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icuRESOLVE-D (Intensive Care Unit REcovery Solutions cO-Led through surVivor Engagement-Digital): Protocol for a multicentre randomised controlled trial of digital peer support for adult survivors of critical illness
No full textBackground
Peer support is a candidate intervention to improve health-related quality of life in survivors of critical illness. This trial will evaluate the effect of a codesigned digital peer support intervention (expert-facilitated, web-based peer support) compared to usual care.
Design
This study is planned as a randomised, multicentre, two-arm, parallel-group (1:1) hybrid effectiveness implementation trial of a digital peer support model versus usual care. This trial will include an embedded process evaluation and health economic analysis.
Participants
A total of 212 adult intensive care unit (ICU) survivors, recruited by telephone from 28 days after hospital discharge.
Study setting
Six health services in Victoria and the Australian Capital Territory, Australia—including five metropolitan and one regional hospital.
Main outcome measures
The primary outcome is the self-reported health status at 90-days post hospital discharge using the EuroQol Visual Analogue Scale. Secondary outcomes will be measured at baseline 28 days after hospital discharge and at 90 days and 180 days after hospital discharge. Secondary outcomes include EuroQol five-dimensional five-level (EQ-5D-5L), Assessment of Quality of Life 6D, Impact of Events Scale-Revised, University of California Los Angeles three-item Loneliness Scale, Patient Health Questionnaire for Depression and Anxiety (PHQ-4), Connor–Davidson Resilience Scale, Patient Activation Measure, and healthcare costs.
Intervention
The codesigned digital peer support intervention is a rolling program consisting of four 1-h peer support sessions, occurring fortnightly, delivered via Zoom and facilitated by an expert clinical social worker or psychologist. The sessions include a formal (standardised education focused on ICU recovery) and an informal component (peer-to-peer discussion and peer support).
Discussion
This is a trial of a novel, codesigned, digital intervention aimed at improving recovery following critical illness. Through this randomised, parallel-group, two-arm, hybrid type 1 effectiveness implementation trial, we will examine the effectiveness and cost-effectiveness of a digital health peer support model and identify implementation factors necessary for scaling (if effective). Due to the digital health design, this trial has the potential to enhance equity of access to post-ICU services.
Trial registration
This study was registered to the Australian New Zealand Clinical Trials Registry (ACTRN12624000267550). This trial will be conducted in compliance with all stipulation of this protocol, the conditions of the ethics committee approval, the National Health and Medical Research Council, National Statement on ethical Conduct in Human Research (2007 and updates), and the Integrated Addendum to ICH E6(R1): Guideline for Good Clinical Practice ICH E6(R2) (2016). The protocol is reported according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist.Full Tex
Histone deacetylase 7 mediates lipopolysaccharide-inducible mitochondrial fission in macrophages
Get PDFHistone deacetylase 7 (HDAC7) drives several immunometabolism-related processes in macrophages including lipopolysaccharide (LPS)-inducible glycolysis and inflammatory mediator production. Using an advanced biotin ligase TurboID system in human macrophages, we report 104 candidate HDAC7 interaction partners that might contribute to its immunometabolic functions. One such protein is the mitochondrial fission-promoting GTPase dynamin-related protein 1 (DRP1, also known as DNM1L), which associates with HDAC7 in cells. Using gain- and loss-of-function genetic approaches, we show that HDAC7 promotes LPS-inducible mitochondrial fission in macrophages, as well as DRP1-dependent metabolic and inflammatory responses. HDAC7 enzymatic activity was dispensable for LPS-inducible fission, as previously reported for LPS-inducible glycolysis. However, a pharmacological inhibitor of HDAC7 attenuated fission in primary human and mouse macrophages, implicating its acetyl-lysine docking function in this response. HDAC7 thus drives inducible mitochondrial fission in macrophages. Small molecules targeting the acetyl-lysine docking function of HDAC7 might have applications in preventing pathological processes driven by dysregulated mitochondrial fission.Full Tex
Stories of 'successful' readers: Matristic ontologies of emotioning, reciprocating and (de)growing
No full textThis article responds to debates about what affects/effects reading in the primary school years, with a focus on tracing examples of matristic ontologies that foster success. We offer matristic ontologies, which are ‘an entirely different concept of life, one based not on domination and hierarchies but on the relational web of life’, as alternative pedagogies for nurturing success in reading in the primary school years. Drawing on decolonial theorising of matriarchal cultures, we attempt to rupture patriarchal ontologies that value individual freedom, competition and growth and underpin children's reading success. Instead, we explore the matristic ontology whereby communal worlds organised around reciprocal relationships support reading success. Using interviews with children who made better-than-expected learning gains in reading during the primary school years, along with their parents and teachers, we highlight their accounts of the criteria for being a successful reader during this period. We consider how aspects of a matristic ontology, grounded in emotioning, reciprocating and (de)growing rupture, challenge the coloniality of literacy and learning to read, thereby nurturing in(ter)dependent reading that is responsive to students, teachers and parents alike.Full Tex
Sedentary time elimination with periodic activity snacks (STEPS): protocol for a codesigned feasibility trial in people with severe mental illness
Get PDFINTRODUCTION: People with severe mental illness (SMI) experience substantially reduced life expectancy, largely due to cardiovascular disease (CVD). Sedentary behaviour is a major risk factor for CVD, and people with SMI spend significantly more time sedentary and are less physically active than the general population. While interventions to increase physical activity have focused on structured exercise, these are not accessible or acceptable to many consumers. The sedentary time elimination with periodic activity snacks (STEPS) study aims to test and evaluate the feasibility of a codesigned novel intervention using 'activity snacks' to interrupt sedentary behaviour in people with SMI. METHODS AND ANALYSIS: The STEPS study is a single-arm feasibility trial. We will recruit 20 participants with SMI to complete a 6-week intervention. The intervention will include the use of the STEPS smartphone app to prompt short bouts of movement across the day, the type of which are personalised to the individual. Feasibility will be assessed through recruitment and retention rates, adherence to the intervention and acceptability measured via qualitative interviews. Secondary outcomes include changes in sedentary time, physical activity, mood and quality of life, with pre-post variables analysed via either a t-test or Mann's Whitney U test, dependent on the normality of the data. Effect sizes for secondary outcomes will be calculated as Cohen's d. ETHICS AND DISSEMINATION: This trial has received ethical clearance from the Metro South Human Research Ethics Committee (HREC/2025/QMS/117193) and was prospectively registered with the Australia New Zealand Clinical Trials Registry (ACTRN12625000265471p). Results from this trial will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: Australia New Zealand Clinical Trials Registry (ACTRN12625000265471p).Full Tex
The Weaponization of Sexual Violence: Boko Haram’s Quest for Control Over Territories and Women’s Bodies
No full textJama’atu Ahlis Sunnah Lida’awati Wal Jihad, or Boko Haram, started in northeastern Nigeria in 2002 as a religious group opposing secularization. By 2010, it had escalated to assassinations and large-scale abductions, forcing women into marriage and using them as suicide bombers. This paper examines Boko Haram through a feminist political economy perspective, utilizing primary and secondary data. It traces the group’s changing ideology by analyzing how it exploited gendered socio-economic structures. The paper shows how deep-rooted inequalities enabled Boko Haram to “weaponise” forms of sexual violence, strengthening its control through fear and terror.No Full Tex
Monitoring and Assessing EPR Compliance of Producers and Importers To Prevent Free Riders in Developing Countries: the Case of Vietnam
Get PDFExtended Producer Responsibility (EPR) represents a critical policy instrument for enhancing waste management systems. While Vietnam has initiated a transition from a discretionary to a mandatory EPR framework, significant challenges persist in the effective monitoring and evaluation of compliance by producers and importers; therefore, this study seeks to develop strategic policy recommendations aimed at strengthening regulatory oversight and mitigating free rider behaviour (when individuals benefit from a good or service without contributing to its cost). By using a multimethod approach that combines desk review and focus group discussions to ensure both document-based and stakeholder-informed insights, the research identifies six key strategies to address non-compliance: cross-checking of data, mandatory registration, periodic and random inspections, enforcement of penalties, public disclosure of EPR-related information, and third-party audits. Moreover, the study delineates four fundamental considerations for conducting EPR inspections: the reliability and availability of data, the level of cooperation from obligated companies, the institutional capacity of inspection authorities, and the risks associated with corruption and lack of accountability among enforcement personnel. Furthermore, to support the inspection process, five practical tools are proposed: a standardized reporting form, a violation report form, a documentary checklist for preparatory review, an on-site inspection checklist, and an inspection reporting template. Finally, the study introduces a conceptual framework for assessing EPR compliance among obligated enterprises. These recommendations are intended to inform policy and regulatory development, thereby contributing to a more accountable, transparent, and effective EPR implementation in Vietnam.Full Tex
Titin-related familial dilated cardiomyopathy: factors associated with disease onset
Get PDFBackground and Aims Truncating variants in the TTN gene (TTNtv) are the most common genetic cause of dilated cardiomyopathy (DCM) but also occur as incidental findings in the general population. This study investigated factors associated with the clinical manifestation of TTNtv. Methods An international multicentre retrospective observational study was performed in families with TTNtv-related DCM. Shared frailty models were used to estimate associations of variant characteristics with lifetime risk of DCM, and logistic regression to estimate odds ratios (ORs) for individual-level clinical risk factor profiles (cardiac conditions, cardiovascular comorbidities, lifestyle) and DCM. Results A total of 3158 subjects in 1043 families with TTNtv-related DCM were studied. TTNtv-positive subjects were 21-fold more likely to develop DCM [OR, 21.21; 95% confidence interval (CI), 14.80-30.39]. Disease onset was earlier in males, but was similar for TTNtv of different types and locations. The presence of clinical risk factors was associated with earlier DCM onset (OR, 3.41; 95% CI, 2.06-5.64), with a prior history of atrial fibrillation having a two-fold increased odds of DCM (OR, 2.05; 95% CI, 1.27-3.32). The prevalence of clinical risk factors increased with age; however, the strength of the DCM association was greatest for young-onset (<30 years) disease (OR, 4.75; 95% CI, 2.35-9.60). Administration of beta-adrenergic receptor or renin-angiotensin system-blocking drugs prior to overt DCM was associated with 87% reduced odds of DCM (OR,. 13; 95% CI,. 08-.23). Conclusions Disease onset in TTNtv-associated familial DCM is dependent on individual patient context and is potentially modifiable by risk factor management and prophylactic therapeutic intervention.Full Tex
Infection risk of peripheral intravenous catheters: meta-synthesis of 18 prospective studies with 14,606 catheters
Get PDFBackground
To quantify the incidence of peripheral intravenous catheter (PIVC) infections and to describe the influence of clinical characteristics, including dwell time, on risk.
Methods
Meta-synthesis of 18 prospective studies (16 randomized controlled trials and two prospective cohort studies) reporting PIVC infections. In total, 14,606 PIVCs (50,096 device-days) were studied from insertion to removal in seven Australian government hospitals. PIVC care was provided by clinical staff with daily follow up by research nurses. We calculated incidences and rates of local infection (without bloodstream infection [BSI]) and PIVC-associated bloodstream infection (i.e., primary BSI) using the National Healthcare Safety Network criteria. The hazard function was assessed by fitting a parametric survival model. PIVC-associated BSI was further categorized as PIVC-related BSI and/or Staphylococcus aureus BSI. Case study methodology explored characteristics of PIVC-associated BSI, and life tables explored the hazard function of PIVC-associated BSI over dwell time.
Results
Of 14,606 PIVCs (dwell 0–42 days), there were five local infections (0.034%; 0.100/1,000 device-days) and six PIVC-associated BSI (0.041%; 0.120/1,000 device-days), of which four were PIVC-related and one was S. aureus BSI. PIVC-associated BSI involved Enterobacter cloacae (n = 3 including one co-infection with Citrobacter braakii), Proteus mirabilis (n = 1), Pseudomonas aeruginosa (n = 1) and S. aureus (n = 1; S. aureus BSI incidence 0.007% catheters or 0.020/1000 device-days). PIVC-associated BSI cases commonly featured: males > 60 years with difficult intravenous access, delayed removal of idle or symptomatic PIVCs, cancer diagnoses, invasive gastrointestinal drains/procedures, insertion site complications, and forearm placement. PIVC-associated BSI daily hazard was constant over time with zero to 0.03% on Days 1 to 5 (n = 11,491), 0.06% to 0.10% on Days 6 and 7 (n = 2,571), and zero on Days 8 to 42 (n = 544).
Conclusions
Infection incidence is very low but remains a serious risk, mainly for complex patients. Gram-negative organisms may now be predominant in Australia. Infection surveillance should be risk-adjusted and prevention efforts to improve both insertion and post-insertion management targeted at high-risk groups. While overall intravenous therapy (exposure) should be minimised, daily risk per PIVC appears constant for at least 5 days.Full Tex
Expansive soil stabilization: multidisciplinary advances in materials, mechanisms, and sustainable strategies
No full textExpansive soil can cause significant damage to various engineering projects, such as building deformations, road heaving, and cracking. The global economic losses caused by expansive soils are substantial every year. Stabilizer-based treatment is a commonly used and effective method for managing expansive soils. However, traditional stabilizers like lime and cement generate considerable pollution during production, prompting the development of more environmentally friendly alternatives in the field of expansive soil stabilization materials. This study provides a comprehensive review and comparative analysis of recently development stabilization materials and approaches—encompassing physical, chemical, and biological techniques. And these techniques were compared from the perspective of effectiveness and environmental sustainability. The study also highlights some key concerns in the current development of expansive soil stabilization materials, such as waste reuse, the potential for combining stabilizers, and issues related to standardization.No Full Tex
Modification of Vegetation Structure and Composition to Reduce Wildfire Risk on a High Voltage Transmission Line
Get PDFThe Mapleton Falls National Park transmission line corridor in Queensland, Australia, has received a number of vegetation management treatments over the last decade to maintain and protect the infrastructure and to ensure continuous electricity supply. Recent treatments have included ‘mega-mulching’ (mechanical mastication of vegetation to a mulch layer) in 2020 and targeted herbicide treatment of woody vegetation, with the aim of reducing vegetation height by encouraging a native herbaceous groundcover beneath the transmission lines. We measured vegetation structure (cover and height) and composition (species presence in 15 × 2 m plots), at 12 transects, 90 m in length on the transmission line corridor, to determine if management goals were being achieved and to determine how the vegetation and fire hazard (based on the overall fuel hazard assessment method) varied among the treated corridor, the forest edge environment, and the natural forest. The results showed that vegetation structure and composition in the treated zones had been modified to a state where herbaceous plant species were dominant; there was a significantly (p 1 m in height) in these areas. For example, mean native grass cover and the cover of herbs and sedges in the treated areas was 10.2 and 2.8 times higher, respectively, than in the natural forest. The changes in the vegetation structure (particularly removal of tall woody vegetation) resulted in a lower overall fuel hazard in the treated zones, relative to the edge zones and natural forest. The overall fuel hazard was classified as ‘high’ in 83% of the transects in the treated areas, but it was classified as ‘extreme’ in 75% of the transects in the adjacent forest zone. Importantly, there were few introduced species recorded. The results suggest that fuel management has been successful in reducing wildfire risk in the transmission corridor. Temporal monitoring is recommended to determine the frequency of ongoing fuel management.Full Tex