The University of Notre Dame Australia

This study examines the role that regulatory frameworks and market-based enforcement mechanisms play in shaping companies’ disclosures on labor and human rights risks. It also looks at the factors that influence the effectiveness of laws in driving change in corporate supply chain practices. The study analyzes 17 businesses operating in two high-risk industry sectors: fashion, textiles, apparel, and luxury goods; and food and beverages, agriculture, and fishing. The disclosure analysis is framed as a cross-jurisdictional analysis, while the performance of reporting entities is critically examined using an established methodology applied in public research reports to analyze business responses to modern slavery. The results indicate that reporting under the Australian Modern Slavery Act appears to have resulted in more meaningful action compared to reporting against the California Transparency in Supply Chains Act. The study examines variations in impact across sectors and jurisdictions and identifies factors that make monitoring compliance and enforcing accountability difficult. Ultimately, regulators and civil society organizations have an important role to play in promoting accountability by scrutinizing company disclosures, advocating for stronger laws and enforcement, and raising public awareness of the issues.

Background: Altered sensitivity to light is a potential mechanism for developing abnormal circadian entrainment. This study investigates the utility of the pupillary light reflex as a method of differentiating youth with emerging mood disorders and healthy controls. Methods: This ongoing study included 58 participants (Mean age=25.86±5.45; 62% Females) aged 14-40 years, seeking mental health care at headspace services in Sydney, and 24 healthy controls (Mean age =25.21±2.59; 54% Females). Participants underwent a 20-min pupillometry assessment to examine the pupil’s response to light. A handheld PLR-3000 Monocular Pupillometer (NeurOptics, California, USA) was used to measure the reflex in a dark room, by delivering two 1-second light pulses (dim [~10 lux] followed by bright [~1500 lux]). Analyses of covariance were conducted to assess group differences, with within-group correlation analysing between pupil metrics and mental health scores. Results: After a dim light pulse, the diameter of the pupil of cases changed significantly less than that of healthy controls (dim: F(1,56)=10.176; pFDR=0.026); bright: F(1,56)=7.480; pFDR=0.039). In addition, the latency of constriction after a bright pulse was significantly longer in cases compared to controls (F(1,56)=8.945; pFDR=0.026). Within cases, change in pupil size and constriction velocity after a bright pulse was positively correlated with psychological distress (K10) and anxiety (GAD-7) scores. Conclusion: These preliminary findings support the potential for pupillary light reflex to clinically differentiate between youth with emerging mood disorders and healthy controls. Future studies will aim to assess the variance in pupillary light reflex between different clinical groups.

Background The Western Australian Football League (WAFL) introduced a new umpire driven ‘blue-card rule’ for concussion, but its benefit to the sports medicine team is unknown. Purpose To determine the experiences and perceptions of medical staff within the 2022-2023 Men’s and Women’s WAFL competitions following the introduction of the ‘blue-card rule’. Study Design Cross-sectional study. Method An online survey was delivered through Qualtrics to all WAFL medical staff (doctors, physiotherapists, head trainers). The survey contained four sections (demographics, concussion knowledge, concussion exposure and blue-card perceptions) with closed and multiple-answer questions. Standard methods for reporting descriptive data were applied, including mean ± standard deviation (SD) and proportions (%). Between-group differences were assessed using chi-square tests, and significance was accepted at p <0.05. Results Response rate was 48% (n=7 doctors, n=12 physiotherapists, n=12 head trainers). Most staff (70%) did not agree that the ‘blue-card rule’ was a helpful concussion policy or should remain within the WAFL. Staff also felt umpires are not qualified to identify suspected concussions on-field (67%). Over two-thirds of medical staff feel the Football Commission needs to provide education about concussion policies before the commencement of each season. Only 33% of medical staff felt completely confident in delivering a sideline assessment, and 17% felt completely confident in their diagnostic capabilities. Relationships between medical and other staff were not substantially impacted by the ‘blue-card rule’. Conclusions Medical staff within the WAFL reported the ‘blue-card rule’ as an ineffective concussion identification tool and did not support its continued use for future WAFL seasons. Staff suggested that the Football Commission needs to provide more education on concussion policies before the commencement of each season. Level of Evidence 3

Objectives Demoralization, a prevalent form of psychological distress, significantly impacts patient care, particularly in terminally ill individuals, notably those diagnosed with cancer. This study aimed to assess psychometric properties of Farsi version of Demoralization Scale-II (DS-II) in Iranian cancer patients. Methods This study was descriptive-analytical cross-sectional research. The statistical population was cancer patients who sought treatment at Imam Khomeini Hospital in Tehran throughout the 2021–2022. In the initial phase of the study, a preliminary sample comprising 200 patients was carefully selected through convenience sampling. After applying these criteria, 160 patients satisfactorily completed the questionnaires, forming the final study sample. They completed series of questionnaires that included sociodemographic information, DS-II, Scale of Happiness of the Memorial University of Newfoundland, and Beck Depression Inventory (BDI-II). The evaluation included exploratory factor analysis, confirmatory factor analysis (CFA), assessments of convergent validity, and internal consistency reliability. Results The CFA revealed a 2-factor model consistent with the original structure. The specific fit indices, including the Comparative Fit Index, Root Mean Square Error of Approximation, and Goodness-of-Fit Index, were 0.99, 0.051, and 0.86, respectively. Significant correlation coefficients ( p < 0.05) were found between the DS-II and the Beck Depression and MUNSH Happiness scales. The internal consistency of the DS-II, as measured by Cronbach’s alpha, yielded values of 0.91 for the meaning and purpose factor, 0.89 for the coping ability factor, and 0.92 for the total score. Significance of results The Farsi version of DS-II has demonstrated reliability and validity in evaluating demoralization among cancer patients in Iran. This tool can offer valuable insights into the psychological problems of terminally ill patients. Further research opportunities may include conducting longitudinal studies to track demoralization over time and exploring the impact of demoralization on the overall well-being and care of terminally ill patients in Iranian society.

This paper explores the intersection of public administration and its administrative state, transnational and global policy, and international sports governance. We start by exploring autonomy and self-governance in international sport before sharing the structures, legal personalities, and nature of transnational private law interaction with international sport. The implications are illustrated through three examples. The first is the legal-policy interactions of the FIFA World Cup 2022 with Qatar. The second are new interactions of human rights with future World Cups and future Olympics. The third is the role of the Court of Arbitration for Sport and the World Anti-Doping Agency. This leads to three implications for administrative scholarship: lex sportiva implications for public administration, a stretching of the autonomy and self-governance concepts, and expanding the evaluation stage of a policy cycle to include the governance legacies of mega sports events.

Background With over five billion people worldwide lacking access to surgery, innovative solutions are vital to address the global surgical crisis. Nurse-surgeons present a promising innovation. Considering their contribution worldwide and impact on surgical care in Australia, an exploration of these advanced practice nurses is timely. Objective To investigate the roles, training, education, and perceptions of career prospects and support received by practicing nurse-surgeons in the Australian public health system. Design Non-experimental descriptive national survey Methods The target population was nurse-surgeons practicing within the Australian public health system. The survey questionnaire comprised of four sections containing questions on nurse-surgeon demographics, roles, training, and perceptions of career prospects and support received. Data collection was conducted through emailing of public hospitals, crowdsourcing, and snowballing. Descriptive analysis was used to report the findings. Results Twenty-eight nurse-surgeons participated in the study, 22 females and six males. Most commonly, participants (n = 10) held master's degrees and trained to become nurse-surgeons for an average of 2·27 years (95 % CI [1·47,3·07]). Training programs varied but were all surgical specialty-specific, and usually included a practical component, theoretical component, and competency assessment prior to independent practice. Participants rated employment prospects for nurse-surgeons as poor to average due to limited work opportunities, politics, and strong pushbacks from Australian medical societies. The support received from nurses, surgeons and management was rated by participants as good providing reasons such as supportiveness, value recognition, jealousy, and resentment. The participants were very likely (95 % CI [7.436 – 9.364] to continue practicing due to positive job satisfaction but recommended the standardising of training and practice to ensure role futureproofing. Conclusions Nurse-surgeons have been practicing in Australia for decades, yet no standard training and credentialing pathway exist for them. This study identified the various roles, non-standard training, and perceptions of nurse-surgeons in the Australian public health system. The findings of this study will have an impact on policymakers and stakeholders to develop standard national credentialing pathway for nurse-surgeons in Australia to enhance clinical practices and ensure a consistent framework for recognition and development of these advanced practice nurses.

Objective The impact of COVID-19 on medical students has predominantly been assessed by one-off survey studies at the pandemic onset. This national study investigated the sustained impacts of the COVID-19 pandemic on medical students’ rural clinical placement learning and well-being. Design Repeated cross-sectional survey design. Setting Annual Federation of Rural Australian Medical Educators (FRAME) survey across 2020 to 2022. Participants Medical students completing an extended (mostly 12 months) rural placement. Outcome measure A mixed-methods survey with closed-ended and open-ended question. Quantitative data were analysed using χ ² and Kruskal-Wallis tests. Qualitative responses were analysed through content analysis. Results Quantitative findings: in 2022 (43%), respondents were more likely to interact with COVID-19 patients in a clinical capacity compared with 2020 (26%) and 2021 (23%; p<0.001). Respondents were more likely to be concerned about missed clinical learning in 2020 (58%) than in 2021 (40%) and 2022 (44%; p<0.001). Respondents in 2020 (41%) and 2022 (39%) were more likely to feel that their performance on assessments was affected by COVID-19 compared with 2021 respondents (28%; p<0.001). Respondents in 2022 (38%) and 2021 (31%) were more likely to report being exposed to an increased breadth of cases than 2020 respondents (13%; p<0.001) and also reported more exposure to community-based placements (2022: 38%, 2021: 31%, 2020: 19%; p<0.001). Qualitative findings: three categories were developed from the data—mental health and well-being impacts, learning preferences at play, and concerns about flow-on effects. Conclusions While the pandemic has now become the ‘new normal’, the mental well-being and learning concerns raised by students in rural Australia, and their concerns about sustained impacts into their internship cannot be ignored. Healthcare organisations need to ensure that when impacted students enter the workforce the practice context is supportive, with mechanisms such as effective clinical supervision in place.

In the last chapter, the embryonic evidence (essentially derived from one, relatively positive, COVID-19 cruelled randomised trial) in respect to the possibility of restoring/promoting resilience in people hospitalised with multimorbid heart disease was presented. However, prevention is always better than cure! Thus, just as the ‘interconnectedness’ of the different spheres that comprise our planet was highlighted in terms of the impact of pollution earlier in this book and considering the tenant of the UNSDGs, it is critical for us to proactively address climate vulnerability from multiple perspectives. Specifically, at multiple levels, there is urgent need for the world/us to—(1) Recognise the pre-existing to evolving threat (due to climate change) of climatic provocations to heart health, (2) Develop a more systematic approach to recognising which regions and communities are most ‘vulnerable’ to climatic challenges (from multiple perspectives), (3) Implement a range of public health measures from raising public awareness to implementing broad public health strategies to promote and enhance climatic resilience at the population level, and, beyond the need to reframe the clinical management of people hospitalised for heart disease, to reduce their risk of readmissions and premature mortality due to pre-existing vulnerability to climate provocations—(4) Strengthen primary care health care teams/services to proactively detect and then manage at risk/vulnerable individuals before they are hospitalised and/or die prematurely due to climatic provocations to their cardiovascular health. Such primary care capacity would also ensure the optimal, post-discharge management of those hospitalised with heart disease from this novel perspective. Bringing all the current evidence in this regard together, this chapter provides a critical review of the progress made thus far around these four key points.

Having described and explored the global to individual context of climate change and health, this chapter now explores the biological imperative of any organism to maintain homeostasis. As a key function of this imperative, in humans, the cardiovascular system plays a key role in maintaining homeostasis. Over time we (humans) have overcome many of the biological limitations/constraints of these protective mechanisms through a combination of behavioural, cultural and technological adaptations—thereby allowing us to migrate and thrive in nearly every corner of the world. Within this biological to historical context, rapid climate change (through exposure to more weather extremes) is now challenging the limits of our ability to maintain homeostasis. How the opposing forces of human adaptability, maintaining thermoregulation and increasing climatic provocations to health plays out in vulnerable individuals and communities (from those living in poverty to older individuals living with chronic heart disease) will provide important context to later chapters.

In the last chapter, the biological limits of human adaptation in the face of climatic conditions outside of our mandated physiological and personal comfort zones were explored—with a major focus on what happens to the heart and cardiovascular system when confronted with cold to hot extremes. It also introduced the concept of non-modifiable versus modifiable factors that modulate the biological impact of climatic provocations to an individual. As an extension of this concept, this chapter now presents a holistic, interdisciplinary framework/model that helps to explain why certain people (with consideration of sex-based differences) are ‘ climatically vulnerable ’, while others are more ‘ climatically resilient ’—identifying the key characteristics and attributes that might be altered to prevent climatically provoked cardiac events and premature mortality at the individual level.

Having briefly introduced this topic from the perspective of the United Nation Development Programme Goals , this introductory chapter provides a personal to scientific perspective on climate change in the modern era. As such, it will specifically describe how it (climate change) has the potential to adversely influence the heart health of the global population. In making this case, a cruel irony will be highlighted—that is, while most of the world’s poorest people barely contribute(d) to the reasons why climate change occurred, unlike high-polluting countries, they still suffer the same and even worse consequences. Moreover, they have limited resources and capacity to address the difficult challenges arising from climate change. In this context, while clinicians are mostly focussed on the individuals they care for, this chapter further explores why having a “ climatic conscience ” or at least awareness of climatic conditions on health, is the pathway to better health outcomes. Specifically, it provides a rationale why health services and clinicians alike, need to acknowledge and understand the link between external conditions and the physiological status of any individual—thereby thinking beyond the four walls of an environmentally controlled hospital or GP clinic.

While it might be tempting to simplify our interactions with weather and longer-term climatic conditions as a simple byproduct of varying atmospheric conditions, this would be a mistake. As will be outlined in this chapter, air pollution (a nasty consequence of the mainly human activities and technology driving climate change!) by itself, is likely cardio-toxic. Moreover, concentrations of outdoor air pollution and its impact on the cardiovascular system varies according to the prevailing climatic conditions, topography and human structures/activity. Other forms of pollution, including indoor air pollution, metal pollutants, microplastics and noise pollution are also important factors in eroding the capacity of an individual’s cardiovascular (and broader cardiopulmonary) system to maintain homeostasis when confronted with provocative climatic conditions. It is for this reason that ‘pollution’ has been elevated to the status of being a “ non-traditional, major risk factor ” for cardiovascular disease. But how much does climate and climate change influence it’s impact on our heart health? To answer this question, in this chapter the synergistic threat of pollution as both a consequence and cause of climate change will be explored.

Before introducing the specific topic of climate change and how it might (and does) influence heart disease-related events on a global scale, this brief chapter frames this book within the bigger picture of the United Nation’s Sustainable Development Goals (United Nations Department of Economic and Social Affairs in Sustainable development (the 17 goals); 2024. https://sdgs.un.org/goals . Accessed June 2024). It should become clear to the reader that the intersection between heart health and climatic conditions spans from the individual to the population level. Throughout, the concept of climatic vulnerability versus resilience will be mainly discussed from an individual perspective. However, the broader picture (in the face of a global threat that extends to every horizon) demands we first consider vulnerability and priorities within the global population. In specific terms, who stands to lose most from climate change and, more pertinently, who is able to respond to the health issues that arise?

Previous chapters have focussed on the broader picture of global health in the context of climate change, before examining why climatic conditions/acute weather events can influence an individual’s heart and broader cardiovascular health through the lens of ‘vulnerability to resilience’. In doing so, an argument for why and how we should alter our collective thinking around the role of climate and health ( essentially embracing a new paradigm in providing clinical car e) is urgently needed. However, such a radical change would be pointless, or at least a low priority, if there was little evidence that health outcomes are indeed—(1) Shaped and influenced by the weather/climatic conditions, thereby resulting in clinically significant variations in event rates and, (2) Climate change is likely to exacerbate the problem in terms of provoking more events that might be preventable. Thus, in the context of a growing body of research and published data (much of which is gravitating towards a more simplistic “ heat is bad ” mindset), this chapter provides hard evidence that the timing and frequency of concrete events such as hospital admissions and deaths linked to cardiovascular disease and the main subtypes of heart disease are not random. Instead, they ebb and flow according to both predictable climatic transitions (seasons) and unpredictable weather conditions (heatwaves and cold spells) in different ways.

This chapter brings together a range of themes covered within the book thus far. It reflects on the diversity of problems different parts of the world are facing as the impact of climate change gathers pace. These problems encompass more cardiac complications arising from the air pollution generated from climate-triggered fires to the proliferation of vector-borne infectious diseases. In doing so, it discusses the complexity of pathways provoked by climatic change that might increase and even extend the burden of heart disease globally. Concurrently, the prospect of some unexpected benefits (in terms of disease reduction due to climate change) are identified. From that global perspective, some important changes in the ‘infectious threats’ posed to people living in the major continents are presented, noting, once again, how the poorest people in the world will likely bear the brunt of any changes in the pattern of disease provoked by climate change.

This book has provided a wide-ranging review (from global health issues to individuals traits of climatic vulnerability) of the key issues surrounding climate change and heart disease. In the process it has argued for a ‘ paradigm change ’ in how clinicians and the broader health system consider ‘where’ people with antecedent risk factors and established forms of heart disease live and work and also ‘when’ climatic conditions in that location, might provoke a clinical crisis and even death. This requires a new mindset around clinical management (including specific sections/reference to climate factors in expert guidelines) and extends to how disease statistics are reported and presented. However, it would be disingenuous to present all the facts, figures and opinions proffered in this book as the unbridled truth or beyond contest. There is still so much to learn and understand about heart disease and other forms of cardiovascular disease—especially beyond high-income populations with well-developed health systems. This truism is even more stark when considering our knowledge (and potential response) to the impact of climate change and how it will affect the global burden of heart disease and other common forms of cardiovascular disease sensitive to external factors. Thus, this final chapter will critically reflect on the topics covered in each chapter and then identify what is needed in terms of action (including new research and resources) to ensure that climate-provoked cardiac events don’t overwhelm already capacity constrained health systems worldwide.