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Subjective and objectives measures of frailty among adults with advanced chronic kidney disease:a cross-sectional analysis of clinician misclassification
No full textBackground: 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
Sex differences in romantic love:An evolutionary perspective
No full textBACKGROUND: Evolutionary selection pressures, most notably sexual selection, have created (and continue to sustain) many psychobehavioral differences between females and males. One such domain where psychobehavioral sex differences may be prominent is romantic love. The ways in which females and males may experience and express romantic love differently has been studied in psychology as well as in the arts down the ages; however, no studies have focused specifically on romantic love (i.e., passionate love) using validated measures of romantic love solely in people who are currently experiencing this form of love.METHODS: This study investigated sex differences in features and aspects of romantic love among 808 young adults experiencing romantic love. Univariate and multivariate analyses were conducted to measure sex differences in the number of times participants had fallen in love, when they fell in love relative to when they started their romantic relationship (love progression), intensity of romantic love, obsessive thinking about a loved one, and commitment. Additional univariate comparisons were made for sex differences in Passionate Love Scale scores.RESULTS: Univariate analyses showed that males had fallen in love a greater number of times than females. Males had also fallen in love more quickly than females. Females had higher intensity of romantic love, higher commitment, and higher obsessive thinking about a loved one than males. These findings remained robust in multivariate analyses, controlling for several variables believed to influence romantic love, with the exception of commitment, which was no longer significant when other variables were controlled for.CONCLUSIONS: The findings are considered with reference to the evolutionary theory of sexual selection. We suggest that the specific adaptive challenges faced by females and males in the evolutionary history of romantic love may contribute to sex differences in romantic love. The findings shed light on contemporary sex differences in romantic love, as well as the possible evolutionary history and evolutionary functions of romantic love.</p
Novel youth mental health services in Australia:What differences are being reported about the clinical needs of those who attend and the outcomes achieved?
No full textGlobally, youth mental health services are evolving, with Australia’s headspace services presented as a leading exemplar. headspace services were designed as enhanced primary care-based entities and were expected to collaborate with local acute, and specialist clinical and psychosocial services. The lack of large-scale health services trials necessitates understanding their impact through systematic monitoring and evaluation. This paper compares data from differing sources that describe the demographic and clinical features, and functional outcomes, of young people presenting to various headspace services. headspace National reports that care is provided largely to youth with transient distress, minimal clinical disorders, suicidality or comorbidities and limited functional impairment. Almost 50% of clients are reported to have no significant psychological symptoms or risk factors, and less than 30% to have a clinical disorder. Consequently, 36% receive only a single session of care and the median number of clinical sessions provided is three. By contrast, empirically derived estimates, utilising data from an academic centre and its affiliated centres, other independent agencies and more refined analyses of headspace national data variously portray 50–60% of youth as presenting with at least moderate clinical complexity (including at least 20% with high complexity), and with another 27% requiring active clinical intervention. Together, these data suggest approximately 75% of attendees require substantive clinical care. Clinical outcomes data from all sources indicate limited impacts on functional outcomes, with less than a third achieving significant improvement. These data support the original intent of headspace services to focus on equitable access to multidimensional and clinical assessment, evidence-based early interventions for early stages of major anxiety, mood or psychotic disorders. As demand for youth services continues to rise, there is an urgent need to reconfigure our national youth service networks to address the unmet clinical and psychosocial needs of youth presenting in the early stages of major mental disorders.</p
Second Skin:Exploring bioclimate wrapping for climate-resilient housing in Australia
No full textSecond Skin (aka. FlaxWing) is a research project that focuses on the possibilities of a more climate responsive architectural approach. Via concepts of adaptation, we consider the social and technical reuse of existing building stock; the transformation of prevailing construction practices via the uptake of bio-based and low-carbon building materials; and the very adaptation of buildings themselves in response to environmental and occupant influences enacted via cyber-physical systems. Our research is situated by designs, visualisations, and prototypes of a second skin, which transforms an existing residential building in Canberra, albeit with a view to expand its deployment to other new and old buildings both here and in other parts of Australia. It is, however, not intended to be read as an architectural project, rather, it employs an architectural scenario as a way of positioning questions that span material research, computational design and fabrication, and machine control. Second Skin is a collocation of multiple research trajectories within a speculative retrofit scenario, and while each trajectory may be nascent, collectively, they highlight the many ways that architecture can contribute to a decarbonised built environment.<br/
Machine teaching in Swarm Metaverse under different levels of autonomy
No full textShepherding algorithms enable scalable swarm control via the utilization of one or a few control agents. Despite their demonstrated effectiveness in controlling swarms of point-particle agents, shepherding algorithms have been barely evaluated in controlling realistic swarms of uncrewed vehicles (UxVs). Furthermore, existing shepherding algorithms face significant challenges in dealing with complex environments such as those featuring obstacles. We address these research gaps by studying the use of human demonstrations for teaching herding behaviours to machine learning controllers. In particular, we focus on how the level of autonomy used for collecting human demonstrations affects the effectiveness of the resulting swarm controller performance. Our experimental investigation shows that demonstrations collected under a high level of autonomy result in a significantly higher success rate than those collected under a low level of autonomy. Our findings highlight that providing high-level commands for the human demonstrator is more effective even when the demonstrations is used for training a low-level controller. This article is part of the theme issue 'The road forward with swarm systems'.</p
Legal Geographies of Water:The Spaces, Places and Narratives of Human-Water Relations
No full textThis book deepens our understanding of humanity’s diverse relationships with water and the law, providing a critical assessment of this relationship, as well as charting the course towards a more sustainable and just water future.By using legal geography, the book pays particular attention to the place-based inter-relationships between water, people, and law, both formal and informal, and to the ways that law both creates and is created by the relationship between people and place. Starting in the 1980s, Chapters 2 and 3 investigate the early commodification of water through the liberalisation of rural water markets in Chile and the urban water and sanitation systems of England and Wales, before examining its global expansion in the 1990s, starting with donor driven water governance reforms in the global south. Chapters 4 and 5 document both the grassroots response to these neoliberal water reforms and the inherent tensions in attempts during the early 2000s to reconcile the recognition of a human right to water with the ongoing roll out of market mechanisms, both in the domestic context of South Africa and within the United Nations human rights system. Moving forward again, Chapter 6 examines the recent intensification of neoliberal water governance through financialisation, and considers its specific impacts in Detroit and Flint, Michigan. Chapter 7 then considers the renewed global emphasis on living waters and Indigenous ontologies of water by examining the new legislative arrangements for the Whanganui River in Aotearoa/New Zealand. In the face of a growing global water crisis, which is being exacerbated by climate change, humanity must confront the fundamental nature of our relationship with living water and the immerse damage that has been wrought through extractivist approaches. The book concludes in Chapter 8 by highlighting the stories of hope that can be found in many of the case studies explored in the book and in emerging examples from around the world.This book is essential reading for students and scholars interested in water law, security, and justice from across a wide range of disciplines, including environmental studies, law, geography, human rights, and political ecology
Connecting Our Stories:Writing an Indigenous Studies Textbook
No full textThis chapter outlines the rationale embedded in the teaching of Indigenous Studies through the Faculty of Arts and Design (FAD) at the University of Canberra (UC), Australia. Our collective works collaboratively across our teaching and research through the First Nations Collaborative Research Web (the Web). The units in Indigenous Studies offer a progressive set of learning encounters via units named: Connections to Country, Indigenous Ways of Knowing, Indigenous Cultures and Digital Contexts and Culture: Voicing the Living Archive. When teaching, we draw on our lived experience, academic backgrounds, and share a little of our knowledge of our Countries (the places we hold ancestral connections to). To do this we talk about research we have done on Country and sometimes tell stories linked to Country or speak the words that have been passed down through family. A key aim is to help students to understand diversity and that each Country produces distinct ways of knowing, being and doing. By compiling some of our anti-colonial teaching practices, research approaches and materials into an open access textbook, we aim to share our stories and learnings to support the learning of students in our units and inspire others to enact anti-colonial teaching and research practices.</p
The Role of Family Planning in Enhancing Community Resilience:Insights from Drought-Affected Youths and Women in Ethiopia
No full textThis study assesses the role of family planning (FP) in resilience building among youths and women in Ethiopia’s drought-affected and food-insecure regions. A mixed-method comparative cross-sectional study design with a total of 1712 study participants with an equal 1:1 ratio of the intervention and control groups was used. Binary logistic regression analysis was carried out to identify factors associated with community resilience. More participants in the intervention districts (58.3%) than in the control districts (49%) were currently using FP services. Approximately 54.1% of the intervention group and 43.6% of the control group were able to pay for food and shelter. Two-thirds of the intervention respondents and half of the control respondents had good social cohesion. The food consumption scores for the intervention and control districts were 26.2 and 24.9, respectively. Additionally, 62.5% of the intervention and 53.5% of the control respondents were found to have a good level of community level resilience. FP use (AOR = 3.4, 95% CI: 1.78–6.49), good social cohesion (AOR = 7.9, 95% CI: 6.09–10.23) and productive assets (AOR = 1.4, 95% CI: 1.07–1.92) were significantly associated with community resilience. To enhance community resilience comprehensively, expanding FP services should empower women in decision-making processes, cultivate ties and promote collaborative efforts across different sectors.</p
Optimal Support for Elite Sprinters Using a Minimal, Adequate, and Accurate Approach
No full textBACKGROUND: In high-performance sport, the support provided by sport scientists and other staff can be a valuable resource for coaches and athletes.PURPOSE: We propose and detail here the approach of "minimal, adequate, and accurate" sport-science support to ensure that programs of work and solutions are both economical and effective.METHODS: Our support provision advocates for utilization of "minimal" resources (employing the least amount of time, tools, and funding) necessary to achieve the desired outcomes. We strive for "adequate" information that fulfills specific objectives without excess and with the requirement that methods and data used are "accurate" (valid and reliable). To illustrate the principles of this approach, we outline a real-world example of supporting 100-m track (athletics) sprinters preparing and competing in an international competition. The provision of performance support emphasizes an integrated approach, combining knowledge and insights from multiple sport-science disciplines. The key facets managed under this approach are (1) neuromuscular readiness, (2) wellness monitoring, (3) movement observation, (4) motivation, (5) biomechanics and performance analysis, and (6) qualitative feedback. These facets are based on the specific performance determinants and influencing factors of an event (100-m dash).CONCLUSIONS: Application of this quantitative and qualitative approach can enhance the ability to make informed decisions. Nevertheless, the approach must be planned, evaluated, and refined on a regular basis to enable effective decision making in sport-science support. The 3-element approach of "minimal, adequate, and accurate" should be codesigned and supported by the athletes, coaches, and staff to ensure successful implementation.</p
