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The association between gestation at birth and maternal sensitivity: An individual participant data (IPD) meta-analysis
No full textBackground and aim: Studies have documented differences in dyadic sensitivity between mothers of preterm (<37 weeks' gestation) and term born children, but findings are inconsistent and studies often include small and heterogeneous samples. It is not known to what extent variations in maternal sensitivity are associated with preterm birth across the full spectrum of gestational age. Objective: To perform a systematic review and individual participant data (IPD) meta-analysis assessing variations in observed dyadic maternal sensitivity according to child gestational age at birth, while adjusting for known confounders correlated with maternal sensitivity. Method: We harmonised data from 12 birth cohorts from ten countries and carried out one-stage IPD meta-analyses (N = 3951) using mixed effects linear regression. Maternal sensitivity was z-standardised according to the scores of contemporary term-born controls within each respective cohort. All models were adjusted for child sex, age at assessment, neurodevelopmental impairment, small for gestational age birth, and maternal education. Results: The fixed linear effect of the association between gestation at birth and maternal sensitivity across all 12 cohorts was small but stable (0.02 per week [95 % CI = 0.01, 0.02], p < .001). The binary effects of maternal education (0.32 [0.24, 0.40], p < .001) and child neurodevelopmental impairment (−0.33 [−0.50, −0.17], p < .001) were associated with maternal sensitivity. Interpretation: Gestational age at birth is positively associated with dyadic maternal sensitivity, however, the size of the effect is small. Over and above gestation, maternal education and child neurodevelopmental impairment appear to affect sensitivity, highlighting the importance of considering these factors in future research and intervention designs
Implementing a national programme of pathogen genomics for public health: the Australian Pathogen Genomics Program (AusPathoGen)
No full textDelivering large-scale routine pathogen genomics surveillance for public health is of considerable interest, although translational research models that promote national-level implementation are not well defined. We describe the development and deployment of the Australian Pathogen Genomics Program (AusPathoGen), a comprehensive national partnership between academia, public health laboratories, and public health agencies that commenced in January, 2021. Successfully establishing and delivering a national programme requires inclusive and transparent collaboration between stakeholders, defined and clear focus on public health priorities, and support for strengthening national genomics capacity. Major enablers for delivering such a programme include technical solutions for data integration and analysis, such as the genomics surveillance platform AusTrakka, standard bioinformatic analysis methods, and national ethics and data sharing agreements that promote nationally integrated surveillance systems. Training of public health officials to interpret and act on genomic data is crucial, and evaluation and cost-effectiveness programmes will provide a benchmark and evidence for sustainable investment in genomics nationally and globally
First seizure care in Australia and Aotearoa/New Zealand: health service needs for addressing the intersectoral global action plan in epilepsy
No full textOBJECTIVE: To explore the current state of first seizure clinics (FSCs) in Australia and Aotearoa/New Zealand (NZ) and identify modifiable risk factors impacting patient access to these services in line with the Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders (IGAP). METHODS: An online survey was distributed to neurologists, epileptologists and heads-of-unit affiliated with the Epilepsy Society of Australia (ESA). Additional clinics not captured by the survey were identified through professional networks and personal communication. Survey responses were recorded using Research Electronic Data Capture (REDCap) software. RESULTS: Survey responses identified 24 first seizure clinics across Australia and Aotearoa/NZ, including 21 adult and 3 paediatric services. These comprised 23 metropolitan services and 1 regional service; 15 were dedicated FSCs. Regional patients comprised more than 20 % of the patient base in 17 services. Telehealth was utilized by 21 (88 %) services, with 8 (33 %) services seeing over half their patients via telehealth. Median estimated wait time for initial FSC appointment was 6 weeks (IQR 3-15, range 2-56). Only 20 % of services were supported by a clinical nurse/care coordinator. This was the most commonly reported service need (58 % of services). Need for additional senior medical staff (54 % of services) and junior medical staff (45 %) was also noted. The most frequently reported barriers to access included limited clinic capacity, insufficient staffing, inappropriate referrals, patients' failure to attend and delays to investigations. SIGNIFICANCE: First seizure services for adults are well established across Australia and Aotearoa/NZ. Despite broad metropolitan coverage in services, there remains a lack of first seizure clinics in regional areas of Australia and Aotearoa/NZ, and a need for additional nursing and medical staff in established services. This study demonstrates areas where improvements could potentially lead to better access to first seizure care across Australia and Aotearoa/NZ and achieve the goals of the IGAP
The support of early-career researchers in health professions education—an expert position statement
No full textIntroduction: The development of health professions education (HPE) as an academic discipline requires well-qualified educational researchers, equipped with the competence to advance the field. There is, therefore, a need to establish and support pathways in which early-career researchers (ECRs) can develop the necessary competence to pursue a career in this field. Approach: A group of 19 international experts in HPE from various professions, conducted a 2.5-day Scoping Workshop in Hannover, Germany, in November 2024. The main output of the workshop is a joint position statement on the support of ECRs in HPE, using appreciative inquiry and collaborative writing. Position: The Scoping Workshop led to a dynamic and productive exchange of ideas and experiences resulting in a common vision and five positions: (1) identify, establish, and recognize distinct career paths, (2) develop and implement a robust funding strategy, (3) create a nurturing and diverse intellectual culture, (4) connect research to practice and address real-world problems, (5) invest in leadership, advocacy, and coaching. There was strong agreement that these areas were not well developed and required urgent attention. Outlook: There is a need to foster interprofessional and interdisciplinary collaboration and provision of sustainable support structures so that ECRs can advance HPE. Only when these areas are addressed can these educational researchers contribute to the development of effective learning which prepares the healthcare workforce to meet today’s challenges. Researchers, educators, decision-makers and stakeholders in academia, education, and health and social care contexts share a responsibility for shaping the way forward
Tuning in to Kids: Theoretical basis, program description, and factors impacting effectiveness
No full textThis paper introduces Tuning in to Kids (TIK), a suite of parenting programs that take an emotion-focused approach to working with parents and carers to improve parent functioning, the parent-child relationship, and children's emotional, social, and behavioural functioning. A range of theoretical influences have shaped the program including emotion socialisation theory. A proposed theoretical model for the program is outlined that considers ways in which the program might lead to change. TIK program content and delivery methods are outlined. The final section of the paper outlines a socioecological model that explores the layering of factors contributing to program effectiveness, including child, parent, and family factors; the program content; facilitator factors; organisational factors; and finally, the wider social, cultural, and political influences. These factors provide a framework for reflecting on and understanding what can be both enablers and barriers to program effectiveness
Publisher Correction: Analysis of R-loop forming regions identifies RNU2-2 and RNU5B-1 as neurodevelopmental disorder genes (Nature Genetics, (2025), 57, 6, (1362-1366), 10.1038/s41588-025-02209-y)
No full text10.1038/s41588-025-02274-
Fibre bundle capacity addresses structural connectivity biases in surgical resection cohorts.
No full textRevisiting Hughlings Jackson's dreamy state: dissociative symptoms in temporal lobe epilepsy
No full textBACKGROUND: Transient, dissociative experiences have been attributed to temporal lobe epilepsy (TLE) since at least the time of John Hughlings Jackson in the 1870s, who described how different dissociative symptoms might have distinct clinical potential. While dissociative symptoms are well-understood as a semiological feature of mesial TLE, they can also occur interictally yet remain poorly understood. We systematically examined the frequency, nature, and clinical correlates of dissociative experiences in TLE in an initial effort to better understand their phenotypic features. METHODS: 157 adults with TLE and 57 healthy controls participated (N = 214). A data-driven statistical approach determined the underlying factor structure of the Wessex Dissociation Scale in this cohort and delineated phenotypic symptom clusters. We then examined group differences in rates of dissociation symptoms, as well as the influence of epilepsy-related and mood factors. RESULTS: People with TLE reported more frequent dissociative experiences (M = 0.96, SD = 0.61) than controls (M = 0.69, SD = 0.38; p < 0.001). A novel five-factor solution of dissociative symptoms emerged, namely intrusive, affective, memory, somatic, and numbing. Memory blanks and somatic distortions were uniquely elevated in TLE. Memory blanks and numbing dissociative symptoms were associated with increased seizure frequency, epilepsy duration, and number of anti-seizure medications. Higher depression and anxiety symptoms were linked to elevated overall dissociative symptoms and scores on each subfactor (r = 0.26-.64; p < 0.01-<.001). CONCLUSIONS: People with TLE experience elevated rates of dissociative symptoms in their daily lives. Rather than a general dissociative phenotype, memory- and sensory-related symptoms predominate. The data-driven five-factor model refines earlier understandings and aligns well with contemporary neurocognitive models of epilepsy as a disorder of large-scale network dysfunction, with psychological and epilepsy-specific mechanisms underpinning dissociative experiences in TLE. While the aetiology of these symptoms is complex and multidetermined, TLE nevertheless remains an insightful model for understanding the neurological basis of dissociation more broadly
Transforming Post-Professional Clinical Skill Education with Digitally Integrated Instructional Design: An Industry-Relevant University-Setting Project Series
No full textTransformative digitally integrated pedagogy can enrich learning experiences, diversify the curriculum and broaden access to industry-relevant advanced clinical education for remote learners in medical education. Clinical skills are characterised as the portfolio of practical and interpersonal skills required by practicing clinicians. The purpose of this project was to design a new wholly online post-professional university subject for clinicians in different healthcare disciplines to advance these skills, which would traditionally be taught and assessed in-person. Our methodology included critically reviewing existing evidence of relevant medical skills which need to be included in the curriculum and approaches to their assessment. We designed a subject which dovetailed learning experiences with continuing clinical practice, and developed a new framework for remote video assessment of practical skills. Our pedagogical approaches included a backwards design coupled with a Four-Component Instructional Design Model (4C-ID) approach, which increased access and contextualised learning opportunities for diverse and practicing clinicians. Our narrative synthesis critically shares our experience and insights of embracing digital-technology opportunities while problem-solving to move past barriers. Our impact evaluation and experiential insights offer a platform to reimagine emerging possibilities for future digitally integrated education in medical education and other clinical-skills professions
Early and Extensive Ultraviolet through Near Infrared Observations of the Intermediate-luminosity Type Iax Supernovae 2024pxl
No full textAbstract
We present ultraviolet (UV) through near-infrared (NIR) photometric and spectroscopic observations of the nearby SN 2024pxl, the third Type Ia supernova (SN Ia) in NGC 6384. SN 2024pxl is a Type Iax supernova (SN Iax) with an intermediate luminosity (M
r
= −16.99 ± 0.32 mag) and an average SN Iax light curve decline rate. SN 2024pxl was discovered ∼3 days after first light, and the rising light curve follows a single power law that is inconsistent with significant interaction with a companion star or circumstellar material. Our extensive NIR photometric coverage is comparable to that of the well-observed SNe Iax 2005hk and 2012Z, and we demonstrate that the J − H colors of SNe Iax differ from normal SNe Ia and appear to be more homogeneous as a class. Spectroscopically, we report the earliest-ever NIR spectrum of an SN Iax as measured from maximum light (t ≈ −9 days): a featureless continuum with similarities to a ∼9000 K blackbody, and the line velocities are consistent with a mixed-ejecta structure, with C, Si, and Fe having similar velocities and velocity evolutions. We find a tentative correlation between the H-band break Co ii velocity ∼20 days post-peak and absolute magnitude, with more luminous SNe Iax showing faster Co ii velocities. Our observations suggest that SN 2024pxl resulted from the thermonuclear disruption of a CO white dwarf star that undergoes deflagration burning