New South Wales Vegetation Classification and Assessment : part 1, plant communities of the NSW Western Plains

For the Western Plains of New South Wales, 213 plant communities are classified and described and their protected area and threat status assessed. The communities are listed on the NSW Vegetation Classification and Assessment database (NSWVCA). The full description of the communities is placed on an accompanying CD together with a read-only version of the NSWVCA database. The NSW Western Plains is 45.5 million hectares in size and covers 57% of NSW. The vegetation descriptions are based on over 250 published and unpublished vegetation surveys and maps produced over the last 50 years (listed in a bibliography), rapid field checks and the expert knowledge on the vegetation. The 213 communities occur over eight Australian bioregions and eight NSW Catchment Management Authority areas. As of December 2005, 3.7% of the Western Plains was protected in 83 protected areas comprising 62 public conservation reserves and 21 secure property agreements. Only one of the eight bioregions has greater than 10% of its area represented in protected areas. 31 or 15% of the communities are not recorded from protected areas. 136 or 64% have less than 5% of their pre-European extent in protected areas. Only 52 or 24% of the communities have greater than 10% of their original extent protected, thus meeting international guidelines for representation in protected areas. 71 or 33% of the plant communities are threatened, that is, judged as being ‘critically endangered’, ‘endangered’ or ‘vulnerable’. While 80 communities are recorded as being of ‘least concern’ most of these are degraded by lack of regeneration of key species due to grazing pressure and loss of top soil and some may be reassessed as being threatened in the future. Threatening processes include vegetation clearing on higher nutrient soils in wetter regions, altered hydrological regimes due to draw-off of water from river systems and aquifers, high continuous grazing pressure by domestic stock, feral goats and rabbits, and in some places native herbivores — preventing regeneration of key plant species, exotic weed invasion along rivers and in fragmented vegetation, increased salinity, and over the long term, climate change. To address these threats, more public reserves and secure property agreements are required, vegetation clearing should cease, re-vegetation is required to increase habitat corridors and improve the condition of native vegetation, environmental flows to regulated river systems are required to protect inland wetlands, over-grazing by domestic stock should be avoided and goat and rabbit numbers should be controlled and reduced. Conservation action should concentrate on protecting plant communities that are threatened or are poorly represented in protected areas

Technology and its role in rehabilitation for people with cognitive-communication disability following a traumatic brain injury (TBI)

© 2017 Taylor & Francis Group, LLC. Purpose: To review the literature on communication technologies in rehabilitation for people with a traumatic brain injury (TBI), and: (a) determine its application to cognitive-communicative rehabilitation, and b) develop a model to guide communication technology use with people after TBI. Method: This integrative literature review of communication technology in TBI rehabilitation and cognitive-communication involved searching nine scientific databases and included 95 studies. Results: Three major types of communication technologies (assistive technology, augmentative and alternative communication technology, and information communication technology) and multiple factors relating to use of technology by or with people after TBI were categorized according to: (i) individual needs, motivations and goals; (ii) individual impairments, activities, participation and environmental factors; and (iii) technologies. While there is substantial research relating to communication technologies and cognitive rehabilitation after TBI, little relates specifically to cognitive-communication rehabilitation. Conclusions: Further investigation is needed into the experiences and views of people with TBI who use communication technologies, to provide the ‘user’ perspective and influence user-centred design. Research is necessary to investigate the training interventions that address factors fundamental for success, and any impact on communication. The proposed model provides an evidence-based framework for incorporating technology into speech pathology clinical practice and research

Content Analysis of Tweets by People with Traumatic Brain Injury (TBI): Implications for Rehabilitation and Social Media Goals

In this Twitter research, 6874 tweets of six adults with traumatic brain injury (TBI) were analyzed qualitatively and quantitatively using content classification [1], inductive coding of content themes, socio-linguistic analysis, and computational analysis in KH Coder. The results reflected that participants used Twitter for: (i) supporting others, including people with TBI; (ii) discussing society and culture, popular issues, news, and personal interests; (iii) connecting with others; (iv) sharing their experiences of life after TBI; (v) knowledge via exchanging information; and (vii) advocacy. ‘Emotional expression’, and ‘connection’ were common threads running across themes. Attending to the expressions of people with TBI on Twitter provides important insights into their lived experiences and could inform the development of user-centered cognitive-communication and social participation goals for people with TBI

Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review

Background: Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. Objective: This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. Methods: This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. Results: In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. Conclusions: There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area

Tribes and tribulations: Interdisciplinary eHealth in providing services for people with a traumatic brain injury (TBI)

© 2017 The Author(s). Background: eHealth has potential for supporting interdisciplinary care in contemporary traumatic brain injury (TBI) rehabilitation practice, yet little is known about whether this potential is being realised, or what needs to be done to further support its implementation. The purpose of this study was to explore health professionals' experiences of, and attitudes towards eHealth technologies to support interdisciplinary practice within rehabilitation for people after TBI. Methods: A qualitative study using narrative analysis was conducted. One individual interview and three focus groups were conducted with health professionals (n = 17) working in TBI rehabilitation in public and private healthcare settings across regional and metropolitan New South Wales, Australia. Results: Narrative analysis revealed that participants held largely favourable views about eHealth and its potential to support interdisciplinary practice in TBI rehabilitation. However, participants encountered various issues related to (a) the design of, and access to electronic medical records, (b) technology, (c) eHealth implementation, and (d) information and communication technology processes that disconnected them from the work they needed to accomplish. In response, health professionals attempted to make the most of unsatisfactory eHealth systems and processes, but were still mostly unsuccessful in optimising the quality, efficiency, and client-centredness of their work. Conclusions: Attention to sources of disconnection experienced by health professionals, specifically design of, and access to electronic health records, eHealth resourcing, and policies and procedures related to eHealth and interdisciplinary practice are required if the potential of eHealth for supporting interdisciplinary practice is to be realised

What guides student learning in the clinical years: A mixed methods study exploring study behaviours prior to the UK Medical Licensing Assessment (UKMLA).

PURPOSE: Student study behaviours that prioritise the UKMLA content map over the local curriculum are a significant risk for UK medical education. To mitigate this, we describe a student-centred faculty process to improve local curriculum guidance based on an evaluation of student study behaviours, concerns and needs. Responses informed the build of an online curriculum map. METHODS: A mixed methods approach was adopted, including an online anonymous survey exploring student study behaviours and preferences for curricular guidance. This was followed by student-led focus groups to explore emergent themes further. Qualitative data underwent reflexive thematic analysis. RESULTS: 121 students responded to the survey, of which 12 consented to participate in two student-led focus groups. Five key themes emerged, including motivation for learning, student use of the intended curriculum, student experience of the enacted curriculum, the hidden curriculum, and expectations of an online curriculum map. CONCLUSIONS: A participatory framework enabled shared aims and responsive outcomes for curricular development in the run up to the UKMLA. Student responses led to clarification of guidance, reorganisation of learning resources and optimal design of an online curriculum map which linked all content in a visible, UKMLA aligned framework, accessible to all students and teachers

Impact of radiographer immediate reporting of X-rays of the chest from general practice on the lung cancer pathway (radioX): a randomised controlled trial

The National Optimal Lung Cancer Pathway recommends rapid progression from abnormal chest X-rays (CXRs) to CT. The impact of the more rapid reporting on the whole pathway is unknown. The aim of this study was to determine the impact of immediate reporting of CXRs requested by primary care by radiographers on the time to diagnosis of lung cancer. Method People referred for CXR from primary care to a single acute district general hospital in London attended sessions that were prerandomised to either immediate radiographer (IR) reporting or standard radiographer (SR) reporting within 24 hours. CXRs were subsequently reported by radiologists blind to the radiographer reports to test the reliability of the radiographer report. Radiographer and local radiologist discordant cases were reviewed by thoracic radiologists, blinded to reporter. Results 8682 CXRs were performed between 21 June 2017 and 4 August 2018, 4096 (47.2%) for IR and 4586 (52.8%) for SR. Lung cancer was diagnosed in 49, with 27 (55.1%) for IR. The median time from CXR to diagnosis of lung cancer for IR was 32 days (IQR 19, 70) compared with 63 days (IQR 29, 78) for SR (p=0.03). 8258 CXRs (95.1%) were reported by both radiographers and local radiologists. In the 1361 (16.5%) with discordance, the reviewing thoracic radiologists were equally likely to agree with local radiologist and radiographer reports. Conclusions Immediate reporting of CXRs from primary care reduces time to diagnosis of lung cancer by half, likely due to rapid progress to CT. Radiographer reports are comparable to local radiologist reports for accuracy. Trial registration International Standard Randomised Controlled Trial Number ISRCTN21818068. Registered on 20 June 2017

Placental FKBP51 mediates a link between second trimester maternal anxiety and birthweight in female infants

Abstract Prenatal distress is associated with adverse outcomes in affected offspring. Alterations in placental glucocorticoid signalling and subsequent foetal overexposure to glucocorticoids have been implicated as an underlying mechanism. Infant sex is emerging as an important factor in disease susceptibility. This study aimed to examine the effects of maternal distress across pregnancy on birth outcomes and placental glucocorticoid genes in a sex-dependent manner. Participants completed psychological distress questionnaires throughout pregnancy. Placental HSD11B2, NR3C1 and FKBP51 were analysed by real time PCR and cortisol was measured in new-born hair. Second trimester stress was negatively correlated with birthweight in males and positively correlated with placental NR3C1 mRNA in females. Second trimester anxiety was negatively correlated with birthweight and placental FKBP51 mRNA in females. In mediation analysis, placental FKBP51 mRNA expression was found to mediate the link between prenatal anxiety and birthweight. New-born cortisol was negatively correlated with second trimester anxiety and positively correlated with female placental FKBP51 mRNA levels. Again, FKBP51 mRNA was found to mediate the link between anxiety and new-born cortisol. These results highlight a role for FKBP51 in the placental response to prenatal distress in females. The precise role that placental FKBP51 has in foetal and infant development has not been extensively studied and warrants further investigations

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury: What’s Changed From 2014 to Now?

IT IS CRITICAL TO KEEP clinical practice guidelines (CPGs) up to date through integration of the latest evidence. Therefore, it is with great excitement that the INCOG team presents the INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury (TBI). In this brief introduction, we provide an overview of changes in the evidence from 2014; share insights into the current state and challenges implementing cognitive rehabilitation; and provide an overview of INCOG 2022

INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part IV: Cognitive-Communication and Social Cognition Disorders

Introduction: Moderate to severe traumatic brain injury causes significant cognitive impairments, including impairments in social cognition, the ability to recognize others\u27 emotions, and infer others\u27 thoughts. These cognitive impairments can have profound negative effects on communication functions, resulting in a cognitive-communication disorder. Cognitive-communication disorders can significantly limit a person\u27s ability to socialize, work, and study, and thus are critical targets for intervention. This article presents the updated INCOG 2.0 recommendations for management of cognitive-communication disorders. As social cognition is central to cognitive-communication disorders, this update includes interventions for social cognition. Methods: An expert panel of clinicians/researchers reviewed evidence published since 2014 and developed updated recommendations for interventions for cognitive-communication and social cognition disorders, a decision-making algorithm tool, and an audit tool for review of clinical practice. Results: Since INCOG 2014, there has been significant growth in cognitive-communication interventions and emergence of social cognition rehabilitation research. INCOG 2.0 has 9 recommendations, including 5 updated INCOG 2014 recommendations, and 4 new recommendations addressing cultural competence training, group interventions, telerehabilitation, and management of social cognition disorders. Cognitive-communication disorders should be individualized, goal- and outcome-oriented, and appropriate to the context in which the person lives and incorporate social communication and communication partner training. Group therapy and telerehabilitation are recommended to improve social communication. Augmentative and alternative communication (AAC) should be offered to the person with severe communication disability and their communication partners should also be trained to interact using AAC. Social cognition should be assessed and treated, with a focus on personally relevant contexts and outcomes. Conclusions: The INCOG 2.0 recommendations reflect new evidence for treatment of cognitive-communication disorders, particularly social interactions, communication partner training, group treatments to improve social communication, and telehealth delivery. Evidence is emerging for the rehabilitation of social cognition; however, the impact on participation outcomes needs further research