3,541 research outputs found

    Improving diagnostic procedures for epilepsy through automated recording and analysis of patients’ history

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    Transient loss of consciousness (TLOC) is a time-limited state of profound cognitive impairment characterised by amnesia, abnormal motor control, loss of responsiveness, a short duration and complete recovery. Most instances of TLOC are caused by one of three health conditions: epilepsy, functional (dissociative) seizures (FDS), or syncope. There is often a delay before the correct diagnosis is made and 10-20% of individuals initially receive an incorrect diagnosis. Clinical decision tools based on the endorsement of TLOC symptom lists have been limited to distinguishing between two causes of TLOC. The Initial Paroxysmal Event Profile (iPEP) has shown promise but was demonstrated to have greater accuracy in distinguishing between syncope and epilepsy or FDS than between epilepsy and FDS. The objective of this thesis was to investigate whether interactional, linguistic, and communicative differences in how people with epilepsy and people with FDS describe their experiences of TLOC can improve the predictive performance of the iPEP. An online web application was designed that collected information about TLOC symptoms and medical history from patients and witnesses using a binary questionnaire and verbal interaction with a virtual agent. We explored potential methods of automatically detecting these communicative differences, whether the differences were present during an interaction with a VA, to what extent these automatically detectable communicative differences improve the performance of the iPEP, and the acceptability of the application from the perspective of patients and witnesses. The two feature sets that were applied to previous doctor-patient interactions, features designed to measure formulation effort or detect semantic differences between the two groups, were able to predict the diagnosis with an accuracy of 71% and 81%, respectively. Individuals with epilepsy or FDS provided descriptions of TLOC to the VA that were qualitatively like those observed in previous research. Both feature sets were effective predictors of the diagnosis when applied to the web application recordings (85.7% and 85.7%). Overall, the accuracy of machine learning models trained for the threeway classification between epilepsy, FDS, and syncope using the iPEP responses from patients that were collected through the web application was worse than the performance observed in previous research (65.8% vs 78.3%), but the performance was increased by the inclusion of features extracted from the spoken descriptions on TLOC (85.5%). Finally, most participants who provided feedback reported that the online application was acceptable. These findings suggest that it is feasible to differentiate between people with epilepsy and people with FDS using an automated analysis of spoken seizure descriptions. Furthermore, incorporating these features into a clinical decision tool for TLOC can improve the predictive performance by improving the differential diagnosis between these two health conditions. Future research should use the feedback to improve the design of the application and increase perceived acceptability of the approach

    Interdisciplinarity as a political instrument of governance and its consequences for doctoral training

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    UK educational policies exploit interdisciplinarity as a marketing tool in a competitive educational world by building images of prosperous futures for society, the economy, and universities. Following this narrative, interdisciplinary science is promoted as superior to disciplinary forms of research and requires the training of future researchers accordingly, with interdisciplinary doctoral education becoming more established in universities. This emphasis on the growth of interdisciplinary science polarises scholars’ views on the role of academic research between the production of knowledge on the one hand and knowledge as an economic resource at the other end of the spectrum. This research asks: what is the rationale behind the perceived value of interdisciplinary research and training, and how does it affect graduate students’ experiences of their PhD? Based on a practice theory perspective for its suitability in generating insights into how university’s social life is organised, reproduced and transformed, the doctorate is conceptualised as sets of interconnected practices that are observable as they happen. This current study, therefore, comprised two stages of data collection and analysis; the examination of documents to elucidate educational policy practices and an educational ethnography of an interdisciplinary doctoral programme. This study found interdisciplinary doctoral training is hindered by the lack of role models and positive social relationships, which are crucial to the way interdisciplinary students learn. Furthermore, it is argued that interdisciplinarity is sometimes applied to research as a label to fit with funders’ requirements. Specifically, in this case, medical optical imaging is best seen as an interdiscipline as it does not exhibit true interdisciplinary integration. Further insights show that while interdisciplinarity is promoted in policy around promises and expectations for a better future, it is in tension with how it is organisationally embedded in higher education. These insights form the basis for a list of practical recommendations for institutions. Overall, interdisciplinary doctoral training was observed to present students with difficulties and to leave policy concerns unaddressed

    FIRST NATIONS LED MENTAL HEALTH RECOVERY IN THE FACE OF ENVIRONMENTAL AND FLOODING JEOPARDY

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    Understanding the factors influencing mental and social health after extreme weather events or incremental climate change is crucial to addressing these issues on First Nation reserves in the Canadian prairies. Previous research on an international level has linked climate change to effects on mental health for general populations but, within a First Nations context, the literature base is severely lacking. What little the literature does indicate, however, is that policy in Canada is failing to prevent physical and mental harm to First Nations people from anthropogenically-driven environmental and climate change when compared with general populations. Using interdisciplinary and mixed methodologies, this thesis explores the academic literature linking climate change, disasters, and weather events, and mental health effects, defines and explores environmental mismanagement affecting reserve land, and critically assesses the colonial policies and circumstances that affect First Nations mental health outcomes. The objectives of the present research are executed through systematic review, and qualitative analysis of first-hand experience with flood recovery. The direction of this research is informed by partnerships with Yellow Quill First Nation and James Smith Cree Nation in Saskatchewan. This thesis forms a better understanding of the circumstances of mental health issues in an environmental context and ultimately places itself to inform policy that can reduce environment-related mental health issues in First Nations reserve communities based on an interdisciplinary and community-driven exploration of First Nations led disaster planning, mental health recovery, and environmental management

    Cultural Health Literacy: A Case Study of Somali Refugee\u27s Information-Seeking Behavior and Health Communication Praxis

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    This case study examines Somalian refugees who have sought health information from a trusted source and how it affected their health decision. Health literacy, the ability to find, understand, and use health information and make health decisions, is an understood barrier to achieving optimal health. Social determinants affect an individual’s ability to access and appropriately use the information for decision-making. The communication inequality theory states that health disparities occur when communication inequalities transpire across the communication continuum, and inequitable access to learning manifests within specific individuals or groups. Research data was collected using a sociodemographic and SNS use questionnaire and interviews. The findings were analyzed using a spiral analysis process. Data analysis determined four themes and eight subthemes answering the CRQ and SRQs. Information access, information processing, source trust, and decision-making themes guided the research findings and implications. This study showed that those with more education and who were proficient in English had more access to mediating communication factors, allowing them to intentionally look for and understand health information to gain knowledge to make an informed health decision

    Screening, risk stratification, and management of atrial fibrillation

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    Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with high morbidity and mortality. Major improvements have been made in the diagnosis and management of AF in the past two decades. However, important questions pertaining to the screening, prognosis, risk stratification, and management of AF remain unanswered. This thesis presents original studies addressing knowledge gaps in these aspects of AF. In Chapter 2, using a large cohort of individuals from the UK Biobank, we investigated the association between lung function and incident AF. We observed that reduced ventilatory function was associated with increased risk of AF independently of age, sex, smoking, and several other known AF risk factors. This suggests that individuals with substantial reduction of their lung function might represent an appropriate population for targeted AF screening and ventilatory parameters might improve AF risk prediction. Chapter 3 assesses data related to implantable cardiac monitors (ICM). The first section reports AF diagnostic yield in a real-world cohort of patients receiving prolonged cardiac monitoring with ICM for stroke and unexplained syncope. It indicates that patients with stroke or transient ischemic attack (TIA) have a higher rate of AF detection compared with patients with unexplained syncope. However, this real-world study shows AF detection rates following stroke significantly lower than what has been previously reported. The second section of this chapter summarizes data on AF detection rates across different rhythm monitoring strategies (non-invasive and ICM) in patients with cryptogenic stroke (CS) or embolic stroke of undetermined source (ESUS). It shows that the yield of ICM increases with the duration of monitoring; more than a quarter of patients with CS or ESUS will be diagnosed with AF during follow-up. About one in seven patients have AF detected within a month of mobile cardiac outpatient telemetry, suggesting that a non-invasive rhythm monitoring strategy should be considered before invasive monitoring. Chapters 4 and 5 address risk stratification in patients with AF. Chapter 4 has two sections. The first section is a meta-analysis that comprehensively summarizes data from prospective cohort studies on clinical predictors of stroke in anticoagulant-naïve patients with AF. It shows that although weighted similarly in most risk stratification schemes such as the CHA2DS2-VASc score, the absolute risk of stroke attributable to hypertension, diabetes, vascular disease, and heart failure may not be the same in individual patients. Furthermore, it shows that female sex seems not to be universally associated with stroke or systemic embolism, suggesting that the decision to initiate oral anticoagulation should not be made on the sole basis of female sex as currently recommended by some scientific societies. By compiling evidence from various studies, the second section of this chapter demonstrates that some anatomic and functional cardiac imaging parameters are associated with stroke in patients with AF and therefore, might improve stroke risk stratification in these patients. Chapter 5 presents two systematic reviews and meta-analysis which show that AF and carotid artery disease frequently co-exist, with about one in ten patients with AF who has carotid stenosis, and vice versa; and non-stenotic carotid disease being much more frequent. Moreover, there is an association between carotid atherosclerosis and the risk of stroke in patients with AF, suggesting that the incorporation of carotid atherosclerosis and characteristics of carotid plaques into scoring systems might improve stroke prediction in patients with AF. Taking this further, the last section of this chapter investigates the potential added value of high-risk carotid plaques on stroke risk stratification compared to the classical CHA₂DS₂-VASc score in a prospective cohort of patients with AF. It shows a low prevalence (5.5%) of moderate to severe carotid stenosis (≥ 50%), whereas one in three participants have carotid plaques considered vulnerable or high-risk. Neither the degree of carotid stenosis nor the presence of vulnerable plaques is associated with incident ischemic stroke, suggesting that carotid disease is probably not an important cause of ischemic stroke in this group of patients with AF and therefore, vulnerable carotid plaques might not improve stroke risk stratification in patients with AF. Chapter 6 presents two pooled analyses of data on the prognostic impact of AF on acute coronary syndromes (ACS) and acute pulmonary embolism (aPE). The first section of the chapter shows that AF is common in patients with ACS (one in nine) and that it (especially newly diagnosed AF) is associated with poor short-term and long-term outcomes including re-infarction, heart failure, stroke, acute kidney injury, heart failure, major bleeding, and death. Likewise, the second section of the chapter demonstrates that AF is frequent in patients with aPE (one in eight) and is associated with increased short-term and long-term mortality. Considering this strong prognostic impact of AF in patients with ACS and aPE, its incorporation into risk stratification schemes for these patients should be considered. Furthermore, considering the significant incidence of AF in patients with ACS and aPE, studies are needed to determine the appropriate rhythm monitoring strategies in these patients. Chapters 7-9 focus on sex differences in the management of AF. Chapter 7 analyses data from 142 randomized controlled trials (RCTs) of AF published in top tiers cardiovascular journals and shows that despite recent progress, females remain substantially less represented in RCTs of AF. This raises concern about the generalizability of these trials and the validity of the evidence guiding the treatment of females. Furthermore, primary outcomes are infrequently reported by sex in these RCTs of AF. Considering established benefit of risk factor modification on outcomes in patients with AF, Chapter 8 assesses sex differences in weight-loss, cardiorespiratory fitness gain, and progression and recurrence of AF in patients undergoing aggressive risk factor modification. It shows that despite sex differences in some baseline characteristics, the benefits of weight-loss and fitness gain were favourable for both males and females. However, improvement in fitness had a much greater benefit for total arrhythmia freedom for females, whereas there was a trend towards more common regression from persistent to paroxysmal AF in males. These findings reinforce the need to address lifestyle risk factors to minimize arrhythmia recurrence and reduce symptom severity for all individuals. Finally, Chapter 9 investigates the impact of sex on the clinical profile, utilization of rhythm control therapies, in-hospital mortality, length of stay (LOS), and cost of hospitalization in patients admitted for AF in the United States. It shows similarities and disparities in risk factors for mortality between males and females, and that unlike what has been reported in several previous studies, although women had a relatively higher mortality rate, after risk adjustment, female sex was not a predictor of mortality.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 02

    Graduate Catalog of Studies, 2022-2023

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    One Small Step for Generative AI, One Giant Leap for AGI: A Complete Survey on ChatGPT in AIGC Era

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    OpenAI has recently released GPT-4 (a.k.a. ChatGPT plus), which is demonstrated to be one small step for generative AI (GAI), but one giant leap for artificial general intelligence (AGI). Since its official release in November 2022, ChatGPT has quickly attracted numerous users with extensive media coverage. Such unprecedented attention has also motivated numerous researchers to investigate ChatGPT from various aspects. According to Google scholar, there are more than 500 articles with ChatGPT in their titles or mentioning it in their abstracts. Considering this, a review is urgently needed, and our work fills this gap. Overall, this work is the first to survey ChatGPT with a comprehensive review of its underlying technology, applications, and challenges. Moreover, we present an outlook on how ChatGPT might evolve to realize general-purpose AIGC (a.k.a. AI-generated content), which will be a significant milestone for the development of AGI.Comment: A Survey on ChatGPT and GPT-4, 29 pages. Feedback is appreciated ([email protected]

    Multilevel governance and control of the Covid-19 pandemic in the Democratic Republic of Congo: Learning from the four first waves

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    The COVID-19 pandemic continues to impose a heavy burden on people around the world. The Democratic Republic of the Congo (DRC) has also been affected. The objective of this study was to explore national policy responses to the COVID-19 pandemic in the DRC and drivers of the response, and to generate lessons for strengthening health systems’ resilience and public health capacity to respond to health security threats. This was a case study with data collected through a literature review and in-depth interviews with key informants. Data analysis was carried out manually using thematic content analysis translated into a logical and descriptive summary of the results. The management of the response to the COVID-19 pandemic reflected multilevel governance. It implied a centralized command and a decentralized implementation. The centralized command at the national level mostly involved state actors organized into ad hoc structures. The decentralized implementation involved state actors at the provincial and peripheral level including two other ad hoc structures. Non-state actors were involved at both levels

    Patenting Genetic Information

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    The U.S. biotechnology industry got its start and grew to maturity over roughly three decades, beginning in the 1980s. During this period genes were patentable, and many gene patents were granted. University researchers performed basic research— often funded by the government—and then patented the genes they discovered with the encouragement of the Bayh-Dole Act, which sought to encourage practical applications of basic research by allowing patents on federally funded inventions and discoveries. At that time, when a researcher discovered the function of a gene, she could patent it such that no one else could work with that gene in the laboratory without a license. She had no right, however, to control genes in nature, including in human bodies. Universities licensed their researchers’ patents to industry, which brought in significant revenue for further research. University researchers also used gene patents as the basis for obtaining funding for start-up enterprises spun out of university labs. It was in this environment that many of today’s biotechnology companies started. In 2013, the Supreme Court held that naturally occurring genes could no longer be patented. This followed a 2012 decision that disallowed patents on many diagnostic processes. These decisions significantly changed the intellectual property protections in the biotechnology industry. Nevertheless, the industry has continued to grow and thrive. This Article investigates two questions. First, if some form of exclusive rights still applied to genes, would the biotech industry be even more robust, with more new entrants in addition to thriving, well-established companies? Second, does the current lack of protection for gene discoveries incentivize keeping such discoveries secret for the many years that it can take to develop a therapeutic based thereon—to the detriment of patients who could benefit from knowledge of the genetic associations, even before a treatment is developed? The Article concludes by analyzing what protection for discovering genetic associations, if any, will most increase social welfare
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