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The Use of Vasoactive Agents in Pulmonary Embolism Among the Critically Ill: A Multi-Centred, Retrospective Cohort Study in Queensland Intensive Care Units
No full textBackground: Pulmonary embolism may cause hemodynamic instability requiring vasoactive support, but evidence on guiding agent selection is very limited. Methods: A retrospective cohort study of adult admissions to 12 Intensive Care Units in Queensland, Australia between 2015–2021. Clinical and outcome data was obtained through statewide hospital databases. Results: Of 89,123 admissions, 460 (0.6%) patients had a primary diagnosis of pulmonary embolism. Vasoactive infusions were administered within the first 24 h of ICU admission to 182/460 patients (39.6%) and 209/460 (45.4%) patients at any time during ICU admission. Norepinephrine was the most common (175/209; 83.7%), followed by epinephrine (37/209; 17.7%). The cohort had a median ICU length of stay of 3 days (IQR; 2-5), and a 30-day mortality rate of 11.3% (52/460). Higher vasoactive requirement on day-1 was associated with significantly higher 30-day mortality (odds ratio per 1-unit increase in vasoactive-inotrope score of 3.72, 95% confidence interval 1.80-8.75, P < .001). Conclusion: Primary diagnosis of PE is uncommon among ICU presentations but 45% of patients require vasoactive support. Norepinephrine was the most used vasoactive agent. Higher vasoactive requirements reflected greater illness severity and were associated with higher 30-day mortality.No Full Tex
The Safety and Effectiveness of the Hydraulic Pressure Sinus Floor Elevation Technique: A Systematic Review
No full textAim: This project aims to systematically review and synthesise the data found in the literature regarding the survival of implants, complications, and gain in bone height using the hydraulic pressure technique to elevate the maxillary sinus floor. Methods: A comprehensive literature search was conducted using databases including PubMed, Scopus, Embase, and Cochrane, covering studies from 2005 to July 2024. A total of 24 studies were included, comprising randomised control trials, cohort studies, and case series. The main outcomes evaluated were implant survival, complication rates, and endo-sinus bone gain. Results: The review included 3053 implants placed in 2290 Sinuses of 2231 patients. The patients' ages ranged from 23 to 84, with a mean of 51.6 years. The included studies reported a pooled implant survival rate of 98.40% over follow-up periods ranging from 6 months to 8 years. The rate of sinus membrane perforation was relatively low (2.05%), and other complications, such as hematoma, sinusitis, nasal discharge, or oedema, occurred in 0.49% of cases. The average endo-sinus bone gain achieved using this technique was 6.72 mm. Conclusion: The hydraulic pressure technique for sinus floor elevation is one of the many proposed solutions to provide predictable, safe, and efficient sinus floor elevation. The results from this review provide some cause for optimism, with high survival rates, low complication rates, and adequate gain in bone height. There is still a need for further long-term, high-quality research by independent third parties to confirm the effectiveness and safety of this technique. Clinical Relevance: There is limited information available for the hydraulic pressure technique for sinus floor elevation. It has only been briefly mentioned in a limited number of literary reviews, none of which quantify the available data. This study presents the first systematic review of the hydraulic pressure technique, synthesising the available data and suggesting that the hydraulic pressure technique demonstrates high success and safety. Prospero: This review is registered in PROSPERO under ID: 1070614.No Full Tex
Examining Infrastructures of Welcome in Regional Australia
No full textNational and local initiatives aim to encourage long-term settlement in regional/rural Australia by creating welcoming environments. This often involves facilitating multicultural events and access to settlement services. Drawing on qualitative research with migrants in regional Queensland, this article addresses how less explicit aspects of reception shape how welcome migrants feel. This includes migration policies, restricted access to formal support services, and limited public transport options. By adopting an infrastructural lens and highlighting the multiscalar and multidimensional nature of welcome, we demonstrate that the ways in which migrants engage with infrastructures that organize their social lives shape their experiences of welcome.No Full Tex
The experience of home for people with chronic pain: A mixed methods study
No full textIntroduction: Chronic pain, defined as intermittent or continuous pain for a minimum of 3 months, is a prevalent and pervasive health issue that commonly results in occupational participation changes and individuals spending more time within the home. Yet the role of the home environment in pain and pain management has not been specifically explored. This study had two aims. The first aim was to explore how home is experienced for people with chronic pain across the six dimensions of home using the Dimensions of Home Measure. The second aim was to explore relationships between pain, mood, and dimensions of home to understand how the experience of home influences reported pain and its co-morbidities. Method: An online cross-sectional survey collected data from people with chronic pain across Australia. Participants provided information on their demographic characteristics, experience of home (Dimensions of Home Measure), pain and interference (Brief Pain Inventory), and symptoms of psychological distress (Depression, Anxiety, and Stress Scale 21 items). Descriptive statistics and mediation regression analyses from pain interference (PI) on psychological distress through aspects of dimensions of home were conducted. Consumer and Community Involvement: An interprofessional chronic pain rehabilitation team, including medical doctors and allied health, highlighted the need for this study and partnered with academics. Professional and consumer pain associations throughout Australia supported the study by promoting the study details and assisting with participant recruitment. The research team included members with lived experience of chronic pain, caring for people with pain, and treating pain who were involved in the design, analysis, and reporting of results. Results: A total of 107 people aged 18 years or older participated. The results suggest that the experience of home is generally considered to be positive for people living with chronic pain; however, some aspects of home life such as perceiving the home as a place for activities, safety within the home, and in temporal aspects of home life (e.g., daily and weekly routines and feeling that the home is set up for the future) may be less positively regarded compared to other aspects of home life. Mediation findings, with pain interference as the predictor, suggest a strong reciprocal relationship between feelings of safety within the home and symptoms of anxiety and with perceiving the home as a place for activities and in temporal dimensions of home life with depressive symptoms. Discussion: The results of this study provide preliminary support for the further examination of the home as a determinant of health, including as a potential factor to be considered beyond the biopsychosocial model of pain. Occupational therapists working with clients for pain management within their home should consider how the home can be modified or structured to improve occupational participation, particularly in relation to safety, the home as a place for activities, the routines of daily life, and that the home is well set up for the future. This may have a profound impact on how home is experienced for people with chronic pain and on their emotional wellbeing.No Full Tex
Nanoconfined homonuclear Mn pairs for efficient oxygen reduction and long-life Zn-air batteries
No full textThe nanoconfined environment offers a synergistic combination of physical confinement and electronic regulation, yet its underlying microscopic mechanisms remain to be systematically elucidated. Herein, we fabricate atomically dispersed homonuclear Mn catalytic pairs through the perhalate cascaded oxidation strategy within nanoconfined pores on activated mesoporous carbon spheres (Mn2-N-AMC). Finite element method (FEM) simulations and density functional theory (DFT) calculations reveal that nanoconfinement enhances O2 transport and weakens the adsorption of oxygen intermediates. Furthermore, the bridge adsorption configuration of intermediates on Mn pairs promotes the subsequent O* protonation and reduces the energy barrier for OH* desorption. Consequently, Mn2-N-AMC exhibits superior radical scavenging capability and delivers excellent oxygen reduction reaction (ORR) performance with a half-wave potential (E1/2) of 0.90 V and remarkable stability. Additionally, Mn2-N-AMC-based aqueous Zn-air batteries (A-ZABs) achieve an ultrahigh power density of 256.7 mW cm−2 and long-life stability (> 800 h). Quasi-solid-state ZABs also display a long-life operation over 100 h across various current densities, with negligible voltage gap decay. This work provides mechanistic insights, advancing the rational design of nanoconfined ORR catalysts for sustainable energy conversion and storage.No Full Tex
PGRM: Positive-unlabeled enhanced recommendation model based on generative adversarial network
No full textAs information overload escalates, recommendation systems play a crucial role in personalized information filtering. Traditional recommendation systems face substantial challenges from implicit feedback, particularly due to the imbalance between positive and negative samples as well as noisy data. To tackle these challenges, we propose a novel Positive-Unlabeled Enhanced Recommendation Model based on Generative Adversarial Network (GAN), named PGRM. This model combines the Positive-Unlabeled (PU) learning and adversarial learning. By analyzing the distributions of positive and unlabeled samples, it can more accurately identify potential reliable negative samples, thus improving the GAN's training process. Furthermore, we introduce a spy mechanism in the PU learning technique and a hybrid negative sampling strategy to further improve the recommendation accuracy. The spy mechanism enhances the model's ability to learn from negative samples through a PU-assisted loss function, while the hybrid negative sampling strategy effectively captures user preferences by combining hard and weak negative samples, thereby reducing interference from noisy data. Extensive experiments on four public datasets show that the proposed model PGRM outperforms state-of-the-art comparison models, with average gains of 4.8% in HR@5 and 4.0% in NDCG@5, especially under sparse and noisy conditions, demonstrating its effectiveness and generalization.No Full Tex
The Limits of Upzoning: Historic Land Use, Amenity, and Lot-Scale Drivers of Densification
No full textProblem, research strategy, and findings: Upzoning has been characterized as a critical solution to increasing housing supply. However, its effectiveness is challenged by persistent gaps between zoned supply, planning approvals, and actual construction. The influence of lot size, historic land use, and proximity to infrastructure on feasibility of redevelopment on upzoned lots is rarely quantified. As a result, planning systems may overestimate the capacity of upzoned land to deliver new housing, overlooking the complex interplay of regulatory history, physical site characteristics, and market dynamics that ultimately shape development outcomes. In response, I examined factors influencing apartment and townhouse construction on individual lots in Brisbane (Australia). Key predictors include zoning categories (including historical zoning changes), historic land use, proximity to amenities, and lot size. The analysis reveals that upzoning alone was an insufficient driver of change, and that lots formerly used for industrial purposes in 1951 (often riverfront, inner-city areas) and larger lot sizes were significantly more likely to contain higher-density development in 2021. The effect of lot size plateaus beyond 1,200 sq. m (∼13,000 sq. ft), suggesting that additional constraints limit development feasibility, despite ample land. The influence of zoning likely reflects regulatory requirements in traditionally zoned jurisdictions, where higher-density zones are explicitly needed to permit such development.
Takeaway for practice: Zoning functions as an essential enabler of densification in Brisbane but does not alone catalyze new construction. Unless market conditions are strong, the translation of increased zoned capacity into actual housing supply takes time. Upzoned sites in low-demand locations may potentially never materialize into increased housing supply. Conversely, restrictive low-density zones remain effective at constraining new development, underscoring zoning’s role as a necessary (but alone, not sufficient) condition for densification. Importantly, findings show restrictive zoning can shape built form for generations, despite subsequent upzoning.No Full Tex
Predictors of Patient Participation in Pressure Injury Prevention: An Observational Substudy
No full textPatient participation improves patient outcomes, but factors that predict participation in pressure injury prevention (PIP) are relatively unknown. This study aimed to identify patient-related factors predictive of patient participation in pressure injury prevention (PPPIP) in hospitalised medical and surgical patients and to assess the psychometric properties of the PPPIP scale. This observational substudy recruited consenting adults at risk of pressure who participated in a parent trial. The seven-item PPPIP scale was administered within 48 h of recruitment, with higher scores reflecting more participation. Multiple regression was used to identify patient-related factors predictive of patient participation. The scale's psychometric properties were assessed using confirmatory factor analysis and Cronbach's alpha. In total, usable data were obtained from 856 patients. Mean PPPIP scale scores were relatively high, with 571 (66.7%) scores reflecting agreement or strong agreement. The Cronbach's alpha was 0.81, and most confirmatory factor analysis criteria for construct validity were met. Only the use of mobility aids was statistically significant in the model, but it predicted a small amount of variability in PPPIP score (adjusted R2 = 0.017; p < 0.001). Targeting patients with limited mobility may be a useful strategy when trying to engage patients in PIP if resources are limited.Full Tex
Improving the management and outcomes of preschool wheeze: protocol of a prospective multicentre cohort study
No full textIntroduction Preschool wheeze and asthma are associated with substantial morbidity and impaired future lung function. Yet, wheeze is unreliably reported with high disagreement (>50%) between parental and physician observations. Objectively defining wheeze and its reversibility could enable an earlier asthma diagnosis and improve preschool wheeze management. Our primary aim is to determine in preschool children (aged 0.5–6 years) suspected of asthma whether adding WheezeScan to routine clinical assessment (vs assessment without WheezeScan) improves the diagnosis of asthma. Our primary hypothesis is that using WheezeScan in preschool children suspected of asthma is associated with increased definitive asthma diagnoses in this age group. Our secondary aims are to (a) examine the effect of using WheezeScan on patient-reported outcomes (PROs) and (b) healthcare costs. Our secondary hypothesis is that using WheezeScan in preschool children suspected of asthma is associated with improved quality of life without incurring additional healthcare costs. Methods and analysis Our multicentre prospective cohort study involves recruiting 102 preschool children suspected of asthma. WheezeScan, a user-friendly digital device, incorporates artificial intelligence to objectively define wheeze and its response to bronchodilators. Over 6weeks, parents/caregivers use the WheezeScan two times per day and whenever wheezing is suspected. If wheeze is detected, an inhaled short-acting β2-agonist is administered and WheezeScan determines if wheeze resolves thereafter. Our primary endpoint is the proportion of children with a definitive asthma diagnosis, compared with baseline, based on the treating clinician’s assessment using WheezeScan data. Our secondary outcomes are PROs, reflecting generic health-related quality-of-life and cough-specific (if chronic cough present) outcomes and health costs. Ethics and dissemination The Children’s Health Queensland Human Research Ethics Committee (HREC/23/QCHQ/100691) and the Queensland University of Technology Office of Research Ethics and Integrity approved the study. We will publish and share results with the academic and healthcare communities and relevant patient organisations.Full Tex
"The hardest 9 months of my life": Parents' experiences of care in pregnancies after perinatal loss in Australia
No full textProblem Pregnancy after perinatal loss is associated with increased risks of adverse psychosocial and biomedical outcomes. Background Standard antenatal care often fails to meet these parents’ needs. Aim To explore parents’ experiences of pregnancy after perinatal loss in Australia and understand the care and support they find most meaningful. Methods National cross-sectional web-based survey of parents in Australia who had experienced perinatal loss and were pregnant or had completed a subsequent pregnancy in the preceding five years. Quantitative data were analysed largely descriptively; qualitative data underwent thematic analysis. Findings Of 332 participants (97 % mothers), most experienced adverse mental health issues at least sometimes during the subsequent pregnancy (70–98 %). Most received additional or specialised care plans (74 %) and reported elements of respectful and compassionate care most-, or all of the time (73–91 %). Participants typically rated their care favourably. Most had access to medical components of care, such as an obstetrician (89 %) and additional ultrasound scans (87 %), while few reported the involvement of a specialist midwife (17 %), bereavement counsellor (23 %) or specialist antenatal classes for pregnancy after loss (5 %). Thematic analysis identified one overarching theme: recognition of the subsequent pregnancy and previous loss; and four subthemes: trusted healthcare professional in a continuity of carer model, additional care and monitoring, emotional and mental health support, and respectful communication. Discussion Recognition of the subsequent pregnancy in the context of prior loss is essential. Conclusion Improving access to integrated, trauma-informed continuity of care models may better support parents in pregnancies after loss.Full Tex