Towards equity and sustainability of rural and remote health services access: supporting social capital and integrated organisational and professional development

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Access to rural health services is compromised in many countries including Australia due to workforce shortages. The issues that consequently impact on equity of access and sustainability of rural and remote health services are complex. Discussion: The purpose of this paper is to describe a number of approaches from the literature that could form the basis of a more integrated approach to health workforce and rural health service enhancement that can be supported by policy. A case study is used to demonstrate how such an approach could work. Summary: Disjointed health services are common in rural areas due to the ‘tyranny of distance.’ Recruitment and retention of health professionals in rural areas and access to and sustainability of rural health services is therefore compromised. Strategies to address these issues tend to have a narrow focus. An integrated approach is needed to enhance rural workforce and health services; one that develops, acknowledges and accounts for social capital and social relations within the rural community. Keywords: Rural workforce, Recruitment and retention, Professional development, Organisational development, Community engagement, Social capital, Rural health service access, Policy development, Chronic conditions, Complex car

Multiple FLC haplotypes defined by independent cis-regulatory variation underpin life history diversity in Arabidopsis thaliana

Relating molecular variation to phenotypic diversity is a central goal in evolutionary biology. In Arabidopsis thaliana, FLOWERING LOCUS C (FLC) is a major determinant of variation in vernalization—the acceleration of flowering by prolonged cold. Here, through analysis of 1307 A. thaliana accessions, we identify five predominant FLC haplotypes defined by noncoding sequence variation. Genetic and transgenic experiments show that they are functionally distinct, varying in FLC expression level and rate of epigenetic silencing. Allelic heterogeneity at this single locus accounts for a large proportion of natural variation in vernalization that contributes to adaptation of A. thaliana

Why do people take part in vaccine trials? A mixed methods narrative synthesis

Objectives To understand why individuals do or do not take part in vaccine trials, exploring the motivators and barriers to identify effective strategies to optimise recruitment in vaccine research. Methods Qualitative studies and quantitative surveys capturing data on reasons for trial participation/decline were included. Six databases were searched from 1996 to October 2021. Two reviewers independently screened and assessed risk of bias. Results were reported narratively and analysed using thematic analysis. Results We included 32 studies (17 qualitative; 12 quantitative; 3 mixed-methods) that covered a wide range of populations, geographical areas and disease types. Eight themes were identified 1) altruism; 2) potential for personal benefit; 3) perceived risks; 4) trust or distrust; 5) social networks; 6) stigma; 7) practical implications; 8) research vanguard. Conclusion Our findings provide a detailed description of how potential participants weigh up their decisions to participate in vaccine trials, which could inform the planning and implementation of studies to enhance recruitment

Digital Libraries, Personalisation, and Network Effects - Unpicking the Paradoxes

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Social stories in mainstream schools for children with autism spectrum disorder : a feasibility randomised controlled trial

OBJECTIVES: To assess the feasibility of recruitment, retention, outcome measures and intervention training/delivery among teachers, parents and children. To calculate a sample size estimation for full trial. DESIGN: A single-centre, unblinded, cluster feasibility randomised controlled trial examining Social Stories delivered within a school environment compared with an attentional control. SETTING: 37 primary schools in York, UK. PARTICIPANTS: 50 participants were recruited and a cluster randomisation approach by school was examined. Participants were randomised into the treatment group (n=23) or a waiting list control group (n=27). OUTCOME MEASURES: Acceptability and feasibility of the trial, intervention and of measurements required to assess outcomes in a definitive trial. RESULTS: An assessment of the questionnaire completion rates indicated teachers would be most appropriate to complete the primary outcome measure. 2 outcome measures: the Social Responsiveness Scale (SRS)-2 and a goal-based measure showed both the highest levels of completion rates (above 80%) at the primary follow-up point (6 weeks postintervention) and captured relevant social and behaviour outcomes. Power calculations were based on these 2 outcome measures leading to a total proposed sample size of 180 participant groups. CONCLUSIONS: Results suggest that a future trial would be feasible to conduct and could inform the policy and practice of using Social Stories in mainstream schools. TRIAL REGISTRATION NUMBER: ISRCTN96286707; Results

Coding reliability and agreement of international classification of disease, 10th revision (ICD-10) codes in emergency department data

Introduction: Administrative health data from the emergency department (ED) play important roles in understanding health needs of the public and reasons for health care resource use. International Classification of Disease (ICD) diagnostic codes have been widely used for code reasons of clinical encounters for administrative purposes in EDs. Objective: The purpose of the study is to examine the coding agreement and reliability of ICD diagnosis codes in ED through auditing the routinely collected data. Methods: We randomly sampled 1 percent of records (n=1636) between October and December from 11 emergency departments in Alberta, Canada. Auditors were employed to review the same chart and independently assign main diagnosis codes. We assessed coding agreement and reliability through comparison of codes assigned by auditors and hospital coders using the proportion of agreement and Cohen’s kappa. Error analysis was conducted to review diagnosis codes with disagreement and categorized them into six groups. Results: Overall, the agreement was 86.5% and 82.2% at 3 and 4 digits levels respectively, and reliability was 0.86 and 0.82 respectively. Variation of agreement and reliability were identified across different emergency departments. The major two categories of coding discrepancy were the use of different codes for the same condition (23.6%) and the use of codes at different levels of specificity (20.9%). Conclusions: Diagnosis codes in emergency department show high agreement and reliability. More strict coding guidelines regarding the use of unspecified codes are needed to enhance coding consistency

Autism Spectrum Social Stories In Schools Trial (ASSSIST):study protocol for a feasibility randomised controlled trial analysing clinical and cost-effectiveness of Social Stories in mainstream schools

INTRODUCTION: Current evidence suggests that Social Stories can be effective in tackling problem behaviours exhibited by children with autism spectrum disorder. Exploring the meaning of behaviour from a child's perspective allows stories to provide social information that is tailored to their needs. Case reports in children with autism have suggested that these stories can lead to a number of benefits including improvements in social interactions and choice making in educational settings. METHODS AND ANALYSIS: The feasibility of clinical and cost-effectiveness of a Social Stories toolkit will be assessed using a randomised control framework. Participants (n=50) will be randomised to either the Social Stories intervention or a comparator group where they will be read standard stories for an equivalent amount of time. Statistics will be calculated for recruitment rates, follow-up rates and attrition. Economic analysis will determine appropriate measures of generic health and resource use categories for cost-effectiveness analysis. Qualitative analysis will ascertain information on perceptions about the feasibility and acceptability of the intervention. ETHICS AND DISSEMINATION: National Health Service Ethics Approval (NHS; ref 11/YH/0340) for the trial protocol has been obtained along with NHS Research and Development permission from Leeds and York Partnership NHS Foundation Trust. All adverse events will be closely monitored, documented and reported to the study Data Monitoring Ethics Committee. At least one article in a peer reviewed journal will be published and research findings presented at relevant conferences. TRIAL REGISTRATION NUMBER: ISRCTN96286707

Genome-Wide Association Mapping in <i>Arabidopsis</i> Identifies Previously Known Flowering Time and Pathogen Resistance Genes

There is currently tremendous interest in the possibility of using genome-wide association mapping to identify genes responsible for natural variation, particularly for human disease susceptibility. The model plant Arabidopsis thaliana is in many ways an ideal candidate for such studies, because it is a highly selfing hermaphrodite. As a result, the species largely exists as a collection of naturally occurring inbred lines, or accessions, which can be genotyped once and phenotyped repeatedly. Furthermore, linkage disequilibrium in such a species will be much more extensive than in a comparable outcrossing species. We tested the feasibility of genome-wide association mapping in A. thaliana by searching for associations with flowering time and pathogen resistance in a sample of 95 accessions for which genome-wide polymorphism data were available. In spite of an extremely high rate of false positives due to population structure, we were able to identify known major genes for all phenotypes tested, thus demonstrating the potential of genome-wide association mapping in A. thaliana and other species with similar patterns of variation. The rate of false positives differed strongly between traits, with more clinal traits showing the highest rate. However, the false positive rates were always substantial regardless of the trait, highlighting the necessity of an appropriate genomic control in association studies.</p