Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003-2015

Objective: High use of CT scanning has raised concern due to the potential ionising radiation exposure. This study examined trends of CT during admission to tertiary hospitals and its associations with length of stay (LOS), readmission and mortality. Design Retrospective observational study from 2003 to 2015. Setting: West Australian linked administrative records at individual level. Participants: 2 375 787 episodes of tertiary hospital admission in adults aged 18+ years. Main outcome measures: LOS, 30-day readmissions and mortality stratified by CT use status (any, multiple (CTs to multiple areas during episode), and repeat (repeated CT to the same area)). Methods: Multivariable regression models were used to calculate adjusted rate of CT use status. The significance of changes since 2003 in the outcomes (LOS, 30-day readmission and mortality) was compared among patients with specific CT imaging status relative to those without. Results: Between 2003 and 2015, while the rate of CT increased 3.4% annually, the rate of repeat CTs significantly decreased −1.8% annually and multiple CT showed no change. Compared with 2003 while LOS had a greater decrease in those with any CT, 30- day readmissions had a greater increase among those with any CT, while the probability of mortality remained unchanged between the any CT/no CT groups. A similar result was observed in patients with multiple and repeat CT scanning, except for a significant increase in mortality in the recent years in the repeat CT group. Conclusion: The observed pattern of increase in CT utilisation is likely to be activity-based funding policydriven based on the discordance between LOS and readmissions. Meanwhile, the repeat CT reduction aligns with a more selective strategy of use based on clinical severity. Future research should incorporate in-hospital and out-of-hospital CT to better understand overall CT trends and potential shifts between settings over time.Thi Ninh Ha, Sviatlana Kamarova, David Youens, Cameron Wright, Donald McRobbie, Jenny Doust, John Slavotinek, Max K Bulsara, Rachael Moori

Antiplatelet use in ischemic stroke

Objective: A literature review of antiplatelet agents for primary and secondary stroke prevention, including mechanism of action, cost, and reasons for lack of benefit. Data sources: Articles were gathered from MEDLINE, Cochrane Reviews, and PubMed databases (1980-2021). Abstracts from scientific meetings were considered. Search terms included ischemic stroke, aspirin, clopidogrel, dipyridamole, ticagrelor, cilostazol, prasugrel, glycoprotein IIb/IIIa inhibitors. Study selection and data extraction: English-language original and review articles were evaluated. Guidelines from multiple countries were reviewed. Articles were evaluated independently by 2 authors. Data synthesis: An abundance of evidence supports aspirin and clopidogrel use for secondary stroke prevention. In the acute phase (first 21 days postinitial stroke), these medications have higher efficacy for preventing further stroke when combined, but long-term combination therapy is associated with higher hemorrhage rates. Antiplatelet treatment failure is influenced by poor adherence and genetic polymorphisms. Antiplatelet agents such as cilostazol may provide extra benefit over clopidogrel and aspirin, in certain racial groups, but further research in more diverse ethnic populations is needed. Relevance to patient care and clinical practice: This review presents the data available on the use of different antiplatelet agents poststroke. Dual therapy, recurrence after initiation of secondary preventative therapy, and areas for future research are discussed. Conclusions: Although good evidence exists for the use of certain antiplatelet agents postischemic stroke, there are considerable opportunities for future research to investigate personalized therapies. These include screening patients for platelet polymorphisms that confer antiplatelet resistance and for randomized trials including more racially diverse populations

Patterns of computed tomography utilisation in injury management: latent classes approach using linked administrative data in Western Australia

Published online: 15 June 2023. OnlinePublPurpose: Whilst computed tomography (CT) imaging has been a vital component of injury management, its increasing use has raised concern regarding ionising radiation exposure. This study aims to identify latent classes (underlying patterns) of CT use over a 3-year period following the incidence of injury and factors predicting the observed patterns. Method: A retrospective observational cohort study was conducted in 21,544 individuals aged 18 + years presenting to emergency departments (ED) of four tertiary public hospitals with new injury in Western Australia. Mixture modelling approach was used to identify latent classes of CT use over a 3-year period post injury. Results: Amongst injured people with at least one CT scan, three latent classes of CT use were identified including a: temporarily high CT use (46.4%); consistently high CT use (2.6%); and low CT use class (51.1%). Being 65 + years or older, having 3 + comorbidities, history with 3 + hospitalisations and history of CT use before injury were associated with consistently high use of CT. Injury to the head, neck, thorax or abdomen, being admitted to hospital after the injury and arriving to ED by ambulance were predictors for the temporarily high use class. Living in areas of higher socio-economic disadvantage was a unique factor associated with the low CT use class. Conclusions: Instead of assuming a single pattern of CT use for all patients with injury, the advanced latent class modelling approach has provided more nuanced understanding of the underlying patterns of CT use that may be useful for developing targeted interventions.Ninh T. Ha, Mark Harris, Max Bulsara, Jenny Doust, Sviatlana Kamarova, Donald McRobbie, Peter O, Leary, Paul M. Parizel, John Slavotinek, Cameron Wright, David Youens, Rachael Moori

THE IMAGE OF THE MOTHERLAND IN THE POETRY OF FARIZA ONGARSYNOVA: Received: 04th October 2021; Revised: 09th January 2022, 23th February 2022, 25th February 2022; Accepted: 26th February 2022

The article examines the image of the Motherland in the poetry of the Kazakh famous poetess Fariza Ongarsynova. Here is revealed the connection of poetess’s poems with folklore works. It is argued that Mangystau, the poetess’s small homeland, is the source of her poetic inspiration. The idea is substantiated that the image of a small homeland occupies a special place in the work of the Kazakh poetess. It is also noted that the lyrical hero of the poetess's works feels like a part of his native land, its nature and destiny. Thanks to the study of the characteristic poetic feature of Fariza Ongarsynova, it is possible to recognize her poetic skill. Artistic individuality, ideological and thematic themes of poetry, contribution to the national artistic tradition, the corresponding place and figurative character occupied in modern Kazakh poetry will be studied

Editorial: Current Perspectives on Social Comparisons and Their Effects

[No abstract available

Effects of achievement goals on perceptions of competence in conditions of unfavourable social comparisons: The mastery goal advantage effect

Background: Previous prospective studies have documented that mastery-approach goals are adaptive because they facilitate less negative psychological responses to unfavourable social comparisons than performance-approach goals. Aims: This study aimed to confirm this so-called ‘mastery goal advantage’ effect experimentally. Methods: A 2 × 3 design was adopted where achievement goals (mastery vs. performance) and normative information (favourable vs. no-normative information vs. unfavourable) were manipulated as between participant factors. Sample: Participants were 201 undergraduates, 57 males and 144 females, ranging in age from 17 to 55 years (Mage = 22.53, SD = 6.51). Results: Regression analyses pointed out that experimentally induced mastery-approach goals facilitated higher levels of competence and happiness with task performance than experimentally induced performance-approach goals in conditions of unfavourable social comparisons. In contrast, although performance-approach goals yielded the highest levels of happiness with task performance in conditions of favourable social comparisons, this positive effect of performance-approach goals did not extend to perceptions of competence. Conclusion: Current findings broaden understanding of the adaptive nature of mastery-approach goals and suggest that it is possible to modulate aversive responses to unfavourable social comparisons by focusing attention on mastery-approach goals. © 2017 The British Psychological Societ

Developing and evaluating utility of school-based intervention programs in promoting leisure-time physical activity: An application of the theory of planned behavior

Building upon tenets of the theory of planned behavior, the present study examined whether school-based intervention programs that aimed to change attitudes, perceptions of control, or both attitudes and perceptions of control in combination, was successful in promoting participation in leisure time physical activities. Participants were 1372 pupils recruited from 10 secondary schools and exercised for less than 3-days per week in the previous month. Using a cluster-randomized design, participants were presented with one of the intervention conditions each lasting 10 minutes delivered as part of physical education classes twice per week over a period of 8 weeks. The interventions included: (i) an attitude-based intervention that targeted salient behavioral beliefs; (ii) a second attitude-based intervention that targeted non-salient behavioral beliefs; (iii) a control-based intervention program that targeted salient control beliefs; and (iv) a combined intervention program that targeted both salient control beliefs and salient behavioral beliefs. Results indicated that while all of the intervention programs resulted in increased participation in leisure time physical activity, the combined intervention program targeting change in attitudes and perceptions of control was least effective. Overall, the findings suggest that schools and teachers can promote leisure time physical activity through brief cost-effective interventions

Improving the Efficiency of the Coal Grinding Process in Ball Drum Mills at Thermal Power Plants

Ensuring the reliable operation of the dust fuel preparation system at thermal power plants (TPP) is a topical issue since it determines the energy strategy of any country that fires coals for thermal energy production. This unit is one of the most energy-intensive units in TPP. Those systems are outdated, poorly automated and high energy-intensive. Furthermore, they must ensure efficient and safe operation of the facility while being environmentally friendly. The current work focuses on the process of grinding coals in ball drum mills for further pulverized combustion. An experimental study was performed in order to determine the main factors (rotational speed of the drum mill, the degree of loading with the grinding balls, and the velocity of the supplied air) that affect the efficiency of the fuel preparation system. The obtained experimental data and performed mathematical modeling resulted in regression equations describing the energy performance of the mill. Three regression equations for mill productivity, power consumed, and specific surface area of the final product were obtained and validated. The study reveals that the lowest specific energy consumption is achieved when the relative rotational speed of the mill is between 0.81 and 0.87; the weighted average diameter of the balls ranges from 33.5 up to 34.5 mm; the load factor of the grinding media ranges from 0.325 up to 0.335, the supplied air velocity is between 0.2 and 0.3 m/s. The proposed methodology allows adjustment of the operating parameters of the grinding process to achieve the lowest energy consumption. The power consumption for the preparation can be reduced up to 5 % for the selected operation mode of the grinding facility

Adolescents' self-determination profiles in physical education: Introjection and its implications

An important outcome of the teaching-learning process in physical education is a physically active student who also demonstrates the intention to be active outside of the school context and/or after graduation. Students typically have multiple and simultaneous motives for behaviour that collectively determine the overall quality of their motivation. As such, the purpose of this study was to examine the behavioural regulations of Singapore junior college students and determine their distinctive motivational profiles. The results offered support for the notion that moving towards autonomous forms of behavioural regulation was advisable for higher levels of intention and sustained adherence to physical activity, since they were likely to involve stronger feelings of personal investment, autonomy and self-identification. The effects of high introjection scores on physical activity intention and physical activity levels were highlighted and discussed in this study