Exercise physiologists: essential players in interdisciplinary teams for noncommunicable chronic disease management

Noncommunicable diseases (NCDs), such as obesity and type 2 diabetes mellitus, are a growing public health challenge in Australia, accounting for a significant and increasing cost to the health care system. Management of these chronic conditions is aided by interprofessional practice, but models of care require updating to incorporate the latest evidence-based practice. Increasing research evidence reports the benefits of physical activity and exercise on health status and the risk of inactivity to chronic disease development, yet physical activity advice is often the least comprehensive component of care. An essential but as yet underutilized player in NCD prevention and management is the “accredited exercise physiologist,” a specialist in the delivery of clinical exercise prescriptions for the prevention or management of chronic and complex conditions. In this article, the existing role of accredited exercise physiologists in interprofessional practice is examined, and an extension of their role proposed in primary health care settings

Protocol: developing a conceptual framework of patient mediated knowledge translation, systematic review using a realist approach

<p>Abstract</p> <p>Background</p> <p>Patient involvement in healthcare represents the means by which to achieve a healthcare system that is responsive to patient needs and values. Characterization and evaluation of strategies for involving patients in their healthcare may benefit from a knowledge translation (KT) approach. The purpose of this knowledge synthesis is to develop a conceptual framework for patient-mediated KT interventions.</p> <p>Methods</p> <p>A preliminary conceptual framework for patient-mediated KT interventions was compiled to describe intended purpose, recipients, delivery context, intervention, and outcomes. A realist review will be conducted in consultation with stakeholders from the arthritis and cancer fields to explore how these interventions work, for whom, and in what contexts. To identify patient-mediated KT interventions in these fields, we will search MEDLINE, the Cochrane Library, and EMBASE from 1995 to 2010; scan references of all eligible studies; and examine five years of tables of contents for journals likely to publish quantitative or qualitative studies that focus on developing, implementing, or evaluating patient-mediated KT interventions. Screening and data collection will be performed independently by two individuals.</p> <p>Conclusions</p> <p>The conceptual framework of patient-mediated KT options and outcomes could be used by healthcare providers, managers, educationalists, patient advocates, and policy makers to guide program planning, service delivery, and quality improvement and by us and other researchers to evaluate existing interventions or develop new interventions. By raising awareness of options for involving patients in improving their own care, outcomes based on using a KT approach may lead to greater patient-centred care delivery and improved healthcare outcomes.</p

Evaluation of an inter-professional workshop to develop a psychosocial assessment and child-centred communication training programme for paediatricians in training

BACKGROUND: The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors. METHODS: The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop. RESULTS: The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and process of the proposed training programme and the opportunity for participants to share experiences of effective practice were valued. Participants identified that the current culture within many health care settings would be an obstacle to successful implementation of a training programme. Working within existing training structures will be essential. Areas for improvement in the workshop included clearer statement of goals at the outset and a more suitable environment for the numbers of participants. CONCLUSIONS: The participants made a valuable contribution to the development of the training programme identifying specific challenges. Inter-professional collaborations are likely to result in more deliverable and relevant training programmes. Continued consultation with potential users of the programme – both trainers and trainees will be essential

Archaeological investigations along the Ruby Pipeline.

405 pages : illustrations (some color), maps ; 26 cm.The Ruby Pipeline originates in Opal, Wyoming, travels westward across Utah and Nevada, and terminates in Malin, Oregon. Almost 360 miles of the line is in Nevada, where it crosses through some of the most remote, sparsely populated land in the lower 48 states. Despite the remote nature of this corridor, it has produced a rich archaeological record reflecting a dynamic history of land-use pattern changes over a period of at least 13,000 years. Archaeological excavations were conducted at 578 prehistoric sites prior to construction of the pipeline. The sites were distributed across four ecological regions, including (from west to east): the High Rock Country, Upper Lahontan Basin, Upper Humboldt Plains, and Thousand Springs Valley. First evidence of human occupation dates to the Paleoindian (14,500-12,800 cal b.p.) and Paleoarchaic (12,800-7800 cal b.p.) periods, when people spent most of their time in the High Rock Country where important economic resources reached their highest densities. Paleoindian findings are limited to a series of Great Basin Concave Base projectile points and small obsidian flaked stone concentrations. Paleoarchaic sites are much more common, and tend to be represented by Great Basin Stemmed projectile points, bifaces, and a limited number of other flaked stone tools. Most of these assemblages reflect small groups of hunters refurbishing their tool kits as they traveled through the area. An important exception to this pattern was found at Five Mile Flat along the west end of pluvial Lake Parman where two significant habitation sites dating to 11,180 cal b.p. were discovered. One of these sites includes a house floor, which is the oldest ever found in the Great Basin. Despite the warm-dry conditions that characterized much of the middle Holocene, it appears that human populations nearly doubled during the Post-Mazama Period (7800-5700 cal b.p.). Most activity remained concentrated in the High Rock Country, but evidence for occupation begins to trickle out into the Upper Lahontan Basin and Upper Humboldt Plains regions as well. Most of the artifact assemblages remain rather narrow, often composed of Northern Side-notched and Humboldt Concave Base points, bifaces, and debitage, and reflect use of the region by mobile groups of hunters. Major changes took place with the arrival of the Early Archaic (5700-3800 cal b.p.) and continued forward into the Middle Archaic Period (3800-1300 cal b.p.). Early Archaic projectile points are largely represented by Humboldt and Gatecliff forms. It appears that population densities increased almost fourfold from the preceding interval, and all four regions experienced significant occupation for the first time. Simultaneous to this population increase and dispersal, a full complement of site types began to emerge, with large-scale residential areas becoming significant for the first time. This trend continued forward into the Middle Archaic Period where the relative frequency of residential sites almost doubled compared with the Early Archaic interval. Plant macrofossil and archaeofaunal assemblages also become more abundant and diversified at this time, probably marking a broadening of the diet breadth. This general trajectory extends into the Late Archaic (1300-600 cal b.p.) and Terminal Prehistoric periods, as people continued to expand into a wider range of habitats. This was particularly case for the latter interval, as the habitat preferences that made sense for over 12,000 years were upended, with population densities highest in the Upper Humboldt Plains and Thousand Springs Valley. This reorientation corresponds to the arrival of Numic speaking populations, especially the Western Shoshone who appear to have reached northern Nevada much earlier than the Northern Paiute, and is probably linked to a greater emphasis on small-seeded plants that are abundantly present in their territory. Although low ranked compared to many other foods, with the proper technology and work organization, small seeds could support higher population densities than was the case earlier in time. Finally, the discovery of obsidian in multiple Terminal Prehistoric sites from sources located much further away than any other time in the past may signal the earliest use of horses in northern Nevada

Many Labs 2: Investigating Variation in Replicability Across Samples and Settings

We conducted preregistered replications of 28 classic and contemporary published findings, with protocols that were peer reviewed in advance, to examine variation in effect magnitudes across samples and settings. Each protocol was administered to approximately half of 125 samples that comprised 15,305 participants from 36 countries and territories. Using the conventional criterion of statistical significance (p < .05), we found that 15 (54%) of the replications provided evidence of a statistically significant effect in the same direction as the original finding. With a strict significance criterion (p < .0001), 14 (50%) of the replications still provided such evidence, a reflection of the extremely highpowered design. Seven (25%) of the replications yielded effect sizes larger than the original ones, and 21 (75%) yielded effect sizes smaller than the original ones. The median comparable Cohen’s ds were 0.60 for the original findings and 0.15 for the replications. The effect sizes were small (< 0.20) in 16 of the replications (57%), and 9 effects (32%) were in the direction opposite the direction of the original effect. Across settings, the Q statistic indicated significant heterogeneity in 11 (39%) of the replication effects, and most of those were among the findings with the largest overall effect sizes; only 1 effect that was near zero in the aggregate showed significant heterogeneity according to this measure. Only 1 effect had a tau value greater than .20, an indication of moderate heterogeneity. Eight others had tau values near or slightly above .10, an indication of slight heterogeneity. Moderation tests indicated that very little heterogeneity was attributable to the order in which the tasks were performed or whether the tasks were administered in lab versus online. Exploratory comparisons revealed little heterogeneity between Western, educated, industrialized, rich, and democratic (WEIRD) cultures and less WEIRD cultures (i.e., cultures with relatively high and low WEIRDness scores, respectively). Cumulatively, variability in the observed effect sizes was attributable more to the effect being studied than to the sample or setting in which it was studied.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ordinances and contracts under which the Mahoning Valley Railway Company, the Youngstown & Sharon Street Railway Company, the Youngstown Park & Falls Street Railway Company, the Youngstown Consolidated Gas & Electric Company are operating within the City of Youngstown, Ohio.

Mode of access: Internet