324139 research outputs found
Sort by
Evaluating primary care expenditure in Australia: the Primary Care Spend ( PC Spend) model
Get PDFObjectives: To assess the distribution of health care expenditure (public and private) for primary care and primary health care as proportions of overall health care funding. Study design: The Primary Care Spend model; estimated distribution of expenditure for three tiers of primary care services by provider and function. Setting: Primary Care Spend model applied to Australian health expenditure, public and private, 2020–21, from a health sector perspective, as recorded by the Australian Institute of Health and Welfare. Main outcome measures: Proportions of all health care spending for essential community and primary health care functions (tier A), comprehensive primary care (services delivered in general practices and family physician clinics; tier B), and enhanced primary care services (long‐term holistic patient care; tier C). Results: In 2020–21, 33.2% of health spending in Australia was classified as primary health care spending (tier A), 6.0% as comprehensive primary care services (tier B), and 0.8% as long term holistic patient care services (tier C). Conclusions: The application of the Primary Care Spend model to Australian data provides a more nuanced analysis of expenditure for primary health care than routine health expenditure reports. Its output could be used to inform targets for spending on different tiers, types, and locations of primary care, especially comprehensive and other high value primary care services, and to monitor progress toward these targets
Blue-light photodegradation of ferricyanide under protein relevant conditions †
Get PDFFerricyanide is commonly used as a reoxidant in photochemical studies of redox proteins including cytochromes, photosystem II and flavoproteins. A low-spin d5 complex, [Fe(iii)(CN)6]3− is a powerful electron acceptor which efficiently reoxidises photo-generated radical species. Unfortunately, ferricyanide itself absorbs strongly in the blue and a better understanding of its own photochemistry is required. Here, we present a combined UV/Vis and infrared spectroscopic study of the blue light photo-induced degradation of ferricyanide under conditions commonly employed in photochemical studies of proteins. Clear differences are observed in the photochemistry in pure water, Tris buffer and 20% glycerol solution, which are interpreted in terms of solvent–ligand exchange and ligand to metal charge transfer. The implications for photochemical studies of proteins employing ferricyanide as a reoxidant are discussed
Protocol for the process evaluation for a cluster randomised controlled trial evaluating primary school-based screening and intervention delivery for childhood anxiety problems
Get PDFIntroduction: Anxiety problems are prevalent in childhood and, without intervention, can persist into adulthood. Effective evidence-based interventions for childhood anxiety disorders exist, specifically cognitive–behavioural therapy (CBT) in a range of formats. However, only a small proportion of children successfully access and receive treatment. Conducting mental health screening in schools and integrating evidence-based interventions for childhood anxiety problems may be an effective way to ensure support reaches children in need. The Identifying Child Anxiety Through Schools—Identification to Intervention (iCATS i2i) trial involves screening for childhood anxiety problems and offering a brief online parent-led CBT intervention. This paper presents the protocol for the process evaluation of the iCATS i2i trial, which aims to examine the implementation and acceptability of the study procedures, the mechanisms of change and whether any external factors had an impact on procedure engagement or delivery. Methods and analysis: This process evaluation will use both quantitative and qualitative methods to evaluate the implementation and acceptability of and barriers/facilitators to engagement and delivery of the iCATS screening/intervention procedures. Quantitative data sources will include opt-out and completion rates of baseline measures and usage analytics extracted from the online intervention platform. Qualitative interviews will be conducted with children, parents, school staff, iCATS i2i clinicians and researchers delivering study procedures. The Medical Research Council framework for process evaluations will guide study design and analysis. Ethics and dissemination: This study has received ethical approval from the University of Oxford Research Ethics Committee (R66068_RE003). Findings from the study will be disseminated via peer-reviewed publications in academic journals, conferences, digital and social media platforms and stakeholder meetings. Trial registration : ISRCTN76119074
Linking Stellar Populations to H ii Regions across Nearby Galaxies. II. Infrared Reprocessed and UV Direct Radiation Pressure in H ii Regions
Get PDFRadiation pressure is a key mechanism by which stellar feedback disrupts molecular clouds and drives H ii region expansion. This includes direct radiation pressure exerted by UV photons on dust grains, pressure associated with photoionization, and infrared (IR) radiation pressure on grains due to dust-reprocessed IR photons. We present a new method that combines high-resolution mid-IR luminosities from JWST-MIRI, optical attenuation, and nebular line measurements from the Very Large Telecope Multi-Unit Spectroscopic Explorer (VLT-MUSE), and the Hubble Space Telescope (HST) Hα-based region sizes to estimate the strength of radiation pressure in ≈18,000 H ii regions across 19 nearby star-forming galaxies. This is the most extensive and direct estimate of these terms beyond the Local Group to date. In the disks of galaxies, we find that the total reprocessed IR pressure is on average 5% of the direct UV radiation pressure. This fraction rises to 10% in galaxy centers. We expect reprocessed IR radiation pressure to dominate over UV radiation pressure in regions where LF2100W/LHαcorr≳75 . Radiation pressure due to H ionizations is lower than pressure on dust in our sample, but appears likely to dominate the radiation pressure budget in dwarf galaxies similar to the Small Magellanic Cloud. The contribution from all radiation pressure terms appears to be subdominant compared to thermal pressure from ionized gas, reinforcing the view that radiation pressure is most important in compact, heavily embedded, and young regions
Methods Used to Assess Early Mathematical Skills in 2‐Year‐Olds: A Review of the Literature
Get PDFWhen children are aged around 2 years, many of the early foundations of mathematical skills are developing. Understanding this is important to shed light on theories of mathematical development. Nevertheless, little research has investigated 2‐year‐olds' early mathematical abilities, with most research focussing on either infants (aged 0–1 years) or pre‐schoolers (aged 3–5 years). One possible reason for this lack of research may be the challenges associated with the methods used with this age group. Here, we review the methods used to assess 2‐year‐olds' basic mathematical skills and identify the gaps and issues with those methods. Our findings indicate several issues, both with individual methods used to test specific skills but also some common challenges applicable across all measures and skills. We discuss the identified issues and highlight a need for more appropriate approaches and for alternative methods of administration to better evaluate 2‐year‐olds' mathematical skills
Developing a core outcome set for assessing interventions and care for parents after neonatal death in high-income countries (iCHOOSE Neonatal study): protocol for a mixed-methods study
Get PDFIntroduction: Neonatal death exerts long-lasting impact on parents’ mental health, finances and relationships, and the wider family. There is national and international momentum to evaluate interventions to support parents after the death of a baby. Core Outcome Sets (COSs) provide a minimum set of outcomes, agreed by stakeholders to be important, which should be evaluated in all studies to support evidence syntheses and identification of the most effective interventions. We aim to develop a COS for assessing interventions and care after neonatal death in high-income countries, to support future evidence syntheses and enable the identification of effective interventions and care for parents. Methods and analysis: We will develop the COS in six phases. A parent involvement group and stakeholder steering committee have been established and have informed each planned phase: (1) systematic review of quantitative studies evaluating care and interventions provided after neonatal death, to describe interventions, outcomes and outcome measurement tools used to assess intervention effectiveness; (2) qualitative interviews with parents who have experienced neonatal death to identify outcomes important and relevant to them; (3) think-aloud interviews with stakeholders (bereaved parents, healthcare professionals and other stakeholders) to develop and refine an online survey; (4) real-time online international Delphi survey with bereaved parents, healthcare professionals and other stakeholders to shortlist outcomes for consideration in the COS; (5) adapted nominal group online consensus meetings with parents, healthcare professionals and other stakeholders to agree final COS and (6) identification of a preliminary set of measurement tools. Ethics and dissemination: Ethical approval has been granted for all activities to be undertaken by the University of Bristol Health Sciences Faculty Research Ethics Committee (reference: 15121). We will disseminate the findings via peer-reviewed publications and relevant academic and professional conferences. PROSPERO registration number: CRD42020151365
Rethinking neglected tropical diseases: A shift towards more inclusive and equitable terminology
Get PDFNeglected tropical diseases (NTD) refer to a group of 21 diseases that disproportionally affect impoverished communities in low- and middle-income countries (LMIC) [1]. NTD collectively impact 1.7 billion people, which is about 20% of the world’s population [1]. Each year, NTD account for more than 200,000 deaths, with millions left disabled and disfigured due to insufficient access to care and affordable treatment, often leading to social exclusion, stigmatization and discrimination. Although the term NTD has successfully directed funding and resources towards these conditions and encouraged global partnerships and high-level policy initiatives, the term may also have unintended negative consequences. In this paper, we aim to explore the term NTD and stimulate a dialogue that re-evaluates its meaning into more inclusive and equitable language
Difficult airway predictors for anticipated or unanticipated difficult airway in patients with fibreoptic intubation: a retrospective observational study
Get PDFAirway management is a cornerstone of anaesthesia. The aim of the study was to identify difficult airway (DA) predictors for patients with fibreoptic intubation (FOI). This retrospective cohort study included 135 adult patients undergoing general anaesthesia with the use of FOI at Rīga East University Hospital from 1 January 2018 to 31 December 2022. For analysis, 135 patients were divided into two groups according to unanticipated (un-DA, n = 33) or anticipated DA: (a-DA, n = 102). Data were analysed using SPSS 26.0, p < 0.05. FOI was used only in 135 cases of 50,186 general anaesthesia cases over the study period. Of 135 FOI cases, 75 (55.6%) were males with a median age of 62 ± 19 years; 24.4% FOI was used in acute and 75.6% in elective surgeries. Those with a-DA had a higher Mallampati score, on average 3.2 vs. 2.1, p = 0.002. Unanticipated DA were reported statistically more frequently in acute admission cases compared to elective surgeries — 39.3% vs 10.8% of cases. Previously known tracheal pathologies such as dislocation (p = 0.001) and stenosis (p = 0.011) were statistically reliable factors for the anticipated DA. Comparing a-DA and un-DA groups for combinations of predictors (Mallampati score, admission and tracheal pathology) we found a sensitivity and specificity 70.3% and 68.7% to predict DA. Mallampati score, acute admission, and previously known tracheal pathology are reliable predictors of DA in patients undergoing FOI. Acute admission had the greatest impact on unanticipated DA
CHAOS: chart analysis with outlier samples
Get PDFCharts play a critical role in data analysis and visualization, yet real-world applications often present charts with challenging or noisy features. However, "outlier charts" pose a substantial challenge even for Multimodal Large Language Models (MLLMs), which can struggle to interpret perturbed charts. In this work, we introduce CHAOS (CHart Analysis with Outlier Samples), a robustness benchmark to systematically evaluate MLLMs against chart perturbations. CHAOS encompasses five types of textual and ten types of visual perturbations, each presented at three levels of severity (easy, mid, hard) inspired by the study result of human evaluation. The benchmark includes 13 state-of-the-art MLLMs divided into three groups (i.e., general-, document-, and chart-specific models) according to the training scope and data. Comprehensive analysis involves two downstream tasks (ChartQA and Chart-to-Text). Extensive experiments and case studies highlight critical insights into robustness of models across chart perturbations, aiming to guide future research in chart understanding domain. Data and code are publicly available at: http://huggingface.co/datasets/omoured/CHAO
Preventing respiratory infection-related cardiovascular disease events in primary care
Get PDFBackground: Cardiovascular disease events (CVD events, comprising coronary and cerebrovascular events) are major causes of morbidity and mortality. CVD can be prevented by medications that target the underlying pathological processes of thrombosis and atherosclerosis. When a patient is diagnosed with a respiratory infection their risk of CVD events is about four times higher than their background risk for the following four weeks. This infection-related CVD event risk is well characterised by epidemiological research, but clinical practice guidelines for primary care do not address it. Prior to this thesis there were no tools for predicting an individual’s risk of an infection-related CVD event and, apart from vaccines, no established interventions for this scenario.
Overall aim: To investigate strategies for preventing infection-related CVD events in primary care.
Approach: 1. Developing statistical models to identify patients with respiratory infections who are at risk of CVD events 2. Validating the prediction models, using them to derive a clinical risk prediction score 3. Estimating the effect of aspirin on infection-related cardiovascular events 4. Estimating the effect of statin use on infection-related cardiovascular events
Methods: Four epidemiological studies using large cohorts from coded UK primary care records held by the Clinical Practice Research Datalink (CPRD). These data were linked to datasets of NHS hospital and Office of National Statistics (ONS) mortality and relative deprivation datasets. The first two studies used prediction modelling methods, and the next two used propensity modelling methods with logistic regression to estimate causal effects.
Results: I developed two statistical models and derived a clinical prediction points-based tool, the DASHI score. DASHI comprises five clinical variables: Diabetes, Age, Smoking status, Heart failure and Infection diagnosis. External validation showed DASHI can predict risk of infection-related CVD events with good calibration and discrimination (both C statistic and observed to expected ratios were 0.85 with IQR 0.85-0.85). This performance was very similar to the regression models. Aspirin and statins were estimated to increase infection-related CVD events; Relative Risk 2.52 (95% CI 2.26 to 2.81) for aspirin and 3.17 (95% CI 2.41 to 4.08) for statins. Aspirin increased bleeding with a relative risk of 1.31 (95% CI 1.06 to 1.16).
Conclusion: The DASHI score can predict risk of primary infection-related CVD events. The absolute risks are low for most people due to the short prediction period. It is unlikely that aspirin and statins increase CVD events given what we know about their effects in other settings. It is more likely the results are inaccurate because of confounding or coding problems in the datasets. In particular, prescriptions are recorded immediately in the clinical record, but there are delays before CVD events enter the datasets. This timing difference may have led to biases exacerbated by the short follow-up period. A definitive answer is likely to require a different approach, and may require different datasets, or a randomised controlled clinical trial