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Aboriginal children living in remote communities have the highest rate of skin sores, or impetigo, in the world. Almost one in two have skin sores at any one time.

Skin sores are a highly contagious bacterial skin infection that may be itchy and painful, but often go unnoticed by children. Parents are more likely to be concerned about the pus and thick crust that develops.

Scabies, another skin infection, also disproportionately affects children in remote Indigenous communities in Australia (as many as one in three).

In the Kimberley region of Western Australia, Aboriginal children are 34 times more likely than non-Aboriginal children to be admitted to hospital with skin infections in their first year of life. Untreated, these skin infections can lead to other health issues including sepsis, rheumatic fever and kidney disease.

With this in mind, we’ve been working for the past five years with nine communities in the Kimberley region on a comprehensive skin health program. Each of the communities has a remote health-care clinic staffed by a mix of nurses, Aboriginal health workers and doctors.

Today, we’ve published two new studies outlining the progress we’ve made to reduce skin infections in children in these communities. Since we started the program, rates of skin sores have halved from around four in ten children to around two in ten.

The SToP program

We partnered with Aboriginal community-controlled health organisations and schools in the Kimberley region and co-designed a program called SToP. It stands for “See, Treat and Prevent”.

Our initial focus was going to be on diagnosing and treating skin sores and scabies. However, community members highlighted the need to incorporate a strong focus on prevention and health promotion too.

The SToP model included training health-care workers in the remote health clinics, community members and school staff to recognise skin infections. The health-care workers were also trained to provide the latest evidence-based treatment for patients with skin sores and scabies.

The prevention activities included recording a hip-hop video with children, developing eight unique healthy skin books in local languages, and yarning with community members. They consistently highlighted the importance of investing in environmental health, including housing maintenance to support healthy living.

Local children recorded a hip-hop video to promote healthy skin.

As part of the SToP program, and to track its results, more than 770 children aged zero to 15 years received regular skin checks over four years from 2019 to 2022. We visited each of the nine communities up to three times each year and completed more than 3,000 skin checks.

One limitation of our research is that the trial was completed during COVID. Regional travel bans forced it to pause for several months in 2020.

The primary aim was to reduce the burden of skin sores by half in school-aged children. We also tracked impetigo and scabies burden in younger children up to age four, and overall clinic presentations for skin infections.

Our results, published in the Lancet Child and Adolescent Health today, confirm skin sores decreased in school-aged children in the first year and improvements were sustained throughout the trial.

Across all communities, skin sores reduced from four in ten children at the start of the study to two in ten children by the end. Most of this reduction occurred in 2019 when skin checks started.

Scabies also declined, but was found in less than one in ten children throughout the study.

The program has reduced skin infections among children in these communities.
The Kids Research Institute Australia

The skin checks were the most important and likely most effective part of the study. Community members want these to continue for all age groups, to extend beyond just the children involved in the study.

Presentations to the remote health clinics for skin infections in each community increased during the trial and stayed high. This suggests the community involvement and focus on healthy skin was reaching all age groups.

Despite training and resource development, uptake of the recommended treatments at the clinic was low.

We predicted at the start of the study that using treatment as prevention, supported by training on the latest evidence-based treatments available, would be the most effective strategy. This turned out to not occur at all. High turnover of clinic staff and longstanding treatment preferences may be the reason.

A holistic approach

While our research has been published today, the results were first presented to community members in 2023. More than 85 community members were able to share their interpretation of the SToP results with us. They strengthened the story we’ve been able to tell in our published papers.

The second paper, in eClinical Medicine, provides a comprehensive, multi-methods evaluation of the trial. Through this process, community members and service providers helped our research team understand the trial results and the critical factors for success.

Future studies should continue to partner with local Aboriginal communities and enable community voices to inform all aspects of the research.

The SToP trial brought together Western medical approaches with community voices to better inform skin disease control where the burden of skin sores and scabies was high. The results have been positive.

We hope there will be future opportunities to implement activities like this in more Indigenous communities across Australia. As a starting point, a variety of SToP resources are available to access. The healthy skin books have been shared with other communities to translate into local contexts and languages.

The skin is the largest organ of the body and always visible. Improvements in skin health can prevent other, more serious health consequences, while also contributing to overall wellbeing. Läs mer…

The Australian construction industry has long been facing a crisis of serious defects in apartment buildings. In the past, alarming incidents such as the Sydney Opal Tower evacuation and the Melbourne Lacrosse fire signalled systemic problems in construction.

The same problem persists today. One recent report shows serious defects in apartment buildings in New South Wales have more than doubled between 2021 and 2023.

As the Albanese government fast-tracks its five-year plan to build 1.2 million dwellings, this number will likely worsen.

We’ve researched the pressures the construction industry feels and how that can result in unsafe apartments, and what can be done to make housing like this better for everyone.

Why are we in this situation?

Serious defects endanger lives, cost building and insurance firms millions of dollars, and put pressure on regulators. Typical responses involve increased regulation, but the lack of change in apartment quality shows increased regulation is not enough. Behavioural and cultural changes are needed.

We found the poor quality of apartment buildings is often the result of deeply entrenched patterns of unprofessional behaviour across the industry. These often arise as professionals face pressures to cut costs in an industry notorious for its low profit margin.

We also found this pressure is exacerbated by aggressive competition, work overload, exploitation and a toxic culture.

As pressures mount, professionals’ decision-making becomes increasingly fraught. For example, many professionals we interviewed largely believe they must choose between profit and quality.

There are no simple answers to this age-old conundrum. However, our study shows a way forward.

What did we find?

Our three-year study funded by the Australian Research Council is the first in Australia to extensively investigate 12 building professions struggling to navigate and resolve this perceived dilemma.

Teams from four Australian universities conducted desktop reviews, analysed professional codes of conduct, interviewed 53 professionals and conducted six focus group discussions. After two years of analysis and model development, we published our industry technical report and presented our findings to practitioners in NSW and Queensland.

We have empirical evidence that shows profitability and quality do not have to be mutually exclusive. We have uncovered powerful, innovative but ad hoc strategies showing businesses can reconcile both.

One builder we profiled, a multinational company and a market leader in apartment construction, took a pioneering approach to this dilemma.

For many years, the company’s strategy was to build as quickly and cheaply as possible to save money. However, these savings were ultimately lost because they found they had “[…] made some money at the time, but we basically spent it all fixing things that we didn’t build that well”.

The company re-examined its business model and developed a new strategy that reconciled profitability, quality and professional behaviours.

The company analysed where the majority of their defects arose from and there were five key areas including:

balcony waterproofing
shower construction and waterproofing
fire wall installations
penetrations through fire walls
brick masonry construction.

They then built prototypes of high quality construction for each of these typical building elements. They found their prototypes addressed defects while also integrating different technical standards.

The company then informed their clients, subcontractors and suppliers that “this is how we will build from now on”. Over time, it became apparent their strategy supported skills training while also improving long-term financial sustainability.

These prototypes are now showcased at a centre in NSW. Subcontractors, architects, engineers, designers, professional associations and other supply-chain actors regularly visit.

The company now conducts training for quality based on these prototypes and reports that since the establishment of this strategy, defects have been reduced by 85%.

Our empirical evidence shows these strategies drive quality and long-term financial sustainability.

Safer homes nationwide

This strategy does not have to be limited to a few large companies.

In our report, we provide a plan to ensure safer, more financially sustainable building practices can be rolled out across the industry. It relies on collaboration across sectors.

Best-practice companies in each state, like the one in NSW, would come under a national umbrella. Commonwealth and state governments would initiate the effort by identifying the best examples in different states. Together, they could focus on design, construction quality and on innovative materials, standards and ways to build safely and cost-effectively.

Having best-practice example companies would help weed out apartment defects.
Shutterstock

With positive role models to follow, other companies can improve. This would instil a mindset and culture of leadership, accountability and responsibility across the sector. More coherent standards would be embedded across the industry would ensure workers at all levels are no longer siloed.

Education and training organisations would progressively incorporate these new standards. Over time, the workforce would rebuild knowledge and skills that are perceived to have largely disappeared.

It’s important to ensure clients help drive this too. By mandating or incentivising companies with safer supply chains, there’s a commercial imperative to do better.

Professional associations also have a role to play. They can support these efforts further by creating resources and advocating for best practice.

Making apartments safer requires a shift in the thinking of the entire construction industry. There are inventive ways to align quality with profitability. We must challenge the assumption that they are always irreconcilable. Läs mer…

Many Year 12 students are preparing for final exams throughout October and November.

What happens if something unexpected happens that makes final preparations or performance on the day more difficult?

This is where special consideration or special provisions can help.

How might you be eligible?

Students who experience something unexpected during the exam period may be eligible for special consideration. This can minimise the impact on a student’s overall marks.

To be eligible, incidents must be beyond the student’s control. For example, a serious illness, an accident, a family crisis or an interruption during the exam. It does not include family holidays, a teacher being away or mixing up exam dates.

A student suffering a flare up of pain and fatigue because of glandular fever is likely to be eligible as long as they have a medical diagnosis and recent documentation such as a letter from their GP. Other unexpected illnesses might include gastro, flu or COVID.

Unexpected mishaps or misadventure such as your home being flooded or a sporting accident that puts you into hospital can prevent you from participating in your exam. In cases like these you will need to provide evidence.

A death of a close relative can also mean a student is considered eligible for special arrangements. Other family crises may also be included depending on the circumstances and how they affect you. It’s best to consult with your school to find out if you might be eligible.

Students with disabilities and chronic illnesses can also apply for special consideration. This is something that must be organised earlier in the year through your school and helps teachers make adjustments that enable students to participate equitably.

There are also a range of entry processes for university and other post-school training and education pathways. Check with the institution you are interested in for more information.

If you get the flu or COVID during your exams, make sure you get documentation from your GP.
JJ-stockstudio/Shutterstock

What do you need to do to apply?

The process of applying for special consideration for exams differs slightly depending which state or territory you live in. However, the same principles apply:

you will need documentary evidence – such as letters from your doctor, police reports, statutory declarations or a death certificate
it must be clear how the unexpected situation impacts your performance, such as being too sick to study or too unwell to attend the exam.

Your school will then manage the process on your behalf and where relevant, submit the application to the local exam board.

Make sure you let your school know as soon as possible if you think something has happened that will have an impact on your exams.

What happens next?

Special consideration aims to ensure a student’s final result is an accurate reflection of their expected achievement. Depending on what has happened, and when it happened, a student may be able to have:

additional reading or writing time
do their exam in another room
extensions to due dates
rest breaks, or
time to attend to medical needs without loss of test or exam time.

If a student can’t do their exam or their participation was significantly impaired, a moderated school result or predicted mark will be used. This is a result based on performance during the year.

This might happen in situations where a whole class is affected. For example, a fire alarm went off half way through an exam.

Unexpected things happen to all of us at some stage in our lives. If something goes wrong in your life around exam time, talk to your school and gather your documentation. And be informed about how you can be supported to be graded fairly.

For more state-specific information, you can go to your state’s exam board:

South Australia and Northern Territory (SACE)
Queensland (QCAA)
New South Wales (HSC)
Tasmania (TASC)
Western Australia (WACE)
Victoria (VCE)
Australian Capital Territory (BSSS). Läs mer…

New Zealand is confronting a perfect storm.

Its energy grid faces three pressing challenges at once: an unreliable electricity supply, strict emissions reduction targets and ongoing environmental issues related to wastewater ponds.

As the country prepares to meet growing energy demands, the variability of wind, solar and hydroelectric power has made year-round electricity generation hard to ensure.

Compounding the issue are New Zealand’s emissions targets and avoidable emissions from wastewater treatment plants.

We need immediate, practical solutions. One lies hidden within our wastewater systems.

Three challenges, one solution

In the search for viable renewable energy sources, one option is to install floating solar panels on wastewater ponds. However, the initial costs and environmental concerns related to manufacturing and disposal may pose temporary challenges.

A more immediate and cost-effective solution is already available: biogas membrane covers.

These covers generate continuous energy at half the cost of solar while addressing environmental concerns such as methane emissions and algal growth.

Even greater efficiency and environmental benefits are possible through combining biogas covers with heat systems and floating solar panels. Together, these three technologies suggest a multi-pronged solution that could help stabilise the grid, meet emissions targets and improve wastewater management.

Biogas from wasterwater

Methane emissions from wastewater ponds are a major environmental concern, contributing significantly to New Zealand’s overall greenhouse gas footprint. By installing biogas membrane covers, this methane can be captured before it escapes into the atmosphere, and instead be used to generate electricity.

This creates a year-round, consistent energy supply – something traditional renewables such as wind, solar and hydro cannot always guarantee.

From a cost perspective, biogas systems are about 50% cheaper to install than solar power per kilowatt of energy produced. Also, because these systems produce energy continuously, they are ten times more cost-effective than solar panels, which suffer from intermittency issues.

But beyond energy production, these covers offer other environmental benefits. They limit harmful emissions and curb ongoing complaints about unpleasant odours in neighbourhoods near wastewater treatment plants.

Excessive algal growth is a recurring problem for wastewater treatment plants.
Getty Images

Repurposing excess heat

While biogas systems have enormous potential, they do have one significant drawback. The heat generated during methane combustion can cause wastewater ponds to overheat, leading to operational challenges such as excessive algal growth.

This is where cogeneration or combined heat and power systems come into play.

These systems capture the excess heat from biogas combustion and convert it into additional electricity. This not only improves energy efficiency but also regulates the temperature of the wastewater ponds, helping to reduce algal growth and evaporation.

The third part of an integrated solution involves solar panels which can be installed on top of the biogas covers. While these are more expensive to install initially, they collectively contribute valuable gains. When installed on the surface of wastewater ponds, the panels generate additional renewable energy without taking up valuable land space.

Floating solar panels can also help manage the ponds themselves. By reducing sunlight penetration, they help limit the growth of algae.

Wastewater ponds as energy hubs

The beauty of an integrated approach is that it addresses several problems simultaneously.

By rethinking wastewater ponds as renewable energy hubs, New Zealand can turn an existing problem into a key part of the solution.

Biogas membrane covers provide immediate energy and emissions benefits. Combined heat and power systems boost efficiency by converting waste heat into electricity. And floating solar panels maximise renewable output while improving wastewater management.

Independently, these systems have been successful overseas. In Melbourne, methane from wastewater ponds is captured and converted into renewable energy, powering thousands of homes. Meanwhile, in parts of the United States, floating solar panels are increasingly being used to boost energy production while managing water systems.

The success of these projects provides a blueprint for New Zealand. By combining these technologies into cohesive systems, New Zealand could demonstrate how environmental challenges can be transformed into opportunities.

The future of renewable energy will require continued exploration and integration of emerging technologies, such as tandem solar cells capable of producing 60% more energy. These could be integrated into biogas membrane covers.

For now, though, an integration of biogas, heat and floating solar panels represents a significant step forward for New Zealand. It could generate enough power to supply about 27% of households with renewable energy from wastewater ponds, offering immediate relief from the electricity crisis while supporting emissions reduction targets. Läs mer…

Barely a month goes by without news of children and adolescents who are imprisoned and being mistreated in youth detention.

A new parliamentary inquiry is shining a light on this mistreatment. It’s investigating if youth detention facilities are complying with children’s human rights conventions, and the need for minimum standards of care.

This inquiry is an opportunity to consider alternatives to youth detention that support and rehabilitate children and adolescents who break the law. This is especially needed for those with disabilities relating to brain function (neurodisability), such as fetal alcohol spectrum disorder (FASD).

FASD is a neurodevelopmental disability. It is caused by exposure to alcohol before birth, which injures the brain. We don’t have prevalence data in the general Australian population but we know it affects children from all demographics.

Here’s what we know about the incarceration of children and adolescents with FASD – and what we could do instead.

Imprisoning children from age 10

Children as young as ten years may be incarcerated in Australia.

But prison is not a solution to youth crime. Imprisonment without care can cause harm and entrench disadvantage.

Young people’s brains experience a period of rapid development between ten and 14 and aren’t able to make complex moral decisions.

Children and adolescents with FASD may have cognitive impairment affecting their ability to think, learn, make decisions and remember, or intellectual disability. Their mental age may therefore be significantly lower than their chronological age.

FASD makes it harder to understand

FASD affects children and adolescents’ motivation before committing a crime and their capacity to comprehend the consequences.

Due to their brain injury, children and adolescents with FASD are often impulsive, easily misled and can’t distinguish right from wrong. They may not learn from past experiences.

When they’re in the justice system, they may be suggestible. Poor memory may make it difficult for them to provide reliable witness statements. Due to poor language and communication skills, they may misunderstand court orders, leading to non-compliance.

Rates of FASD are high among young people in the youth justice system. An estimated one in three detainees in Australia has FASD. But many adolescents in contact with the justice system have un-diagnosed FASD and complex needs.

Internationally, young people with FASD are 19 times more likely to be jailed than people without FASD.

Diverting adolescents from prisons

The Productivity Commission’s 2024 report on government services found diversion programs reduced youth re-offending.

It also found diversion programs were significantly cheaper than incarceration. In 2022–2023, the average cost for each adolescent under community-based supervision was A$305 per day, compared to $2,827 per day for adolescents in custody.

In a 2024 report, National Children’s Commissioner Anne Hollonds recommended expanding evidence-based youth justice diversion programs:

Tragically, by not addressing their human rights early on, and instead taking a punitive approach to their offending, we are essentially criminalising some of the most vulnerable children in Australia.

So what do these programs look like?

Many countries have moved from a justice system to a welfare system, which is especially appropriate for adolescents with disabilities like FASD.

Ireland ended the imprisonment of children aged under 18 years in 2017. Children under 18 can now be sent to children detention campuses, which have games rooms and bedrooms instead of cells.

Scotland closed its youth prisons in 2024.

Spain has long used an in-patient approach. Adolescents live in a therapeutic environment with compassionate contact with professionally trained staff.

Other countries are replacing child prisons with theraptutic environments and compassionate staff.
Shutterstock/SeventyFour

Successful Australian initiatives offer a foundation for a new model of youth justice.

The Yiriman Project, for example, is run by Elders near Fitzroy Crossing in Western Australia, where rates of FASD are high. The project takes Aboriginal young people at risk of offending onto remote country to engage in culturally based activities, such as assisting Indigenous rangers to care for country. A three-year review of the Yiriman project found positive outcomes for Aboriginal youth with FASD.

Research shows it’s crucial that Aboriginal and Torres Strait Islander people are involved in the design of any programs that affect their communities.

Early detection to prevent re-offending

Early identification of FASD allows children to receive appropriate intervention and support to enhance their social and emotional wellbeing. This may prevent them from re-offending and improve their life trajectory.

FASD assessments are available nationally. Support services for young people with FASD aim to improve their health and wellbeing, address secondary disability, and reduce exposure to risks such as substance use.

For young people who have offended, intensive community-based support programs improve young people’s access to education, life skills and heath-care access. Therapeutic and diversionary activities can also strengthen family relationships, which are crucial to successful community reintegration.

What needs to happen next?

Governments need to invest in evidence-based diversion programs for children and adolescents who commit serious crimes.

These programs provide rehabilitation and support and are effective, compassionate and cost-efficient.

Governments also need to urgently up-skill justice professionals to improve their recognition and assessment of adolescents with FASD and other neurodevelopmental problems.

Early identification and understanding of young people with challenges such as FASD and cognitive impairment will enhance the young person’s health and mental health outcomes, prevent youth crime and benefit society. Läs mer…

There is a lot of talk about the hot onscreen chemistry between actors Kristin Bell and Adam Brody in the hit new Netflix series, Nobody Wants This. Based loosely on series creator Erin Foster’s own romance with husband Simon Tikhman, the irreverent romcom follows a sex podcasters’ whirlwind love affair with a rabbi.

Notably, the sensual first kiss between the couple on a Los Angeles sidewalk one evening two episodes in has tongues wagging. But this is not the first case of opposites attract on TV nor, arguably, the steamiest small-screen smooch.

The onscreen kiss has a long and storied history. Many viewers form strong connections with characters they enjoy and consider them friends – called parasocial relationships – more so when story lines lean towards love.

Seeing caresses on screen can trigger the same neurons that fire when we lock lips in real life, making certain scenes very memorable and oh-so-marketable. Here are some of the best and the ingredients that make them great.

From friends to lovers

What fan of Friends could forget the classic first kiss when Rachel watches an old prom video and finally realises the depth of Ross’ feelings for her? Or when Jim on The Office (US) confesses his unrequited love for Pam, leading to an impassioned embrace? Both are preceded by a long, slow burn that heightens anticipation.

More than colleagues then.

Other kisses are more technically or narratively ambitious. Game of Thrones’ Jon Snow and Ygritte (real-life married couple Kit Harington and Rose Leslie) share a sizzling embrace in the geothermal springs of Grjótagjá, an Icelandic lava cave –although the actual location is only used in the establishing shots.

‘You know nothing Jon Snow.’

On New Girl, Jess and Nick share an unpredicted pash at the end of an episode called Cooler. Jess (Zooey Deschanel) has been left out of her male housemates’ night of carousing because Nick believes she ruins his chances of scoring. It turns out he has a willing kissing partner closer to home.

A sudden New Girl make-out sesh.

Challenging the script

Unexpected televisual trysts confront cultural scripts about romance. They can challenge viewer expectations about sex and relationships more generally. As such, some kisses have longstanding impact.

Take for example Star Trek’s interracial kiss between Kirk and Uhura in 1968, for which actor Nichelle Nichols recalled receiving an overwhelmingly positive reaction.

‘I’m not afraid. I am not … afraid.’

Dawson’s Creek characters Jake and Ethan were celebrated for being the first men to kiss on prime-time American television in 2000 (two women had already kissed on L.A. Law in 1991).

Australian television set the standard for gay men and women kissing in the 1970s and, more recently, Franky and Bridget found a lusty forbidden bond in the prison drama Wentworth.

‘You’ve got tickets on yourself.’

Future connections

How we might connect in the future have also been a part of televisual treatments of intimacy.

In Black Mirror’s San Junipero the creators explore the possibility of elderly bodies inhabiting their younger sexual selves via simulated reality. And then there’s the time The Doctor saved Rose’s life by absorbing a power vortex in her body via his lips in The Parting of the Ways episode of Doctor Who.

‘I think you need a doctor.’

Extreme close up

From the lighting and framing to the perfect music, there is a lot that goes into a kissing scene. All this can add up to a moment that prompts audiences to think about highlights from their own kissing histories – or their desired futures.

Typically screen kisses last longer than in real life, and research suggests some audience expectations of their own sex lives are unrealistically influenced by what they see on TV. In other words, if you’re expecting the same intensity or duration as Joanne and Noah on Nobody Wants This on your next first date, you should probably modify your expectations.

Today, filming kisses can be challenging and consent is an important part of the production process both onscreen and off. The role of an intimacy coordinator behind the scenes is still relatively new (and we don’t know if this Netflix production had one). But it’s clear when watching the hyped Nobody Wants This scene that both characters are willing kissers.

There apparently wasn’t much detailed planning involved, other than an objective to capture the “best kiss ever”. Their job well done adds to a pantheon of pashes that will be remembered (and replayed) fondly. Läs mer…

Vice President Kamala Harris outlined a proposal to allow Medicare to expand its coverage of home health care for older Americans. The Democratic presidential nominee announced this plan on the television talk show “The View.”

Harris explained that she aimed to take the burden off members of the “sandwich generation,” who are taking care of their kids and aging parents at the same time. She said the cost of this additional paid care could be paid for with the money the government will save by negotiating with pharmaceutical companies to reduce what Medicare pays for prescription drugs.

The Conversation U.S. asked Jane Tavares and Marc Cohen, scholars of long-term care, to assess what’s known so far about the plan.

Why is long-term care significant?

Long-term services and supports are one of the most significant expenses for older adults. They range from nonmedical assistance with food preparation, bathing, dressing and other activities of daily living to medical care in a skilled nursing facility.

Today’s 65-year-olds have a 70% chance of eventually needing some kind of long-term care as they age, and 20% will need long-term care for more than five years.

The costs associated with even one year of long-term care can prove to be unaffordable for most people. In 2023, the median yearly cost of a private room in a nursing home was US$116,796 and that of a home health care aide was $33 per hour. That’s $96,360 yearly for eight hours of daily in-home care.

The National Council on Aging has found that 80% of older adults would be unable to absorb a financial shock — such as the need for long-term care — without impoverishing themselves. The council noted that 20% of older adults had no assets at all, and another 60% would not be able to afford more than two years of either nursing home care or care in their own homes. The average length of a long-term care stay is just over three years.

Medicare currently does not cover any long-term care, but it does cover short-term professional in-home care for recovery after a qualifying illness or injury for up to 21 days and a maximum of 100 days in a skilled nursing facility after a qualifying hospital stay.

Medicaid currently covers about 61% of the country’s total long-term care costs, over 70% of which are for home-based services. However, Medicaid has strict income and asset eligibility requirements. Although Medicaid eligibility and coverage vary by state, those who qualify for the program are at or near the federal poverty level and have less than $2,000 in individual assets, or $3,000 as a couple.

Only 15% of Americans who were 65 and older were covered by Medicaid as of 2022.

Adding to the challenge, there is a shortage of long-term care workers. In 2022, about 700,000 people were on Medicaid waitlists for home- and community-based services, and 10% of those with skilled medical needs were waiting in hospitals for spots to open in nursing homes.

What would be the impact of increasing the number of older people getting care?

An estimated 77% of older Americans desire to stay in their homes as they age, but 1 in 5 need assistance with activities of daily living. With the high costs of long-term care and few coverage options, unpaid family caregivers typically provide this care.

Expanding Medicare coverage to include professional in-home long-term care, as Harris proposes, would make it easier for older adults to stay in their homes without impoverishing themselves. It could also help alleviate burdens born by unpaid family caregivers.

Although it will depend on details that weren’t immediately available, expanding long-term care coverage beyond the people who are enrolled in Medicaid has the potential to help many vulnerable older adults.

For example, getting professional assistance with eating or bathing could prevent health complications associated with malnutrition or poor hygiene. And this care would not be at the expense of a family caregiver who might otherwise have to leave their job or take on additional physical and mental stress to provide that care.

How much will this cost the government?

Clearly, the costs associated with any new program depend on many factors. The most important are who qualifies for the program, the circumstances under which they can get benefits, and how generous those benefits are.

Harris has indicated that the new Medicare home care benefit she’s proposing would be paid for by the savings from reductions in Medicare drug costs. A relatively recent estimate for that savings in 2026 is $6.3 billion. If this is the primary way to pay for the program, it could finance only a very modest home-care benefit.

Other long-term care proposals put forward by researchers and policymakers look at increasing the Medicare tax to pay for expanding access to this benefit. Here again, how much money needs to be raised depends on how comprehensive the program would be. Researchers at the Brookings Institution estimated that making long-term care more widely available to people covered by Medicare would probably cost about $40 billion.

Why hasn’t Medicare covered in-home care until now?

When it was originally launched in 1966, the Medicare program was intended to cover acute medical care services. At that time, life expectancy was lower than it is today – meaning that fewer Americans over 65 were eligible for its benefits and would live long enough to require long-term care.

In the following six decades, no public insurance program like Medicare has emerged to help people pay for this care.

But as far back as 1994, lawmakers were drafting proposals to cover long-term care. More recently, legislators have introduced bills that could fill this gap. However, many prior efforts have failed due to a lack of agreement on how to pay for these benefits and whether everyone should be eligible, or just low-income people.

Because the federal government hasn’t stepped up, some states have introduced their own policies.

Washington state is the furthest along in this effort. It has created a public long-term care insurance program where working Washington residents contribute a small percentage of their income into the fund and can then access earned benefits to pay for services. However, due to a ballot measure that Washington voters will weigh in on during the November 2024 elections, the program may become voluntary. We believe that letting people opt out would likely make that program unsustainable.

California has also made headway, completing two feasibility studies to examine the potential of a statewide long-term care insurance program. In 2024, California also eliminated the financial asset limits for Medicaid eligibility to help expand the program so it can cover more of the state’s older residents. Läs mer…

While engineering students may specialize in particular areas of engineering — for example, civil, electrical, chemical, mechanical or biomedical engineering — they all work in a similar way in applying design thinking.

Design thinking is a problem-solving approach that emphasizes tailored innovation.

What follows is a look at design thinking seen through a first-year project at Western University’s John M. Thompson Centre for Engineering Leadership and Innovation.

As part of their core curriculum, students pursued engineering experiences through practising design thinking with a variety of organizations including George Bray Sports Association (GBSA). The association was created to offer hockey opportunties for children and youth with disabilities. Today, athletes with this inclusive league may experience conditions such as Down syndrome, autism, ADHD, deafness, visual impairments and other challenges.

Applying design thinking

Three GBSA projects were among 10 community projects where students worked to apply design thinking.

Other projects included improving rock climbing opportunities for visually impaired people at the Canadian National Institute for the Blind, developing inclusive school yard games for kindergarteners experiencing exclusion at Thames Valley District School Board and exploring solutions for people with disabilities and workforce entry barriers at employment services specialist Hutton House.

Design thinking involves engaging with the user and learning as much as possible.
(Shutterstock)

Design thinking begins by defining a problem. While people practise design thinking across disciplines, when it’s taught as part of industrial design and innovation it incorporates learning about intellectual property (open-source, copyrights and patents).

All the students worked through similar processes, exemplified here through a look at projects with GBSA.

1. Broadly defining the problem

Angela Mawdsley, an assistant professor of engineering at Western, and I worked closely with GBSA leadership to analyze their operations and identify potential areas where design thinking could have an impact towards solving problems. Emphasis was given to potential problems that could not only be solved in the moment, resulting in a better immediate experience for GBSA, but that could also yield solutions applicable to broader situations.

Three candidate problems emerged:

1. Playing beyond the whistle: Some of the younger players, either due to deafness, cochlear implants, cranial shunts (a device draining fluid from the brain), attention disorders or other difficulties with focus, can often be seen to carry on in hockey play, after the referee blows the whistle.

2. Many players are challenged in learning how to skate: Standardized devices for learning to skate (sometimes popularly called “skate mates”) present size and use issues. Use issues include not considering relative strength or weakness of a player’s ankles, a key criteria in establishing effective push. Also, some athletes do not progress beyond using a device, so devices must be able to pass between the
player’s bench and the ice.

Engineers heard that players forgetting equipment was a significant problem.
(Shutterstock)

3. Players forgetting hockey items: Hockey requires a lot of equipment that needs regular airing and cleaning. Regardless of whether kids or parents pack an equipment bag, something can be left out, leading to pre-game disappointment. GBSA may be able to find an emergency replacement for items like elbow pads, but other items are too individual (like skates) or too personal (like jocks).

Each student group working with GBSA tackled one of these problems.

2. Understanding via empathizing, reframing

Design thinking involves engaging with the user and learning as much as possible. This means studying, even experiencing the situation. But more significantly it means experiencing empathy with the person or group whose problem it is. Empathy is defined as understanding and sharing the feelings of another person — like love, joy, satisfaction, disappointment, frustration, discouragement in a given situation.

Design thinkers ask as many questions and collect as much information as possible. The information is then weeded, sorted and prioritized. This is known as reframing.

By following an iterative process of empathizing and reframing, the target problem can be settled upon. It involves challenging assumptions and redefining problems to identify alternative strategies and solutions that might not be immediately apparent.

My colleague and I practised empathizing and reframing when establishing something close to the scope of a problem for each of the three opportunities with GBSA. Once we provided boundaries to this scope, we then knew that students could replicate this process by fine-tuning the parameters of each broad problem.

Student groups pursued unique empathetic, experiential and research efforts, with student groups asking many questions with a GBSA representative in a series of Zoom meetings. A typical zoom call involved about 20 to 50 students, asking a total of about 50 questions.

3. Define the solution

Students built different versions of assistive devices for skating.
(Western University Faculty of Engineering Communications)

A next stage involves generating ideas, trialling them via prototyping and then repeating this process until a solution is established.

This meant students developed a range of solutions which GBSA gave feedback on. Preferred solutions could then be championed by professors and executed by students hired to work in summer months.

For example, with the problem now established via research, experiential learning and empathy, students working on the learning to skate challenge built a small collection of assistive devices for skating which were then provided to GBSA for consideration.

Different student groups had yielded 10 different versions of assistive devices for skating, each with its own construction and assembly documentation. Among these different models, GBSA staff chose one to develop further in the summer months.

Software to track hockey equipment, pioneered through a student engineering design challenge.
(Mia Ezekowitz)

The project to track missing equipment yielded a favoured solution by GBSA: a software solution to be available for all GBSA families in 2024.

For the problem of playing beyond the whistle, students explored a range of ideas from American Sign Language, to other sensory approaches. ASL was tough to implement because the player is not always looking at the referee when play stops. One approach commonly settled on included introducing a system whereby when the referee blew an electronically modified whistle, an FM signal was transmitted from the whistle to a receiver on the player, who felt a vibration.

An early prototype for the problem of playing beyond the whistle.
(Western University Faculty of Engineering Communications), Author provided (no reuse)

Taking it a step further, professors were able to hire student support in the summer, and leverage on campus expertise, to generate open-source Bluetooth solutions. The transmission strategy remained the same, but the reception strategy changed to be altered from one of feeling vibration, to one of hearing “the play has stopped” in an existing hearing aid the player might be wearing.

“Hearing the whistle” solutions are under further investigation by the research team at the National Centre for Audiology at Western University, where work to replicate the Bluetooth solution for technical advances in Bluetooth known as “Auracast” is under consideration. Läs mer…

Hysterectomy is one of the most common inpatient surgeries. Currently, nearly one in three Canadian women aged 60 and older have had their uterus removed.

While this rate is falling, mainly due to greater use of non-surgical treatments for many gynecological conditions, hysterectomy appears to be normalized in Canada. Many women and some physicians view hysterectomy as a routine part of aging or natural step after childbearing.

This cultural acceptance is a problem because, in the long term, hysterectomy appears to be associated with an increased risk of heart problems and other chronic illnesses.

In Canada, approximately 35,000 hysterectomies are performed annually. The majority are for non-cancerous conditions such as abnormal uterine bleeding, fibroid growths, and pelvic organ prolapse.

In Alberta, the rate of hysterectomy is more than 20 per cent higher than the national rate (328 versus 269 per 100,000 adult women), and Canadian Institute for Health Information (CIHI) data shows the province has had a comparatively higher rate since 2010.

Hysterectomy and education

Within our team of medical professionals and health researchers, we know hysterectomy can have long-term health consequences and that it is overused in certain patient populations. Our research focuses on female reproductive health across the lifespan, with an overarching vision to make the future of women’s health a priority. We want to understand who is most at risk for poor health outcomes and identify strategies to reduce avoidable harm.

In a recent study, we investigated whether women with lower levels of education were more likely to have a hysterectomy, and at what ages.

Data show the relationship between education and the likelihood that a woman will have a hysterectomy.
(Brennand, McDonagh Hull, Scime), Author provided (no reuse)

We analyzed data from Alberta’s Tomorrow Project, a large, long-term study tracking health and chronic illness in Albertans. We studied almost 35,000 women over a 15-year period. The findings were stark: 29.7 per cent of women with a high school diploma or less had a hysterectomy, compared to 14.7 per cent with a university degree.

After we accounted for several social and medical factors, it appeared that women with a high school education were roughly 1.7 times as likely to have a hysterectomy than those with a university education. Even women with a college degree were approximately 1.6 times as likely to have a hysterectomy than those who were university educated.

We also found that less education meant women were more likely to have surgery at a younger age, and before menopause. This timing is important because when performed before natural menopause, hysterectomy appears to increase the risk of cardiovascular disease, osteoporosis and earlier onset of menopause symptoms.

Social disparities

Our findings raise important questions about social disparities in Canadian medical care. We know that women with lower levels of education often face economic challenges that can limit access to alternative treatments.

For example, if employment does not provide extended health benefits to cover the costs of medical management, women may view surgery — which is covered by Canada’s universal health-care system — as their only viable option. Moreover, they may have less access to health-care providers who are familiar with newer, non-surgical treatments, or who are willing to offer them.

Women with precarious employment or multiple roles at work and home may not be able to cope with unpredictable symptoms, such as unpredictable uterine bleeding, leading them to choose a more definitive treatment earlier.

Our research also questions whether health-care providers may be more likely to recommend surgery to women with less education, possibly due to biases or assumptions about women’s ability to afford or manage non-surgical treatments.

It is also possible that women with less education may have lower health literacy, affecting their ability to make informed decisions, or to participate in shared decision-making. Being less likely to question a doctor’s recommendations or seek second opinions could lead to a higher likelihood of surgery.

Despite medical advances reducing the need for hysterectomy, there are significant variations in its use across different groups of women.
(Brennand, McDonagh Hull, Scime), Author provided (no reuse)

It is evident that despite medical advances reducing the need for hysterectomy, there are significant variations in its use across different groups of women. This suggests some surgeries are not driven by medical necessity and may be avoidable. Our study adds to growing evidence calling for greater attention to the social determinants of female reproductive health. We expect it will require multiple approaches to address these disparities.

To begin with, it is essential to improve information about, and access to, non-surgical treatments for all women, including tailoring this as needed for those with less education. One potential area of improvement is Canada’s recent commitment to federal coverage for birth control, since this can provide excellent treatment for conditions such as heavy uterine bleeding.

Investment in pelvic floor physiotherapy is also necessary to ensure non-surgical treatment for pelvic organ prolapse is available to everyone.

Secondly, there is an urgent need for increasing awareness among health-care providers about the importance of shared decision-making and addressing unconscious bias.

Lastly, interventions to improve health literacy among women with lower education levels are critical to enable patients to be more active participants in their health-care decisions. It could also reduce the likelihood of experiencing a potentially avoidable hysterectomy and subsequent long-term health issues. Läs mer…

With this year’s annual United Nations Framework Convention on Climate Change Conference of the Parties (COP29) summit set to take place in a little over a month in Azerbaijan, the world’s attention once again turns to climate change, resource security and the goals of sustainable development.

The aims of sustainable development are to build a system that meets the needs of society without compromising the ability of future generations to fulfil their own. The UN adopted 17 sustainable development goals in 2015 and real progress has been made in advancing some of them. But can true sustainable development be achieved, and how might it work in practice?

I am an engineer with experience in mining and geotechnics. To help answer these questions, I have been researching the interplay between sustainability challenges in the natural resource sector, the evolving concept of the circular economy and the implications of economic models founded upon sustained growth.

Read more:
Mining the depths: Norway’s deep-sea exploitation could put it in environmental and legal murky waters

Striking a balance between resource extraction and environmental sustainability is essential for the continued existence of human societies and the risks of biodiversity loss must be accounted for in all resource extraction activities. At the same time, the need to protect the rights of all people — including Indigenous rights — remains paramount.

To help better understand the nuances of sustainable development, in my forthcoming research I propose a model of the impact(s) of human activities on the Earth’s planetary boundaries, which I refer to as the (un)sustainable machine.

Sustainable mining requires looking at the practices required to ensure long-term economic development remains in equilibrium with environmental and social considerations. The (un)sustainable machine model describes the delicate balancing acts at play, highlighting the intricate relationship between what drives minerals demand and consumption and how these forces impact Earth’s planetary boundary.

(Un)sustainable development

While progress may be being made in some areas of sustainable development — particularly around areas of poverty and malnutrition — as a planetary system, the report is much less positive. Take, for example, the issue of recycling.

The (un)sustainable machine model and its components.
(Davide Elmo), Author provided (no reuse)

Can recycling keep up with increased demand and counter resource extraction? Over 3.3 billion tonnes of metals are produced globally each year, and most demand predictions show rising consumption of metals in the coming decades.

Models developed by the World Bank indicate that by 2050, secondary supply (recycling) for aluminum, copper and nickel could meet about 60 per cent of the demand. Despite the enthusiasm among researchers and economists, however, these long-term projections indicate the difficulty of transitioning to a circular economy. Indeed, these predictions show that a 40 per cent unmatched demand must continue being supplied by primary sources like mining.

Read more:
Slow mining could be a solution to overconsumption in an increasingly fast-paced world

In my model, recycling is represented as a set of springs resisting the extraction of additional mineral resources. To achieve 100 per cent recycling of the entire spectrum of the mineral resources, our economy needs to solve problems that are not achievable with today’s technology. Furthermore, when developed on an industrial scale, recycling plants raise some of the same environmental challenges of large mineral processing and smelting plants.

Amidst this backdrop, the circular economy has presented itself as a transformative solution predicated on keeping products and materials in use, and regenerating natural systems. It challenges the linear extract-produce-dispose approach and questions the sustainability of perpetual economic growth, especially in a world with finite resources and known environmental constraints. Analogous to the (un)sustainable machine model, I also propose the model of the (un)sustainable cone of demand and consumption.

The (un)sustainable cone of demand and consumption and its (conceptual) implications for Earth’s planetary boundaries.
(Davide Elmo)

The (un)sustainable cone model highlights the discrepancy between an economic concept based on the idea of a closed-loop system (circular economy) and the current financial framework based on the idea that infinite growth is possible. The larger the unbalanced cross-sectional area of the (un)sustainable cone of demand and consumption, the larger the stresses imposed upon Earth’s planetary boundaries.

A different path?

To remain within Earth’s planetary boundaries requires solutions beyond simple technical means. Actions by a few individuals are not sufficient. As engineers, we often believe it is possible to develop solutions to mitigate the anthropogenic impacts on Earth’s planetary boundaries. However, by doing so, we fail to realize that finite barriers to growth remain and that our engineering solutions may in time become part of the problem.

Read more:
GDP is not enough to measure a country’s development. What if we used the Sustainable Development Goals instead?

It is essential for individuals who are not economists or environmental scientists to think about the meaning of sustainability in the context of extracting mineral resources. At the same time, economists and social-environmental scientists need to recognize that when it comes to mineral resources, policies and permitting regulations should not be addressed separately from the technical and economic aspects of mining engineering problems.

To paraphrase the work of eminent American social scientist Garrett Hardin:

Therein is the tragedy. Each financial market is locked into a system that compels it to increase its value without limit – in a world with finite resources. Earth’s ruin is the destination toward which all companies rush, each pursuing its own best interest in a market that (only) believes in the benefits of the shareholders.

Simply put, while both policy and technology are necessary to achieve true sustainability, unless our efforts are unified across discipline and economies, there is little hope for staying within the finite bounds of what our planet can provide. Läs mer…