University of Melbourne Institutional Repository

    Rheumatic Heart Disease-Attributable Mortality at Ages 5-69 Years in Fiji: A Five-Year, National, Population-Based Record-Linkage Cohort Study

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    BACKGROUND: Rheumatic heart disease (RHD) is considered a major public health problem in developing countries, although scarce data are available to substantiate this. Here we quantify mortality from RHD in Fiji during 2008-2012 in people aged 5-69 years. METHODS AND FINDINGS: Using 1,773,999 records derived from multiple sources of routine clinical and administrative data, we used probabilistic record-linkage to define a cohort of 2,619 persons diagnosed with RHD, observed for all-cause mortality over 11,538 person-years. Using relative survival methods, we estimated there were 378 RHD-attributable deaths, almost half of which occurred before age 40 years. Using census data as the denominator, we calculated there were 9.9 deaths (95% CI 9.8-10.0) and 331 years of life-lost (YLL, 95% CI 330.4-331.5) due to RHD per 100,000 person-years, standardised to the portion of the WHO World Standard Population aged 0-69 years. Valuing life using Fiji's per-capita gross domestic product, we estimated these deaths cost United States Dollar $6,077,431 annually. Compared to vital registration data for 2011-2012, we calculated there were 1.6-times more RHD-attributable deaths than the number reported, and found our estimate of RHD mortality exceeded all but the five leading reported causes of premature death, based on collapsed underlying cause-of-death diagnoses. CONCLUSIONS: Rheumatic heart disease is a leading cause of premature death as well as an important economic burden in this setting. Age-standardised death rates are more than twice those reported in current global estimates. Linkage of routine data provides an efficient tool to better define the epidemiology of neglected diseases

    SWAT ungauged: Water quality modeling in the Upper Mississippi River Basin.

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    Improving model performance in ungauged basins has been a chronic challenge in watershed model application to understand and assess water quality impacts of agricultural conservation practices, land use change, and climate adaptation measures in large river basins. Here, we evaluate a modified version of SWAT2012 (referred to as SWAT-EC hereafter), which integrates an energy balanced soil temperature module (STM) and the CENTRUY-based soil organic matter algorithm, for simulating water quality parameters in the Upper Mississippi River Basin (UMRB), and compare it against the original SWAT2012. Model evaluation was performed for simulating streamflow, sediment, and nitrate-N (NO3-N) and total nitrogen (TN) loadings at three stations near the outlets of UMRB. The model comparison was conducted without parameter calibration in order to assess their performance under ungauged conditions. The results indicate that SWAT-EC outperformed SWAT2012 for stream flow and NO3-N and TN loading simulation on both monthly and annual scales. For sediment, SWAT-EC performed better than SWAT2012 on a monthly time step basis, but no noticeable improvement was found at the annual scale. In addition, the performance of the uncalibrated SWAT-EC was comparable to other calibrated SWAT models reported in previous publications with respect to sediment and NO3-N loadings. These findings highlight the importance of advancing process representation in physically-based models to improve model credibility, particularly in ungauged basins

    Overseas Medical Referral: the health system challenges for Pacific Island Countries

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    The delivery of specialised clinical services in the small Island nations of the Pacific region is an increasing challenge in the context of a rising burden of non-communicable diseases. Resources are limited and case-loads too low to support local specialists. This article focuses on the common practice of Overseas Medical Referral (OMR), which is an increasing challenge in the region. We collected interview and secondary data across 16 Pacific Island Countries. We found that OMR policies are often weak or incomplete, systems inadequate and reforms needed. Integrating OMR fully into national health referral systems and national strategic planning and prioritisation processes is needed. There is an additional need for collection of routine data on OMR service providers in the recipient countries and the outcomes of clinical care. With these reforms, a move towards increased regional cooperation and some form of strategic purchasing is possible

    No tension between pulsar timing array upper limits on the nano-Hertz gravitational wave background and assembly models of massive black hole binaries

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    Pulsar timing arrays provide a means to observe the nano-Hertz gravitational wave background from the population of merging massive black hole binaries. Observations are placing increasingly stringent upper limits on the gravitational wave background. Upper limits and future detections will enable the study of the properties of the merging population. Recent upper limits have cast doubt on current predictions of the gravitational wave background. Here we perform a Bayesian analysis comparing upper limits to astrophysical prediction. So far models are consistent with observation. These proceedings summarise previous work in Ref. [1]

    Very low field 19F MRI of perfluoro-octylbromide: Minimizing chemical shift effects and signal loss due to scalar coupling.

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    19F images have been obtained from perflurooctylbromide (PFOB) at very low magnetic field (50 mT). The small spectral dispersion (in Hz) means that all fluorine nuclei contribute to the signal without chemical shift artifacts or the need for specialized imaging sequences. Turbo spin echo trains with short interpulse intervals and full 180° refocussing pulses suppress scalar coupling, leading to long apparent T2 values and highly efficient data collection. Overall, the detection efficiency of PFOB is very similar that of water in tissue

    Development and content validation of the Safe Surgery Organizational Readiness Tool: A quality improvement study

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    BACKGROUND: Recent efforts to increase access to safe and high-quality surgical care in low- and middle-income countries have proven successful. However, multiple facilities implementing the same safety and quality improvement interventions may not all achieve successful outcomes. This heterogeneity could be explained, in part, by pre-intervention organizational characteristics and lack of readiness of surgical facilities. In this study, we describe the process of developing and content validating the Safe Surgery Organizational Readiness Tool. MATERIALS AND METHODS: The new tool was developed in two stages. First, qualitative results from a Safe Surgery 2020 intervention were combined with findings from a literature review of organizational readiness and change. Second, through iterative discussions and expert review, the Safe Surgery Organizational Readiness Tool was content validated. RESULTS: The Safe Surgery Organizational Readiness Tool includes 14 domains and 56 items measuring the readiness of surgical facilities in low- and middle-income countries to implement surgical safety and quality improvement interventions. This multi-dimensional and multi-level tool offers insights into facility members' beliefs and attitudes at the individual, team, and facility levels. A panel review affirmed the content validity of the Safe Surgery Organizational Readiness Tool. CONCLUSION: The Safe Surgery Organizational Readiness Tool is a theory- and evidence-based tool that can be used by change agents and facility leaders in low- and middle-income countries to assess the baseline readiness of surgical facilities to implement surgical safety and quality improvement interventions. Next steps include assessing the reliability and validity of the Safe Surgery Organizational Readiness Tool, likely resulting in refinements
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