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Maternal and Neonatal Outcomes and Health System Costs in Standard Public Maternity Care Compared to Private Obstetric-Led Care: A Population-Level Matched Cohort Study
No full textAvailable online 14 July 2025Objective: We aimed to compare health outcomes and costs in standard public maternity care compared to private obstetric-led maternity care. Design: Observational study with linked administrative data. Setting: Australian maternity care. Population: 867 334 births, covering all births in three states of Australia between 2016 and 2019. Methods: Standard public care involved mainly fragmented midwifery, obstetric and General Practitioner provider care, with birth in a public hospital. Private obstetric-led care was led by a personally selected obstetrician, with midwifery involvement and birth in a private hospital. We analysed outcomes from pregnancy onset to 4 weeks post-birth. Matching was utilised to account for demographic, socio-economic and clinical characteristics. Main Outcome Measures: Stillbirths or neonatal deaths; neonatal intensive care admissions; APGAR score < 7 at 5 min; 3rd or 4th degree perineal tears; maternal haemorrhages; mean cost per pregnancy episode. Results: Higher adverse outcomes in standard public maternity care compared to private obstetric-led care, including 778 more stillbirths or neonatal deaths (OR 2.0, 95% CI: 1.8–2.1), 2747 more APGAR score < 7 at 5 min (OR 2.0, 95% CI: 2.0–2.1), 3273 more 3rd or 4th degree perineal tears (OR 2.9, 95% CI: 2.7–3.1) and 10 627 additional maternal haemorrhages (OR 2.7, 95% CI: 2.6–2.8). Mode of birth correlated with neonatal death. Mean cost to all funders in Australian dollars per pregnancy episode was $5929 higher in standard public maternity care. Conclusion: We have shown significantly lower adverse health outcomes and costs in private obstetric-led care compared to standard public maternity careEmily J. Callander, Joanne Enticott, Ben W. Mol, Shakila Thangaratinam, Jenny Gamble, Stephen Robson, Helena Teed
The issues caused by misinformation - How workers and organizations deal with it: A systematic literature review. An Annual Review of Information Science and Technology (ARIST) paper
No full textPublished online 23 May 2025In today's digital age, misinformation propagates rapidly through digital channels, blurring the lines between truth and fiction, and challenging the foundations of trust in information sources. Although affecting all spheres of life, misinformation poses a significant threat to workers highlighting a critical intersection between technological advancement and vulnerability. This systematic literature review identifies how misinformation impacts organizational outcomes including workers' job productivity, engagement, job satisfaction, etc. It recognizes implications for workplace dynamics, including disrupted communication channels, increased workload, decreased work engagement, and professional challenges, including implications for client-professional dynamics. It discusses the strategies organizations employ to manage misinformation to maintain their workforce productivity and service delivery, including information verification and fact-checking protocols, technological strategies, communication and information management strategies, development of media literacy programs, and collaborative efforts. Understanding the role of emerging technologies in creating misinformation, the impact of misinformation on workers, and how organizations can proactively address it is vital within organizations.Ashwani Malhotra, Nina Evans, Jing Gao, Jia Tina Du, Connie Zhen
Multi-modal multi-objective firefly algorithm with multi-stage niches and route planning application
No full textMulti-objective Firefly Algorithm faces challenges when address multi-modal multi-objective optimization problems, such as the inability to recognize equivalent solutions and poor Pareto set completeness. To address these challenges, this paper proposes Multi-modal Multi-objective Firefly Algorithm with Multi-stage Niches (MMOFA-MN). In the niche initialization stage, non-dominated individuals and clustering algorithms are employed to find species seeds. This is accomplished by assigning population individuals to their corresponding species based on proximity. The species radius and the species archive capacity are calculate according to the species distribution, forming stable niches. During the evolutionary stage, each niche evolves independently, enabling the algorithm to recognize the equivalent solution. A learning mechanism and variation operators are incorporated to improve the attraction model of firefly algorithm, thereby improving the population’s exploitation capability. In the niche evaluation stage, each niche undergoes global evaluation to eliminate inferior individuals. Additionally, an update strategy based on the special crowding distance is introduced to increase the species diversity. MMOFA-MN was compared with 9 competing algorithms on 20 test functions through experimental evaluations and Friedman tests based on two performance metrics. Stability analysis revealed that the average success rates and the average computation time of the top three performing algorithms MMOFA-MN, DRSC-MOAGDE, and MMEA-PSL were (86.55 %, 15.02 s), (73.01 %, 3.13 s), and (43.79 %, 42.62 s), respectively. Lastly, MMOFA-MN was applied to weighted grid map route planning, resulting in a collection of high-quality solutions with superior diversity
Contemporary structures, processes, and outcomes of critical care nursing education: An integrative review
No full textObjective: The critical care workforce requires nurses who are specialised, educated, and adaptable to manage complex situations, with the capability to make informed decisions for optimal patient care. The Australian College of Critical Care Nurses supports evidence-based practice through an education position statement, which is periodically updated to reflect evolving needs. In this review, our aim was to inform revisions to the position statement on critical care nurse education by examining the structure, processes, and outcomes of contemporary education programs designed to enhance the capability of registered nurses working in critical care environments internationally.
Review method used: An integrative review was conducted using Whittemore and Knafl’s framework.
Data resources: Data were collected from Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid Medline, Embase, Emcare, Joanna Briggs Institute, and Google Scholar from January 2017 to the end of December 2024
Review methods: Articles were included if they were peer reviewed, published in the English language, and focused on education programs for critical care nurses. Data extraction and quality appraisal were performed using appropriate tools.
Results: A total of 35 papers were included, revealing significant variations in the structure of critical care nursing education programs. Key facilitating processes were diverse delivery methods (online, face-to-face, and hybrid), structured curricula, and infrastructure (digital tools, human, and support systems). Positive outcomes included developing capability; improved patient outcomes; enhanced confidence, competence, and clinical performance; advanced communication skills; and leadership confidence to assume a decisional role. However, a lack of a standardised tiered education framework was observed.
Conclusions: The findings indicate significant variations in the structure of critical care nursing education programs, emphasising the need for a standardised tiered framework to ensure consistent theoretical underpinning and skill levels, leading to improved patient outcomes and the transferability of qualifications. The review advocates for technologically integrated, culturally safe, and flexible education programs that support the development of advanced practice critical care knowledge and capabilities
Operating high-rate algal ponds as sequencing batch reactors: a novel approach to enhanced wastewater treatment
No full textEffective wastewater treatment is critical for public health and environmental protection. In regional communities, where resources are limited, there is a need for sustainable and low-cost wastewater treatment solutions. Commonly used waste stabilisation ponds, have large land requirements, inconsistent treatment performance and high rates of evaporative water loss. High rate algal ponds (HRAPs) offer a smaller area footprint and consequentially reduced capital expenditure, enhanced treatment performance and a low maintenance alternative. HRAPs are commonly operated as continuously stirred tank reactors, at shallow depth (0.2–0.5 m) mixed by a paddlewheel. Effective wastewater treatment is then achieved by a consortium of naturally occurring, harmless microalgae and bacteria. However, there is a need to further improve their operation and the quality of the treated effluent to enhance water reuse opportunities and alleviate water insecurity concerns in rural communities. Here we uniquely propose two different operational strategies for HRAPs as the next step forward for this treatment technology. The two strategies require operation as sequencing batch reactors, which enables independent management, of hydraulic retention time and solids retention time, providing additional operational management strategies. Significantly, this offers the potential to develop influent feeding and mixing strategies to develop biofilm like assemblages of photogranules or to selectively enrich and maintain filamentous algal populations. The increased density of either photogranules or filamentous algae will enable efficient biosolids separation yielding an effluent low in suspended solids. The biomass separation may also be achieved within the HRAP avoiding the need to construct and manage additional infrastructure. The enhanced treated effluent quality increases opportunities for added value beneficial water reuse in climate change related water stressed communities. Future research is needed to validate this approach and the optimum operating conditions to achieve treatment and efficient in situ biomass separation.Sam Butterworth, Felipe Sabatte, Harriet Whiley, Enzo Palombo, Melissa H. Brown, Ngai Ning Cheng, Ben Van Den Akker and Howard Fallowfiel
Clinical toxicity of nitazene detections in two Australian emergency department toxicosurveillance systems
No full textBrief ReportIntroduction: Nitazenes are a group of potent synthetic opioids that have had increasing prominence as novel psychoactive drugs in the last 5 years. We describe emergency department nitazene-related presentations. Methods: This is a prospective series of patients with analytically confirmed nitazene presentations identified by the Emerging Drugs Network of Australia and Emerging Drugs Network of Australia Victoria. Both studies' databases were searched between July 2020 and February 2024 with clinical data and blood nitazene concentrations abstracted. Results: There were 32 presentations, 23 (72%) males, with a median age of 31 years (range 18–63 years). Only five (16%) intentionally ingested a nitazene, with most (12, 38%) believing they had taken alternative opioids. Co-exposures occurred in 31 (97%), mostly metamfetamine. Naloxone was administered in 23 (72%) presentations, with a median total dose of intravenous naloxone within 1 h post hospital presentation of 400 μg (interquartile range [IQR] 160–450 μg). Four (13%) received a naloxone infusion. Thirteen (41%) were admitted to the intensive care unit. The median length of stay was 17 h (IQR 7–39 h). Protonitazene was the commonest nitazene detected in 23 (72%) presentations with a median concentration of 2.0 μg/L (range 0.7–15 μg/L). The lowest concentration of protonitazene in a patient that received naloxone was 0.7 μg/L. Discussion and Conclusions: Most patients were unaware they were using nitazenes. Given their potency, this has important implications for harm, particularly in those not intentionally using opioids. Nitazene exposure was mostly unintentional. Naloxone use was common and standard dosing regimens appeared effective in most cases.Katherine Z. Isoardi, Sam Alfred, Courtney Weber, Keith Harris, Jessamine Soderstrom, Rebekka Syrjanen, Amanda Thompson, Jennifer Schumann, Peter Stockham, Paul Sakrajda, Daniel Fatovich, Shaun L. Greene, on behalf of the EDNA and EDNAV Investigator
High-intensity grinding mill media wear detection via real-time vibration monitoring: a case study on a Metso HIGmill™ pilot plant
No full textHigh-intensity grinding (HIG) mills are widely utilised in mineral processing for efficient fine and ultra-fine grinding, where significant challenges are present in online monitoring of grinding media wear due to the abrasive environment, high rotational speed, and fine particle sizes. Vibration-based analysis has been shown applicable to address these challenges, serving as a non-invasive and real-time diagnostic tool to improve predictive maintenance and operational efficiency. However, its implementation varies largely between mills of different types and sizes, highly depending on corresponding mechanical properties and operation conditions. This study, therefore, focused on a Metso HIGmill\ᵗᵉˣᵗᵗʳᵃᵈᵉᵐᵃʳᵏ pilot plant and was scoped as an in-situ feasibility assessment under production constraints, aiming to discover whether correlations exist between mill vibration signals and grinding media wear. Wear tests were conducted using different grinding media, and mill vibration was monitored on the external wall of its shell at different longitudinal locations. Qualitative findings suggest that mill shell vibration can indicate grinding media wear in HIG mills
Review of soft glass step-index preform fabrication methods
No full textVersion of Record available 22 September 2025.Step-index core/clad optical fibers made from fluoride, tellurite, and chalcogenide soft glasses, that have minimum propagation loss in the near- and mid-infrared (IR) regions, are gaining remarkable attention in various applications. The propagation loss originates primarily from the absorption and scattering of light due to several reasons, such as the existence of impurities and/or defects within the fiber. This review explores the preform fabrication techniques on selected examples of soft glasses to seek an understanding of the impact of fabrication methods on the dimension and quality of the core/clad interface and propagation loss of the corresponding fibers. First, a brief background about the main characteristics of soft glasses considered here and the origin of propagation loss in optical fibers is explored. Later, the fabrication methods of soft glass-based optical fibers and preforms are highlighted with emphasis on the preform fabrication methods. More specifically, three main categories of the preform fabrication are explored: direct casting (i.e., built-in casting, rotational casting, and suction casting), direct extrusion (i.e., axially stacked core/clad billet extrusion and radially stacked core/clad billet extrusion), and cane-in-tube assembly. The rationale for choosing these methods is that the interface is generated at various viscosities and temperatures, which would give an overview of the influence of fabrication conditions on the core/clad interface dimension and quality, core tapering, and propagation loss of the resulting fiber. The review concludes with a summary and outlook for developing soft glass fibers with a low core/clad ratio, high-quality interface (i.e., interface that does not show voids, crystals, and other scattering centers when inspected with microscopy), and reduced propagation loss.Ehab Salih, Yunle Wei, Heike Ebendorff-Heideprie
Absolute neutrophil count and adverse drug reaction monitoring during clozapine treatment: consensus guidelines from a global Delphi panel
No full textPosition Paper.
Published Online 2 July 2025Despite its superior effectiveness for treatment-resistant schizophrenia, clozapine has a high burden of adverse drug reactions (ADRs), which require monitoring and treatment. This global Delphi study has established consensus guidelines for absolute neutrophil count (ANC) thresholds for consideration of clozapine cessation and provided monitoring protocols for ADR management. Recommendations include lowering ANC thresholds for consideration of clozapine cessation to 1·0 × 10⁹ cells per L (0·5 × 10⁹ cells per L for Duffy antigen receptor for chemokines-null individuals) and discontinuing routine ANC monitoring after 2 years. Comprehensive ADR monitoring, with ANC monitoring in the first 2 years, then every 3 months after discontinuing routine ANC monitoring, should address the metabolic syndrome, constipation, gastro-oesophageal reflux, sialorrhea, nocturnal enuresis, tachycardia, sleep apnoea, sedation, and other ADRs. Consumer representatives underscored the need for shared decision-making, streamlined monitoring, and accessible patient education. Although barriers persist, these findings support updating global policies to reduce burden on patients, enhance adherence, and optimise clinical outcomes. Incorporating evidence-based guidelines into practice could transform clozapine care, balancing safety with practicality to improve the lives of those with treatment-resistant schizophreniaDan Siskind, Korinne Northwood, Toby Pillinger, Sherry Chan, Christoph Correll, Robert O. Cotes, Susanna Every-Palmer, Maggie Hahn, Oliver D. Howes, John M Kane, Deanna Kelly, Nicole Korman, Julia Lappin, Cristián Mena, Nick Myles, the Clozapine Delphi Expert Panel (Dan Siskind ... Scott R Clark ... et al.), Robert A. McCutcheo
I Feel I Need to Think about It: A Defence of Affective Moral Enhancement
No full textPublished online 22 September 2025Critics of affective moral enhancement generally contend that moral improvement can only be properly achieved through interventions that engage a person's rational faculties. Therefore, they view attempts to achieve moral improvement by targeting emotions as futile at best and detrimental to moral agency at worst. In this paper, I argue that even if we accept the view that genuine moral improvement requires the engagement of rational faculties, we need not reject all forms of affective moral enhancement. My argument premises on the view that certain types of affect are highly informative. Affective moral enhancement that aims to elicit these affective states grants enhancement recipients access to vital moral knowledge they may not be able to attain otherwise. I then introduce the distinction between two types of affect—emotions and moods—and argue that the concerns regarding affective moral enhancement only apply to interventions that aim to achieve moral improvement via direct mood modulation.Pei‐hua Huan