Treatment dilemmas in a young man presenting with narcolepsy and psychotic symptoms.

Psychotic features can be present in both narcolepsy and psychosis, which can result in challenges in diagnosis and management. The prevalence of both conditions is low and the reports in young people are scarce. Our report illustrates the relevance of a thorough differential diagnosis as well as the need to explore treatment avenues based on the evidence available for both narcolepsy and psychosis symptoms to try and maximise the therapeutic impact

Training and Employment of Classic and Semi-Professions: Intensifying versus Accommodating Logics

Over a half century ago, researchers found that so-called classic professions attract socially advantaged recruits with better labour market outcomes; however, as semi professions become increasingly institutionalized, and classic professional programs expand, differences between these two groups may be less pronounced. Using Statistics Canada’s 2018 National Graduate Survey, we compare inputs and outcomes of four classic professions (law, pharmacy, medicine, and dentistry) and three semi-professions (teaching, social work, and nursing). Bivariate statistics show semi-professions have more non-traditionalgraduates who invest less in training. Multiple linear regression models also show that after controlling for demographics, classic professions have stronger education-job matches and higher earnings three years after graduation. We interpretthese findings as being consistent with our theory of intensifying logic, where classic professions have tight training-job connections, and accommodating logic which suggests semi-professions have looser labour market connections. We end bydiscussing directions for future research on the classic and semi-professions.Des recherches menées il y a plus de cinquante ans ont montré que les professions dites « classiques » attiraient les candidats favorisés sur le plan social tout en offrant de meilleurs résultats sur le marché de l’emploi. Néanmoins, à mesure que les « semi-professions » s’institutionnalisent et que les programmes professionnels classiques se développent, les différences entre ces deux catégories peuvent sembler moins marquées. En nous fondant sur l’Enquête nationale auprès des diplômés (END) de 2018 réalisée par Statistique Canada, nous avons comparé les formations académiques et les résultats sur le marché du travail de quatre professions « classiques » (droit, pharmacie, médecine et art dentaire) et de trois « semi-professions » (enseignement, travail social et soins infirmiers). Les statistiques bivariées montrent que les diplômés « non traditionnels » sont davantage représentés parmi les semi-professions et qu’ils investissent moins dans leur formation. Les modèles de régression linéaire multiple, tenant compte des aspects démographiques, montrent que les domaines d’études et les emplois pourvus concordent davantage au sein des professions classiques, avec des niveaux de rémunération supérieurstrois ans après l’obtention du diplôme. Ces résultats s’inscrivent dans notre théorie des logiques « d’intensification » où les liens sont étroits entre la formation et l’emploi, et « d’accommodement » où les semi-professions ont des liens plus lâches avec le marché du travail. Enfin, nous concluons en discutant des orientations futures de la recherche ayant trait aux professions classiques et aux semi-professions

Monitoring changes in genetic diversity

DNA is the most elemental level of biodiversity, drives the process of speciation, and underpins other levels of biodiversity, including functional traits, species and ecosystems. Until recently biodiversity indicators have largely overlooked data from the molecular tools that are available for measuring variation at the DNA level. More direct analysis of trends in genetic diversity are now feasible and are ready to be incorporated into biodiversity monitoring. This chapter explores the current state-of-the-art in genetic monitoring, with an emphasis on new molecular tools and the richness of data they provide to supplement existing approaches. We also briefly consider proxy approaches that may be useful for many-species, global scale monitoring cases

Health inequalities for older people from minority ethnic groups receiving palliative care and end of life care: a scoping review protocol

OBJECTIVE: The proposed scoping review aims to explore international literature on how older people from minority ethnic groups engage with and utilise palliative and end of life care, investigate the barriers and facilitators, and compare how this varies between ethnicities and health conditions. INTRODUCTION: Minority ethnic groups make up substantial parts of the populations of many countries around the world. Research has found that there are disparities in access to palliative care and end of life care among minority ethnic groups. Language barriers, cultural values, and socio-demographic factors have been cited as preventing access to quality palliative and end of life care. However, it is unclear how these barriers and inequalities differ across different minority ethnic groups in different countries, and across different health conditions within these groups. INCLUSION CRITERIA: The population will be older people of different minority ethnic groups who are receiving palliative or end of life care, family caregivers, and health and social care professionals. The sources of information will include quantitative, qualitative and mixed methods research, and sources that focus on minority ethnic groups’ interactions with palliative and end of life care. METHODS: A scoping review guided by the Joanna Briggs Institute Manual for Evidence Synthesis. Searches of MEDLINE, Embase, PsycInfo, CINAHL, Scopus, Web of Science, Assia, and the Cochrane Library will be conducted. Citation tracking, reference list checking and grey literature searches will be undertaken. Data will be extracted, charted and summarised descriptively. IMPLICATIONS: This review will highlight the health inequalities present in palliative and end of life care, the research gaps in understudied minority ethnic populations, locations where further study is required, and how barriers and facilitators differ across different ethnic groups and health conditions. The results of this review will be shared with stakeholders and will provide evidence-based recommendations for inclusive palliative and end of life care

Ultrasonic monitoring to assess the impacts of forest conversion on Solomon Island bats

Paleotropical islands are experiencing extensive land-use change, yet little is known about how such changes are impacting wildlife in these biodiversity hotspots. To address this knowledge gap, we characterized bat responses to forest conversion in a biodiverse, human-threatened coastal rainforest habitat on Makira, Solomon Islands. We analysed ~200hrs of acoustic recordings from echolocating bats in the four dominant types of land-use on Makira: intact forest, secondary forest, food gardens and cacao plantations. Bat calls were identified to the species level using a supervised classification model (where labelled data are used to train the system). We examined relative activity levels and morphological traits across habitats. Relative activity levels were highest in intermediately disturbed habitats and lowest in the most heavily disturbed habitat, although these differences were not significant. There were significant differences in the mean forearm length of bat assemblages across habitats, with the highest mean forearm length found in the most open habitat (Cacao). Overall, our study constitutes the first detailed exploration of anthropogenic effects on mammalian diversity in the Solomon Islands and includes the first acoustic and morphological information for many bat species in Melanesia. We use our experience to discuss the challenges of acoustic monitoring in such a remote and poorly studied region.Publisher PDFPeer reviewe

Experiences of advance care planning in Parkinson’s disease and atypical Parkinsonian disorders: a mixed methods systematic review

Background and purpose: Advance care planning allows people to plan for their future care needs and can include medical, psychological and social aspects. However, little is known on the use, experience of and attitudes towards advance care planning in patients with parkinsonian disorders, their family carers and healthcare professionals. Methods: A systematic search of online databases was conducted in April 2019 using a narrative synthesis approach with thematic analysis and tabulation to synthesize the findings. Results: In all, 507 articles were identified and 27 were included. There were five overarching themes: (i) what is involved in advance care planning discussions, (ii) when and how advance care planning discussions are initiated, (iii) barriers to advance care planning, (iv) the role of healthcare professionals and (v) the role of the family carer. This evidence was used to highlight eight effective components to support optimal advance care planning in parkinsonian disorders: advance care planning discussions should be individualized in content, timing and approach; patients should be invited to discuss advance care planning early and regularly; palliative care services should be introduced early; a skilled professional should deliver advance care planning; support to family carers should be offered in the advance care planning process; healthcare professionals should be educated on parkinsonian disorders and palliative care; advance care planning should be clearly documented and shared with relevant services; and healthcare professionals should be enabled to conduct effective advance care planning. Conclusions: These components can inform best practice in advance care planning in patients with parkinsonian disorders

The effectiveness of web-based interventions designed to decrease alcohol consumption – a systematic review

OBJECTIVE To review the published literature on the effectiveness of web-based interventions designed to decrease consumption of alcohol and/or prevent alcohol abuse. METHOD Relevant articles published up to, and including, May 2006 were identified through electronic searches of Medline, PsycInfo, Embase, Cochrane Library, ASSIA, Web of Science and Science Direct. Reference lists of all articles identified for inclusion were checked for articles of relevance. An article was included if its stated or implied purpose was to evaluate a web-based intervention designed to decrease consumption of alcohol and/or to prevent alcohol abuse. Studies were reliably selected and quality-assessed, and data were independently extracted and interpreted by two authors. RESULTS Initial searches identified 191 articles of which 10 were eligible for inclusion. Of these, five provided a process evaluation only, with the remaining five providing some pre-to post-intervention measure of effectiveness. In general the percentage quality criteria met was relatively low and only one of the 10 articles selected was a randomized control trial. CONCLUSION The current review provides inconsistent evidence on the effectiveness of eIectronic screening and brief intervention (eSBI) for alcohol use. Process research suggests that web-based interventions are generally well received. However further controlled trials are needed to fully investigate their efficacy, to determine which elements are keys to outcome and to understand if different elements are required in order to engage low- and high-risk drinkers

Intervention components in the self-management of Parkinson’s: A mixed-methods synthesis of qualitative and quantitative evidence

INTRODUCTION: Self-management interventions consist of multiple components to support people in the management of medical, emotional, and behavioural aspects of their condition, and aim to improve quality of life, function, and other outcomes. A systematic review of self-management interventions in Parkinson’s showed no conclusive evidence for effectiveness of specific self-management approaches in Parkinson’s to date but identified several potentially useful components. AIM: To identify the key required components for self-management in people with Parkinson’s by synthesising evidence from a body of primary qualitative evidence and systematic reviews, and to explore which of these key components should be incorporated into trials of self-management in Parkinson’s. METHOD: A mixed-methods synthesis was conducted. We combined data from two primary qualitative studies and a systematic review of qualitative studies that focused on self-management in Parkinson’s to identify key intervention components. These were then mapped onto the results of a systematic review of Randomised Controlled Trials (RCTs) using matrices. First, data were extracted from the qualitative studies with people with Parkinson’s and healthcare professionals on the key self-management components in this population. Second, a matrix table was created to map the identified Parkinson’s specific self-management components against potential effectiveness from published RCTs of self-management interventions. RESULTS: Synthesis of qualitative data identified 15 potential self-management components. These 15 components included components needed to start self-managing (e.g., information, skill acquirement) and components needed to maintain self-managing (e.g., self-motoring, increasing motivation). From 18 RCTs, interventions varied in how many components were included (range 1–10). Trials reporting significant beneficial effects of their intervention included a higher number of components (4 or more self-management components) than trials without significant findings (1–3 self-management components). CONCLUSION: Fifteen key self-management components were identified that should be incorporated into interventions or programs of self-management in Parkinson’s. No current trial has incorporated all aspects, but a higher number of these key components appears to make trials of self-management interventions more likely to be successful