The quality of life and social needs of international medical graduates : emerging themes in research

A literature review was conducted to identify the experiences, challenges and acculturation of International Medical Graduates (IMGs) living and working throughout rural and remote Australia. As such recently published literature highlighted key factors impacting IMGs living and working in rural and remote areas which informed the acculturation process in western society. IMGs acculturation throughout Australian rural settings occurs rapidly among these higher educated migrants. Those IMGs with Australian spouses or who have practiced in rural settings prior to migration also experience a new phase of acculturation. However, maintaining cultural and religious connectivity continues to be challenging in these settings. Community awareness and an ability to embrace IMGs and cultural differences remain crucial for identity and cultural retention. Nevertheless, few studies recognised quality of life and social needs of IMGs and their family’s impact on the rural acculturation and settlement success. Previous research has focused primarily on employment integration, satisfaction and practice support. The identified literature is in no way extensive as it focuses on IMGs in the Australian context, which may impact on transferability. A gap exists where quality of life and social needs of IMGs and their families have been overlooked. These are crucial factors impacting rural acculturation, retention and IMGs health and wellbeing. The literature highlights insights into IMGs acculturation as they migrate and reside in Tasmania, a less culturally diverse population, remains absent with very little comparable research conducted

A Call to Build Trust and Center Values in Food Systems Work

In September of 2019, 70 people from across the U.S. came together to learn from each other about the work of coordinating state level food system plans. The initial intention for this gathering was to surface promising practices of developing and implementing food systems plans—meaning guiding documents, such as the Michigan Good Food Charter or the Vermont Farm to Plate Strategic Plan, that are developed with public input, set out a vision for the food system of a particular place, and identify high priority policies and strategies. Over the course of planning and hosting the three day convening, it became clear that a focus exclusively on technical practices was neither practical nor what participants were most interested in. Instead, it was the complex and adaptive process of bringing people together and the way in which we shared our time that most resonated with many participants. To share more about the design and experience of the gathering, we—the facilitation team—first decided to write a reflection shortly after the event. Much has happened in the months that have followed. The urgency of our present moment in time can no longer be downplayed. The tumultuous events of 2020 have brought the long-standing inequities of our society into stark relief. Six months ago, we were prepared to inspire you to bring values and a focus on equity into your food systems work. Now, we are sending out a call to deep care and accountability to our fellow food system practitioners. If you are not actively working to counter white supremacy culture and structural racism, then your food systems work is in vain and you are reinforcing the status quo

Overcoming the challenges of translating mental health instruments into sign languages

The Strengths and Difficulties Questionnaire (SDQ) is widely used in CAMHS, and has been translated into over sixty spoken languages. British Sign Language (BSL) is a visuo-gestural language, and the first language of up to 50,000 deaf people in the UK. Translating diagnostic tools into BSL is important to provide valid assessment of common mental health problems in Deaf signing young people. We report the process of translation from a written language (English) into a visual language (BSL) using adapted, existing methodologies. We highlight the challenges we faced, with particular reference to the difficulties in translating for a population of signing Deaf young people, followed by suggestions of how to overcome these difficulties

Improving cost-efficiency of faecal genotyping:new tools for elephant species

Despite the critical need for non-invasive tools to improve monitoring of wildlife populations, especially for endangered and elusive species, faecal genetic sampling has not been adopted as regular practice, largely because of the associated technical challenges and cost. Substantial work needs to be undertaken to refine sample collection and preparation methods in order to improve sample set quality and provide cost-efficient tools that can effectively support wildlife management. In this study, we collected an extensive set of forest elephant (Loxodonta cyclotis) faecal samples throughout Gabon, Central Africa, and prepared them for genotyping using 107 single-nucleotide polymorphism assays. We developed a new quantitative polymerase chain reaction (PCR) assay targeting a 130-bp nuclear DNA fragment and demonstrated its suitability for degraded samples in all three elephant species. Using this assay to compare the efficacy of two sampling methods for faecal DNA recovery, we found that sampling the whole surface of a dung pile with a swab stored in a small tube of lysis buffer was a convenient method producing high extraction success and DNA yield. We modelled the influence of faecal quality and storage time on DNA concentration in order to provide recommendations for optimized collection and storage. The maximum storage time to ensure 75% success was two months for samples collected within 24 hours after defecation and extended to four months for samples collected within one hour. Lastly, the real-time quantitative PCR assay allowed us to predict genotyping success and pre-screen DNA samples, thus further increasing the cost-efficiency of our approach. We recommend combining the validation of an efficient sampling method, the build of in-country DNA extraction capacity for reduced storage time and the development of species-specific quantitative PCR assays in order to increase the cost-efficiency of routine non-invasive DNA analyses and expand the use of next-generation markers to non-invasive samples

Improving the Detection, Assessment, Management and Prevention of Delirium in Hospices (the DAMPen-D study): protocol for a co-design and feasibility study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care

INTRODUCTION: Delirium is a complex condition in which altered mental state and cognition causes severe distress and poor clinical outcomes for patients and families, anxiety and stress for the health professionals and support staff providing care, and higher care costs. Hospice patients are at high risk of developing delirium, but there is significant variation in care delivery. The primary objective of this study is to demonstrate the feasibility of an implementation strategy (designed to help deliver good practice delirium guidelines), participant recruitment and data collection. METHODS AND ANALYSIS: Three work packages in three hospices in the UK with public involvement in codesign, study management and stakeholder groups: (1) experience-based codesign to adapt an existing theoretically-informed implementation strategy (Creating Learning Environments for Compassionate Care (CLECC)) to implement delirium guidelines in hospices; (2) feasibility study to explore ability to collect demographic, diagnostic and delirium management data from clinical records (n=300), explanatory process data (number of staff engaged in CLECC activities and reasons for non-engagement) and cost data (staff and volunteer hours and pay-grades engaged in implementation activities) and (3) realist process evaluation to assess the acceptability and flexibility of the implementation strategy (preimplementation and postimplementation surveys with hospice staff and management, n=30 at each time point; interviews with hospice staff and management, n=15). Descriptive statistics, rapid thematic analysis and a realist logic of analysis will be used be used to analyse quantitative and qualitative data, as appropriate. ETHICS AND DISSEMINATION: Ethical approval obtained: Hull York Medical School Ethics Committee (Ref 21/23), Health Research Authority Research Ethics Committee Wales REC7 (Ref 21/WA/0180) and Health Research Authority Confidentiality Advisory Group (Ref 21/CAG/0071). Written informed consent will be obtained from interview participants. A results paper will be submitted to an open access peer-reviewed journal and a lay summary shared with study site staff and stakeholders. TRIAL REGISTRATION NUMBER: ISRCTN55416525

Improving the Detection, Assessment, Management, and Prevention of Delirium in Hospices (the DAMPen-D study): Feasibility Study of a flexible and scalable implementation strategy to deliver guideline-adherent delirium care

BackgroundDelirium is a complex condition, stressful for all involved. Although highly prevalent in palliative care settings, it remains underdiagnosed and associated with poor outcomes. Guideline-adherent delirium care may improve its detection, assessment, and management. AimTo inform a future definitive study that tests whether an implementation strategy designed to improve guideline-adherent delirium care in palliative care settings improves patient outcomes (reduced proportion of in-patient days with delirium).DesignWith Patient Involvement members, we conducted a feasibility study to assess the acceptability of and engagement with the implementation strategy by hospice staff (intervention), and whether clinical record data collection of process (e.g., guideline-adherent delirium care) and clinical outcomes (evidence of delirium using a validated chart-based instrument;) pre- and 12-weeks post-implementation of the intervention would be possible.Setting/participantsIn-patient admissions in three English hospices.Results Between June 2021-December 2022, clinical record data were extracted from 300 consecutive admissions. Despite data collection during COVID-19, target clinical record data collection (n=300) was achieved. Approximately two-thirds of patients had a delirium episode during in-patient stay at both timepoints. A 6% absolute reduction in proportion of delirium days in those with a delirium episode was observed. Post-implementation improvements in guideline-adherent metrics include: clinical delirium diagnosis 15% to 28%; delirium risk assessment 0% to 16%; screening on admission 7% to 35%.Conclusions Collection of data on delirium outcomes and guideline-adherence from clinical records is feasible. The signal of patient benefit supports formal evaluation in a large-scale study

OMG Do Not Say LOL: Obese Adolescents' Perspectives on the Content of Text Messages to Enhance Weight Loss Efforts

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93769/1/oby.2011.266.pd

Accelerating tropicalization and the transformation of temperate seagrass meadows

Climate-driven changes are altering production and functioning of biotic assemblages in terrestrial and aquatic environments. In temperate coastal waters, rising sea temperatures, warm water anomalies and poleward shifts in the distribution of tropical herbivores have had a detrimental effect on algal forests. We develop generalized scenarios of this form of tropicalization and its potential effects on the structure and functioning of globally significant and threatened seagrass ecosystems, through poleward shifts in tropical seagrasses and herbivores. Initially, we expect tropical herbivorous fishes to establish in temperate seagrass meadows, followed later by megafauna. Tropical seagrasses are likely to establish later, delayed by more limited dispersal abilities. Ultimately, food webs are likely to shift from primarily seagrass-detritus to more directconsumption- based systems, thereby affecting a range of important ecosystem services that seagrasses provide, including their nursery habitat role for fishery species, carbon sequestration, and the provision of organic matter to other ecosystems in temperate regions

A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians:The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics.

Background:Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer’s disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive.Objective:The MedWalk trial’s primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment.Methods:MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60–90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation.Progress and Discussion:Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community.<br/