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Pericatheter leak associated with earlier peritoneal dialysis initiation does not influence long-term outcomes
No full textIntroduction: Internationally, peritoneal dialysis (PD) is increasingly being commenced within 2 weeks of catheter insertion. Studies are warranted to evaluate outcomes of this strategy.
Methods: This study examines outcomes of early-start PD (ESPD) and conventional-start PD (CSPD), commencing at ≤14 days and >14 days after catheter insertion, respectively. All adults with kidney failure within a large metropolitan PD unit initiating PD through a new catheter, inserted using laparoscopic or modified Seldinger technique, between August 2019 and August 2022, were included in this retrospective observational study. Demographic data and episodes of infectious and mechanical complications were collected using electronic medical records. Analysis was conducted using analysis of variance and Chi-square testing. A P-value < 0.05 was significant with Bonferroni correction performed where relevant. Kaplan-Meier and competing risks analyses were performed for time to PD-related peritonitis and transfer to hemodialysis.
Results: A total of 297 patients (70% male, mean age 58.7 years) were included, with 130 (43.8%) patients undertaking ESPD. Most patients had laparoscopically inserted catheters (65.3%) and 65 patients (22.0%) received prior hemodialysis. When compared to CSPD, ESPD was associated with a higher number of pericatheter leaks (6.9% vs. 0.6%, P = 0.003), with otherwise similar complication episodes and no significant difference with respect to time to PD-related peritonitis or transfer to hemodialysis. Catheter insertion technique or prior hemodialysis treatment did not significantly influence outcomes.
Conclusion: ESPD is associated with increased pericatheter leaks when compared to CSPD, with an otherwise similar complication profile
Levator–urethra gap : is there a need for individualization of cut-offs?
No full textObjectives: To determine whether height, weight and body mass index (BMI) are associated with the levator–urethra gap (LUG) measurement, and whether these factors confound the relationship between LUG and symptoms and signs of pelvic organ prolapse (POP).
Methods: This was a retrospective study of women seen at a tertiary urogynecology unit between January 2020 and December 2021. Postprocessing of saved ultrasound volume data was used to measure the LUG, blinded against all other data. This measurement was tested for its association with organ descent and hiatal area, and height, weight and BMI were investigated for any potential confounding effect.
Results: The 624 women seen during the inclusion period presented mostly with stress urinary incontinence (448/624 (72%)), urgency urinary incontinence (469/624 (75%)) and/or prolapse (338/624 (54%)). Mean age at assessment was 58 (range, 20–94) years, mean height was 163 (range, 142–182) cm, mean weight was 80 (range, 41–153) kg and mean BMI was 30 (range, 17–65) kg/m2. LUG measurements could be obtained in 613 women, resulting in 7356 (12 x 613) measurements. The average LUG in individual women measured 2.35 cm on the right and 2.32 cm on the left side (difference not significant), with a mean ± SD of 2.34 ± 0.63 cm overall. Mean LUG was associated with symptoms and signs of prolapse, both on clinical examination (POP quantification system) and on imaging, but not with height (P = 0.36), weight (P = 0.20) or BMI (P = 0.09).
Conclusions: Levator–urethra gap measurements do not seem to be significantly associated with height, weight or BMI in our population, obviating the need for individualization of LUG. However, this does not exclude interethnic variability of this biometric measure
Exploring neuropsychological underpinnings of poor communication after traumatic brain injury : the role of apathy, disinhibition and social cognition
Full text linkBackground: Dysarthria, aphasia and executive processes have been examined for their role in producing impaired communicative competence post traumatic brain injury (TBI). Less understood is the role of emotional dysregulation, that is, apathy and disinhibition, and social cognition, that is, reading and interpreting social cues.
Methods & Procedures: In this study, we examined 49 adults with moderate to severe TBI and 18 neurologically healthy adults. We hypothesised that apathy and disinhibition would predict communication outcomes as would social cognition. We also predicted that apathy and disinhibition would influence social cognition. Communication outcomes were measured by the La Trobe Communication Questionnaire (LCQ) and the Social Skills Questionnaire-TBI (SSQ-TBI). Apathy and disinhibition were measured by the Frontal Systems Behavior Scale (FrSBe). We measured four aspects of social cognition: emotion perception and theory of mind using The Awareness of Social Inference Test (TASIT) and the Complex Audio-Visual Evaluation of Affect Test (CAVEAT), empathy using the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Balanced Emotional Empathy Scale (BEES), and alexithymia using the Toronto Alexithymia Scale (TAS-20) and the Bermond–Vorst Alexithymia Questionnaire.
Outcomes & Results: Consistent with predictions, the LCQ and SSQ-TBI were associated with disinhibition and the LCQ was also associated with apathy. The LCQ was associated with the full range of social cognition constructs although the SSQ-TBI was not. Finally, apathy and disinhibition predicted a number of social cognition measures.
Conclusions and Implications: These results are discussed in relation to understanding the nature of communication disorders following TBI and how they are measured, as well as the interrelation between emotion dysregulation and social cognition
Experiences and challenges related to wellbeing faced by Australian higher degree research candidates prior to and during the COVID-19 pandemic
Full text linkHigher degree research candidates experience higher rates of anxiety and depression than the general population. This study explored the wellbeing and experiences of two independent groups of HDR candidates. One participating prior to the pandemic, and the second group during the COVID-19 pandemic. A mixed methods study comprising of a survey and focus group were conducted with 17 participants. The results of this preliminary study suggest there may have been differences in HDR candidates’ wellbeing between pre-pandemic and those participating in the study during COVID-19. However, the study sample was small, and the results cannot be generalised to the HDR cohort. Two main themes were identified from the focus groups: ‘wellbeing challenges, culture and connectivity’ and ‘university response: culture and connectivity’. Some participants identified multiple stressors that impacted their wellbeing including challenges of establishing a research community to support their voice, and identity. Additional challenges that related to connectivity were evident for international students during COVID-19, due to international border closures in Australia. Further studies are needed to inform evidence-based policies
Aotearoa New Zealand : is the grass really greener here? : social, political and cultural implications of COVID-19 in New Zealand
No full textIn global terms, New Zealand (NZ) has managed COVID-19 comparatively well, with low case and death rates, until the arrival of the Omicron variant in November 2021. Like many other states, the New Zealand government has used public health ordinances to impose restrictions on immigration, limit movement within New Zealand, enact regulations on social distancing and impose occasional lockdowns. Low transmission and case rates translated into high public support for the government’s response, which waned from October 2021 onwards. We attribute this initial high buy-in to a rigorous evidence-based policy and regulation approach and the clear and often empathetic communication by political leaders and other government officials. Nonetheless, New Zealand’s pandemic responses have directly visible, but also unintended, consequences such as the stigmatisation of some groups or the delay of surgeries. While enacting policies such as closing borders and requiring a ‘lockdown’ was swift and firm each time, and accompanied by an attempt to develop a disposition of care and empathy towards the public, more critical engagement with this approach and public health measures are warranted. This chapter will shine a light on the less-heard stories and consequences of the ’winner narrative’ often used in the New Zealand context to highlight the lived experiences, rifts in and consequences of the public health ordinances in New Zealand
Cognitive and behavioral abnormalities in individuals with Alzheimer’s disease, mild cognitive impairment, and subjective memory complaints
No full textIn this study, we investigated the ability of commonly used neuropsychological tests to detect cognitive and functional decline across the Alzheimer’s disease (AD) continuum. Moreover, as preclinical AD is a key area of investigation, we focused on the ability of neuropsychological tests to distinguish the early stages of the disease, such as individuals with Subjective Memory Complaints (SMC). This study included 595 participants from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset who were cognitively normal (CN), SMC, mild cognitive impairment (MCI; early or late stage), or AD. Our cognitive measures included the Rey Auditory Verbal Learning Test (RAVLT), the Everyday Cognition Questionnaire (ECog), the Functional Abilities Questionnaire (FAQ), the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog), the Montreal Cognitive Assessment scale (MoCA), and the Trail Making test (TMT-B). Overall, our results indicated that the ADAS-13, RAVLT (learning), FAQ, ECog, and MoCA were all predictive of the AD progression continuum. However, TMT-B and the RAVLT (immediate and forgetting) were not significant predictors of the AD continuum. Indeed, contrary to our expectations ECog self-report (partner and patient) were the two strongest predictors in the model to detect the progression from CN to AD. Accordingly, we suggest using the ECog (both versions), RAVLT (learning), ADAS-13, and the MoCA to screen all stages of the AD continuum. In conclusion, we infer that these tests could help clinicians effectively detect the early stages of the disease (e.g., SMC) and distinguish the different stages of AD
Teaching and learning the art of nursing through aged care work experience
No full textTo explore how working as an undergraduate Assistant in Nursing, in an aged care setting, contributed to the preparation of novice nurses for new graduate practice. The art of nursing, while not clearly defined reflects behaviors and actions that embody the values of nursing. The aged care setting is underutilized as a clinical learning environment but can potentially teach novice nurses the importance of human relationships and connectedness that underpin the art of nursing. This paper reports on the qualitative phase of a broader study. Semistructured interviews were used to collect narrative data. Narrative analysis was undertaken to construct meaning from stories shared by participants. The COREQ checklist was used as the reporting framework for the study. The aged care setting was found to be a valuable learning environment for novice nurses. Two primary narratives are presented: aged care as a learning environment, which describes barriers and supportive learning factors within the aged care setting; and learning the complexities of nursing care, which illustrates the significance of caring interactions and the practice of holistic care. The value of aged care work experience is in developing humanistic skills such as the importance of social interaction. These are paramount to providing care and building therapeutic relationships
Digital twin for indoor condition monitoring in living labs : university library case study
No full textDigital twin, a technology bridging the physical and digital domains, has found extensive application in digitally advanced industries. However, its adoption in the construction sector remains limited, hindered by challenges related to construction, integration with real-time data capture, and visualisation platforms. This paper presents a construction industry digital twin that combines Building Information Modelling-based data visualisation with an Internet of Things-driven live data capture platform, outlining a methodology for its development. The digital twin was implemented in a university library embodying the ‘Living Lab’ concept to account for the nuances associated with live environments. It integrates sensors with Building Information Modelling to offer a semiotic representation of the library's internal conditions in digital twin, empowering facility managers to proactively optimize thermal, lighting, and air quality
Childhood cumulative trauma, social support and stress as predictors of illness outcomes and quality of life in bipolar disorder
No full textObjective: Trauma, social support and stress have been identified as factors which may be associated with the bipolar disorder illness course. However, these are yet to be examined in prospective studies as predictors of illness outcomes and overall quality of life in bipolar disorder. Method: One hundred and fourteen participants (N=97; 85.1% female) living with bipolar disorder I (41.2%) or II (58.8%) completed a semi-structured interview and a range of self-report measures assessing trauma history, social support, perceived stress, depression, anxiety, mania, suicidality, number of mood episodes and quality of life, at baseline and 6-month follow-up. Results: Childhood cumulative trauma, social support and perceived stress accounted for a substantial and significant portion of the variance in quality of life (62%; 23.6%), anxiety severity (34.6%; 24.5%) and depression severity (49.6%; 26.7%), at both baseline and 6-month follow-up. Perceived stress made significant unique contributions to the prediction of all outcomes, and social support made significant unique contributions to depression and quality of life in bipolar disorder. Conclusion: Stress and social support play an important role in bipolar disorder and in quality of life for people living with this condition. Given that stress and social support are modifiable risk factors, this provides a promising direction for future intervention-based research
Dynamics of power and participation : lessons from Cambodia and Thailand
No full textThis chapter draws on two initiatives launched in Thailand and Cambodia, inspired by strength-based capacity-building approaches known as ‘asset-based community development’ (ABCD) and ‘Appreciative inquiry’ (Ai). Our approach challenges western-centric conceptions of equality in participatory design and novelty in the creative process. In Cambodia, a failed experiment with bamboo furniture led to the re-evaluation of welfare safety nets and sustainable social arrangements. In Thailand, an initiative revealed a multitude of capacities among Karen migrants that were considered as important by an economic development NGO, but also revealed that a high priority for Karen migrants themselves was the veneration of their culture, which renewed the conversation about development priorities. By discussing contexts in which real-world decisions are embedded, we offer designers and researchers insight into how local dynamics become articulated through capacity building. We seek to sharpen design discourse regarding hierarchies of knowledge and power, and the factors underlying the adoption or rejection of solutions by communities