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Assessment of metabolic dysfunction-associated fatty liver disease in primary care: a consensus statement summary
No full textINTRODUCTION: Metabolic dysfunction-associated fatty liver disease (MAFLD) is common. This evidence-based consensus statement summary provides recommendations for the assessment and monitoring of adults with MAFLD in primary care. MAIN RECOMMENDATIONS: Adults with type 2 diabetes, obesity or two or more other metabolic risk factors should be tested for MAFLD. Hepatic steatosis should be evaluated using ultrasound, whereas the presence and complications of type 2 diabetes and obesity should be assessed according to current Australian guidelines. Cardiovascular disease, chronic kidney disease and obstructive sleep apnoea are common in people with MAFLD and should be considered as part of a holistic health assessment. Alternative causes of hepatic steatosis, including excess alcohol consumption, must be considered, and patients with elevated serum aminotransferase levels should be tested for hepatitis B and C infection and iron overload. The risk of advanced liver fibrosis requires assessment using the Fibrosis-4 (FIB-4) Index; a low score ( 2.7), an elevated direct liver fibrosis serum test, high elastography results or with clinical, laboratory or imaging evidence of cirrhosis should be referred for further evaluation. Individuals with a low FIB-4 score (< 1.3), low elastography or direct liver fibrosis serum test results should be monitored with a repeat FIB-4 test at least every three years. Monitoring of weight, body mass index and/or waist circumference and for emergence of type 2 diabetes (in individuals without) should be performed at least annually. CHANGE IN MANAGEMENT AS A RESULT OF THIS CONSENSUS STATEMENT SUMMARY: Appropriate identification, assessment and risk stratification of people with MAFLD will aid referral pathways, further investigation and management
Evaluating the effectiveness and sustainability of a primary healthcare strategy to reduce the prevalence of strongyloidiasis in endemically infected Indigenous communities in Northern Australia
No full textBACKGROUND: Strongyloidiasis is endemic in many remote Indigenous communities in Australia. Early diagnosis, treatment, and follow-up of chronic strongyloidiasis can prevent life-threatening clinical complications and decrease transmission in these endemic communities. The aim of this paper is to evaluate the effectiveness and sustainability of a primary healthcare strategy designed to measure and reduce the prevalence of strongyloidiasis in four remote communities in northeast Arnhem Land. METHODOLOGY: The primary healthcare strategy was a prospective, longitudinal, health-systems intervention designed to integrate serological testing for chronic strongyloidiasis into the Indigenous preventive adult health assessment utilising the electronic health-record systems in four Aboriginal health services. Positive cases were recalled for treatment, and opportunistic follow-up serology after six months. Results were tracked using Strongyloides reports generated by the electronic health-record system. This paper describes the changes in prevalence, effectiveness of treatment, and reinfection during the implementation phase, 2012-2016. An improved Strongyloides electronic report was developed to evaluate the effectiveness and sustainability of the intervention to the end of 2020. PRINCIPAL FINDINGS: During the entire period 2012-2020, 84% (2390/2843) of the resident adults in the four communities were tested for strongyloidiasis at least once. Prevalence was reduced from 44% (1056/2390) ever-positive to 10% (232/2390) positive on their last test. Of positive, treated cases with a follow-up serology test, the last test was negative in 85% (824/967) of individuals. Point prevalence continued to decrease in each community four years after the end of the implementation phase. CONCLUSIONS: The results provided practice-based evidence of a significant decrease in the prevalence of strongyloidiasis attributable to the strategy which could be replicated in other health services utilising electronic health-record systems. The final evaluation demonstrated the sustainability and ongoing benefits for endemically infected communities, and the key role that health services can play in strongyloidiasis prevention and control programs
Implicit sensing self-supervised learning based on graph multi-pretext tasks for traffic flow prediction
No full textAbstract
In recent years, spatio-temporal graph neural networks (GNNs) have successfully been used to improve traffic prediction by modeling intricate spatio-temporal dependencies in irregular traffic networks. However, these approaches may not capture the intrinsic properties of traffic data and can suffer from overfitting due to their local nature. This paper introduces the Implicit Sensing Self-Supervised learning model (ISSS), which leverages a multi-pretext task framework for traffic flow prediction. By transforming data into an alternative feature space, ISSS effectively captures both specific and general representations through self-supervised tasks, including contrastive learning and spatial jigsaw puzzles. This enhancement promotes a deeper understanding of traffic features, improved regularization, and more accurate representations. Comparative experiments on six datasets demonstrate the effectiveness of ISSS in learning general and discriminative features in both supervised and unsupervised modes. ISSS outperforms existing models, demonstrating its capabilities in improving traffic flow predictions while addressing challenges associated with local operations and overfitting. Comprehensive evaluations across various traffic prediction datasets, have established the validity of the proposed approach. Unsupervised learning scenarios have shown the improvements in RMSE for the METR-LA and PEMSBAY datasets of 0.39 and 0.35 for location-dependent and location-independent tasks, respectively. In supervised learning scenarios, for the same datasets, the improvements were 1.16 for location-dependent tasks and 0.55 for location-independent tasks
Leg stiffness during running in adults with traumatic brain injury: A comparative study with healthy adults
No full textBackground: While leg stiffness during running has been shown to be lower in children with cerebral palsy compared to their typically developing peers, no studies have examined leg stiffness during running in adults with traumatic brain injury. The aim of this study was to compare leg stiffness during running in adults with traumatic brain injury to healthy controls. Methods: Sixty-one adults with traumatic brain injury and 20 healthy controls were included. Participants ran overground while three-dimensional kinematic and kinetic data were recorded. Leg stiffness was calculated during the stance phase of running. Statistical analyses to compare leg stiffness between limbs and between groups were conducted using t-tests. Findings: There was a large range of leg stiffness in adults with traumatic brain injury during running (affected leg median = 21.56 [range 11.07 to 57.44] kN/m; less affected leg =20.87 [9.38 to 54.72] kN/m) compared to healthy controls (20.94 [13.40 to 31.50] kN/m). However, there were no statistically significant differences in leg stiffness during running between the affected and less affected limbs (p = 0.59, effect size [ES] =0.08) nor between both traumatic brain injury limbs and healthy controls (affected limb; p = 0.44, ES =0.12; less affected limb; p = 0.47, ES =0.11). Interpretation: Although no statistical significance was found on a group level, the results demonstrated high variability in leg stiffness in traumatic brain injury compared to healthy controls. Further research is needed to determine which factors influence leg stiffness during running and how this measure relates to clinical outcomes in traumatic brain injury
Correction to: Heritable polygenic editing: the next frontier in genomic medicine? (Nature, (2025), 637, 8046, (637-645), 10.1038/s41586-024-08300-4)
No full textDevelopment and results of a customised theoretical framework-based survey on barriers and enablers to hearing aid uptake and use in older adults
No full textCurrent studies have explained only a small proportion of variance in hearing aid (HA) uptake and use. This novel study applied theoretical frameworks of human behaviour to develop surveys to identify further barriers and enablers that could be addressed with behavioural interventions. Data on hearing healthcare decisions/behaviours and/or acceptability of interventions was extracted from an ongoing systematic review of barriers and enablers to uptake and use of hearing interventions conducted by some of the authors. Two surveys, one each for HA users and non-users, were administered primarily online. Respondents were 38 adult HA users and 48 non-users in Australia with diagnosed hearing loss recruited across three metropolitan/rural audiology clinics. Survey responses yielded 5 barriers and 7 enablers not previously identified. Barriers included other health concerns being more important, and lack of knowledge about HAs and trust in service providers. Enablers included the input of others, and the beliefs that HAs are easy to manage and that HAs would make people feel good about themselves. Applying behavioural frameworks to identify barriers and enablers to hearing aid uptake and use resulted in identification of influences not previously reported. These should be addressed with behavioural interventions
Epileptic seizure detection using heart rate variability from ambulatory ECG: a pseudoprospective study
No full textObjective.Seizure detection algorithms enable clinicians to accurately assess seizure burden for epilepsy diagnosis and long-term management. State-of-the-art algorithms rely on electroencephalography (EEG) data to identify electrographic seizures. Previous research that used non-EEG signals, such as electrocardiography (ECG) and wristband data, were collected in epilepsy monitoring units. We aimed to investigate the feasibility of ECG seizure detection in ambulatory settings.Approach.We developed a patient-independent, machine learning-based seizure detector using ambulatory long-term ECG monitoring data. The model was trained on long-term studies of 47 patients and evaluated pseudoprospectively using event detection on a hold-out test set of 18 patients.Main results.In the hold-out test set, the seizure detector performed better than chance for 14 out of 18 patients. The average sensitivity was 72% and the average specificity was 68% for the whole test cohort. Overall, across training and test sets, the performance was better for patients diagnosed with focal epilepsy and for patients who were identified as responders (had substantial heart rate changes during seizures).Significance.Key contributions of this study include the development of a patient-independent seizure detector using ambulatory data and the introduction of a pseudoprospective evaluation framework, which can benefit chronic ambulatory seizure monitoring
Enabling an ultraefficient lithium-selective construction through electric field–assisted ion control
No full textMembranes with precise ion transport behaviors are regarded as an alternative for lithium (Li) extraction from water streams. Current membranes demonstrate limited viability due to the lack of efficient Li+-selective architectures. We propose an electric field–assisted ion control hypothesis in reinforcing ultraefficient Li+-selective membranes, in which an ionized zeolitic imidazolate framework layer (Q-PEI@ZIF) is constructed via polyethylenimine (PEI) in situ confinement conversion and subsequent quaternization of 2,3-epoxypropyl trimethyl ammonium chloride. In electrodialysis at 5 milliampere per square centimeter, the resulting membrane Q(5%)-PEI(1.0)@ ZIF#CEM shows that the ion permeation rates follow the order of K+ ~ Li+ > Na+ > Ca2+ ~ Mg2+, corresponding to 0.31, 0.30, 0.25, 0, and 0 mole per square meter per hour in 120 minutes, respectively. With a 25-millimolar Li+/ Mg2+ mixed solution, it exhibits an unprecedented Li+/Mg2+ permselectivity of 20,000 and 99.99% purity of Li+ product in 120 minutes. This study expands the hypothesis of electric field–assisted ion control in enabling an ultraefficient Li+-selective construction
Mid-Adolescents’ Social Media Use: Supporting and Suppressing Autonomy
No full textAutonomy development is an important process in adolescence and is central to a successful transition to adulthood. Social contexts play a crucial role in supporting and suppressing autonomy. Considering social media is a salient and important context for mid-adolescents it has the potential to strongly influence autonomy development. This study applied qualitative methods to examine mid-adolescents’ perspectives of how their social media use impacts autonomy. Participants included 36 students aged 15 years from four schools in Melbourne, Australia. All participants completed a rich picture mapping activity and focus group discussions, and a sub-sample of 11 adolescents participated in follow-up, one-on-one interviews. Reflexive thematic analysis generated two overarching themes; supporting autonomy and suppressing autonomy. Sub-themes included; promoting self-governance, facilitating choicefulness, developing a sense of self, external forces motivating use, fostering compulsive and non-intentional use, and affordances of social media threaten personal control. This study revealed that social media contributes to today’s adolescents encountering unique experiences with regard to their autonomy development compared with other generations. Findings highlighted the need to harness the autonomy-supportive aspects of social media use whilst mitigating the autonomy-suppressive ones to help mid-adolescents engage with social media in a way that promotes healthy functioning and wellbeing
Incorporation of brown seaweed (Ecklonia radiata) polyphenol crude extracts in whey protein isolate‑sodium alginate emulsion delivery systems
No full textTernary complexes composed of whey protein isolate, sodium alginate, and seaweed-derived polyphenols were developed as emulsifiers to stabilize oil-in-water emulsions. Different formulations were prepared and characterized for their physicochemical properties, including particle size and surface charge. The ternary complexes produced emulsions with improved storage and thermal stability compared to other formulations, and transmission electron microscopy confirmed well-defined morphology. During simulated gastrointestinal digestion, changes in composition and antioxidant activity were monitored, revealing that the ternary complexes effectively protected lipids and bioactive compounds. This study demonstrates that combining protein, polysaccharide, and polyphenol from natural sources can yield multifunctional emulsifiers with enhanced stability and antioxidant capacity, which offer promising applications for the delivery of lipid-soluble nutrients and functional ingredients in food systems