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New evidence of megafaunal bone damage indicates late colonization of Madagascar
Get PDFCopyright: © 2018 Anderson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The estimated period in which human colonization of Madagascar began has expanded recently to 5000–1000 y B.P., six times its range in 1990, prompting revised thinking about early migration sources, routes, maritime capability and environmental changes. Cited evidence of colonization age includes anthropogenic palaeoecological data 2500–2000 y B.P., megafaunal butchery marks 4200–1900 y B.P. and OSL dating to 4400 y B.P. of the Lakaton’i Anja occupation site. Using large samples of newly-excavated bone from sites in which megafaunal butchery was earlier dated >2000 y B.P. we find no butchery marks until ~1200 y B.P., with associated sedimentary and palynological data of initial human impact about the same time. Close analysis of the Lakaton’i Anja chronology suggests the site dates <1500 y B.P. Diverse evidence from bone damage, palaeoecology, genomic and linguistic history, archaeology, introduced biota and seafaring capability indicate initial human colonization of Madagascar 1350–1100 y B.P
The background and development of quality of life and family quality of life: applying research, policy, and practice to individual and family living
Get PDFCopyright (c) 2018 Roy I. Brown, Alice Schippers .
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.This article introduces the concepts of quality of life and family quality of life and shows how they have developed in the field of intellectual and developmental disabilities in terms of concepts and principles. The article underscores the relevance of many of the principles and practices to a wide range of disabilities and challenges in the broad field of human development. Finally, the article provides an introduction to the other articles in this special issue, and considers their relationship to the broader areas of research, practice, and policy
‘Sustainable’ Rather Than ‘Subsistence’ Food Assistance Solutions to Food Insecurity: South Australian Recipients’ Perspectives on Traditional and Social Enterprise Models
Get PDF© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).South Australian (SA) food charity recipients’ perspectives were sought on existing services and ideas for improvement of food assistance models to address food insecurity. Seven focus groups were conducted between October and November 2017 with 54 adults. Thematically analysed data revealed five themes: (1) Emotional cost and consequences of seeking food relief; (2) Dissatisfaction with inaccessible services and inappropriate food; (3) Returning the favour—a desire for reciprocity; (4) Desiring help beyond food; and, (5) “It’s a social thing”, the desire for social interaction and connection. Findings revealed that some aspects of the SA food assistance services were disempowering for recipients. Recipients desired more empowering forms of food assistance that humanise their experience and shift the locus of control and place power back into their hands. Some traditional models, such as provision of supermarket vouchers, empower individuals by fostering autonomy and enabling food choice in socially acceptable ways. Improvement in the quality of existing food assistance models, should focus on recipient informed models which re-dress existing power relations. Services which are more strongly aligned with typical features of social enterprise models were generally favoured over traditional models. Services which are recipient-centred, strive to empower recipients and provide opportunities for active involvement, social connection and broader support were preferred. View Full-Tex
Novel Bacterial Cellulose-Poly (Acrylic Acid) Hybrid Hydrogels with Controllable Antimicrobial Ability as Dressings for ChronicWounds
Get PDF© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).This investigation examines the combination of poly (acrylic acid) (PAA) and bacterial cellulose (BC) nanofibers to synthesize hydrogel hybrid composites used for wound dressing application. Amoxicillin (AM) was also grafted onto the composites for drug release. Fourier transform infrared analysis and scanning electron microscopy conducted revealed the structure and porosity of the composite being developed, as well as the successful fabrication of BC-PAA composites. The results of mechanical testing and hygroscopicity revealed that the composite shows higher stability than hydrogels which are currently used worldwide, albeit with a slight reduction in swelling capabilities. However, the composite was revealed to be responsive to a rise in pH values with an increase in composite swelling and drug release. These results together with their morphological characteristics suggest that BC-PAA hydrogel hybrid composite is a promising candidate for wound dressing application. View Full-Tex
Single-Cell Profiling Identifies Key Pathways Expressed by iPSCs Cultured in Different Commercial Media
Get PDF© 2018 The Author(s).
This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).We assessed the pluripotency of human induced pluripotent stem cells (iPSCs) maintained on an automated platform using StemFlex and TeSR-E8 media. Analysis of transcriptome of single cells revealed similar expression of core pluripotency genes, as well as genes associated with naive and primed states of pluripotency. Analysis of individual cells from four samples consisting of two different iPSC lines each grown in the two culture media revealed a shared subpopulation structure with three main subpopulations different in pluripotency states. By implementing a machine learning approach, we estimated that most cells within each subpopulation are very similar between all four samples. The single-cell RNA sequencing analysis of iPSC lines grown in both media reports the molecular signature in StemFlex medium and how it compares to that observed in the TeSR-E8 medium
Monte Carlo Simulations Demonstrate Algorithmic Interventions Over Time Reduce Hospitalisation in Patients With Schizophrenia and Bipolar Disorder
Get PDF© The Author(s) 2018. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).Non-adherence with pharmacologic treatment is associated with increased rates of relapse and rehospitalisation among patients with schizophrenia and bipolar disorder. To improve treatment response, remission, and recovery, research efforts are still needed to elucidate how to effectively map patient’s response to medication treatment including both therapeutic and adverse effects, compliance, and satisfaction in the prodromal phase of illness (ie, the time period in between direct clinical consultation and relapse). The Actionable Intime Insights (AI2) application draws information from Australian Medicare administrative claims records in real time when compliance with treatment does not meet best practice guidelines for managing chronic severe mental illness. Subsequently, the AI2 application alerts clinicians and patients when patients do not adhere to guidelines for treatment. The aim of this study was to evaluate the impact of the AI2 application on the risk of hospitalisation among simulated patients with schizophrenia and bipolar disorder. Monte Carlo simulation methodology was used to estimate the impact of the AI2 intervention on the probability of hospitalisation over a 2-year period. Results indicated that when the AI2 algorithmic intervention had an efficacy level of (>0.6), over 80% of actioned alerts were contributing to reduced hospitalisation risk among the simulated patients. Such findings indicate the potential utility of the AI2 application should replication studies validate its methodologic and ecological rigour in real-world settings
The role of community and professional engagement in teaching allied health higher education: the academic perspective
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Copyright © 2018 Association of Schools of Allied Health Professions, Wash., DC
This author accepted manuscript is made available following 12 month embargo from date of publication (September 2018) in accordance with the publisher’s archiving policyCommunity and professional engagement describes a collaborative model of interaction between institutions of higher education and the communities in which they operate. This qualitative study aimed to examine how professional and community engagement is understood and incorporated into the role of staff members within the School of Health Sciences of one university. Twenty-one academic and professional staff were interviewed. Participants identified a range of definitions for both 'community' and 'professional' engagement, as well as the benefits and limitations of such engagement. Ability to conduct engagement was limited by time capacity when competing with other role requirements. Integration of community engagement with research and teaching requires development of a framework that addresses both the common barriers and facilitators to engagement
Developing clinical educators in the Western Pacific: Part 1
No full text© James Cook University. This work is licensed under a Creative Commons Attribution 4.0 International LicenceIn the past 5 years there has been a rapid rise in numbers of foreign-trained medical graduates returning to their
countries to work as interns across the Western Pacific. These graduates were found to have a varied and different
level of clinical knowledge and skill from that previously experienced in the region. This change in workforce profile led
to an urgent need for upskilling clinicians as educators and supervisors. A team of clinical education facilitators were
invited to design and deliver context-specific professional education workshops to address this need. These workshops
were designed to equip clinical staff with education and supervision skills to optimise teaching and learning
opportunities in clinical settings for these new graduates of foreign medical programs. Embracing a collaborative
approach and addressing learning needs in local contexts has enabled the team to enhance medical education capacity in the Western Pacific region. This article presents the context of the need for and development of clinical
education workshops for intern supervisors in the Western Pacific
Economic evaluation of an extended nutritional intervention in older Australian hospitalized patients: a randomized controlled trial
Get PDF© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBackground
Prevalence of malnutrition in older hospitalized patients is 30%. Malnutrition is associated with poor clinical outcomes in terms of high morbidity and mortality and is costly for hospitals. Extended nutrition interventions improve clinical outcomes but limited studies have investigated whether these interventions are cost-effective.
Methods
In this randomized controlled trial, 148 malnourished general medical patients ≥60 years were recruited and randomized to receive either an extended nutritional intervention or usual care. Nutrition intervention was individualized and started with 24 h of admission and was continued for 3 months post-discharge with a monthly telephone call whereas control patients received usual care. Nutrition status was confirmed by Patient generated subjective global assessment (PG-SGA) and health-related quality of life (HRQoL) was measured using EuroQoL 5D (EQ-5D-5 L) questionnaire at admission and at 3-months follow-up. A cost-effectiveness analysis was conducted for the primary outcome (incremental costs per unit improvement in PG-SGA) while a cost-utility analysis (CUA) was undertaken for the secondary outcome (incremental costs per quality adjusted life year (QALY) gained).
Results
Nutrition status and HRQoL improved in intervention patients. Mean per included patient Australian Medicare costs were lower in intervention group compared to control arm (by 2956 to 13,882 versus 838 versus 1000 per unit improvement in PG-SGA was > 98% while it was 78% at a willingness to pay $50,000 per QALY gained.
Conclusion
This health economic analysis suggests that the use of extended nutritional intervention in older general medical patients is likely to be cost-effective in the Australian health care setting in terms of both primary and secondary outcomes
An empirical comparison of the measurement properties of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U for older people in residential care
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Purpose
This study aimed to empirically compare the measurement properties of self-reported and proxy-reported (in cases of severe cognitive impairment) generic (EQ-5D-5L) and condition-specific (DEMQOL-U and DEMQOL-Proxy-U) preference-based HRQoL instruments in residential care, where the population is characterised by older people with high rates of cognitive impairment, dementia and disability.
Methods
Participants were recruited from seventeen residential care facilities across four Australian states. One hundred and forty-three participants self-completed the EQ-5D-5L and the DEMQOL-U while three hundred and eight-seven proxy completed (due to the presence of severe dementia) the EQ-5D-5L and DEMQOL-Proxy-U. The convergent validity of the outcome measures and known group validity relative to a series of clinical outcome measures were assessed.
Results
Results satisfy convergent validity among the outcome measures. EQ-5D-5L and DEMQOL-U utilities were found to be significantly correlated with each other (p < 0.01) as were EQ-5D-5L and DEMQOL-Proxy-U utilities (p < 0.01). Both self-reported and proxy-reported EQ-5D-5L utilities demonstrated strong known group validity in relation to clinically recognised thresholds of cognition and physical functioning, while in contrast neither DEMQOL-U nor DEMQOL-Proxy-U demonstrated this association.
Conclusions
The findings suggest that the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U capture distinct aspects of HRQoL for this population. The measurement and valuation of HRQoL form an essential component of economic evaluation in residential care. However, high levels of cognitive impairment may preclude self-completion for a majority. Further research is needed to determine cognition thresholds beyond which an individual is unable to reliably self-report their own health-related quality of life