136986 research outputs found
Sort by
The addition of peri-operative gentamicin with ciprofloxacin reduces infection and sepsis rates post transrectal prostate biopsy
No full textOBJECTIVE: Despite the advent of transperineal (TP) biopsy and reduced risk of infective complications, transrectal ultrasound-guided (TRUS) prostate biopsy is still widely performed worldwide. The accepted prophylactic antibiotic is usually a single agent oral fluoroquinolone; however, this approach is beset by growing antibiotic resistance. The aim of this study was to assess whether the addition of intravenous gentamicin (2 mg/kg or at least 160 mg), immediately prior to biopsy, in conjunction with routine ciprofloxacin prophylaxis, reduced infection and sepsis rates post TRUS biopsy. METHOD: Six hundred fifty-eight patients underwent TRUS biopsy at our center from 2017 to 2022, of whom 648 had data sufficient for analysis. We performed a retrospective analysis focusing on patient demographics (age, BMI, diabetes status), biopsy parameters, and outcomes of sepsis and urinary tract infection . Patients were recorded as developing sepsis if they required hospital admission for intravenous antibiotics. Fisher's exact test was employed for categorical variables, while the Student's t test was utilized for continuous variables for statistical significance. RESULTS: The rate of sepsis was 3.9% in the ciprofloxacin-only group, versus 0% in the ciprofloxacin plus gentamicin group (P value = 0.03). Overall aggregated post-TRUS infection rates was also 0% in the ciprofloxacin plus gentamicin group (P value = 0.005). We found no associated between infection and secondary risk factors. CONCLUSION: The administration of 2 mg/kg intravenous gentamicin with oral ciprofloxacin prophylaxis reduces infection and sepsis rates post TRUS biopsy
Planning and conducting cross-cultural qualitative research: a methodological framework and resources for health researchers
No full textPURPOSE: The aim of this review was to develop a methodological framework that could be applied during the design and conduct of cross-cultural qualitative research with people from culturally and linguistically diverse backgrounds in health contexts or settings. METHODS: Developing the methodological framework in this study consisted of three phases. In Phase 1, a literature review was undertaken to identify relevant evidence by searching bibliographic databases, online sources and relevant journals. In Phase 2, methodological and ethical concepts, issues and considerations were summarized, synthesized and consolidated into a framework. In Phase 3, the methodological framework was refined by applying it to a cross-cultural qualitative study. RESULTS: The resulting methodological framework proposes two stages (preparation and action) and eleven key steps for designing, conducting and reporting cross-cultural qualitative research. Other practical resources (i.e. glossary of terms and detailed prompt tool) for health researchers that can be used with the framework are also presented. CONCLUSIONS: This article presents a methodological framework that can guide high-quality cross-cultural qualitative research and is intended for use by health researchers, especially those new to cross-cultural qualitative research. It has the potential to improve the inclusivity and cultural responsiveness of qualitative research
Recommended daily rainfall-runoff model for Australian hydrology consulting
No full textAustralian consulting engineers widely use the Australian Water Balance Model (AWBM) to estimate runoff at a daily time-step. AWBM is a simple conceptual rainfall-runoff model that has similar complexity to many other models of this type. Here, we compare the performance of AWBM against three other conceptual rainfall-runoff models – SIMHYD, IHACRES and GR4J – that are used in Australia and around the world. The comparison is based on calibration and evaluation of model performance under current conditions as well as under changing conditions, indicative of likely future hydroclimate. Across all the comparisons, GR4J performed the best of the four models. SIMHYD and IHACRES had similar performance to each other, but were slightly inferior to GR4J, while AWBM was the worst performing model. GR4J was clearly the best model under current conditions, but its outperformance reduced under contrasting conditions. We recommend industry practitioners consider replacing AWBM with GR4J for their modelling requirements when modelling current conditions. For contrasting conditions GR4J is a very good selection, but care needs to be taken when catchment annual rainfall–runoff relationships shift under prolonged drying, when IHACRES may also prove to be a good selection
Improving Data-Based Decision-Making in Early Childhood Services: A Systematic Review Informed by the Capability Opportunity and Motivation Model of Behavior
No full textMonitoring early childhood service (ECS) quality, accessibility, and participation is crucial to ensuring that services make data-based decisions and redress inequities. This review sought to identify effective data-utilization interventions and specific strategies in five ECS settings: antenatal care; nurse home visiting; early childhood education; parenting programs, and early years of school. Searches across five bibliographic databases yielded 12 independent-groups studies, all in primary schools. Application of a behavior change framework showed that in addition to education and training to build capability, strategies to increase opportunities and motivation were important components of effective interventions. Rigorous research in pre-primary settings is needed
Predicting the length-of-stay of pediatric patients using machine learning algorithms
No full textThe management of hospitals’ resource capacity has a strong impact on the quality of care, and the length-of-stay (LOS) of patients is an indicator that reflects its efficiency and effectiveness. This study aims at predicting the LOS of pediatric patients (LOS-P) in hospitals to assist in decision-making regarding resource utilisation. LOS-P forecasting presents additional challenges to the analyst compared to other medical specialties since Pediatrics comprises several other subspecialties (e.g. pediatric oncology and traumatology). Pediatric patients within subspecialties compete for the same hospital resources, and aggregate LOS-P predictions are more useful for resource planning. However, aggregate pediatric LOS datasets are harder to model and result in lower forecasting accuracy. To address that problem, we propose a forecasting model based on Machine Learning algorithms. The method for LOS-P forecasting comprises five steps (data visualisation, data pre-processing, sample partitioning, model testing, and model definition through parameter setting and variable selection) and is tested using a dataset of hospitalisations of pediatric patients from a large Brazilian University hospital. Multiple linear regression, random forest, support vector regression, ridge regression, and partial least squares algorithms are applied and compared to determine the best forecasting model. Results indicate that all forecasting models yield satisfactory accuracy, with the best algorithms being random forest and support vector regressor. After refining the model through variable selection and using a Grid Search to find the best parameters, the random forest algorithm yielded an R2 of 65.67%, with an average absolute error of 3.51 days. Prediction of the length of stay of pediatric patients (LOS-P) in hospitals based on Machine Learning algorithmsMultiple linear regression, random forest, support vector regression, ridge regression, and partial least squares algorithms were applied and comparedRandom forest algorithm yielded an R2 of 65.67%, with an average absolute error of 3.51 days Prediction of the length of stay of pediatric patients (LOS-P) in hospitals based on Machine Learning algorithms Multiple linear regression, random forest, support vector regression, ridge regression, and partial least squares algorithms were applied and compared Random forest algorithm yielded an R2 of 65.67%, with an average absolute error of 3.51 day
Effects of Decentralized Sequencing on National Listeria monocytogenes Genomic Surveillance, Australia, 2016-2023
No full textWe assessed turnaround times in the national Listeria monocytogenes genomic surveillance system in Australia before and after decentralized sequencing. Using 1,204 samples collected during 2016-2023, we observed statistically significant reductions in median time from sample collection to issuance of national genomic surveillance report to 26 days, despite sample numbers doubling in 2022 and 2023. During 2016-2018, all jurisdictions referred samples to the National Listeria Reference Laboratory for sequencing and analysis, but as jurisdictional sequencing capacity increased, 4 jurisdictions transitioned to sequencing their own samples and referring sequence data to the national laboratory. One jurisdiction had well-established genomics capacity, transitioned without noticeable disruption, and continued to improve. Another 3 jurisdictions initially had increased turnaround times, highlighting the need for defined sequence referral mechanisms. Overall, timeliness and throughput improved, and sequencing decentralization strengthened Australia's genomic surveillance system while maintaining timeliness. The practices described could be beneficial and achievable in other countries
P-2126. ‘SPECIFIC’ First-In-Human Clinical Trial of 68Ga-triacetylfusarinine (TAFC) Siderophore PET/CT for Detection of Invasive Aspergillosis
No full textAbstract
Background
Invasive Aspergillus spp. infections (IAI) confer high morbidity and mortality in immunocompromised patients. Diagnosis often requires invasive and risky sampling. 18F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) is useful in diagnosis but is non-specific.
Siderophores are pathogen-specific iron chelators which are a promising radiolabelling target for IAI diagnosis. Aspergillus fumigatus secretes 2 siderophores, fusarinine C and triacetylfusarinine (TAFC), which are upregulated during IAI. Gallium-68 (68Ga)-labelled TAFC is attractive due to its short half life, rapid renal clearance, and low radiation risk. Preclinical mouse studies demonstrate diagnostic potential of 68Ga-TAFC PET/CT with specific visualisation of A. fumigatus infection.Figure 1:68Ga-TAFC-PET/CT in a patient with leukemia and probable pulmonary A. fumigatus IAI. Specific infective uptake of known pulmonary lesions at around blood pool level intensity (SUVmax 3.5, SUVmean 2.3). There was minimal liver and marrow uptake, with progressive washout to 60 minutes.
Methods
We report the first result from a 10 patient pilot trial of 68Ga-TAFC PET/CT for IAI diagnosis (NCT06105411). Inclusion criteria are adults with pulmonary IAI within 2 weeks of diagnosis. Exclusion criteria are pregnant/lactating patients or those within a week of iron infusion.
68Ga-TAFC PET/CT was performed at 15, 62, and 209 minutes after IV 139 MBq 68Ga-TAFC administration. Findings pertinent to IAI and physiologic uptake were analysed.
Results
The patient had probable A. fumigatus IAI in the setting of leukemia. Galactomannan and Aspergillus fumigatus PCR were positive on bronchoalveolar lavage fluid. Empiric antifungal treatment was commenced with fever resolution at 72 hours.
68Ga-TAFC-PET/CT was performed 10 days after treatment start and 4 days after microbiological diagnosis. Blood pool activity (SUVmax at 15/60/209 mins: 4.1/2.7/1.9) was demonstrated with minimal liver, spleen and gastrointestinal tract uptake (SUVmax 2.7), early renal excretion, and no marrow or other organ uptake. There was focal uptake in multiple pulmonary lesions (SUVmax 3.5), similar to blood pool activity, with synchronous washout over time. No adverse effects occurred.
Conclusion
Very low background physiologic biodistribution was seen in the first participant in this study. Focal low grade pulmonary uptake was visualised, likely demonstrating specific activity for A.fumigatus. Trial recruitment continues.
Disclosures
Abby Douglas, MBBS, Gilead Sciences: Honorari
Studying organisational closure in biological systems with process-enablement graphs
No full textAt the heart of many contemporary theories of life is the concept of biological self-organisation: organisms have to continuously produce and maintain the conditions of their own existence in order to stay alive. The way in which these varying accounts articulate this concept, however, differs quite significantly. As a result, it can be difficult to identify self-organising features within biological systems, and to compare different descriptions of such features. In this article, we develop a graph-theoretic formalism - process-enablement graphs - to study the organisational structure of living systems. A process-enablement graph is a directed graph where the vertices represent processes, the edges represent direct enablements, and a cycle within the graph captures a self-organising component of a physical system in a general and abstract way. We use our notion of a process-enablement graph to provide a concise definition of organisational closure in the language of graph theory. Further, we define a class of graph homomorphism which allows us to compare biological models as process-enablement graphs. These homomorphisms facilitate a comparison of descriptions of self-organisation in a consistent and precise manner. We apply our formalism to a range of classical theories of life including autopoiesis, (F,A)-systems, and autocatalytic sets. We demonstrate exactly how these models are similar, and where they differ, with respect to their organisational structure. While our current framework does not demarcate living systems from non-living ones, it does allow us to better study systems that lie in the grey area between life and non-life
An evaluation of Human Papillomavirus vaccination resources available to Aboriginal and Torres Strait Islander adolescents and parents and caregivers in Australia
No full textObjectives: This study aimed to assess the availability, understandability, actionability, readability and cultural relevance of HPV vaccination resources available online for Aboriginal and Torres Strait Islander adolescents and parents/caregivers. Methods: HPV vaccination resources were collected via Google and website searches. Resources were assessed for readability, understandability, actionability, and cultural relevance. Results: We found eight resources, most of which were easy to read, understandable and actionable. While several resources met some criteria for cultural relevance, many lacked reporting on consultation and leadership and did not have a specific Aboriginal and Torres Strait Islander contact for further support. Three of four reported up-to-date information about the HPV vaccine schedule. On balance, a short video performed best across all assessment items. Conclusions: The evaluation highlights the need for HPV vaccination resources that are culturally safe, accurate, and easy for a consumer to understand and act upon. Practice implications: Further work is required to ensure that resources are developed in partnership with Aboriginal and Torres Strait Islander communities, are sustainable and can be rapidly updated to align with evolving policies. This will support Aboriginal and Torres Strait Islander adolescents and parents/caregivers to make informed decisions about HPV vaccination