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A note on switching eigenvalues under small perturbations
No full textSensitivity of eigenvectors and eigenvalues of symmetric matrix estimates to the removal of a single observation have been well documented in the literature. However, a complicating factor can exist in that the rank of the eigenvalues may change due to the removal of an observation, and with that so too does the perceived importance of the corresponding eigenvector. We refer to this problem as “switching of eigenvalues”. Since there is not enough information in the new eigenvalues, post observation removal, to indicate that this has happened, how do we know that this switching has occurred? In this article, we show that approximations to the eigenvalues can be used to help determine when switching may have occurred. We then discuss possible actions researchers can take based on this knowledge, for example making better choices when it comes to deciding how many principal components should be retained and adjustments to approximate influence diagnostics that perform poorly when switching has occurred. Our results are easily applied to any eigenvalue problem involving symmetric matrix estimators. We highlight our approach with application to two real data examples
A policy option towards improving efficiencies in Victorian public oral healthcare
No full textBackground: International oral health policy directions led by the World Health Organisation call for the inclusion of oral health within universal health coverage. The aim of this study is to perform a budget impact analysis of a policy option for a more cost-efficient oral health workforce skill-mix (dentists and oral health therapists) to provide public oral healthcare in Victoria, Australia. Methods: Two hypothetical standard care pathways were developed. A dynamic population Markov model in TreeAge software, with a time horizon of 6 years. Two scenarios were modelled to determine: (1) base-case scenario: the threshold the dentist workforce could reduce per year, while achieving the same service delivery outputs, and (2) alternative scenario: the potential cost-savings for utilising an optimally cost-efficient oral health workforce skill-mix. Results: The threshold analysis showed a minimum reduction of 13% of the dentist workforce being replaced with oral health therapists can occur without having any impact on the same service delivery outputs. Under the alternative scenario, the potential cost-savings would be AUD$1,425,037 (standard deviation 58,954). Conclusions: Governments and policy-decision makers should consider strategies in training, attracting, and retaining oral health therapists to achieve an optimally cost-efficient oral health workforce skill-mix when delivering public oral healthcare.</p
How the 1989 Tiananmen Massacre Shaped China’s Approach to International Human Rights
No full textNo description supplied</p
Differential in vivo roles of Mpl cytoplasmic tyrosine residues in murine hematopoiesis and myeloproliferative disease
No full textThrombopoietin (Tpo), which binds to its specific receptor, the Mpl protein, is the major cytokine regulator of megakaryopoiesis and circulating platelet number. Tpo binding to Mpl triggers activation of Janus kinase 2 (Jak2) and phosphorylation of the receptor, as well as activation of several intracellular signalling cascades that mediate cellular responses. Three tyrosine (Y) residues in the C-terminal region of the Mpl intracellular domain have been implicated as sites of phosphorylation required for regulation of major Tpo-stimulated signalling pathways: Mpl-Y565, Mpl-Y599 and Mpl-Y604. Here, we have introduced mutations in the mouse germline and report a consistent physiological requirement for Mpl-Y599, mutation of which resulted in thrombocytopenia, deficient megakaryopoiesis, low hematopoietic stem cell (HSC) number and function, and attenuated responses to myelosuppression. We further show that in models of myeloproliferative neoplasms (MPN), where Mpl is required for pathogenesis, thrombocytosis was dependent on intact Mpl-Y599. In contrast, Mpl-Y565 was required for negative regulation of Tpo responses; mutation of this residue resulted in excess megakaryopoiesis at steady-state and in response to myelosuppression, and exacerbated thrombocytosis associated with MPN. (Figure presented.)
Recommendations for uniform terminology in animal-assisted services (AAS)
No full textThrough the years, the range of services involving animals benefiting people, often described as “animal-assisted interventions” (AAIs), has been plagued with confusing and inconsistent taxonomy, terminology, and definitions. This has caused difficulties for the delineation of roles of service providers, for the recipients of services, as well as for the preparation, training, and expectations of the animals that work in different roles. It can be argued that these difficulties have compromised the development of the field in terms of establishing agreed standards of practice, qualifications, and competencies and adopting good animal welfare practices. It has also likely limited the base of evidence, as search terms used to access studies are not consistent, and study protocols are difficult to compare, lacking uniformity in terminology. Additionally, the current terminology cannot accommodate the expansion and diversification of programs in recent years, which is likely to continue as the field evolves. Establishing internationally agreed upon uniform taxonomy, terminology, and definitions is crucial to more accurately reflect the key features of different approaches, to define the scope and competencies for different service providers and their animals, to provide transparency about services for recipients, and to ensure the appropriate preparation, training, and support of the animals that work with them.
The recommendations in this article are the result of an international work group that convened over the course of two years. The umbrella term animal-assisted services (AAS) is proposed, defined as services that are facilitated, guided or mediated by a health or human service provider or educator, who works with and maintains the welfare of a specially alongside a specially qualifying animal to provide therapeutic, educational, supportive and/or ameliorative processes aimed at enhancing the well-being of humans. AAS are further categorized into three main areas: treatment, education, and support programs. A recommendation for provider-specific terminology is also suggested. The aim of these proposals is to set clear expectations and boundaries for each specialty of practice, without compromising the richness and diversity of each approach. The adoption of this new umbrella term and its categories is intended to improve clarity for all involved in the receipt and delivery of services, as well as for those who study their effects.</p
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textEstimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. </p
Attenuating Muscle Damage Biomarkers and Muscle Soreness After an Exercise-Induced Muscle Damage with Branched-Chain Amino Acid (BCAA) Supplementation: A Systematic Review and Meta-analysis with Meta-regression
No full textBackground: Branched-chain amino acid (BCAA) supplementation is one of the most popular strategies used by the general population and athletes to reduce muscle soreness and accelerate the recovery process of muscle damage biomarkers after an intense exercise or training session. Objectives: This systematic review and meta-analysis investigated the effects of BCAA supplementation on muscle damage biomarkers and muscle soreness after exercise-induced muscle damage (EIMD). Methods: The systematic literature search for randomized controlled trials was conducted using seven databases, up to September 13th, 2022. The eligibility criteria for selecting studies were as follows: studies performed on healthy active participants, using BCAA at least once, controlled with a placebo or control group, performing resistance or endurance exercises, and followed up at least once post-EIMD. The methodological quality of the studies was assessed using the “SIGN RCT checklist”. Random-effects meta-analyses were processed to compute the standardized mean difference (Hedges’ g). Meta-regression analyses were completed with daily and total dosage and supplementation as continuous moderator variables. Results: Of the 18 studies included in this meta-analysis, 13 were of high quality and five were of acceptable quality. Our results revealed BCAA supplementation elicits a significant effect on reducing creatine kinase (CK) levels immediately (g = − 0.44; p = 0.006) and 72 h (g = − 0.99; p = 0.002), but not 24 h, 48 h, and 96 h post-EIMD. Additionally, a significant effect on delayed onset of muscle soreness (DOMS) was identified at 24 h (g = − 1.34; p < 0.001), 48 h (g = − 1.75; p < 0.001), 72 h (g = − 1.82; p < 0.001), and 96 h (g = − 0.82; p = 0.008), but not immediately post-EIMD. No significant effect was found on lactate dehydrogenase (LDH) levels at any time point. Meta-regression indicated higher daily and total dosages of BCAA, and longer supplementation periods were related to the largest beneficial effects on CK (total dosage and supplementation period) at 48 h, and on DOMS at 24 h (only daily dosage). Conclusion: The overall effects of BCAA supplementation could be considered useful for lowering CK and DOMS after EIMD, but not LDH. The longer supplementation period prior to the EIMD could be more effective for CK and DOMS reduction
Nurse rostering: understanding the current shift work scheduling processes, benefits, limitations, and potential fatigue risks
No full textBackground: Implementing appropriate shift work schedules can help mitigate the risk of sleep impairment and reduce fatigue of healthcare workers, reducing occupational health and safety risks. In Australia, the organisation has a responsibility to make sure all reasonable measures are taken to reduce fatigue of staff. Therefore, it is important to assess what the current rostering processes is for staff responsible for creating the rosters for nurses. Aim: The aims of the project were to understand (1) who creates the rosters and what the process is, (2) what training and knowledge these staff have in establishing rostering schedules that optimise the sleep and wellbeing of staff, and (3) what the benefits and limitations are of current rostering practices. Methods: Findings were generated through semi-structured interviews, using cluster coding to form categories. Twenty four nurses responsible for rostering staff were interviewed from three different sites in Victoria (one metropolitan and two regional/rural hospitals). Data was analysed using selected grounded theory methods with thematic analysis. Results: The common themes that came out of the interviews were that rostering staff were under prepared, unaware of fatigue and safety guidelines and polices from governing bodies and had not received any education or training before taking on the role. The most common rostering style was self-rostering, where staff could submit preferences. However, there were concerns about staff fatigue but were divided as to who should be responsible, with many saying it was up to staff to preference shifts that they could cope with. The final theme was cultural barriers to change. Conclusion: While self-rostering resulted in staff having more freedom and flexibility, shift preferences may be influenced more so by a need to fit with lifestyle rather than to minimise fatigue and increase safety in the workplace. Greater consideration of the impact of shift work schedules on fatigue is required to ensure that the layers of clinical governance in health care organisations minimise the risk of occupation health and safety issues for employees delivering direct patient care
Unmasking the carbon conundrum: How emissions impact stock price crash risk
No full textAbstract: This study examines the influence of carbon risk on stock price crash risk. Using a comprehensive dataset of 3,417 US companies from 2006 to 2021, we provide evidence that carbon risk is significantly linked to a higher crash risk for firms. Moreover, our findings suggest that this positive association is more pronounced during the Democratic presidency and to companies operating in carbon-intensive industries. The main results are consistent after conducting endogeneity and several robustness tests.</p
Access to and effectiveness of clinical supervision for allied health workers: A cross-sectional survey
No full textIntroduction: Clinical supervision supports patient care and health worker wellbeing. However, access to effective clinical supervision is not equitable. We aimed to explore the access and effectiveness of clinical supervision in allied health workers. Methods: A cross-sectional survey design using the Manchester Clinical Supervision Scale (MCSS-26), including open-ended survey responses, to collect data on effectiveness. Multivariable regression was conducted to determine how MCSS-26 scores differed across discipline, work location and setting. Open-ended responses were analysed using content analysis. Results: 1113 workers completed the survey, with 319 (28%) reporting they did not receive supervision; this group were more likely to hold management positions, work in a medical imaging discipline and practice in a regional or rural location. For those who received supervision, MCSS-26 scores significantly differed between disciplines and work settings; psychologists and those practising in private practice settings (i.e. fee-for-service) reported the highest levels of effectiveness. Suggested strategies to enhance effectiveness included the use of alternate supervision models, dedicated time for supervision, and training. Conclusion: Targeted subgroups for improving access include senior staff, medical imaging professionals, and those working across regional and rural settings. Where supervision was least effective, strategies to address behaviours with organisational support may be required