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The purpose of this study was to better understand how LGBT+ college students find a safe space on college and university campuses when there is not one already provided for them. Strange and Banning’s (2015) four environments served as the theoretical framework. Data were collected through individual interviews with six college students who identify within the LGBT+ community and attend a mid-sized institution in South Georgia which does not have an established safe space. Students indicated locations like the library, front lawn, and individuals such as faculty, staff, and student organizations offered safe spaces. The results can better inform student affairs educators or any professional who works with LGBT+ populations on how to better support these students while they are under their guise. It also supports the trend of colleges and universities establishing safe spaces for their LGBT+ students.

Abstract Background There is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature of participatory approaches complicates application of implementation theories, methods, and strategies which do not address researchers’ situatedness within participatory processes. As an implementation scientist, addressing one’s own situatedness through critical reflection is important to unearth how conscious and unconscious approaches, including ontological and epistemological underpinnings, influence the participatory context, process, and outcomes. Therefore, the aim of this exploratory work is to investigate the heretofore blind spot toward the lived experience of implementation researchers within the participatory process. Methods We developed an integrated research-practice partnership (IRPP) to inform the implementation of a gestational weight gain (GWG) control program. Within this IRPP, one investigator conducted a 12-month autoethnography. Data collection and triangulation included field notes, cultural artifacts, and systematic timeline tracking. Data analysis included ethnographic-theoretical dialogue and restorying to synthesize key events and epiphanies into a narrative. Results Analysis revealed the unpredicted evolution of the GWG program into a maternal health fair and three themes within the researchers’ lived experience: (1) permeable work boundaries, (2) individual and collective blind spots toward the ontological and epistemological underpinnings of implementation paradigms, and (3) maladaptive behaviors seemingly reinforced by the research culture. These themes contributed to the chaos of implementation and to researchers’ experience of inadequate recovery from cognitive, emotional, and practical demands. These themes also demonstrated the importance of contextual factors, subjectivity, and value-based judgments within implementation research. Conclusion Building on extant qualitative research guidelines, we suggest that researchers anchor their approach to implementation in reflexivity, intentionally and iteratively reflecting on their own situatedness. Through this autoethnography, we have elucidated several strategies based on critical reflection including examining philosophical underpinnings of research, adopting restorative practices that align with one’s values, and embracing personal presence as a foundation of scientific productivity. Within the predominant (post-) positivism paradigms, autoethnography may be criticized as unscientifically subjective or self-indulgent. However, this work demonstrates that autoethnography is a vehicle for third-person observation and first-person critical reflection that is transformative in understanding and optimizing implementation contexts, processes, and outcomes.

Abstract Background Shared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care. In this review, we sought to better understand opportunities, barriers, and limitations to SMAs based on patient experience in the primary care context. Methods An experienced biomedical librarian conducted literature searches of PubMed, Cochrane Library, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and SSRN for peer-reviewed publications published 1997 or after. We searched grey literature, nonempirical reports, social science publications, and citations from published systematic reviews. The search yielded 1359 papers, including qualitative, quantitative, and mixed method studies. Categorization of the extracted data informed a thematic synthesis. We did not perform a formal meta-analysis. Results Screening and quality assessment yielded 13 quantitative controlled trials, 11 qualitative papers, and two mixed methods studies that met inclusion criteria. We identified three consistent models of care: cooperative health care clinic (five articles), shared medical appointment / group visit (10 articles) and group prenatal care / CenteringPregnancy® (11 articles). Conclusions SMAs in a variety of formats are increasingly employed in primary care settings, with no singular gold standard. Accepting and implementing this nontraditional approach by both patients and clinicians can yield measurable improvements in patient trust, patient perception of quality of care and quality of life, and relevant biophysical measurements of clinical parameters. Further refinement of this healthcare delivery model will be best driven by standardizing measures of patient satisfaction and clinical outcomes.

Globally, habitat loss has been deemed a major threat to wetland bird populations. However, the underlying mechanism of population declines and variations in the birds' vulnerability throughout their annual cycle is challenging to determine, yet critical for development of targeted conservation strategies. Over seven years, landscape water availability explained occupancy of breeding territories best when breeding performance, migratory performance, and annual survival of the White-naped Crane (Grus vipio) population in eastern Mongolia were studied. Also, the hatching success of eggs was positively correlated with water availability in addition to plant productivity. High ambient temperatures and large numbers of herder families (and hence more livestock) negatively affected hatching success. High water availability at Luan, a major stopover site increased migration speed during the cranes' northbound migration to their breeding grounds. In contrast, when water conditions were favorable, the birds stayed longer at the stopover site during southbound migration. Increased human density reduced the use of the stopover site during northbound migration. Finally, cranes arrived early at the breeding grounds when ambient temperature was high in northeast Mongolia. Combining these findings with historical trends in key environmental factors on their breeding grounds explains the general decline observed in this population of cranes in recent decades. Extrapolating our findings with future climate predictions, the outlook seems poor unless urgent action is taken. Knowledge of the mechanisms underlying White-naped Crane population decline in eastern Mongolia identified in this paper should improve the effectiveness of these actions., (© 2022. The Author(s).)

Subspecies are often less well-defined than species but have become one of the basic units for legal protection. Evidence for the erection or synonymy of subspecies therefore needs to be founded on the best science available. Here we show that there is clear genetic disjunction in the Sarus Crane Antigone antigone, where previously the variation had appeared to be clinal. Based on a total sample of 76 individuals, analysis of 10 microsatellite loci from 67 samples and 49 sequences from the mitochondrial control region, this research establishes that the Australian Sarus Crane A. a. gillae differs significantly from both A. a. antigone (South Asia) and A. a. sharpii (Myanmar and Indochina). A single sample from the extinct Philippine subspecies A. a luzonica clustered with A. a. gillae, hinting at the potential for a more recent separation between them than from A. a. antigone and A. a. sharpii, even though A. a. sharpii is closer geographically. The results demonstrate that failure to detect subspecies through initial genetic profiling does not mean discontinuities are absent and has significance for other cases where subspecies are dismissed based on partial genetic evidence. It could also be potentially important for sourcing birds for reintroduction to the Philippines., Competing Interests: The authors have declared that no competing interests exist.

Herbicides increase crop yields by allowing weed control and harvest management. Glyphosate is the most widely-used herbicide active ingredient, with $11 billion spent annually on glyphosate-containing products applied to >350 million hectares worldwide, using about 8.6 billion kg of glyphosate. The herbicidal effectiveness of glyphosate can depend upon the time of day of spraying. Here, we show that the plant circadian clock regulates the effectiveness of glyphosate. We identify a daily and circadian rhythm in the inhibition of plant development by glyphosate, due to interaction between glyphosate activity, the circadian oscillator and potentially auxin signalling. We identify that the circadian clock controls the timing and extent of glyphosate-induced plant cell death. Furthermore, the clock controls a rhythm in the minimum effective dose of glyphosate. We propose the concept of agricultural chronotherapy, similar in principle to chronotherapy in medical practice. Our findings provide a platform to refine agrochemical use and development, conferring future economic and environmental benefits.

Introduction: Care by Design™ (CBD) (Canada), a model of coordinated team-based primary care, was implemented in long-term care facilities (LTCFs) in Halifax, Nova Scotia, Canada, to improve access to and continuity of primary care and to reduce high rates of transfers to emergency departments (EDs)., Methods: This was an observational time series before and after the implementation of CBD (Canada). Participants are LTCF residents with 911 Emergency Health Services calls from 10 LTCFs, representing 1424 beds. Data were abstracted from LTCF charts and Emergency Health Services databases. The primary outcome was ambulance transports from LTCFs to EDs. Secondary outcomes included access (primary care physician notes in charts) and continuity (physician numbers and contacts)., Results: After implementation of CBD (Canada), transports from LTCFs to EDs were reduced by 36%, from 68 to 44 per month (P = .01). Relational and informational continuity of care improved with resident charts with ≥10 physician notes, increasing 38% before CBD to 55% after CBD (P = .003), and the median number of chart notes increased from 7 to 10 (P = .0026). Physicians contacted before 911 calls and onsite assessment increased from 38% to 54% (P = .01) and 3.7% to 9.2% (P = .03), respectively, before CBD to after CBD., Conclusion: A 34% reduction in overall transports from LTCFs to EDs is likely attributable to improved onsite primary care, with consistent physician and team engagement and improvements in continuity of care., (© Copyright 2016 by the American Board of Family Medicine.)

Background: Prior to the implementation of a new model of care in long-term care facilities in the Capital District Health Authority, Halifax, Nova Scotia, residents entering long-term care were responsible for finding their own family physician. As a result, care was provided by many family physicians responsible for a few residents leading to care coordination and continuity challenges. In 2009, Capital District Health Authority (CDHA) implemented a new model of long-term care called "Care by Design" which includes: a dedicated family physician per floor, 24/7 on-call physician coverage, implementation of a standardized geriatric assessment tool, and an interdisciplinary team approach to care. In addition, a new Emergency Health Services program was implemented shortly after, in which specially trained paramedics dedicated to long-term care responses are able to address urgent care needs. These changes were implemented to improve primary and emergency care for vulnerable residents. Here we describe a comprehensive mixed methods research study designed to assess the impact of these programs on care delivery and resident outcomes. The results of this research will be important to guide primary care policy for long-term care., Objective: We aim to evaluate the impact of introducing a new model of a dedicated primary care physician and team approach to long-term care facilities in the CDHA using a mixed methods approach. As a mixed methods study, the quantitative and qualitative data findings will inform each other. Quantitatively we will measure a number of indicators of care in CDHA long-term care facilities pre and post-implementation of the new model. In the qualitative phase of the study we will explore the experience under the new model from the perspectives of stakeholders including family doctors, nurses, administration and staff as well as residents and family members. The proposed mixed method study seeks to evaluate and make policy recommendations related to primary care in long-term care facilities with a focus on end-of-life care and dementia., Methods: This is a mixed methods study with concurrent quantitative and qualitative phases. In the quantitative phase, a retrospective time series study is being conducted. Planned analyses will measure indicators of clinical, system, and health outcomes across three time periods and assess the effect of Care by Design as a whole and its component parts. The qualitative methods explore the experiences of stakeholders (ie, physicians, nurses, paramedics, care assistants, administrators, residents, and family members) through focus groups and in depth individual interviews., Results: Data collection will be completed in fall 2013., Conclusions: This study will generate a considerable amount of outcome data with applications for care providers, health care systems, and applications for program evaluation and quality improvement. Using the mixed methods design, this study will provide important results for stakeholders, as well as other health systems considering similar programs. In addition, this study will advance methods used to research new multifaceted interdisciplinary health delivery models using multiple and varied data sources and contribute to the discussion on evidence based health policy and program development.

Nucleophilic addition of Grignard reagents and organolithium species to a 3-silyloxy-3,4,5,6-tetrahydropyridine N-oxide provides trans-2,3-disubstituted N-hydroxypiperidines exclusively. The application of this methodology to the preparation of a diversity of useful trans-2-substituted-3-hydroxypiperidines, a concise synthesis of (+)-swainsonine, and an enantiopure 1-substituted quinolizidine of utility in target-directed synthesis is reported.

Objective: To document the potential for drug interactions in seniors with osteoarthritis and to consider the usefulness of computerized support for detecting clinically important interactions., Design: Self-administered mailed survey. One question requested a list of all medications (prescribed drugs and self-care products, including herbal and "natural" health products) taken in the last 7 days. Interactions among all medications were assessed using an on-line software package., Setting: Three urban primary care practices in Nova Scotia., Participants: Questionnaires were sent to 244 patients aged 65 years and older with physician-confirmed osteoarthritis., Main Outcome Measures: Number of potential interactions and level of clinical significance associated with each., Results: Response rate was 78% (n = 191); 174 respondents (92%) supplied information on medications. Respondents took an average of 4.7 products of which 2.8 were prescription medications and 1.9 were self-care products. A total of 214 potential interactions were identified; 30 (14%) of these were clinically significant. Most interactions involved nonprescription products, most frequently acetylsalicylic acid. Recommendations in 29 of these 30 clinically significant interactions were cautionary, advising such measures as closer monitoring of blood tests, observation for toxic effects, or making patients aware of side effects. Only 1 interaction prompted a recommendation for avoidance. Respondents reported use of 7 different herbal and natural health products; these products were associated with 5 clinically insignificant interactions., Conclusion: Risk of drug interactions in seniors might be high, but few interactions are clinically significant. Only 1 found in our study carried a recommendation for avoidance. The on-line program reported all significant interactions, but the high proportion of insignificant interactions (6 : 1) also reported could lead physicians to override computer-generated alerts.

Objective: To determine what types of medication seniors in the community were using to manage osteoarthritis (OA)., Design: Mailed self-administered survey., Setting: Three family medicine community practice sites in cities in Nova Scotia., Participants: All seniors (aged 65 and older) on the electronic record of each practice site with a physician-confirmed diagnosis of OA (N = 244)., Main Outcome Measures: Proportion of seniors using prescribed medications or self-care products (nonprescribed medications and herbal and natural health products) for OA., Results: Response rate was 78%. About 15% were using no medication, 74% were using at least one type of self-care product (60% were using nonprescribed medications, and 45% were using herbal and natural health products), and 52% were using prescribed medications alone or in combination with self-care products., Conclusion: Seniors' use of prescribed and self-care products for OA is very high. Physicians must be aware that patients seeking prescriptions likely are also using self-care products. The potential for drug interactions is high; patients should be made aware of the risks associated with taking multiple products.

We describe a neutron radiography technique that can be used to map the distribution of 3He impurities in liquid 4He, providing direct and quantitative access to underlying transport processes. Images reflecting finite normal- and superfluid-component 4He velocity fields are presented.

The time-dependent diffusion of 3Heatoms perpendicular to the axis of a single macroscopically large cylindrical pore is studied using a steady (or constant) gradient-recalled echo sequence. Measurements of the effective 3Hediffusion coefficient extending from the free-diffusion regime to the motionally averaged regime are presented, and are well-described by analytic solutions to the Bloch-Torrey equation based on the gaussian phase approximation. Our data yield the value 0.140(6)m2/s for the self diffusion coefficient of 3Heat a temperature of 296 K and a pressure of 1.00 Torr. Adaptations of these methods should enable the study of complex pore geometries as model systems., (Copyright 2004 Elsevier Inc.)

Background: Hip fracture is a major cause of mortality and morbidity, particularly among older people, but there is little information on how individuals experience this., Aims: This study was conducted to explore the experiences of individuals who had suffered a hip fracture. The aim was not to produce generalizable findings but, rather, to generate a rich description of the experience of incurring and recovering from a hip fracture, to inform nursing practice., Method: Phenomenological methodology was used. A purposeful sample of five older patients was interviewed, following a stay in a community hospital for rehabilitation after surgical repair of a hip fracture. The unstructured interviews were tape-recorded, transcribed verbatim and analysed for significant statements and meanings., Findings: Four major themes emerged: the injury experience, the pain experience, the recovery experience and the disability experience. The injury experience consisted of storytelling, recalling the experience of the injury itself. The pain experience consisted of coping with the pain. The recovery experience involved the operation, beginning the struggle of recovery, and regaining independence. The disability experience consisted of the disability itself, depending on others, and being housebound., Conclusions: Pain management, meeting psychological and physical needs for nursing care, planning for discharge, and ensuring a reasonable quality of life are areas for nursing care development. Consideration of appropriate settings for rehabilitation is needed and there should be further investigation into improving quality of life after discharge.

For some time, nursing has been based on the structure of the nursing process and nursing models. However, in an age where the old order of science and medicine can no longer answer all of society's questions, can a nursing model, with its roots firmly based in the modernist structure of the nursing process, be post-modern?

Nurses have a responsibility to meet the health needs of culturally diverse groups of patients. The health needs of patients with a terminal illness from the South Asian community are often not met. Nurses need to ensure that they have the knowledge and information available to meet the needs of this patient group.