‘SHE IS IN THERE’: CONNECTING ACUTELY ILL INDIGENOUS CHILDREN WITH PEDIATRIC CRITICAL CARE SPECIALISTS USING REMOTE PRESENCE TECHNOLOGY

Indigenous children living in rural and remote Saskatchewan have limited access to pediatric specialty services. As such, they experience a high rate of medical transport out of their home communities. The Truth and Reconciliation Commission’s Calls to Action prioritized access to health care that is culturally safe, and community directed. Remote presence technology (RPT), a novel form of telemedicine, seeks to overcome the barriers of distance and time to improve health care access. RPT allows for direct patient visualization, examination, and communication between the urban specialists and the local health care providers and family members. This study is part of a larger community-based participatory research (CBPR) project that evaluated RPT as a method of pediatric acute health care delivery. A single medical case from the larger CBPR project was used to explore the lived experience of a child, family, local and urban health care provider using RPT for a pediatric acute health care consultation. The exploration employed phenomenology guided by Indigenous world view. Findings revealed themes related to the value of building local capacity for pediatric specialized care and the related broader advantages of Indigenous children staying home for health care. Finally, the study revealed that indeed the technology created access, however its successful reception into the specialist-child interaction, is inextricably linked to the specialist that embodies it practicing cultural humility in order to provide culturally safe care

The challenge of change : a case study of the institutionalization of employability skills at Guilford Technical Community College

Characteristics of a knowledge economy have been extensively documented in the literature. Rapid change resulting from increased technologies and globalization has triggered an unprecedented urgency for all citizens to possess high-level workplace employability skills in order for the U.S. to maintain economic vitality and global competitiveness. Community colleges are primary providers of workplace skills, therefore, faculty are expected to teach high-level workplace skills to students. The purpose of this research was to examine the impact of Guilford Technical Community College’s SACS Quality Enhancement Plan on faculty commitment to economic development and teaching high-level workplace employability skills. Additionally, the study described the implementation of the QEP as a large-scale strategic change at GTCC. A thorough review of the literature confirmed the significance of the need to examine institutional implementation of employability skills and faculty commitment to economic development and delivering high-level workplace employability skills to students. The study was conducted at GTCC utilizing a qualitative case study methodology. The dynamics of naturalistic inquiry provided rich insight of the implications for faculty commitment to economic and workforce development, and institutional change surrounding implementation. Data were amassed through interviews, documents, studies, surveys, and other relevant texts obtained from GTCC. Themes and patterns that emerged during the data collection to produce findings were used to address the following research questions: 1. What has been the impact of Guilford Technical Community College’s (GTCCs) QEP on commitment of faculty to incorporating high-level workplace employability skills in the curriculum? 2. What has been the impact of GTCCs QEP on commitment of faculty to economic development? 3. How did GTCCs administration facilitate the implementation of the QEP? 4. What were barriers to implementation of the QEP? 5. How did Guilford Technical Community College overcome barriers to implementation of the QEP? The research was rooted in Conner’s theory of the Stages of Change Commitment, and existing literature related to the topic. The study revealed that teaching employability skills to students was institutionalized by GTCC faculty participants; and hence, was a significant part of the college’s philosophy and culture. The findings of the study further addressed how GTCC administrators implemented the campus-wide strategic initiative, barriers to implementation of employability skills, and how GTCC overcame barriers

Very Low Frequency Propagation Mapper (VPM) Experience and Results from the Systems Engineering Cycle of a Small Satellite

The Very Low Frequency Propagation Mapper, an Air Force Research Laboratory 6U CubeSat, is currently in operations complementing the Demonstration and Science Experiments (DSX) satellite by taking coincident measurements with DSX of the inner magnetosphere. This presents an exciting way to have a low-cost platform enhance an existing mission’s data set with multiple spatial collection points. The Small Satellite Portfolio (SSP) had overall responsibility for the vehicle, ground system, and mission design; by enabling the team to make technical and programmatic decisions on their own, the team has been able to overcome many hurdles in short timeframes. Further, the team was constructed with a diverse set of skills to handle the many complexities of space systems. Finally, the team, and SSP as a whole, recognize that changes to the system and mission are not only expected but desired as mission maturity is gained. This paper outlines a selected set of issues and challenges that occurred, the ways the team dynamically handled the situations, and lessons learned for systems that are constrained in both cost and capability (e.g. small satellites)

Parenting behavior and the risk of becoming a victim and a bully/victim : a meta-analysis study

Objective: Being bullied has adverse effects on children's health. Children's family experiences and parenting behavior before entering school help shape their capacity to adapt and cope at school and have an impact on children's peer relationship, hence it is important to identify how parenting styles and parent–child relationship are related to victimization in order to develop intervention programs to prevent or mitigate victimization in childhood and adolescence. Methods: We conducted a systematic review of the published literature on parenting behavior and peer victimization using MEDLINE, PsychINFO, Eric and EMBASE from 1970 through the end of December 2012. We included prospective cohort studies and cross-sectional studies that investigated the association between parenting behavior and peer victimization. Results: Both victims and those who both bully and are victims (bully/victims) were more likely to be exposed to negative parenting behavior including abuse and neglect and maladaptive parenting. The effects were generally small to moderate for victims (Hedge's g range: 0.10–0.31) but moderate for bully/victims (0.13–0.68). Positive parenting behavior including good communication of parents with the child, warm and affectionate relationship, parental involvement and support, and parental supervision were protective against peer victimization. The protective effects were generally small to moderate for both victims (Hedge's g: range: −0.12 to −0.22) and bully/victims (−0.17 to −0.42). Conclusions: Negative parenting behavior is related to a moderate increase of risk for becoming a bully/victim and small to moderate effects on victim status at school. Intervention programs against bullying should extend their focus beyond schools to include families and start before children enter school

The longer-term effects of access to HIV self-tests on HIV testing frequency in high-risk gay and bisexual men: follow-up data from a randomised controlled trial

Background: A wait-list randomised controlled trial in Australia (FORTH) in high-risk gay and bisexual men (GBM) showed access to free HIV self-tests (HIVSTs) doubled the frequency of HIV testing in year 1 to reach guideline recommended levels of 4 tests per year, compared to two tests per year in the standard-care arm (facility-based testing). In year 2, men in both arms had access to HIVSTs. We assessed if the effect was maintained for a further 12 months. Methods: Participants included GBM reporting condomless anal intercourse or > 5 male partners in the past 3 months. We included men who had completed at least one survey in both year 1 and 2 and calculated the mean tests per person, based on the validated self-report and clinic records. We used Poisson regression and random effects Poisson regression models to compare the overall testing frequency by study arm, year and testing modality (HIVST/facility-based test). Findings: Overall, 362 men completed at least one survey in year 1 and 343 in year 2. Among men in the intervention arm (access to HIVSTs in both years), the mean number of HIV tests in year 2 (3⋅7 overall, 2⋅3 facility-based tests, 1⋅4 HIVSTs) was lower compared to year 1 (4⋅1 overall, 1⋅7 facility-based tests, 2⋅4 HIVSTs) (RR:0⋅84, 95% CI:0⋅75-0⋅95, p=0⋅002), but higher than the standard-care arm in year 1 (2⋅0 overall, RR:1⋅71, 95% CI:1⋅48-1.97, p<0⋅001). Findings were not different when stratified by sociodemographic characteristics or recent high risk sexual history. Interpretation: In year 2, fewer HIVSTs were used on average compared to year 1, but access to free HIVSTs enabled more men to maintain higher HIV testing frequency, compared with facility-based testing only. HIV self-testing should be a key component of HIV testing and prevention strategies. Funding:: This work was supported by grant 568971 from the National Health and Medical Research Council of Australia

A study protocol to investigate the management of depression and challenging behaviors associated with dementia in aged care settings

Background:&nbsp;The high occurrence and under-treatment of clinical depression and behavioral and psychological symptoms of dementia (BPSD) within aged care settings is concerning, yet training programs aimed at improving the detection and management of these problems have generally been ineffective. This article presents a study protocol to evaluate a training intervention for facility managers/registered nurses working in aged care facilities that focuses on organisational processes and culture as well as knowledge, skills and self-efficacy. Methods. A Randomised Control Trial (RCT) will be implemented across 18 aged care facilities (divided into three conditions). Participants will be senior registered nurses and personal care attendants employed in the aged care facility. The first condition will receive the training program (Staff as Change Agents - Enhancing and Sustaining Mental Health in Aged Care), the second condition will receive the training program and clinical support, and the third condition will receive no intervention. Results: Pre-, post-, 6-month and 12-month follow-up measures of staff and residents will be used to demonstrate how upskilling clinical leaders using our transformational training approach, as well as the use of a structured screening, referral and monitoring protocol, can address the mental health needs of older people in residential care. Conclusions: The expected outcome of this study is the validation of an evidence-based training program to improve the management of depression and BPSD among older people in residential care settings by establishing routine practices related to mental health. This relatively brief but highly focussed training package will be readily rolled out to a larger number of residential care facilities at a relatively low cost.</div

"Give me some space" : exploring youth to parent aggression and violence

A small scale qualitative project, undertaken by an interdisciplinary domestic violence research group involving academic researchers and research assistants, with colleagues from Independent Domestic Abuse Services (IDAS), investigated youth aggression and violence against parents. Following the literature review, data was generated through several research conversations with young people (n = 2), through semi-structured interviews with mothers (n = 3) and practitioners (n = 5), and through a practitioner focus group (n = 8). Thematic analysis and triangulation of the data from parents, practitioners and young people, elicited interconnected and complex overarching themes. Young people could be both victim and perpetrator. The witnessing or experiencing of domestic aggression and violence raised the concept of ‘bystander children’. The impact of young people experiencing familial violence was underestimated by parents. For practitioners, the effects of working with domestic violence was shown to be significant - both positively and negatively

wMel Wolbachia genome remains stable after 7 years in Australian Aedes aegypti field populations.

Infection of wMel Wolbachia in Aedes aegypti imparts two signature features that enable its application for biocontrol of dengue. First, the susceptibility of mosquitoes to viruses such as dengue and Zika is reduced. Second, a reproductive manipulation is caused that enables wMel introgression into wild-type mosquito populations. The long-term success of this method relies, in part, on evolution of the wMel genome not compromising the critical features that make it an attractive biocontrol tool. This study compared the wMel Wolbachia genome at the time of initial releases and 1-7 years post-release in Cairns, Australia. Our results show the wMel genome remains highly conserved up to 7 years post-release in gene sequence, content, synteny and structure. This work suggests the wMel genome is stable in its new mosquito host and, therefore, provides reassurance on the potential for wMel to deliver long-term public-health impacts

Recombination and Population Structure in Salmonella enterica

Salmonella enterica is a bacterial pathogen that causes enteric fever and gastroenteritis in humans and animals. Although its population structure was long described as clonal, based on high linkage disequilibrium between loci typed by enzyme electrophoresis, recent examination of gene sequences has revealed that recombination plays an important evolutionary role. We sequenced around 10% of the core genome of 114 isolates of enterica using a resequencing microarray. Application of two different analysis methods (Structure and ClonalFrame) to our genomic data allowed us to define five clear lineages within S. enterica subspecies enterica, one of which is five times older than the other four and two thirds of the age of the whole subspecies. We show that some of these lineages display more evidence of recombination than others. We also demonstrate that some level of sexual isolation exists between the lineages, so that recombination has occurred predominantly between members of the same lineage. This pattern of recombination is compatible with expectations from the previously described ecological structuring of the enterica population as well as mechanistic barriers to recombination observed in laboratory experiments. In spite of their relatively low level of genetic differentiation, these lineages might therefore represent incipient species

The 2021 WHO catalogue of Mycobacterium tuberculosis complex mutations associated with drug resistance: a genotypic analysis.

Background: Molecular diagnostics are considered the most promising route to achievement of rapid, universal drug susceptibility testing for Mycobacterium tuberculosis complex (MTBC). We aimed to generate a WHO-endorsed catalogue of mutations to serve as a global standard for interpreting molecular information for drug resistance prediction. Methods: In this systematic analysis, we used a candidate gene approach to identify mutations associated with resistance or consistent with susceptibility for 13 WHO-endorsed antituberculosis drugs. We collected existing worldwide MTBC whole-genome sequencing data and phenotypic data from academic groups and consortia, reference laboratories, public health organisations, and published literature. We categorised phenotypes as follows: methods and critical concentrations currently endorsed by WHO (category 1); critical concentrations previously endorsed by WHO for those methods (category 2); methods or critical concentrations not currently endorsed by WHO (category 3). For each mutation, we used a contingency table of binary phenotypes and presence or absence of the mutation to compute positive predictive value, and we used Fisher's exact tests to generate odds ratios and Benjamini-Hochberg corrected p values. Mutations were graded as associated with resistance if present in at least five isolates, if the odds ratio was more than 1 with a statistically significant corrected p value, and if the lower bound of the 95% CI on the positive predictive value for phenotypic resistance was greater than 25%. A series of expert rules were applied for final confidence grading of each mutation. Findings: We analysed 41 137 MTBC isolates with phenotypic and whole-genome sequencing data from 45 countries. 38 215 MTBC isolates passed quality control steps and were included in the final analysis. 15 667 associations were computed for 13 211 unique mutations linked to one or more drugs. 1149 (7·3%) of 15 667 mutations were classified as associated with phenotypic resistance and 107 (0·7%) were deemed consistent with susceptibility. For rifampicin, isoniazid, ethambutol, fluoroquinolones, and streptomycin, the mutations' pooled sensitivity was more than 80%. Specificity was over 95% for all drugs except ethionamide (91·4%), moxifloxacin (91·6%) and ethambutol (93·3%). Only two resistance mutations were identified for bedaquiline, delamanid, clofazimine, and linezolid as prevalence of phenotypic resistance was low for these drugs. Interpretation: We present the first WHO-endorsed catalogue of molecular targets for MTBC drug susceptibility testing, which is intended to provide a global standard for resistance interpretation. The existence of this catalogue should encourage the implementation of molecular diagnostics by national tuberculosis programmes. Funding: Unitaid, Wellcome Trust, UK Medical Research Council, and Bill and Melinda Gates Foundation