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The hotter and shorter the better? Strategy comparison for atrial fibrillation ablation using high power short duration settings
No full textA pilot implementation study of a chronic pain core outcome set and decision tree for children and young people with cerebral palsy
No full textPURPOSE: This study aimed to (i) develop a decision tree to guide clinicians to use a core outcome set (COS) of chronic pain assessment tools specific to children and young people with cerebral palsy and (ii) pilot test the implementation of the decision tree and core set in clinical practice. MATERIALS AND METHODS: The study involved two stages. Stage one was the development of the decision tree using a focus group with clinicians. Stage two implemented the decision tree and COS in one rehabilitation service over three months. Evaluation involved an online survey with clinicians (physiotherapists, occupational therapists, nurses and doctors). The Capability, Opportunity, Motivation-Behaviour model was used to guide qualitative analysis of survey responses and identify barriers and enablers to use of the decision tree. RESULTS: Eight clinicians participated, completing 103 pain assessments on 82 children during the implementation period. All clinicians reported increased knowledge and confidence after using the decision tree (capability) and ease of access to assessment tools (opportunity) as primary enablers to assessing pain in the clinic. Lack of time for pain assessment was the most common barrier reported. CONCLUSION: The decision tree showed promise in assisting clinicians to include pain assessment in clinical care
Sequencing of Mycoplasma genitalium genomes using a tiling amplicon method on the Nanopore MinION
No full textMycoplasma genitalium is challenging to work with and new methods are needed to study this bacterium directly in clinical samples. This study designed and validated a proof-of-concept polymerase chain reaction (PCR)-based 'tiling' methodology to sequence M. genitalium genomes. Primers were designed to produce 2.5 kb amplicons covering the 580 kb genome with a minimum overlap of 100 bp. Analysis was performed using the laboratory strain G37 and a clinical isolate. Amplicons were sequenced on the Oxford Nanopore MinION using ligation sequencing. Reads were mapped to a reference to produce a consensus genome. A total of 262 primer pairs were designed and amplification was successful for 99.5% (261/262) of 2.5 kb amplicons, with G37 genome coverage of 99.5% (mean read depth, 1973X). Using larger 5kb amplicons, amplification was successful for 92.4% (121/131) of primer pairs, with a coverage of 92.2% (mean read depth, 223X). When validated on a clinical isolate, 98.3% coverage was achieved (read depth, 443X). In conclusion, this study developed a PCR-based tiling approach to whole genome sequencing of M. genitalium by designing and validating a set of 262 primer pairs
Antagonistic Effects of Hydrated Lime and Calcium Formate on Early-Age Strength in High Volume Fly Ash Composites: Mechanisms and Engineering Implications
No full textThe utilization of high-volume fly ash (HVFA, ≥50% cement replacement) in concrete is pivotal for sustainable construction but hindered by low early-age strength. This study investigates the individual and combined effects of hydrated lime (HL) and calcium formate (CF) on the strength development, hydration kinetics, and microstructure of HVFA pastes (60% and 70% FA). Individual additions of 11% HL (HVFA60) or 14% HL (HVFA70) raised 28-day compressive strength by 18% and 22%, respectively, and shortened final setting from 10.0 h to 3.8 h. Similarly, 3% CF increased 28-day strength by 15% (HVFA60) and 12% (HVFA70) while cutting final setting to 2.1 h and 3.3 h. In contrast, combining HL and CF suppressed strength by 15–22% despite accelerating final setting to less than 1 h. Isothermal calorimetry showed a 40% reduction in cumulative heat release at 44 h for the combined system. XRD, TGA and SEM confirmed 20–30% lower C-S-H content, 25% less CH, and a rise in porosity when HL and CF were used together. These findings demonstrate that HL and CF act as competing accelerators, where rapid heat release compromises microstructural integrity. For practical applications using HVFA materials, individual use of HL or CF is recommended to enhance early-age performance, while combined application should be avoided to prevent strength reduction
Cancer and fertility management: FIGO best practice advice
No full textCancer diagnoses in patients of reproductive age require balancing urgent oncological treatment with the need to preserve fertility. This FIGO Best Practice Advice outlines key considerations for fertility management in this population given the rising cancer incidence among young women and the reproductive risks posed by cancer treatments. The guidance evaluates the impact of chemotherapy, radiotherapy, surgery, and emerging therapies-such as targeted agents and immunotherapies-on gonadal function and fertility. Established fertility preservation methods, including oocyte/embryo cryopreservation, sperm banking, and ovarian tissue freezing, are detailed alongside barriers to their adoption, such as cost and limited access. Early collaborative counseling with oncologists and fertility specialists is central to addressing timelines, psychological impacts, and priorities. Post-treatment pathways, including assisted reproduction and surrogacy, are also explored. The guidance stresses the importance of integrating fertility-sparing interventions and fertility preservation into cancer care while advocating for equitable access to resources. Further research is needed to refine preventive interventions, evaluate long-term outcomes, and expand options for survivors globally. By prioritizing fertility preservation within oncological care, healthcare providers can better support the holistic needs of young individuals facing cancer
Imaging findings of scleroderma-associated myopathy: A systematic literature review
No full textAims: Systemic sclerosis (SSc) affects skeletal muscle directly, with SSc-associated myopathy (SSc-myopathy) increasingly recognised as a distinct immune-mediated myopathy. Manual muscle testing and creatine kinase (CK) are insensitive diagnostic tools for SSc-myopathy. We aimed to evaluate the role of imaging in SSc-myopathy diagnosis. Methods: A systematic search of MEDLINE(Ovid), Pubmed, and EMBASE databases was performed to identify studies of ≥10 SSc patients that reported skeletal muscle imaging results. Eligibility criteria were defined a priori. Risk of bias assessment was performed using the National Heart, Lung and Blood Institute (NHLBI) quality assessment tool. Descriptive summaries were used to present data owing to inter-study heterogeneity. Results: Of 2426 studies identified, 17 articles met the inclusion criteria. Imaging modalities varied, but magnetic resonance imaging (MRI) was the most commonly applied imaging technique (n = 9 studies). Abnormalities on MRI were reported in 38–100 % of patients and included muscle oedema, atrophy, and fatty infiltration. Changes were observed in skeletal muscles (n = 14 studies), axial muscles (n = 1), masseter muscle (n = 1), and accessory respiratory muscles (n = 2). Blood oxygenation level-dependent MRI, dynamic contrast-enhanced ultrasound, and scintigraphic evaluation have each been used to assess skeletal muscle perfusion. A lack of correlation between creatine kinase, clinical weakness, and imaging findings was consistently reported. We were unable to identify any distinct imaging patterns or relationship between imaging and histopathological skeletal muscle abnormalities owing to limited data available. Conclusion: Imaging detects inflammatory, atrophic, and vasculopathic changes in the skeletal musculature of SSc patients. The discordance between clinical assessment and imaging findings underscores the potential role for muscle imaging to both screen and diagnose SSc-myopathy
Beyond “Dead Words”: Enhancing Documentation Practices for Domestic Violence-Informed Work
No full textAbstract
Purpose
Domestic violence-informed documentation practices across health and human services were explored as an aspect of a wider action research project in New South Wales, Australia. In health and human service responses to families living at the intersection of domestic violence, substance misuse and mental ill-health, practitioners navigate the complexities of collaborative and integrated work to address violence and abuse. Documentation is an aspect of practice where ethical, quality and safety issues arise, impacting individuals, organizations, and service sectors.
Methods
Senior practitioners from specialist domestic violence, substance use, mental health and child protection services participated in a series of Communities of Practice to explore integrated and collaborative practice using the Safe & Together™ Model approach to working with families impacted by domestic violence and abuse. Documentary practices were explored as an important aspect of the wider research project, and ethnographic notes from Community of Practice and reflective focus groups were thematically analyzed.
Results
Four key themes regarding domestic violence-informed documentation practices were highlighted in the analysis: recognizing the power of documentation; maintaining an all-of-family focus; focussing on patterns and context; and the importance of language that emphasizes behavioral specificity. Taken together, these themes speak to the powerful role played by domestic violence-informed documentation for clients accessing services, as well as to the opportunity for practice-changing work through documentation that diverse practitioners can take up when working with families and with each other.
Conclusion
This paper contributes to a growing body of practice-led knowledge building and provides an in-depth examination of domestic violence-informed documentation practices from the perspectives of practitioners working at the intersections of domestic violence, substance use, mental health and child protection issues across health and human services. It highlights the complex and empowering opportunities that attention to language and documentation holds and emphasizes the need for further research exploration and capacity building for domestic violence-informed practice
Opportunities and challenges to enhance the welfare of livestock through positive human-animal relationships
No full textA negative human-animal relationship from the farm animal’s perspective can, mainly through fear and stress, compromise the animal’s welfare, health and productivity. Studies particularly in the dairy and pig industries demonstrate a causal link between stockperson attitudes, stockperson behaviour, animal fear and stress and animal welfare. Equally, a positive relationship can improve these outcomes for the animal. Furthermore, since stockperson attitudes and behaviour are amenable to change, they can be improved by appropriate training. Indeed, cognitive behavioural training has been shown to improve stockperson attitudes and behaviour towards animals, with consequent reductions in animal fear and improvements in animal productivity. While our understanding of the implications of the human-animal relationship in other livestock industries is relatively poor, there is limited evidence of relationships between stockperson attitudes, stockperson behaviour and animal fear responses in other livestock industries, such as the goat, poultry and sheep industries. There is a clear need for the livestock industries to train their personnel to care for and handle their animals effectively and humanely
Toxoplasma gondii seropositivity as a risk factor for epilepsy: A discordant monozygotic twin study
No full textOBJECTIVE: Toxoplasma gondii (T. gondii) seropositivity has been reported to have up to a five-fold increased risk for epilepsy. However, substantial heterogeneity in methodology exists across these studies. Furthermore, other studies failed to replicate an association between T. gondii seropositivity and epilepsy. To address these inconsistencies, we investigated this issue in monozygotic (MZ) twin pairs discordant for epilepsy, a method that controls for age, sex and genetic factors. METHODS: We analyzed 32 MZ twin pairs who are discordant for epilepsy, comparing rates of T. gondii seropositivity (IgG) between affected and unaffected twins. The odds ratio for T. gondii seropositivity in affected twins compared to their unaffected co-twins was calculated using McNemar's chi-squared paired proportion test. Factors associated with T. gondii seropositivity were assessed using Fisher's exact test and Welch's t-test, as appropriate. RESULTS: The frequency of seropositivity in affected twins compared to their unaffected co-twins did not differ (odds ratio of 1.67 [95 % CI: 0.39-6.97], p = 0.72), indicating no significant association between T. gondii seropositivity and epilepsy in this cohort. Age at testing was associated with T. gondii seropositivity, with individuals found to be seropositive being older than those who were seronegative [mean age at testing (SD) 59.1 years (12.6) vs 47.7 years (14.3), p = 0.03]. CONCLUSION: In our cohort of MZ twins discordant for epilepsy, we found no evidence for an association between T. gondii seropositivity and epilepsy. Larger carefully controlled studies are warranted
Safety assurance for automated systems in transport: A collective case study of real-world fatal crashes
No full textINTRODUCTION: Traditional vehicle safety assurance frameworks are challenged by Automated Driving Systems (ADSs) that enable dynamic driving tasks to be performed without active involvement of a human driver. Further, an ADS's driving functionality can be changed during in-service operation, using software updates developed using Machine Learning (ML). Learnings from real-world cases will be a key input to reforming current regulatory frameworks to assure ADS safety. However, ADSs are yet to be deployed in mass volumes, and limited data are available regarding their in-service safety performance. METHOD: To overcome these limitations, a collective case study was undertaken, drawing upon three relevant real-world cases involving automated control systems that were a causative factor in major transport safety incidents. RESULTS: A range of findings were identified, which informed recommendations for reform. The study found some assurance processes, decisions and oversight were not commensurate with risk or safety integrity levels, including a lack of independence with reviews and approvals for safety-critical system components. Two cases were also impacted by conflict or bias with regulatory approvals. Other commonalities included a lack of safeguards to ensure systems were not operated outside their design domain, and a lack of system redundancy to ensure safe operation if a system component fails. Further, the identification and validation of system responses to scenarios that could be encountered within design domain boundaries was lacking. For the two cases in which safety-critical functionality was developed using ML, it's concerning no regulator reports provided detailed findings regarding the role of ML models, algorithms, or training data