50716 research outputs found
Sort by
The hepatitis B virus surface antigen:An evolved perfection and its unresolved mysteries
No full textThe Hepatitis B Virus has long afflicted the human race, with a widespread impact on the global health system and profound medical implications for those who are chronically infected. Despite its relatively recent discovery, over the last 50 years great advancements have been made towards the characterisation of this complex etiological agent. The virus itself has a highly evolved genome which encodes for seven viral proteins, three of which (the surface antigens) were consequential in the initial discovery and isolation of the virus. These surface antigens are ubiquitously important throughout the viral lifecycle, from capsid envelopment through to receptor-mediated invasion into the hepatocytes. The hepatitis B surface antigens (in particular, the large protein) adopt complex topological folds and tertiary structures, and it is this topological intricacy which facilitates the diverse roles the three surface antigens play in HBV maturation and infection. Here, the biochemical and topological attributes of the three surface antigens are reviewed in detail, with particular focus on their relevance to the establishment of infection. Further research is still required to elucidate the coordinates of the antigen loop and the dynamic topological changes of key motifs during entry and viral morphogenesis; these in turn may provide new leads for therapeutics which may potentiate a functional cure for chronic hepatitis B.</p
Particle filtration efficiency of respirators during the COVID-19 pandemic
No full textBackground: Respirators are an essential medical device vital to prevent the transmission of airborne illness between persons. This study presents an investigation conducted by the Therapeutic Goods Administration (TGA) into the particle filtration efficiency (PFE) performance of respirators supplied in Australia that were included as medical devices in the Australian Register of Therapeutic Goods (ARTG) throughout the COVID-19 pandemic or supplied to the TGA from other jurisdictions for compliance testing. Methods: A total of 400 real-world batches of respirators were tested against a rapid-screen PFE method developed by the TGA. The TGA analysed a respirator's ability to meet its claimed filtration efficiency with a statistical power analysis differentiated by the claimed PFE standard, country of manufacture, time of inclusion into the ARTG and respirators with surgical against non-surgical claims. Findings: Of the tested batches of respirators (n = 400), 70 % were compliant with the pre-set compliance criteria. The results indicate statistically significant PFE differences (p < 0.05) between respirators claiming the standards 42 CFR Part 84, AS 1716:2012, GB 19083: 2010 and EN 149:2001+ A1:2009 when tested against respirators claiming GB 2626:2006. There were no observed significant differences between the PFE of surgical and non-surgical respirators (p > 0.05). Interpretation: The findings of this study highlight the importance of ensuring respirators meet their claimed PFE level based on their claimed standard prior to manufacturer release. Further studies should be focussed on investigating the effect of respiratory protection devices and their claimed efficiency in clinical settings such as hospitals against aerosolised particulates using a range of respiratory protection devices.</p
The Digital Economy is the ‘New Normal’
No full textThis editorial introduces a new issue of the Journal of Telecommunications and the Digital Economy, exploring the growth of the digital economy post-COVID-19. The pandemic accelerated online interactions, revealing a lag in social norms despite decades-old technologies. Developed nations integrate AI into shopping, while developing countries advance rapidly, yet design principles remain rooted in tradition. The contributions in this issue underscore the human element in technology adoption and the Journal’s role in bridging telecommunications’ legacy with today’s digital challenges, enriching understanding of the evolving digital economy.</p
Understanding the unique goals of complex support clients accessing alcohol and other drug treatment
No full textBackground: Actively involving clients of Alcohol and Other Drug (AOD) services in selecting their own treatment goals may help to align clients’ and service providers’ expectations of treatment and improve engagement with services. This study explored the type and frequency of client-selected treatment goals; self-reported progress towards their goals; client and clinician views of their progress, and the acceptability of selecting and tracking goals in a non-residential AOD treatment provider in New South Wales, Australia. Methods: A mixed method study was conducted. Clients selected their goals during AOD treatment then self-rated their progress towards goals using the validated 11-point goal-based outcome (GBO) rating tool. Qualitative interviews were conducted with clients and clinicians. Mean GBO ratings were reported for each timepoint. Goals were thematically analysed to identify type, then descriptively analysed to identify frequency. Interviews were thematically analysed by one researcher and reviewed by a second. Results: Among the 22 clients who completed the GBO at least once, the median number of self-identified goals was 3. The most common goals included: (1) managing mental health and (2) developing strategies to prevent relapse and manage AOD cravings. Most participants reported improvements in their selected goals; there were no participants who reported lower GBO scores at the second timepoint compared to the first. Qualitative themes demonstrate that while the GBO approach provided clarity for clients, was acceptable to clients and clinicians, and considered client expectations of treatment, the approach was difficult for those with limited literacy and reflexive thinking. Those experiencing lapse or relapse reported the linear GBO rating approach was potentially demotivating. Conclusions: Findings demonstrate that a goals-based outcome approach can promote shared decision-making between client and clinicians about treatment goals which are valued by clients. Service providers should be aware of potential complexity of recalling selected goals and completing ratings particularly among clients with co-occurring mental illness and memory impairment. Goals that are time-specific, realistic and relevant should be prioritised to minimise risks of demotivation arising from non-linear progress towards goals.</p
Best Practice Pathways for Knee Osteoarthritis:Project Report – Executive Summary
No full textThe project, ‘Best practice pathway for knee osteoarthritis –Implementing an advanced musculoskeletal pre-surgical triage and assessment clinic’ was instituted in response to Canberra Health Service (CHS) identifying delays to access consultants in orthopaedics and asking University of Canberra (UC) to develop and conduct a collaborative project to address the issues by implementing best practice solutions. A structured project was developed collaboratively to investigate factors contributing to extended waits for patients with knee osteoarthritis referred for orthopaedic consultation at Canberra Hospital, guide changes to care and evaluate outcomes. The project was funded by a Translation Grant from HCF Foundation for a 3-year period from July 2022 to June 2025. Key Findingsü Wait times improved: wait times to clinician consultation in 2023 were 14%, and in 2024 10% of comparable 2022 wait times. ü The APPs saw more patients: from 20% in 2022, to 81% in 2023 and 76% in 2024. ü Patients seen first in the APP clinic risked less delays than those seen only in the surgical clinic (APP clinic IRR: 0.55; 95%CI: 0.43, 0.72); and if seen in both APP and surgical clinics incidence rate ratio (IRR): 0.54; 95%CI:0.41, 0.70). ü Risk of delays outside of clinical recommendations for patients reduced in 2023 and 2024 (AOR: 0.11; 95% CI: 0.04, 0.31; AOR: 0.02; 95% CI: 0.004, 0.09). ü Less patients referred to orthopaedics were listed for knee replacement: from 46% to 38% then 35%. ü As a measure of adverse response, people referred-back to see a surgeon by their GP after APP consultation were counted, but there was no difference between the years.ü The surgeons saw more patients ready for surgery: a patient examined by a surgeon in 2023-2024 was 1.9 times more likely to be listed for surgery than a patient in 2022 (Odds Ratio 1.9, Chi2 = 6.5, p = 0.011). ConclusionsPositive changes can be attributed to:• Significantly reduced wait to see a clinician,• An increased proportion of people with knee osteoarthritis being seen by APP, • Digital health records reducing the risk of lost referrals, • Availability of community exercise and education programs (GLA:D), • Efficient use of consultant time,• Compliance with the clinical standards for management of knee osteoarthritis. Care has improved for patients following these improved pathways. There is now an urgent imperative to expand this model of care to patients with other conditions in Orthopaedics and to other specialist clinics across CHS where it has been identified that advanced clinical practitioners would benefit access to care. An example is patients with chronic shoulder pain where strong evidence supports non-surgical interventions, but at present community care does not have capacity to treat this number of patients, which would be essential. Resourcing and planning are needed for APPs to provide these additional services. APP clinics can improve access to care and efficiency of the surgical clinics, in that the patients in surgical clinics are more likely to be ready for surgery. However, there are insufficient APPs trained, and it is very difficult to recruit them from elsewhere. The interviews showed that GPs referring a patient to orthopaedics are seeking a specialist consultation for their patient; they are not necessarily seeking surgery for this patient and the consultation with the APP met their needs. Surgeons, however, prefer to see patients ready for surgery, except where complex conditions require specialist expertise.<br/
Molecular impact of metabolic and endocrine disturbance on endometrial function in polycystic ovary syndrome
No full textPolycystic ovary syndrome (PCOS) is a systemic metabolic and endocrine disorder that significantly disrupts reproductive physiology and endometrial function. In this narrative review, we examine the molecular impact of metabolic and hormonal imbalances on the endometrium of women with PCOS. We investigate the specific mechanisms that delineate how hyperinsulinemia and insulin resistance, chronic low-grade inflammation, and estrogen/progesterone/androgen imbalance contribute to altered epigenetic, transcriptomic, metabolomic, and signaling profiles in a wide array of different cell types within endometrial tissues. The synergistic interplay between upregulated inflammatory cytokines (e.g., IL-1,2,6,8,17,18, and TNF-α), along with key changes in critical molecular pathways associated with hyperinsulinemia and insulin resistance (e.g., PI3K/AKT/MAPK, and Wnt/β-catenin), in addition to aberrant sex steroid hormone signaling (e.g., CYP19A1, COX-2, PGE 2, HOXA10, 11βHSD2), promotes deleterious changes within the endometrial microenvironment. These anomalies underpin a spectrum of clinical manifestations observed in women with PCOS at each stage of the life course, including abnormal uterine bleeding in reproductive-age women, impaired decidualization in pregnancy, and altered postmenopausal endometrial physiology. Clinically, these alterations are associated with abnormal uterine bleeding, subfertility, implantation failure, miscarriage, pregnancy complications, and postmenopausal endometrial hyperplasia and cancer. Overall, our review provides novel insights into the molecular mechanisms linking systemic metabolic and endocrine dysfunction with endometrial pathology in PCOS and has broader implications that apply to all women.</p
A saddle point-guided clustering algorithm for data with complex structure
No full textDensity-based clustering is a fundamental unsupervised learning technique with broad applications across diverse domains. However, most existing density-based clustering algorithms have difficulty in discovering clusters of different densities and sizes, especially in the case of significant variations in the density of points within the same cluster. In this paper, we propose a novel clustering algorithm that addresses this limitation by integrating a mode-seeking phase with a fragmented cluster fusion phase. In the mode-seeking phase, the dataset is partitioned into initial clusters, where each cluster center represents a point whose density is a local maximum, and the remaining points are assigned through an innovative majority voting mechanism. Natural clusters containing multiple local maxima of the underlying density function are thus partitioned into multiple initial clusters accordingly. To accurately capture the intrinsic cluster structure of the data, we introduce a saddle point-guided cluster similarity measure that quantifies the homogeneity between adjacent initial clusters; here, a saddle point is defined as the point of maximum density located on the boundary between the two clusters. With the cluster similarity, the obtained initial clusters are processed for merging using a fragmented cluster fusion technique based on minimum spanning forest (MSF). Extensive experiments on 31 benchmark datasets—including 20 synthetic and 11 real-world datasets—demonstrate the superior performance of the proposed algorithm. Specifically, it achieves the highest NMI scores on 23 datasets and the highest ARI scores on 21 datasets.</p
Patient Preferences for Cancer Nurses as Care Providers:A Systematic Review of Discrete Choice Experiments
No full textBackground: Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made. Aim: To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer. Methods: A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised. Results: Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer. Conclusion: Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care. Patient or Public Contribution: Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.</p
Bridging the Gap:Citizens, Elected Officials and Deliberative Engagement in Australian Democracy
No full textAcross the world, democracies are grappling with a widening gap between citizens and those who govern. Australia is no exception. Drawing on a nationally representative survey of 4,200 adult respondents, our new research report shows that Australians don't want less democracy, they want a more meaningful one: one that listens, responds, and creates genuine opportunities between elections for people to have a say in the decisions that shape their lives
FULL STACK FABULATOR (OR THE PROMETHEAN CURATOR)
No full textCuratorial practice is often associated with open processes of meaning-making (and -unmaking), as provisional relations between artworks are catalysed through artful exhibition design, writing and live programming. In the process, ‘curatorial fabulation’ may conjure speculative worlds, while also allowing us to reconsider persistent holes of official histories. Building on the thought of Ursula Le Guin, curators may be seen as stitching temporary ‘carrier bags’, for divergent histories and futures; a practice that is particularly pertinent to online curating. The work of online curating requires beguiling storytelling, where multi-layered fabulations of back- and front-end forms, are replete with gaps that invite recursive re-thinking. FULL STACK FABULATOR is an experimental work of confessional fictocriticism that uses programmatic citation, free-association and readymade pop graphics to tell one of many possible stories of online curating. Drawing on source materials from seminal texts, Curating Digital Art (Dekker 2021), Patchwork Girl (Jackson 1995) and Frankenstein (Shelley 1818), the essay highlights how online curating engages in a process of narrating itself into existence, knitting itself a loose ‘carrier bag’ to gather invisible and invisible forms. Through this work, FULL STACK FABULATOR, invites readers to consider house online curating destabilises technological and cultural fictions, while weaving its own tales