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Effectiveness of nasal high-flow oxygen during apnoea on hypoxaemia and intubation success in paediatric emergency and ICU settings: a randomised, controlled, open-label trial
No full textBACKGROUND: The use of nasal high-flow (NHF) oxygen for apnoeic oxygenation during emergency paediatric intubation is not universally adopted. Although previous studies suggest potential benefits, it remains unclear whether NHF enhances the likelihood of achieving successful first-attempt intubation without oxygen desaturation in children. We aimed to investigate whether the provision of NHF oxygen during paediatric emergency intubation can improve intubation outcomes.METHODS: We conducted a randomised, controlled, open-label trial at ten hospitals in Australia, New Zealand, and Switzerland (four emergency departments, ten paediatric intensive care units, and one non-maternity neonatal intensive care unit were included). Children younger than 16 years undergoing emergency endotracheal intubation were eligible for inclusion. Participants were randomly assigned (1:1) to receive either NHF apnoeic oxygenation or standard care during intubation. The primary outcomes were the occurrence of hypoxaemic events (defined as oxygen saturation [SpO 2] ≤90%) and successful intubation on the first attempt without desaturation in the modified intention-to-treat population (all intubations in participants for whom prospective or retrospective consent was given and a primary outcome was recorded). This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000147381) and is now completed. FINDINGS: Between May 9, 2017, and Oct 22, 2022, 1069 intubations in 969 children were randomly assigned to the NHF group (535 intubations) or standard care group (534 intubations). The primary analysis comprised 950 intubations in 860 children, with 476 intubations in the NHF group and 474 in the standard care group. In the NHF group, hypoxaemic events occurred in 61 (12·8%) of 476 intubations, compared with 77 (16·2%) of 474 in the standard care group (adjusted odds ratio [aOR] 0·74; 97·5% CI 0·46-1·18; p=0·15). Successful intubation was achieved at the first attempt in 300 (63·0%) of 476 intubations in the NHF group and 280 (59·1%) of 474 intubations in the standard care group (aOR 1·13; 97·5% CI 0·79-1·62; p=0·43). In the per-protocol analysis of 905 intubations, NHF reduced the rate of hypoxaemia (48 [10·8%] of 444) compared with standard care (77 [16·7%] of 461; aOR 0·59; 97·5% CI 0·36-0·97; p=0·017). In this analysis, first-attempt successful intubation was achieved in 284 (64·0%) of 444 intubations in the NHF group versus 268 (58·1%) of 461 intubations in the standard care group (aOR 1·22; 97·5% CI 0·87-1·71; p=0·19).INTERPRETATION: The use of NHF during emergency intubation in children did not result in a reduction in hypoxaemic events or an increase in the frequency of successful intubation on the first attempt. However, in the per-protocol analysis, there were fewer hypoxaemic events but no difference in successful intubation without hypoxaemia on first attempt. Barriers to the application of NHF during emergency intubation and the reasons for abandoning intubation attempts before physiological compromise should be further investigated to inform future research and recommendations for intubation guidelines and clinical practice.FUNDING: Thrasher Research Fund (USA), National Health and Medical Research Council (Australia), and the Emergency Medicine Foundation (Australia).</p
A review of structural health challenges in community title schemes above three storeys in Queensland
Get PDFThe Community Title Scheme (CTS) sector in the state of Queensland, is in a state of rapid development with high rise residential buildings all along its coastline from Coolangatta through to Noosa, with the Gold Coast and Brisbane having the densest concentrations. With limited or no structural health knowledge or foresight, and after builders’ warranty expiry or bankruptcy, lot owners are at the mercy of a structural health event occurring. The consequences of such an event can cause death or leave lot owners and their tenants with no recourse to remedy and possible financial ruin. This paper reviews structural health challenges in Queensland's Community Title Schemes, identifying significant management deficiencies, inadequate maintenance practices, and insufficient regulatory oversight. These gaps can contribute to unforeseen and devastating structural failures or a temporary or permanent building evacuation order. The paper advocates for regular, qualified inspections and the creation of a structural health registry to improve oversight and reduce risks, proposing foundational strategies for future research and policy development for the sector
Determinants of Physical Activity 10 Months Following a Supervised Exercise Program in People With Type 2 Diabetes
No full textAIMS: Supervised exercise provides numerous health benefits for people with type 2 diabetes mellitus (T2D); however, long-term adherence is poor. We aimed to identify (1) factors associated with total physical activity (PA) participation 10 months following supervised exercise and (2) barriers to and enablers of self-directed exercise.METHODS: Fifty-seven adults with type 2 diabetes mellitus (age: 60.4 [8.6] y, 23% women, glycated hemoglobin [HbA1c]: 8.7% [1.9%], PA: 68.1 [142.3] min·wk-1) were allocated to low-volume combined aerobic and resistance high-intensity interval training (78 min·wk-1) or combined moderate intensity continuous training (210 min·wk-1). Participants completed 8 weeks of supervised training, then 10 months of self-directed exercise (12 mo total). Sociodemographic, medical, psychological, and health determinants of total PA at 12 months were identified using correlation and multiple regression analyses. Barriers and enablers were derived from individual participant interviews.RESULTS: At 12 months, average weighted total PA was 209.4 (174.3) minutes per week. Only allocation to combined aerobic and resistance high-intensity interval training was an independent predictor of total PA at 12 months (β = 0.477, P = .027). Enablers of self-directed exercise included flexible exercise schedule and social support. Barriers were limited access to specialized equipment and competing time demands.CONCLUSIONS:This study highlights factors to consider when designing long-term exercise support for people with type 2 diabetes mellitus
Automating Research Synthesis with Domain-Specific Large Language Model Fine-Tuning
No full textThis research pioneers the use of fine-tuned Large Language Models (LLMs) to automate Systematic Literature Reviews (SLRs), presenting a significant and novel contribution in integrating AI to enhance academic research methodologies. Our study employed advanced fine-tuning methodologies on open sourced LLMs, applying textual data mining techniques to automate the knowledge discovery and synthesis phases of an SLR process, thus demonstrating a practical and efficient approach for extracting and analyzing high-quality information from large academic datasets. The results maintained high fidelity in factual accuracy in LLM responses, and were validated through the replication of an existing PRISMA-conforming SLR. Our research proposed solutions for mitigating LLM hallucination and proposed mechanisms for tracking LLM responses to their sources of information, thus demonstrating how this approach can meet the rigorous demands of scholarly research. The findings ultimately confirmed the potential of fine-tuned LLMs in streamlining various labor-intensive processes of conducting literature reviews. As a scalable proof-of-concept, this study highlights the broad applicability of our approach across multiple research domains. The potential demonstrated here advocates for updates to PRISMA reporting guidelines, incorporating AI-driven processes to ensure methodological transparency and reliability in future SLRs. This study broadens the appeal of AI-enhanced tools across various academic and research fields, demonstrating how to conduct comprehensive and accurate literature reviews with more efficiency in the face of ever-increasing volumes of academic studies while maintaining high standards.</p
Exploring behaviour change skill development during final placements: Practice educator and student perspectives
No full textAims:The integration of behaviour change science into dietetics education is crucial for developing competent health practitioners. However, the ability of final placements to provide student dietitians with the opportunity to practice skills for supporting dietary behaviour change is not yet understood. This study aims to explore how placements shape the development of dietetics students' knowledge and skills in behaviour change through the novel approach of drawing on practice educator and student perspectives.Methods:Using a constructivist approach, qualitative data were collected through semi-structured interviews with practice educators and focus groups with graduating dietitians. Questions aimed to explore the practice educator role in developing student behaviour change skills and aspects of hospital placement that improved student confidence. Data were transcribed verbatim and analysed using inductive thematic analysis to identify key themes and sub-themes.Results:Eleven hospital-based practice educators and eight dietetics graduands participated. Three key themes were identified: (1) limited modelling of behaviour change within a hospital placement; (2) experiential learning needed to consolidate behaviour change skill development; and (3) the need to strengthen behaviour change science in dietetics. Throughout each theme, educators and students described challenges to skill development on placement, such as limited opportunities to practise behaviour change interventions, insufficient attention to behaviour change in feedback and assessment, and differing educator confidence in teaching these skills.Conclusions:This study suggests a need to strengthen opportunities for students to link theoretical and practical learning of behaviour change skills to work toward producing a workforce of confident behaviour change agents
A systematic review of applications, manipulations and manipulation checks of construal level theory in advertising
No full textAdvertising research has increasingly applied construal level theory (CLT) to predict advertising effectiveness. This study systematically reviews and synthesizes CLT-based advertising research by focusing on the theoretical tenets of CLT, construal-level manipulations, and construal-level manipulation checks applied in this research domain. This is the first systematic review of CLT-based advertising research involving psychological distance, which is the distance from self, here, and now. The review identified 86 relevant articles published in top-ranked journals between 2009 and 2023, retrieved from seven electronic academic databases. It found that CLT-based advertising studies are primarily anchored on the theoretical tenets of matching effect, categorization effect, and psychological distance. It further identified and classified the construal-level manipulations used in CLT-based advertising research into three categories: psychological-distance dimensions, psychological manipulations, and marketing-related factors. Finally, this review highlights the critical gaps in existing research and offers avenues for future research
Hypoxia and Cognitive Ability in Humans: A Systematic Review and Meta-Analysis
No full textThis systematic and meta-analytical review examined how a reduction in oxygen availability to tissue (hypoxia) affects cognitive function. Hypoxia had a moderate-to-large detrimental effect on general cognitive ability and across domains, including memory, attention, executive function, processing speed, and psychomotor speed. Increased hypoxic severity was associated with greater declines in general cognitive ability and executive function, while longer duration of exposure was associated with greater declines in executive function and psychomotor speed. Participant age was a moderator for executive function and psychomotor speed, with older adults experiencing greater impairments. For executive function and psychomotor speed, the magnitude of these effects was less pronounced during intermittent and hypobaric exposures, potentially due to adaptive physiological mechanisms. While our models accounted for exposure characteristics and age of participants, substantial unexplained variance remained. These findings highlight hypoxias impact on cognition and emphasize the need to investigate underlying neurophysiological mechanisms that may influence individual vulnerability.Competing Interest StatementThe authors have declared no competing interest
Patient outcomes and surgical strategies in revision cervical arthroplasty following M6-C™ disc-related osteolysis
Get PDFPURPOSE: Periprosthetic osteolysis from the M6-C™ Artificial Cervical Disc (Orthofix, Lewisville, Texas) has become a significant issue, sometimes requiring revision spine surgery (RSS). This study evaluates patient-reported outcome measures (PROMs) and revision strategies for managing device-related wear and osteolysis.METHODS: PROMs, including the Visual Analogue Scale (VAS) for neck/arm pain and the Neck Disability Index (NDI), were analyzed at pre-index surgery (T1), pre-RSS (T2), and final follow-up (T3). Osteolysis severity was graded radiographically. A control group who underwent primary M6-C cervical total disc replacement (CTDR) without RSS was included for comparison.RESULTS:Of 53 patients with M6-C CTDR, 19 (35.9%) required RSS due to osteolysis. Osteolysis grades included Grade 1 (4 patients), Grade 2 (7 patients), Grade 3 (3 patients), and Grade 4 (5 patients). Revision strategies included removal and anterior fusion, requiring vertebrectomy for Grade 4 cases; revisions to a different CTDR prosthesis were reserved for Grades 1-3. The RSS group showed significant VAS neck pain improvement at T3 (mean = 36.2 points, p < 0.001), exceeding the minimum clinically important difference (MCID). However, VAS arm pain and NDI did not meet MCID thresholds. The control group showed clinically significant improvements across all PROMs. At T2, the RSS group had a higher disability (NDI, p = 0.027) than the controls.CONCLUSION: Revision surgery for M6-C osteolysis improves neck pain, not arm pain or disability. Early detection and tailored revision strategies are crucial to optimize patient outcomes and mitigate osteolysis-related disability
Business model innovation and its impact on the diffusion of innovation in construction business organizations
No full textThe evolving business landscape, driven by digitalization and environmental, social, and governance (ESG) considerations, requires a systems approach to construction business. The discussion around digitalization as a key driver of innovation and a catalyst for change has been crucial, prompting construction organizations to adapt their business models. Due to the dynamic nature of the construction industry, construction organizations often encounter challenges in embracing new technologies and updating their business models to meet changing market demands. Consequently, business model innovation often takes a backseat. This chapter delves into how innovation, particularly driven by public sector clients, can influence business model innovations in construction organizations, drawing insights from an extensive literature review and the Hong Kong Housing Authority case. The findings suggest that construction organizations may be more inclined to adopt new technologies, implement systems, and explore business model innovations when public policies are in place to support such initiatives
Climate and Environment in CCP’s Control Strategy in Tibet
No full textThe Tibetan Plateau is warming rapidly, leading to significant ecological changes and threatening water security for millions. This issue brief examines the impact of the Chinese Communist Party’s (CCP) governance on Tibet’s environment and the global environment. Rooted in Marxism-Leninism, the CCP’s governance model prioritizes Party control, resulting in policies that often neglect environmental and global concerns. The CCP’s development projects exacerbate these issues, causing habitat fragmentation and pollution. Social and cultural impacts include the erosion of Tibetan identity and traditional lifestyles. China’s global initiatives, such as the One Belt One Road program, further extend its development model, financing coal projects while resisting zero-emissions initiatives. Despite pledges to combat climate change, China remains heavily reliant on coal. Effective global governance requires a realist approach, as the CCP’s unilateral actions hinder collaborative efforts. Addressing these challenges necessitates sustainable development policies to protect Tibet’s unique ecosystems and mitigate global emissions