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The overarching cultural context of the brain injury survivor, particularly that related to minority peoples with a history of colonisation and discrimination, has rarely been referred to in the research literature, despite profoundly influencing a person’s recovery journey in significant ways, including access to services. This study highlights issues faced by Australian Aboriginal traumatic brain injury (TBI) survivors in terms of real-life consequences of the high incidence of TBI in this population, current treatment and long-term challenges.
A case study approach utilised qualitative interview and file review data related to five male Aboriginal TBI survivors diagnosed with acquired communication disorders. The five TBI survivors were from diverse areas of rural and remote Western Australia, aged between 19 and 48 years at the time of injury, with a range of severity.
Common themes included: significant long-term life changes; short-term and long-term dislocation from family and country as medical intervention and rehabilitation were undertaken away from the person’s rural/remote home; family adjustments to the TBI including permanent re-location to a metropolitan area to be with their family member in residential care; challenges related to lack of formal rehabilitation services in rural areas; poor communication channels; poor cultural security of services; and lack of consistent follow-up.
Discussion and Conclusion:
These case reports represent some of the first documented stories of Aboriginal Australian TBI survivors. They supplement available epidemiological data and highlight different contexts for Aboriginal people after TBI, contributing to an overall profile that is relevant for rehabilitation service planning.
Patients with chronic obstructive pulmonary disease (COPD) who experience acute exacerbations usually require treatment with oral steroids or antibiotics, depending on the etiology of the exacerbation. Current management is based on clinician's assessment and judgement, which lacks diagnostic accuracy and results in overtreatment. A test to guide these decisions in primary care is in development. We developed an early decision model to evaluate the cost-effectiveness of this treatment stratification test in the primary care setting in the United Kingdom.
A combined decision tree and Markov model was developed of COPD progression and the exacerbation care pathway. Sensitivity analysis was carried out to guide technology development and inform evidence generation requirements.
The base case test strategy cost GBP 423 (USD 542) less and resulted in a health gain of 0.15 quality-adjusted life-years per patient compared with not testing. Testing reduced antibiotic prescriptions by 30 percent, potentially lowering the risk of antimicrobial resistance developing. In sensitivity analysis, the result depended on the clinical effects of treating patients according to the test result, as opposed to treating according to clinical judgement alone, for which there is limited evidence. The results were less sensitive to the accuracy of the test.
Testing may be cost-saving in primary care, but this requires robust evidence on whether test-guided treatment is effective. High quality evidence on the clinical utility of testing is required for early modeling of diagnostic tests generally.
Evidence regarding the seasonality of urinary tract infection (UTI) consultations in primary care is conflicting and methodologically poor. To our knowledge, this is the first study to determine whether this seasonality exists in the UK, identify the peak months and describe seasonality by age. The monthly number of UTI consultations (N = 992 803) and nitrofurantoin and trimethoprim prescriptions (N = 1 719 416) during 2008–2015 was extracted from The Health Improvement Network (THIN), a large nationally representative UK dataset of electronic patient records. Negative binomial regression models were fitted to these data to investigate seasonal fluctuations by age group (14–17, 18–24, 25–45, 46–69, 70–84, 85+) and by sex, accounting for a change in the rate of UTI over the study period. A September to November peak in UTI consultation incidence was observed for ages 14–69. This seasonality progressively faded in older age groups and no seasonality was found in individuals aged 85+, in whom UTIs were most common. UTIs were rare in males but followed a similar seasonal pattern than in females. We show strong evidence of an autumnal seasonality for UTIs in individuals under 70 years of age and a lack of seasonality in the very old. These findings should provide helpful information when interpreting surveillance reports and the results of interventions against UTI.
(1) To systematically search for all dynamic mathematical models of infectious disease transmission in long-term care facilities (LTCFs); (2) to critically evaluate models of interventions against antimicrobial resistance (AMR) in this setting; and (3) to develop a checklist for hospital epidemiologists and policy makers by which to distinguish good quality models of AMR in LTCFs.
The CINAHL, EMBASE, Global Health, MEDLINE, and Scopus databases were systematically searched for studies of dynamic mathematical models set in LTCFs. Models of interventions targeting methicillin-resistant Staphylococcus aureus in LTCFs were critically assessed. Using this analysis, we developed a checklist for good quality mathematical models of AMR in LTCFs.
RESULTS AND DISCUSSION
Overall, 18 papers described mathematical models that characterized the spread of infectious diseases in LTCFs, but no models of AMR in gram-negative bacteria in this setting were described. Future models of AMR in LTCFs require a more robust methodology (ie, formal model fitting to data and validation), greater transparency regarding model assumptions, setting-specific data, realistic and current setting-specific parameters, and inclusion of movement dynamics between LTCFs and hospitals.
Mathematical models of AMR in gram-negative bacteria in the LTCF setting, where these bacteria are increasingly becoming prevalent, are needed to help guide infection prevention and control. Improvements are required to develop outputs of sufficient quality to help guide interventions and policy in the future. We suggest a checklist of criteria to be used as a practical guide to determine whether a model is robust enough to test policy.
Many adults with autism spectrum disorder (ASD) remain undiagnosed. Specialist assessment clinics enable the detection of these cases, but such services are often overstretched. It has been proposed that unnecessary referrals to these services could be reduced by prioritizing individuals who score highly on the Autism-Spectrum Quotient (AQ), a self-report questionnaire measure of autistic traits. However, the ability of the AQ to predict who will go on to receive a diagnosis of ASD in adults is unclear.
We studied 476 adults, seen consecutively at a national ASD diagnostic referral service for suspected ASD. We tested AQ scores as predictors of ASD diagnosis made by expert clinicians according to International Classification of Diseases (ICD)-10 criteria, informed by the Autism Diagnostic Observation Schedule-Generic (ADOS-G) and Autism Diagnostic Interview-Revised (ADI-R) assessments.
Of the participants, 73% received a clinical diagnosis of ASD. Self-report AQ scores did not significantly predict receipt of a diagnosis. While AQ scores provided high sensitivity of 0.77 [95% confidence interval (CI) 0.72–0.82] and positive predictive value of 0.76 (95% CI 0.70–0.80), the specificity of 0.29 (95% CI 0.20–0.38) and negative predictive value of 0.36 (95% CI 0.22–0.40) were low. Thus, 64% of those who scored below the AQ cut-off were ‘false negatives’ who did in fact have ASD. Co-morbidity data revealed that generalized anxiety disorder may ‘mimic’ ASD and inflate AQ scores, leading to false positives.
The AQ's utility for screening referrals was limited in this sample. Recommendations supporting the AQ's role in the assessment of adult ASD, e.g. UK NICE guidelines, may need to be reconsidered.
The Cornell High-order Adaptive Optics Survey for brown dwarfs (CHAOS), currently about 90% complete, uses the Palomar Hale Telescope's adaptive optics system to survey 80 bright stars out to 13 parsecs. Using the telescope's AO Science camera, brown dwarf companions 4–200 AU can be identified using coronagraphic imaging and spectroscopic modes. We will be using monte carlo simulations to create population models consistent with the CHAOS data set.
Currently, we have observed 70 systems out of a target sample of 80. Five candidate companions await follow-up observations. As of now, no systems in the target sample have shown strong evidence of having brown dwarf companions. These early results support previous speculations of a “brown dwarf desert” at orbital separations out to 200 AU.
While the target sources revealed no evidence of brown dwarf companions, accompanying observations of calibration stars provided evidence of an early methane dwarf candidate around the binary system HD150451AB. Forty seven parsecs from earth, the candidate indicated a projected orbital separation of 280 AU.
An enigma of deep-sea biodiversity research is that the abyss with its low productivity and densities appears to have a biodiversity similar to that of shallower depths. This conceptualization of similarity is based mainly on per-sample estimates (point diversity, within-habitat, or α-diversity). Here, we use a measure of between-sample within-community diversity (β1H) to examine benthic foraminiferal diversity between 333 stations within 49 communties from New Zealand, the South Atlantic, the Gulf of Mexico, the Norwegian Sea, and the Arctic. The communities are grouped into two depth categories: 200–1500 m and >1500 m. β1H diversity exhibits no evidence of regional differences. Instead, higher values at shallower depths are observed worldwide. At depths of >1500 m the average β1H is zero, indicating stasis or no biodiversity gradient. The difference in β1H-diversity explains why, despite species richness often being greater per sample at deeper depths, the total number of species is greater at shallower depths. The greater number of communities and higher rate of evolution resulting in shorter species durations at shallower depths is also consistent with higher β1H values.
While more and more long-period giant planets are discovered by direct imaging, the distribution of planets at these separations (≳5 AU) has remained largely uncertain, especially compared to planets in the inner regions of solar systems probed by RV and transit techniques. The low frequency, the detection challenges, and heterogeneous samples make determining the mass and orbit distributions of directly imaged planets at the end of a survey difficult. By utilizing Monte Carlo methods that incorporate the age, distance, and spectral type of each target, we can use all stars in the survey, not just those with detected planets, to learn about the underlying population. We have produced upper limits and direct measurements of the frequency of these planets with the most recent generation of direct imaging surveys. The Gemini NICI Planet-Finding Campaign observed 220 young, nearby stars at a median H-band contrast of 14.5 magnitudes at 1”, representing the largest, deepest search for exoplanets by the completion of the survey. The Gemini Planet Imager Exoplanet Survey is in the process of surveying 600 stars, pushing these contrasts to a few tenths of an arcsecond from the star. With the advent of large surveys (many hundreds of stars) using advanced planet-imagers we gain the ability to move beyond measuring the frequency of wide-separation giant planets and to simultaneously determine the distribution as a function of planet mass, semi-major axis, and stellar mass, and so directly test models of planet formation and evolution.
Background: Aboriginal and Torres Strait Islander Australians experience stroke and traumatic brain injury (TBI) with much greater frequency than non-Aboriginal Australians. Acquired communication disorders (ACD) can result from these conditions and can significantly impact everyday life. Yet few Aboriginal people access rehabilitation services and little is known about Aboriginal peoples’ experiences of ACD. This paper describes the protocol surrounding a study that aims to explore the extent and impact of ACD in Western Australian Aboriginal populations following stroke or TBI and develop a culturally appropriate screening tool for ACD and accessible and culturally appropriate service delivery models.
Method/Design: The 3-year, mixed methods study is being conducted in metropolitan Perth and five regional centres in Western Australia. Situated within an Aboriginal research framework, methods include an analysis of linked routine hospital admission data and retrospective file audits, development of a screening tool for ACD, interviews with people with ACD, their families, and health professionals, and drafting of alternative service delivery models.
Discussion: This study will address the extent of ACD in Aboriginal populations and document challenges for Aboriginal people in accessing speech pathology services. Documenting the burden and impact of ACD within a culturally secure framework is a forerunner to developing better ways to address the problems faced by Aboriginal people with ACD and their families. This will in turn increase the likelihood that Aboriginal people with ACD will be diagnosed and referred to professional support to improve their communication, quality of life and functioning within the family and community context.
In England, hospital admissions for severe staphylococcal boils and abscesses trebled between 1989 and 2004. We investigated this trend using routine data from primary and secondary care. We used The Health Improvement Network (THIN), a large primary-care database and national data on hospital admissions from Hospital Episode Statistics (HES). Time trends in the incidence of primary-care consultations for boils and abscesses were estimated for 1995–2010. HES data were used to calculate age-standardized hospital admission rates for boils, abscesses and cellulitis. The incidence of boil or abscess was 450 [95% confidence interval (CI) 447–452] per 100 000 person-years and increased slightly over the study period (incidence rate ratio 1·005, 95% CI 1·004–1·007). The rate of repeat consultation for a boil or abscess increased from 66 (95% CI 59–73) per 100 000 person-years in 1995 to peak at 97 (95% CI 94–101) per 100 000 person-years in 2006, remaining stable thereafter. Hospital admissions for abscesses, carbuncles, furuncles and cellulitis almost doubled, from 123 admissions per 100 000 in 1998/1999 to 236 admissions per 100 000 in 2010/2011. Rising hospitalization and recurrence rates set against a background of stable community incidence suggests increased disease severity. Patients may be experiencing more severe and recurrent staphylococcal skin disease with limited treatment options.
Ramalina celastri is a highly variable, widely distributed pan-subtropical lichen species. In Australasia the species had been separated into two subspecies; R. celastri subsp. celastri and R. celastri subsp. ovalis. This study compares morphological variation, substratum preference and sequences of the internal transcribed spacer (ITS) and intergenic spacer (IGS) regions of ribosomal DNA from a range of specimens from New Zealand and one from Australia. Bayesian and ML trees generated using the sequence data form two well-supported clades corresponding to the two previously recognized subspecies. Molecular, morphological and geographical differences support the recognition of R. ovalis at the species rank.
Attention deficit hyperactivity disorder (ADHD) often, but not always, persists into adulthood. Investigations of the associations between clinical and biological markers of persistence can shed light on causal pathways. It has been proposed that compensatory improvements in executive neuropsychological functioning are associated with clinical improvements. This is the first study to test this hypothesis prospectively.
The clinical and neuropsychological functioning of 17 boys with ADHD (mean age 10.45 years at time 1; 14.65 years at time 2) and 17 typically developing (TYP) boys (mean age 10.39 years at time 1; 14.47 years at time 2) was tested on two occasions, 4 years apart. This was done using a battery of standardized neuropsychological tests that included tasks with high and low executive demands.
Clinical improvements were observed over time. Neuropsychological performance improvements were also evident, with ADHD boys developing with a similar pattern to TYP boys, but with a developmental lag. Whilst there was an association between reduced symptoms and superior performance at retest for one task with a high executive demand (spatial working memory), this was not seen with two further high executive demand tasks [Stockings of Cambridge and intra-dimensional extra-dimensional (ID/ED) set shifting]. Also, there was no association between change in executive functioning and change in symptoms. Baseline performance on the ID/ED set-shifting task predicted better clinical outcome. Only change in performance on the low executive demand delayed matching-to-sample task predicted better clinical outcome.
These data highlight the importance of longitudinal measurements of cognition, symptoms and treatment response over time in children and adolescents with ADHD.
We have carried out high contrast imaging of 70 young, nearby B and A stars to search for brown dwarf and planetary companions as part of the Gemini NICI Planet-Finding Campaign. Our survey represents the largest, deepest survey for planets around high-mass stars (≈1.5–2.5 M⊙) conducted to date and includes the planet hosts β Pic and Fomalhaut. Despite detecting two new brown dwarfs, our observations did not detect new planets around our target stars, and we present upper limits on the fraction of high-mass stars that can host giant planets that are consistent with our null result.
Using a hybrid computational approach, we introduce A-like nanorods into a phaseseparating AB blend, which has 45/55 composition. In the absence of the rods, the minority A phase forms droplets in the matrix of B. With the addition of N = 670 rods that interact solely through a short range repulsive interaction (mimicking the steric stabilization provided by a coating of A ligands), the mixture retains this droplet morphology. When, however, we add an effective attraction between the sterically stabilized rods, the nanoparticles form extensive networks in the A phase, which can form a continuous phase. In addition to altering the morphology of the mixture, the attractive interaction influences the rate of domain growth. In particular, at early times, the mutually attractive rods increase the growth rate of the domains in the early stage. At late times, the domain growth crosses over to a slow growth regime. Our findings demonstrate that the morphology and coarsening of a rod-filled blend can be controlled by varying the rod-rod interaction and hence, provides guidelines for tailoring the electrical and mechanical properties of the nanocomposites.
An evolving hypothesis postulates that melanomas may arise through ‘nevus-associated’ and ‘chronic sun exposure’ pathways. We explored this hypothesis by examining associations between nevus-associated loci and melanoma risk across strata of body site and histological subtype. We genotyped 1028 invasive case patients and 1469 controls for variants in methylthioadenosine phosphorylase (MTAP), phospholipase A2, group VI (PLA2G6), and Interferon regulatory factor 4 (IRF4), and compared allelic frequencies globally and by anatomical site and histological subtype of melanoma. Odds-ratios (ORs) and 95% confidence intervals (CIs) were calculated using classical and multinomial logistic regression models. Among controls, MTAP rs10757257, PLA2G6 rs132985 and IRF4 rs12203592 were the variants most significantly associated with number of nevi. In adjusted models, a significant association was found between MTAP rs10757257 and overall melanoma risk (OR = 1.32, 95% CI = 1.14–1.53), with no evidence of heterogeneity across sites (Phomogeneity =.52). In contrast, MTAP rs10757257 was associated with superficial spreading/nodular melanoma (OR = 1.34, 95% CI = 1.15– 1.57), but not with lentigo maligna melanoma (OR = 0.79, 95% CI = 0.46–1.35) (Phomogeneity =.06), the subtype associated with chronic sun exposure. Melanoma was significantly inversely associated with rs12203592 in children (OR = 0.35, 95% CI = 0.16–0.77) and adolescents (OR = 0.61, 95% CI = 0.42–0.91), but not in adults (Phomogeneity =.0008). Our results suggest that the relationship between MTAP and melanoma is subtype-specific, and that the association between IRF4 and melanoma is more evident for cases with a younger age at onset. These findings lend some support to the ‘divergent pathways’ hypothesis and may provide at least one candidate gene underlying this model. Further studies are warranted to confirm these findings and improve our understanding of these relationships.