19683 research outputs found
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Symptomology, Outcomes and Risk Factors of Acute Coronary Syndrome Presentations without Cardiac Chest Pain: A Scoping Review
No full textFor patients experiencing acute coronary syndrome, early symptom recognition is paramount; this is challenging without chest pain presentation. The aims of this scoping review were to collate definitions, proportions, symptoms, risk factors and outcomes for presentations without cardiac chest pain. Full-text peer reviewed articles covering acute coronary syndrome symptoms without cardiac chest pain were included. MEDLINE, CINAHL, Scopus and Embase were systematically searched from 2000 to April 2023 with adult and English limiters; 41 articles were selected from 2,954. Dyspnoea was the most reported (n=39) and most prevalent symptom (11.6–72%). Neurological symptoms, fatigue/weakness, nausea/ vomiting, atypical chest pain and diaphoresis were also common. Advancing age appeared independently associated with presentations without cardiac chest pain; however, findings were mixed regarding other risk factors (sex and diabetes). Patients without cardiac chest pain had worse outcomes: increased mortality, morbidity, greater prehospital and intervention delays and suboptimal use of guideline driven care. There is a need for structured data collection, analysis and interpretation.</p
Springs of the Arabian Desert: Hydrogeology and Hydrochemistry of Abu Jir Springs, Central Iraq
No full textThe Arabian Desert is characterised by very low rainfall and high evaporation, yet over 210 springs are on its northeastern edge in central Iraq along the Abu Jir lineament, which represents the western depositional margin of a foreland basin infilled by the floodplain sediments of the Tigris and Euphrates Rivers; there is little evidence of faulting. The springs discharge from gently east-dipping Paleocene–Eocene limestones, either where groundwater flowpaths intersect the ground surface or where groundwater flow is forced to the surface by confining aquitards. Calculated annual recharge to the aquifer system across the Arabian Desert plateau (130–500 million m3) is significant, largely due to rapid infiltration through karst dolines, such that karst porosity is the primary enabler of groundwater recharge. The recharge is enough to maintain flow at the Abu Jir springs, but active management of groundwater extraction for agriculture is required for their long-term sustainability. The hydrochemistry of the springs is determined by evaporation, rainfall composition (high SO4 concentrations are due to the dissolution of wind-blown gypsum in rainfall), and plant uptake of Ca and K (despite the sparse vegetation). Limestone dissolution has relatively little impact; many of the springs are undersaturated with respect to calcite and lack tufa/travertine deposits. The springs at Hit-Kubaysa contain tar and high levels of H2S that probably seeped upwards along subvertical faults from underlying oil reservoirs; this is the only location along the Abu Jir lineament where deep-seated faults penetrate to the surface. The presence of hydrocarbons reduces the Hit-Kubaysa spring water and converts the dissolved SO4 to H2S.</p
Empathic Conversational Agent Platform Designs and Their Evaluation in the Context of Mental Health: Systematic Review
No full textBACKGROUND: The demand for mental health (MH) services in the community continues to exceed supply. At the same time, technological developments make the use of artificial intelligence-empowered conversational agents (CAs) a real possibility to help fill this gap. OBJECTIVE: The objective of this review was to identify existing empathic CA design architectures within the MH care sector and to assess their technical performance in detecting and responding to user emotions in terms of classification accuracy. In addition, the approaches used to evaluate empathic CAs within the MH care sector in terms of their acceptability to users were considered. Finally, this review aimed to identify limitations and future directions for empathic CAs in MH care. METHODS: A systematic literature search was conducted across 6 academic databases to identify journal articles and conference proceedings using search terms covering 3 topics: "conversational agents," "mental health," and "empathy." Only studies discussing CA interventions for the MH care domain were eligible for this review, with both textual and vocal characteristics considered as possible data inputs. Quality was assessed using appropriate risk of bias and quality tools. RESULTS: A total of 19 articles met all inclusion criteria. Most (12/19, 63%) of these empathic CA designs in MH care were machine learning (ML) based, with 26% (5/19) hybrid engines and 11% (2/19) rule-based systems. Among the ML-based CAs, 47% (9/19) used neural networks, with transformer-based architectures being well represented (7/19, 37%). The remaining 16% (3/19) of the ML models were unspecified. Technical assessments of these CAs focused on response accuracies and their ability to recognize, predict, and classify user emotions. While single-engine CAs demonstrated good accuracy, the hybrid engines achieved higher accuracy and provided more nuanced responses. Of the 19 studies, human evaluations were conducted in 16 (84%), with only 5 (26%) focusing directly on the CA's empathic features. All these papers used self-reports for measuring empathy, including single or multiple (scale) ratings or qualitative feedback from in-depth interviews. Only 1 (5%) paper included evaluations by both CA users and experts, adding more value to the process. CONCLUSIONS: The integration of CA design and its evaluation is crucial to produce empathic CAs. Future studies should focus on using a clear definition of empathy and standardized scales for empathy measurement, ideally including expert assessment. In addition, the diversity in measures used for technical assessment and evaluation poses a challenge for comparing CA performances, which future research should also address. However, CAs with good technical and empathic performance are already available to users of MH care services, showing promise for new applications, such as helpline services.</p
Geographical variations in cancer nursing education and practice across Australia: A cross-sectional study
No full textProblem: Patients and health systems rely on a skilled and available cancer nursing workforce to deliver quality nursing care to optimise cancer outcomes. Understanding the education, qualifications, and roles of cancer nurses across Australia is an essential aspect of effective service planning. Aim: To explore the associations between the geographical location of cancer nurses and their education, qualifications, roles, activities, and scope of practice. Methods: A cross-sectional electronic survey was distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The self-report survey captured demographics, education, qualifications, roles, scope of practice, and salary. Descriptive statistics and bivariate analysis were used to summarise and report the findings. Findings: Responses were received from 930 nurses. Most identified as female (94%), lived in metropolitan areas (69%), worked in dedicated cancer centres (79%), and in the public sector (69%). While 80% had more than 10 years of nursing experience and 70% possessed postgraduate qualifications, 58% indicated their intention to remain in the profession for 10 years or less. Roles, pay, education, and activities varied across regions, states, and territories, with regional nurses more likely to be involved in multiple activities and roles compared with their metropolitan counterparts. Conclusion: This study highlights the importance of understanding geographic variations within the cancer nursing workforce to formulate strategies aimed at enhancing workforce sustainability and, consequently, patient outcomes. Addressing disparities in education and opportunities for career advancement is crucial to ensuring equitable access to quality cancer care nationwide.</p
Changing the focus: Facilitating engagement in physical activity for people living with mild dementia in a local community—Protocol for a pre-post mixed methods feasibility study
No full textThis study aims to address and improve the low physical activity levels among people with mild dementia by implementing a novel shared decision-making and motivational support program, named "Changing the Focus". It will utilise a pre-post mixed methods approach, aiming to recruit 60 community living older people with mild dementia and their care-partners. The shared decision-making process will involve the person living with dementia, their care-partner, and a research therapist, using a purpose-designed discussion tool including factors such as preferred physical activities, health status, local opportunities and program accessibility. This process aims to identify personalised local physical activity opportunities. Participants will be supported with the help of a research therapist to engage in targeted community-based physical activities for 12-months, to progress towards the recommended physical activity guidelines of 150 minutes per week. The intervention provided by the research therapist will include three home visits (baseline, 6- and 12-months) and seven motivational support phone calls (within the first six months). Research therapists may provide additional home visits and support calls as needed. Primary outcomes include program participation (participants living with dementia continuing with the program after 12-months), total physical activity time per week (measured using the Active Australia Survey at baseline, 6- and 12- months) and program acceptability (assessed through semi-structured interviews with participants, care-partners, referrers, and physical activity providers). Secondary outcomes include physical performance, mental health, wellbeing measures, and impact on care-partners (evaluated through physical tests or validated scales at baseline, 6- and 12-months). Other implementation aspects include reach, maintenance, safety (falls, other adverse events) and an economic evaluation. Results will inform feasibility, potential benefits, and challenges associated with this innovative shared decision-making and supported physical activity program for people living with mild dementia. Findings will guide future large-scale studies and contribute to enhancing physical activity opportunities for this population
Gold nugget formation from earthquake-induced piezoelectricity in quartz
No full textNo description supplie
Two thirds of patients may not need routine 12-month specialist review in an epilepsy clinic: A cross-sectional study of clinic appointments
No full textObjectives: Timely access to specialist outpatient clinics can be difficult to achieve as outpatient services are often oversubscribed leading to unacceptable wait times. New patients, or those with emergent issues may wait for appointments whilst existing patients are booked in for routine reviews “just in case” there is a problem, using considerable clinic resources. We investigated routine 12-month review appointments to assess whether these appointments changed patient management. Methods: The medical records of 100 randomly selected adult patients attending annual review appointments over 12 months at a publicly-funded specialist outpatient epilepsy clinic in Melbourne, Australia were audited. Demographic and clinical data as well as information about the content of each appointment were analysed to determine whether the appointment resulted in changes to epilepsy management (eg medication change), administrative actions (eg drivers license approval) or the provision of information or education. Logistic regression was performed to assess what clinical factors were associated with changes in patient care arising from the 12-month review appointment. Results: Almost half (47%) of appointments resulted in no change to patient care and 37% had only administrative outcomes, such as the completion of a regulatory driving report. Only 16% of appointments resulted in a change in medical management. The only factor that independently predicted a change in medical management was the occurrence of a seizure in the previous year. The only factor independently associated with not having any change in medical management or administrative action was having an unknown seizure type. Conclusions/ significance: Only a small number of patients experience a change in medical management when attending a 12-month epilepsy clinic appointment, with a need for management change associated with the presence of ongoing seizure. Outpatient services should limit the use of routine annual follow up to those patients most likely to need intervention or support, creating “just in time” capacity for timely access to review as issues arise
An ecological systems model of employee experience in industry-led autism employment programmes
No full textIndustry-led employment programmes have emerged to transition autistic people into employment and meet industry labour needs. However, theoretical research is limited in this area, often failing to appreciate the influence of the broader employment ecosystem. In this study, we interviewed 33 autistic employees (n = 29 males, Mage = 29.00 years) from two industry-led employment programmes regarding their experience of the programme’s supports, relationships and impact. We used qualitative content analysis to identify five themes: (1) working involves multiple job tasks that evolve as the employment context changes; (2) workplace relations are diverse and shaped by the type of work and the work environment; (3) workplace needs evolve as autistic individuals navigate the work environment; (4) developing a professional identity in the workplace through mastery and integration; and (5) recommendations for the development of supportive workplace environments for autistic individuals. We describe the way that factors within (e.g. training) and outside the two employment programmes changed and interacted over time to contribute to the participant’s work experience and professional identity. Building on ecological systems theory, our unique contribution to the literature is a new model capturing individual and workplace factors that contribute to the work experience of autistic people who participate in industry employment programmes. </p
Does annual report readability influence the design of SEOs?
No full textMotivated by the rapid growth in non-quantitative corporate disclosure and seasoned equity offerings (SEOs) in the U.S., we take a fresh look at the decision-making process behind accelerated offerings in SEOs, with a specific emphasis on the readability of annual reports within 10-K filings. In particular, our study explores whether readability of annual reports affects the choice of SEOs methods. Using a hand-collected sample of 3143 instances of seasoned equity issues between 2002 and 2021, we show a significantly positive relation between readability scores and accelerated offerings. These results hold across various robustness tests. We further reveal a negative relationship between abnormal operating performance and long-term stock performance following the announcements of SEOs, demonstrating that: firstly, SEOs provide valuable insights into future earnings; and secondly, these insights have a lasting impact on stock performance. Overall, our evidence strongly highlights the substantial influence of annual report readability on the design of SEOs, emphasizing the critical importance of conveying financial information concisely and effectively to the market.</p
How contraflow enhances clearance time during assisted mass evacuation – A case study exploring the Australian 2013–14 Gippsland bushfires
No full textEvacuation during a catastrophic disaster is a crucial operation that needs to be appropriately managed and is of more importance when considering the elderly and people with disabilities. The uncertain and unpredictable nature of disasters can cause long-term repercussions, especially in traffic congestion. This study presents a mathematical model to formulate traffic balance for regular and assisted evacuation (that is, disabled and the elderly) whilst considering traffic congestion in evacuation clearance time by applying contraflow. A Branch and Price (B&P) related approach is developed to help solve the proposed model in large-size problems. The presented algorithm is applied to a case study of Australia's 2013–14 bushfires in Gippsland, located in the eastern part of Victoria. A variation test is performed to evaluate the robustness of results generated by the developed model. Results indicate that the participation percentage of edges is different based on their location, capacity, and sustainability of blockage. The edges’ capacity influences the evacuated population most compared to route capacity and time window. The output of this approach enables authorities to improve the resilience of communities by making optimal strategic and operational decisions for enhancing an evacuation response as well as influencing appropriate policies.</p