A perspective on trends in Australian government spending

This paper provides a summary of trends in government spending, revealing strong growth in government spending and the size of government, particularly over the past four years. It also discusses the distribution and sustainability of spending and notes the importance of high quality spending and flexibility in resource allocation in responding to future pressures

The Continuum of Lens through Which Teachers View Cultural Differences: How Perceptions Impact Pedagogy

This paper describes a study conducted in a school district that experienced a significant shift in student demographics. As this shift parallels a national increase of immigrants in public schools, the study explored teachers’ perceptions of students’ cultural differences and how these differences impact their own pedagogy. The authors propose a Cultural Lens Continuum as a metaphorical heuristic structure for making meaning of the differing participating teachers’ views (i.e., microscopic, telescopic, panoramic, and holographic). This continuum aligns with existing research on culturally relevant pedagogy, in that the type of lens one possesses indicates the level of responsiveness to and adoption of culturally relevant pedagogy

Risk factors for developing acute kidney injury in older people with diabetes and community-acquired pneumonia: a population-based UK cohort study.

BACKGROUND: Acute kidney injury (AKI) is being increasingly recognised in ageing populations. There are a paucity of data about AKI risk factors among older individuals with diabetes and infections, who are at particularly high risk of AKI. The objective of this study was to evaluate the risk factors for developing acute kidney injury (AKI) amongst older patients with diabetes and community-acquired pneumonia (CAP) in England, and whether the impact of underlying kidney function varied with age. METHODS: This was a population-based retrospective cohort study over 7 years (01/04/2004-31/3/2011) using electronic health records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. The study population comprised individuals with diabetes aged ≥65 years with CAP. Associations between demographic, lifestyle factors, co-morbidities and medications and development of AKI within 28 days of CAP were explored in a logistic regression model. RESULTS: Among 3471 patients with CAP and complete covariate data, 298 patients developed subsequent AKI. In multivariable analyses, factors found to be independently associated with AKI included: male sex (adjusted odds ratio, aOR: 1.56 95% confidence interval (CI): 1.20-2.04), hypertension (aOR1.36 95% CI 1.01-1.85), being prescribed either angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor-blockers (aOR: 1.59 95% CI: 1.19-2.13), or insulin (aOR: 2.27 95% CI: 1.27-4.05), presence of proteinuria (aOR 1.27 95% CI 0.98-1.63), and low estimated glomerular filtration rate (eGFR). The odds of AKI were more graded amongst older participants aged ≥80 years compared to those of younger age: for eGFR of ≤29 mL/min/1.73m2 (vs 60 ml/min/1.73m2) aOR: 5.51 95% CI 3.28-9.27 and for eGFR 30-59 mL/min/1.73m2 1.96 95% CI 1.30-2.96, whilst any eGFR < 60 ml/min/1.73m2 was associated with approximately 3-fold increase in the odds of AKI amongst younger individuals (p-value for interaction = 0.007). CONCLUSIONS: The identified risk factors should help primary care and hospital providers identify high risk patients in need of urgent management including more intensive monitoring, and prevention of AKI following pneumonia

Prevalence, incidence, indication, and choice of antidepressants in patients with and without chronic kidney disease: a matched cohort study in UK Clinical Practice Research Datalink.

PURPOSE: People with chronic kidney disease (CKD) have an increased prevalence of depression, anxiety, and neuropathic pain. We examined prevalence, incidence, indication for, and choice of antidepressants among patients with and without CKD. METHODS: Using the UK Clinical Practice Research Datalink, we identified patients with CKD (two measurements of estimated glomerular filtration rate < 60 mL/min/1.73m2 for ≥3 months) between April 2004 and March 2014. We compared those with CKD to a general population cohort without CKD (matched on age, sex, general practice, and calendar time [index date]). We identified any antidepressant prescribing in the six months prior to index date (prevalence), the first prescription after index date among non-prevalent users (incidence), and recorded diagnoses (indication). We compared antidepressant choice between patients with and without CKD among patients with a diagnosis of depression. RESULTS: There were 242 349 matched patients (median age 76 [interquartile range 70-82], male 39.3%) with and without CKD. Prevalence of antidepressant prescribing was 16.3 and 11.9%, and incidence was 57.2 and 42.4/1000 person-years, in patients with and without CKD, respectively. After adjusting for confounders, CKD remained associated with higher prevalence and incidence of antidepressant prescription. Regardless of CKD status, selective serotonin reuptake inhibitors were predominantly prescribed for depression or anxiety, while tricyclic antidepressants were prescribed for neuropathic pain or other reasons. Antidepressant choice was similar in depressed patients with and without CKD. CONCLUSIONS: The rate of antidepressant prescribing was nearly one and a half times higher among people with CKD than in the general population. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd

Methodological challenges when carrying out research on CKD and AKI using routine electronic health records.

Research regarding chronic kidney disease (CKD) and acute kidney injury (AKI) using routinely collected data presents particular challenges. The availability, consistency, and quality of renal data in electronic health records has changed over time with developments in policy, practice incentives, clinical knowledge, and associated guideline changes. Epidemiologic research may be affected by patchy data resulting in an unrepresentative sample, selection bias, misclassification, and confounding by factors associated with testing for and recognition of reduced kidney function. We systematically explore the issues that may arise in study design and interpretation when using routine data sources for CKD and AKI research. First, we discuss how access to health care and management of patients with CKD may have an impact on defining the target population for epidemiologic study. We then consider how testing and recognition of CKD and AKI may lead to biases and how to potentially mitigate against these. Illustrative examples from our own research within the UK are used to clarify key points. Any research using routine renal data has to consider the local clinical context to achieve meaningful interpretation of the study findings

COVID-19 vaccines and autoimmune disorders: A scoping review protocol

&lt;abstract&gt; &lt;p&gt;Two years into the global vaccination campaign, important questions about COVID-19 vaccines and autoimmune disorders have arisen. A growing number of reports have documented associations between vaccination and autoimmunity, and research is needed to elucidate the nature of these linkages as well as the mechanisms and causal directions (i.e., whether persons with no history of autoimmune disorders may experience them upon vaccination or persons with autoimmune disorders may experience exacerbation or new adverse events, autoimmune or not, post-vaccination). This scoping review will follow Arksey and O'Malley's framework, which is enhanced by Levac et al.'s team-based approach, to address the relationship between COVID-19 vaccinations and autoimmune disorders. Moreover, it will explore the evidence informing the consensus of care concerning COVID-19 vaccinations in people experiencing these disorders. Data from refereed articles and preprints will be synthesized through a thematic analysis. A subgroup analysis will compare the findings according to the previous existence of autoimmune disorders, presence of co-morbidities, vaccine type, and other potentially relevant factors. COVID-19 has triggered the largest vaccination campaign in history. Drug safety is critical to properly assess the balance of risks and benefits of any medical intervention. Our investigation should yield information useful to assist in clinical decision-making, policy development, and ethical medical practices.&lt;/p&gt; &lt;/abstract&gt

Successful provision of inter-hospital extracorporeal cardiopulmonary resuscitation for acute post-partum pulmonary embolism

Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived. Following ECMO support, the patient experienced massive hemorrhage which was managed with uterotonic agents, targeted transfusion, bilateral uterine artery embolisation and abdominal re-exploration. The patient was transferred to an adult unit where she remained on ECMO for five days. She was discharged home with normal cognitive function. This case highlights the role ECMO plays in providing extracorporeal respiratory or mechanical circulatory support in a high risk obstetric patient

Protein lipograms

Linguistic analysis of protein sequences is an underexploited technique. Here, we capitalize on the concept of the lipogram to characterize sequences at the proteome levels. A lipogram is a literary composition which omits one or more letters. A protein lipogram likewise omits one or more types of amino acid. In this article, we establish a usable terminology for the decomposition of a sequence collection in terms of the lipogram. Next, we characterize Uniref50 using a lipogram decomposition. At the global level, protein lipograms exhibit power-law properties. A clear correlation with metabolic cost is seen. Finally, we use the lipogram construction to assign proteomes to the four branches of the tree-of-life: archaea, bacteria, eukaryotes and viruses. We conclude from this pilot study that the lipogram demonstrates considerable potential as an additional tool for sequence analysis and proteome classification

High-spectral-resolution Observations of the Optical Filamentary Nebula Surrounding NGC 1275

We present new high-spectral-resolution observations (R = λ/Δλ = 7000) of the filamentary nebula surrounding NGC 1275, the central galaxy of the Perseus cluster. These observations have been obtained with SITELLE, an imaging Fourier transform spectrometer installed on the Canada–France–Hawai Telescope with a field of view of 11′×11′ , encapsulating the entire filamentary structure of ionized gas despite its large size of 80 kpc × 50 kpc. Here, we present renewed fluxes, velocities, and velocity dispersion maps that show in great detail the kinematics of the optical nebula at [S ii] λ6716, [S ii] λ6731, [N ii] λ6584, Hα (6563 Å), and [N ii] λ6548. These maps reveal the existence of a bright flattened disk-shaped structure in the core extending to r ∼10 kpc and dominated by a chaotic velocity field. This structure is located in the wake of X-ray cavities and characterized by a high mean velocity dispersion of 134 km s−1. The disk-shaped structure is surrounded by an extended array of filaments spread out to r ∼ 50 kpc that are 10 times fainter in flux, remarkably quiescent, and have a uniform mean velocity dispersion of 44 km s−1. This stability is puzzling given that the cluster core exhibits several energetic phenomena. Based on these results, we argue that there are two mechanisms that form multiphase gas in clusters of galaxies: a first triggered in the wake of X-ray cavities leading to more turbulent multiphase gas and a second, distinct mechanism, that is gentle and leads to large-scale multiphase gas spreading throughout the core