The prevalence of dementia is predicted to increase significantly as the population ages and with no foreseeable cure options the burden of dementia will continue to grow. Early diagnosis provides many benefits, inclu...The prevalence of dementia is predicted to increase significantly as the population ages and with no foreseeable cure options the burden of dementia will continue to grow. Early diagnosis provides many benefits, including timely access to appropriate support services and provision of tailored therapeutic interventions for people with dementia and their carers. Memory clinics are a key response to the need for specialist assessment and diagnosis of dementia. Multidisciplinary team memory clinics are considered the “gold standard”;however, such resource intensive clinics are likely unsustainable. The nurse-led memory clinic format may provide a primary care focused, diagnostic service for dementia that does not have the cost implications of multidisciplinary memory clinics but there is limited research using nurse practitioners. This study is exploring the potential of a nurse-led memory clinic as a primary health care approach to health promotion (brain health awareness), disease prevention (risk factor reduction) and early intervention (diagnosis and management of dementia). A realistic evaluation of a nurse practitioner-led memory clinic is described. Realistic evaluation is concerned not only with the outcomes of an intervention but also with the context and mechanisms of the intervention. We are using a mixed methods case study design to describe and evaluate the impact of the nurse practitioner-led memory clinic. The nurse practitioner in this study is an advanced practice aged care nurse who focuses on mental health, and dementia diagnosis, management and risk factor reduction. This study seeks to inform the development of an expanded scope role for nurse practitioners in assessment and referrals for dementia diagnosis. The heterogeneity of clients attending the nurse-led memory clinic will allow us to evaluate what works in the memory clinic, for whom, and under what circumstances, in what respects, and to what extent.展开更多
Objective: To describe patterns of preterm birth and low birth weight (LBW) for infants born after assisted reproductive technology (ART) and determine whether these were associated with maternal or treatment characte...Objective: To describe patterns of preterm birth and low birth weight (LBW) for infants born after assisted reproductive technology (ART) and determine whether these were associated with maternal or treatment characteristics. Design: Retrospective cohort study of national population data of infants conceived through ART. Setting: Australian birth records from 1996 to 2000. Patient(s): Eighteen thousand, four hundred twenty- nine liveborn and stillborn infants conceived through ART. Intervention(s): In vitro fertilization, intracytoplasmic sperm injection, and gamete intrafallopian transfer. Main Outcome Measure(s): Preterm birth and LBW. Result(s): Preterm birth and LBW were more common among singletons and twins conceived with IVF and born to nulliparous mothers. Preterm birth and LBW were, respectively, 1.3 times and 1.5 times more likely to occur among singletons conceived by transfer of fresh embryos, compared with transfer of frozen embryos. Preterm birth and LBW was more common among couples who had female- factor infertility compared with male- factor infertility. Conclusion(s): The transfer of fresh embryos and female- factor infertility were independently associated with preterm birth and LBW for both singletons and twins after ART.展开更多
OBJECTIVE: To estimate the pattern of maternal vascular reactivity in normal a nd high-risk pregnancies using postocclusion brachial artery diameter. METHODS: Prospective, longitudinal study of 44 low-risk singleton p...OBJECTIVE: To estimate the pattern of maternal vascular reactivity in normal a nd high-risk pregnancies using postocclusion brachial artery diameter. METHODS: Prospective, longitudinal study of 44 low-risk singleton pregnancies and 28 hi gh-risk pregnancies, defined as pregestational diabetes (n = 7), chronic hypert ension (n = 4), twin gestation (n = 6), and a previous history of preeclampsia, fetal growth restriction, or vascular disease (n = 11). During each trimester, t he brachial artery was ultrasonographically imaged above the antecubital crease. Brachial artery diameter was measured and then occluded for 5 minutes using an inflated blood pressure cuff. Changes in brachial artery diameter at 1 minute af ter occlusion were expressed as percent change from baseline and were compared a cross trimesters for both low-risk and high-risk groups, adjusting for potenti al confounders. RESULTS: Brachial artery diameters were increased after occlusio n in every trimester for all groups. For low-risk women, the degree of postoccl usion brachial artery dilatation was similar in the first and second trimesters, but was lower in the third trimester. In the first trimester, low-risk women h ad significantly greater brachial artery diameter increases at 1 minute compared with high-risk singleton pregnancies (19%compared with 12%; P < .001). Compa red with low-risk women, pregnancies complicated by pregestational diabetes or chronic hypertension had significantly smaller 1-minute brachial artery diamete r changes in the first trimester (7.0 ±0.5%, P < .001), whereas twin gestation s had greater brachial artery responses (22.9 ±6.0%, P < .001). Women with pre vious preeclampsia or vascular disease had responses similar to low-risk women. CONCLUSION: Maternal vascular reactivity as assessed by postocclusion brachial artery dilatation decreases in the third trimester in both low-risk and high-r isk women. In addition, singleton pregnancies at high risk for preeclampsia disp lay decreased brachial artery reactivity compared with low-risk women.展开更多
AIM To determine if exacerbation of pre-existing chronic colitis in Winnie(Muc2 mutant) mice induces colonic dysplasia.METHODS Winnie mice and C57BL6 as a genotype control, were administered 1% w/v dextran sulphate so...AIM To determine if exacerbation of pre-existing chronic colitis in Winnie(Muc2 mutant) mice induces colonic dysplasia.METHODS Winnie mice and C57BL6 as a genotype control, were administered 1% w/v dextran sulphate sodium(DSS) orally, followed by drinking water alone in weeklong cycles for a total of three cycles. After the third cycle, mice were killed and colonic tissue collected for histological and immunohistochemical evaluation. Inflammation and severity of dysplasia in the colonic mucosa were assessed in H&E sections of the colon. Epithelial cell proliferation was assessed using Ki67 and aberrant β-catenin signalling assessed with enzyme-based immunohistochemistry. Extracted RNA from colonic segments was used for the analysis of gene expression using real-time quantitative PCR. Finally, the distribution of Cxcl5 was visualised using immunohistochemistry.RESULTS Compared to controls, Winnie mice exposed to three cycles of DSS displayed inflammation mostly confined to the distal-mid colon with extensive mucosal hyperplasia and regenerative atypia resembling epithelial dysplasia. Dysplasia-like changes were observed in 100% of Winnie mice exposed to DSS, with 55% of these animals displaying changes similar to high-grade dysplasia, whereas high-grade changes were absent in wild-type mice. Occasional penetration of the muscularis mucosae by atypical crypts was observed in 27% of Winnie mice after DSS. Atypical crypts however displayed no evidence of oncogenic nuclear β-catenin accumulation, regardless of histological severity. Expression of Cav1, Trp53 was differentially regulated in the distal colon of Winnie relative to wild-type mice. Expression of Myc and Ccl5 was increased by DSS treatment in Winnie only. Furthermore, increased Ccl5 expression correlated with increased complexity in abnormal crypts. While no overall difference in Cxcl5 mucosal expression was observed between treatment groups, epithelial Cxcl5 protein appeared to be diminished in the atypical epithelium. CONCLUSION Alterations to the expression of Cav1, Ccl5, Myc and Trp53 in the chronically inflamed Winnie colon may influence the transition to dysplasia.展开更多
This is a consumer-reference feedback and feasibility testing of a protocol to obtain qualitative responses of co-residing caregivers to questions regarding the timing of dementia diagnosis and their experience of the...This is a consumer-reference feedback and feasibility testing of a protocol to obtain qualitative responses of co-residing caregivers to questions regarding the timing of dementia diagnosis and their experience of the disclosure of a diagnosis of dementia. Data collection involved focus group discussions and individual phone interviews of a convenience sample (N = 5) of an Alzheimer’s Australia state based Consumer Advisory Committee. Thematic analysis utilised the Leximancer software. Consumer feedback suggested a reordering of the interview questions and reversing the data collection sequence to reduce the emotional impact on participants. Suggestions were offered to limit the number of participants in the focus group to shorten the duration of the focus group session to prevent fatigue and to provide a support person to improve participant focus group comfort. Responses to the interview questions indicated caregivers retrospectively considered a timely diagnosis would have provided useful dementia-focused planning, reduced the difficulties of living with uncertainty and would have provided more time to obtain information and support. There were strong expectations for medical practitioners to be sensitive to the possibility of dementia and to be cognisant of the diagnostic concerns of caregivers. The diagnosis of dementia and its timing is important to the dementia caregiver in providing an explanation of the problems experienced and allowing earlier organisation of care, future planning and caregiver education to reduce the difficulties of living with undiagnosed and unrecognised dementia.展开更多
There is growing interest in the role that apex predators play in shaping terrestrial ecosystems and maintaining tro- phic cascades. In line with the mesopredator release hypothesis, Australian dingoes (Canis lupus d...There is growing interest in the role that apex predators play in shaping terrestrial ecosystems and maintaining tro- phic cascades. In line with the mesopredator release hypothesis, Australian dingoes (Canis lupus dingo and hybrids) are assumed by many to regulate the abundance of invasive mesopredators, such as red foxes Vulpes vulpes and feral cats Fells catus, thereby providing indirect benefits to various threatened vertebrates. Several recent papers have claimed to provide evidence for the bio- diversity benefits of dingoes in this way. Nevertheless, in this paper we highlight several critical weaknesses in the methodologi- cal approaches used in many of these reports, including lack of consideration for seasonal and habitat differences in activity, the complication of simple track-based indices by incorporating difficult-to-meet assumptions, and a reduction in sensitivity for as-sessing populations by using binary measures rather than potentially continuous measures. Of the 20 studies reviewed, 15 of them (75%) contained serious methodological flaws, which may partly explain the inconclusive nature of the literature investigating interactions between invasive Australian predators. We therefore assert that most of the "growing body of evidence" for meso- predator release is merely an inconclusive growing body of literature only. We encourage those interested in studying the eco- logical roles of dingoes relative to invasive mesopredators and native prey species to account for the factors we identify, and cau- tion the value of studies that have not done so [Current Zoology 57 (5): 568-583, 2011].展开更多
We propose a scheme to construct predictive models for Hamiltonian matrices in atomic orbital representation from ab initio data as a function of atomic and bond environments.The scheme goes beyond conventional tight ...We propose a scheme to construct predictive models for Hamiltonian matrices in atomic orbital representation from ab initio data as a function of atomic and bond environments.The scheme goes beyond conventional tight binding descriptions as it represents the ab initio model to full order,rather than in two-centre or three-centre approximations.We achieve this by introducing an extension to the atomic cluster expansion(ACE)descriptor that represents Hamiltonian matrix blocks that transform equivariantly with respect to the full rotation group.The approach produces analytical linear models for the Hamiltonian and overlap matrices.Through an application to aluminium,we demonstrate that it is possible to train models from a handful of structures computed with density functional theory,and apply them to produce accurate predictions for the electronic structure.The model generalises well and is able to predict defects accurately from only bulk training data.展开更多
The studies of Allen (2011) and Allen et al. (2011) recently examined the methodology underpinning claims that dingoes provide net benefits to biodiversity by suppressing foxes and cats. They found most studies to...The studies of Allen (2011) and Allen et al. (2011) recently examined the methodology underpinning claims that dingoes provide net benefits to biodiversity by suppressing foxes and cats. They found most studies to have design flaws and/or observational methods that preclude valid interpretations from the data, describing most of the current literature as 'wild dogma'. In this short supplement, we briefly highlight the roles and implications of wild dogma for wild dog management in Australia. We discuss nomenclature, and the influence that unreliable science can have on policy and practice changes related to apex predator management展开更多
文摘The prevalence of dementia is predicted to increase significantly as the population ages and with no foreseeable cure options the burden of dementia will continue to grow. Early diagnosis provides many benefits, including timely access to appropriate support services and provision of tailored therapeutic interventions for people with dementia and their carers. Memory clinics are a key response to the need for specialist assessment and diagnosis of dementia. Multidisciplinary team memory clinics are considered the “gold standard”;however, such resource intensive clinics are likely unsustainable. The nurse-led memory clinic format may provide a primary care focused, diagnostic service for dementia that does not have the cost implications of multidisciplinary memory clinics but there is limited research using nurse practitioners. This study is exploring the potential of a nurse-led memory clinic as a primary health care approach to health promotion (brain health awareness), disease prevention (risk factor reduction) and early intervention (diagnosis and management of dementia). A realistic evaluation of a nurse practitioner-led memory clinic is described. Realistic evaluation is concerned not only with the outcomes of an intervention but also with the context and mechanisms of the intervention. We are using a mixed methods case study design to describe and evaluate the impact of the nurse practitioner-led memory clinic. The nurse practitioner in this study is an advanced practice aged care nurse who focuses on mental health, and dementia diagnosis, management and risk factor reduction. This study seeks to inform the development of an expanded scope role for nurse practitioners in assessment and referrals for dementia diagnosis. The heterogeneity of clients attending the nurse-led memory clinic will allow us to evaluate what works in the memory clinic, for whom, and under what circumstances, in what respects, and to what extent.
文摘Objective: To describe patterns of preterm birth and low birth weight (LBW) for infants born after assisted reproductive technology (ART) and determine whether these were associated with maternal or treatment characteristics. Design: Retrospective cohort study of national population data of infants conceived through ART. Setting: Australian birth records from 1996 to 2000. Patient(s): Eighteen thousand, four hundred twenty- nine liveborn and stillborn infants conceived through ART. Intervention(s): In vitro fertilization, intracytoplasmic sperm injection, and gamete intrafallopian transfer. Main Outcome Measure(s): Preterm birth and LBW. Result(s): Preterm birth and LBW were more common among singletons and twins conceived with IVF and born to nulliparous mothers. Preterm birth and LBW were, respectively, 1.3 times and 1.5 times more likely to occur among singletons conceived by transfer of fresh embryos, compared with transfer of frozen embryos. Preterm birth and LBW was more common among couples who had female- factor infertility compared with male- factor infertility. Conclusion(s): The transfer of fresh embryos and female- factor infertility were independently associated with preterm birth and LBW for both singletons and twins after ART.
文摘OBJECTIVE: To estimate the pattern of maternal vascular reactivity in normal a nd high-risk pregnancies using postocclusion brachial artery diameter. METHODS: Prospective, longitudinal study of 44 low-risk singleton pregnancies and 28 hi gh-risk pregnancies, defined as pregestational diabetes (n = 7), chronic hypert ension (n = 4), twin gestation (n = 6), and a previous history of preeclampsia, fetal growth restriction, or vascular disease (n = 11). During each trimester, t he brachial artery was ultrasonographically imaged above the antecubital crease. Brachial artery diameter was measured and then occluded for 5 minutes using an inflated blood pressure cuff. Changes in brachial artery diameter at 1 minute af ter occlusion were expressed as percent change from baseline and were compared a cross trimesters for both low-risk and high-risk groups, adjusting for potenti al confounders. RESULTS: Brachial artery diameters were increased after occlusio n in every trimester for all groups. For low-risk women, the degree of postoccl usion brachial artery dilatation was similar in the first and second trimesters, but was lower in the third trimester. In the first trimester, low-risk women h ad significantly greater brachial artery diameter increases at 1 minute compared with high-risk singleton pregnancies (19%compared with 12%; P < .001). Compa red with low-risk women, pregnancies complicated by pregestational diabetes or chronic hypertension had significantly smaller 1-minute brachial artery diamete r changes in the first trimester (7.0 ±0.5%, P < .001), whereas twin gestation s had greater brachial artery responses (22.9 ±6.0%, P < .001). Women with pre vious preeclampsia or vascular disease had responses similar to low-risk women. CONCLUSION: Maternal vascular reactivity as assessed by postocclusion brachial artery dilatation decreases in the third trimester in both low-risk and high-r isk women. In addition, singleton pregnancies at high risk for preeclampsia disp lay decreased brachial artery reactivity compared with low-risk women.
基金Supported by a Clifford Craig Medical Research Trust project grant and Cancer Council Tasmania(to Kunde D and Eri R)a Bowel Cancer Funding Partners Ph D scholarship generously funded by Rotary District 9830,Australian Rotary Health and the University of Tasmania(to Randall-Demllo S)
文摘AIM To determine if exacerbation of pre-existing chronic colitis in Winnie(Muc2 mutant) mice induces colonic dysplasia.METHODS Winnie mice and C57BL6 as a genotype control, were administered 1% w/v dextran sulphate sodium(DSS) orally, followed by drinking water alone in weeklong cycles for a total of three cycles. After the third cycle, mice were killed and colonic tissue collected for histological and immunohistochemical evaluation. Inflammation and severity of dysplasia in the colonic mucosa were assessed in H&E sections of the colon. Epithelial cell proliferation was assessed using Ki67 and aberrant β-catenin signalling assessed with enzyme-based immunohistochemistry. Extracted RNA from colonic segments was used for the analysis of gene expression using real-time quantitative PCR. Finally, the distribution of Cxcl5 was visualised using immunohistochemistry.RESULTS Compared to controls, Winnie mice exposed to three cycles of DSS displayed inflammation mostly confined to the distal-mid colon with extensive mucosal hyperplasia and regenerative atypia resembling epithelial dysplasia. Dysplasia-like changes were observed in 100% of Winnie mice exposed to DSS, with 55% of these animals displaying changes similar to high-grade dysplasia, whereas high-grade changes were absent in wild-type mice. Occasional penetration of the muscularis mucosae by atypical crypts was observed in 27% of Winnie mice after DSS. Atypical crypts however displayed no evidence of oncogenic nuclear β-catenin accumulation, regardless of histological severity. Expression of Cav1, Trp53 was differentially regulated in the distal colon of Winnie relative to wild-type mice. Expression of Myc and Ccl5 was increased by DSS treatment in Winnie only. Furthermore, increased Ccl5 expression correlated with increased complexity in abnormal crypts. While no overall difference in Cxcl5 mucosal expression was observed between treatment groups, epithelial Cxcl5 protein appeared to be diminished in the atypical epithelium. CONCLUSION Alterations to the expression of Cav1, Ccl5, Myc and Trp53 in the chronically inflamed Winnie colon may influence the transition to dysplasia.
文摘This is a consumer-reference feedback and feasibility testing of a protocol to obtain qualitative responses of co-residing caregivers to questions regarding the timing of dementia diagnosis and their experience of the disclosure of a diagnosis of dementia. Data collection involved focus group discussions and individual phone interviews of a convenience sample (N = 5) of an Alzheimer’s Australia state based Consumer Advisory Committee. Thematic analysis utilised the Leximancer software. Consumer feedback suggested a reordering of the interview questions and reversing the data collection sequence to reduce the emotional impact on participants. Suggestions were offered to limit the number of participants in the focus group to shorten the duration of the focus group session to prevent fatigue and to provide a support person to improve participant focus group comfort. Responses to the interview questions indicated caregivers retrospectively considered a timely diagnosis would have provided useful dementia-focused planning, reduced the difficulties of living with uncertainty and would have provided more time to obtain information and support. There were strong expectations for medical practitioners to be sensitive to the possibility of dementia and to be cognisant of the diagnostic concerns of caregivers. The diagnosis of dementia and its timing is important to the dementia caregiver in providing an explanation of the problems experienced and allowing earlier organisation of care, future planning and caregiver education to reduce the difficulties of living with undiagnosed and unrecognised dementia.
文摘There is growing interest in the role that apex predators play in shaping terrestrial ecosystems and maintaining tro- phic cascades. In line with the mesopredator release hypothesis, Australian dingoes (Canis lupus dingo and hybrids) are assumed by many to regulate the abundance of invasive mesopredators, such as red foxes Vulpes vulpes and feral cats Fells catus, thereby providing indirect benefits to various threatened vertebrates. Several recent papers have claimed to provide evidence for the bio- diversity benefits of dingoes in this way. Nevertheless, in this paper we highlight several critical weaknesses in the methodologi- cal approaches used in many of these reports, including lack of consideration for seasonal and habitat differences in activity, the complication of simple track-based indices by incorporating difficult-to-meet assumptions, and a reduction in sensitivity for as-sessing populations by using binary measures rather than potentially continuous measures. Of the 20 studies reviewed, 15 of them (75%) contained serious methodological flaws, which may partly explain the inconclusive nature of the literature investigating interactions between invasive Australian predators. We therefore assert that most of the "growing body of evidence" for meso- predator release is merely an inconclusive growing body of literature only. We encourage those interested in studying the eco- logical roles of dingoes relative to invasive mesopredators and native prey species to account for the factors we identify, and cau- tion the value of studies that have not done so [Current Zoology 57 (5): 568-583, 2011].
基金This work was financially supported by a Leverhulme Trust Research Project Grant (RPG-2017-191)the Engineering and Physical Science Research Council (EPSRC) under grant EP/R043612/1+3 种基金the NOMAD Centre of Excellence (European Commission grant agreement ID 951786)the UKRI Future Leaders Fellowship programme (MR/S016023/1)We acknowledge computational resources provided by the Scientific Computing Research Technology Platform of the University of Warwick,the EPSRC-funded HPC Midlands+ consortium (EP/P020232/1,EP/T022108/1)on ARCHER2 via the UK Car-Parinello consortium (EP/P022065/1).
文摘We propose a scheme to construct predictive models for Hamiltonian matrices in atomic orbital representation from ab initio data as a function of atomic and bond environments.The scheme goes beyond conventional tight binding descriptions as it represents the ab initio model to full order,rather than in two-centre or three-centre approximations.We achieve this by introducing an extension to the atomic cluster expansion(ACE)descriptor that represents Hamiltonian matrix blocks that transform equivariantly with respect to the full rotation group.The approach produces analytical linear models for the Hamiltonian and overlap matrices.Through an application to aluminium,we demonstrate that it is possible to train models from a handful of structures computed with density functional theory,and apply them to produce accurate predictions for the electronic structure.The model generalises well and is able to predict defects accurately from only bulk training data.
文摘The studies of Allen (2011) and Allen et al. (2011) recently examined the methodology underpinning claims that dingoes provide net benefits to biodiversity by suppressing foxes and cats. They found most studies to have design flaws and/or observational methods that preclude valid interpretations from the data, describing most of the current literature as 'wild dogma'. In this short supplement, we briefly highlight the roles and implications of wild dogma for wild dog management in Australia. We discuss nomenclature, and the influence that unreliable science can have on policy and practice changes related to apex predator management