“Write My Story Before I Forget”: An Auto-Ethnography Of Aboriginal Alcohol Dementia

The diagnosis of Alcohol Dementia and its health implications comes with an uncertain future for the individual and their families. To add to the minimal existing literature on the subject, this auto-ethnography focuses on three generations of Indigenous oral storytelling to re-construct the past of an Anishanabe father to understand his addiction in connection to broader social constructs. Decolonizing methodologies are used in the form of first person experience and connecting research to activism. Alcohol Dementia is examined using Aboriginal social determinants of health to critically discuss the direct affects of intergenerational trauma, uprooting and displacement and flaws within the Canadian health care system. Neo-liberal governmentality within the perception of healthcare professionals towards Alcohol Dementia is analyzed including the lack of support and services for diagnosed individuals and their families, especially in First Nations communities

\u27I Honoured Him Until the End\u27: Storytelling of Indigenous Female Caregivers and Care Providers Focused on Alzheimer\u27s Disease and Other Dementias (ADOD)

Focused on the experiences of Indigenous female caregivers for a loved one diagnosed with Alzheimer’s disease and other dementias (ADOD); this study uses Indigenous methodology of oral storytelling to examine systemic barriers of navigating the Canadian healthcare system. Non-Indigenous healthcare providers who care for families and individuals affected by dementia also share their experiences to give insight to culturally safe care and what institutional supports are needed for frontline staff to achieve this. Indigenous caregivers were all Anishanaabe and Métis who share stories about caring for their male loved ones. Through their stories of strength and resiliency, the importance of family, intergenerational kinship and caregiving with minimal supports are discussed. Themes of jurisdictional barriers, continuity of care, cultural safety, discrimination, self-determination for community programming and funding are examined. Supports and services for seniors with regular substance use is a gap in healthcare that is discussed as a case study because healthcare providers are not addressing it because of ageism and a lack of education. This creates barriers for Indigenous and non-Indigenous seniors for accessing services and supports. Throughout the study, recommendations are provided based on the stories of caregivers and health care providers to inform practice. This shifts the onus from caregivers to healthcare providers to have the knowledge, education and resources to support caregivers and their loved ones on their journey. This research contributes to the lack of existing research focused on Indigenous experiences of caring for a loved one with dementia and works from a social determinants of health framework. The audience for this research is health care providers, thus, resources to support Indigenous and non-Indigenous families affected by dementia are included throughout to improve their practice

CASE 5: A Stakeholder Analysis: Developing an Indigenous-Specific Intercultural Competency Training Module (Part A)

The case focuses on developing an Indigenous-specific intercultural competency training module and outlines the steps needed to achieve this, with particular emphasis on the importance of conducting a stakeholder analysis and developing a stakeholder engagement plan. The protagonist of the case, Nia Singh, heads up the Intercultural Education Program at the Southwestern Ontario Intercultural Education Centre. After working at the organization as an intercultural education specialist for several years, Nia is looking to expand her project portfolio by redesigning the Intercultural Education Program’s pre-existing Indigenous intercultural competency training module. Nia determines the objective of the new training module will be to educate health care workers about the importance of intercultural competency within health care organizations. Specifically, the module will focus on Indigenous populations and will aim to improve the quality of care they receive so their long-term health outcomes ultimately improve. Nia works with her colleague, Steven Miller, to complete a stakeholder analysis and engagement plan, and they use four different steps to accomplish this: 1) brainstorming all possible stakeholders who have a vested interest in the training module; 2) prioritizing and categorizing each stakeholder as a core stakeholder, involved stakeholder, supportive stakeholder, or peripheral stakeholder; 3) determining the level of engagement required for each stakeholder; and 4) determining which engagement strategies to use for each stakeholder. After completing the stakeholder analysis and engagement plan, Nia and Steven arrange to interview the key stakeholders in order to gather additional opinions, ideas, and perspectives related to developing the training module. These stakeholders include health care workers, Indigenous community members, and other relevant informants. Once the interview process is complete, Nia and Steven develop a pilot version of the training module that is ready to be implemented on a small scale. However, Nia and Steven know they still have their work cut out for them in terms of identifying an effective implementation strategy. This case is intended to be a skills practice case with the primary objective of having students learn about conducting a stakeholder analysis and then learn about stakeholder engagement. By examining this case and completing the learning team activity, students will be able to understand the importance of stakeholder analysis and stakeholder engagement as they relate to developing an Indigenous-specific intercultural competency training module. Once students have acquired this knowledge, they will be able to apply stakeholder analyses and engagement strategies to developing a variety of public health programs. However, given that the training module focuses on Indigenous populations, the case will focus on concepts related to health equity and the barriers faced by Indigenous people when they access health care services. A secondary learning objective is for students to acquire knowledge pertaining to intercultural competency, particularly in terms of its significance within the field of public health and how it can be used as a strategy for reducing health disparities for other marginalized populations

CASE 7: Implementation Research: A Strategy for Developing Indigenous-Specific Intercultural Competency Training Programs (Part B)

Nia Singh is an intercultural education specialist and leads the Intercultural Safety Training Program (ISTP) at the Southwestern Ontario Intercultural Education Centre (SOIEC). She has undertaken significant work with the ISTP developing and implementing training sessions and webinars to help clients make their workplace more culturally competent. Nia has recently observed that the ISTP could greatly benefit from including training materials to help health care practitioners provide improved health care to Indigenous patients. Indigenous people face numerous social, political, historical barriers while accessing healthcare services in Canada. Cultural differences can also lead healthcare practitioners to discriminate against their Indigenous patients and consequently, lead to worsening health outcomes (Harfield et al., 2018). Therefore, seeing the need for an Indigenous-specific program aimed at improving the intercultural competence and awareness of health care professionals, Nia contacted relevant stakeholders to help her research and develop a training module. With the background research and stakeholder input complete, Nia is finalizing the training module and delivery plan. She is now faced with the task of optimally implementing the training and assessing the challenges that may arise as the training is disseminated to its intended audience. During the implementation phase of the process, Nia collaborates with prospective clients to ensure the training module is used effectively and successfully fosters important dialogue about health equity and patientcentred care among health care professionals. At the end of the case, Nia decides to collaborate with the Middlesex-London Public Health Unit’s Indigenous Health Coordinator, Vanessa Anderson, to draft an implementation research proposal so she can assess the impact of the new training program and evaluate it as it is disseminated in a practical, real-world setting. This case is intended to provide students practice with contextualizing an implementation research plan so they can assess an Indigenous-specific cultural safety training program through an Indigenous lens. In addition, it will help students consider the value of multiple stakeholder perspectives while implementing these types of programs

Quantifying sources of variability in infancy research using the infant-directed-speech preference

Psychological scientists have become increasingly concerned with issues related to methodology and replicability, and infancy researchers in particular face specific challenges related to replicability: For example, high-powered studies are difficult to conduct, testing conditions vary across labs, and different labs have access to different infant populations. Addressing these concerns, we report on a large-scale, multisite study aimed at (a) assessing the overall replicability of a single theoretically important phenomenon and (b) examining methodological, cultural, and developmental moderators. We focus on infants’ preference for infant-directed speech (IDS) over adult-directed speech (ADS). Stimuli of mothers speaking to their infants and to an adult in North American English were created using seminaturalistic laboratory-based audio recordings. Infants’ relative preference for IDS and ADS was assessed across 67 laboratories in North America, Europe, Australia, and Asia using the three common methods for measuring infants’ discrimination (head-turn preference, central fixation, and eye tracking). The overall meta-analytic effect size (Cohen’s d) was 0.35, 95% confidence interval = [0.29, 0.42], which was reliably above zero but smaller than the meta-analytic mean computed from previous literature (0.67). The IDS preference was significantly stronger in older children, in those children for whom the stimuli matched their native language and dialect, and in data from labs using the head-turn preference procedure. Together, these findings replicate the IDS preference but suggest that its magnitude is modulated by development, native-language experience, and testing procedure. (This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 798658.

Developing Ethical Research Practices Between Institutional and Community Partners: A Look at the Current Base of Literature Surrounding Memorandums of Understanding in Canada

Few institutionalized examples exist wherein Indigenous communities have participated in the co-development of ethics initiatives. This article explores one such process—the Memorandum of Understanding (MOU). A MOU is a document created between institutional and community research partners to outline project guidelines. Based on Canadian MOUs developed between 1980 and 2016, this research has four objectives; (a) to describe current trends of MOU use and recognition in research; (b) to describe the challenges of collaborative research and how MOUs might mitigate them; (c) to understand if a standard MOU is feasible; and (d) to offer policy suggesting for implementing MOUs. Local MOUs mark a way for engaging in good research practices that actually benefit the involved community

Passive drag in Para swimmers with physical impairments: Implications for evidence-based classification in Para swimming.

The inherent hydrodynamic resistance force, or passive drag, of a swimmer directly influences how they move through the water. For swimmers with physical impairments the strength of association between passive drag and swimming performance is unknown. Knowledge on this factor could improve the World Para Swimming classification process. This study established the relationship between passive drag and 100 m freestyle race performance in Para swimmers with physical impairments. Using a cross-sectional study design, an electrical-mechanical towing device was used to measure passive drag force in 132 international-level Para swimmers. There was a strong, negative correlation between normalised passive drag force and 100 m freestyle race speed in the combined participant cohort (ρ = -0.77, P 2 = 0.65, χ2 = 11.5, P = 0.025). These findings contribute to the body of evidence that passive drag can provide an objective assessment of activity limitation in Para swimmers with physical impairments. The effect of physical impairment type on the relationship between passive drag and swimming performance should be accounted for in Para swimming classification

Protocol for SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home): feasibility of a home-based double-blind randomised controlled trial to improve gait and cognition in individuals at risk for dementia

IntroductionPhysical exercise and cognitive training have the potential to enhance cognitive function and mobility in older adults at risk of Alzheimer's disease and related dementia (ADRD), but little is known about the feasibility of delivering multidomain interventions in home settings of older adults at risk of ADRD. This study aims to assess the feasibility of home-based delivery of exercise and cognitive interventions, and to evaluate the relationship between participants' intervention preferences and their subsequent adherence. Secondary objectives include the effect of the interventions on ADRD risk factors, including frailty, mobility, sleep, diet and psychological health.Methods and analysisThe SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) feasibility trial is a randomised control trial that follows a 2×2 factorial design, with a 16-week home-based intervention programme (3 sessions per week) of physical exercises and cognitive training. Participants will be randomised in blocks of four to one of the following four arms: (1) combined exercise (aerobic and resistance)+cognitive training (NEUROPEAK); (2) combined exercise+control cognitive training (web searching); (3) control exercise (balance and toning)+cognitive training; and (4) control exercise+control cognitive training. SYNERGIC@Home will be implemented through video conferencing. Baseline and post-intervention assessments at 4-month and 10-month follow-up will include measures of cognition, frailty, mobility, sleep, diet and psychological health. Primary feasibility outcome is adherence to the interventions. Primary analytic outcome is the relationship between pre-allocation preference for a given intervention and subsequent adherence to the allocated intervention. A series of secondary analytic outcomes examining the potential effect of the individual and combined interventions on cognitive, mobility and general well-being will be measured at baseline and follow-up.Ethics and disseminationEthics approval was granted by the relevant research ethics boards. Findings of the study will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences.Trial registration numberNCT04997681, Pre-results

Quantifying Sources of Variability in Infancy Research Using the Infant-Directed-Speech Preference

Psychological scientists have become increasingly concerned with issues related to methodology and replicability, and infancy researchers in particular face specific challenges related to replicability: For example, high-powered studies are difficult to conduct, testing conditions vary across labs, and different labs have access to different infant populations. Addressing these concerns, we report on a large-scale, multisite study aimed at (a) assessing the overall replicability of a single theoretically important phenomenon and (b) examining methodological, cultural, and developmental moderators. We focus on infants’ preference for infant-directed speech (IDS) over adult-directed speech (ADS). Stimuli of mothers speaking to their infants and to an adult in North American English were created using seminaturalistic laboratory-based audio recordings. Infants’ relative preference for IDS and ADS was assessed across 67 laboratories in North America, Europe, Australia, and Asia using the three common methods for measuring infants’ discrimination (head-turn preference, central fixation, and eye tracking). The overall meta-analytic effect size (Cohen’s d) was 0.35, 95% confidence interval = [0.29, 0.42], which was reliably above zero but smaller than the meta-analytic mean computed from previous literature (0.67). The IDS preference was significantly stronger in older children, in those children for whom the stimuli matched their native language and dialect, and in data from labs using the head-turn preference procedure. Together, these findings replicate the IDS preference but suggest that its magnitude is modulated by development, native-language experience, and testing procedure

Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Background: Respiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity. Methods: PRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of pneumonia, endotracheal re-intubation, or death within 30 days after randomisation, assessed in the intention-to-treat population. Safety was assessed in all patients who received CPAP. The trial is registered with the ISRCTN registry, ISRCTN56012545. Findings: Between Feb 8, 2016, and Nov 11, 2019, 4806 patients were randomly assigned (2405 to the CPAP group and 2401 to the usual care group), of whom 4793 were included in the primary analysis (2396 in the CPAP group and 2397 in the usual care group). 195 (8\ub71%) of 2396 patients in the CPAP group and 197 (8\ub72%) of 2397 patients in the usual care group met the composite primary outcome (adjusted odds ratio 1\ub701 [95% CI 0\ub781-1\ub724]; p=0\ub795). 200 (8\ub79%) of 2241 patients in the CPAP group had adverse events. The most common adverse events were claustrophobia (78 [3\ub75%] of 2241 patients), oronasal dryness (43 [1\ub79%]), excessive air leak (36 [1\ub76%]), vomiting (26 [1\ub72%]), and pain (24 [1\ub71%]). There were two serious adverse events: one patient had significant hearing loss and one patient had obstruction of their venous catheter caused by a CPAP hood, which resulted in transient haemodynamic instability. Interpretation: In this large clinical effectiveness trial, CPAP did not reduce the incidence of pneumonia, endotracheal re-intubation, or death after major abdominal surgery. Although CPAP has an important role in the treatment of respiratory failure after surgery, routine use of prophylactic post-operative CPAP is not recommended