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Tactile localization accuracy at the low back
No full textLocalizing tactile stimulation is an important capability for everyday function and may be impaired in people with persistent pain. This study sought to provide a detailed description of lumbar spine tactile localization accuracy in healthy individuals. Sixty-nine healthy participants estimated where they were touched at nine diferent points, labelled in a 3 × 3 grid over the lumbar spine. Mislocalization between the perceived and actual stimulus was calculated in horizontal (x) and vertical (y) directions, and a derived hypotenuse (c) mislocalization was calculated to represent the direct distance between perceived and actual points. In the horizontal direction, midline sites had the smallest mislocalization. Participants exhibited greater mislocalization for left- and right-sided sites, perceiving sites more laterally than they actually were. For all vertical values, stimulated sites were perceived lower than reality. A greater inaccuracy was observed in the vertical direction. This study measured tactile localization for the low back utilizing a novel testing method. The large inaccuracies point to a possible distortion in the underlying perceptual maps informing the superfcial schema; however, further testing comparing this novel method with an established tactile localization task, such as the point-to-point method, is suggested to confrm these fndings
Towards a constructivist view of instructional explanations as a core practice of science teachers
No full textInstructional explanations are sometimes viewed as part of a nonconstructivist, solely teacher-centered learning environment, leading to the perception that they are ineffective or inappropriate for teaching science. Consequently, teacher education programmes seldom focus on preparing teachers to explain scientific concepts effectively. Interestingly, the perception of a specific kind of instructional explanation in teaching has evolved in recent years: explanatory videos, in particular, are being viewed as promising digital tools for learning. This article asserts that instructional explanations constitute integral components within nearly all learning environments where communication about science takes place. It has two goals. Firstly, the article aims to develop a coherent, constructivist theory of explaining, including both teacher explanations and explanatory videos. This theory offers an inductive-statistical explanation of the underlying mechanisms of communicative situations that involve experts and novices. Secondly, based on this constructivist perspective, the article distinguishes instructional explanations from scientific explanations and argumentation. It contends that (a) reducing instructional explanations solely to teacher-centered, didactic teaching represents a misconception with potentially adverse effects and (b) it also is a misconception that instructional explanations, scientific explanations, and argumentation are (nearly) interchangeable. The paper argues that instructional explanations, including both teacher explanations and explanatory videos, are not only a potentially effective part of all kinds of science teaching but also a core practice of science teachers
COVID-19 vaccination of at-risk and marginalised groups: recentering the state in vaccine uptake
No full textRecent studies have used the World Health Organization\u27s new Behavioural and Social Drivers (BeSD) framework to analyse vaccine uptake. However, this study of COVID-19 vaccination among marginalised population groups highlights the framework\u27s limitations regarding the centrality of the state in shaping people\u27s vaccination intentions in high income countries. We conducted interviews and focus groups with service providers and community members to explore COVID-19 vaccination amongst Western Australians experiencing homelessness and/or from other marginalised populations (such as people with substance use dependence). Analysing this data iteratively to emphasise the state\u27s role and functions, we elaborate how trauma and mistrust of government drive thoughts, feelings, and social interactions regarding vaccination programs, which are mutually reinforcing and which inhibit individuals\u27 willingness to engage. Government systems that leave some populations behind increase those populations\u27 susceptibility to misinformation. Policies may generate new unintended problems: social service providers worried about vaccine advocacy damaging clients\u27 trust, especially in the context of vaccine mandates. Reframing the state\u27s responsibility for designing culturally and socially appropriate services, we outline how end-users and trusted providers can lead this process. We share a new framework, Recentering the State in Vaccine Uptake, arising from our analyses
Exploring progesterone deficiency in first-trimester miscarriage and the impact of hormone therapy on foetal development: A scoping review
No full textBackground and Objectives: Progesterone deficiency during pregnancy may lead to various complications, including first-trimester miscarriage, which is the most common pregnancy complication. However, progesterone therapy may play a role in pregnancy maintenance and foetal development. The aim of this scoping review is to present evidence on the link between progesterone deficiency and first-trimester miscarriage among pregnant women and assess the impact of progesterone therapy on foetal development.
Methods: A comprehensive global systematic search of mainly primary research studies was conducted using several databases. Peer-reviewed studies published between 2010 and 2023 were included. The scoping review was conducted using the framework outlined by the Joanna Briggs Institute (JBI) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews (PRISMA-ScR) statement.
Results: Twenty-three articles (which included 35,862 participants) were included in the analysis. Most studies were conducted in mid- to high-income countries. All 23 articles reported a significant positive relationship between progesterone deficiency and first-trimester miscarriage. Furthermore, the majority of studies reported a higher risk of miscarriage when lower levels of progesterone are combined with other declined hormones. While most studies reported that progesterone therapy may reduce the rate of first-trimester miscarriage among pregnant women, no evidence of health-related harm to offspring development was reported.
Conclusions: The findings from this systematic–scoping review indicate possible benefits of progesterone replacement therapy in maintaining a healthy pregnancy and foetal development. Rigorous studies that include large sample sizes and systematic reviews are required to confirm these findings further
Waking up the Snake: Ancient wisdom for regeneration
No full textBringing together interdisciplinary climate change scholarship and grassroots activism, this book considers the possibilities of planetary justice across human difference, generations, species and the concept of life and non-life. Writing amidst bushfires, cyclones, global climate strikes and a global pandemic, contributors from the Earth Unbound Collective share stories from India, Australia, Canada and Scotland. Chapters draw on Indigenous, Black, Southern, ecosocialist and ecofeminist perspectives to call for more radical and interconnected ideas of justice and solidarity
Ultrasound-guided Lipiodol hysterosalpingography: A prospective study on pregnancy and complication rates
No full textBackground: Fluoroscopic hysterosalpingography (HSG) with Lipiodol® is safe and has a therapeutic effect on fertility: transient in endometriosis-related infertility and sustained in unexplained infertility. Ultrasound is replacing fluoroscopy asthe preferred imaging modality for HSG due to comfort and radiation safety (noionising radiation). The safety of ultrasound-guided Lipiodol® HSG is uncertain.
Aims: Prospectively observe pregnancy and complication rates after ultrasound-guided Lipiodol® HSG.
Materials and Methods: A single-centre prospective study of women with unexplained infertility undergoing ultrasound-guided Lipiodol® uterine bathing and tubal flushing after tubal patency confirmed with ExEm® Foam HyFoSy (hysterosalpingo-foam-sonography). Pregnancy outcomes at six months and serum and urinarythyroid function at one, three and eight weeks were recorded. Pain scores were re-corded during and immediately after HSG. Descriptive statistics are reported.
Results: Fifty-two participants were enrolled between July 2019 and April 2021, median age 33 years (range 21–45). Only 45 (87%, 45/52) completed the Lipiodol® HSG;5/7 experienced intravasation during initial HyFoSy. Of 30 women at follow-up, 57%had biochemical (17/30, 95% CI 37%–75%), 53% clinical (16/30 95% CI 34%–72%) and35% ongoing pregnancies (11/30, 95% CI 20%–56%). The rate of subclinical hypothy-roidism (SCH) at two months was 41% (7/17). One intravasation event occurred dur-ing Lipiodol® HSG (2%, 1/45). Median pain score was 5/10 (range 0–9, interquartile range 2.5–7). No anaphylaxis, infection or oil embolism was observed.
Conclusion: Outpatient ultrasound-guided Lipiodol® HSG was safe, with pregnancy rates comparable to previous studies of fluoroscopic guidance. Rates of intravasation and SCH were also similar, confirming the need to monitor thyroid functio
Thoracoscopic left atrial appendage occlusion with the AtriClip PRO2: An experience of 144 patients
No full textAim: To report the clinical outcomes of thoracoscopic left atrial appendage occlusion (LAAO) with the AtriClip PRO2 device (Atricure Inc, Mason, OH, USA). Stroke risk reduction with LAAO in patients with atrial fibrillation is now well-established. Many surgical and percutaneous techniques have been used, with varying rates of success. The percutaneous devices have had issues with procedural complications and peridevice flow. Thoracoscopic AtriClip offers an epicardial linear closure of the appendage at its ostium. This study sought to evaluate its safety and efficacy in achieving complete LAA closure.
Method: This is a prospective series of thoracoscopic AtriClip PRO2 as a standalone procedure or a thoracoscopic AtriClip deployed as an adjunct to minimal access cardiac and thoracic surgery. Study ethical approval was granted by the hospital Human Research Ethics Committee.
Results: In total, 144 thoracoscopic AtriClip procedures were conducted by a single surgeon from 2017 to 2022, 56 standalone and 88 concomitant. There was no mortality or major morbidities. A 100% success in complete LAA closure was observed, with 87% complete follow-up imaging. For patients that underwent standalone AtriClip after cessation of anticoagulation, no thromboembolic phenomena were seen in the 180 patient-years of follow-up.
Conclusion: This study demonstrates that thoracoscopic placement of AtriClip is safe and effective in achieving consistent and complete LAAO. Future randomised trials will be useful to compare outcomes with percutaneous devices
National Hypertension Taskforce of Australia: A roadmap to achieve 70% blood pressure control in Australia by 2030
No full textBackground: Raised blood pressure is the leading preventable cause of death in Australia. One in three Australian adults (6.8 million people) have hypertension, defined as clinic or office blood pressure greater than or equal to 140/90mmHg, based on randomised population data.10 Screening campaigns found that about half of these adults (3.4 million) have not had their high blood pressure values detected and are unaware of their hypertension,11 hence are not receiving appropriate treatment. Of those who are diagnosed with hypertension, and treated in the general population, only 32% (2.2 million) are treated effectively, that is, reducing their blood pressure to less than 140/90mmHg (Box 1).10,11 Australians who visit primary care centres have somewhat different rates, where 55% of patients are treated and have their blood pressure effectively controlled.12
Goal: Increase current population blood pressure control rates (\u3c140/90mmHg) from 32% to at least 70% by 2030.5,10
Targets and strategies: The roadmap for 2024–2030 (Box 2) is built on three pillars: (A) prevent; (B) detect; and (C) effectively treat raised blood pressure. An international modelling study recommended 80–80–80 blood pressure targets, which translates to 80% of individuals with hypertension being screened and aware of their diagnosis; 80% of those who are aware being prescribed treatment; and 80% of those on treatment having achieved blood pressure targets.13 However, because 20% remain unaware, and 20% of those aware remain untreated, and 20% of those treated not achieving target, this model would only achieve 51% blood pressure control. To achieve the Taskforce’s target of 70%, a 90–90–90 model is required for Australia, as this approach would achieve a 73% blood pressure control rate
Use of an emulated trial to investigate the association between use of nitrogen-based bisphosphonates and risk of epithelial ovarian cancer
No full textBackground: Epithelial ovarian cancer (EOC) is the eighth most common cancer in women, with poor survival outcomes. Observational evidence suggests that nitrogen-based bisphosphonate (NBB) use may be associated with reduced risk of EOC, particularly the endometrioid and serous histotypes; however, confounding by indication is a concern. An alternative approach to investigate the chemo-preventive potential of NBBs is to emulate a target trial by identifying all women who initiate use of NBBs and investigate the risk of EOC for continued users compared with discontinued users.
Methods: Using population-based linked data, we identified all Australian women aged over 50 years who first used NBBs over 2004–12. We used the year after first use to define treatment for each woman as either continued or discontinued use. We emulated randomization using stabilized inverse probability weights to balance the treatment groups using covariates including age, comorbidities and socioeconomic status. We followed women from treatment assignment until EOC diagnosis, death or 31 December 2013. We assessed the risk of EOC (overall and by histotype) using flexible parametric time-to-event models allowing for time-varying effects, and produced time-varying coefficients.
Results: Of the 313 383 women in the study, 472 were diagnosed with EOC during follow-up (261 serous EOC), with an average age at diagnosis of 72 years. Continued use of NBBs was associated with reduced risk of EOC overall (HR ¼ 0.87, 95% CI: 0.69, 1.10), and serous EOC (HR ¼ 0.71, 95% CI: 0.53, 0.96), compared with discontinued treatment, with estimates remaining constant over the 9-year follow-up.
Conclusions: Results from our emulated trial suggest that in women who initiated NBB treatment, those who continued use had 13% and 29% lower hazards of being diagnosed with EOC overall and serous EOC, respectively, compared with women who discontinued use
as a dedicated biodiversity offsets policy improved the environmental and social compensation outcomes of development in Australia?
No full textBiodiversity offsets are used worldwide to provide environmental compensation for the impacts of development and to meet the goals of sustainable development. Australia has embraced the use of ofsets and its ofset methodologies have been used as models by other jurisdictions. However, the maturity of ofset requirements in Australia is unknown. To understand this, development referrals submitted under the Australian Environment Protection and Biodiversity Conservation Act 1999 (Commonwealth) between October 2011 and September 2017 were reviewed to determine if ofset requirements in Australia were improving in complexity, transparency and/or environmental outcomes (termed maturity) over time. Despite the implementation of dedicated policy in Australia in 2012, our analysis showed that offset requirements were not on a trajectory towards improvement (maturity) over the 6-year period examined. There was no evidence to suggest the type of offsets required and compensation for impacts to specific species and habitats increased in complexity over time. The level of detail included for offset requirements, mandatory commencement dates and requirements for ecological outcomes similarly did not increase over time. Consequently, dedicated legislation for ofsets is recommended to remedy these omissions and enable efective functionality for biodiversity ofsets through the protection of the environment and conservation of biodiversity, ecosystem function and ecosystem services