Insights into DNA platination within unusual structural settings

2D [1H, 15N] HSQC NMR spectroscopy has been used to monitor reaction and product formation between [Pt(15NH3)2I2] and nucleic acids possessing irregular topologies and containing site specific phosphorothioate substitution in the phosphodiester backbone. Comparison of the reaction profiles of dimer nucleic acids with and without phosphorothioate substitution is made with their short nucleic acid counterparts containing the key dimer components. Whereas d(GpA) is relatively unreactive towards [Pt(15NH3)2I2], NMR evidence suggests that the tandem sheared mismatch duplex d(GCG3pAGC)2 reacts to form the head-to-tail inter-strand G3-N7-Pt-G3-N7 cross-link. The equivalent phosphorothioate R,S-d(GsA) reacts to form a mono-iodo, mono-sulphur adduct, whereas the tandem sheared mismatch phosphorothioate duplex d(GCGsAG5C)2 (VIs) reacts to form the unusual intra-strand macrochelate [Pt(15NH3)2{d(VIs-G5-N7)},S]2+ in which platinum is attached at both sulphur and G5-N7. Experimental evidence supports the formation of a stabilized mismatch duplex in which platinum is attached to two nitrogen centres in the sequence d(CGCGpTGCG) in contrast to R,S-d(CGCGsT5GCG) for which NMR evidence supports macrochelate-stabilized hairpin loop formation cross-linked at both phosphorothioate sulphur and T5-N

A multi-component evaluation framework of a state-wide preventive health program : My health for life

Issue Chronic disease is a growing problem affecting approximately half of all Australian adults. In response to growing calls for action on chronic disease, the My health for life program was created, aimed at improving the health of individuals at high risk of developing preventable chronic disease. The preventive health program is multi-modal, cross-culturally tailored and contains complex social marketing, community engagement, risk assessment and health promotion components. Therefore, a multi-component evaluation framework is essential to understand the effectiveness of the My health for life program. This brief report details the evaluation. Methods The evaluation design uses non-randomised, longitudinal analysis using repeated measures, observational, program goal-based and pretest-posttest design features to assess the program, its specific modalities and its program adaptations. To ensure timely and credible evaluation, different evaluative implementation frameworks and methods are considered. Quantitative and qualitative methods collect an array of program data at differing levels to assess the processes, outcomes and impacts of My health for life. Discussion The implemented evaluation framework has allowed measurement of: (i) process impacts including uptake, retention and attrition, participant satisfaction, fidelity and program stakeholder engagement and (ii) outcomes relating to individual participant level changes in health behaviours. So what? This evaluation is an example of an integrated evaluation approach in a large successful preventive health program. Findings from the evaluation will ultimately inform the applicability and transferability of the program and inform policy makers, stakeholders and other health professionals in preventive health practice

Upper and lower lumbar segments move differently during sit-to-stand

Sit-to-stand (STS) is a functional dynamic task, requiring movement of the lumbar spine, however, little is known about whether regional differences or between-gender differences exist during this task. The aim of this study was to confirm whether kinematic differences existed within regions of the lumbar spine during STS and also to determine whether between-gender differences were evident. An electromagnetic measurement device, recording at 25 Hz, determined how different lumbar spine regions (combined, lower and upper) moved during STS in 29 healthy participants (16 males, 13 females). Discrete outputs including mean range of motion (ROM), maximum and minimum were calculated for each lumbar spine region. Analyses of covariance (ANCOVA) with repeated measures were used to determine whether regional differences and between-gender differences were evident in the lumbar spine during STS. With the lumbar spine modelled as two segments, the lower lumbar (LLx) and upper lumbar (ULx) regions made different contributions to STS: F1, 27=21.8; p < 0.001. No between-gender differences were found with the lumbar spine modelled as a single region (combined lumbar: CLx), however, modelled as two regions there was a significant gender difference between the LLx and ULx regions: F1, 27=7.3 (p=0.012). The results indicate that modelling the lumbar spine as a single segment during STS does not adequately represent lumbar spine kinematics and there are important gender differences. These findings also need to be considered when investigating STS in clinical populations

Geographic remoteness and socioeconomic disadvantage reduce the supportiveness of food and physical activity environments in Australia

Objective An analysis of food and physical activity environments in relation to socioeconomic disadvantage was conducted in 25 communities across Queensland, Australia. Methods Physical activity and food environments were assessed in 25 Queensland communities using The Systematic Pedestrian and Cycling Environmental Scan (SPACES) and the Nutrition Environment Measurement Survey (NEMS). Spearman's correlation tested the association between physical activity and food environments and degree of remoteness and socioeconomic disadvantage of each region. Results A significant negative association was observed between the supermarket food environment and degree of remoteness and socioeconomic disadvantage. All regions have a moderately supportive environment for physical activity. Food availability and price varied in supermarkets with more remote communities having less supportive food environments. Conclusions Areas with a high degree of remoteness and socioeconomic disadvantage were more likely to experience disadvantages in the physical activity, supermarket, and restaurant food environments than metropolitan areas and socioeconomically disadvantaged areas. Implications for public health Socioeconomic disadvantage and remoteness were associated with reduced supportiveness of the built environment hindering the ability of consumers to make healthy food and physical activity choices. Improving the food and physical activity environments in these areas may assist in reducing the health inequalities experienced by these communities

Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills : Protocol for a single-arm pilot trial of Living Well After Stroke

Introduction Survivors of stroke have an elevated risk of recurrent stroke. Prompt intervention to support healthy lifestyle modification following an initial stroke is crucial for effective secondary prevention of stroke. However, many patients do not receive adequate postdischarge support for secondary prevention, particularly if not referred to inpatient rehabilitation. Living Well After Stroke is a health promotion programme based on the health action process approach (HAPA), which is designed to support this underserviced group to improve and self-manage secondary prevention behavioural performance (eg, diet, exercise, medication-adherence) by equipping participants with a toolkit of theory-based and evidence-based behaviour change strategies and techniques that are transferable to different behavioural contexts. Methods and analysis The target sample is 118 adults living in Queensland, Australia, with stroke or transient ischaemic attack not referred to inpatient rehabilitation. Adopting a prospective single-arm trial design, the intervention comprises five behaviour change sessions over an 8-week period. Participants will receive a mix of individual-based and group-based assessments and interventions, based on the HAPA theoretical framework, delivered via telehealth or in-person (eg, public library). Measures of primary (ie, goal behaviours 1 and 2) and secondary outcomes (intention, outcome expectancy, risk perception, self-efficacy, planning, action control, subjective well-being) will be taken at 2 weeks, 4 weeks, 8 weeks and 16 weeks. The primary outcomes of the trial will be behavioural performance and transferability of behaviour change skills at 16 weeks. Ethics and dissemination The study has received ethical approval from the Griffith University Human Research Ethics Committee (Ref no: 2022/308). Informed consent is obtained via telephone prior to data collection. Findings will be presented in the form of peer-reviewed journal articles, industry reports and conference presentations, and will be used to inform the continued development and refinement of the programme for testing in a future fully powered trial

Exploring the Reactions of Peer Learners to a New Model of Peer-Assisted Simulation-Based Learning Clinical Placement

In response to the paucity of clinical placements available in 2020 due to the COVID-19 pandemic, alternate options for prelicensure students were necessary in order for them to complete the fieldwork required for graduation. In response, Curtin University replaced a faculty-led fully-simulated placement with a peer-assisted learning model. This incorporated final-year students acting as peer teachers to penultimate-year students, thus creating new learning and teaching placements for the final-year students. To our knowledge, this had never been done on such a scale before. Considering the importance of meeting learner expectations in the tertiary setting, the perceptions of peer learners around the innovation were important but unknown. This study used a prospective qualitative observational design that utilized feedback from peer learners relating to learning using the peer-assisted model. Peer learners provided written reflections that were analysed thematically. During November and December 2020, 171 penultimate-year physiotherapy students participated in one of two three-week placements, and 170 consented to participate in data collection. Qualitative data reflected several enablers and barriers to learning during the experience. These related to the peer teacher attributes, the provision of performance feedback, the learning environment, and the facilitation of clinical reasoning. Peer learners enjoyed the peer-assisted model, found peer teachers able to facilitate learning, and provided useful insights that will shape future placements. The success of the model supports repeating it in the future. This will maintain a bilateral exchange of peer-led clinical learning and teaching with diminished faculty supervisory workload

Health action process approach : Promoting physical activity, and fruit and vegetable intake among Australian adults

Based on the health action process approach (HAPA) this study examined whether changes in social cognition constructs could predict change in physical activity and fruit and vegetable intake for adult participants in My health for life, an Australian health promotion behaviour change program. Variance-based structural equation modelling was used to analyse data obtained from Australian adult program participants (n = 167) at baseline (T1), week 14 (T2), week 26 (T2), and 6-month post-program (T4). Change scores were calculated for the social cognition constructs and behaviour. Changes in action self-efficacy and outcome expectancies positively predicted changes in intentions. Action self-efficacy changes also predicted changes in maintenance self-efficacy which, in turn, mediated the effect of action self-efficacy on recovery self-efficacy and planning. Planning was predicted by changes in intentions and maintenance self-efficacy. Findings support the use of the HAPA model in designing complex health behaviour change interventions to achieve sustained behaviour change

High quality, patient centred andcoordinated care for Alstrom syndrome: amodel of care for an ultra-rare disease

Background: Patients with rare and ultra-rare diseases make heavy demands on the resources of both health and social services, but these resources are often used inefficiently due to delays in diagnosis, poor and fragmented care. We analysed the national service for an ultra-rare disease, Alstrom syndrome, and compared the outcome and cost of the service to the standard care. Methods: Between the 9th and 26th of March 2014 we undertook a cross-sectional study of the UK Alstrom syndrome patients and their carers. We developed a semi-structured questionnaire to assess our rare patient need, quality of care and costs incurred to patients and their careers. In the UK all Alstrom syndrome patients are seen in two centres, based in Birmingham, and we systematically evaluated the national service and compared the quality and cost of care with patients’ previous standard of care. Results: One quarter of genetically confirmed Alstrom syndrome UK patients were enrolled in this study. Patients that have access to a highly specialised clinical service reported that their care is well organised, personalised, holistic, and that they have a say in their care. All patients reported high level of satisfaction in their care. Patient treatment compliance and clinic attendance was better in multidisciplinary clinic than the usual standard of NHS care. Following a variable costing approach based on personnel and consumables’ cost, our valuation of the clinics was just under £700/patient/annum compared to the standard care of £960/patient/annum. Real savings, however, came in terms of patients’ quality of life. Furthermore there was found to have been a significant reduction in frequency of clinic visits and ordering of investigations since the establishment of the national service. Conclusions: Our study has shown that organised, multidisciplinary “one stop” clinics are patient centred and individually tailored to the patient need with a better outcome and comparable cost compared with the current standard of care for rare disease. Our proposed care model can be adapted to several other rare and ultra-rare diseases

Non-Pharmacological interventions designed to reduce health risks due to unhealthy eating behaviour and linked risky or excessive drinking in adults aged 18-25 years:A systematic review protocol

BACKGROUND: Excess body weight and heavy alcohol consumption are two of the greatest contributors to global disease. Alcohol use peaks in early adulthood. Alcohol consumption can also exacerbate weight gain. A high body mass index and heavy drinking are independently associated with liver disease but, in combination, they produce an intensified risk of damage, with individuals from lower socio-economic status groups disproportionately affected. METHODS: We will conduct searches in MEDLINE, Embase, PubMed, PsycINFO, ERIC, ASSIA, Web of Knowledge (WoK), Scopus, CINAHL via EBSCO, LILACS, CENTRAL and ProQuest Dissertations and Theses for studies that assess targeted preventative interventions of any length of time or duration of follow-up that are focused on reducing unhealthy eating behaviour and linked risky alcohol use in 18-25-year-olds. Primary outcomes will be reported changes in: (1) dietary, nutritional or energy intake and (2) alcohol consumption. We will include all randomised controlled trials (RCTs) including cluster RCTs; randomised trials; non-randomised controlled trials; interrupted time series; quasi-experimental; cohort involving concurrent or historical controls and controlled before and after studies. Database searches will be supplemented with searches of Google Scholar, hand searches of key journals and backward and forward citation searches of reference lists of identified papers. Search records will be independently screened by two researchers, with full-text copies of potentially relevant papers retrieved for in-depth review against the inclusion criteria. Methodological quality of RCTs will be evaluated using the Cochrane risk of bias tool. Other study designs will be evaluated using the Cochrane Public Health Review Group's recommended Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Studies will be pooled by meta-analysis and/or narrative synthesis as appropriate for the nature of the data retrieved. DISCUSSION: It is anticipated that exploration of intervention effectiveness and characteristics (including theory base, behaviour change technique; modality, delivery agent(s) and training of intervention deliverers, including their professional status; and frequency/duration of exposure) will aid subsequent co-design and piloting of a future intervention to help reduce health risk and social inequalities due to excess weight gain and alcohol consumption. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016040128

Observational Study Exploring the Efficacy and Effectiveness of a New Model of Peer-Assisted Simulation-Based Learning Clinical Placement

(1) Background: Immersive simulation-based learning is relevant and effective in health care professional pre-licensure training. Peer-assisted learning has reciprocal benefit for the learner and the teacher. A fully simulated model of fieldwork placement has been utilised at [de-identified] University since 2014, historically employing full-time faculty supervisors. Due to the COVID-19 pandemic in 2020, traditional clinical placement availability diminished. (2) Methods: This mixed-methods prospective observational study aimed to translate the existing faculty-led placement for penultimate-year physiotherapy students to a peer-taught model, thereby creating new teaching placements for final-year students. Final-and penultimate-year physiotherapy students undertook the fully simulated fieldwork placement either as peer learners or peer teachers. The placement was then evaluated using four outcome measures: The ‘measure of quality of giving feedback scale’ (MQF) was used to assess peer learner satisfaction with peer-teacher supervision; plus/delta reflec-tions were provided by peer teachers and faculty supervisors; student pass/fail rates for the penul-timate-year physiotherapy students. (3) Results: For 10 weeks during November and December 2020, 195 students and 19 faculty participated in the placement. Mean MQF scores ranged from 6.4 (SD 0.86) to 6.8 (SD) out of 7; qualitative data reflected positive and negative aspects of the experience. There was a 4% fail rate for penultimate-year students for the placement. Results suggested that peer learners perceived peer-led feedback was of a high quality; there were both positives and challenges experienced using the model. (4) Conclusions: Physiotherapy students effectively adopted a peer-taught fully simulated fieldwork placement model with minimal faculty supervision, and comparable clinical competency outcomes