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The healthcare experience of young stroke survivors:an interpretative phenomenological study
Get PDFPurpose: While stroke is becoming increasingly prevalent in young people (<65 years), diagnosis, treatment, rehabilitation, and management continue to reflect the needs of older people. This study aimed to characterise and appreciate the healthcare experiences of young stroke survivors, whose needs and trajectories differ from those of older people. Materials and methods: Qualitative in-depth semi-structured interviews were conducted with 11 stroke survivors aged 18–49 using virtual conferencing software. The data were analysed using interpretative phenomenological analysis. Results: Four main themes were identified that reflect the experiences and needs of young stroke survivors and are (1) The health system overlooks the experiences and needs of young stroke survivors; (2) Support is fragmented rather than holistic; (3) Feelings of helplessness at a time agency is required; and (4) Positive attitudes despite challenges. Conclusions: The experiences of young stroke survivors are distinct. Health services that consider the unique trajectories of young stroke survivors will better facilitate rehabilitation and support for this population.</p
A new exceptionally preserved sawfly fossil (Hymenoptera: Pergidae) and an evaluation of its utility for divergence time estimation and biogeography
Get PDFWe report the discovery of the first fossil of an Australian species of Pergidae, Baladi warru gen. et sp. n., found at McGraths Flat, a newly discovered Miocene Konservat-Lagerstätte in central New South Wales. Using morphological data from the well-preserved fossil, along with a previously published molecular dataset of 59 taxa and a newly generated molecular dataset for 8 taxa, we constructed a data matrix and generated the first chronogram for Pergidae that incorporates internal calibration points. Our data reveal that Baladi warru belongs to the subfamily Perginae and is closely related to the Australian genera Cerealces and Xyloperga (tribe Cerealcini). According to our analysis, the origin of Pergidae appears slightly younger than previously hypothesised; however, additional calibration points are needed for a more detailed age constraint. Furthermore, ancestral character reconstruction indicates four independent adaptations to toxic Myrtaceae as host plants, while biogeographic analyses suggest that sympatry followed by founder events were the primary processes shaping the current disjunct distribution of pergids. Two significant founder events correspond with transitions to utilising Myrtaceae as host plants. With the approval of the Mudgee Local Aboriginal Land Council, Wiradjuri words were used to name the newly described species. ‘Baladi’ means ‘saw’ and ‘warru’ means ‘wasp’. This name honours the Traditional Owners of the lands on which the fossil was collected
One-quarter of freshwater fauna threatened with extinction
No full textFreshwater ecosystems are highly biodiverse1 and important for livelihoods and economic development2, but are under substantial stress3. To date, comprehensive global assessments of extinction risk have not included any speciose groups primarily living in freshwaters. Consequently, data from predominantly terrestrial tetrapods4,5 are used to guide environmental policy6 and conservation prioritization7, whereas recent proposals for target setting in freshwaters use abiotic factors8, 9, 10, 11, 12–13. However, there is evidence14, 15, 16–17 that such data are insufficient to represent the needs of freshwater species and achieve biodiversity goals18,19. Here we present the results of a multi-taxon global freshwater fauna assessment for The IUCN Red List of Threatened Species covering 23,496 decapod crustaceans, fishes and odonates, finding that one-quarter are threatened with extinction. Prevalent threats include pollution, dams and water extraction, agriculture and invasive species, with overharvesting also driving extinctions. We also examined the degree of surrogacy of both threatened tetrapods and freshwater abiotic factors (water stress and nitrogen) for threatened freshwater species. Threatened tetrapods are good surrogates when prioritizing sites to maximize rarity-weighted richness, but poorer when prioritizing based on the most range-restricted species. However, they are much better surrogates than abiotic factors, which perform worse than random. Thus, although global priority regions identified for tetrapod conservation are broadly reflective of those for freshwater faunas, given differences in key threats and habitats, meeting the needs of tetrapods cannot be assumed sufficient to conserve freshwater species at local scales.</p
Engineering a Sustainable Future Through the Integration of Generative AI in Engineering Education
No full textEngineers’ work impacts society and the environment and plays a central role in delivering on the United Nations Sustainable Development Goals. However, developing sustainability skills in engineering programs competes with a dense technical curriculum and has proven challenging. The mainstream adoption of generative AI (GAI) tools has prompted a review of teaching and learning, with expanding possibilities as new use cases emerge. This study reviews the impact that GAI is having on engineering education and proposes a framework for the use of GAI to facilitate greater socio-enviro-technical integration in the engineering curriculum. Based on a scoping review of the literature and a conceptual analysis, this paper provides a forward-looking perspective. Artificial intelligence (AI) is also transforming the practice of engineering, triggering the need to adjust graduate attributes accordingly. The increased productivity expected with the rise of AI in the workplace can scale-up the impact of engineering developments and underscores the need for graduates’ sustainability skills. Furthermore, engineers have a prominent role in the development of AI systems. Therefore, in advocating for the need to enhance graduate’s sustainability skills, we emphasize understanding its limitations and the sustainability of AI systems to address the paradox of AI for sustainability and the sustainability of AI itself.</p
How Do Fluctuations in Endogenous Sex Hormones Affect Breast Pain in Female Athletes?
No full textCyclic breast pain (mastalgia) is speculatively associated with hormonal fluctuations during the menstrual cycle. No research to date has quantified this effect through circulating concentrations of estradiol and progesterone in a sample of female athletes. Such data are essential for understanding how hormonal changes contribute to the incidence and severity of cyclic breast pain, with implications for enhancing breast pain management and athletic performance in women's sport. Twenty-four female Australian First Nation athletes from the National Rugby League Indigenous Women's Academy pathways program participated in a Female Athlete Research Camp. Over 5 weeks, participants completed a daily survey about their experience of breast pain and, at three approximate phases of the menstrual cycle (Phases 1, 2, and 4), presented to the laboratory for venous blood samples to track circulating estradiol and progesterone concentrations. Average mastalgia ratings spiked during the commencement of the menstrual period and 14–26 h prior to ovulation. Higher levels of estradiol and progesterone were associated with a decreased likelihood of experiencing mastalgia; elevated progesterone levels were also linked to a reduction in mastalgia severity. These effects were highly interdependent, such that the effect that progesterone had on mastalgia was dependent on the value of estradiol, and vice versa. This study provides the first quantitative evidence that circulating estradiol and progesterone levels influence the occurrence and severity of cyclic breast pain in female athletes. These findings support the development of targeted strategies for managing mastalgia, ultimately promoting well-being and enhancing performance for women in sport.</p
Individual-level and community-level factors for 10-year cardiovascular disease risk in Ethiopia:a retrospective, population-based, cross-sectional, observational study
No full textBackground: No study has quantified the 10-year cardiovascular disease (CVD) risk in individuals without previous CVD in Ethiopia using the latest 2019 WHO CVD risk equation. Our study aimed to quantify the proportion of the Ethiopian population with at least a 10% risk of developing primary CVD in the following 10 years, and to identify variations in risk associated with individual-level and community-level factors. Methods: This retrospective, population-based, cross-sectional, observational study used data on Ethiopians aged 40–69 years from across enumeration areas sampled in the WHO STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance (STEPS) national survey. The survey was conducted between April 14 and June 26, 2015. The outcome variable was 10-year CVD risk, calculated using the 2019 WHO CVD risk equation. Risk factors used to calculate 10-year CVD risk were age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. Participants with missing data on risk factors were excluded, as were pregnant individuals and those with a history of CVD. Multilevel regression analyses were used to identify individual-level and community-level factors associated with 10-year primary CVD risk. Findings: Of 2658 Ethiopian participants from 453 enumeration areas included in the analysis (1207 [45·4%] male and 1451 [54·6%] female), 7·3% (95% CI 6·3–8·2) had a 10-year CVD risk of at least 10%. Overall, 10-year CVD risk was higher in urban residents (β coefficient percentage 0·88%, 95% CI 0·60–1·15; p<0·0001) versus rural residents, in participants who were retired or unable to work (0·50, 0·05–0·96; p=0·028) versus working or unemployed participants, and in participants with low physical activity (0·46, 0·16–0·76; p=0·0021) versus participants with high physical activity. The odds of 10-year CVD risk of at least 10% were higher in those with primary education or less (adjusted odds ratio 4·14; 95% CI 1·25–13·68; p=0·021) or with secondary education (4·04, 1·15–14·10; p=0·028) versus participants educated to at least college status; in urban residents (2·03, 1·26–3·27; p=0·0031) versus rural residents; in those who were retired or unable to work (2·01, 1·15–3·49; p=0·014) versus those who were working or unemployed but able to work; and in those with low physical activity (2·35, 1·47–3·76; p<0·0001) versus those with high activity. Communities living in climates with higher water vapour pressure had higher overall 10-year CVD risk than those with lower water vapour pressure (β coefficient percentage 1·56%, 95% CI 0·68 to 2·43; p<0·0001), whereas those in hotter climates had lower risk than those in cooler climates (–0·07, –0·14 to –0·01; p=0·023). Interpretation: This study shows variations in CVD risk with individual-level and community-level factors in the Ethiopian population in 2015. Priority populations for the assessment of CVD risk and early intervention include individuals in urban areas, those who are retired or unable to work, individuals with low physical activity and lower education, as well as communities experiencing inherently higher water vapour pressure and cooler climates. Funding: None.</p
A qualitative study exploring influencers on metropolitan and regional physiotherapy practice in prostate cancer
No full textPhysiotherapists play a crucial role in managing symptoms that can arise from treatments for prostate cancer. Despite the benefits, limited evidence exists on physiotherapists’ self-perceived capabilities, enablers, and barriers in service provision. This qualitative study employed a phenomenological approach to explore the experiences of physiotherapists providing supportive care to patients with prostate cancer in metropolitan and regional Victoria, Australia. Two online focus groups were conducted, one with metropolitan and the other with regional physiotherapists. Reflexive thematic analysis identified three key themes: 1) the need for accessible professional development, 2) the impact of public system operational constraints on service access, and 3) the importance of rapport building within the multidisciplinary team and with patients. Positive enablers included online learning opportunities and effective multidisciplinary collaboration. Recommendations highlight the importance of bolstering professional development opportunities, fostering mentorship programs, and dismantling systemic barriers to enhance access to physiotherapy services. This study identifies the necessity for targeted support for physiotherapists in delivering optimal care for patients with prostate cancer across different geographical contexts. Contribution of the Paper: • This study provides valuable insights into the experiences of physiotherapists providing supportive care to people with prostate cancer (PCa). • It highlights critical areas requiring attention, such as enhancing professional development, the constraints of systems operations, the value of multi-disciplinary collaboration and unique challenges faced by regionally located physiotherapists. • Addressing these challenges will enhance the ability to provide accessible and evidence-based care to patients with PCa, ultimately improving treatment outcomes and quality of life.</p
Blockchain's role in social welfare, financial inclusion, and public sector innovations in India:A multi-sector analysis of government-led initiatives
No full textThis study investigates the integrated impact of blockchain technology in enhancing transparency, mitigating corruption, fostering trust, and promoting financial inclusion within India's public sector, focusing on social welfare programs and related services for economically weaker sections (EWS) in urban slums. Using a mixed-methods approach combining surveys (n = 700) and qualitative insights from beneficiaries and public sector experts (n = 30) in Punjab, the research assesses government-led blockchain initiatives like the Vishvasya-Blockchain Technology Stack and NBFLite. Findings reveal significant positive associations between blockchain implementation and improvements in transparency (β = 0.74), trust (β = 0.76), financial inclusion (β = 0.68), and perceived corruption reduction (β = −0.63). Qualitative data contextualizes these findings, highlighting user experiences and critical adoption barriers, particularly digital literacy. The study contributes a novel, synthesized perspective on blockchain's potential to drive synergistic improvements across interconnected public service domains (welfare, financial inclusion, potentially others like health/education), offering a holistic view crucial for urban policy and planning. Results provide actionable recommendations for policymakers regarding scaling adoption, addressing implementation challenges, investing in digital literacy, and establishing robust governance frameworks to leverage blockchain as a tool for inclusive socio-economic development in rapidly digitalizing urban environments.</p
Reducing plastic in single-use central line insertion packs:A mixed methods observational study
Get PDFCentral venous catheter (CVC) line insertion packs contain single-use plastic and metal items that are disposed of after the pack is opened, regardless of whether the item was used. This study aimed to collect data on the experiences and views of Australian clinicians who use CVC line insertion packs in paediatric critical care, elicit possible solutions to reduce waste associated with these packs, and to estimate the potential for financial and carbon footprint savings from a refined pack. This study was performed in two large paediatric tertiary referral hospitals in Sydney, Australia. Clinicians were invited to a survey and an interview to determine if and what items from a CVC line insertion pack could be excluded. Outcome measures included financial costs and embodied carbon emissions (CO 2e). Of approximately 200 eligible clinicians who were invited, 25 (12.5%) completed the survey and 18 (9%) were interviewed (five did both). All survey respondents were willing to use a new pack that had less waste. They identified five items within the existing CVC pack as commonly non-essential. Interview data identified additional strategies for waste minimisation, including use of a trolley that allowed choice of items to use. Many clinicians expressed moral distress concerning healthcare's impact on the environment. We calculated that a refined CVC pack without these five items would save the two participating hospitals approximately A$1400 and 230 kg CO 2e per year. Financial and carbon savings may be achieved through removing items that are infrequently used and/or through use of a trolley. </p
Impact of pharmacist-led interventions on COVID-19, herpes zoster, influenza, pneumococcal, and respiratory syncytial virus vaccines uptake in people aged 60 years and older:Systematic review and meta-analysis
Get PDFBACKGROUND: While some review studies have assessed the role of pharmacists in vaccination services, none have comprehensively assessed their impact specifically on improving vaccination uptake among older adults across all major recommended vaccines. These include COVID-19, herpes zoster, influenza, pneumococcal disease, and respiratory syncytial virus. This systematic review aimed to generate evidence on the effectiveness of pharmacist-led interventions in promoting the uptake of these vaccines among individuals aged 60 years and older.METHOD: Relevant publications up to June 2024 were comprehensively searched across six databases: Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Google Scholar. The pooled effect size was estimated using a random-effects model with a 95 % confidence interval (CI). Subgroup analyses were used to evaluated differences in effect sizes according to pharmacist roles.RESULT: A total of 10,998 studies were initially identified, of which 13 met the inclusion criteria. In eight pre-post studies, pharmacist involvement in immunisation services significantly increased vaccine uptake among older adults, yielding a pooled relative risk (RR) of 3.29 (95 % CI: 2.01-5.39). Similarly, in five randomised studies, pharmacist-led interventions were significantly associated with increased vaccine uptake, with a pooled RR of 3.04 (95 % CI: 1.46-6.34).CONCLUSION: This review demonstrates the substantial impact of pharmacist-led interventions on vaccination uptake among older people. The findings suggest that the greatest improvements occur when pharmacists serve as educators, facilitators, immunisers, and advocators. Healthcare policymakers and organisations should prioritise and implement comprehensive pharmacist-led strategies to enhance vaccine uptake in this population.</p