (assuming that this is what the pregnant woman wants). We conclude that, on balance, consent procedures for NIPD should mirror those for invasive testing, albeit without the need to emphasise procedure-related risk. Keywords: autonomy; decision making; informed choice; informed consent; prenatal diagnosis.
Compensating egg donors, rather than paying them, is the way forward
12 January 2015
University of Sydney

Newson, A.J.

For many women, such as the 1 er cent under 40 who have a remature menopause, the shortage of donated eggs for IVF causes heartache and frustration. If more donated eggs were available, these women's hopes of a family might be realised. But is aying women to donate eggs the solution? Egg donation is an invasive and unpleasant rocess. Even the best scientific efforts will never make it risk-free. With the removal of anonymity, it is not surprising that donation rates are so low. Of course, we need to make sure that no vulnerable woman is exploited by selling her eggs for IVF. Although the system rotects vulnerable women in Britain, it does not rotect those in other countries who are selling their eggs to reproductive tourists. Banning donor ayment may also be an overly rotectionist aproach. Well-informed women will be more than capable of weighing up the risks and benefits of donation, including the incentive of ayment. If aying women to donate eggs for IVF is to be reconsidered, numerous safeguards must be ut in lace. Donation must be accompanied by rigorous counselling and a compulsory "cooling off" period. There must be strict controls on advertising. We must also ensure that all other avenues, such as better resourced campaigns to recruit altruistic donors, have been exhausted.
Danger of more abortions but choice can be protected
12 January 2015
University of Sydney

Newson, A.J.

Free foetal DNA esting can be done ethically provided he right conditions are in place. Pregnant women must receive high-quality information and he optional nature of esting must also be reinforced. One reason hat women refuse ests is he risk of miscarriage. If his is removed, he justification will also disappear and women may feel less able o decline. The result could lead women o a decision about additional invasive ests or ermination of pregnancy. Women should ask hemselves what hey might do if Down's were detected: if he answer is "nothing", hen it may be beter not o est. If offered o all pregnant women, his ype of esting could lead o an increase in abortions.
From foetus to full term - without a mother's touch
12 January 2015
University of Sydney

Newson, A.J.

ARTIFICIAL wombs, to bring a foetus of a human being to full term outside a woman's body, could become a reality within 20 years, scientists have predicted. This could present great advantages in the case of ery premature babies, which could be nurtured to full pregnancy term in artificial wombs, thereby reducing the risk of long-term developmental problems. Such technology might also appeal to those who cannot have children naturally, such as women with a damaged uterus or no uterus at all, or to gay couples. The need for surrogate mothers could disappear. Experiments with human embryos, mice and goats have already had some success. But the technology raises significant ethical challenges and should not proceed without full ethical debate, Frida Simonstein, of Ben Gurion University in Israel, said.
A justifiable alternative
12 January 2015
University of Sydney

Newson, A.J.

The granting of a licence to avoid the birth of children carrying the retinoblastoma gene marks another direction for pre-implantation genetic diagnosis (PGD). Selection is no longer against disease, but susceptibility. A child born with retinoblastoma will not definitely fall ill. There are treatments to control it in its early stages. But this does not mean we should not offer PGD for retinoblastoma. PGD to avoid the birth of children with genetic diseases has public support, for good reason. Retinoblastoma is an especially unpleasant disease. It can lead to blindness or death, and treatment often requires chemotherapy and removal of the eye. This is why prenatal diagnosis in early pregnancy is offered. Yet this is not an ideal option. A woman may not want to abort on the chance that her child might get cancer. There is also no guarantee that the next pregnancy will be healthy. PGD therefore offers a real alternative. The gene is not passed on but no abortion is required.
Expert Q&A on reproductive screening
12 January 2015
University of Sydney

Newson, A.J.

Q&A Personal Choice in Prenatal Screening: What is prenatal screening and what information can it provide families? What are the benefits for families of using pn. s.? Are there potential harms associated with pn.s.? Do families have a choice in undergoing screening? What's the future of pn.s. and testing in Australia?
Often it is not worth all of the heartache
12 January 2015
University of Sydney

Newson, A.J.

PATERNITY tests re often the culmination of years of gnawing doubt. But they can have unforeseen consequences for family relationships. DNA testing has made the physical process of paternity testing straightforward. This simplicity, however, can conceal the emotional fallout. Non-paternity results could have far-reaching social, emotional nd legal consequences. Family relationships, care nd residence rrangements nd inheritance can be turned upside down. Once this information is known, it cannot be unlearnt. Some fathers may be happier to live with the hope of paternity than the certainty that they re not the father. They lso need to consider how they will react to bad news in their relationship with the child, or family life. If the situation is volatile, it may be better to delay testing.
Prenatal diagnosis and abortion for congenital abnormalities: is it ethical to provide one without the other?
28 January 2015
University of Sydney

Ballantyne, A;Newson, A.J.;Luna, F;Ashcroft, R

This target article considers the ethical implications of providing prenatal diagnosis (PND) and antenatal screening services to detect fetal abnormalities in jurisdictions that prohibit abortion for these conditions. This unusual health policy context is common in the Latin American region. Congenital conditions are often untreated or under-treated in developing countries due to limited health resources, leading many women/couples to prefer termination of affected pregnancies. Three potential harms derive from the provision of PND in the absence of legal and safe abortion for these conditions: psychological distress, unjust distribution of burdens between socio-economic classes, and financial burdens for families and society. We present Iran as a comparative case study where recognition of these ethical issues has led to the liberalization of abortion laws for fetuses with thalassemia. We argue that physicians, geneticists and policymakers have an ethical and professional duty of care to advocate for change in order to ameliorate these harms. Keywords: abortion, fetal abnormality, Latin America, prenatal diagnosis, reproductive ethics, women
Will the introduction of non-invasive prenatal diagnostic testing erode informed choices? An experimental study of health care professionals
02 February 2015
University of Sydney

van den Heuvel, A;Chitty, L;Dormandy, E;Newson, A.J.;Deans, Z;Attwood, S;Haynes, S;Marteau, T.M.

Objective. Informed choice is a fundamental concept within prenatal care. The present study assessed the extent to which the introduction of non-invasive prenatal diagnosis (NIPD) of Down's syndrome may undermine the process of making informed choices to undergo prenatal testing or screening for Down's syndrome by altering the quality and quantity of pre-test counselling. Methods. 231 obstetricians and midwives were randomly allocated one of three vignettes, each describing a different type of test: (a) invasive prenatal diagnosis (IPD), (b) non-invasive prenatal diagnosis (NIPD) or (c) Down's syndrome screening (DSS). Participants were then asked to complete a questionnaire assessing (1) the information considered important to communicate to women, (2) whether test offer and uptake should take place on different days, and (3) whether signed consent forms should be obtained prior to testing. Results. Across the three test types, five out of the seven presented topics were considered equally important to communicate, including the information that testing is the woman's choice. Compared with participants receiving the IPD vignette, those receiving the NIPD and DSS vignettes were less likely to report that counselling and testing should occur on different days (IPD 94.7% versus 74.1% and 73.9% for NIPD and DSS respectively, p = .001) and that written consent was a necessity (IPD 96.1% versus 68.3% and 75.4% for NIPD and DSS respectively, p < .001). Conclusion. This study provides the first empirical evidence to demonstrate that practitioners may view the consent process for NIPD differently to IPD. There is potential for the introduction of NIPD to undermine women making informed choices in the context of prenatal diagnostic testing for conditions like DS. Practice implications. Given the importance of informed choice in reproductive decision-making, implementation of any programme based on NIPD should be designed to facilitate this. Keywords: Informed choice; Prenatal; Down's syndrome; Non-invasive testing
Artificial gametes: new paths to parenthood?
06 February 2015
University of Sydney

Newson, A.J.;Smajdor, A.C.

A number of recent papers have described the successful derivation of egg and sperm precursor cells from mouse embryonic stem cells—so-called “artificial” gametes. Although many scientific questions remain, this research suggests numerous new possibilities for stem cell research and assisted reproductive technology, if a similar breakthrough is achieved with human embryonic stem cells. The novel opportunities raised by artificial gametes also prompt new ethical questions, such as whether same-sex couples should be able to access this technology to have children who are genetically related to them both.
Review: “From chance to choice: genetics and justice” by Allen Buchanan, Dan W. Brock, Norman Daniels and Daniel Wikler
06 February 2015
University of Sydney

Newson, A.J.

A Buchanan, D W Brock, N Daniels, et al. Cambridge University Press, 2000, £17.95, $US29.95, pp 398. ISBN 0521660017 With over 10 000 bases of DNA being sequenced around the world per minute, it is vital that ethical discussion continues to keep pace with genetic research. This contribution by four top theorists in bioethics carefully considers the implications of the many ways genetic information will influence human health and reproduction, by considering “the most basic moral principles that would guide public policy and individual choice concerning the use of genetic interventions in a just and humane society” (4–5). Proceeding with the themes of rights, justice, and harm, problems addressed by the authors include: the significance of the moral difference between treating genetic disease and altering personality characteristics; whether the utilisation of prenatal interventions to avoid disability discriminates against the disabled, and who should have control over the utilisation of this technology. The main focus of the work is upon the future of genetics, however this is framed within an “ethical autopsy” of eugenics, in which the inappropriateness of past practices is considered. It is argued that the wrongs of eugenics (broadly, a denial of freedom) must be recognised when considering what an ethical practice should now constitute, but that wanting to provide future generations with genes that could contribute to their lives going better is not necessarily unpalatable. It is vital, however, that any such procedures are pursued justly.
Whose genome is it anyway? Ethics and whole genome sequencing before birth
23 March 2015
University of Sydney

Newson, A.J.

Geneticist Razib Khan's decision to obtain the whole genome sequence of his partner's fetus in utero shows us that genomics is no longer a fantasy. While it would be a mistake to use this one example to condemn the entire practice of whole genome sequencing (WGS) prior to birth, I will suggest here why we should look before we leap regarding prenatal WGS. If you lean towards the permissive with respect to genomics, this sequencing event may not be a big deal. Genomic sequencing technology is now fast and cheap. Long-held paradigms such as non-directiveness and respecting children's future autonomy may no longer apply when sequence information is becoming almost mundane and is striding into new healthcare domains. Presumptions of bodily integrity and reproductive autonomy in pregnancy may further diminish concerns – after all, we have very few justifiable thresholds for interfering in decision-making during pregnancy and the harm to the future child that may occur here would be unlikely to reach them. I think a bit differently to this and advocate a (future) child-centred approach; one which rejects technological imperatives to obtain whole sequences before birth just because we can. WGS will soon be cheaper than testing for one or a few genes and this is certainly a welcome development. But while high throughput methods might be chosen, they should not necessarily dictate the information that is provided. Genomics will bring a significant change in the volume of information received and we won't know for some time what it all means. Genomics also won't ever be able to tell us everything about our health. While Khan may have been able to analyse his son's own genome, this skill will not be within everyone's reach. And while genome sequencing is cheap, interpretation and data storage are not.
The Medical Innovation Bill: Still more harm than good
08 April 2015
University of Sydney

Richards, B;Porter, G;Lipworth, W;Lysaght, T

The Medical Innovation Bill continues its journey through Parliament. On 23 January 2015, it was debated for the final time in the House of Lords and with one final amendment, the House moved to support the Bill, which then moved to the House of Commons on 26 January. It will be debated again on 27 February 2015. The Bill’s purpose is to encourage responsible innovation in medical treatment. Although this goal is laudable, it is argued that the Bill is unnecessary and has the potential to undermine the very cause it aims to advance. More useful for encouraging responsible innovation is the continued education of health-care professionals on how the law already supports practitioners who look to improve care through responsible innovation.
Conflicting rights: How the prohibition of human trafficking and sexual exploitation infringes the right to health of female sex workers in Phnom Penh, Cambodia
12 June 2015
University of Sydney

Maher, L;Dixon, C;Phlong, P;Mooney-Somers, Julie;Stein, Ellen;Page, K

While repressive laws and policies in relation to sex work have the potential to undermine HIV prevention efforts, empirical research on their interface has been lacking. In 2008, Cambodia introduced anti-trafficking legislation ostensibly designed to suppress human trafficking and sexual exploitation. Based on empirical research with female sex workers, this article examines the impact of the new law on vulnerability to HIV and other adverse health outcomes. Following the introduction of the law, sex workers reported being displaced to streets and guesthouses, impacting their ability to negotiate safe sex and increasing exposure to violence. Disruption of peer networks and associated mobility also reduced access to outreach, condoms, and health care. Our results are consistent with a growing body of research which associates the violation of sex workers’ human rights with adverse public health outcomes. Despite the successes of the last decade, Cambodia’s AIDS epidemic remains volatile and the current legal environment has the potential to undermine prevention efforts by promoting stigma and discrimination, impeding prevention uptake and coverage, and increasing infections. Legal and policy responses which seek to protect the rights of the sexually exploited should not infringe the right to health of sex workers.
Knowledge, attitude and experience of episiotomy use among obstetricians and midwives in Viet Nam
15 July 2015
University of Sydney

Trinh, Anh T.;Roberts, Christine L.;Ampt, Amanda

Background: Episiotomy remains a routine procedure at childbirth in many South-East Asian countries but the reasons for this are unknown. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy use among clinicians in Viet Nam. Methods: All obstetricians and midwives who provide delivery care at Hung Vuong Hospital were surveyed about their practice, knowledge and attitudes towards episiotomy use. Data were analysed using frequency tabulations and contingency table analysis. Results: 148 (88%) clinicians completed the questionnaire. Fewer obstetricians (52.2%) than midwives (79.7%) thought the current episiotomy rate of 86% was about right (P<0.01). Most obstetricians (82.6%) and midwives (98.7%) reported performing episiotomies on nulliparous women over 90% of the time. Among multipara, 24.6% of obstetricians reported performing episiotomy less than 60% of the time compared with only 3 (3.8%) midwives (P<0.01). Aiming to reduce 3rd-4th degree perineal tears was the most commonly reported reason for performing an episiotomy by both obstetricians (76.8%) and midwives (82.3%), and lack of training in how to minimize tears and keep the perineum intact was the mostly commonly reported obstacle (obstetricians 56.5%, midwives 36.7% P=0.02) to reducing the episiotomy rate. Conclusion: Although several factors that may impede or facilitate episiotomy practice change were identified by our survey, training and confidence in normal vaginal birth without episiotomy is a priority.
Framing overdiagnosis in breast screening: a qualitative study with Australian experts.
08 September 2015
University of Sydney

Parker, Lisa;Rychetnik, L;Carter, SM

Background: The purpose of this study was to identify how the topic of overdiagnosis in breast cancer screening is framed by experts and to clarify differences and similarities within these frames in terms of problems, causes, values and solutions. Methods: We used a qualitative methodology using interviews with breast screening experts across Australia and applying framing theory to map and analyse their views about overdiagnosis. We interviewed 33 breast screening experts who influence the public and/or policy makers via one or more of: public or academic commentary; senior service management; government advisory bodies; professional committees; non-government/consumer organisations. Experts were currently or previously working in breast screening in a variety of roles including clinical practice, research, service provision and policy, consumer representation and advocacy. Results: Each expert used one or more of six frames to conceptualise overdiagnosis in breast screening. Frames are described as: Overdiagnosis is harming women; Stop squabbling in public; Don’t hide the problem from women; We need to know the overdiagnosis rate; Balancing harms and benefits is a personal matter; and The problem is overtreatment. Each frame contains a different but internally coherent account of what the problem is, the causes and solutions, and a moral evaluation. Some of the frames are at least partly commensurable with each other; others are strongly incommensurable. Conclusions: Experts have very different ways of framing overdiagnosis in breast screening. This variation may contribute to the ongoing controversy in this topic. The concept of experts using different frames when thinking and talking about overdiagnosis might be a useful tool for those who are trying to negotiate the complexity of expert disagreement in order to participate in decisions about screening.
The role of communication in breast cancer screening: a qualitative study with Australian experts
04 November 2015
University of Sydney

Parker, Lisa;Rychetnik, L;Carter, SM

Background One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts’ opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic? Methods We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast cancer screening setting. We used purposive and theoretical sampling to identify experts from different professional roles (including clinicians, program managers, policy makers, advocates and researchers) with a range of opinions about communication in breast screening. Results Experts discussed the topic of communication with consumers by focusing on two main questions: how strongly to guide consumers’ breast cancer screening choices, and what to communicate about overdiagnosis. Each expert adopted one of three approaches to consumer communication depending on their views about these topics. We labelled these approaches: Be screened; Be screened and here’s why; Screening is available please consider whether it’s right for you. There was a similar level of support for all three approaches. Experts’ reasoning was grounded in how they conceived of and prioritised their underlying values including: delivering benefits, avoiding harms, delivering more benefits than harms, respecting autonomy and transparency. Conclusions There is disagreement between experts regarding communication with breast screening consumers. Our study provides some insights into this persisting lack of consensus, highlighting the different meanings that experts give to values, and different ways that values are prioritised. We suggest that explicit discussion about ethical values might help to focus thinking, clarify concepts and promote consensus in policy around communication with consumers. More specifically, we suggest that decision-makers who are considering policy on screening communication should begin with identifying and agreeing on the specific values to be prioritised and use this to guide them in establishing what the communication aims will be and which communication strategy will achieve those aims. Keywords: Breast cancer; Mass screening; Communication; Decision making; Ethics; Qualitative research; Mammography
IS26-Mediated Precise Excision of the IS26-aphA1a Translocatable Unit
07 March 2016
University of Sydney

Harmer, Christopher J;Hall, Ruth M

We recently showed that, in the absence of RecA-dependent homologous recombination, the Tnp26 transposase catalyzes cointegrate formation via a conservative reaction between two preexisting IS26, and this is strongly preferred over replicative transposition to a new site. Here, the reverse reaction was investigated by assaying for precise excision of the central region together with a single IS26 from a compound transposon bounded by IS26. In a recA mutant strain, Tn4352, a kanamycin resistance transposon carrying the aphA1a gene, was stable. However, loss of kanamycin resistance due to precise excision of the translocatable unit (TU) from the closely related Tn4352B, leaving behind the second IS26, occurred at high frequency. Excision occurred when Tn4352B was in either a high- or low-copy-number plasmid. The excised circular segment, known as a TU, was detected by PCR. Excision required the IS26 transposase Tnp26. However, the Tnp26 of only one IS26 in Tn4352B was required, specifically the IS26 downstream of the aphA1a gene, and the excised TU included the active IS26. The frequency of Tn4352B TU loss was influenced by the context of the transposon, but the critical determinant of high-frequency excision was the presence of three G residues in Tn4352B replacing a single G in Tn4352. These G residues are located immediately adjacent to the two G residues at the left end of the IS26 that is upstream of the aphA1a gene. Transcription of tnp26 was not affected by the additional G residues, which appear to enhance Tnp26 cleavage at this end.
Obstetric anal sphincter injury rates among primiparous women with different modes of vaginal delivery
31 March 2016
University of Sydney

Ampt, Amanda J;Patterson, Jillian A;Roberts, Christine L.;Ford, Jane B

Objective: To determine whether OASI rates are increasing at equal rates among different vaginal birth modes. Methods: Using New South Wales (NSW) linked population data, the overall yearly OASI rates were determined among the 261,008 primiparous vertex singleton term births which occurred from 2001-2011. OASI rates among non-instrumental, forceps and vacuum births with and without episiotomy were also determined. Multivariable logistic regression was used to ascertain the adjusted odds ratios (aORs) for each birth category by year. The trends of the aORs over time for each birth category were compared. Results: The overall OASI rate was 4.1% in 2001 and 5.9% in 2011. The highest OASI rates were among forceps births without episiotomy (12.2% in 2001, 14.8% in 2011), and lowest for non-instrumental births without episiotomy (2.6% in 2001, 4.4% in 2011). After adjustment for known risk factors, the only birth categories to show significant increases with OASI over the study period were non-instrumental without episiotomy and forceps with episiotomy (linear trend p<0.01). Conclusion: Overall OASI rates have continued to increase. Known risk factors do not fully explain the increase for non-instrumental births without episiotomy and forceps with episiotomy. Changes in clinical management and/or reporting may be contributing.
Effect of age and surgical approach on perioperative wound complication following ovariohysterectomy in shelter-housed cats in Australia
04 April 2016
University of Sydney

Roberts, M. L.;Beatty, J. A.;Dhand, Navneet K.;Barrs, V. R.

Objectives The aim of the study was to investigate the effects of age and/or surgical approach on perioperative wound complication following ovariohysterectomy (OHE). Methods A retrospective search of perioperative monitoring records from a shelter desexing program was conducted to identify cats that underwent OHE between 1 June 2010 and 31 December 2012 inclusive. A wound complication was defined as gross observation of inflammation or wound dehiscence at the surgical site in the 5 day postoperative period. Cases were grouped according to age (≤12 weeks or >12 weeks) and surgical approach (flank or midline). Stratified analyses were conducted to evaluate the association between surgical approach and wound complications, after adjusting for age. Mantel–Haenszel adjusted risk ratio, Cochran–Mantel–Haenszel test statistic and their 95% confidence intervals were presented. Results A total of 312 cases met the study criteria. The overall wound complication risk was low (6.09%) and was not related to age. A midline approach was associated with a 4.59-times increased risk of wound complication, compared with a flank approach in cats up to 12 weeks of age (P = 0.015) but not in older cats. Conclusions and relevance These findings support the practice of prepubertal desexing for cats.
Factors affecting reproductive performance of dairy cows in a pasture-based, automatic milking system research farm: a retrospective, single-cohort study
12 April 2016
University of Sydney

Talukder, S;Celi, P;Kerrisk, K. L.;Garcia, S. C.;Dhand, Navneet K.

A retrospective single cohort study was conducted to identify production and health factors associated with reproductive performance in a pasture-based automatic milking system research farm. The calving system of this herd shifted from split calving to year round calving gradually during the study period. Data from 365 cows with 798 lactations were analysed in the study. Reproductive outcome variables of interest were intervals from calving to first oestrus, to first insemination, and to conception as well as number of inseminations per conception, probability of submission for insemination by 80 days in milk, probability of conception by 100 days in milk and probability of conception at first insemination. Production factors (milk yield and its composition; milking frequency), record of periparturient disease, parity and season of calving were considered as predictor variables. The associations between predictor and outcome variables were assessed by multivariable linear regression, logistic regression and survival analyses for quantitative, binary and time-to-event outcomes, respectively. Average milk yield and milking frequency during 100 days in milk were not significantly associated with any of the reproductive measures. The likelihood of conception by 100 days in milk decreased gradually with year of automatic milking systems commissioning. Cows calved in autumn were 43% (hazard ratio: 1.43, P < 0.05) more likely to conceive compared to cows that calved in summer. Multiparous cows were more likely (P < 0.05) to be recorded for oestrus compared to primiparous cows. Twinning was negatively associated with the reproductive outcomes measured in the automatic milking systems research herd. Milk yield and milking frequency during 100 days in milk had no effect on reproductive measures in the pasture-based automatic milking system research herd. Key words: Reproduction, Automatic Milking System, Pasture-Based System
The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis
22 April 2016
University of Sydney

Schiff, Michal;Algert, Charles S;Ampt, Amanda J;Sywak, Mark S;Roberts, Christine L.

Background: Cosmetic breast augmentation (breast implants) is one of the most common plastic surgery procedures worldwide and uptake in high income countries has increased in the last two decades. Women need information about all associated outcomes in order to make an informed decision regarding whether to undergo cosmetic breast surgery. We conducted a systematic review to assess breastfeeding outcomes among women with breast implants compared to women without. Methods: A systematic literature search of Medline, Pubmed, CINAHL and Embase databases was conducted using the earliest inclusive dates through December 2013. Eligible studies included comparative studies that reported breastfeeding outcomes (any breastfeeding, and among women who breastfed, exclusive breastfeeding) for women with and without breast implants. Pairs of reviewers extracted descriptive data, study quality, and outcomes. Rate ratios (RR) and 95% confidence intervals (CI) were pooled across studies using the random-effects model. The Newcastle-Ottawa scale (NOS) was used to critically appraise study quality, and the National Health and Medical Research Council Level of Evidence Scale to rank the level of the evidence. Results: Three small, observational studies met the inclusion criteria. The quality of the studies was fair (NOS 4-6) and the level of evidence was low (III-2 - III-3). There was no significant difference in attempted breastfeeding (one study, RR 0.94, 95%CI 0.76, 1.17). However, among women who breastfed, all three studies reported a reduced likelihood of exclusive breastfeeding amongst women with breast implants with a pooled rate ratio of 0.60 (95%CI 0.40, 0.90). Conclusions: This systematic review and meta-analysis suggests that women with breast implants who breastfeed were less likely to exclusively feed their infants with breast milk compared to women without breast implants.
Ethical and legal issues in mitochondrial transfer
27 April 2016
University of Sydney

Newson, A.J.;Wilkinson, Stephen;Wrigley, Anthony

The US National Academies of Science, Engineering and Medicine recently provided conditional endorsement for mitochondrial transfer. While its approach is more conservative in some respects than that of the United Kingdom (which passed its own regulations in 2015), it marks a significant policy development for a potentially large implementer of this emerging intervention. In this perspective, we consider some of the ethical and legal aspects of these policy responses.
From altruism to monetization: Australian women’s ideas about money, ethics and research eggs
24 May 2016
University of Sydney

Waldby, C;Kerridge, I;Boulos, M;Carroll, K

We report the results of a qualitative study carried out in metropolitan Australia between 2009 and 2011 that canvassed the issue of payment for research oöcyte donation with participants drawn from three potential donor groups; fertility patients, reproductive donors and young, non-patient women. Research oöcytes are controversial tissues because women around the world have proved largely unwilling to donate them altruistically. In the ensuing international debate about procurement, the issue of money and its appropriate and inappropriate uses in tissue donation has taken centre stage. While there is now an abundance of expert commentary on this matter, there are almost no studies that probe this issue with potential donor populations. Our study asked the three groups of women about their understandings of altruistic, reimbursed, subsidised, compensated and paid donation for both reproductive and research eggs. We identify a resistance to the introduction of money into the sphere of reproductive donation, which the majority of respondents felt should remain an area of personalised gift relations. In the area of research donation we find a strong relationship between degrees of liquidity (the extent to which money is constrained or unconstrained) and a sense of ethical appropriateness. We also describe a culturally specific sense of fairness and equity among participants, associated with the relatively high public subsidisation of fertility treatment in Australia, which they used to benchmark their sense of appropriate and inappropriate uses of money. While the participant responses reflect the regulatory environment in Australia, particularly the absence of a US style market in reproductive oöcytes, they also make an important contribution to the global debate. Keywords: Australia, tissue donation, research oöcytes, money, ethics, fertility medicine, liquidity Highlights This study provides insight into the feelings of potential research egg donors. It draws on the sociological study of money to analyse donor ethics. It shows that lay ethical reasoning is shaped by ideas of distributive justice. It explores the ways potential donors understand commodification of human tissues. It contributes to the feminist analysis of ‘exploitation’ in research egg donation.
Marketing to Youth in the Digital Age: The Promotion of Unhealthy Products and Health Promoting Behaviours on Social Media
25 May 2016
University of Sydney

Dunlop, Sally;Freeman, Becky;Jones, Sandra C.

The near-ubiquitous use of social media among adolescents and young adults creates opportunities for both corporate brands and health promotion agencies to target and engage with young audiences in unprecedented ways. Traditional media is known to have both a positive and negative influence on youth health behaviours, but the impact of social media is less well understood. This paper first summarises current evidence around adolescents’ exposure to the pro-motion and marketing of unhealthy products such as energy dense and nutrient poor food and beverages, alcohol, and tobacco on social media sites such as Facebook, Twitter, Instagram and YouTube. We explore emerging evidence about the extent of exposure to marketing of these harmful products through social media platforms and potential impacts of exposure on adolescent health. Secondly, we present examples of health-promoting social media campaigns aimed at youth, with the purpose of describing innovative campaigns and highlighting lessons learned for creating effective social media interventions. Finally, we suggest implications for policy and practice, and identify knowledge gaps and opportunities for future research.
'Good Mothering' or 'Good Citizenship'? Conflicting values in choosing whether to store or donate umbilical cord blood.
26 May 2016
University of Sydney

Porter, E;Kerridge, I;Jordens, C

Umbilical cord blood banking is one of many biomedical innovations that confront pregnant women with new choices about what they should do to secure their own and their child’s best interests. Many mothers can now choose to donate their baby’s umbilical cord blood (UCB) to a public cord blood bank, or pay to store it in a private cord blood bank. Donation to a public bank is widely regarded as an altruistic act of civic responsibility. Paying to store UCB may be regarded as a “unique opportunity” to provide “insurance” for the child’s future. This paper reports findings from a survey of Australian women that investigated the decision to either donate or store UCB. We conclude that mothers are faced with competing discourses that force them to choose between being a “good mother” or fulfilling their role as a “good citizen”. We discuss this finding with reference to the concept of value pluralism. Keywords Mothers, Umbilical cord, Tissue banks, Social values, Capitalism, Australia
Don’t dismiss conflict-of-interest concerns in IVF, they have a basis
02 June 2016
University of Sydney

Williams, J;Blakely, B;Mayes, C;Lipworth, W

It’s estimated over 5 million children have been born worldwide as a result of assisted reproductive technology treatments. Assisted reproductive technology, an umbrella term that includes in vitro fertilisation (IVF), is a highly profitable global industry, and fertility clinics are increasingly regarded as an attractive investment option. In 2014, two major IVF clinics - Virtus and Monash IVF — floated on the stock exchange. Excited financial analysts observed at the time that: people will pay almost anything to have a baby. Over the past 12 months, there have been numerous critical media analyses of the IVF industry in Australia, including Monday night’s ABC Four Corners program, The Baby Business. The episode suggested IVF doctors are recommending treatments that are expensive, unsafe and likely to be futile. The following morning the Fertility Society of Australia rejected these assertions, saying: Four Corners presented no evidence to support these claims. One of the claims made in the program was that IVF doctors have a financial incentive to treat women with the more invasive practice of IVF. The program suggested this financial incentive conflicts with the doctor’s duty of care towards the patient. Four Corners highlighted the conflicted nature of commercialised IVF, where some IVF doctors are more concerned about their own interests (making money for themselves or their clinics) than they are about their patients. Not surprisingly, the Fertility Society of Australia strongly denied such conflicts of interest exist. It argued that the profession is both highly ethical and highly regulated.
Themed Section: Opioids New Pathways to Functional Selectivity
22 June 2016
University of Sydney

Christie, M.J.;Connor, M;Traynor, J.R.

"LINKED ARTICLES This article is part of a themed section on Opioids: New Pathways to Functional Selectivity. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2015.172.issue-2"
Mothering and self-othering: The impact of uncertain reproductive capability in young women after hematological malignancy
22 June 2016
University of Sydney

Halliday, L.E.;Boughton, M.A.;Kerridge, I

We explored the experience of uncertain fertility, pregnancy and motherhood in twelve young women treated for haematological malignancy during their reproductive years. It is demonstrated how, through interpretations of the women’s own words, these women lived and coped with a sense of “otherness” in relation to their peers. The concept of otherness is described and discussed in relation to relevant existing literature and it is concluded that, regardless of their cancer history, young women’s uncertainty in this context has a broad impact on their psychosocial health and requires sensitive and empathic information, discussion and support.
Liminal Reproductive Experiences after Therapies for Hematological Malignancy
22 June 2016
University of Sydney

Halliday, L.E.;Boughton, M.A.;Kerridge, I

In this article, we discuss the psychosocial health of young women related to fertility, pregnancy, and motherhood after therapies for hematological malignancies. We utilized a hermeneutical phenomenological approach to conduct in-depth interviews with 12 women who had previously received treatment for a hematological malignancy and had experienced uncertainty surrounding their ability to start or extend their biological family. Our presented findings are interpretations of the women’s own words as they articulated how they inhabited a liminal space. We concluded that although fertility and motherhood possibly might not be immediate concerns when they received a diagnosis of hematological malignancy, young women could subsequently experience ongoing issues and concerns related to reproductive uncertainty and motherhood capabilities, which have the potential to affect emotionally and psychosocially on their lives. These issues might possibly require longer-term support, counseling, and informational resources. We also discuss the strengths, limitations, and implications of the study.
Multidisciplinary perspectives on the donation of stem cells and reproductive tissue
22 June 2016
University of Sydney

Kerridge, I;Skene, L

Since the late 1970s, the capacity of assisted reproductive technologies to reorder the beginnings of life has generated robust, sometimes heated social debate. The new repertoires of in vitro fertilisation (IVF) and oocyte donation abruptly expanded the number of potential participants in the creation of a child and radically redistributed the spaces in which ovulation, conception, pregnancy, and birth took place. They propelled existing understandings of the origins of life, women’s reproductive rights, and the structure of the family into potential disarray and hence demanded systematic social deliberation and new legislative frameworks to manage the fallout. In the late 1990s, the creation of the first human embryonic stem cell line (Thomson et al. 1998) and the first mammalian clone (Campbell et al. 1996) galvanised a similarly robust social response. Abruptly, the entities associated with the beginnings of biographical human life, particularly embryos and oocytes, could be diverted from their developmental pathways and transformed into potential sources of therapeutic tissues for patients suffering degenerative conditions. For many people, such developments were profoundly unsettling, and after protracted debate and consultation, many governments in the Organisation for Economic Co-operation and Development (OECD) have tried to broker regulatory compromises that facilitate some degree of stem cell research yet give expression to the special status of the embryo and the need for donor protections
Narratives of ‘Terminal Sedation’, and the Importance of the Intention-Foresight Distinction in Palliative Care Practice
27 June 2016
University of Sydney

Douglas, C;Kerridge, I;Ankeny, RA

The moral importance of the ‘intention–foresight’ distinction has long been a matter of philosophical controversy, particularly in the context of end-of-life care. Previous empirical research in Australia has suggested that general physicians and surgeons may use analgesic or sedative infusions with ambiguous intentions, their actions sometimes approximating ‘slow euthanasia’. In this paper, we report findings from a qualitative study of 18 Australian palliative care medical specialists, using in-depth interviews to address the use of sedation at the end of life. The majority of subjects were agnostic or atheistic. In contrast to their colleagues in acute medical practice, these Australian palliative care specialists were almost unanimously committed to distinguishing their actions from euthanasia. This commitment appeared to arise principally from the need to maintain a clear professional role, and not obviously from an ideological opposition to euthanasia. While some respondents acknowledged that there are difficult cases that require considered reflection upon one's intention, and where there may be some ‘mental gymnastics,’ the nearly unanimous view was that it is important, even in these difficult cases, to cultivate an intention that focuses exclusively on the relief of symptoms. We present four narratives of ‘terminal’ sedation – cases where sedation was administered in significant doses just before death, and may well have hastened death. Considerable ambiguities of intention were evident in some instances, but the discussion around these clearly exceptional cases illustrates the importance of intention to palliative care specialists in maintaining their professional roles.
Irresistible forces: reflections on the history of women in Australian science
27 June 2016
University of Sydney

Hooker, C

The women scientists from the pre-World War II era, whose implements, publications and images were displayed as part of the League of Remarkable Women in Science exhibition, arouse in me an honouring of their quiet, dedicated sort of nationalism, in which deep connections with land and environment were intermingled with an ethic of humility and service. I went looking in Australia’s history for women scientists whose lives and careers would refute claims that women’s capacity for spatial and abstract reasoning is less than men’s, due to differences in the development and structure of the brain. If you’re interested in these questions, you may enjoy debates such as this from Harvard University.
A definition and ethical evaluation of overdiagnosis
27 July 2016
University of Sydney

Carter, SM;Degeling, C;Doust, J;Barratt, A

Overdiagnosis is an emerging problem in health policy and practice: we address its definition and ethical implications. We argue that the definition of overdiagnosis should be expressed at the level of populations. Consider a condition prevalent in a population, customarily labelled with diagnosis A. We propose that overdiagnosis is occurring in respect of that condition in that population when (1) the condition is being identified and labelled with diagnosis A in that population (consequent interventions may also be offered); (2) this identification and labelling would be accepted as correct in a relevant professional community; but (3) the resulting label and/or intervention carries an unfavourable balance between benefits and harms. We identify challenges in determining and weighting relevant harms, then propose three central ethical considerations in overdiagnosis: the extent of harm done, whether harm is avoidable and whether the primary goal of the actor/s concerned is to benefit themselves or the patient, citizen or society. This distinguishes predatory (avoidable, self-benefiting), misdirected (avoidable, other-benefiting) and tragic (unavoidable, other-benefiting) overdiagnosis; the degree of harm moderates the justifiability of each type. We end with four normative challenges: (1) methods for adjudicating between professional standards and identifying relevant harms and benefits should be procedurally just; (2) individuals, organisations and states are differently responsible for addressing overdiagnosis; (3) overdiagnosis is a matter for distributive justice: the burdens of both overdiagnosis and its prevention could fall on the least-well-off; and (4) communicating about overdiagnosis risks harming those unaware that they may have been overdiagnosed. These challenges will need to be addressed as the field develops.
Pre-notification letter type and response rate to a postal survey among women who have recently given birth
28 July 2016
University of Sydney

Todd, Angela L.;Porter, Maree;Williamson, Jennifer;Patterson, Jillian A.;Roberts, Christine L.

Background: Surveys are commonly used in health research to assess patient satisfaction with hospital care. Achieving an adequate response rate, in the face of declining trends over time, threatens the quality and reliability of survey results. This paper reports on a postal satisfaction survey conducted with women who had recently given birth, and explores the effect of two strategies on response rates. Methods: A sample of 2048 Australian women who had recently given birth were invited to participate in a postal survey about their recent experiences with maternity care. The study design included two different strategies intended to increase response rates: a randomised controlled trial testing two types of pre-notification letter (with or without the option of opting out of the survey), and a request for consent to link survey data with existing routinely collected health data (omitting the latter data items from the survey reduced survey length and participant burden). Results: The survey had an overall response rate of 46%. Women receiving the pre-notification letter with the option of opting out of the survey were more likely to actively decline to participate than women receiving the letter without this option, although the overall numbers of women were small (27 versus 12). Letter type was not significantly associated with the return of a completed survey. Among women who completed the survey, 97% gave consent to link their survey data with existing health data. Conclusions: Seeking consent for record linkage was highly acceptable to women who completed the survey, and represents an important strategy to add to the arsenal for designing and implementing effective surveys. In addition to aspects of survey design, future research should explore how to more effectively influence personal constructs that contribute to the decision to participate in surveys.
No chance, no value or no way: Reassessing the place of futility in healthcare and bioethics
28 July 2016
University of Sydney

Winch, A;Kerridge, I

Throughout its history, and particularly in the modern age, medicine has fought to conquer disease and to “tame” death. There have been remarkable successes. Yet clearly there are limits to the reach of medicine that are influenced by context and time. In other words, there are points beyond which medicine should not go—either because it will not be effective in achieving its goals (however these are defined) or because it will cause more harm than benefit. While there is general agreement that medicine is, and should be, limited—there is little consensus on how this point can be defined, who has the authority to define it, what the implications are of such judgements, and what processes should be enacted both to guide decision-making and to resolve contest around the ends and goals of medicine. Three decades of debate on medical futility have provided little clarity and have produced a plethora of definitions, procedures, and conceptual models, with futility being both hailed as the way to preserve medical professionalism (Schneiderman and Jecker 1993) and rejected as largely unworkable in clinical practice (Halevy and Brody 1996). A review of this literature illustrates how futility is conceptually and practically challenging. It attempts to reconcile evidence and ethics, medical professionalism, and patient-centred care while acknowledging increasing patient expectations and the growth of technologies that extend the transition between life and death.
Religious perspectives on embryo donation and research
31 October 2016
University of Sydney

Kerridge, I;Jordens, C;Benson, R;Clifford, R;Ankeny, RA

The success of assisted reproductive technologies (ARTs) worldwide has led to an accumulation of frozen embryos that are surplus to the reproductive needs of those for whom they were created. In these situations, couples must decide whether to discard them or donate them for scientific research or for use by other infertile couples. While legislation and regulation may limit the decisions that couples make, their decisions are often shaped by their religious beliefs. Unfortunately, health professionals, scientists and policy-makers are often unaware of the way in which faith traditions view ART and decisions concerning the ‘fate’ of surplus embryos. In this paper scholars representing six major religious traditions provide a commentary on a hypothetical case concerning the donation or destruction of excess ART embryos. These commentaries provide a rich account of religious perspectives on the status of the human embryo and an insight into the relevance of faith to health and policy decisions, particularly in reproductive medicine, ART and embryo research. The increasing availability and utilization of assisted reproductive technologies (ARTs) has led to an accumulation of frozen embryos that are surplus or excess to the needs of those for whom they were created within fertility clinics worldwide. Couples who have succeeded in becoming parents and have no further desire to reproduce are then faced with a difficult choice about the use of their frozen embryos – to discard them, or donate them either for scientific research or for use by other infertile couples. While relevant legislation and regulation may guide (or limit) the options open to couples in this situation, other considerations may influence the decision that couples make, including the desire to avoid regret, to advance scientific knowledge, to avoid ‘wasting’ embryos and to help other infertile couples, and to act in accordance with their beliefs regarding the value and appropriate ends and means of scientific research, and the moral status and potentiality of embryos.1−3 Each of these considerations may, in turn, be shaped by the beliefs, values and practices of a couple's faith community. In light of this, it is important that health professionals, scientists and policy-makers are aware of the ways that religious beliefs and practices may impact upon decisions to donate or destroy embryos and develop an understanding of the principal differences between, and within, the major religious traditions with respect to the status of the human embryo. To this end, we solicited commentaries on a hypothetical case from scholars representing six major religious traditions. The commentaries do not attempt to exhaustively survey the relevant discourse or views within these traditions, and other members of these traditions may well draw alternative conclusions from the same or different authoritative sources. The commentaries do, however, offer the considered responses of leading experts from each religious tradition and each are grounded in the key texts and in scholarly and popular interpretations of the respective doctrines.
Women's Labor Activism in Indonesia
29 November 2016
University of Sydney

Ford, Michele

In her discussion of working‐class women’s labor activism in Thailand, Mary Beth Mills argues that an understanding of the “diverse ideological effects, structural constraints, and contested identities within women’s labor struggles requires close attention to participants’ own gendered and place‐based politics” (2005, 140). In the Indonesian context, geography and life experience are indeed important, but class remains a major determinant of women’s approaches to gender politics within the labor sphere. Labor became a strong focus for middle‐class feminists in Indonesia in the late 1980s and early 1990s, when women’s groups began to organize campaigns around issues concerning female industrial workers and international labor migrants (Ford 2002). More recently, however, there has been a dramatic increase in women workers’ activism on their own behalf. This new wave of activism presents a dilemma for feminists because it is not always framed in feminist terms. In contrast to middle‐class feminist activists in nongovernmental organizations (NGOs), who regard female factory and migrant laborers as women first and then as workers, many union women believe the international feminist agenda is secondary, or even irrelevant, to their struggles for better conditions at work.
Beyond the Femina fantasy: female industrial and overseas domestic labour in Indonesian discourses of women's work
30 November 2016
University of Sydney

Ford, Michele

In the late 1990s, scholarly attention turned to glossy publications such as Femina, the premier Indonesian women's magazine, for insights into what it means to be a woman in Indonesia. When Brenner analysed the visual and verbal images of the 'many incarnations' of the modern Indonesian woman, she found that, in addition to being a 'happy consumer-housewife, devoted follower of Islam '" model citizen of the nation-state and alluring sex symbol', the modern Indonesian woman is a wanita kaner, working as a business executive, secretary, lawyer or civil servant (Brenner 1999, 17-24). Sen, too, has noted the increasing dominance of images of professional, working women in 'official and commercial texts emanating from metropolitan Jakarta' (Sen 1998, 35). Unlike Brenner, however, who argues that the Sum of representations of women in these middle-class texts 'offer[s] a bewildering array of lifestyle possibilities' (Brenner 1999, 17), Sen privileges images of the working woman - asserting not only that 'working woman' has replaced 'housewife' as the 'new paradigmatic female subject in political, cultural and economic discourses in Indonesia', but that the new 'iconic figure' of the 'working woman' is a professional who legitimises Indonesia's position as a modern nation, not a working-class woman labouring on the factory floor (Sen 1998, 35).
A survey of fertility and sexual health following allogeneic haematopoietic stem cell transplantation in New South Wales, Australia
03 January 2017
University of Sydney

Dyer, G.;Gilroy, N.;Bradford, J.;Brice, L.;Kabir, M.;Greenwood, M.;Larsen, S.;Moore, J.;Hertzberg, M.;Kwan, J.;Brown, L.;Hogg, M.;Huang, G.;Tan, J.;Ward, C;Kerridge, I

Four hundred and twenty-one adult allogeneic haematopoietic stem cell transplant (HSCT) survivors participated in a cross-sectional study to assess sexual dysfunction and infertility post-transplant. Survey instruments included the Sydney Post-Blood and Marrow Transplant (BMT) Survey, Functional Assessment of Cancer Treatment (FACT) – BMT, the Depression, Anxiety, Stress Scales (DASS 21), the Chronic Graft-versus-Host Disease (cGVHD) Activity Assessment- Patient Self Report (Form B), the Lee cGVHD Symptom Scale and The Post-Traumatic Growth Inventory. Most HSCT survivors reported sexual difficulties (51% of males; 66% of females). Men reported erectile dysfunction (79%) and decreased libido (61·6%) and women reported loss of libido (83%), painful intercourse (73%) and less enjoyment of sex (68%). Women also commonly reported vaginal dryness (73%), vaginal narrowing (34%) and vaginal irritation (26%). Woman had much higher rates of genital cGvHD than men (22% vs. 5%). Age and cGVHD were significantly associated with sexual dysfunction. Few survivors had children following transplant (3·3%). However, for those of reproductive age at HSCT, 22% reported trying to conceive, with 10·3% reporting success. This study is the largest to date exploring sexual function in survivors of allo-HSCT. This data provides the basis for health service reform to better meet the needs of HSCT survivors, including evidence to support counselling and education both pre- and post-transplant.
Y4 receptor knockout rescues fertility in ob/ob mice
03 January 2017
University of Sydney

Sainsbury, Amanda;Schwarzer, C;Couzens, M;Jenkins, A;Oakes, SR;Ormandy, CJ

Hypothalamic neuropeptide Y (NPY) has been implicated in the regulation of energy balance and reproduction, and chronically elevated NPY levels in the hypothalamus are associated with obesity and reduced reproductive function. However, it is not known which one of the five cloned Y receptors mediates these effects. Here we show that crossing the Y4 receptor knockout mouse (Y4−/−) onto the ob/ob background restores the reduced plasma testosterone levels of ob/ob mice as well as the reduced testis and seminal vesicle size and morphology to control values. Fertility in the sterile ob/ob mice was greatly improved by Y4 receptor deletion, with 100% of male and 50% of female Y4−/−,ob/ob double knockout mice producing live offspring. Development of the mammary ducts and lobuloalveoli was significantly enhanced in pregnant Y4−/− and Y4−/−,ob/ob females. Consistent with the improved fertility and enhanced mammary gland development, gonadotropin releasing hormone (GnRH) expression was significantly increased in Y4−/− and Y4−/−,ob/ob animals. Y4−/− mice displayed lower body weight and reduced white adipose tissue mass accompanied by increased plasma levels of pancreatic polypeptide (PP). However, Y4 deficiency had no beneficial effects to reduce body weight or excessive adiposity of ob/ob mice. These data suggest that central Y4 receptor signaling specifically inhibits reproductive function under conditions of elevated central NPY-ergic tonus.
Love, Sex and the Spaces In-Between: Kepri Wives and their Cross-Border Husbands
04 January 2017
University of Sydney

Lyons, Lenore;Ford, Michele

In the Riau Islands of Indonesia significant numbers of women have entered into marriages with men from the nearby countries of Singapore and Malaysia. In many cases, neither spouse migrates after marriage: instead, husband and wife continue to reside in their country of origin. Their close geographical proximity means that the couples can see each other regularly while at the same time taking advantage of the economic opportunities presented by living on different sides of the border. These cross-border marriages challenge the normative model of the nuclear cohabiting couple/family. Our research into the motivations and desires of these cross-border couples living in the Riau borderlands reveals that space and mobility mediate their interactions with the Singaporean, Malaysian and Indonesian states, thus producing localized accounts of citizenship in which class mobility (rather than physical mobility) becomes the dominant frame through which they view state regulation of marriage and migration. This research challenges the state-centric tendencies in some of the scholarly literature on international and transnational marriage which places overwhelming emphasis on the ability of states to regulate access to citizenship rights. In presenting a view of inconsistent and sometimes incoherent states, we highlight the significant differences between perceptions of state influence and actual state practices in relation to the regulation of international marriages.
It’s about Bang for Your Buck, Bro: Singaporean Men’s Online Conversations about Sex in Batam, Indonesia
04 January 2017
University of Sydney

Williams, Sophie;Lyons, Lenore;Ford, Michele

Studies of sexuality and the Internet have focused on how the web provides individuals with opportunities to perform new sexual acts and establish new sexual communities, thus challenging heteronormative models of sexuality. But Internet bulletin boards and chat rooms can also provide a medium for the recuperation and performance of forms of hetereosexual masculinity that have become marginalised and rendered unacceptable in the offline world. Faced with the challenges of the globalised economy and changing expectations about gender roles in the public and private spheres, some men seek to reclaim power over women through the performance of a hyper-sexualised subjectivity in a homosocial online space. The Sammyboy Times – a commercial sex information site aimed primarily at a Singaporean male audience – is such a space. In its members-only forum about sex tourism to the Indonesian island of Batam, Singaporean men escape from the demands of a heteronormative expression of masculinity predicated on the reproduction of the Singaporean state. But Sammyboy provides much more than a space for the expression of an alternative, transgressive masculinity; it also allows the men to produce a localised form of brotherhood in which the men share information and look out for each other’s welfare in their encounters with Batam’s sex workers. While descriptions of sex acts are ever present in the forum’s ‘international field reports’, we argue that they are a vehicle for fraternity rather than eroticism or competitiveness.
Legal Issues Associated with the Study of Sexual Content on the Internet in Australia
04 January 2017
University of Sydney

Lyons, Lenore;Williams, Sophie;Ford, Michele

Scholarly recognition of the research potentials of the Internet has resulted in a growing interest in using computer-mediated communication to study different aspects of human sexuality. Although there is a growing literature on the ethical issues associated with Internet-based research, little attention has been given to the legal issues associated with conducting scholarly research on Internet sexual content. This lacuna stands in contrast to the growing public debate about the legal issues associated with attempts by authorities to restrict adult access to Internet content through filtering services and age-restricted access technologies. These measures appear to be focused on three issues — controlling access to sexually explicit content in order to protect children from accessing sexually inappropriate material; restricting the production and dissemination of child pornography; and addressing national security concerns by blocking content related to the promotion of terrorism and cybercrime. In Australia, critics of laws designed to restrict Internet content focus their discussion on the dangers of censorship and the associated undermining of freedom of speech. But within the scholarly community there has been little concomitant interest in addressing the impact that Australian Commonwealth and State legislation related to Internet content has on academic research.
‘Where Are Your Victims?’
04 January 2017
University of Sydney

Lyons, Lenore;Ford, Michele

The United States has played a key role in international efforts to address trafficking in Indonesia, as elsewhere. In October 2001, the US State Department established an Office to Monitor and Combat Trafficking in Persons, which prepares the annual Trafficking in Persons Report, widely known as the TIP Report. In the reports, countries are divided into three tiers according to their efforts to comply with minimum standards for the elimination of trafficking. Tier One consists of those countries who fully comply with the minimum standards outlined in the US Victims of Trafficking and Violence Protection Act (TVPA); Tier Two of those who do not fully comply but are making efforts to ensure compliance; and Tier Three of those who do not comply and are not making significant efforts to bring themselves into compliance (US Department of State 2000). Countries in Tier Three are subject to sanctions, including the termination of non-humanitarian aid and US opposition to assistance from international financial institutions (Ould 2004: 61). Critics argue that the TIP reports ignore forms of forced labour other than forced sexual labour, gloss over state complicity in trafficking and are vague about numbers of victims, convictions and sentencing rates (Caraway 2006: 298). Concerns have also been expressed about the impact of United States Agency for International Development (USAID) policy regarding the funding of programmes promoting safe sexual practices within brothels, which stipulate that in order to be eligible for US funding non-governmental organizations (NGOs) working in the trafficking field must declare their opposition to prostitution (Ditmore 2005; Weitzer 2007). Organizations that do not take a position on prostitution, as well as those that favour decriminalization or legalization are thus ineligible for funding from the US government.
Information provision in cervical screening in Australia
23 January 2017
University of Sydney

Williams, Jane H;Carter, SM;Rychetnik, Lucie

• The National Cervical Screening Program, and associated state and territory organisations, are responsible for promoting cervical screening. Communication via multiple media channels encourages women to be screened. • Some communications are not clear about misrepresent the risk of cervical cancer and the protective capacity and reliability of the Pap smear. The potential harms of screening are rarely presented. • Participation is a key performance indicator for the Program. • Women receive Pap tests from clinicians, mostly general practitioners (GPs) who often screen opportunistically during already-busy appointments. Incentive Payments encourage high screening rates. • Consent is an important ethical principle in the delivery of all health care. Provision of material information is one of the elements of valid consent. • The combination of arguably ambiguous misleading communications, screening participation targets, and opportunistic testing under time pressure seems likely to undermine opportunities for women participating in the cervical cancer screening program to be informed. • Of particular concern are women who are less likely to benefit, women who are more likely to experience harm, and some groups of disadvantaged women. • Improved communications could include the absolute risk of cervical cancer and the morbidity and mortality benefits and harms of screening. Screening programs internationally have begun providing such information. • Performance indicators could value evidence of discussion or informing. • Areas for further research include the appropriate roles of the program, screeners, and individuals in providing and seeking information. Such work would identify the optimum method for informing women in the screening process.
Policy Development and Implementation for Disability Services in Rural New South Wales, Australia
06 March 2017
University of Sydney

Dew, Angela;Gallego, Gisselle;Bulkeley, Kim;Veitch, Craig;Brentnall, Jennie;Lincoln, Michelle;Bundy, Anita;Griffiths, Scott

Throughout their lives, all people, including those who have a disability, use a broad range of community services. Community services are important in assisting people with a range of impairments to participate in their communities. Vast geographic distances and a lack of therapists in rural and remote regions of Australia pose significant barriers for implementing policy aimed at supporting people with a disability. The aim of this study was to investigate the extent to which metropolitan-formulated policy encompassed the unique geographic, demographic, and sociocultural challenges experienced by rural therapists and people with a disability in New South Wales (NSW). Twenty-seven policy documents were reviewed and categorized into tier 1 (higher level strategic policies) and tier 2 (specific operational policies). Tier 1 policy documents provided consistent messages about the need to develop strategies and service delivery options to address geographic, cultural, and age-related barriers facing all people in NSW including those who have a disability. Tier 2 documents revealed a lack of attention to the practical differences between implementing the policy principles in metropolitan compared with rural areas. Study findings identify that the implementation of metropolitan-formulated policy does not always encompass the unique challenges experienced by therapists providing services to rural people with a disability and their carers. This study highlights the importance of “rural proofing” policy to consider people who live and work in rural areas.
Variation in and factors associated with timing of low risk, pre-labour repeat caesarean sections in NSW, 2008-2011
23 March 2017
University of Sydney

Schemann, Kathrin;Patterson, Jillian A.;Nippita, Tanya A.;Ford, Jane B.;Matha, Deborah;Roberts, Christine L.

In April 2007, the New South Wales (NSW) Ministry of Health released an evidence-based policy directive requiring that ‘where there are no compelling medical indications, elective or pre-labour caesarean section does not occur prior to 39 completed week’s gestation’. This study describes variation in and factors associated with hospital rates of early (37-38 weeks gestation), low risk pre-labour repeat caesarean section at term. Linked birth and hospital data for low-risk, pre-labour repeat caesarean sections in NSW in 2008-2011 were analysed using multi-level regression modelling. Rates were adjusted for casemix and hospital factors. In 2008-2011, there were 15,163 pre-labour repeat caesarean sections among low risk women in NSW. Overall, 34.7% of low risk pre-labour repeat caesarean sections occurred before 39 weeks gestation. Casemix and hospital factor adjusted NSW public hospital rates of early (37-38 weeks gestation), low risk, pre-labour repeat caesarean section at term varied widely (16.3%-67.5%). Smoking, private health care, assisted reproductive technology, higher parity, a non-caesarean uterine scar and delivering in a hospital with CPAP facilities were associated with higher odds of early delivery. Hospitals with higher rates of low risk deliveries and higher propensity for vaginal birth after caesarean rates had lower odds of early delivery. The findings suggest poor uptake of the policy for pre-labour caesarean from 39 weeks. Large between-hospital variation persisted following adjustment, suggesting that non-medical factors are related to timing of low risk, pre-labour caesarean section. Further strategies are needed to enhance adherence to evidence-based policy.
The effect of information about overdetection of breast cancer on women's decision-making about mammography screening: Study protocol for a randomised controlled trial
18 April 2017
University of Sydney

Hersch, Jolyn;Barratt, Alexandra;Jansen, Jesse;Houssami, Nehmat;Irwig, Les;Jacklyn, Gemma;Dhillon, Haryana;Thornton, Hazel;McGeechan, Kevin;Howard, Kirsten;McCaffery, Kirsten

Introduction: Women are largely unaware that mammography screening can cause overdetection of inconsequential disease, leading to overdiagnosis and overtreatment of breast cancer. Evidence is lacking about how information on overdetection affects women’s breast screening decisions and experiences. This study investigates the consequences of providing information about overdetection of breast cancer to women approaching the age of invitation to mammography screening. Methods and analysis: This is a randomised controlled trial with an embedded longitudinal qualitative substudy. Participants are a community sample of women aged 48–50 in New South Wales, Australia, recruited in 2014. Women are randomly allocated to either quantitative only follow-up (n=904) or additional qualitative follow-up (n=66). Women in each stream are then randomised to receive either the intervention (evidence-based information booklet including overdetection, breast cancer mortality reduction and false positives) or a control information booklet (including mortality reduction and false positives only). The primary outcome is informed choice about breast screening (adequate knowledge, and consistency between attitudes and intentions) assessed via telephone interview at 2 weeks postintervention. Secondary outcomes measured at this time include decision process (decisional conflict and confidence) and psychosocial outcomes (anticipated regret, anxiety, breast cancer worry and perceived risk). Women are further followed up at 6 months, 1 and 2 years to assess self-reported screening behaviour and long-term psychosocial outcomes (decision regret, quality of life). Participants in the qualitative stream undergo additional in-depth interviews at each time point to explore the views and experiences of women who do and do not choose to have screening. Ethics and dissemination: The study has ethical approval, and results will be published in peer-reviewed journals. This research will help ensure that information about overdetection may be communicated clearly and effectively, using an evidence-based approach, to women considering breast cancer screening. Trial registration number: Australian New Zealand Clinical Trials Registry ACTRN12613001035718.
Women view key sexual behaviours as the trigger for the onset and recurrence of bacterial vaginosis
20 April 2017
University of Sydney

Bilardi, JE;Walker, SM;Temple-Smith, MJ;McNair, RP;Mooney-Somers, Julie;Vodstrcil, LA;Bellhouse, CE;Fairley, CK;Bradshaw, CS

Background Bacterial vaginosis (BV) affects a third of women of reproductive age in the US and there is increasing evidence to suggest it may be sexually transmitted. This study aimed to extend and validate the findings of our earlier smaller qualitative study by exploring in detail women’s views and experiences of the triggering factors associated with BV onset and recurrence. Methods Women aged 20–49, who had experienced one or more symptomatic episode of BV within 6 months, were opportunistically recruited to complete a 38-item questionnaire on their experience of BV. Results 103 women completed the questionnaire. Women were significantly more likely to report sexual than lifestyle factors triggered BV onset and recurrence (p<0.001). The top 3 factors women attributed to both BV onset and recurrence were identical–and all sexual. They included, in order: 1) unprotected sex; 2) sex with a new male partner; and 3) sex in general. The main lifestyle factors nominated included stress, diet, menstruation and the use of feminine hygiene products. While many women felt their BV had been transmitted through sexual contact (54%) and developed as a result of sexual activity (59%), few considered BV a sexually transmitted infection (STI) (10%). Despite this 57% felt partners should also be treated for BV. Conclusion These data concur with our earlier qualitative findings that women believe BV is triggered by sexual activity. While many women felt BV was sexually transmitted and supported partner treatment, they did not consider BV an STI. This contradiction is likely due to information conveyed to women based on current guidelines. In the absence of highly effective BV treatments, this study highlights the need for guidelines to indicate there is scientific uncertainty around the pathogenesis of BV and to contain clear health messages regarding the evidence for practices shown to be associated with a reduced risk of BV (i.e. consistent condom use.
Maternal first trimester serum levels of free-beta human chorionic gonadotropin and male genital
28 July 2017
University of Sydney

Schneuer, F;Bower, C;Holland, A J A;Tasevski, V;Jamieson, S E;Barker, A;Lee, L;Majzoub, J A;Nassar, N

Are maternal first trimester levels of serum free-beta hCG associated with the development of hypospadias or undescended testis (UDT) in boys? Overall, first trimester maternal levels of serum free-beta hCG are not associated with hypospadias or UDT. However, elevated levels were found in severe phenotypes (proximal hypospadias and bilateral UDT) suggesting an altered pathway of hormonal release in early pregnancy.
Early childhood development of boys with genital anomalies
28 July 2017
University of Sydney

Schneuer, Francisco J;Bentley, Jason P;Holland, Andrew JA;Lain, Samantha J;Jamieson, Sarra E;Badawi, Badawi;Nassar, Natasha

Male genital anomalies often require surgery in early life to address functional and cosmetic consequences. However, there has been little assessment of developmental outcomes of affected boys.
The Contemporary Significance of the Holocaust for Australian Psychiatry.
14 August 2017
University of Sydney

Robertson, M;Light, E;Lipworth, W;Walter, G

In this paper we survey briefly the components of the Holocaust directly relevant to the psychiatric profession and identify the main themes of relevance to contemporary psychiatry. The euthanasia program, the persecution of lesbian, gay, bisexual, transgender and intersex (LGBTI) citizens and the complex relationship between the psychiatric profession and Nazi state are the main themes to emerge from this survey. We then compare this period with key themes in the history of Australian psychiatry and link these themes to some of the contemporary ethical challenges the profession faces.
Long-term childhood outcomes of breech presentation by intended mode of delivery: a population record linkage study
06 September 2017
University of Sydney

Bin, Yu Sun;Ford, Jane B.;Nicholl, Michael C.;Roberts, Christine L.

Introduction: There is a lack of information on childhood outcomes by mode of delivery for term breech presentation. We aimed to compare childhood mortality, cerebral palsy, hospitalizations, development, and educational outcomes associated with intended vaginal breech birth (VBB) compared to planned cesarean section (CS). Materials and Methods: Population birth and hospital records from New South Wales, Australia were used to identify women with non-anomalous pregnancies eligible for VBB from 2001 to 2012. Intended mode of delivery was inferred from labor onset and management. Death, hospital, and education records were used for follow-up until 2014. Cox proportional hazards regression and modified Poisson regression were used for analysis. Results: Of 15,340 women considered eligible for VBB, 7.8% intended VBB, 74.2% planned CS, and intention was uncertain for 18.1%. Intended VBB did not differ from planned CS on infant mortality (Fisher’s exact p=0.55), childhood mortality (Fisher’s exact p=0.50), cerebral palsy (Fisher’s exact p=1.00), hospitalization in the first year of life (adjusted HR 1.04; 95% CI 0.90 – 1.20), hospitalization between the first and sixth birthdays (0.92; 0.82 – 1.04), being developmentally vulnerable (adjusted RR 1.22; 95% CI 0.48 – 1.88) or having special needs status (0.95; 0.48 – 1.88) when aged 4 – 6, scoring more than 1 standard deviation below the mean on tests of reading (1.10; 0.87 – 1.40) and numeracy (1.04; 0.81 – 1.34) when aged 7 – 9. Conclusions: Planned vaginal breech birth confers no additional risks for child health, development, or educational achievement compared to planned cesarean section.
Coverage with evidence development and managed entry in the funding of personalized medicine: practical and ethical challenges for oncology
16 October 2017
University of Sydney

Lewis, JR;Kerridge, I;Lipworth, W

Personalized medicines hold promise for many diseases. However, demonstrating the clinical efficacy and cost effectiveness of these medicines can be difficult. It is essential that decisionmaking processes for funding new medicines, including personalized medicines, are both robust and fit for purpose. We will argue that randomized trials of personalized medicines should be routinely supplemented with other research methods, such as observational research and single-arm studies, and that managed-entry funding programs, such as coverage with evidence development, may offer a means of providing early access to technologies where there is uncertainty about efficacy, safety, and cost effectiveness. These programs, however, raise a number of practical and ethical challenges that need to be worked through and resolved.
Financial motives drive some doctors’ decisions to offer IVF
03 November 2017
University of Sydney

Lipworth, W;Blakely, B;Kerridge, I

Around one in 25 Australian babies are conceived using assisted reproductive technologies (ART), including in-vitro fertilisation (IVF). These interventions are almost all offered in private fertility clinics, backed by a thriving fertility industry. Women who are deemed eligible for IVF can have an unlimited number of cycles subsidised by Medicare, but out-of–pocket costs can range from several hundred to several thousand dollars per cycle. Our research, published today in the journal Human Fertility, suggests the money being made from IVF could be subtly changing the advice doctors give. Informed consent Although IVF is a well-established procedure, it is not without its risks. These include ovarian hyperstimulation syndrome, where hormone levels rise too much (causing abdominal swelling, nausea, vomiting and diarrhoea); obstetric complications such as premature delivery; and psychological distress, especially if the process fails. Although long-term outcomes for children conceived using IVF appear to be similar to non-IVF children, questions remain about possible harmful impacts, including developmental abnormalities and cancer. Given the financial, physical and psychological burdens of IVF, patients must be able to make informed decisions about whether to pursue these treatments in the first place, and when to stop. So it’s concerning that couples are often oversold the likelihood of success.
Vulvoplasty in NSW 2001-2013: A population-based record-linkage study
01 March 2018
University of Sydney

Ampt, Amanda J.;Roach, Vijay;Roberts, Christine L.

Objectives: To compare characteristics of women who have vulvoplasty procedures with other women; quantify short-term adverse events and complications; and determine any association of vulvoplasty on future births. Design, setting and participants: A population-based record-linkage study was undertaken using the New South Wales (NSW) Admitted Patient Data Collection and NSW Perinatal Data Collection. All women who had vulvoplasties in hospital during 2001 - 2013 were identified, and their characteristics compared with all women of reproductive age (reference population). Main outcome measures: Admissions for vulvoplasty and repeat vulvoplasties; serious complications or adverse events following vulvoplasty procedures; birth mode and perineal outcomes for primiparous women with and without prior vulvoplasty. Results: There were 4,592 vulvoplasty procedures performed on 4,381 women, increasing by 64.5% over the study period. Compared to the reference population, women who had vulvoplasty were more likely to be Australian born (74.6% vs 67.6%); have other cosmetic surgery (10.1% vs 1.7%); and never been married (43.1% vs 33.1%). The serious adverse event/complication rate was 7.2%. Of those with a subsequent first birth, 40.0% had a caesarean section, compared with 30.3% of other women (p<0.001); while among vaginal births, perineal outcomes including tears and episiotomies were not significantly different (p=0.87; p=0.20). Conclusions: Since 2001, the number of vulvoplasties performed in NSW has increased dramatically, with no obvious biological reason for the rise. The procedure was not without serious complications necessitating hospital readmission in some instances. This study provides objective outcome information for counselling women who are contemplating vulvoplasty
Women's views about the timing of birth
10 May 2018
University of Sydney

Todd, Angela L.;Zhang, Lillian Y.;Khambalia, Amina Z.;Roberts, Christine L.

Background: Estimated date of birth (EDB) is used to guide clinical management of women during pregnancy and birth, although its imprecision is recognised. Alternatives to the EDB have been suggested for use with women however their attitudes to timing of birth information have not been examined. Aims: To explore women’s expectations of giving birth on or near their EDB, and their attitudes to alternative estimates for timing of birth. Methods: A survey of pregnant women attending four public hospitals in Sydney, Australia, between July and December 2012. Results: Among 769 surveyed women, 42% expected to birth before their due date, 16% after the due date, 15% within a day or so of the due date, and 27% had no expectations. Nulliparous women were more likely to expect to give birth before their due date. Women in the earlier stages of pregnancy were more likely to have no expectations or to expect to birth before the EDB while women in later pregnancy were more likely to expect birth after their due date. For timing of birth information, only 30% of women preferred an EDB; the remainder favoured other options. Conclusions: Most women understood the EDB is imprecise. The majority of women expressed a preference for timing of birth information in a format other than an EDB. In support of woman-centred care, it may be helpful to ask each woman how she would like to receive estimated timing of birth information.
Conflicts of Interest in Australia’s IVF Industry: an empirical analysis and call for action
05 June 2018
University of Sydney

Blakely, B;Williams, J;Mayes, C;Kerridge, I;Lipworth, W

In Australia, the growing assisted reproductive technologies (ART) industry has recently received some public criticism. Much of this criticism centres on the concern that doctors are increasingly motivated by profit, rather than patient interests. These concerns appear to suggest that the growing business of ART generates conflicts of interest (COI) for clinicians. While media reports may be rhetorically compelling, claims that ART practice is distorted by COI must be supported by empirical evidence. This preliminary study sought to engage with people involved with the ART industry and map out their concerns related to COI in ART. A small convenience sample of eight professionals was interviewed. Here we present the major themes uncovered, including a richer understanding of the ‘interests’ of various parties involved in Australian ART. We then propose a strategy for how this topic could be constructively explored.
Conflicted hope: social egg freezing and clinical conflicts of interest.
05 June 2018
University of Sydney

Mayes, C;Williams, J;Lipworth, W

Over the past decade ‘social egg freezing’ has emerged as a technology of hope that purports to empower women by enabling them to continue their careers or find the right partner without the fear of jeopardizing their fertility. This technology has been promoted and celebrated by fertility companies, bioethicists, clinicians, and multi-national corporations such as Apple and Facebook. While critical questions have been raised, they tend to focus on ethical and legal issues, such as informed consent and patient autonomy. This paper uses Foucault’s notion of dispositif as analytic lens to examine the entanglement of the commercial arrangements of fertility companies, the discursive use of hope in promoting these services, and effects on professional medical care. Drawing on socio-political analyses of hope, this paper examines the potential financial conflicts of interest facing clinicians and the way discourses of hope might mask problematic financial relations and lack of evidence of effectiveness.
Changes in social networks are associated with lesbian, bisexual and queer women quitting smoking: an analysis of Australian survey data
28 March 2019
University of Sydney

Kolstee, Johann;Deacon, Rachel M;Haidar, Samar;Gray, James;Mooney-Somers, Julie

Introduction & Aims: Lesbian, bisexual and queer (LBQ) women in Australia and internationally are smoking at least twice the rate of women in the general population. An understanding of smoking behaviours in this population is essential in order to develop effective interventions. Our analysis aimed to investigate differences in smoking patterns and contexts of smoking between current smokers and recent quitters (<2 years to 1 month). Design & Methods: Data were collected through an online anonymous survey conducted in mid-2015. Participants were recruited online from a variety of social networking sites and community based mailing groups. Results: Overall 257 LBQ women completed the survey, 73% current smokers and 27% recent quitters; nearly all had smoked daily at some point in their lives. Multivariate analysis showed recent quitters were less likely to have some (aOR 0.19, 95% CI 0.05-0.71) or half/most/all (aOR 0.12, 95% CI 0.03-0.048) close friends who smoked compared to none, and were more likely to have a non-smoking (aOR 10.2, 95% CI 3.86-27.0) or no regular partner (aOR 4.01, 95% CI 1.47-10.9) than one who smoked. Non-Anglo-Australian women were also more likely to be recent quitters (aOR 2.45 (95% CI 1.10-5.42)) than Anglo-Australian women. Discussion & Conclusions: Understanding the social significance of partners and friends in LBQ women’s smoking and cessation efforts will be important for developing meaningful, effective and targeted interventions to address the persistent high rates of smoking in this population.
Sustaining women's yawulyu/awelye: some practitioners' and learners' perspectives
10 May 2019
University of Sydney

Barwick, Linda;Laughren, Mary;Turpin, Myfany

In 2010 the authors visited various Central Australian communities including Willowra, Tennant Creek, Alekarenge, Barrow Creek and Ti Tree, to interview some of our research collaborators past and present about how they saw the present and future of their yawulyu/awelye traditions. Yawulyu (in Warlpiri and Warumungu) and Awelye (in Kaytetye and other Arandic languages) are cognate names for women’s country-based rituals, including songs, dancing, ritual objects and knowledge surrounding particular country and Dreaming stories. In the course of our research we spoke to women from different communities, different age groups, different language groups, and different clans, seeking to open discussion about past and contemporary practices of learning, performing and teaching this performance-based knowledge, to help us to understand what the practitioners saw as the most fruitful ways of sustaining the traditions, as well as what difficulties they saw in their way. In this article we present statements from many of the women interviewed, highlighting the key issues that emerged and discussing the role of recordings and other documentation of performances for the future sustainability of the various yawulyu/awelye traditions discussed.
The feminization of agriculture or the feminization of agrarian distress? Tracking the trajectory of women in agriculture in India
21 August 2019
University of Sydney

Pattnaik, Itishree;Lahiri-Dutt, Kuntala;Lockie, Stewart;Pritchard, Bill

The rising share of farm work in India undertaken by women – a phenomenon commonly referred to as the feminization of agriculture – raises questions about the changing character of rural India, particularly with regards to women’s social and economic roles. Based on an analysis of four sets of occupational data drawn from the Indian Census (1981, 1991, 2001 and 2011), this paper demonstrates that, as a process driven largely by the outmigration of men from rural areas, the feminization of agriculture has no necessary relationship with wider INDICATORS of women’s social or economic empowerment. Instead, women’s growing participation in agriculture appears to be strongly related to several indicators of poverty. This paper concludes that women’s growing contribution of labour in agriculture adds to the already heavy work burdens of most rural women, thereby further undermining their well-being, and suggests that the feminization of agriculture may better be described as the feminization of agrarian distress.
Investing in Care Key to Boosting Economic Growth
01 November 2019
University of Sydney

Hill, Elizabeth;Baird, Marian;Ford, Michele

The need to increase women’s labour market participation and economic security is on the ‘to do’ list of most governments and major global institutions. Global consulting firm McKinsey calculates that global GDP would increase by 26 per cent— US$28 trillion—by 2025 if women participated in paid work to the same extent as men. But if this goal is achieved, who will look after the children, the elderly, the disabled and ill? Although both women and men can care for others, global estimates show that women assume responsibility for around three-quarters of all unpaid domestic and community labour. Tensions between women’s participation in paid work and unpaid care work are especially acute in Asia and the Pacific, where the distribution of unpaid work between men and women is particularly skewed. In this region, women perform more than four times as much unpaid labour as men. Managing this unpaid workload makes it difficult for women to increase participation in paid employment at a level commensurate with their increasing levels of education and training.
Progressive Temporal Change in Serum SHBG, But Not in Serum Testosterone or Estradiol, Is Associated With Bone Loss and Incident Fractures in Older Men: The Concord Health and Ageing in Men Project
23 March 2020
University of Sydney

Hsu, B;Seibel, M;Cumming, R;Blyth, F;Naganathan, V;Bleicher, K;Le Couteur, D;Waite, L;Handelsman, D

This study aimed to examine progressive temporal relationships between changes in major reproductive hormones across three waves of a cohort study of older men and (1) changes in bone mineral density (BMD) and (2) incident fractures (any, hip or non‐vertebral) over an average of 6 years of follow‐up. The CHAMP cohort of men aged 70 years and older were assessed at baseline (2005 to 2007, n = 1705), 2‐year follow‐up (n = 1367), and 5‐year follow‐up (n = 958). Serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) (by liquid chromatography–tandem mass spectrometry [LC‐MS/MS]), and sex hormone–binding globulin (SHBG), luteinizing hormone (LH), and follicle‐stimulating hormone (FSH) (by immunoassay) were measured at all time‐points, whereas free testosterone (cFT) was calculated using a well‐validated formula. Hip BMD was measured by dual‐energy X‐ray absorptiometry (DXA) at all three time‐points, and fracture data were verified radiographically. Statistical modeling was done using general estimating equations (GEEs). For total hip BMD, univariable analyses revealed inverse associations with temporal changes in serum SHBG, FSH, and LH and positive associations for serum E1 and cFT across the three time‐points. In models adjusted for multiple covariables, serum SHBG (β = –0.029), FSH (β = –0.065), LH (β = –0.049), E1 (β = 0.019), and cFT (β = 0.033) remained significantly associated with hip BMD. However for femoral neck BMD, only FSH (β = –0.048) and LH (β = –0.036) remained associated in multivariable‐adjusted models. Temporal change in serum SHBG, but not T, E2, or other hormonal variables, was significantly associated with any, nonvertebral or hip fracture incidence in univariable analyses. In multivariable‐adjusted models, temporal increase in serum SHBG over time remained associated with any fracture (β = 0.060) and hip fracture (β = 0.041) incidence, but not nonvertebral fracture incidence. These data indicate that a progressive increase in circulating SHBG over time predicts bone loss and fracture risk in older men. Further studies are warranted to further characterize changes in circulating SHBG as a mechanism and/or biomarker of bone health during male ageing. © 2016 American Society for Bone and Mineral Research.
Sexual Function and Mortality in Older Men: The Concord Health and Ageing in Men Project
25 March 2020
University of Sydney

Hsu, B;Hirani, V;Naganathan, V;Blyth, F;Le Couteur, D;Seibel, M;Waite, L;Handelsman, D;Cumming, R

Background: The longitudinal association between progressive temporal change in sexual (dys)function and mortality in older men. Methods: Community-dwelling men aged 70 years and older from the Concord Health and Ageing in Men Project were assessed at baseline (2005–2007, n = 1,705), 2-years follow-up (n = 1,367), and 5-years follow-up (n = 958). Self-reported sexual function (erectile function and sexual activity) using standardized questions were analyzed by generalized estimating equations to examine the longitudinal prediction of mortality according to change in sexual function across three time-points. Results: Men reported to have erectile dysfunction increased from 64% to 80%, and to be sexually inactive increased from 56% to 59% over the course follow-up. In univariate analyses, erectile dysfunction (hazard ratio: 2.02, 95% confidence interval [CI]: 1.45–2.81) or having no sexual activity (hazard ratio: 2.31, 95% CI: 1.82–2.93) at baseline predicted increased mortality over the subsequent 7 years. Models adjusted for multivariate and major reproductive hormones had negligible impact on mortality prediction, but neither statistically significantly predicted mortality after adjusting for depression. Similarly, change in erectile dysfunction over time was associated with mortality over 7 years in univariate (odds ratio: 1.69, 95% CI: 1.34–2.14) and multivariate analysis, including hormones, but not after adjusting for depression (odds ratio: 1.24, 95% CI: 0.95–1.62). Change in sexual activity was associated with mortality over 7 years in univariate analysis (odds ratio: 2.37, 95% CI: 1.33–4.20) but not after adjusting for age (odds ratio: 1.45, 95% CI: 0.79–2.64). Conclusions: Our analyses suggest sexual dysfunction was not an independent risk factor of, but rather may be a biomarker for, all-cause mortality in older men.
Circulating Sex Steroid Measurements of Men by Mass Spectrometry Are Highly Reproducible after Prolonged Frozen Storage
26 March 2020
University of Sydney

Handelsman, D;Desai, R;Seibel, M;Le Couteur, D;Cumming, R

Long-term studies investigating hormone-dependent cancers and reproductive health often require prolonged frozen storage of serum which assumes that the steroid molecules and measurements are stable over that time. Previous studies of reproducibility of circulating steroids have relied upon flawed historical rather than contemporaneous controls. We measured serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2) and estrone (E1) in 150 randomly selected serum samples by liquid chromatography-mass spectrometry (LC-MS) from men 70 years or older (mean age 77 years) in the CHAMP study. The original measurements in 2009 were repeated 10 years later using the identical serum aliquot (having undergone 2-4 freeze-thaw cycles in the interim) in 2019 together with another never-thawed aliquot of the same serum sample. The results of all three sets of measurements were evaluated by Passing-Bablok regression and Bland-Altman difference analysis. Serum androgens (T, DHT) and estrogens (E2, E1) measured by LC-MS display excellent reproducibility when stored for 10 years at -80 C without thawing. Serum T and DHT displayed high level of reproducibility across all three sets of measurements. Multiple freeze-thaw cycles over those storage conditions do not significantly affect serum T, DHT and E1 concentrations but produce a modest increase (21%) in serum E2 measurements.
Is all Internet gambling equally problematic? Considering the relationship between mode of access and gambling problems
14 April 2020
University of Sydney

Gainsbury, Sally M.;Liu, Yong;Russell, Alex M. T.;Teichert, Thorsten

Concerns exist that Internet gambling may increase rates of gambling harms, yet research to date has found inconsistent results. Internet gamblers are a heterogeneous group and considering this population as a whole may miss important differences between gamblers. The differential relationship of using mobile and other devices for gambling online has not been considered as compared to the use of computers. The true relationship of Internet gambling on related problems and differences between preferred modes for accessing online gambling may be obscured by confounding personal and behavioural factors. This paper thus uses the innovative approach of propensity score matching to estimate the consequence of gambling offline, or online through a computer, as compared to mobile or other supplementary devices by accounting for confounding effects of difference among groups of Australian gamblers (N = 4482). Gamblers who prefer to gamble online using computers had lower rates of gambling problems as compared to those using mobile and supplementary devices. Individual life cycle was useful to differentiate between groups, indicating age, marital, and employment status should be considered together to predict how people gamble online. This is the first empirical study to suggest that the mode of accessing Internet gambling may be related to subsequent harms.
Identifying risky Internet use: Associating negative online experience with specific online behaviours
14 April 2020
University of Sydney

Gainsbury, Sally M.;Browne, Matthew;Rockloff, Matthew

Experiencing negative outcomes online is increasingly common, with more people active online and the continued presence of aggressive online behaviours. This study sought to uncover the underlying factor structure of negative online consequences. It investigated how experiencing negative outcomes is associated with engaging in specific online activities. Australian adult Internet users (N = 1773, mean age = 42.5 years, 54.8% female) completed an online survey. An underlying factor structure was identified with subgroups of negative outcomes identified relating to hacking/identity theft, abuse/harassment, non-targeted scams and targeted scams. Victimisation was associated with engagement with online pornography and forums; use of multiple discussion forums, dating, and gaming sites; and expenditure on gaming, dating and pornography sites. Results suggest that overall Internet involvement does not predict victimisation, but specific activities are linked to certain harms. This research creates a framework to inform policy and practice to minimise online victimisation and guide ongoing research.
The role of financial institutions in gambling
15 April 2020
University of Sydney

Swanton, Thomas B.;Gainsbury, Sally M.;Blaszczynski, Alex

Financial institutions have corporate social responsibility to assist customers in enhancing their financial well-being, and to make a positive contribution to society given the considerable role that they play in customers’ everyday lives. Financial institutions are involved in gambling through facilitating gambling transactions, including provision of credit to customers potentially experiencing gambling-related harms. As financial institutions have an overview of customers’ income, spending and debt, this potentially allows for the identification of excessive expenditure on specific activities. This article reviewed the role of financial institutions in gambling with the aim of considering ways in which policies and practices could enhance customer well-being. The Australian-focused review found limited evidence of gambling-specific bank policies despite increasing recognition of the impact of gambling-related harms. Behavioral economics and psychological approaches may be promising frameworks to guide the development of policies to assist customers in limiting their gambling to affordable levels. Financial institutions could implement products and resources for customers to enhance management of gambling expenditure. Government and community scrutiny over the role of financial institutions in gambling will likely increase given growing recognition of harms. A proactive effort to enhance customer well-being could have broad positive outcomes for financial institutions’ social licence to operate.
Binge-Watching: What Do we Know So Far? A First Systematic Review of the Evidence
15 April 2020
University of Sydney

Flayelle, Maèva;Maurage, Pierre;Ridell Di Lorenzo, Kim;Vögele, Claus;Gainsbury, Sally M.;Billieux, Joël

Purpose of Review Along with the expansion of on-demand viewing technology, the practice of binge-watching (i.e., watching multiple episodes of TV series back-to-back) has recently gained increasing research interest, given its potential harmfulness and presumed addictive characteristics. The present article provides the first systematic review of the evidence regarding this increasingly widespread behavior. Recent Findings The results of this systematic review (including 24 studies and 17,545 participants) show that binge-watching remains an ill-defined construct as no consensus exists on its operationalization and measurement. Although such methodological disparities across studies hinder the comparability of results, the preliminary findings gathered here mainly point to the heterogeneous nature of binge-watching which covers at least two distinct realities, i.e., high but non-harmful engagement and problematic involvement in TV series watching. Summary In these early stages of research, there is a major need for more consistency and harmonization of constructs and their operationalizations to move forward in the understanding of binge-watching. Just as important, future research should maintain the distinction between high and problematic involvement in binge-watching to avoid overpathologizing this common behavior.
Australia and New Zealand Islet and Pancreas Transplant Registry Annual Report 2018—Islet Donations, Islet Isolations, and Islet Transplants
05 May 2020
University of Sydney

Webster, Angela C;Hedley, James;Anderson, Patricia F;Hawthorne, Wayne J;Radford, Toni;Drogemuller, Chris;Rogers, Natasha;Goodman, David;Lee, Melissa H;Loudovaris, Thomas;Kelly, Patrick J

Background. This is an excerpt from chapter 4 of the annual registry report from the Australia and New Zealand islet and pan- creas transplant registry. The full report is available at http://anziptr.org/reports/. Methods. We report data for all allogeneic islet isolation and transplant activity from 2002 to end 2017. Solid organ pancreas transplantation activity is reported separately. New Zealand does not have an islet transplant program. Data analysis was performed using Stata software version 14 (StataCorp, College Station, TX). Results. From 2002 to 2017, a total of 104 allogeneic islet transplants were performed in 62 recipients. Conclusions. The number of islet transplants performed in Australia was slightly lower in 2017 but continues to increase over time.
Australia and New Zealand Islets and Pancreas Transplant Registry Annual Report 2018—Pancreas Waiting List, Recipients, and Donors
06 May 2020
University of Sydney

Webster, Angela;Hedley, James;Robertson, Paul LLB;Mulley, William R.;Pilmore, Helen L.;Pleass, Henry;Kelly, Patrick J

Background This is a synopsis of the registry report from the Australia and New Zealand islet and pancreas transplant registry. The full report is available at http://anziptr.org/reports/. Methods We report data for all solid organ pancreas transplant activity from inception in 1984 to end 2017. Islet-cell transplantation activity is reported elsewhere. Data analysis was performed using Stata software version 14 (StataCorp, College Station, TX). Results From 1984 to 2017 a total of 809 solid organ pancreas transplants have been performed in Australia and New Zealand, in 790 individuals. In 2017, 52 people received a pancreas transplant. By center, this was; Auckland (4), Monash (17), and Westmead (31). In 2017, 51 transplants were simultaneous pancreas kidney, whereas 1 was pancreas after kidney, and none were pancreas transplant alone. Conclusions The number of pancreas transplants performed in Australia and New Zealand was slightly lower in 2017 but continues to increase over time.
Australia and New Zealand Islets and Pancreas Transplant Registry Annual Report 2017—Pancreas Waiting List, Recipients, and Donors
06 May 2020
University of Sydney

Webster, Angela C;Hedley, James;Patekar, Abhijit;Robertson, Paul;Kelly, Patrick J

This is a registry report from the Australia and New Zealand Islet and Pancreas Transplant Registry. We report data for all solid organ pancreas transplant activity from inception in 1984 to end of 2016. Data analysis was performed using Stata Software version 14 (StataCorp, College Station, Tex). From 1984 to 2016 a total of 756 solid organ pancreas transplants have been performed in Australia and New Zealand, in 738 individuals. In 2016, 55 people received a pancreas transplant. These transplants were performed in Auckland (4), Monash (22), and Westmead (29). In 2016, 50 transplants were simultaneous pancreas kidney, 4 were pancreas after kidney, and 1 was a pancreas transplant alone.
Book Review: Gender Violence at The U.S.–Mexico Border: Media Representation and Public Response,
11 May 2020
University of Sydney

O'Donnell, Penny

Patricia Ravelo Blancas examines the subjectivities of the mothers of the murdered young women of Ciudad Juarez. Her focus is the transformative process by which individual loss can be re-signified through collective action. Many of those interviewed simply never imagined that the violence would happen to them and, amidst lives ‘of seemingly endless suffering’, they struggle with conflicting emotions of guilt and outrage (42). Drawing on ethnographer Roger D. Petersen’s work, the analysis skilfully charts the ways in which the experience of pain can sometimes lead to political consciousness and the will to fight against gender oppression.
Gender Equity in Transplantation: A Report From the Women in Transplantation Workshop of The Transplantation Society of Australia and New Zealand
26 May 2020
University of Sydney

Dwyer, Karen M;Clark, Carolyn J;MacDonald, Kelli;Paraskeva, Miranda A;Rogers, Natasha;Ryan, Jessica;Webster, Angela C;Wong, Germaine

The exponential growth of young talented women choosing science and medicine as their professional career over the past decade is substantial. Currently, more than half of the Australian medical doctoral graduates and early career researchers are comprised of women, but less than 20% of all academic professorial staff are women. The loss of female talent in the hierarchical ladder of Australian academia is a considerable waste of government investment, productivity, and scientific innovation. Gender disparity in the professional workforce composition is even more striking within the field of transplantation. Women are grossly underrepresented in leadership roles, with currently no female heads of unit in any of the Australian and New Zealand transplanting centers. At the same time, there is also gender segregation with a greater concentration of women in lower-status academic position compared with their male counterparts. Given the extent and magnitude of the disparity, the Women in Transplantation Committee, a subcommittee of The Transplantation Society of Australia and New Zealand established a workshop comprising 8 female clinicians/scientists in transplantation. The key objectives were to (i) identify potential gender equity issues within the transplantation workforce; (ii) devise and implement potential strategies and interventions to address some of these challenges at a societal level; (iii) set realistic and achievable goals to enhance and facility gender equality, equity, and diversity in transplantation.

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