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Maternal interleukin 6 in pregnancy is associated with everyday, but not test-based executive functioning in 10-year-old children
No full textBackground Elevated maternal interleukin 6 (IL-6) during pregnancy has been associated with adverse fetal brain development and neurodevelopmental disorders, which often involve executive functioning (EF) impairments. However, the association between maternal IL-6 levels during pregnancy and EF remains largely unexplored. Methods The COPSYCH study is based on the prospective COPSAC2010 birth cohort of 700 mother-child pairs, recruited during pregnancy. The children's executive functioning was assessed at age 10 using: (i) the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) parental questionnaire, and (ii) a comprehensive neuropsychological test battery. Maternal blood levels of IL-6 and hs-CRP were measured at gestational week 24. Associations between IL-6 (main analysis) and hs-CRP (secondary analysis) and EF in children at age 10 were investigated with regression models with extensive confounder adjustment. Results Six hundred and four children (86% of the cohort) completed the 10-year follow-up. Higher maternal IL-6 levels were significantly associated with less efficient parental-rated executive functioning in the children: BRIEF-2 Global Executive Composite score (p = 0.003), Behavior Regulation Index (p = 0.005), Emotion Regulation Index (p=0.04), and Cognitive Regulation Index (p=0.007). Interaction analysis with sex was significant (p-value=0.01) and exploratory analyses showed that IL-6 associations to BRIEF-2 were solely driven by boys. Associations between IL-6 and neuropsychological tests, as well as associations between hs-CRP and EF outcomes, were non-significant. Conclusion IL-6 during pregnancy was associated with less efficient everyday EF in children at age 10. If replicated, preventive strategies targeting inflammation in pregnancy may ameliorate adverse cognitive outcomes in offspring
Implementation of a best-practice model of care for cognitive impairment and dementia for first nations peoples attending primary care in Australia: a stepped-wedge cluster-randomised trial
No full textBackground: Dementia and cognitive impairment not dementia (CIND) are under-detected amongst First Nations peoples attending primary care. This trial implemented a culturally adapted best-practice model of care to increase detection and optimise management of CIND/dementia. Methods: This closed cohort open-label, stepped-wedge, cluster-randomised trial recruited 12 Aboriginal community-controlled primary health care services (ACCHSs) across urban, regional and remote settings in Australia. ACCHSs were eligible to participate if they conducted annual health checks, engaged in continuous quality improvement processes and had ≥55 clients aged ≥50 years. After a baseline control period, four ACCHSs were scheduled to enter the intervention phase every six months. During the intervention phase, ACCHSs were supported to embed best-practice dementia care through staff education and practice change initiatives. Co-primary outcomes were: (i) documented detection of CIND/dementia and, (ii) evidence of uptake of the diagnostic pathway measured as presence of ≥2 of: use of cognitive assessment tools, relevant pathology investigations, neuroimaging, and/or referral of clients with cognitive concerns to specialist services. Data were analysed with mixed effects complementary log–log regression. This study was registered with the Australia and New Zealand Clinical Trials Registry, ACTRN12618001485224. Findings: Between September 2018 and January 2019, 12 ACCHSs were recruited, comprising a sample of 1655 ACCHS clients aged ≥50 years (mean 60.3 ± 8.2 years), of whom 935 (56.5%) were female. One ACCHS withdrew during the study. After adjustment for time, the intervention did not show evidence of an effect for the first co-primary outcome (detection of CIND/dementia): HR = 1.53 (95% CI 0.64, 3.65). However, the intervention improved the second co-primary outcome (uptake of diagnostic pathway): HR = 2.34 (95% CI 1.05, 5.25). Intention-to-treat analyses yielded similar results. Interpretation: The co-developed best-practice model of care for cognitive impairment and dementia for Aboriginal and Torres Strait Islander people attending primary care improved the diagnostic CIND/dementia management process. Funding: National Health and Medical Research Council (Australia) and Dementia Training Australia
Capacity-building strategy for next-generation mental health research: Embedding a national network infrastructure to grow mental health researcher capabilities and mental health lived-experience research leaders
No full textInternationally, capacity building for mental health implementation and translation research has lagged. A review of literature found initiatives since 2008 indicating limited dedicated attention to growing capabilities of early-to-mid-career mental health researchers, and little reporting of tailored career pathways and skills growth. Significant gaps in capacity building thus exist. This perspective article describes a networked infrastructure for a capacity building strategy of the Australian-based ALIVE National Centre for Mental Health Research Translation. The Centre was funded as a special initiative in mental health with an initial five-year investment. In 2022, the Centre established the first national, cross-disciplinary mental health Next Generation Researcher Network, including a tailored Lived-Experience Research Collective with the aim to grow future research leaders and establish career pathways embedded within the research activities of the Centre. After three years of operation, membership is upward of 280 people in the Next Generation Researcher Network and more than 250 people for the Collective. Specific components implemented as part of the strategy include a central coordination hub, coleadership approaches, coresearch models, tailored traineeships, skills-building through short courses and learning events, cocreation of resources, an online peer discussion platform and annual seed funding schemes. A continuous capacity-building strategy is critical for advancing global research agendas to improve mental health implementation and translation outcomes. Success requires network infrastructure to ensure research methodologies advance, and research addresses the priorities of people most impacted, and early and mid-career researcher capabilities across all research settings connected with universities and service sectors grow
Managing Acute Esophageal Necrosis Secondary to Diabetic Ketoacidosis in a Rural Centre: A Case Report and Proposed Algorithm for Management.
No full textAcute esophageal necrosis (AEN) is a rare phenomenon, usually presenting with hematemesis or melena in patients who are already unwell with concurrent pathology. We present a case of AEN in an acutely unwell 82-year-old man who presented in diabetic ketoacidosis (DKA). He was successfully managed in our rural centre with remote guidance from a tertiary centre. We propose an evidence-informed management algorithm to guide and assist clinicians caring for patients with AEN in resource-limited settings. Initial management of AEN should prioritize resuscitation and correction of any underlying pathology, such as DKA. Early endoscopic assessment is required for the diagnosis of AEN and quantification of the extent of necrosis. Early repeat endoscopy (48-72 h) is recommended to assess healing and is useful in guiding ongoing management. In resource-limited settings, early referral and transfer for patients with AEN is recommended in the absence of intensive care support, endoscopy, or limited blood products
A Digital Pornography Education Prototype Co-Designed With Young People: Formative Evaluation
No full textBackground: Interventions to help young people make sense of sex and relationships in the context of widely available pornography are becoming increasingly supported in school settings. However, young people who experience disruptions to their education often have less access to such programs. Digital platforms may offer a more accessible method to deliver tailored sexual health and pornography literacy to young people who are disengaged from mainstream schooling, or who experience other types of structural disadvantage. Objective: This study aimed to describe the formative evaluation of “The Gist” a co-designed online sexual health education and pornography literacy prototype designed to meet the sexual health information needs of structurally marginalized young people in Australia. Methods: We conducted iterative workshops with 33 young people aged between 15 and 24 years recruited from an alternative education school in Melbourne, Australia. Through interactive activities, participants evaluated the overall prototype design, including its usability, desirability, inclusiveness, and potential for impact. Results: Participants reported The Gist to be easy to use (17/20, 85%) and safe (19/23, 83%), with “hot” branding (25/30, 83%). However, perceived content relevance was dependent on the participants’ existing level of sexual health knowledge and experience, with only 31% (7/23) agreeing that “The Gist feels like it was made for me.” The interactive learning activities such as the debunked (myth-busting) and quiz features were among the most used and well-liked on The Gist platform. Low unprompted engagement with the prototype outside of facilitated workshop settings also confirmed previous researcher postulations that The Gist as a standalone digital platform is unlikely to meet the needs of this population group. Further design refinements are needed to improve user experience, including more interactive activities and visual information in place of heavily text-based features. Conclusions: This study provides important insights into the design and sexual health information needs of structurally marginalized young people. Further research is needed to assess the overall efficacy of The Gist prototype, as well as its ability to positively influence young people’s sexual attitudes, beliefs, and behaviors. Future iterations should consider hybrid or face-to-face delivery models to better capture student engagement
Nonlinearity in thermal comfort-based control systems: A systematic review
No full textThis work presents an in-depth systematic literature review of the strategies used to characterise and quantify thermal comfort conditioned by mechanical HVAC systems. The model development is paramount for the study on the stability and robustness of the ventilation process control. They are required to establish supervisory and local control loops to improve the component sequence of the HVAC systems, and the interaction among the indoor environment, occupants, and the HVAC system response. Over the past decade, innovative technologies and artificial intelligence revamped the HVAC control research with a reluctancy of application in practice due to complex computations and lack of understanding for these innovations. However, the need to find the balance between the functionality of the HVAC system and suitable comfort levels of occupants still persisted. This work examines three research clusters of HVAC systems: zone thermal conditions representation, the inherent nonlinearity of HVAC complex systems and model reduction strategies, and HVAC processes optimisation and control methods. This enables a holistic view of the complexities folded in delivering occupants’ thermal comfort. Central to constructing these research clusters, existing studies were investigated following the four-step protocol based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines: identification of relevant literature based on keywords, screening of the chosen literature quality, setting eligibility criteria for scoping the objectives of the study and lastly inclusion of literature categories into one set. Based on the findings of this work, the application of linearisation and model reduction is found to be a promising area of research in the field of HVAC system control and optimisation. This is because emerging deep learning methods could facilitate the integration of linearisation to high-dimensional data of zone thermal interactions presented by computational fluid dynamics. Finally, this work discusses the challenges faced in the data-driven control strategies of HVAC systems, opens future direction of evaluating occupants’ comfort and highlights the importance of interpretability and tracking of control process in relation to thermal comfort
Authoritarian Survival and Leadership Succession in North Korea and Beyond
No full textAuthoritarian Survival and Leadership Succession in North Korea and Beyond examines how dictators manage elites to facilitate succession. Theoretically, it argues that personalistic incumbents facilitate the construction of a power base of elites from outside of their inner circle to help the successor govern once he comes to power. Then, once in office, successors consolidate power by initially relying on this power base to govern while marginalizing elites from their predecessor's inner circle before later targeting members of their own power base to further consolidate power. The Element presents evidence for these arguments from North Korea's two leadership transitions, leveraging original qualitative and quantitative evidence from inside North Korea. Comparative vignettes of succession in party-based China, Egypt's military regime, and monarchical Saudi Arabia demonstrate the theory's broader applicability. The Element contributes to research on comparative authoritarianism by highlighting how dictators use the non-institutional tool of elite management to facilitate succession
Advancing optometric education through peer-reviewed publication: innovations and insights for the future
No full textClinical optometric practice has evolved rapidly over the past century towards evidence-based, patient-centred care. As graduate requirements have changed, so too has optometric education – from eminence-based, observational and ad-hoc teaching methodology with a didactic predominance, to developing curricula based on evidence and active learning strategies, designed to meet diverse learning needs, and having assessment constructively aligned with learning opportunities. Many lessons can be learned and pedagogical approaches adapted from the work of other health professions educators, of which the medicine and nursing SoTL communities are particularly strong. However, aspects of optometry practice (e.g., primary eye care providers in most jurisdictions across the globe; independent practice including diagnostics and monitoring immediate upon registration) mean that optometry education has unique requirements. For optometry educators to customise curricula upon a strong evidence base, the ability to find optometry-centric education papers is key
Global, regional, and national burden of suicide, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
No full textBackground: Deaths from suicide are a tragic yet preventable cause of mortality. Quantifying the burden of suicide to understand its geographical distribution, temporal trends, and variation by age and sex is an essential step in suicide prevention. We aimed to present a comprehensive set of global, regional, and national estimates of suicide burden.
Methods: We produced estimates of the number of deaths and age-standardised mortality rates of suicide globally, regionally, and for 204 countries and territories from 1990 to 2021, and disaggregated these results by age and sex. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 estimates of deaths attributable to suicide were broken down into two comprehensive categories: those by firearms and those by other specified means. For this analysis, we also produced estimates of mean age at the time of death from suicide, incidence of suicide attempts compared with deaths, and age-standardised rates of suicide by firearm. We acquired data from vital registration, verbal autopsy, and mortality surveillance that included 23 782 study-location-years of data from GBD 2021. Point estimates were calculated from the average of 1000 randomly selected possible values of deaths from suicide by age, sex, and geographical location. 95% uncertainty intervals (UIs) were derived from the 2·5th and 97·5th percentiles from a 1000-draw distribution.
Findings: Globally, 746 000 deaths (95% UI 692 000–800 000) from suicide occurred in 2021, including 519 000 deaths (485 000–556 000) among males and 227 000 (200 000–255 000) among females. The age-standardised mortality rate has declined over time, from 14·9 deaths (12·8–15·7) per 100 000 population in 1990 to 9·0 (8·3–9·6) per 100 000 in 2021. Regionally, mortality rates due to suicide were highest in eastern Europe (19·2 [17·5–20·8] per 100 000), southern sub-Saharan Africa (16·1 [14·0–18·3] per 100 000), and central sub-Saharan Africa (14·4 [11·0–19·1] per 100 000). The mean age at which individuals died from suicide progressively increased during the study period. For males, the mean age at death by suicide in 1990 was 43·0 years (38·0–45·8), increasing to 47·0 years (43·5–50·6) in 2021. For females, it was 41·9 years (30·9–46·7) in 1990 and 46·9 years (41·2–52·8) in 2021. The incidence of suicide attempts requiring medical care was consistently higher at the regional level for females than for males. The number of deaths by suicide using firearms was higher for males than for females, and substantially varied by country and region. The countries with the highest age-standardised rate of suicides attributable to firearms in 2021 were the USA, Uruguay, and Venezuela.
Interpretation: Deaths from suicide remain variable by age and sex and across geographical locations, although population mortality rates have continued to improve globally since the 1990s. This study presents, for the first time in GBD, a quantification of the mean age at the time of suicide death, alongside comprehensive estimates of the burden of suicide throughout the world. These analyses will help guide future approaches to reduce suicide mortality that consider a public health framework for prevention. Funding: Bill & Melinda Gates Foundation
Antimicrobial Phenolic Materials: From Assembly to Function
No full textInfectious diseases pose considerable challenges to public health, particularly with the rise of multidrug-resistant pathogens that globally cause high mortality rates. These pathogens can persist on surfaces and spread in public and healthcare settings. Advances have been made in developing antimicrobial materials to reduce the transmission of pathogens, including materials composed of naturally sourced polyphenols and their derivatives, which exhibit antimicrobial potency, broad-spectrum activity, and a lower likelihood of promoting resistance. This review provides an overview of recent advances in the fabrication of antimicrobial phenolic biomaterials, where natural phenolic compounds act as active antimicrobial agents or encapsulate other antimicrobial agents (e.g., metal ions, antimicrobial peptides, natural biopolymers). Various forms of phenolic biomaterials synthesized through these two strategies, including antimicrobial particles, capsules, hydrogels, and coatings, are summarized, with a focus on their application in wound healing, bone repair and regeneration, oral health, and antimicrobial coatings for medical devices. The potential of these advanced phenolic biomaterials provides a promising therapeutic approach for combating antimicrobial-resistant infections and reducing microbial transmission