Purpose: Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and methods: An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results: A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions: This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.
This study examines how organizational factors interact with individual factors in influencing female leaders' intentions to engage in corporate social responsibility (CSR) through the lens of planned behavior. Through in‐depth interviews with 20 female corporate leaders from Australia and China, seven themes emerged as factors shaping their CSR engagement. We examined those factors using the theory of planned behavior (TBP) conceptual framework, and found that organizational factors, especially corporate culture and peer influence, dominated female leaders' intentions to engage in CSR. Power interacts with culture and affects female leaders in two countries in different manners: in China, the distance to top corporate power determines female leaders' intentions toward and the way they engage in CSR, while lack of critical mass is often cited by their Australian counterparts as the main factor deterring their CSR engagement. This study demonstrates how organizational factors shape leaders' CSR decisions, reveals the nuances behind the gender–CSR link, and posits for different remedies to unleash the power of female leaders in different cultures.
Our knowledge of biodiversity hinges on sufficient data, reliable methods, and realistic models. Without an accurate assessment of species distributions, we cannot effectively target and stem biodiversity loss. Species range maps are the foundation of such efforts, but countless studies have failed to account for the most basic assumptions of reliable species mapping practices, undermining the credibility of their results and potentially misleading and hindering conservation and management efforts. Here, we use examples from the recent literature and broader conservation community to highlight the substantial shortfalls in current practices and their consequences for both analyses and conservation management. We detail how different decisions on data filtering impact the outcomes of analysis and provide practical recommendations and steps for more reliable analysis, whilst understanding the limits of what available data will reliably allow and what methods are most appropriate. Whilst “perfect” analyses are not possible for many taxa given limited data, and biases, ensuring we use data within reasonable limits and understanding inherent assumptions is crucial to ensure appropriate use. By embracing and enacting such best practices, we can ensure both the accuracy and improved comparability of biodiversity analyses going forward, ultimately enhancing our ability to use data to facilitate our protection of the natural world.
Background and aims Problematic Internet use (PIU) has become a global public health problem. It has been suggested that parenting style is associated with adolescent PIU. However, the evidence in favor of this view is mixed. Based on the PRISMA method, the present study employed three-level meta-analysis approach to investigate the relationship between these two variables and further explore potential moderators. Methods After a systematic search for published articles, 35 studies were included, reporting 171 effect sizes ( N = 40,587). Results The results showed that positive parenting styles were significantly negatively related to PIU. This association was moderated by gender, age, publication year, and measurements of PIU, but was not by culture and measurements of parenting styles. Negative parenting styles were significantly positively related to PIU, which was moderated by publication year, culture, and sub-types of negative parenting, but not by gender, age, and measurements of both parenting styles and PIU. In addition, the correlation of PIU with negative parenting styles was stronger than that with positive parenting styles. Discussion and Conclusions The present results demonstrated that parenting styles, especially punitive parenting styles, should be attached to more important when treating adolescent PIU.
Introduction Novel biomarkers of inflammation and oxidative stress might enhance the early recognition, management, and clinical outcomes of patients with rheumatic diseases (RDs). We assessed the available evidence regarding the pathophysiological role of neopterin, the oxidation product of 7,8-dihydroneopterin, a pteridine generated in macrophages activated by interferon-γ, by conducting a systematic review and meta-analysis of studies reporting its concentrations in biological fluids in RD patients and healthy controls. Methods We searched electronic databases for relevant articles published between inception and 31 August 2023. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development and Evaluation Working Group system, respectively. Results In 37 studies, when compared to healthy controls, RD patients had significantly higher concentrations of neopterin both in plasma or serum (standard mean difference, SMD=1.31, 95% CI 1.01 to 1.61; p<0.001; moderate certainty of evidence) and in the urine (SMD=1.65, 95% CI 0.86 to 2.43, p<0.001; I ² = 94.2%, p<0.001; low certainty of evidence). The results were stable in sensitivity analysis. There were non-significant associations in meta-regression and subgroup analysis between the effect size and age, male to female ratio, year of publication, sample size, RD duration, C-reactive protein, erythrocyte sedimentation rate, specific type of RD, presence of connective tissue disease, analytical method used, or biological matrix investigated (plasma vs . serum). By contrast, the effect size was significantly associated with the geographical area in studies assessing serum or plasma and with the type of RD in studies assessing urine. Discussion Pending additional studies that also focus on early forms of disease, our systematic review and meta-analysis supports the proposition that neopterin, a biomarker of inflammation and oxidative stress, can be useful for the identification of RDs. (PROSPERO registration number: CRD42023450209). Systematic review registration PROSPERO, identifier CRD42023450209
Objective The objective of this scoping review is to describe models of palliative care for under-served populations in high-income countries, defined as adults of culturally and linguistically diverse communities; low socioeconomic status; and/or residing in rural areas. Introduction Models of palliative care are processual, referring to the way palliative care services are delivered as people experience a condition, injury, or event. The aim of these models is to ensure people get the right care, at the right time, by the right team, in the right place. Evidence suggests there is a wide variety of models of palliative care; but what is not known is how these models can vary to meet the needs of under-served populations. Inclusion criteria This scoping review will consider articles that focus on models of palliative care for under-served populations, irrespective of sex, age, or primary diagnosis. Methods MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), Emcare (Ovid), CINAHL (EBSCO), and Scopus will be searched for articles, irrespective of language, published from 2014. Two independent reviewers will screen titles and abstracts, followed by a full-text review of potentially relevant articles. Discrepancies will be reconciled with another reviewer. Two independent reviewers will extract data from included articles using a data extraction tool developed for this review. Results will be tabulated and/or presented diagrammatically, as well as summarized to explicitly address the objective of the review. Review registration Open Science Framework https://osf.io/x4ky3
Background High-stakes assessments are often used as a ‘gate-keeper’ activity for entry into the health professions by ensuring that the minimum core competency thresholds of the profession are met. The aim of the study was to explore if common areas of underperformance existed in international candidates assessed with a high-stakes clinical-based simulation assessment for entry into the physiotherapy profession in Australia. Methods A retrospective mixed methods analysis of the clinical assessments completed by international candidates over a one-month period in 2021 that were deemed as not meeting competency. The clinical assessments were completed in one of the three practice areas: cardiorespiratory, musculoskeletal, or neurological rehabilitation. Each assessment was scored by two independent assessors, who discussed the performance and then completed a moderated assessment form. The assessment form used to score competency included seven domains such as initial assessment, effective treatment, communication skills, and risk management. Results Fifty-one clinical assessments graded as not competent were analysed. Across the practice areas, a high failure rate was found in domains related to interpreting assessment findings and developing a treatment plan. This trend was also observed in the qualitative data, suggesting candidates struggled to meet competency in areas of planning and prioritisation, interpretation and implementation of the information gathered, and selection and evaluation of effective treatment. Conclusion These findings align with published data on the underperformance of Australian physiotherapy students in clinical placement settings, suggesting these issues are not specific to high stakes assessment of overseas physiotherapists, and that education needs to focus on improving these skills within the profession at all levels. With the identified areas of underperformance aligning with the ability to use higher order thinking and skills integral to clinical reasoning, improvements in the education and implementation of clinical reasoning may be a place to start.
Predicting the risk of in-hospital mortality from electronic health records (EHRs) has received considerable attention. Such predictions will provide early warning of a patient’s health condition to healthcare professionals so that timely interventions can be taken. This prediction task is challenging since EHR data are intrinsically irregular, with not only many missing values but also varying time intervals between medical records. Existing approaches focus on exploiting the variable correlations in patient medical records to impute missing values and establishing time-decay mechanisms to deal with such irregularity. This paper presents a novel contrastive learning-based imputation-prediction network for predicting in-hospital mortality risks using EHR data. Our approach introduces graph analysis-based patient stratification modeling in the imputation process to group similar patients. This allows information of similar patients only to be used, in addition to personal contextual information, for missing value imputation. Moreover, our approach can integrate contrastive learning into the proposed network architecture to enhance patient representation learning and predictive performance on the classification task. Experiments on two real-world EHR datasets show that our approach outperforms the state-of-the-art approaches in both imputation and prediction tasks.
Introduction Using case law, the aims of this study were to document the methods for trafficking of performance and image‐enhancing drugs (PIED) into Australia, and the characteristics of individuals and groups involved. Methods Data was collected from judges' sentencing comments. Searches were conducted using the Australasian Legal Information Institute database across all states in Australia, for the period of January 2010 to December 2021. After removing duplicates and cases which did not meet the inclusion criteria, 31 cases were included in the analysis. Results Across the 31 cases, 37 individuals were named as being involved in the supply and/or trafficking of PIEDs, with three cases involving an unknown number of individuals. One case named four actors involved in the supply and/or trafficking of PIEDs, three cases involved three actors, four cases involved two actors and 17 cases involved one actor. In 20 of the 31 cases, individuals operated alone. Over half (19 of the 37) of the individuals were health professionals. The majority ( n = 17) of cases involved prescription as the method of acquisition, while seven cases involved the importation of PIEDs. Discussion and Conclusion The small number of cases identified, with the majority involving only a single actor, and half of the cases involving those in the medical profession. The findings suggest that discrete occurrences of trafficking involves individuals or small groups that do not appear to be linked to large‐scale networks or networks involving the supply and trafficking of other illicit substances.
This chapter summarizes the main findings of the previous chapters to tease out the key messages of the whole book project. We note down the contribution of English language education to the development of Vietnamese students’ employability and its influence on their career prospects. We also provide a clearer picture of how English language education has been conducted in Vietnamese higher education institutions, amidst the vigorous English language teaching and learning reforms in the country. Identifying the limitations of English language education in preparing students for the world of work, we argue that there is a pressing need to consider changing the approach to English language education, focusing more on the use of the language at the workplace and moving away from testing students’ acquisition of linguistic abilities or introducing cultural snap-shot of English speaking countries. Extending Kumaravadivelu’s (Beyond methods, Yale University Press, 2003) macro-strategic framework, we propose a new approach to English language teaching and learning that can better foster the development of Vietnamese graduates’ employability.
This chapter provides an introduction into the book. It briefly summarizes issues related to graduate employability and points out that English language competency is an essential employability capital itself, and English language education can help develop other types of employability capital. Based on evidence from the literature, it points out that there is a mismatch between the current delivery approach (content and structure of the curriculum, learning materials, teaching–learning methods, and assessment purpose) and students’ learning approach to English language education in Vietnam, and other Asian countries. This requires a change in the approaches to English language education to better accommodate the demands of the society and economy for students’ English competency and better position English language education to match its importance in this globalized world. The chapter then narrows down to the current context of teaching and learning English in Vietnam, arguing that Vietnam can provide an appropriate case to investigate how English language education can help develop graduate employability for students. The chapter ends with a brief summary of the content of each chapter presented in the book.
This chapter sketches out the socio-economic, cultural, political, and technological changes at the national level in Vietnam since the Đổi Mới policy in 1986, marking Vietnam’s readiness to embrace national economic development, internationalization, and globalization. It reviews Vietnam’s national foreign language policy and current practices of English education alongside the employability agenda in Vietnamese higher education. It also highlights both contextual and pedagogical challenges facing Vietnam’s English language education. It argues that although English skills are classified as essential soft skills necessary for graduates’ employability, the current situation of Vietnamese graduates’ low English language proficiency levels revealed a huge gap between what is intended ambitiously in Government policies and what is actually being implemented at the institutional, curriculum, and subject levels across education levels, including higher education. This Chapter suggests that Vietnamese English education context provides an appropriate case study to investigate how English education can contribute to graduates’ employability.
Objective The Objective Structured Clinical Examination (OSCE) has been removed from the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) training pathway. This decision occurred in the context of an Alternative Assessment Pathway (AAP) necessitated by Covid-19, justified by logistical, methodological and equity concerns. The false positive rate of trainees progressing to Fellowship before achieving competence is a key indicator for evaluating any assessment leading to psychiatric Fellowship. Variations in the statistical properties of the AAP and OSCE were analysed for their impact on pre-competent trainees progressing to Fellowship. Method Starting with the false positive scenario presented to justify discontinuing the OSCE, false positive rates associated with the AAP and OSCE were calculated based on different assumptions about reliability and accuracy. Results The analyses suggest that less reliable and less accurate alternatives to the OSCE, such as the AAP, increase the number of pre-competent trainees progressing to Fellowship. Conclusions Given possible increases in pre-competent trainees progressing to Fellowship while alternatives to the OSCE are finalised, confidence in the RANZCP's training program demands robust public analyses of those alternatives.
According to the literature, the success of deinstitutionalization (DI) practices in low-and middle-income countries (LMICs) is dependent on key factors including, a well-functioning family-based alternative care and social protection system, adequate funding and resources, and professional and other stakeholders' engagement and support. Following a practice research qualitative method, the study explored practitioner's experiences and perceptions on the status of Ghana's ongoing DI efforts and their recommendations for improving implementation. The study's main themes were establishing the need for residential homes for children (RHCs), RHCs not being an ideal family environment and RHCs as respite. Family marital problems, poor financial situation, stigma attached to some children in care, abusive parents and a lack of suitable alternatives when families have a crisis were identified as key factors that impede DI implementation in Ghana. The findings suggest the need for a progressive approach towards DI implementation in LMICs, with the first step being the re-positioning of RHCs as respite care centres while progressively developing other alternative family-based care options (such as kinship care) for children. K E Y W O R D S alternative care, deinstitutionalization, family-based care, Ghana, residential homes
The pursuit of the goal of ‘All for Health’ can be enabled by the adoption of ‘Digital Health’ and ‘Technology’ in all levels of care which can facilitate greater cooperation between health sectors and across different health systems. This chapter will review the development of e-health into the era of ‘Digital Health’ with the emphasis on technological advancement in connected patient care concerning health improvement, health protection, consumer participation as well as improvement of health service effectiveness and efficiency. Case studies from Australia and Hong Kong are used to highlight the rationale, importance, policy, and implementation issues of adopting digital technologies and innovative models of care that contribute to achieving healthcare goals in different health system contexts. Together with the advocation of ‘Smart City’ and ‘Smart Health’ by a lot of countries, government initiatives and commitments from key stakeholders are the important factors that facilitate this international movement. Similarly, a well-developed specialised digital health workforce and the competence of health services managers and health information managers in supporting the health system in transitioning into the era of ‘Digital Health’ are critical. A holistic approach in developing the workforce that can lead and manage digital health transformation is also discussed.
Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT3) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT3 antagonists for the treatment of nausea across all clinical settings. MEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT3 antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE. From 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD − 20.06; 95% CI − 26.26, − 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT3 antagonist. The overall GRADE assessment of evidence quality ranged from very low to low. IPA may provide rapid, effective relief of nausea when compared with 5-HT3 antagonists.
High-grade prostatic intraepithelial neoplasia (HGPIN) is a well-characterised precursor lesion in prostate cancer. The term atypical intraductal proliferations (AIP) describes lesions with features that are far too atypical to be considered HGPIN, yet insufficient to be diagnosed as intraductal carcinoma of the prostate (IDCP). Here, a panel of biomarkers was assessed to provide insights into the biological relationship between IDCP, HGPIN, and AIP and their relevance to current clinicopathological recommendations. Tissue samples from 86 patients with prostate cancer were assessed by routine haematoxylin and eosin staining and immunohistochemistry (IHC) with a biomarker panel (Appl1/Sortilin/Syndecan-1) and a PIN4 cocktail (34βE12+P63/P504S). Appl1 strongly labelled atypical secretory cells, effectively visualising intraductal lesions. Sortilin labelling was moderate-to-strong in > 70% of cases, while Syndecan-1 was moderate-to-strong in micropapillary HGPIN/AIP lesions (83% cases) versus flat/tufting HGPIN (≤ 20% cases). Distinct biomarker labelling patterns for atypical intraductal lesions of the prostate were observed, including early atypical changes (flat/tufting HGPIN) and more advanced atypical changes (micropapillary HGPIN/AIP). Furthermore, the biomarker panel may be used as a tool to overcome the diagnostic uncertainty surrounding AIP by supporting a definitive diagnosis of IDCP for such lesions displaying the same biomarker pattern as cribriform IDCP.
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