Project description:Nurses and midwives can be instrumental to global efforts to address child abuse and neglect through a public health approach of prevention and early intervention. However, there is limited understanding of nurses' and midwives' roles, and no international or local guidelines to inform and evaluate their safeguarding practices. The aim of this modified Delphi study was to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children in Australia. Sixty-four statements located within seven clusters were developed from a literature review and nursing and midwifery practice standards. Participants (N = 102) were nurses and midwives working with children in diverse contexts. They were asked to indicate the importance of each statement to their practice setting. Consensus (80%) was achieved on all statements in Round Two. Findings highlight that participating nurses and midwives agreed safeguarding children is a core component of their practice in diverse child-focussed settings. Findings can inform ongoing discussions about development of nursing and midwifery practice standards and guide effective workforce preparation, education, support and resourcing. Further research about ongoing development of nursing and midwifery roles in safeguarding children is essential to explore how to most effectively mobilise these professions to prevent child abuse and neglect.
Project description:Long-term literacy outcomes for children with hearing loss, particularly those with severe-to-profound deafness who are fitted with cochlear implants (CIs) lag behind those of children with normal hearing (NH). The causes for these long-term deficits are not fully clear, though differences in auditory access between children who use CIs and those with NH may be a partial cause. This paper briefly reviews the emergent literacy model as proposed by Whitehurst and Lonigan (1998). We then examine the development of each of Whitehurst and Lonigan's identified factors in children who use CIs and how the extant knowledge of language and literacy development in children who use CIs may bear on the emergent literacy model. We then propose to modify the model for children who use CIs based on their unique developmental trajectories, influenced at least in part by their unique auditory access. We conclude with future directions for further development of an evidence-based emergent literacy model for children who use CIs and how this model could be used to inform intervention.
Project description:Federated learning is an emerging research paradigm enabling collaborative training of machine learning models among different organizations while keeping data private at each institution. Despite recent progress, there remain fundamental challenges such as the lack of convergence and the potential for catastrophic forgetting across real-world heterogeneous devices. In this paper, we demonstrate that self-attention-based architectures (e.g., Transformers) are more robust to distribution shifts and hence improve federated learning over heterogeneous data. Concretely, we conduct the first rigorous empirical investigation of different neural architectures across a range of federated algorithms, real-world benchmarks, and heterogeneous data splits. Our experiments show that simply replacing convolutional networks with Transformers can greatly reduce catastrophic forgetting of previous devices, accelerate convergence, and reach a better global model, especially when dealing with heterogeneous data. We release our code and pretrained models to encourage future exploration in robust architectures as an alternative to current research efforts on the optimization front.
Project description:BackgroundCoronavirus disease 2019 (COVID-19) has infected over 22 million people in the United States (US) and has had a devastating impact on the US economy and healthcare system. In order to help slow the spread of the virus and save hospital resources, nonessential businesses were forced to close and elective surgeries have been postponed.MethodsAs we reach the peak of the pandemic and the COVID-19 vaccine gets distributed, healthcare systems must develop plans to safely resume elective surgeries. This article outlines a single center academic medical center's perioperative COVID-19 protocol to help keep surgeons, operating room teams, and patients safe.ResultsWhile testing protocols can help minimize the transmission of the virus, there is still the potential for COVID+ patients to undergo surgery undetected, due to potential false negative tests and the long incubation period before seroconversion and symptom development.ConclusionsAn effective institutional strategy not only includes clear perioperative testing protocols, but also education regarding clinical manifestations and exposure control.
Project description:Reducing the global diseases burden requires effective diagnosis and treatment. In the developing world, accurate diagnosis can be the most expensive and time-consuming aspect of health care. Healthcare cost can, however, be reduced by use of affordable rapid diagnostic tests (RDTs). In the developed world, low-cost RDTs are being developed in many research laboratories; however, they are not being equally adopted in the developing countries. This disconnect points to a gap in the design philosophy, where parameterization of design variables ignores the most critical component of the system, the point-of-use stakeholders (e.g., doctors, nurses and patients). Herein, we demonstrated that a general focus on reducing cost (i.e., "low-cost"), rather than efficiency and reliability is misguided by the assumption that poverty reduces the value individuals place on their well-being. A case study of clinicians in Kenya showed that "zero-cost" is a low-weight parameter for point-of-use stakeholders, while reliability and standardization are crucial. We therefore argue that a user-driven, value-addition systems-engineering approach is needed for the design of RDTs to enhance adoption and translation into the field.
Project description:Globally, catadromous freshwater eels of the genus Anguilla are of conservation concern, including critically endangered European eel (Anguilla anguilla). Pumping stations that move river water to a higher elevation severely impact eels during their seaward spawning migration. Fish-friendly pumps can mitigate fish injury and mortality but here we uniquely rethink a fish-friendly pump as a fish passage solution. In this pluriannual study, the seasonal timing of pump operation was misaligned with the typical silver eel migration period. Eels were almost exclusively nocturnal but night-time pumping represented as little as 5.6% a year. Night-time eel approaches were primarily influenced by pump duration and temperature, but did not align with lunar phase, unlike in unregulated rivers. After reaching the pumping station, eel passage was influenced by weedscreen aperture and increased when the aperture was increased. Passive sensor collision suggested non-pump infrastructure could cause injury and mortality to eels. It is therefore recommended pump operation should align with the timing of silver eel migration, weedscreen and pump entrance efficiencies should be maximised, and non-pump infrastructure must have low fish injury risk. Ultimately, considering the entire structure a fish passage solution will help ensure fish-friendly pumps have high conservation value for anguillid eels globally.
Project description:Children represent a vulnerable population in which management of nociceptive pain is complex. Drug responses in children differ from adults due to age-related differences. Moreover, therapeutic choices are limited by the lack of indication for a number of analgesic drugs due to the challenge of conducting clinical trials in children. Furthermore the assessment of efficacy as well as tolerance may be complicated by children's inability to communicate properly. According to the World Health Organization, weak opioids such as tramadol and codeine, may be used in addition to paracetamol and ibuprofen for moderate nociceptive pain in both children and adults. However, codeine prescription has been restricted for the last 5 years in children because of the risk of fatal overdoses linked to the variable activity of cytochrome P450 (CYP) 2D6 which bioactivates codeine. Even though tramadol has been considered a safe alternative to codeine, it is well established that tramadol pharmacodynamic opioid effects, efficacy and safety, are also largely influenced by CYP2D6 activity. For this reason, the US Food and Drug Administration recently released a boxed warning regarding the use of tramadol in children. To provide safe and effective tramadol prescription in children, a personalized approach, with dose adaptation according to CYP2D6 activity, would certainly be the safest method. We therefore recommend this approach in children requiring chronic or recurrent nociceptive pain treatment with tramadol. In case of acute inpatients nociceptive pain management, prescribing tramadol at the minimal effective dose, in a child appropriate dosage form and after clear instructions are given to the parents, remains reasonable based on current data. In all other situations, morphine should be preferred for moderate to severe nociceptive pain conditions.
Project description:Protein therapeutics play an important role in controlling the functions and activities of disease-causing proteins in modern medicine. Despite protein therapeutics having several advantages over traditional small-molecule therapeutics, further development has been hindered by drug complexity and delivery issues. However, recent progress in deep learning-based protein structure prediction approaches, such as AlphaFold2, opens new opportunities to exploit the complexity of these macro-biomolecules for highly specialised design to inhibit, regulate or even manipulate specific disease-causing proteins. Anti-CRISPR proteins are small proteins from bacteriophages that counter-defend against the prokaryotic adaptive immunity of CRISPR-Cas systems. They are unique examples of natural protein therapeutics that have been optimized by the host-parasite evolutionary arms race to inhibit a wide variety of host proteins. Here, we show that these anti-CRISPR proteins display diverse inhibition mechanisms through accurate structural prediction and functional analysis. We find that these phage-derived proteins are extremely distinct in structure, some of which have no homologues in the current protein structure domain. Furthermore, we find a novel family of anti-CRISPR proteins which are structurally similar to the recently discovered mechanism of manipulating host proteins through enzymatic activity, rather than through direct inference. Using highly accurate structure prediction, we present a wide variety of protein-manipulating strategies of anti-CRISPR proteins for future protein drug design.
Project description:BackgroundRecent evidence from randomized controlled trials has raised concerns about the long-term safety of paclitaxel-coated peripheral devices used for femoropopliteal artery revascularization. In response to a call for more real-world data on the safety of these devices, the SAFE-PAD study (Safety Assessment of Femoropopliteal Endovascular treatment with Paclitaxel-coated Devices) was designed with input from the Food and Drug Administration to provide a long-term, comprehensive evaluation of the mortality risk associated with paclitaxel-coated devices among Medicare beneficiaries.Methods and resultsSAFE-PAD is an observational cohort study of fee-for-service Medicare beneficiaries that underwent femoropopliteal artery revascularization with either a drug-coated device or nondrug-coated device from 2015 through 2018. All patients age 66 years or older who underwent revascularization will be identified using a combination of International Classification of Diseases, Tenth Revision procedural codes, Current Procedural Terminology codes, and Healthcare Common Procedure Coding System C-codes. The safety end point of all-cause death will be updated semiannually and continued until the median duration of follow-up surpasses 5 years. Sub-group analyses will be conducted by device type, patient characteristics, and procedural setting. Registration: The SAFE-PAD study has been registered on URL: https://www.clinicaltrials.gov; Unique identifier: NCT04496544.ConclusionsThe SAFE-PAD study will evaluate the long-term safety of drug-coated devices compared with nondrug-coated devices for femoropopliteal artery revascularization among a broad, real-world population of patients with peripheral artery disease.
Project description:BackgroundDigitalisation of death documentation in Bangladesh's graveyards is crucial for accurate mortality data and public health planning. Additionally, studying the usability, technology acceptance, and implementation aspects of the digital death record-keeping system, an innovative intervention that has not been previously explored, ensures the effectiveness, user adoption, and long-term sustainability. We designed, implemented, and evaluated a digital mortality surveillance system in graveyards in Dhaka city of Bangladesh.MethodsThe study was conducted in six graveyards of the Dhaka North City Corporation (DNCC). First, we conducted formative research to understand the documentation process of the graveyard record-keeping and inform architecture for a digital record-keeping system. We then developed a digital record-keeping system for graveyard. A cross-sectional quantitative and qualitative study was conducted among web and app users, and graveyard managers and death records keepers.ResultsA total of 200 app and web users and 14 record-keepers and managers participated. App and web users had high levels of system usability (88%) and found them easy to use (100%) and well-integrated (100%), with disagreement on complexity (100%), inconsistency (100%), and technical support needs (100%). These users had high technology acceptance and agreed the tools help accomplish tasks quickly (100%), improve performance (100%), and were easy to learn (100%). Digital death record-keepers reported using the system frequently (71%) but found it somewhat complex (14%) and not consistently easy to use (28%), with some reported that the systems were well integration (50%) and easy to learn (43%). While technology acceptance varied, death record keepers generally agreed that the system helps with quick task completion (50%) and performance improvement (57%), increase productivity (43%), enhance effectiveness (57%), and easy to use (50%). The digital death record-keeping system received mixed reactions, with younger, tech-savvy operators being optimistic, while older supervisors were sceptical and uncomfortable with technology. Additionally, the system was found to be feasible to an extent, particularly by data entry operators and graveyard managers.ConclusionsThe digital death record-keeping system was generally well-received by app and web users for its usability and integration, though graveyard supervisor found it somewhat complex, with mixed reactions based on tech-savviness; overall, the system was deemed feasible and sustainable.