ResearchOnline@ND (University of Notre Dame)
Not a member yet
7734 research outputs found
Sort by
Accountability in a Catholic systemic context
No full textThis research investigated the complex and unique nature of accountability within a systemic educational context in Australia. It explored the perspective of those who primarily develop and impose accountability on school leaders (the systemic authority). The study looked to secular statute law and canon law with a focus on the interaction as a source of accountability, evidenced in policy and governance structures, for Catholic principals. Participants’ assumptions of compatibility, understanding and implementation and the specific statutory responsibilities were examined. Six expert leaders working in the Catholic education system participated in individual interviews to provide their insights into how obligations that derive from a uniquely Catholic context sit within the accountabilities of modern educational leaders. The system experts suggested that principals experience a prescription within tools of accountability such as policy and governance, combined with an unease with canonical and ecclesiastical mandates beyond the implicit obligations they need to fulfill in their role as faith leaders
Projected burden and distribution of elevated blood pressure levels and its consequence among adolescents in sub-Saharan Africa
No full textBackground
There is minimal data on the number of adolescents in sub-Saharan Africa (SSA) with elevated blood pressure (BP) at increased risk of future cardiovascular events. Combining country-specific population data with data derived from two previously conducted meta-analyses (one African-specific, one based on international cohorts), we sought to address this knowledge deficit. Methods
We used meta-analysis data from 37 926 adolescents participating in 36 contemporary SSA studies to generate sex-specific proportions of adolescents aged 10–14 and 15–19 years with elevated BP. The estimates were applied to the 2021 World Bank population data for each country in SSA. We then applied the rate of cardiovascular events attributable to elevated BP levels, derived from a meta-analysis of 17 observational, longitudinal cohort studies comprising 4.5 million young adults (non-African), to determine the excess number of cardiovascular events linked to hypertension among those aged 15–19 years transitioning to adulthood. Results
The estimated prevalence of elevated BP among male and female adolescents aged 10–14 years living in SSA was 7.2% (95% confidence interval (CI) = 4.9–9.9) and 6.9% (95% CI = 4.7–9.5), respectively, which increased to 13.0% (95% CI = 10.6–15.6) and 12.5% (95% CI = 10.4–15.3) among male and female adolescents aged 15–19 years, respectively. Consequently, we estimate that 13.6/138.0 million (95% CI = 10.4–17.3) male and 12.9/135.7 million (95% CI = 9.83–16.3) female adolescents living in SSA have elevated BP. Among the estimated 16.1 million adolescents aged 15–19 years with elevated BP approaching adulthood, the projected excess in cardiovascular events attributable to hypertension (vs normotension) is 201 000 (95% CI = 115 000–322 000) to 503 000 (95% CI = 286 000–805 000) over the next 10–25 years. Conclusions
Based on the best available data, we estimate that 26.5 million adolescents living in SSA have elevated BP. If left undetected and untreated among those approaching adulthood (those aged 15–19 years), they will experience \u3e0.5 million excess cardiovascular events associated with persistently elevated BP within the next 25 years
Time trends in stroke risk management among high-risk patients with non-valvular atrial fibrillation in Australia between 2011-2019
No full textBackground: Atrial fibrillation (AF) is associated with stroke. Major changes to AF management recommendations in 2016–2018 advised that: 1. Stroke risk be estimated using the CHA2DS2-VA score; 2. Antiplatelet agents (APAs) do not effectively mitigate stroke risk; 3. Anticoagulation is prioritised above bleeding risk among highrisk patients; and 4. Non-vitamin K oral anticoagulants (NOACs) are used as first-line anticoagulants.
Aim: To examine trends in stroke risk management among high-risk patients with non-valvular AF in Australia between 2011–2019.
Method: De-identified data of patients were obtained from 164 separate general practices. Data included information on patient demographics, diagnoses, health risk factors and recent prescriptions. Patients with a diagnosis of non-valvular AF were identified and stroke risk was calculated by CHA2DS2-VA score. High risk patients (i.e. CHA2DS2-VA ≥ 2) were categorised as being managed by oral anticoagulants (OACs, i.e., warfarin or NOACs), APAs only, or neither (i.e., no OACs or APAs) and time trends in prescribing were examined. Multivariate analyses examined the characteristics of patients receiving the guideline recommended OAC management. Results: Data were available for 337,964 patients; 8696 (2.6 %) had AF. Most patients with AF (85.8 %, n = 7116) had high stroke risk. The proportion of high-risk patients managed on OACs increased from 56.7 % in 2011 to 73.7 % in 2019, while the proportion prescribed APAs declined from 31.1 % to 14.0 %. Those receiving neither treatment remained steady (around 12 %). Overall, 26.3 % of patients were inadequately anticoagulated at the end of the study period. There were no age or gender differences in receiving the guideline-recommended therapy, and patients with comorbidities associated with increased stroke risk were more likely to receive OAC therapy.
Conclusions: Stroke risk management among patients with AF has improved between 2011–2019, however there is still scope for further gains as many high-risk patients remain inadequately anticoagulated. Better stroke risk assessment by clinicians coupled with addressing practitioner concerns about bleeding risk may improve management of high-risk patients
Is staging breast magnetic resonance imaging for invasive lobular carcinoma worthwhile?
No full textBackground: Invasive lobular carcinoma (ILC) is challenging to stage accurately using mammography (MG) and ultrasound (US) with undiagnosed ipsilateral and contralateral cancer resulting in poor patient outcomes including return to surgery. Our institution employs routine staging breast MRI in ILC for this reason. However, increased time for further imaging/biopsies contributes to patient anxiety and potentially delays definite management. We aimed to quantify the frequency of staging MRI-detected additional lesions requiring biopsy or follow-up, the added cancer detection rate and MRI prompted change in surgical management.
Methods: An observational study on staging breast MRI for newly diagnosed ILC at a tertiary Western Australian hospital from January 2019 to August 2022. Standardized 3T MRI protocol was performed, double read by unblinded fellowship-trained radiologists. Histopathology from biopsy, surgery, or first annual surveillance was the reference standard for additional MRI-detected lesions.
Results: One hundred ten MRI studies demonstrated 49 (45%) patients had at least one additional clinically significant MRI-detected lesion. Thirty-one patients had an additional ipsilateral lesion detected, of which 18 (58%) proved malignant; 14 (45%) multifocal and 4 (13%) multicentric ILC. Additional work-up of MRI-detected lesions averaged a 9-day delay to definitive surgery compared to patients with a negative or definitively benign MRI. MRI changed surgical planning in 11 of 110 cases from breast conservation surgery (BCS) to mastectomy and there were two contralateral cancers diagnosed. BCS reoperation rate was 11%.
Conclusion: Staging MRI for ILC identifies clinically significant lesions in nearly half of patients, predominantly ipsilateral multifocal disease, without significant delay to definitive surgery
Notification rates for syphilis in women of reproductive age and congenital syphilis in Australia, 2011-2021: a retrospective cohort analysis of national notifications data
No full textObjectives: To estimate notification rates for infectious syphilis inwomen of reproductive age and congenital syphilis in Australia.
Study design: Retrospective cohort study; analysis of national infectious syphilis and enhanced congenital syphilis surveillance data.
Setting, participants: Women aged 15–44 years diagnosed with infectious syphilis, and babies with congenital syphilis, Australia,2011–2021.Main outcome measures: Numbers and rates of infectious syphilis notifications, by Indigenous status and age group; numbers and rates of congenital syphilis, by Indigenous status of the infant; antenatal care history for mothers of infants born with congenital syphilis.
Results: During 2011–2021, 5011 cases of infectious syphilis in women aged 15–44 years were notified. The notification rate for Aboriginal and Torres Strait Islander women rose from 56 (95%confidence interval [CI], 45–65) cases per 100 000 in 2011 to 227(95% CI, 206–248) cases per 100 000 population in 2021; for non-Indigenous women, it rose from 1.1 (95% CI, 0.8–1.4) to 9.2(95% CI, 8.4–10.1) cases per 100 000 population. The notification rate was higher for Aboriginal and Torres Strait Islander women than for non-Indigenous women (incidence rate ratio [IRR], 23.1;95% CI, 19.7–27.1), lower for 15–24- (IRR, 0.7; 95% CI, 0.6–0.9)and 35–44-year-old women (IRR, 0.6; 95% CI, 0.5–0.7) than for25–34-year-old women, and higher in remote regions than in major cities (IRR, 2.7; 95% CI, 2.2–3.8). During 2011–2021, 74 cases of congenital syphilis were notified, the annual number increasing from six in 2011 to a peak of 17 in 2020; the rate was consistently higher among Aboriginal and Torres Strait Islander infants than among non-Indigenous infants (2021: 38.3v 2.1 per 100 000 livebirths). The mothers of 32 infants with congenital syphilis (43%)had not received antenatal care.
Conclusions: The number of infectious syphilis notifications for women of reproductive age increased in Australia during2011–2021, as did the number of cases of congenital syphilis. To avert congenital syphilis, antenatal screening of pregnant women, followed by prompt treatment for infectious syphilis when diagnosed, needs to be improved
Marine bryozoan colonization of terrestrial biomineralized tissues: Taphonomic insights and forensic implications
No full textThe taphonomy and diagenesis of bone and teeth recovered from any environments provide crucial information for forensic sciences and investigations. This leads to the estimation of the postmortem interval (PMI) and the postmortem submersion interval (PMSI) of the organism/s. Aquatic taxa can induce macroscopic and microscopic alterations in biomineralized tissues (e.g., grooves) or can colonize them by attachment (e.g., Bryozoa). Bryozoa are tiny invertebrates that form colonies in freshwater and saltwater. They can survive for years as suspension feeders in all climates. Most marine Bryozoa species have a biomineralized exoskeleton that can be preserved after their death. This research analyzes eight fragments of archeological elephant ivory with a known PMSI of 314 years, which were inhabited by three distinct bryozoan colonies. The variations in the preservation of the bryozoan exoskeletons and the overgrowth of different marine taxa reveal that one colony (lichenoporid cyclostomatid) was alive at the time of the ivory collection from the submerged archeological site while the two other colonies (cheilostomatid) had previously died at different times. The primary objective of this observation is to contribute to the understanding of the taphonomy of terrestrial mammalian biomineralized tissues recovered in marine environments. Additionally, the study discusses the potential forensic implications of this association, such as the evidence of marine submersion and the PMSI. A secondary objective is to present the Bryozoa colonies within a distinctive depositional context, considering that many bryozoan species of the Western Australian coast remain undescribed. The complexity of the Bryozoa ecobiology is also highlighted, with the need of further research (e.g., minimum time for colonization). Finally, this study highlights the urgency of multidisciplinary collaboration to advance aquatic forensic capabilities
Process evaluation of a randomised controlled trial intervention designed to improve rehabilitation services for Aboriginal Australians after brain injury: The Healing Right Way Trial
No full textBackground: Healing Right Way (HRW) aimed to improve health outcomes for Aboriginal Australians with stroke or traumatic brain injury by facilitating system-level access to culturally secure rehabilitation services. Using a steppedwedge randomised controlled trial (RCT) design (ACTRN12618000139279, 30/01/2018), a two-pronged intervention was introduced in four rural and four urban hospitals, comprising 1.Cultural security training (CST) for staf and 2. Training/employment of Aboriginal Brain Injury Coordinators (ABIC) to support Aboriginal patients for 6-months post-injury. Three-quarters of recruited patients lived rurally. The main outcome measure was quality-of-life, with secondary outcomes including functional measures, minimum processes of care (MPC); number rehabilitation occasions of service received, and improved hospital experience. Assessments were undertaken at baseline, 12- and 26-weeks post-injury. Only MPCs and hospital experience were found to improve among intervention patients. We report on the process evaluation aiming to support interpretation and translation of results.
Methods: Using mixed methods, the evaluation design was informed by the Consolidated Framework for Implementation Research. Data sources included minutes, project logs, surveys, semi-structured interviews, and observations. Four evaluation questions provided a basis for systematic determination of the quality of the trial. Findings from separate sources were combined to synthesise the emerging themes that addressed the evaluation questions. Three components were considered separately: the trial process, CST and ABIC.
Results: The complex HRW trial was implemented to a satisfactory level despite challenging setting factors, particularly rural–urban system dynamics. Patient recruitment constraints could not be overcome. The vulnerability of stepped-wedge designs to time efects infuenced recruitment and trial results, due to COVID. Despite relativel
A national evaluation of undergraduate nursing and midwifery curricula
No full textAim: To conduct a comprehensive review of Undergraduate Nursing and Midwifery Curricula leading to registration in Ireland.
Design: A mixed methods approach using a curriculum evaluation framework that was underpinned by the philosophy and principles of appreciative inquiry.
Methods: Five separate workstreams completed an evaluation of national policy documents and international curriculum documents, a literature review and two phases of stakeholder engagement including a graduate survey and peer-grouped stake holder focus groups. The workstreams were emulated for the professions of nursing and midwifery.
Results: National policy indicates a significant shift in healthcare delivery to the community environment, with a strong focus on the social determinants of health and a flexible interprofessional workforce. International curricula review revealed that nursing and midwifery education was split equally between academia and clinical practice at bachelor\u27s degree level. Graduates were assessed for clinical competence with a variance of four to seven domains of competence evident for nurses and five principles for midwives. Direct entry midwifery was not widely available. The graduate survey identified that students were satisfied with the academic components of the curriculum; however, significant challenges in clinical placement were reported. Stakeholder focus groups reported a need for a learner-focused approach to the curricula, increased access to education, a deeper understanding and appreciation of the various roles required to educate nurses and midwives and a recognition of midwifery as a separate profession.
Conclusion: There is a need for a significant revision of the current nursing and midwifery curricula to meet the future health-care needs of the diverse patient population with a community-focused delivery.
Reporting Method: The good reporting of a mixed methods study was used to guide the development of this manuscrip
Emergency management of orbital compartment syndrome: Lateral canthotomy and cantholysis case series
No full textBackground: Orbital compartment syndrome (OCS) is considered a time critical condition that requires urgent surgical decompression to preserve vision. This study aims to evaluate the current clinical criteria for performing a lateral canthotomy and cantholysis (LCC) in the emergency management of suspected traumatic OCS.
Methods: A retrospective audit of patients with suspected traumatic OCS presenting to an adult major trauma centre between January 1, 2017, and August 1, 2022, was performed.
Results: 20 patients with traumatic OCS treated with a LCC were identified. Five patients satisfied the definitive clinical criteria for LCC. The remaining 15 patients received LCC based on secondary clinical findings, or computed tomography (CT) findings suggestive of OCS. 17 patients received non-contrast CT scanning prior to LCC. Of the nine patients noted to regain baseline or close to baseline vision, only one was decompressed within two hours of injury.
Conclusion: Despite OCS being a clinical diagnosis, the signs and symptoms associated with OCS are difficult to elicit on presentation. Seeking imaging should not delay time to decompression when clinical diagnostic criteria are present. However, imaging may have a role in determining the need for orbital decompression where the absolute indications for LCC cannot be adequately assesse
