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Investigating older people’s preferences for an urgent care service: a discrete choice experiment
No full textBackground: Emergency and urgent care, where patients perceive the need for immediate access to medical advice or treatment, comprises a large and significant component of health care delivery. Older people are over-represented in Emergency Departments (ED) and over 55% are likely to be hospitalised with extended lengths of stay. To date, little research has been conducted to assess the needs and preferences of older people concerning alternative models of urgent care. The purpose of this study was to identify older people’s preferences for key characteristics of an urgent care service as an alternative to ED presentation using discrete choice experiment methods. Methods: Attributes and levels for the Discrete Choice Experiment (DCE) were informed by older people and health care professionals with recent ED experience. Attributes included waiting time for ED admission, knowledge and training of medical professionals, the extent to which the older person is treated holistically, how the physical environment is designed to best support older people, and the level of follow-up care received. The DCE was embedded within a larger survey to assess older people’s (aged >65 years) views and preferences for alternative models of emergency and urgent care. Data were analysed using conditional and mixed logit regressions. Results: Overall, 995 older people consented to participate and fully completed the DCE. Respondents attached the strongest relative importance to an urgent care service with reduced waiting times (within 2 hours of making the triple zero call), followed by medical professionals with specialist training in the care of older people, holistic support and regular communication updates, physical environment to support older people, and a comprehensive discharge summary and follow up. All of these attribute levels were highly statistically significant (p<0.001) in influencing preferences for the total sample and by subgroups reflecting key socio-demographic characteristics and emergency care experience. Conclusions: This study has identified older people’s preferences for key characteristics of an urgent care service as an alternative to ED presentation. The findings will inform policymakers and practitioners in the design and configuratiCon of an optimal urgent care service model from the perspective of older people
Estimated unit costs of anaemia interventions for women of reproductive age in 193 UN member states: a costing study
No full textBACKGROUND: Anaemia affects an estimated 1·92 billion people worldwide. The UN Sustainable Development Goals set targets for reducing anaemia prevalence by 50% in women of reproductive age, for whom the risks and consequences of anaemia are the greatest. Prioritisation of cost-effective anaemia reduction strategies relies on robust estimates of the costs of interventions. We aimed to develop country-specific unit cost estimates for WHO-recommended anaemia interventions for women of reproductive age. METHODS: A micro-costing approach was used to estimate unit costs (per recipient per year) for six anaemia prevention and treatment interventions in 193 UN member states using data from secondary sources. The interventions included were oral iron supplementation for pregnant and non-pregnant women, fortification of staple foods, multiple micronutrient supplementation for pregnant women, intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine, presumptive deworming treatment for pregnant and non-pregnant women, and insecticide-treated bednets. A health-care sector perspective and 1-year timeframe were adopted. Cost categories included commodity, supply chain, service delivery, and administrative programme costs. Parameter uncertainty was explored in deterministic sensitivity analyses. Costs are presented as population-weighted means and SDs in 2023 US dollars. FINDINGS: In most countries, staple food fortification and deworming were the lowest cost interventions, with population-weighted average costs of less than US0·27 [SD 0·25] for staple fortification in low-income-countries to 9·57 (SD 0·58) in low-income countries to $135·56 (SD 25·95) in high-income countries. Commodity and service delivery costs were the largest cost drivers, although this varied across interventions and settings. INTERPRETATION: Our standardised methodology and dataset estimate country-level unit costs and describe cost drivers for WHO-recommended anaemia interventions. These findings can facilitate cost-effectiveness analyses of anaemia interventions for women of reproductive age and strengthen priority-setting processes. FUNDING: Gates Foundation
Dispersion conditions affect the physico-chemical and technofunctional properties of quinoa protein isolates precipitated with different acids
No full textThis study was designed to assess whether the functionality of quinoa protein isolate (QPI) precipitated with acetic acid (QPI-A), citric acid (QPI-C) or HCl (QPI-H) could be further improved or modulated by the dispersion conditions. The soluble protein content, protein profile, secondary structure, thermal properties, gelation behaviour and microstructure of the isolates were evaluated. Dispersion in water for 24 h promoted the solubilisation of QPI-H and improved gel strength. Dispersion in 0.1 M NaCl for 1 h resulted in extensive protein aggregation and hindered gel formation in QPI-A and QPI-C. Dialysis before dispersion impaired the gelation properties for all three types of isolates. The demonstrated ability to improve or modulate the functional properties of QPI not only by choice of precipitation acid but also by dispersion conditions provides a handle for product formulators to broaden the application spectrum for QPI across a range of food textures
A Community Empowerment Framework to Promote Social Connection and Engagement of South Sudanese Youth in Australia
No full textBackground: Significant factors impact the wellbeing of South Sudanese youth who settle in Australia. This article proposes a community empowerment framework based on outcomes from research and community feedback undertaken in Melbourne, with South Sudanese youth and elders to improve social connection and community engagement of the youth. Methods: Twenty-three semi-structured interviews, four focus groups and two community forums were conducted using qualitative, case study methodology. Data were collected from South Sudanese youth aged 14 to 21 years, social workers, elders and parents from the South Sudanese community. Inductive thematic analysis was used to gain an understanding of the social issues facing South Sudanese youth, Results: Four themes-health and wellbeing, the experience of racism, sports and intergenerational conflict-were identified during analysis. These themes were then used to develop and propose a Community Empowerment Framework (CEF), that outlines strategies to empower South Sudanese youth to improve their wellbeing at different levels: personal empowerment, career empowerment and community empowerment (both internal and external). Conclusions: The CEF provides a community-informed model for service providers and policy makers to promote positive community engagement and social connection to improve the lives of South Sudanese youth living in Australia
Data-Driven Detection of Internal Erosion Initiation in Gap-Graded Soils: Combining Particle-Scale CFD-DEM Simulation With 3D Convolutional Autoencoder
No full textABSTRACT
Internal erosion in gap‐graded soils poses significant risks to water‐retaining structures such as earth dams. However, its underlying mechanisms at the particle scale remain poorly understood. This study couples the discrete element method (DEM) with computational fluid dynamics (CFD) to simulate internal erosion in gap‐graded soil assemblies and employs data‐driven techniques to detect early‐stage erosion. Particle‐scale parameters, such as contact forces, particle velocity and fluid velocity, are extracted from the transient CFD‐DEM simulations. These features are transformed into multi‐dimensional voxel‐based tensors representing the particle–fluid interactions, which are used to train deep learning models. Autoencoder models with 3D convolutional neural network (CNN) layers as encoder and decoder are developed to investigate the micro‐scale patterns within the particle‐fluid assembly. Through sequential training techniques, the temporal evolution of anomalies is captured, enabling identification of the initiation point of internal erosion. The results reveal how microscale behaviours, such as particle motion, contact forces and contact number, contribute to macroscale erosion processes. The outcome of this research can inspire further research into AI‐based early detection techniques for internal erosion in earth dams
Pollination in a fire-prone world: Reduced solar radiation and warming alter plant–pollinator interactions
No full textAbstract
Climate change can disrupt ecosystem services such as pollination. Warming increases the frequency and scale of wildfires, leading to smoke‐induced reductions in incident solar radiation, which together may affect plants, pollinators and their interactions.
To determine the emergent effects of these factors on pollination, we exposed experimental communities comprising a solitary bee species and three annual wildflower species to treatments representing combinations of warming and reduced solar radiation conditions. We measured floral traits, plant–pollinator interactions and reproduction.
Slight warming did not affect floral traits or plant–pollinator interactions, whereas a higher level of warming combined with reduced solar radiation stressed both partners of the mutualism. Compared to ambient conditions, warming combined with reduced solar radiation significantly lowered floral abundance and caused a 91.5% reduction in nectar volume, likely by depressing primary productivity. This limitation of floral resources translated into less caloric intake for bees and lowered flower visitation rates, lengthened flower handling times and increased diet breadth. Slight increases in temperature above ambient allowed bees to produce 48.2% more offspring, likely by bringing bees closer to their thermal optimum, but the reduction in solar radiation negated this positive effect. Conversely, seeds produced under warming combined with reduced solar radiation had the highest germination success.
Our results suggest that warming and reduced solar radiation have synergistic, negative effects on pollination through a range of mechanisms including changes in primary productivity and nectar production, and bee attraction and behaviour. The reduced strength of these plant–pollinator mutualisms raises concern for the future of biodiversity and pollination services in a warmer world with more frequent wildfires.
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NUMERICAL DESIGN OF EXPERIMENTS FOR REPEATING LOW-PRESSURE TURBINE STAGES PART II: EFFECT OF REYNOLDS NUMBER ON DIFFERENT BLADE GEOMETRIES
No full textAbstract
The trend towards more compact and efficient low-pressure turbine (LPT) designs can benefit significantly from advanced numerical predictive tools. Faithfully capturing the complex transitional and turbulent nature of unsteady flows in LPTs often necessitates high-fidelity methods such as Large Eddy Simulations (LES) for accurate predictions of turbine efficiency and loss generation. Integrating high-fidelity simulations into design cycles, which are currently predominantly driven by rapid low-fidelity Unsteady Reynolds-Averaged Navier-Stokes (URANS) calculations, requires cutting-edge numerical tools that leverage modern high-performance computing architectures. In Part II of this paper, we present results from a newly established, highly-resolved LES and state-of-the art URANS database for three newly designed LPT profiles. These are a conventional standard lift profile, a front-loaded high-lift profile, and an aft-loaded profile. These profiles are evaluated individually within a repeating 1.5-stage LPT configuration operating under engine-like conditions at an isentropic exit Mach number of 0.3. A Reynolds number sweep, ranging from 70,000 to 320,000, captures a broad spectrum of engine-relevant flow conditions. The LES study incorporates time-resolved, time-averaged, and phase-locked averaged results, enabling a detailed examination of unsteady flow dynamics driven by the rotor blade passing frequency. This analysis provides deep insights into blade-wake interactions, unsteady boundary layer evolution, and loss generation mechanisms across the profiles and Reynolds numbers, highlighting the influence of loading distribution on aerodynamic performance and stage efficiency. On top of that, state-of-the-art URANS of the same configurations are undertaken. While trends are largely recovered, there are important differences with the LES data. These are especially present for the aft-loaded profile, being a radical blade design compared to conventional profiles, as a result of the large flow separation on the blades’ suction side which cannot be adequately captured by URANS. This reveals regions where improvements in turbulence and transition modeling are necessary in a mean sense, and in a phase-locked averaged sense, relevant for capturing the by-nature unsteady flow phenomena in LPT stages. By establishing this high-fidelity database, the work advances the understanding of unsteady aerodynamic phenomena in realistic LPT modules and lays the foundation for the development of more accurate predictive models to improve URANS given the cost of LES. The findings contribute to the design of more compact, efficient, and high-performance turbine systems, addressing critical challenges in modern turbomachinery
Development and validation of clinical prediction models for cardiorespiratory fitness in atrial fibrillation patients following radiofrequency catheter ablation
No full textBackground: Assessment of cardiorespiratory fitness (CRF) is imperative in patients with atrial fibrillation (AF) who have had radiofrequency catheter ablation (RFCA). This study aimed to develop and validate CRF prediction models in this population. Methods: 141 AF patients with RFCA were recruited. The cardiopulmonary exercise test was used to assess CRF with VO2peak and METsmax. Multidimensional predictors (demographics, serum biomarkers, cardiovascular parameters, and motor function parameters) were analyzed through Spearman correlation analysis and stepwise multivariate linear regression analysis. The internal validity of the prediction equation was tested by paired Student's t-test, Pearson correlation analysis and Bland-Altman analysis. Results: Sex, BMI, ln NT-proBNP, glucose (GLU), 6-minute walking distance (6MWD), and systolic blood pressure (SBP) were found to be significantly associated with CRF in this population. Multivariate linear regression generated the equations: VO2peak = 35.080 − 0.286 * BMI − 1.927 * Sex − 1.090 * ln NT-proBNP + 0.011 * 6MWD − 0.039 * SBP − 0.512 * GLU, and METsmax = 9.646 − 0.447 * Sex − 0.260 * ln NT-proBNP − 0.140 * GLU − 0.078 * BMI − 0.016 * SBP + 0.004 * 6MWD, (VO2peak: adjusted R2 = 0.506, and METsmax: adjusted R2 = 0.469, both P 2peak: r = 0.616, and METsmax: r = 0.581, both P 2peak values were slightly lower than the measured values (mean difference = −0.13; 95% limits of agreement: −5.20 to 4.93), while the predicted METsmax values were in close agreement with the measured values (mean difference = −0.00; 95% limits of agreement: −1.59 to 1.59). Conclusion: Sex, BMI, NT-proBNP, glucose, 6MWD, and SBP are robust predictors of VO2peak and METsmax in AF population after RFCA. This study generates and internal validates the first multivariable CRF prediction models with easy-to use clinical paraments in AF patients after RFCA, thereby providing safe and effective alternatives to conventional CPX, which may help to optimize personalized patient management
Transcutaneous Versus Arterial Carbon Dioxide Monitoring in Adult Polysomnography Studies.
No full textSTUDY OBJECTIVES: To determine the accuracy of transcutaneous carbon dioxide measurements using SenTec tcPCO2 during adult polysomnography compared to arterial PCO2. METHODS: In consecutive patients having polysomnography with transcutaneous CO2 (tcPCO2) monitoring using a SenTec monitor, arterial blood gas samples were taken at the beginning and at the end of each sleep study. tcPCO2 measurements recorded at 0, 60 and 120 seconds after arterial sampling was determined in 51 participants who underwent polysomnography with tcPCO2 monitoring at the Austin Health Sleep Laboratory (Heidelberg, Victoria, Australia) during the period 01/05/22 - 10/06/22. The mean of differences between arterial carbon dioxide tension (PaCO2) and the predicted value based on tcPCO2 measurements determined at each time point for evening and morning arterial samples. RESULTS: Data was obtained from 37 participants. A statistically significant difference in the tcPCO2 values at the point of arterial sampling was found, with tcPCO2 on average 2.2 - 2.8 mmHg less than PaCO2 at various timepoints after arterial sampling. The upper limit of measurement accuracy represented a moderate difference (2 - 4.9 mmHg), within the clinically acceptable range of -7.5 to +7.5 mmHg variation from PaCO2 values. CONCLUSIONS: The SenTec tcPCO2 electrode was found to be an appropriate alternative to arterial sampling for assessment of arterial carbon dioxide in adult patients in the polysomnography setting, with no significant difference in tcPCO2 accuracy based on the timing of transcutaneous measurements (up to two minutes) following arterial sampling
Phosphoproteomics Uncovers Exercise Intensity-Specific Skeletal Muscle Signaling Networks Underlying High-Intensity Interval Training in Healthy Male Participants
No full textBACKGROUND: In response to exercise, protein kinases and signaling networks are engaged to blunt homeostatic threats generated by acute contraction-induced increases in skeletal muscle energy and oxygen demand, as well as serving roles in the adaptive response to chronic exercise training to blunt future disruptions to homeostasis. High-intensity interval training (HIIT) is a time-efficient exercise modality that induces superior or similar health-promoting skeletal muscle and whole-body adaptations compared with prolonged, moderate-intensity continuous training (MICT). However, the skeletal muscle signaling pathways underlying HIIT's exercise intensity-specific adaptive responses are unknown. OBJECTIVE: We mapped human muscle kinases, substrates, and signaling pathways activated/deactivated by an acute bout of HIIT versus work-matched MICT. METHODS: In a randomized crossover trial design (Australian New Zealand Clinical Trials Registry number ACTRN12619000819123; prospectively registered 6 June 2019), ten healthy male participants (age 25.4 ± 3.2 years; BMI 23.5 ± 1.6 kg/m2; V ˙ O 2 max 37.9 ± 5.2 ml/kg/min, mean values ± SD) completed a single bout of HIIT and MICT cycling separated by ≥ 10 days and matched for total work (67.9 ± 10.2 kJ) and duration (10 min). Mass spectrometry-based phosphoproteomic analysis of muscle biopsy samples collected before, during (5 min), and immediately following (10 min) each exercise bout, to map acute temporal signaling responses to HIIT and MICT, identified and quantified 14,931 total phosphopeptides, corresponding to 8509 phosphorylation sites. RESULTS: Bioinformatic analyses uncovered exercise intensity-specific signaling networks, including > 1000 differentially phosphorylated sites (± 1.5-fold change; adjusted P 3000 phosphosites significantly correlated with lactate (q < 0.05) including top functional phosphosites underlying metabolic regulation. CONCLUSIONS: Collectively, this first global map of the work-matched HIIT versus MICT signaling networks has revealed rapid exercise intensity-specific regulation of kinases, substrates, and pathways in human skeletal muscle that may contribute to HIIT's skeletal muscle adaptations and health-promoting effects. Preprint: The preprint version of this work is available on medRxiv, https://doi.org/10:1101/2024.07.11.24310302