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Australian healthcare personnel acceptance of the seasonal influenza vaccine:a qualitative exploration
No full textAim: Australian healthcare personnel (HCP) are a vulnerable, yet essential cohort prioritised for seasonal influenza vaccination (SIV). Despite extensive SIV programs, and other health protective behaviours, high levels of influenza exposure contribute to almost 23% of HCP being infected each season. In that context, understanding determinants that maximise SIV uptake among HCP is an important but under-explored area. Subject and methods: We conducted 14 semi-structured interviews with Australian HCP, primarily those most involved with vaccination procedures, including nurses, midwives, pharmacists, and medical practitioners. The question guide development was based on constructs from the Triandis Theory of Interpersonal Behaviour and an integrative review. All interviews were transcribed verbatim with the application of Braun and Clarke’s reflexive thematic analysis to identify and explore pertinent themes. Results: Six distinct but inter-related themes were associated with HCP seasonal influenza vaccination behaviour. Most significantly, professional responsibility and identity appeared highly associated with positive vaccine intention, followed by vaccination convenience and ease of access. Protection, habit, risk perception, and experience and knowledge were also found to influence HCP decision making around SIV. Vaccination complacency, not hesitancy, was described as impeding the progression of vaccination intention (acceptance) to vaccine behaviours (uptake). Conclusion: Findings suggest interventions that foster professional identity, leverage camaraderie and a ‘duty of care’ to protect others may enhance SIV intention. While improved access to SIV in the workplace could promote positive vaccination behaviour, particularly if triggers or nudges are applied to prompt the vaccination habit in the presence of SIV acceptance.</p
The Effects of Transcranial Direct Current Stimulation and Exercise on Salivary S100B Protein Indicated Blood-Brain Barrier Permeability:A Pilot Study
No full textOBJECTIVE: This study aimed to assess the effect of transcranial direct current stimulation (tDCS) and exercise on blood-brain barrier (BBB) permeability in humans as assessed through the quantification of the salivary protein biomarker S100B. It was hypothesized that active tDCS would induce a significant increase in salivary S100B concentration when compared with sham stimulation and no stimulation. It also was hypothesized that the increase in salivary S100B concentration would be greater after active tDCS and exercise than after tDCS or exercise alone.MATERIALS AND METHODS: A total of 13 healthy adults (five male, eight female), ranging in age from 21 to 32 years, underwent three experimental conditions (active tDCS, sham tDCS, inactive control). To assess exercise- and tDCS-induced changes in BBB permeability, S100B in saliva was measured. Saliva samples were taken before tDCS, after tDCS, and immediately after a ramped cycling time-to-exhaustion (TTE) task. Active tDCS involved the application of anodal stimulation over the primary motor cortex for 20 minutes at 2 mA.RESULTS: S100B concentrations in the control condition did not differ significantly from the active condition (estimate = 0.10, SE = 0.36, t = 0.27, p = 0.79) or the sham condition (estimate = 0.33, SE = 0.36, t = 0.89, p = 0.38). Similarly, S100B concentrations at baseline did not differ significantly from post-intervention (estimate = -0.35, SE = 0.34, t = -1.03, p = 0.31) or post-TTE (estimate = 0.66, SE = 0.34, t = 1.93, p = 0.06).CONCLUSIONS: This research provides novel insight into the effect of tDCS and exercise on S100B-indicated BBB permeability in humans. Although the effects of tDCS were not significant, increases in salivary S100B after a fatiguing cycling task may indicate exercise-induced changes in BBB permeability.</p
The paleobiology of a new osmeriform fish species from Australia
No full textOsmeriformes represent an important component of freshwater ecosystems in Australia and New Zealand yet are poorly represented in the fossil record in these countries. Here we describe Ferruaspis brocksi gen. et sp. nov. from the Miocene of New South Wales, Australia. Phylogenetic analyses place the species as a basal member of the southern radiation of Osmeriformes. The fossils are embedded and mineralized in the iron oxide-hydroxide mineral goethite, resulting in an unusual degree of structural preservation. Preserved stomach contents indicate an opportunistic benthopelagic diet, evidenced by the remains of numerous phantom midge larvae (Chaoborus), two insect wings, and a bivalve. Another bivalve (Unionidae) was found attached to the tail of one of the specimens. The preservation of melanosomes indicates that the species was counter-shaded with two lateral stripes. Discovering this species west of the Great Dividing Range, with a population that includes a range of body sizes, suggests that at least this population if not the species spent its entire life in freshwater, unlike most extant Osmeriformes. The description of F. brocksi highlights the ability of specimens with preserved soft tissues to reveal aspects of the paleobiology of extinct species
Pilot of a multicomponent program for people with dementia and their care partners: Health services staff expectations, experiences and observations
No full textThere is increased recognition of the need to improve post-diagnostic pathways for people with dementia and their care partners living in the community to access rehabilitation services to support independence and wellbeing. However, there is minimal evidence on implementing rehabilitation services for this population. The study aimed to present the expectations and experiences of allied health staff involved in piloting the Sustainable Personalised Interventions for Cognition, Care and Engagement (SPICE) program based at an outpatient clinic of a public rehabilitation hospital. Over twelve weeks, the program combines small group and dyadic evidence-based interventions including cognitive stimulation therapy, occupational therapy, physical activity, care partner education, and dietetics. A qualitative exploratory methodology was used with pre- and post-program interviews conducted with ten allied health staff. Questions were designed to elicit the expected and actual benefits and challenges of the initial implementation of the multicomponent program. The multidisciplinary team were motivated by the potential for the SPICE program to meet an important service gap, and confident people with dementia and their care partners would benefit. Staff reported enjoyment, satisfaction, and confidence in delivering the program, and believed the multiple components had synergistic effects on participants, particularly regarding social connection and functional engagement. While staff had pre-program concerns regarding retention, participant fatigue, and managing challenging situations, these were not realised. At times, staff observed program intensity to cause unintended stress for some care partners. Resourcing and strategies to ensure sustainability were identified as important by staff, as well as the need for ongoing support to participants post-program. Overall, the SPICE program exceeded expectations and was rewarding for staff. Further work to refine and evaluate the program is necessary to support its potential to continue providing dementia rehabilitation to promote the independence and wellbeing of people with dementia and care partners living in the community.</p
Seasonal analysis of indoor and outdoor ratios of PM 2.5 and PM 10 in Bangkok and Chiang Mai:A comparative study of haze and non-haze episodes.
No full textParticulate matter (PM) air pollution has been identified as one cause of human health impact with the estimated global 8.8 million attributable deaths. Thailand experiences haze episode every year, which can lead to high ambient concentrations of particulate matter in ambient air. This study aims to investigate the relationship of indoor and outdoor air quality in both haze and non-haze period in two cities in Thailand: namely Bangkok and Chiang Mai. We conducted the air quality sampling in various styles of house, with 17 houses in both urban and rural areas, between April to October 2019. The results indicated that the concentration of PM 2.5 in indoor air in Bangkok were 19.85 and 11.40 μg/m 3 for haze and non-haze period, respectively, whereas the PM 10 concentrations were 32.124 and 17.49 μg/m 3 for haze and non-haze period, respectively. The corresponding average of outdoor air concentrations were 26.26 and 16.68 μg/m 3 for haze and non-haze, respectively. While the PM 10 concentrations were 46.36 and 23.86 μg/m 3 for haze and non-haze period, respectively. In Chiang Mai, it was observed that the mean concentration of PM 2.5 in indoor was 106.80 μg/m 3 and 5.52 μg/m 3 for haze and non-haze periods, respectively. Regarding PM 10, it was observed that the mean concentration in indoor was 118.54 μg/m 3 and 9.74 μg/m 3 for haze and non-haze periods, respectively. Indoor/Outdoor (I/O) ratios of PM 2.5 varied in Bangkok average was 0.76 for haze and 0.68 for non-haze period. The I/O ratio in Chiang Mai was 0.91 and 1.16 for haze and non-haze episode, respectively. Indoor/Outdoor (I/O) ratios of PM 10 varied in Bangkok average was 0.70 for haze and 0.73 for non-haze period. The I/O ratio in Chiang Mai was 0.92 and 0.96 for haze and non-haze episode, respectively Our findings indicated the influences of outdoor air quality on indoor air quality during both haze and non-haze episode. The intrusion of outdoor air in Chiang Mai to the houses caused a higher I/O ratio than Bangkok due to the characteristics of house and culture. The indoor air quality in terms of particulate matter were dominated by outdoor air quality. Thus, people should close doors/windows during the haze as well as non-haze episode to avoiding the pollutant accumulation. </p
Determining the process components of impact assessment in health and social program implementation:A scoping review of theories, models and frameworks
No full textObjectives: Health and social service research impact analysis play a pivotal role in demonstrating research value. Impact analysis of programs, interventions, or policies in real-world settings is complex. There are many implementation evaluation theories, models, and frameworks (TMF) and researchers find choosing one challenging. Our objective was to systematically scope TMFs, review and chart key components of the process of implementation impact analysis to identify gaps. Study design: A scoping review was undertaken and reported using PRISMA-ScR guidelines. Methods: Systematic literature searches were conducted for impact analysis and impact assessment TMFs in MEDLINE, SCOPUS databases, hand searches, and expert directed search (2010–2024). Peer-reviewed articles were eligible for inclusion if they described an implementation evaluation TMF in English and used in the real world. Data extracted by the study team was charted in an Excel spreadsheet. Results: The review identified 71 relevant papers which included a theory (n = 6), model (n = 14), or framework (n = 51). Most considered resources and/or results, whereas only 25 % considered implementation process components. Ten frameworks were deemed comprehensive and covered at least two phases of implementation and five components. Most frameworks had not developed or tested practical tools to facilitate use of the framework. Conclusions: No frameworks were identified that incorporated all phases of implementation, nor key components of the process in each phase of implementation research. The findings highlight the need to identify key components and develop a taxonomy, glossary and tools to assess the process components of implementation in real world settings.</p
Registered Nurse‐Led Interdisciplinary Care: A Single Case Study of a Young Woman With Intellectual Disability and Chronic and Complex Health Problems
No full textAimTo describe how specialised models of registered nurse-led care and support can play a vital role in the health and quality of life of someone with intellectual disability and multiple chronic and complex health problems.DesignSingle instrumental case study.MethodsData collection occurred between March and August 2023, and included interviews with parents, historical case files, descriptions of the nurse-led model of care and a list of the daily registered nurse-led interventions.ResultsThe evidence presented strongly support the positive impact a nurse-led model of care can have for persons with profound disability and complex health conditions, and their families. The improved quality of life observed in this project underscores the significant role nurses play in enhancing the well-being of this vulnerable population.ConclusionFurther research on a larger scale should be completed to create a robust foundation of a specialised, nurse-led model of care for individuals with profound disability and complex health conditions.ImplicationsThere is room for funded intermediate models of care as the health system cannot be expected, and nor is it appropriate, to provide ongoing care for all people with intellectual disability.Reporting MethodThis study adhered to the COREQ guidelines for qualitative research.Patient or Public ContributionNo patient or public contribution
Subjective and objectives measures of frailty among adults with advanced chronic kidney disease:a cross-sectional analysis of clinician misclassification
Get PDFBackground: Frailty is a recognisable clinical measure of impaired physiological reserve and vulnerability to adverse outcomes that is validated among patients with kidney disease. Practice patterns reveal inconsistent use of objective frailty measures by nephrologists, with clinicians prioritising subjective clinical impressions, possibly risking misclassification and discrimination. Aims: The aim of this study was to examine correlations between subjective and objective measures of frailty in a cohort of patients attending routine nephrologist review. Methods: Eighty-nine participants attending scheduled review with their primary treating nephrologist (n = 6) were included in cross-sectional analysis. Measured frailty based on Fried phenotype and subjective clinician impression were assessed for congruence using Pearson's correlation analysis and ĸ statistic. Ordinal logistic regression examined patient demographics associated with perceived frailty. Misclassification was explored using descriptive statistics and contingency table analysis. Results: Frailty and prefrailty were prevalent by both objective and subjective means of assessment with minimal correlation between clinician impression and measured Fried phenotype (r = 0.50, P = 0.00, ĸ = 0.25, P =&#x02009;0.00). Subjective clinician impression misclassified half of participants, influenced by surrogate frailty measures including female sex, comorbidity and reliance on a walking aid. Clinicians were equally likely to over-classify prefrailty as to under-recognise established frailty, with no evidence of systemic misclassification bias. Subjective clinican impression of frailty had a positive predictive value of 19.1% and a negative predictive value of 56.2%. Conclusions: Nephrologists' reliance on subjective clinical impressions that overlook or misclassify prefrailty offers incomplete prognostic assessment and potentially misses opportunities for early intervention.</p
The European Union’s Reform of International Investment Law: per aspera ad astra or an unfeasible aspiration?
No full textAs states continue exploring options for the reform of Investor-State Dispute Settlement, the EU’s proposal to establish a Multilateral Investment Court faces an uncertain legal and political landscape
In We Do Not Part, Han Kang faces unbearable historical traumas with sorrow and compassion
No full textWe Do Not Part tells the story of Kyungha, a writer of 20th-century South Korean history, and her longterm friend Inseon, a documentary filmmaker and photographer, both of whom have been traumatised by their professional research into institutionally authorised massacres. The novel is told in three parts. The long first section establishes the context in a comparatively linear narrative of past and present. The shorter middle part is a deep dive into the horrors of history. The ending is very short, told in fragments. The novel ends with what seems to be a dream, where the two women light a candle in the dark, in the depths of snow