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Association of pulmonary artery pressures with mortality in adults with reduced left ventricular ejection fraction
Get PDFBackground The independent effect of pulmonary hypertension (PHT) severity on mortality in those with reduced left ventricular ejection fraction (LVEF) is not well known. Objectives The authors aimed to examine the prognostic impact of increasingly elevated pulmonary pressures in a large clinical cohort of adults with reduced LVEF. Methods The authors analyzed data from the National Echocardiography Database of Australia, a large clinical registry linking routine echocardiographic investigations to mortality. In 23,675 adults with a recorded tricuspid regurgitation peak velocity (TRV) and reduced LVEF (\u3c50%), the authors evaluated the relationship between conventional thresholds of increasing risk of PHT and mortality during median follow-up of 2.9 years (Q1-Q3: 1.0-5.4 years). Results Mean age was 70 ± 15 years, and 7,498 (31.7%) individuals were female. Overall, 8,801 (37.2%) had normal (TRV \u3c2.5 m/s), 7,061 (29.8%) had borderline (2.5-2.8 m/s), 5,676 (24.0%) intermediate (2.9-3.4 m/s), and 2,137 (9.0%) individuals had high-risk PHT (\u3e3.4 m/s). With increasing risk of PHT, 1- and 5-year actuarial mortality increased from 13.3% and 43.8% to 41.5% and 81.4%, respectively (P \u3c 0.0001) from normal to severely elevated TRV. The adjusted HR of mortality increased by 1.31-fold (95% CI: 1.23-1.38), 1.82-fold (95% CI: 1.72-1.93), and 2.38-fold (95% CI: 2.21-2.56) in those with borderline, intermediate, and high risk of PHT respectively, compared with normal TRV. Further analyses suggested a distinctive threshold with a TRV reached \u3e2.41 m/s (adjusted HR: 1.18 [95% CI: 1.04-1.33]). Conclusions The authors demonstrate the prevalence and negative prognostic impact of increasingly elevated TRV levels in individuals with reduced LVEF, with a threshold for mortality lying within the range of “borderline risk” PHT
The inositol-requiring enzyme 1 (IRE1) endoplasmic reticulum stress pathway promotes MDA-MB-231 cell survival and renewal in response to the aryl-ureido fatty acid CTU
No full textCurrent treatment options for triple-negative breast cancer (TNBC) are limited to toxic drug combinations of low efficacy. We recently identified an aryl-substituted fatty acid analogue, termed CTU, that effectively killed TNBC cells in vitro and in mouse xenograft models in vivo without producing toxicity. However, there was a residual cell population that survived treatment. The present study evaluated the mechanisms that underlie survival and renewal in CTU-treated MDA-MB-231 TNBC cells. RNA-seq profiling identified several pro-inflammatory signaling pathways that were activated in treated cells. Increased expression of cyclooxygenase-2 and the cytokines IL-6, IL-8 and GM-CSF was confirmed by real-time RT-PCR, ELISA and Western blot analysis. Increased self-renewal was confirmed using the non-adherent, in vitro colony-forming mammosphere assay. Neutralizing antibodies to IL-6, IL-8 and GM-CSF, as well as cyclooxygenase-2 inhibition suppressed the self-renewal of MDA-MB-231 cells post-CTU treatment. IPA network analysis identified major NF-κB and XBP1 gene networks that were activated by CTU; chemical inhibitors of these pathways and esiRNA knock-down decreased the production of pro-inflammatory mediators. NF-κB and XBP1 signaling was in turn activated by the endoplasmic reticulum (ER)-stress sensor inositol-requiring enzyme 1 (IRE1), which mediates the unfolded protein response. Co-treatment with an inhibitor of IRE1 kinase and RNase activities, decreased phospho-NF-κB and XBP1s expression and the production of pro-inflammatory mediators. Further, IRE1 inhibition also enhanced apoptotic cell death and prevented the activation of self-renewal by CTU. Taken together, the present findings indicate that the IRE1 ER-stress pathway is activated by the anti-cancer lipid analogue CTU, which then activates secondary self-renewal in TNBC cells
The Fremantle Back Awareness Questionnaire: cross-cultural adaptation, reliability, and validity of the Italian version in people with chronic low back pain
No full textBackground and aim: There is evidence to suggest that assessing back-specifc altered self-perception may be useful when seeking to understand and manage low back pain (LBP). The Fremantle Back Awareness Questionnaire (FreBAQ) is a patient-reported measure of back-specifc body perception that has never been adapted and psychometrically analysed in Italian. Hence, the objectives of this research were to cross-culturally adapt and validate the Italian version of this outcome measure (namely, the FreBAQ-I), to make it available for use with Italians suffering from chronic LBP.
Methods: The FreBAQ-I was developed by forward and backward translation, review by a committee skilled in patient-reported measures and test of the pre-final version to assess its clarity, acceptability, and relevance. The statistical analyses examined: structural validity based on Rasch analysis; hypotheses testing by investigating correlations of the FreBAQ-I with the Roland Morris Disability Questionnaire (RMDQ), a pain intensity numerical rating scale (PINRS), the Pain Catastrophising Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) (Pearson’s correlations); reliability by internal consistency (Cronbach’s alpha) and test–retest repeatability (intraclass correlation coefcient, ICC (2,1)); and measurement error by determining the minimum detectable change (MDC). After the development of a consensus-based translation of the FreBAQ-I, the new outcome measure was delivered to 100 people with chronic LBP.
Results: Rasch analysis confirmed the substantial unidimensionality and the structural validity of the FreBAQ-I. Hypothesis testing was considered good as at least 75% of the hypotheses were confrmed; correlations: RMDQ (r=0.35), PI-NRS (r=0.25), PCS (r=0.41) and TSK (r=0.38). Internal consistency was acceptable (alpha=0.82) and test– retest repeatability was excellent (ICC (2,1)=0.88, 95% CI: 0.83, 0.92). The MDC95 corresponded to 6.7 scale points.
Conclusion: The FreBAQ-I was found to be a unidimensional, valid, and reliable outcome measure in Italians with chronic LBP. Its application is advised for clinical and research use within the Italian speaking community
Young men and feminism: gendered struggle and sense-making for Australian university students
No full textThis paper explores feminism as a site of explicit struggle and implicit sense-making for young men. Through an analysis of interviews with twenty young people at two Australian universities, it considers how popularised feminist (and anti-feminist) discourses shape discussions of men, boys and masculinity. Actively grappling with the place of boys and men in certain high-profile feminist debates, participants’ responses revealed core sites of tension around their collective and individual responsibility for gendered harms, tensions reflective of those present within feminist debates themselves. The impact of feminism could also be seen in the gendered analysis so many participants produced to make sense of limiting emotional norms, even though they did not recognise this analysis as a feminist inheritance. Moving beyond an approach seeking to categorise young men’s responses as either pro- or anti-feminist, this paper highlights the entanglement of feminism in young men’s sensemaking around gendered issues
Dealing with the Trustworthy Gospel in a Post-Christian Australia
No full textWhat is truth? We have entered another period fraught with Gospel confusion—beyond postmodernism to what can be called “post-Christianity”. This is not unusual—so we should not be overwhelmed. This happens periodically, as early as Gal 1:9: “If anybody is preaching to you a gospel other than what you accepted, let him be eternally condemned”. It is all a question of the Gospel, or put another way, evangelism (the communication or announcing “the good news of God”). Evangelism is proclaiming and living a distinct message of Jesus Christ. Jesus is Himself the embodiment of the “good news”. The Gospel has been challenged, eroded and corrupted over the centuries—yet rediscovered by those who practice exegesis of the Biblical record of the New Testament. This article moves on to look at how secular philosophy—rather than Christian philosophy—and other “forms of the truth” have influenced the current situation we find ourselves in
Early biblical fundamentalisms Xenophobic rejection of the subject in European philosophy: How rejecting the knowing subject formed fundamentalisms way of thinking
No full textThis article is part of a wider project that addresses gaps in the scholarly knowledge of the philosophical and theological foundations of the Biblical Fundamentalism that originated in North America. Through exploring the relevant literature, including primary sources from within Fundamentalism, the article examines the anti-European sentiment in early Fundamentalism and how this sentiment led to a rejection of philosophical values associated with Europe, especially with Germany. The article will show that anti-European, especially anti-German, sentiment bolstered Fundamentalism’s rejection of subjectivity in thinking, and even its rejection of human subjects themselves. In the place of subjectivity associated with European philosophy, Fundamentalism embraced an extreme objectivity that claimed the heritage of Reid and Bacon but eliminated subjectivity from the Fundamentalist horizon. This article thus shows how Fundamentalism radically opposes God and human beings, and faith and philosophy, with the resulting way of thinking that can be characterised as “naïve realism”, an approach to thinking that exclude
No improvement in AUDIT-C screening and brief intervention rates among wait-list controls following support of Aboriginal Community Controlled Health Services: Evidence from a cluster randomised trial
No full textBackground
While Aboriginal and Torres Strait Islander Australians are less likely to drink any alcohol than other Australians, those who drink are more likely to experience adverse alcohol-related health consequences. In a previous study, providing Aboriginal Community Controlled Health Services (ACCHSs) with training and support increased the odds of clients receiving AUDIT-C alcohol screening. A follow-up study found that these results were maintained for at least two years, but there was large variability in the effectiveness of the intervention between services. In this study, we use services that previously received support as a comparison group to test whether training and support can improve alcohol screening and brief intervention rates among wait-list control ACCHSs. Methods
Design: Cluster randomised trial using routinely collected health data. Setting: Australia. Cases: Twenty-two ACCHSs that see at least 1000 clients a year and use Communicare as their practice management software. Intervention and comparator: After initiating support, we compare changes in screening and brief intervention between wait-list control services and services that had previously received support. Measurement: Records of AUDIT-C screening and brief intervention activity in routinely collected data. Results
During the reference period we observed 357,257 instances where one of 74,568 clients attended services at least once during a two-monthly data extraction period. Following the start of support, the odds of screening (OR = 0.94 [95% CI 0.67, 1.32], p = 0.74, BF10 role= presentation style= margin: 0px; box-sizing: inherit; display: inline-block; line-height: normal; word-spacing: normal; overflow-wrap: normal; text-wrap: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; position: relative; \u3e10≈ role= presentation style= margin: 0px; box-sizing: inherit; display: inline-block; line-height: normal; word-spacing: normal; overflow-wrap: normal; text-wrap: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; position: relative; \u3e≈ 0.002) and brief intervention (OR = 1.43 [95% CI 0.69, 2.95], p = 0.34, BF10 role= presentation style= margin: 0px; box-sizing: inherit; display: inline-block; line-height: normal; word-spacing: normal; overflow-wrap: normal; text-wrap: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; position: relative; \u3e10≈ role= presentation style= margin: 0px; box-sizing: inherit; display: inline-block; line-height: normal; word-spacing: normal; overflow-wrap: normal; text-wrap: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; position: relative; \u3e≈ 0.002) did not improve for the wait-list control group, relative to comparison services. Conclusions
We did not replicate the finding that support and training improves AUDIT-C screening rates with wait-list control data. The benefits of support are likely context dependent. Coincidental policy changes may have sensitised services to the effects of support in the earlier phase of the study. Then the COVID-19 pandemic may have made services less open to change in this latest phase. Future efforts could include practice software prompts to alcohol screening and brief intervention, which are less reliant on individual staff time or resources. Trial registration
Retrospectively registered on 2018-11-21: ACTRN12618001892202
Jalngangurru Healing: Summary evaluation report of the Traditional Healing Practices Pilot
Get PDFThis report details findings from a traditional healing practices pilot, Jalngangurru Healing, which was trialled as a service model for the towns of Derby and Fitzroy Crossing in the Kimberley of Western Australia during August 2022 to October 2023. Under the auspices of the Kimberley Aboriginal Law and Cultural Centre (KALACC), Yiriman Women was funded by the Western Australian Primary Health Alliance (WAPHA) in 2018 to establish a Traditional Healing Practices Pilot (THPP). The THPP was one of 45 activities funded across nine communities under the Kimberley Aboriginal Suicide Prevention Trial (KASPT), which began in 2016. The Kimberley was one of 12 regions across Australia that was chosen to participate in the National Suicide Prevention Trial, a systems-based approach to suicide prevention. Jalngangurru Healing is now a project directly under the management of KALACC.
This summary report presents key findings from a Developmental Evaluation of the service. A literature review will be published as an accompanying report. Requests to access the full final evaluation report can be made through KALACC.https://researchonline.nd.edu.au/nulungu_reports/1004/thumbnail.jp
Epidemiology of horse trauma: A literature review
No full textPurpose: Horses are used for many recreational and occupational activities. They are large, strong, temperamental, and unpredictable animals and people involved with them are at risk for injuries, from minor abrasions to severe injuries that may lead to death. This review reports on horse trauma in relation to the characteristics of injured equestrians, characteristics of horse trauma, and clinical outcomes.
Methods: A literature search was conducted from health-related electronic databases to identify studies from 2018 to 2023. The search returned 115 relevant full-text articles but after screening and assessment for eligibility, 39 were included in this review for a detailed examination of horse trauma epidemiology. Most studies were undertaken in the USA and the most used method was a retrospective review of hospital or trauma registry data.
Results: There have only been very slight changes in horse trauma numbers and outcomes over the past 5 years. Most injuries often follow falls and kicks. Females in their late-20 s to mid-30 s who are recreational equestrians are the group most represented in the data. The commonest injuries include fractures, and head, thoracic, and abdominal trauma. Most individuals with horse trauma were treated in the Emergency Department and discharged. For the equestrians who were admitted to hospital, around one-third required surgery. Mortality rates are very low.
Conclusion: The popularity of occupational and recreational horse activities does not seem to wane and horse trauma continues to represent a signifcant concern for the health system. Health care workers need to be cognizant of the scope of trauma presentations as the mechanisms of injury can be complicated putting the equestrian at a high risk of associated injuries that may be life-threatening
Upload, cyber-spirituality and the quest for immortality in contemporary science-fiction film and television
No full textAs a genre, science fiction has long played with the idea of all-powerful virtual beings and explored notions of transcendence through technological advancements. It has also been at the forefront of exploring our anxieties and hopes regarding new technologies and the ethical and moral consequences of scientific advancement, raising deeply philosophical and theological concerns about an age-old question, namely: what makes us distinct as human beings and what lies beyond our own existence? This article aims to provide an overview of recent themes that have emerged in science fiction film and television, especially with regard to extending our lives beyond their natural biological age. As the article will outline, these ideas generally appear in notions of cyborgization or mind uploading into cyberspace. Both indicate a deeply human desire to avoid death, and the films and shows discussed in this article offer a range of different ideas on this. As we will see, the final case study, the Amazon Prime television show Upload (2020–), brings both of these elements together, touching on a broad range of ideas about cyber-spirituality along the way. The article concludes that although many shows raise interesting questions about the ethical challenges inherent in transhumanist fantasies of mind uploading, they ultimately remain ambiguous in their critique of the dream of digital immortality