Six ways to help fix energy hardship in New Zealand

Energy hardship is caused by the interaction of factors including housing quality, appliance efficiency, energy source and price, and occupant needs and income. Multiple policy approaches are needed to address these varied causes of energy hardship, and the lack of an official definition and a measurement strategy in Aotearoa should not preclude policy action to address this critical social determinant of health. Here we outline six ways to help fix energy hardship in New Zealand

Bioactive Indanes: Insight Into the Bioactivity of Iindane Dimers Related to the Lead Anti‐inflammatory Molecule PH46A

Objectives PH46A (1) demonstrates significant anti-inflammatory activity in phenotypic models but its mechanism and site of action have been elusive. Current study focused on the bioactivity of PH46 (2) and related novel indane dimers (6-10) to investigate the impact of changes in substitution and stereochemistry at the C-1 and C-2 positions of the PH46 (2) scaffold. Methods Cytotoxicity profiles of compounds were established using THP-1 macrophages and SW480 cells. Effects of the compounds were then evaluated at 10 μM using 5-lipoxygenase (LOX) and 15-LOX enzymes, and 5-LOX binding was evaluated in silico against NDGA, nitric oxide (NO) released from LPS-induced SW480 cells and cytokines in THP-1 macrophages (IL-6, IL-1b, TNF-a and IFN-c) and in SW480 cells (IL-8). Key findings PH46 (2) and 7 cause reduction in NO, inhibition of 5-LOX with high binding energy and no cytotoxicity effects in THP-1 macrophages and SW480 cell lines (up to 50 μM). The cytokine profiling of the series demonstrated inhibition of IL-6 and TNF-a in THP-1 macrophages together with IL-8 in SW480 cells. Conclusions The observed profile of cytokine modulation (IL-6/ TNF-a, IL-8) and inhibition of release of NO and 5-LOX may contribute to the in vivo effects demonstrated by indane dimers and PH46A (1) in murine models of colitis

A pilot evaluation of simulation-based interprofessional education for occupational therapy, speech pathology and dietetic students: improvements in attitudes and confidence

© 2019, © 2019 Taylor & Francis Group, LLC. Many higher education institutions struggle to provide interprofessional practice opportunities for their pre-licensure students due to demanding workloads, difficulties with timetabling, and problems with sourcing suitable placements that provide appropriate practice opportunities. A series of complex unfolding video-based simulation scenarios involving a patient who had experienced a stroke was utilized as a case study for a three-hour interprofessional practice workshop. 69 occupational therapy (OT), speech pathology (SP) and dietetics (DT) students participated in a mixed-methods study comparing interprofessional attitudes before and after the workshop. Attitudes toward interprofessional practice improved pre- vs. post-workshop and overall. Students were highly satisfied with the workshops contribution toward learning, although OT and SP students were more satisfied than DT students. Focus groups confirmed students liked the format and structure of the workshop, suggested that students better understood the role of other professions and improved role clarification, increased their confidence to practice in interprofessional practice settings, but noted the experience could have been improved with the incorporation of nursing and smaller groups to better facilitate participation. There is widespread support for implementing interprofessional education (IPE) in the health sciences, yet widespread implementation is not yet a reality. This research suggests that a simulation-based, three-hour IPE workshop can have an immediate benefit on confidence and attitudes toward interprofessional practice for allied health students

To what extent has COVID-19 impacted hard-to-reach energy audiences?

Energy users who don’t participate in efficiency and conservation programmes despite ongoing outreach are often referred to as ‘Hard-to-Reach’ (HTR). These individuals or organisations can include, e.g., low income or vulnerable households; renters; and small businesses. More effectively engaging HTR audiences is key to ensuring everyone benefits equitably from low-carbon energy transitions and related (policy) interventions. This is even more so the case in light of the COVID-19 pandemic, and the ongoing implications for energy use and affordability for the most vulnerable (and newly-vulnerable) members of our society.Within this context, the main purpose of this paper is to explore the extent to which HTR energy audiences have been impacted by COVID-19. Our primary method for this work was a comprehensive, critical literature review and a compilation of official statistics. We also collected survey, interview and focus group data during 2020 COVID-19 pandemic responses in the U.S., UK, NZ and Sweden. The geographical scope is determined by a 3-year project focusing on HTR energy users and implemented in partnership with the User-Centred Energy Systems Technology Collaboration Programme (Users TCP) by the International Energy Agency (IEA). Key findings we highlight and discuss in this paper:● Sweden has taken a different approach to manage COVID-19, yet when it comes to mobility, declines in demand (~25%) have shown relatively similar patterns to countries with stricter measures. ● In the UK, energy debt is growing due to higher domestic consumption arising from lockdown measures and the reduced income of many households. Most households (72%) have increased their energy (monthly gas and electricity bills are up £32) use. In response, 36% are turning thermostats down and 27% limiting lighting.● In the U.S., a survey of 1,000 energy customers found that more than 50% are using more energy, and monitoring their energy use less; 15% reported postponing a utility bill. ● NZ’s model COVID-19 “elimination” response has included housing, financial support, and specific energy payments to date, though unhealthy and unaffordable housing remains a major issue.Whereas the pandemic has exacerbated several elements of the HTR policy discourse (e.g. impacts on vulnerable and/or low-income households), our findings also reveal several opportunities and critical aspects for policy makers, researchers and utilities to identify and engage HTR energy users

Intersection of diet and exercise with the gut microbiome and circulating metabolites in male bodybuilders : A pilot study

Diet, exercise and the gut microbiome are all factors recognised to be significant contributors to cardiometabolic health. However, diet and exercise interventions to modify the gut microbiota to improve health are limited by poor understanding of the interactions between them. In this pilot study, we explored diet–exercise–microbiome dynamics in bodybuilders as they represent a distinctive group that typically employ well-defined dietary strategies and exercise regimes to alter their body composition. We performed longitudinal characterisation of diet, exercise, the faecal microbial community composition and serum metabolites in five bodybuilders during competition preparation and post-competition. All participants reduced fat mass while conserving lean mass during competition preparation, corresponding with dietary energy intake and exercise load, respectively. There was individual variability in food choices that aligned to individualised gut microbial community compositions throughout the study. However, there was a common shift from a high protein, low carbohydrate diet during pre-competition to a more macronutrient-balanced diet post-competition, which was associated with similar changes in the gut microbial diversity across participants. The circulating metabolite profiles also reflected individuality, but a subset of metabolites relating to lipid metabolism distinguished between pre- and post-competition. Changes in the gut microbiome and circulating metabolome were distinct for each individual, but showed common patterns. We conclude that further longitudinal studies will have greater potential than cross-sectional studies in informing personalisation of diet and exercise regimes to enhance exercise outcomes and improve health

Feasibility of home-based exercise training during adjuvant treatment for metastatic castrate-resistant prostate cancer patients treated with an androgen receptor pathway inhibitor (EXACT)

BackgroundExercise is an effective adjuvant therapy that can alleviate treatment-related toxicities for men with prostate cancer (PC). However, the feasibility of delivering exercise training to men with advanced disease and the wider impact on clinical outcomes remain unknown. The purpose of the EXACT trial was to determine the feasibility and effects of home-based exercise training in men with metastatic castrate-resistant prostate cancer (mCRPC). MethodsPatients with mCRPC receiving ADT + an androgen receptor pathway inhibitor (ARPI) were prescribed 12 weeks of home-based, remotely monitored, moderate intensity, aerobic and resistance exercise. Feasibility was assessed using recruitment, retention and adherence rates. Safety and adverse events were monitored throughout, with functional and patient-reported outcomes captured at baseline, post-intervention and at 3-month follow-up. ResultsFrom the 117 screened, 49 were deemed eligible and approached, with 30 patients providing informed consent (61% recruitment rate). Of those who consented, 28 patients completed baseline assessments, with 24 patients completing the intervention and 22 completing follow-up (retention rates: 86% and 79% respectively). Task completion was excellent throughout, with no intervention-related adverse events recorded. Self-reported adherence to the overall intervention was 82%. Exercise training decreased mean body mass (−1.5%), improved functional fitness (> 10%) and improved several patient-reported outcomes including clinically meaningful changes in fatigue (p = 0.042), FACT-G (p = 0.054) and FACT-P (p = 0.083), all with moderate effect sizes. ConclusionHome-based exercise training, with weekly remote monitoring, was feasible and safe for men with mCRPC being treated with an ARPI. Given that treatment-related toxicities accumulate throughout the course of treatment, and as a result, negatively impact functional fitness and health-related quality of life (HRQoL), it was positive that exercise training improved or prevented a decline in these clinically important variables and could better equip patients for future treatment. Collectively, these preliminary feasibility findings support the need for a definitive, larger RCT, which downstream may lead to the inclusion of home-based exercise training as part of adjuvant care for mCRPC

A review of characteristics and outcomes of Australia’s undergraduate medical education rural immersion programs

Background: A key strategy for increasing the supply of rural doctors is rurally located medical education. In 2000, Australia introduced a national policy to increase rural immersion for undergraduate medical students. This study aims to describe the characteristics and outcomes of the rural immersion programs that were implemented in Australian medical schools. Methods: Information about 19 immersion programs was sourced in 2016 via the grey and published literature. A scoping review of the published peer-reviewed studies via Ovid MEDLINE and Informit (2000-2016) and direct journal searching included studies that focused on outcomes of undergraduate rural immersion in Australian medical schools from 2000 to 2016. Results: Programs varied widely by selection criteria and program design, offering between 1- and 6-year immersion. Based on 26 studies from 10 medical schools, rural immersion was positively associated with rural practice in the first postgraduate year (internship) and early career (first 10years post-qualifying). Having a rural background increased the effects of rural immersion. Evidence suggested that longer duration of immersion also increases the uptake of rural work, including by metropolitan-background students, though overall there was limited evidence about the influence of different program designs. Most evidence was based on relatively weak, predominantly cross-sectional research designs and single-institution studies. Many had flaws including small sample sizes, studying internship outcomes only, inadequately controlling for confounding variables, not using metropolitan-trained controls and providing limited justification as to the postgraduate stage at which rural practice outcomes were measured. Conclusions: Australia's immersion programs are moderately associated with an increased rural supply of early career doctors although metropolitan-trained students contribute equal numbers to overall rural workforce capacity. More research is needed about the influence of student interest in rural practice and the duration and setting of immersion on rural work uptake and working more remotely. Research needs to be more nationally balanced and scaled-up to inform national policy development. Critically, the quality of research could be strengthened through longer-term follow-up studies, adjusting for known confounders, accounting for postgraduate stages and using appropriate controls to test the relative effects of student characteristics and program designs

Clinical capabilities of graduates of an outcomes-based integrated medical program

<p>Abstract</p> <p>Background</p> <p>The University of New South Wales (UNSW) Faculty of Medicine replaced its old content-based curriculum with an innovative new 6-year undergraduate entry outcomes-based integrated program in 2004. This paper is an initial evaluation of the perceived and assessed clinical capabilities of recent graduates of the new outcomes-based integrated medical program compared to benchmarks from traditional content-based or process-based programs.</p> <p>Method</p> <p>Self-perceived capability in a range of clinical tasks and assessment of medical education as preparation for hospital practice were evaluated in recent graduates after 3 months working as junior doctors. Responses of the 2009 graduates of the UNSW’s new outcomes-based integrated medical education program were compared to those of the 2007 graduates of UNSW’s previous content-based program, to published data from other Australian medical schools, and to hospital-based supervisor evaluations of their clinical competence.</p> <p>Results</p> <p>Three months into internship, graduates from UNSW’s new outcomes-based integrated program rated themselves to have good clinical and procedural skills, with ratings that indicated significantly greater capability than graduates of the previous UNSW content-based program. New program graduates rated themselves significantly more prepared for hospital practice in the confidence (reflective practice), prevention (social aspects of health), interpersonal skills (communication), and collaboration (teamwork) subscales than old program students, and significantly better or equivalent to published benchmarks of graduates from other Australian medical schools. Clinical supervisors rated new program graduates highly capable for teamwork, reflective practice and communication.</p> <p>Conclusions</p> <p>Medical students from an outcomes-based integrated program graduate with excellent self-rated and supervisor-evaluated capabilities in a range of clinically-relevant outcomes. The program-wide curriculum reform at UNSW has had a major impact in developing capabilities in new graduates that are important for 21^st century medical practice.</p