Liver transplant recipients’ experiences and perspectives of a telehealth-delivered lifestyle programme A qualitative study

Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25-68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) 'broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) 'impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) 'adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) 'increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. Discussion A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations

The Influence of Medicare Home Health Payment Incentives: Does Payer Source Matter?

During the late 1990s, an interim payment system (IPS) was instituted to constrain Medicare home health care expenditures. Previous research has largely focused on the implications of the IPS for Medicare patients, but our study broadens the analysis to consider patients with other payer sources. Using the National Home and Hospice Care Survey, we found similar effects of the IPS across payer types. Specifically, the IPS was associated with a decrease in access to care for the sickest patients, less agency assistance with activities of daily living, and shorter length-of-use. However, these changes did not translate into worse discharge outcomes.Medicare, health, incentives

The Journey to R4D: An institutional history of an Australian Initiative on Food Security in Africa

Internal Revie

Disruption of female reproductive function by endotoxins

Endotoxemia can be caused by obesity, environmental chemical exposure, abiotic stressors, and bacterial infection. Circumstances that deleteriously impact intestinal barrier integrity can induce endotoxemia and controlled experiments have identified negative impacts of lipopolysaccharide (LPS; an endotoxin mimetic) on folliculogenesis, puberty onset, estrus behavior, ovulation, meiotic competence, luteal function and ovarian steroidogenesis. In addition, neonatal LPS exposures have transgenerational female reproductive impacts, raising concern about early life contacts to this endogenous reproductive toxicant. Aims of this review are to identify physiological stressors causing endotoxemia, to highlight potential mechanism(s) by which LPS compromises female reproduction, and identify knowledge gaps regarding how acute and/or metabolic endotoxemia influence(s) female reproduction

How much do disasters cost? A comparison of disaster cost estimates in Australia

Extreme weather events in Australia are common and a large proportion of the population are exposed to such events. Therefore, there is great interest as to how these events impact Australia's society and economy, which requires understanding the current and historical impact of disasters. Despite global efforts to record and cost disaster impacts, no standardised method of collecting and recording data retrospectively yet exists. The lack of standardisation in turn results in a range of different estimates of economic impacts. This paper examines five examples of aggregate disaster loss and impacts of natural disasters in Australia, and comparisons between them reveal significant data shortcomings. The reliability of data sources, and the methodology employed to analyse them can have significant impacts on conclusions regarding the overall cost of disasters, the relative costs of different hazards (disaster types), and the distribution of losses across Australian states. We highlight difficulties with time series comparisons, further complicated by the interdependencies of the databases. We reiterate the need for consistent and comparable data collection and analysis, to respond to the increasing frequency and severity of disasters in Australia

Europe as a multilevel federation

Peer reviewedPublisher PD

Separating E and B types of polarization on an incomplete sky

Detection of magnetic-type ($B$-type) polarization in the Cosmic Microwave Background (CMB) radiation plays a crucial role in probing the relic gravitational wave (RGW) background. In this paper, we propose a new method to deconstruct a polarization map on an incomplete sky in real space into purely electric and magnetic polarization type maps, ${\mathcal{E}}(\hat{\gamma})$ and ${\mathcal{B}}(\hat{\gamma})$, respectively. The main properties of our approach are as follows: Firstly, the fields ${\mathcal{E}}(\hat{\gamma})$ and ${\mathcal{B}}(\hat{\gamma})$ are constructed in real space with a minimal loss of information. This loss of information arises due to the removal of a narrow edge of the constructed map in order to remove various numerical errors, including those arising from finite pixel size. Secondly, this method is fast and can be efficiently applied to high resolution maps due to the use of the fast spherical harmonics transformation. Thirdly, the constructed fields, ${\mathcal{E}}(\hat{\gamma})$ and ${\mathcal{B}}(\hat{\gamma})$, are scalar fields. For this reason various techniques developed to deal with temperature anisotropy maps can be directly applied to analyze these fields. As a concrete example, we construct and analyze an unbiased estimator for the power spectrum of the $B$-mode of polarization $C_{\ell}^{BB}$. Basing our results on the performance of this estimator, we discuss the RGW detection ability of two future ground-based CMB experiments, QUIET and POLARBEAR.Comment: 43 pages, 15 figures, 1 table. The finial version, will appear in PR

COMPASS: a 2.6m telescope for CMBR polarization studies

COMPASS (COsmic Microwave Polarization at Small Scale) is an experiment devoted to measuring the polarization of the CMBR. Its design and characteristics are presented

The de Morton Mobility Index (DEMMI): An essential health index for an ageing world

BACKGROUND: Existing instruments for measuring mobility are inadequate for accurately assessing older people across the broad spectrum of abilities. Like other indices that monitor critical aspects of health such as blood pressure tests, a mobility test for all older acute medical patients provides essential health data. We have developed and validated an instrument that captures essential information about the mobility status of older acute medical patients. METHODS: Items suitable for a new mobility instrument were generated from existing scales, patient interviews and focus groups with experts. 51 items were pilot tested on older acute medical inpatients. An interval-level unidimensional mobility measure was constructed using Rasch analysis. The final item set required minimal equipment and was quick and simple to administer. The de Morton Mobility Index (DEMMI) was validated on an independent sample of older acute medical inpatients and its clinimetric properties confirmed. RESULTS: The DEMMI is a 15 item unidimensional measure of mobility. Reliability (MDC(90)), validity and the minimally clinically important difference (MCID) of the DEMMI were consistent across independent samples. The MDC(90) and MCID were 9 and 10 points respectively (on the 100 point Rasch converted interval DEMMI scale). CONCLUSION: The DEMMI provides clinicians and researchers with a valid interval-level method for accurately measuring and monitoring mobility levels of older acute medical patients. DEMMI validation studies are underway in other clinical settings and in the community. Given the ageing population and the importance of mobility for health and community participation, there has never been a greater need for this instrument

Random matrix theory, the exceptional Lie groups, and L-functions

There has recently been interest in relating properties of matrices drawn at random from the classical compact groups to statistical characteristics of number-theoretical L-functions. One example is the relationship conjectured to hold between the value distributions of the characteristic polynomials of such matrices and value distributions within families of L-functions. These connections are here extended to non-classical groups. We focus on an explicit example: the exceptional Lie group G_2. The value distributions for characteristic polynomials associated with the 7- and 14-dimensional representations of G_2, defined with respect to the uniform invariant (Haar) measure, are calculated using two of the Macdonald constant term identities. A one parameter family of L-functions over a finite field is described whose value distribution in the limit as the size of the finite field grows is related to that of the characteristic polynomials associated with the 7-dimensional representation of G_2. The random matrix calculations extend to all exceptional Lie groupsComment: 14 page