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Changes to Gestational Diabetes Mellitus (GDM) Testing and Associations with the GDM Prevalence and Large- and Small-for-Gestational-Age Infants—An Observational Study in an Australian Jurisdiction, 2012–2019
No full textBackground: Two changes to gestational diabetes mellitus (GDM) testing were implemented in the Australian Capital Territory in 2015 and 2017. Aims: We aimed to determine the associations between testing regimes and the prevalence of GDM and large-for-gestational-age (LGA) and small-for-gestational-age (SGA) infants and to compare the prevalence of LGA and SGA infants between women with and without GDM in each testing period. Methods: A total of 23,790 singleton live births with estimated GDM testing and birth dates between June 2012 and December 2019 were stratified into groups: pre-testing changes (June 2012–December 2014, group 1, n = 8069), revised diagnostic criteria (January 2015–May 2017, group 2, n = 8035) and changed pathology centrifugation protocol (June 2017-December 2019, group 3, n = 7686). Women were allocated to groups based on their estimated GDM testing date and stratified by their GDM status. A chi-square test, pairwise z-tests and logistic regression tested the associations. Results: The GDM prevalence significantly increased from 9.5% (group 1) to 19.4% (group 2) to 26.3% (group 3) (all: p < 0.001). The LGA infant prevalence significantly decreased in non-GDM women following revised diagnostic criteria implementation (11.6% vs. 9.7%, p = 0.001). Compared to group 1, women with GDM in groups 2 and 3 had significantly reduced odds of having LGA infants (aOR = 0.73, 95% CI of 0.56–0.95 and p = 0.021 and aOR = 0.75, 95% CI of 0.59–0.97 and p = 0.029, respectively). Compared to group 1, non-GDM women in groups 2 and 3 had significantly reduced odds of having LGA infants (aOR = 0.83, 95% CI of 0.74–0.92 and p < 0.001 and aOR = 0.88, 95% CI of 0.79–0.99 and p = 0.026, respectively). There were no significant associations for group 3 compared to group 2 nor for SGA infants. Conclusions: While significantly increasing the GDM prevalence, implementing the testing changes was associated with a reduced whole-population LGA infant prevalence without a change in the SGA infant prevalence.</p
Is there a golden hour for exercise in aging females?:A perspective on the female-specific effects of estradiol in regulating vascular endothelial function
Get PDFSex hormones are known for their roles in reproductive health; however, they pose auxiliary actions on nonreproductive tissues such as the vasculature, notably involving the mediation of endothelial vasodilation and vasoconstriction (1). Abrupt declines in estrogen during the menopausal transition have been associated with endothelial dysfunction and a subsequent increase in cardiovascular events (2). It should come as no surprise that participation in physical activity and exercise is recommended as a common strategy to enhance endothelial function, and the effectiveness of different exercise modalities on vascular health outcomes and risk modulation has been investigated (3–7). However, despite the awareness of increased cardiovascular disease (CVD) risk during and after menopause, there is conflicting evidence surrounding the efficacy of exercise as a means to enhance endothelial function in females throughout this critical period
Risk assessment processes within healthcare simulation centers:A scoping review
No full textObjectives: All healthcare workplace activities contain inherent safety threats; however, these may be potentially unique within the context of a simulation center. Simulation prioritises safety yet introduces risks. This scoping review aims to map the existing literature on risk assessment in healthcare simulation centers and identify how risk is assessed, measured and mitigated in these spaces. Design: The review adhered to the Joanna Briggs Population, Concept and Context (PCC) mnemonic, was reported using the Preferred Reporting Items for Systematic Reviews and Meta Analysis extension for Scoping reviews (PRISMA-ScR) guidelines and registered with Open Science Framework. Results: A total of 490 articles were found, however only 8 studies met the inclusion criteria. The review highlights a lack of literature regarding the proactive assessment of risks in simulation learning. Conclusion: There is a need for the development and implementation of standardized risk assessment frameworks to ensure the safety of nursing faculty and students during simulation-based learning activities.</p
Adaptability and Implementation of Climate-Resilient Retrofit Toolkits for Older People
No full textFollowing the Black Summer Bushfires of 2019–2020, a number of bushfire-resilient retrofit toolkits started to emerge across Australia and were made available to homeowners in affected areas. These retrofit toolkits primarily address property maintenance and building construction to comply with the Australian Standard 3959-2018 Construction of Buildings in Bushfire Prone Areas. However, these toolkits are not tailored to the diverse housing needs and capabilities of the growing population of Australians over 65, the most vulnerable and affected age group during the event of natural disasters. Therefore, the purpose of this research is to examine the adaptability and implementation of available bushfire-resilient retrofit toolkits with consideration to the needs and perceptions of older people. This paper presents a critical literature review of global, National, State, local, and independent guidance on building for bushfire resilience, through the lens of building construction and architecture. It identifies the challenges and gaps in knowledge for how to tailor disaster-resilient guidance for older people. It further presents a future research agenda to adopt universal design principles into available retrofit guidance to promote inclusive climate action. This paper is part of a broader research project funded by the Australian Black Summer Bushfire Recovery Grants Program.</p
Mythical, slippery, shapeshifting:Grief is the Thing With Feathers transforms tragedy into literature
No full textThis short book gives voice to a family who have lost their wife and mother, and their sorrows, in an impressive example of how to write about tragedy. Critics have called it, variously, a novel, a verse novel, a prose poem, magical realism, formal experimentation, and a play for voices. Like Porter's later novels, this is a story of people on the margins, people struggling against adversities. He tells those tales in fragments, flickering images, surprising swirls of language and wit
Mandibular repositioning effects on running until exhaustion at moderate intensity
No full textBACKGROUND: Wearing a mandibular repositioning dental splint may enhance ventilatory function and exercise performance. We aim to analyze the performance and the biophysical effects of wearing an intraoral splint with mandibular repositioning when running until exhaustion at moderate intensity. METHODS: Sixteen trained male runners completed a crossover randomized controlled study to evaluate the effects of two intraoral splints (with and without mandibular forward repositioning) on performance, ventilatory and bioenergetic profiles during running until exhaustion at the velocity corresponding to the anaerobic threshold. Ventilatory variables were analyzed at different running time-points, and a paired samples t-test was employed to compare the experimental conditions across all evaluated variables. RESULTS: The splint with mandibular forward repositioning facilitated ~12% longer running than the splint without mandibular repositioning. Oxygen uptake was the sole ventilatory variable demonstrating a higher value across all the analyzed running time-points when the mandible was advanced (10th min, 58.1±9.4 vs. 55.3±9.8; 10 min before the end, 57.7±8.7 vs. 55.3±9.1; and at the end of the exercise, 57.2±8.2 vs. 54.2±9.0 mL∙kg-1∙min-1; P≤0.05). The splint with mandibular forward repositioning also elicited a lower rate of perceived exertion (17.1±0.77 vs. 17.4±0.63, P=0.05) and higher aerobic contribution (2611±708 vs. 2212±640 kJ), overall energy spent (2633±708 vs. 2232±642 kJ) and exercise energy cost (0.28±0.05 vs. 0.26±0.05 kJ∙m-1, P≤0.005). CONCLUSIONS: The mandibular forward repositioning elicited a marked improvement in moderate intensity performance, with beneficial physiological and perceived effects.</p
Perceptions of air pollution and health communication for people with asthma among Australia’s Arabic-speaking communities
No full textAir pollution is a major public health risk factor globally and a significant threat to people with respiratory conditions. People with asthma, and particularly those from culturally and linguistically diverse (CALD) backgrounds, are disproportionally affected and have less capacity to protect themselves from air pollution. There is a critical lack of accessible resources and advice for people with asthma who are from CALD backgrounds. This qualitative study aimed to better understand Arabic-speaking Australians’ perceptions of air quality, support their health literacy, and co-design resources to help them reduce their exposure to air pollution. A virtual roundtable discussion was conducted with key stakeholders from Australian Arabic-speaking communities to explore perceptions of air pollution and effective ways to communicate related public health messages to people with asthma within these communities. Australian Arabic-speaking communities generally have low awareness of air pollution. Although they use social media platforms and traditional media widely, more needs to be done to raise their awareness of air pollution and related health issues through targeted bilingual (English-Arabic) messaging and audiovisual material. The importance of religious and other community leaders in promoting environmental and public health messages within the diverse Arabic-speaking communities was highlighted. Future asthma-awareness and air pollution literacy campaigns should be designed in ways that reach CALD communities that have previously been underserved by public health promotion. Culturally sensitive health communication approaches are particularly important as Australia’s population continues to diversify.</p
From anarchy to clarity, data pre-processing and statistical choices influence quantitative environmental DNA (eDNA) analyses
No full textEnvironmental DNA (eDNA) analyses hold great potential for increasing species detection sensitivities and estimating species abundances. The rapidly growing user base, continuous method development and optimisation have led to diverse approaches for capturing and analysing eDNA. While significant efforts have been made to standardise field and laboratory protocols, a notable gap remains in understanding the consequences of data pre-processing and statistical choices on the final results obtained, particularly in quantitative eDNA analyses. These insights are crucial for developing best-practice guidelines that can harmonise analytical workflows. To address this gap, we conducted an extensive literature review focusing on quantitative species-specific eDNA studies. We assessed the diversity of data pre-processing and statistical choices made to evaluate the correlation between eDNA concentrations and species' abundance or biomass, and collected the raw datasets when available. We then applied commonly used data analysis strategies to the datasets to formulate general recommendations for improving the reliability and reproducibility of quantitative eDNA analyses. Our results indicate that, within the available literature, statistical methods are not always clearly described and raw data are rarely made publicly available. Furthermore, the choice of data pre-processing strategies and statistical tests used to assess quantitative correlations can significantly influence the likelihood of detecting positive correlations and the effect sizes. Overall, we recommend the following: (i) increase transparency in method descriptions and data availability; (ii) assess correlations using mixed-effect models that can account for data characteristics; (iii) avoid pre-processing quantitative eDNA data, especially when combined with sub-optimal statistical tests. Implementing these guidelines should enhance the accessibility and transparency of quantitative eDNA data and ultimately their use for managers and policy makers.</p
Cumulative Effects Assessment under the World Heritage and Ramsar Regimes
No full textManaging cumulative pressures on socio-ecological systems presents as one of the foremost policy challenges of our time. Climate change, invasive species, development and pollution all have the potential to individually, and collectively, degrade the earth’s natural and cultural resources. International environmental law, a crucial element of global environmental governance, has a role to play in prompting and coordinating a response to cumulative effects. Hitherto, however, international approaches have been fragmented and unfocused, further complicating the already challenging application of Cumulative Effects Assessment (CEA) at the local level. This article examines how the two primary protected area treaties—the World Heritage Convention and the Ramsar Convention on Wetlands—have evolved to address the concepts of CEA and cumulative effects. It uncovers instances of ambiguity and fragmentation in treaty guidance material and concludes with a suggestion for further empirical research into how CEA could (or should) apply in the context of internationally protected areas
Multimodal Automatic Acute Pain Recognition Using Facial Expressions and Physiological Signals
No full textAccurate and objective pain assessment is crucial for effective pain management. This paper proposes a novel multimodal deep learning framework for automatic pain detection using a hybrid architecture with feature-level fusion. The framework leverages multimodal data including facial expressions and physiological signals (EDA and ECG) from the BioVid Heat Pain database (Part A). The novel hybrid architecture consists of two streams as stream 1 employs an attention-based CNN-LSTM to extract features from facial expressions videos, capture temporal dependencies, and focus on relevant aspects of the video data, and stream 2 with an LSTM to capture temporal patterns in the physiological signals. The performance of the proposed model was examined in both unimodal and multimodal settings. In a binary classification task distinguishing No Pain from Severe Pain, electrodermal activity (EDA) outperformed all other single data sources, achieving high average accuracy (83.05% for 67 subjects and 82.69% for 87 subjects) and F1-scores (81.66 and 80.18, respectively) using k-fold cross-validation. Additionally, the multimodal setting (Video + EDA) achieved higher accuracy (84.15% for 67 subjects and 83.35% for 87 subjects) and F1-scores (82.86 and 82.36, respectively).</p