The Problem: Novel community-acquired, non-multiresistant strains of oxacillin- (methicillin-) resistant Staphylococcus aureus (ORSA) have emerged in many parts of the globe. Little is known of the clinical features, the epidemiology, and the antibiotic treatment of these strains. Materials and Methods: A retrospective chart review was performed on patients presenting to Emergency Departments or Dermatology Clinics with staphylococcal infections. Patients were stratified into three groups, non-multiresistant ORSA (NORSA), multiresistant ORSA (MORSA) and oxacillin-susceptible S. aureus, and clinical comparisons made. Strains of NORSA and MORSA were typed using antibiograms, phage typing and pulsed-field gel electrophoresis. Antimicrobial studies were performed to compare different methods of detecting resistance to oxacillin and to non-beta-lactams. Time-kill studies were performed with one drug to explore killing kinetics. The interaction between drug combinations was examined using disk approximation and time-kill methodologies. A single point pharmacodynamic analysis was performed. Results: There was an increase in infections with NORSA, MORSA and OSSA. NORSA strains appeared to be more virulent than OSSA and MORSA strains. NORSA was strongly associated with skin and soft tissue infections and with Polynesians. Most of the NORSA strains were related to New Zealand ????Western Samoan Phage Pattern???? (WSPP) isolates, and unrelated to community-acquired, non-multiresistant MRSA strains from Western Australia. Two patients were found to have British EMRSA-15 strains. NORSA strains were unrelated to MORSA strains. Resistance to rifampicin, fusidic acid, ciprofloxacin and trimethoprim emerged in the time-kill assays. Combinations of antibiotics, particularly with ciprofloxacin, often showed antagonism. Gentamicin, fusidic acid, clindamycin, teicoplanin, vancomycin, and linezolid were predicted to perform well. Ciprofloxacin, erythromycin, doxycycline, flucloxacillin and quinupristin/dalfopristin were predicted to fail. Conclusions: WSPP strains of New Zealand and EMRSA-15 strains from Britain exist in South Western Sydney. These organisms are virulent, and increasing in incidence in several areas of Australia. Antimicrobial treatment of infections with these strains is problematic and requires further study.

The Problem: Novel community-acquired, non-multiresistant strains of oxacillin- (methicillin-) resistant Staphylococcus aureus (ORSA) have emerged in many parts of the globe. Little is known of the clinical features, the epidemiology, and the antibiotic treatment of these strains. Materials and Methods: A retrospective chart review was performed on patients presenting to Emergency Departments or Dermatology Clinics with staphylococcal infections. Patients were stratified into three groups, non-multiresistant ORSA (NORSA), multiresistant ORSA (MORSA) and oxacillin-susceptible S. aureus, and clinical comparisons made. Strains of NORSA and MORSA were typed using antibiograms, phage typing and pulsed-field gel electrophoresis. Antimicrobial studies were performed to compare different methods of detecting resistance to oxacillin and to non-beta-lactams. Time-kill studies were performed with one drug to explore killing kinetics. The interaction between drug combinations was examined using disk approximation and time-kill methodologies. A single point pharmacodynamic analysis was performed. Results: There was an increase in infections with NORSA, MORSA and OSSA. NORSA strains appeared to be more virulent than OSSA and MORSA strains. NORSA was strongly associated with skin and soft tissue infections and with Polynesians. Most of the NORSA strains were related to New Zealand ????Western Samoan Phage Pattern???? (WSPP) isolates, and unrelated to community-acquired, non-multiresistant MRSA strains from Western Australia. Two patients were found to have British EMRSA-15 strains. NORSA strains were unrelated to MORSA strains. Resistance to rifampicin, fusidic acid, ciprofloxacin and trimethoprim emerged in the time-kill assays. Combinations of antibiotics, particularly with ciprofloxacin, often showed antagonism. Gentamicin, fusidic acid, clindamycin, teicoplanin, vancomycin, and linezolid were predicted to perform well. Ciprofloxacin, erythromycin, doxycycline, flucloxacillin and quinupristin/dalfopristin were predicted to fail. Conclusions: WSPP strains of New Zealand and EMRSA-15 strains from Britain exist in South Western Sydney. These organisms are virulent, and increasing in incidence in several areas of Australia. Antimicrobial treatment of infections with these strains is problematic and requires further study.

Thesis (Ph. D.)--University of New South Wales, 2004. / Also available online.

Background: The South Western Sydney Area Health Service (SWSAHS) contains many areas of socio-economic disadvantage and ethnic diversity. It has a high incidence of lung cancer, which is the leading cause of cancer deaths. The aims of this study were to document lung cancer patterns of care (POC) for SWSAHS residents, compare POC before and after the opening of an oncology centre in SWSAHS and compare POC with other areas in NSW. Methods: The study population consisted of SWSAHS residents diagnosed with lung cancer in 1993 and 1996. A clinical audit of medical records was performed to extract details on patient demographics, management of lung cancer and outcomes. Collaborating investigators performed identical studies in the Northern Sydney Area Health Service (NSAHS) and the Hunter Area Health Service (HAHS) for lung cancers diagnosed in 1996. Results: The SWSAHS study population comprised 527 patients. Nine percent did not have a pathological diagnosis. Twelve percent did not see a lung cancer specialist. Twenty-eight percent did not receive any treatment throughout the course of their illness. The median survival was 6.7 months and five-year actuarial survival was 8% (95% CI 6%-10%). Increasing age and poorer performance status were associated with a lower likelihood of obtaining a pathological diagnosis, specialist referral and treatment. Socio-economic factors did not influence POC. The establishment of an oncology center resulted in more referrals to medical oncologists and palliative care services. Other aspects of POC and survival were similar. Variability in POC was noted between SWSAHS, NSAHS and HAHS. HAHS residents were almost twice as likely not to have pathological confirmation of diagnosis or treatment. Despite this survival was not significantly different. Conclusions: This study has identified deficiencies in the management of lung cancer. To improve outcomes, referral to specialists and utilisation of treatment, particularly radiotherapy and chemotherapy, needs to be increased. Ageist and nihilistic attitudes need to be overcome. Prospective data collection is necessary to ensure quality of patient care. The formation of national guidelines for the management of lung cancer will play an important role in achieving better outcomes.

The purpose of this thesis is to examine the educational outcomes of Lebanese-background students in high schools in South-western Sydney, and to investigate some of the factors contributing to their pattern of achievement. The main thrust of this study is to empirically examine in detail two factors which are strong contributors to school achievement. The first is the motivational goals of these students. The second is the Language proficiency of Lebanese-background students in their first language (Arabic) and their second lanaguage (English). The study involves quantitative analyses of two sets of questionnaires administered to all the Year 9 students in three South-western metropolitan Sydney high schools. The Year 10 School Certificate results of this same group of students was then used to measure their level of achievement. Four groups were established for comparison: the non-Lebanese-, English-, Chinese- and Vietnamese- background groups. This study is contextualized within a discussion of some of the family factors which contribute to the achievement of migrant children in schools. Of particular relevance to Lebanese-background students are the socio-economic and educational background of parents, and the historical and social context of the Lebanese in Australia. The thesis concludes by putting forth some recommendations which involve the collaborative efforts of the home, the school and the community, suggesting that part of the solution lies in this collaborative effort. Boundaries can be crossed and stereotypes changed only through a concerted effort by the three sides / Doctor of Philosophy (PhD)

There is a need for research to understand change processes and knowledge management in health service organisations, and indeed public sector organisations in general. This research seeks to explain how knowledge becomes formulated and thereby mobile, and also how practice has come to be established, visibilised and thereby sustained in a specific context. Exploring practice within a health service organisation, and in particular a public health service organisation, is a particular feature of this research. The research demonstrates how collaboration becomes necessitated under pressure of enacting increasingly complex work activities, an outcome being changing practices and extended accountability relationships which enacts discipline while realising expertise. Using an ethnographic approach, the research explores how the practice of early childhood nursing in the South Western Sydney Area Health Service became a specialised expert undertaking. The research examines how change has occurred, whereby early childhood nursing was refined from being one part of the generalist community nursing practice to being a specialised practice through the increasing technologisation of practice. The technologisation of practice refers to the artefacts, conduct and the processes through which the conceptualisation and enactment of early childhood nursing has become increasingly standardised. Through the technologisation of practice explicit knowledge becomes distributed within the artefacts for practice and tacit knowing becomes distributed across, and is continually enacted by, the collaboration of the practice community. There are four interrelated aspects to the technologisation of practice. Firstly, the technologisation of practice involves standardising the conceptualisation and enactment of practice through constructing a multi-dimensional practice resource within a community of practice. Secondly, the technologisation of practice involves the mobilisation and refinement of the multi-dimensional practice resource to realise a practice network involving extended relationships of accountability. These relationships of accountability are within a profession and also with other professionals. Thirdly, the technologisation of practice involves the ongoing enactment of accountability in a collaborative community of practice. The research shows that a team can become a collaborative community by constructing an accountability context, reorganising and facilitating the team, and then amalgamating the organising and service delivery activities through integrating formal meetings and informal interactions. Fourthly, the technologisation of practice involves the collaborative community assemblage and/or appropriation of further technologies into practice thereby strengthening the local and extended relationships of accountability and expanding the boundaries of practice. The research describes how the technologisation of practice is the enactment of a number of mutually enabling practice dualities, which together simultaneously discipline and realise expertise. The interrelated practice dualities are individual-community, subjective-objective, local-global, formal-informal and governmentality-communal self-governance. The situatedness of practice is shown to necessitate a subjectivity-objectivity duality, whereby individual and communal experience is drawn upon to see through the otherwise opaque nature of statistics and information. The alignment of practice with the broader organisation and professional colleagues realises a local-global duality, whereby the community's local understandings are informed and shaped by distant issues. The formal-informal duality is a mechanism by which practice is increasingly collaboratively conceptualised and enacted, and thereby standardised. Individual and communal 'expertise' becomes realised through the assemblage and appropriation of organising and transforming tools and artefacts, or alternatively technologies. At the same time, the community in defining the use of such technologies as competent practice is disciplining their own conduct. Through this action a governmentality-communal self-governance duality is realised as the nursing community pursues expertise while disciplining themselves; by engaging in collaborative interactions and using standardised technologies the community constructs and makes visible their knowing, practice and expertise.