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Mapping treatment advances in the neurobiology of binge eating disorder : a concept paper
No full textBinge eating disorder (BED) is a complex and heritable mental health disorder, with genetic, neurobiological, neuroendocrinological, environmental and developmental factors all demonstrated to contribute to the aetiology of this illness. Although psychotherapy is the gold standard for treating BED, a significant subgroup of those treated do not recover. Neurobiological research highlights aberrances in neural regions associated with reward processing, emotion processing, selfregulation and executive function processes, which are clear therapeutic targets for future treatment frameworks. Evidence is emerging of the microbiota-gut-brain axis, which may mediate energy balance, high-lighting a possible underlying pathogenesis factor of BED, and provides a potential therapeutic strategy
A snapshot of primary care physiotherapy management of knee osteoarthritis in an Australian setting : does it align with evidence-based guidelines?
No full textBackground: Systematic implementation of evidence-based, clinical practice guidelines for management of knee osteoarthritis (OA) in primary care physiotherapy in Australia is embryonic. Clinical practice guidelines have been implemented in the public healthcare sector at a State-level for physiotherapists in the form of multidisciplinary programs, but the reach of physiotherapy-led OA management programs is grossly inadequate in the private sector. Objective: To provide a snapshot of the management of people with knee OA in private physiotherapy practice in an Australian setting. Primarily the aim was to determine the alignment between the treatment provided and guideline-based management. Secondary aims included the capture of both patient-reported improvement after 3-months and patient satisfaction with treatment. Whether patient-reported outcome measures (PROMS) were routinely used was also ascertained. Methods: A prospective, observational study enrolling adults >=45Â years with knee OA across nine primary care physiotherapy practices. Knee injury OA Outcome Score (KOOS) and Routine Assessment Patient Index 3 (RAPID3) were collected (baseline; 3 months) by researchers along with satisfaction with treatment. Treatment details and use of PROMS were obtained from physiotherapy record audit and patient interview. The treatment provided was compared to the minimum core elements of management stipulated in OA management guidelines. Results: Twenty-six adults (58% female, mean age 60 (9) years, 54% overweight or obese) participated. 100% were prescribed ≥1 appropriate exercise(s); 42% received OA education; 12% received weight management advice. Mean improvement (95%CI) in KOOS Pain was 9.8 (3.4 to 16.1) and RAPID3 was −3.4 (−5.5 to −1.3). Satisfaction with treatment was high (8.3/10). No PROMs were used for assessment or monitoring. Conclusion: Primary care physiotherapy treatment of knee OA did not meet minimum criteria per clinical practice guidelines. However, participant improvement at three months reached minimally important change thresholds for patient-reported measures and satisfaction was high. The data provide useful insights about areas that are deficient, thus, should inform future implementation strategies designed to improve care delivery and the uptake of routine measurement of patient-reported outcomes
Communication and coordination of care for people living with HIV : a qualitative study of the patient perspective
No full textBackground: There is growing consensus that primary health care (PHC) providers have an important role in providing holistic, preventative care for people living with human immunodeficiency virus (PLHIV). In regional Australia, HIV care is primarily delivered through specialist services, thus adequate coordination and communication between specialist and PHC professionals is crucial. This study aimed to explore patient experiences of the coordination of care and health care professional communication for PLHIV in regional Australia. Methods: Semi-structured interviews with PLHIV in a regional area of Australia were conducted in March to April 2022. Interviews were conducted via video conferencing, face-to-face, or via telephone call. Interviews were audio-recorded and manually transcribed. Transcripts were coded inductively and thematic analysis was conducted to explore perspectives on communication and coordination. Results: Thirteen participants were interviewed. Most participants were male, aged 50–70, were diagnosed with HIV more than ten years ago, and had been living in regional Australia long-term. Through qualitative analysis, themes emerged in the following areas: (1) Patient perception of care coordination; (2) Patient understanding of modality of communication; (3) Positive attitudes towards communication between healthcare professionals; and (4) Concerns for information sharing between healthcare professionals. Many participants highlighted lack of clarity around care coordination as a key issue in their healthcare, with some citing themselves as the primary care coordinator. Participants identified that coordination and communication between PHC professionals and specialist services are essential in the delivery of their health care, but some were hesitant for this to occur. Hesitancy was entrenched in some patients’ distrust of healthcare due to previous experiences of confidentiality breaches and stigma. Conclusion: This study identifies the need for clarity in coordination between health care professionals to deliver safe and effective HIV care, which may occur through care plans. Patient support for communication between healthcare providers may be strengthened by ensuring trust in the people and systems involved. Eliminating stigma in healthcare as well as building more trustworthy electronic-based communication technologies are essential components to trust-building between PLHIV and healthcare systems
Two sympatric lineages of Australian Cnestus solidus share Ambrosiella symbionts but not Wolbachia
No full textSympatric lineages of inbreeding species provide an excellent opportunity to investigate species divergence patterns and processes. Many ambrosia beetle lineages (Curculionidae: Scolytinae) reproduce by predominant inbreeding through sib mating in nests excavated in woody plant parts wherein they cultivate symbiotic ambrosia fungi as their sole source of nutrition. The Xyleborini ambrosia beetle species Cnestus solidus and Cnestus pseudosolidus are sympatrically distributed across eastern Australia and have overlapping morphological variation. Using multilocus sequencing analysis of individuals collected from 19 sites spanning their sympatric distribution, we assessed their phylogenetic relationships, taxonomic status and microbial symbionts. We found no genetic differentiation between individuals morphologically identified as C. solidus and C. pseudosolidus confirming previous suggestions that C. pseudosolidus is synonymous to C. solidus. However, within C. solidus we unexpectedly discovered the sympatric coexistence of two morphologically indistinguishable but genetically distinct lineages with small nuclear yet large mitochondrial divergence. At all sites except one, individuals of both lineages carried the same primary fungal symbiont, a new Ambrosiella species, indicating that fungal symbiont differentiation may not be involved in lineage divergence. One strain of the maternally inherited bacterial endosymbiont Wolbachia was found at high prevalence in individuals of the more common lineage but not in the other, suggesting that it may influence host fitness. Our data suggest that the two Australian Cnestus lineages diverged allopatrically, and one lineage then acquired Wolbachia. Predominant inbreeding and Wolbachia infection may have reinforced reproductive barriers between these two lineages after their secondary contact contributing to their current sympatric distribution
[In Press] Supporting preservice teachers to implement an alternative physical education pedagogy on practicum
No full textBackground: Various student-centred teaching approaches have been promoted within physical education teacher education (PETE) courses for many years. However, building preservice teachers’ (PTs’) pedagogical skills for the effective implementation of these approaches beyond university and into their school practicum has been challenging for PE teacher educators. A recent study by Moy, Rossi, and Russell ([2023]. “Supporting PETE students to Implement an Alternative Pedagogy.” Physical Education and Sport Pedagogy 28 (2): 165–182.) investigated a practical university teaching experience widely suggested by researchers to overcome this challenge. The experience involved PTs working in small groups in collaboration with a pedagogical expert to explore the implementation of the student-centred constraints led approach (CLA) in an authentic but simplified physical education context. The authors found that the teaching experience was effective in supporting PT’s learning and implementation of the key principles of the alternative pedagogy. Whilst these results are encouraging, it was deemed critical to investigate the effectiveness of the university teaching experience in a transition to a more authentic teaching environment, namely the school practicum. Purpose: The study sought to follow these same PTs and investigate how this learning gained through the university teaching experience influenced their teaching practice while on their subsequent school practicum. Participants and Setting: The study sample consisted of 36 of the 40 PTs who participated in the study by Moy, Rossi, and Russell ([2023]. “Supporting PETE students to Implement an Alternative Pedagogy.” Physical Education and Sport Pedagogy 28 (2): 165–182.). Participation involved undertaking a 4-week block of supervised practicum at an Australian secondary school, and then submitting an individual written reflection about the influence of the university teaching experience on their practicum teaching practice. Data collection and analysis: To improve the trustworthiness of PTs’ accounts of their experiences, two qualitative sources, written reflections, and a semi-structured focus group interview, were used to collect data. Data from both sources were combined and analysed collectively using thematic analysis to identify repeated patterns of meaning within the data. Results: According to PT’s accounts, the research-informed university teaching experience appears to have had a profound impact on their teaching practice on practicum. PTs recounted their ability to effectively design and deliver physical education learning environments that embedded the same pedagogical principles they learned to embed in their teaching practice at university. The main factors that facilitated this transfer were the design and delivery of the university teaching experience and a supportive school practicum environment. Conclusion: This study has provided evidence of a practical teaching experience that has the capacity to facilitate the transition of learning from university to the ‘real world’. This model has the potential to improve teaching quality not only in physical education but across all subject areas and importantly enhance student learning outcomes in schools
Outdoor climate drives diversity patterns of dominant microbial taxa in caves worldwide
No full textThe cave microbiota is assumed to be shaped by indoor microclimate, biotic and abiotic factors, which are largely dependent from outside environmental conditions; however, this knowledge is available at local or regional scales only. To address this knowledge gap, we reanalyzed over 1050 bacterial and fungal communities of caves worldwide, and found that outdoor temperature and rainfall play a critical role in explaining differences in microbial diversity patterns of global caves, selecting specific dominant taxa across gradients of growing aridity conditions with arid climate leading to a reduction in total cave microbial diversity. Moreover, we found that fungal (from 186 to 1908 taxa) and bacterial (from 467 to 1619 taxa) diversity increased under temperate-tropical and temperate-continental climatic regions, respectively, highlighting an opposite preference for the two microbial compartments. We hypothesized that outdoor geographical, climatic variables and lithology are critical epistatic drivers in assembling microbial communities and their dominant taxa, whose ecological responses could be useful to predict the fate of these subterranean environments in the context of climate change. Our work elucidates the intimate connection between caves microbiota and surface ecosystems highlighting the sensitivity of cave microbial communities to climatic changes and environmental degradation. This work also provides a natural benchmark for the biogeographic information for caves globally and for protection strategies aiming at conservation of underground environments
[In Press] Developing a haemodialysis acuity tool (the HAT study) : a qualitative study
No full textBackground: Haemodialysis units are now managing an increasing number of patients with varying needs and levels of acuity. To maintain safety, haemodialysis patients must be placed in the most appropriate dialysis unit that has the required human and physical resources to care for them. The first step towards achieving these goals is to develop a tool specific to haemodialysis units to effectively measure patient acuity. Objective: To develop a haemodialysis acuity tool, utilising a focus group approach, in assessing patient's suitability for a specific dialysis location thus ensuring patient safety. Design: This is a cross-sectional qualitative study via a focus group approach. Participants: Participants were nurse unit managers and team leaders of a District Renal Service. Approach: Participants were interviewed to explore their views on the elements and measures identified in the research aims. Themes for interviews were informed by current literature on acuity tools for haemodialysis patients' admission to the dialysis units. Interviews were recorded and transcribed verbatim and progressively analysed using a thematic analysis approach. Results: Ten nurse unit managers/team leaders (100%) were interviewed and thematic analysis of the transcripts was conducted utilising the deductive approach. Five themes were identified which will form the main categories in the development of the tool, namely: Age/frailty; co-morbidity; physical; dialysis; and psychosocial. Conclusion: This study is instrumental in the development of the haemodialysis acuity tool which can be used in allocating dialysis location specific to patient's needs and available resources. The tool can also be used in analysing patient care processes and resource requirements based on the patients’ and unit's profile
Trends and projections of cause-specific premature mortality in Australia to 2044 : a statistical modelling study
No full textBackground: Long-term projections of premature mortality (defined as deaths age <75 years) help to inform decisions about public health priorities. This study aimed to project premature mortality rates in Australia to 2044, and to estimate numbers of deaths and potential years of life lost (PYLL) due to premature mortality overall and for 59 causes. Methods: We examined the past trends in premature mortality rates using Australian mortality data by sex, 5-year age group and 5-year calendar period up to 2019. Cigarette smoking exposure data (1945–2019) were included to project lung cancer mortality. Age-period-cohort or generalised linear models were developed and validated for each cause to project premature mortality rates to 2044. Findings: Over the 25-year period from 1990–1994 to 2015–2019, there was a 44.4% decrease in the overall age-standardised premature mortality rate. This decline is expected to continue, from 162.4 deaths/100,000 population in 2015–2019 to 141.7/100,000 in 2040–2044 (12.7% decrease). Despite declining rates, total numbers of premature deaths are projected to increase by 22.8%, rising from 272,815 deaths in 2015–2019 to 334,894 deaths in 2040–2044. This is expected to result in 1.58 million premature deaths over the 25-year period 2020–2044, accounting for 24.5 million PYLL. Of the high-level cause categories, cancer is projected to remain the most common cause of premature death in Australia by 2044, followed by cardiovascular disease, external causes (including injury, poisoning, and suicide), and respiratory diseases. Interpretation: Despite continuously declining overall premature mortality rates, the total number of premature deaths in Australia is projected to remain substantial, and cancer will continue to be the leading cause. These projections can inform the targeting of public health efforts and can serve as benchmarks against which to measure the impact of future interventions. They emphasise the ongoing importance of accelerating the prevention, early detection, and treatment of key health conditions. Funding: No funding was provided for this study
Quah Ee Ling: If the Situation Is Sick, You Will Be Too
No full textIn this DearNelly Podcast espisod, Nelly and Dr Ee Ling Quah talk about marriage migration, PTSD, social anxiety and the idea that couples that grow and change together have the best chance. They talk about what romance actually is and how social introverts can manage dating and socialising. They take a listener letter on how to make friends when you have social anxiety and are a bit longer in the tooth
Temperature-dependent cutting physics in orthogonal cutting of carbon fibre reinforced thermoplastic (CFRTP) composite
No full textThe global commitment towards reducing carbon emissions drives the implementation of sustainable carbon- fibre-reinforced-thermoplastic composites (CFRTPs). However, the machining of CFRTPs presents challenges due to the material’s ductile–brittle composition and sensitivity to machining-induced high temperatures. For the first time, we conducted temperature-controlled orthogonal cutting of CFRTP (using CF/PEKK as a demonstrator) to unveil its temperature-dependent cutting physics. Three representative cutting temperatures, 23 ℃ (ambient temperature),100 ℃ (T g ) and four typical fibre cutting orientations (0◦, 45◦, 90◦, and 135◦) have been investigated. The evolution of chip microstructural morphology and surface/subsurface damage have been analysed by advanced microscopy to reveal temperature-dependent material removal mechanisms. The experimental results were elucidated through a novel microscale finite- element-analysis (FEA) model considering thermal softening of the matrix and interface. Results show the transition of the cutting physics with increasing temperature is associated to the degradation of the thermoplastic matrix stiffness/ultimate strength and interface bonding strength and fracture toughness, especially when > Tg