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Pilot Implementation of a Post–Hypertensive Disorders of Pregnancy Education and Follow-Up Package for Health Care Providers: Protocol for a Mixed Methods Pilot Study
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Abstract
Background:
Medical complications of pregnancy provide a window into a woman’s future health risk. Hypertensive disorders of pregnancy (HDP) affect 1 in 10 pregnant women and elevate the risk for women of experiencing long-term health complications within 5 years of the affected pregnancy, continuing lifelong. These risks include a doubled to tripled risk of developing cardiovascular disease, a doubled risk of developing type 2 diabetes, and a 5- to 10-fold risk of developing chronic kidney disease. Early assessment and intervention following HDP are therefore crucial to improving women’s life-course health trajectory, as well as outcomes for any subsequent pregnancies. However, previous research has shown that Australian women and their primary health care providers are largely unaware of ongoing health risks and the necessary follow-up screening and assessments. Primary care providers also receive inadequate hospital-to-community handover and support to promote preventive health measures to women following pregnancy complications. Consequently, post-HDP care remains insufficient for optimizing long-term health.
Objective:
This study aims to (1) explore whether a post-HDP education and follow-up service package can be designed, developed, and implemented among targeted general practitioners (GPs) and maternity hospitals across Sydney, Australia, and (2) evaluate whether the post-HDP education and follow-up package can address knowledge gaps among health care providers regarding the long-term health risks after HDP and build capacity among GPs to implement evidence-based care.
Methods:
This pilot study will design, develop, and implement a post-HDP education and follow-up package (“the package”) adopting a collaborative and implementation methodological approach. The package, designed by expert health care providers and informed by prior evidence-based research, will include educational materials, improved hospital-to-community handover, and a funded 6-month postpartum visit.
Results:
Data collection occurred over an 18-month implementation and follow-up period between April 2024 and October 2025. Sixteen GPs across the Central and Eastern Primary Health Network (CESPHN) were recruited, along with their antenatal shared care (ANSC) affiliated tertiary referral hospitals in Sydney. Postimplementation data collection and analysis is planned for completion throughout 2026.
Conclusions:
Mixed methods evaluation will assess the efficacy, acceptability, and utility of the post-HDP package among health care providers and inform its suitability for deployment at scale.Full Tex
Are Behavioral Ecotoxicity Endpoints Relevant at the Population Level? Evidence-Based Insights for Environmental Protection
No full textA substantial body of evidence exists demonstrating that exposure to environmental contaminants can alter animal behavior. Moreover, methodological and technological advancements, as well as increasing standardization, mean that behavioral ecotoxicity studies are more rigorous and reliable than ever before. Despite this, behavioral data are still seldom used in the risk assessment and regulation of chemicals. This is partly due to a lack of clarity among some stakeholders about whether changes in behavior at the individual level result in population-level outcomes. To address this, we first consider the state of evidence within the field of behavioral ecotoxicology linking individual-level behavioral alterations with population-level consequences. We then assess the evidence from behavioral ecology and other neighboring fields that supports this link. Further, we evaluate whether some behavioral endpoints are more easily tied to population-level changes than others. In this regard, we propose combining insights from two complementary ecological frameworks─the functional trait framework and the limiting traits framework─to evaluate which behaviors should be prioritized in ecotoxicological research and regulatory efforts. We contend that the link between behavioral changes and population-level outcomes is evident, with behavioral endpoints representing a highly valuable yet so far underutilized line of evidence in applied environmental protection.Full Tex
Effect of Enhanced Recovery After Surgery programs on surgical site infection and 30-day readmission in patients undergoing gastro-intestinal procedures: An umbrella review
No full textBackground: Enhanced Recovery After Surgery programs have been implemented across surgical specialties; however, their effectiveness in reducing surgical site infection and 30-day hospital readmission remains unclear. Objective: To determine the effect of Enhanced Recovery After Surgery programs on the clinical outcomes of surgical site infection and readmission and identify items of and implementation strategies for such programs. Design: An umbrella review of published systematic reviews. Methods: Systematic searches of MEDLINE, Embase, CINAHL, Cochrane Library, and Scopus databases were conducted in January 2025. Systematic reviews of randomised controlled trials and non-randomised studies of interventions comparing Enhanced Recovery After Surgery programs with standard care in adults after major open or laparoscopic gastrointestinal surgery, focusing on surgical site infection and 30-day hospital readmission, were included. Review quality and certainty of evidence were assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and GRADE (Grading of Recommendations Assessment, Development and Evaluation) tools. Results: 49 reviews were included in the analysis. Meta-analysis of 42 unique primary randomised controlled trials with 5112 patients suggests a significant association between Enhanced Recovery After Surgery programs use and surgical site infection reduction (estimated odds ratio 0.70, 95 % confidence interval 0.59–0.82, p 2 = 0 %). Meta-analysis of 53 primary randomised controlled trials with 7360 patients suggests no significant relationship between Enhanced Recovery After Surgery programs and hospital readmission (estimated odds ratio 1.025, 95 % confidence interval 0.85–1.23, p = 0.792, I2 = 0 %). Summary estimates for surgical site infection were similar across non-randomised studies of interventions. GRADE assessments suggest ‘very low’ certainty across outcomes. Enhanced Recovery After Surgery programs included 5 to 28 components; implementation strategies were not described. Discussion: Results suggest an association between Enhanced Recovery After Surgery programs and reductions in surgical site infection, and no relationship between hospital readmissions. However, the body of evidence is weak and inconclusive. These results also indicate heterogeneity in compliance with Enhanced Recovery After Surgery, reflecting the complexity in standardising this surgical care pathway. Conclusions: Well-controlled primary research is warranted to understand the impact of Enhanced Recovery After Surgery programs. Registration: PROSPERO registration number: CRD42024503357. Social media abstract: Enhanced Recovery After Surgery programs may significantly reduce surgical site infections after GI surgery but there is no clear impact on 30-day readmissions.Full Tex
Micropatterned Surfaces with Unidirectional Wetting Properties for Liquid Transport
No full textInterest in micropatterned surfaces with unidirectional wetting properties has grown significantly due to their unique ability to enable controlled liquid manipulation. This property is essential for diverse applications, including microfluidics, water harvesting, and self-cleaning systems, where directional droplet motion promotes efficient removal of contaminants and reduces surface fouling. Despite extensive research on anisotropic wetting, a comprehensive framework encompassing design considerations, fabrication methods, and practical challenges for unidirectional liquid transport remains underdeveloped. This review paper addresses this gap by presenting a holistic overview of micropatterned anisotropic surfaces and their wetting behaviors in unidirectional fluid handling. Key mechanisms of liquid transport, ranging from passive modes such as gravity and wettability gradient to active modes involving external stimuli, are discussed. This review critically evaluates surface fabrication techniques, highlighting their advantages and limitations. By critically analyzing recent advances and identifying key structure–function relationships, this review offers design principles and emerging fabrication strategies that can accelerate the development of next-generation micropatterned surfaces for directional liquid transport in microfluidics, diagnostics, and surface engineering.Full Tex
Effect of Vitamin D Supplementation on Cardiometabolic Outcomes in Older Australian Adults—Results from the Randomized Controlled D-Health Trial
No full textBackground/Objectives: Observational studies have found inverse associations between 25-hydroxyvitamin D concentration and risk of hypertension, hypercholesterolemia and type 2 diabetes (T2D). More robust evidence from large-scale randomized controlled trials, however, is limited or inconclusive. Methods: The D-Health Trial (N = 21,315) is a randomized, double-blind, placebo-controlled trial of supplementation with monthly doses of 60,000 international units of oral vitamin D3, conducted in Australians aged 60–84 years. Commencing treatment with anti-hypertensive, lipid-modifying, or anti-diabetic drugs was used as a surrogate for incident hypertension, hypercholesterolemia, and T2D, respectively. Outcomes were ascertained via linkage with the Australian Pharmaceutical Benefits Scheme database. Follow-up began 6 months after randomization; we excluded participants without linked data, and those who were prevalent cases or who died prior to start of follow-up. Flexible parametric survival models were used to estimate the effect of vitamin D supplementation on each outcome. Results: We included 10,964 participants (vitamin D, n = 5456 [49.8%]; placebo, n = 5508 [50.2%]) in the analysis of hypertension, 12,126 participants (vitamin D, n = 6038 [49.8%]; placebo, n = 6088 [50.2%]) in the analysis of hypercholesterolemia, and 17,846 (vitamin D, n = 8931 [50.0%]; placebo, n = 8915 [50.0%]) in the analysis of T2D. Over a median follow-up of 4.6 years, 2672 (24.4%), 2554 (21.1%), and 779 (4.4%) participants developed hypertension, hypercholesterolemia, and T2D, respectively. Vitamin D supplementation had no material effect on the incidence of any of hypertension (HR 1.00; 95% CI 0.93 to 1.08), hypercholesterolemia (HR 1.05; 95% CI 0.97 to 1.13), or T2D (HR 0.97; 95% CI 0.84 to 1.12). Conclusions: Monthly supplements of vitamin D did not alter the incidence of any of the three conditions in older, largely vitamin D-replete Australians.Full Tex
Stakeholder perspectives on build-to-rent housing development in Australia: an industry-based qualitative analysis of challenges and opportunities
No full textThe build-to-rent (BTR) housing model is experiencing growth in Australia. This research aims to identify the key themes that emerged from BTR practices and develop a roadmap for achieving success in Australian BTR developments. Nineteen semi-structured interviews with industry professionals from key BTR stakeholders were conducted to capture experts’ insights and perspectives on BTR developments. The findings reveal the drivers and challenges of BTR development in Australia, such as high rental demand, investment opportunities, planning approval, taxation, and local government concerns. The study also highlights the tenant-focused management and design strategies to meet developers’ expectations. The interviews provide valuable insights into the Australian BTR landscape and its potential as a viable rental housing approach. The locality and reduced number of participants (19) are limitations and may not necessarily reflect the overall view. The study is focused on the Australian BTR characteristics and compares them to a successful BTR framework, offering practical recommendations to various stakeholders for enhancing BTR projects in Australia. It concludes that government and industry should focus on creating or reforming policies and improving sustainability, efficiency, quality, and customer satisfaction in the sector. This research underscores the importance of the BTR model in addressing rental housing challenges and improving living standards.Full Tex
Semisynthetic indole alkaloids restrain the invasiveness of glioblastoma cell lines and inhibit human Aquaporin-1 water channels
No full textThe clinical challenge for treating glioblastoma (GBM) brain cancers is that even with best therapy, median survival time is still only ∼15 months after diagnosis. The unmet need is how to control lethal spreading of these highly invasive cells. We tackled this challenge by running blinded high-throughput screens of the rigorously curated Davis Open Access Compound Library. Positive hits captured a structurally-related array of five novel indole alkaloid compounds (RAD116, RAD117, RAD118, RAD119, RAD120) derived from a natural indole alkaloid scaffold (RAD114). The agents at 1 µM reduced invasiveness of pediatric and adult GBM lines U87-MG, U251-MG, KNS-42, and DBTRG-05 in transwell assays. RAD116 and RAD117 were most effective, reducing invasiveness in all lines up to 76 %. In adult lines, RAD118 and RAD119 reduced invasiveness by 27–47 %, and RAD120 blocked invasion by 14–32 %. RAD114 was least effective, causing 12–30 % reduction in two lines. The candidate mechanism of action involves block of Aquaporin-1 (AQP1) water channels, which are located in leading edges of GBM cells and linked to high cell motility. RAD117 blocked human AQP1 water flux in Xenopus laevis assays at sub-micromolar doses, making it the most potent inhibitor of AQP1 water channels identified to date. High potency and low toxicity of the novel indole alkaloids introduced here support feasibility for further preclinical testing, and may hold promise for future clinical translation as an adjunct therapy to hold GBM cells in place while other first line treatments are in progress.Full Tex
Asymmetric Total Synthesis of Vilmotenitine A and Structural Revision of Hemsleyaconitine F
No full textThe first asymmetric total synthesis of the diterpenoid alkaloid (+)-vilmotenitine A has been accomplished. Strategically, we employed an enantioselective Michael addition to construct the C4 all-carbon quaternary stereocenter and an oxidative dearomatization/Diels–Alder cycloaddition for assembly of the A/B-ring system. Initial attempts to install the E-ring via hydrodealkenylative fragmentation/reductive amination in the presence of the D-ring, or conversely, to construct the D-ring via a Robinson-type annulation with the E-ring in place, were fruitless. The successful route ultimately relied on a hydrodealkenylative fragmentation/Mannich cyclization sequence to forge the E-ring as well as a biogenetically inspired Grob fragmentation to access the complete framework through cleavage of the C7–C17 bond and formation of the requisite C7–C8 double bond. The successful Grob fragmentation provides support for the proposed biosynthetic pathway. This work also leads to definitive revision of the structure originally assigned to hemsleyaconitine F.No Full Tex
Soil Protist Diversity and Biotic Interactions Shape Ecosystem Functions Under Climate Change
No full textSoil protists significantly influence ecosystem multifunctionality (EMF) through their roles in microbial predation, parasitism, and organic matter decomposition. However, the multifaceted contributions of protist diversity, along with its interactions with other microbial groups and plant diversity, to EMF—especially under climate-induced stresses such as drought—remain poorly understood. To address this knowledge gap, we conducted a factorial microcosm experiment, manipulating microbial diversity (protists, bacteria and fungi), plant species richness, and drought stress. In total, 203 microcosms were established, generating 812 soil samples and 2436 amplicon sequencing libraries. Using structural equation modelling (SEM) and multiple regression analyses, we found that protist diversity was positively correlated with EMF, carbon sequestration, soil organic matter (SOM) decomposition, and nutrient cycling. Furthermore, protist communities exhibited distinct, phylum-specific relationships with these ecosystem functions. Under drought conditions, microbial interaction networks experienced significant restructuring, with protists emerging as keystone taxa—enhancing protist connectivity and highlighting their central role in ecosystem resilience, especially in relation to leaf carbon dynamics. Our findings provide novel empirical evidence that protists act as multitrophic integrators in soil ecosystems and highlight their role in buffering ecosystems against global environmental change.No Full Tex
Assessing the assessors: A systematic review of neighbourhood sustainability assessment tool effectiveness
Full text linkNeighbourhood Sustainability Assessment Tools (NSATs) have been essential instruments for evaluating and guiding sustainable urban development. Despite insights provided into various aspects of sustainability assessment in the literature, limited research focuses on how effectively NSATs measure sustainability or what should be benchmarked in their assessment criteria. This study addresses this gap by identifying key factors that contribute to NSAT effectiveness. A systematic literature review, guided by PRISMA protocols, analyses 70 peer-reviewed articles from Scopus and Web of Science. Thematic analysis identifies three core dimensions that influence NSAT effectiveness: performance, applicability, and operational efficiency. Effective NSATs incorporate comprehensive assessment frameworks, standardised metrics, balanced sustainability dimensions, clear prerequisites, and long-term performance tracking. Applicability improves through policy alignment, institutional integration, and stakeholder engagement. Operational efficiency results from technological integration, cost-effective processes, and data-driven decision-making. The study proposes benchmark criteria to guide the development and evaluation of NSATs and demonstrates how standardised indicators and GIS-enabled workflows support benchmark-based planning decisions. It emphasises the need for tools that remain consistent, adaptable, and capable of driving measurable progress toward sustainable urban outcomes.Full Tex