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Occupational therapy (OT) educators strive to design learning experiences to enhance OT students' clinical reasoning and promote preparedness for the complexities of clinical practice. Occupational therapy programs have collaborated with the Amyotrophic Lateral Sclerosis (ALS) Association and taken a novel approach to the development of interprofessional experiential learning through student-led ALS Caregiver Learning Labs (CLLs). A retrospective pre-test post-test study was completed to identify outcomes related to participation in three different ALS CLLs embedded into a master's level OT curriculum. A 6-point rating scale questionnaire was used to assess students' perception of their clinical reasoning, clinical skills, and comfort level. Improvement was noted in the level of comfort when interacting with caregivers and students' perceptions of their clinical skills and clinical reasoning improved across all questions. In addition, students completed a case study assignment to examine clinical reasoning performance. On average, post-lab scores were higher than pre-lab scores for each question, and the differences were statistically significant with the level of significance at p < 0.05. Results suggest that a CLL experience is an effective learning method to increase students' comfort level interacting with caregivers, enhance students' perception of clinical reasoning ability, and improve clinical reasoning skills. Occupational therapy students benefited from the experience at different levels of progression, delivery methods, and opportunities for interprofessional interaction. Occupational therapy programs at other institutions may benefit from embedding a CLL into the curriculum to meet the needs of the community while improving students' clinical reasoning and enhancing the ability to provide client-centered care.

Abstract Purpose The primary objective of this study was to gauge resident and faculty sentiments surrounding a general surgery program merger between two programs, and to assess the effect on workplace morale and productivity. Secondarily, the authors sought to objectively examine the impact program expansion had on in-service training exam results and operative volumes. Methods This was a single-center, prospective, observational study that evaluated surgical resident and faculty feedback pertaining to the merger of two regional general surgery residency programs. The survey utilized the Likert scale at merger onset and post-merger to gather responses from residents and faculty from July 2020 to August 2021. Secondary outcomes evaluated case volume and ABSITE performance pre- and post-merger. Results A total of 27 residents and 31 faculty participated in the initial survey. The merger onset and post survey investigation found that there was increased workplace efficiency (78% onset, 96% post; p = 0.004), and increased comfort with effectively triaging patients (41% onset, 83% post; p = 0.001). Satisfaction levels regarding research infrastructure and mentorship also increased significantly (63% onset, 83% post; p = 0.03). ABSITE performance and operative volumes were not significantly changed post-merger. Conclusion The merging of two academic programs led to feelings of increased mentorship, operative competency, and workplace efficiency among the residents. This was achieved without significant detriment to resident case volume or ABSITE performance. Our investigation also identified legitimate challenges that speak to the need for fluidity in a residency program and the constant need for continued growth and development.

COVID-19 social distancing measures forced many university courses to be offered online. The performance-based assessments originally designed for in-person learning may not work well in online environments. This study investigated students' perceptions of performance-based assessments, and their associated resources, during a course that was offered both in-person and online. The results from 312 undergraduate education students (n = 248 in-person and n = 64 online) indicated all the resources for one of the two assessments were rated statistically significantly higher by students who attended the course in-person. This indicated students who completed the course in-person had a stronger interaction with the assessment resources and rating having higher cognitive and affective skills needed to perform a similar assessment task in their future classrooms. Online students indicated some resources, such as assessment instructions and scoring rubrics, should be better explained during the course for more clarity regarding expectations.

Nature-based Solutions (NbS) can be applied to alleviate negative human impacts on ecosystems and promote the general health or well-being of the environment. Human-induced activities, including installation of NbS, are governed by legislative requirements (e.g. Environmental Impact Assessments (EIA)), especially when such activities occur in Marine Protected Areas (MPA's). A correct and thorough description of the legislative framework governing the application and development of NbS is therefore essential. The Drivers-Activities-Pressures-State change-Impacts (on human Welfare)-Responses (using Measures) or DAPSI(W)R(M) framework is valuable when environmental assessment procedures include a NbS, as well as when policy and industry require guidance for the practical application of a NbS concept. In this study, we applied the DAPSI(W)R(M) framework to the Coastbusters approach, in which mussel beds (Mytilus edulis) and tubeworm aggregations (Lanice conchilega) are installed in the Belgian part of the North Sea with the aim of improving coastal resilience and maritime infrastructure works. Within the context of the Coastbusters approach, the various elements of the DAPSI(W)R(M) framework were elucidated. Coastal defense is a driver, with activities including the integration of coastal infrastructure and aquaculture practices. Pressures related to these activities on benthic habitats were described using the MarESA sensitivity approach. State change assessments were performed based on the various marine regulations (e.g. Marine Strategy Framework Directive, Habitat Directive, Water Framework Directive) which together outline a precise set of criteria and indicators designed to assess the sustainability and health of ecosystems. The present study provides a detailed framework for the environmental evaluation of seaward NbS, from state changes to impacts on human welfare. Three quantitative estimations of ecosystem service indicators (coastal protection, carbon retention and water quality (N) regulation) were used, with the indicators quantified by in-situ measurements and data from literature. Subsequently, the 10-tenets approach for taking measures (e.g. use of biodegradable material, local species, etc.) was used to develop responses that facilitate the optimal implementation of NbS. The approach outlined in this study can be used as a guide for stakeholders as they move through the environmental evaluation processes that are required for successful development of a seaward NbS. Our results underscore the importance of a favorable institutional environment for NbS and suggest that public acceptance and stakeholder involvement play a crucial role in successful implementation. This study contributes to the understanding and operationalization of Nature-based Solutions in coastal management.

Nature-based solutions (NbS) offer a promising path to enhance climate-resilient shorelines. For instance, the creation of mussel beds in subtidal sandy shore systems provides a versatile strategy for coastal management, reinforcing coastal defense and fostering biodiversity, ultimately strengthening the resilience and well-being of coastal communities. This study analysed the changes in seabed dynamics and surrounding benthic communities as a result of the formation of mussel beds (Mytilus edulis) using an aquaculture longline system. Therefore, a comprehensive monitoring approach at two sites characterized by distinct hydrodynamic conditions was applied over a three-year period. To assess the effects, a before/after control/impact design (BACI) was employed. Seabed dynamics were evaluated by observing mussel bed persistence, erosion/deposition, and sediment composition. The influence on the benthic community included assessments of community structure and biodiversity. Finally, the impact of mussels, hydrodynamic conditions, and their interactions on seabed dynamics and benthic communities was examined using linear mixed models (LMMs). Factors such as mussel presence, Lanice conchilega abundance, shell cover, and sediment composition played a role in shaping the distinct characteristics observed between two different sites: a site that lies at a location that is more sheltered from hydrodynamic conditions, and a second site that is exposed to higher current and wave conditions. The sheltered site exhibited higher species density, richness, biomass, and diversity compared to the exposed site. In relation to the mussel bed development, mussel patches were found at both sites (with higher occurrence at the sheltered site) in the 2nd and 3rd years (mainly in summer towards early winter). The influence of mussels on sediment deposition was noticeable at the sheltered site, albeit lacking statistical significance, suggesting their potential role in erosion/deposition mechanisms. Also, a higher proportion of very fine sand was observed in the mussel bed compared to the bare sand. However, due to the absence of higher-density permanent mussel beds and irregular sedimentation/erosion patterns throughout the study period, no significant effect of the mussel beds on the community structure or diversity was found. In order to achieve a sustained and dense mussel bed and maximize the potential impact of mussels in combating climate change (e.g., shore protection and biodiversity enrichment), additional measures to increase coastal resilience against harsh hydrodynamic conditions may be necessary.

ABSTRACT Giant clams (Tridacna and Hippopus) are large marine bivalves occupying tropical and subtropical reefs in the Indo‐Pacific. Giant clam populations have declined in many areas of the Indo‐Pacific and continue to be threatened by harvesting and environmental change. The small giant clam (Tridacna maxima) occurs throughout the Indo‐Pacific and has been subject to several phylogeographic studies across its range. However, given its broad range, there are several areas where the genetic diversity and connectivity of T. maxima populations has not been characterised. Here, we analyse the mitochondrial marker cytochrome oxidase 1 (CO1) to examine the genetic diversity and connectivity of T. maxima in two regions: Australia's Coral Sea Marine Park and the Cook Islands. Samples were collected from 13 reefs within the Coral Sea Marine Park and ten islands within the Cook Islands archipelago. Tridacna maxima across the sampled region of the Coral Sea did not display any population structure, whereas significant population structure was detected for T. maxima within the Cook Islands. For the Cook Islands, most pairwise comparisons involving an island in the northern group (Manihiki) were significant, as were comparisons for Palmerston (a more centrally located island) and the southern islands, Rarotonga and Mangaia. Both regions displayed high haplotype diversities (> 0.90), indicating that they are important repositories of genetic diversity. Additional CO1 data from throughout T. maxima's distribution showed that the Coral Sea clams belonged to the clade occurring in the South‐Western Pacific Ocean, whilst those from the Cook Islands belonged to a unique clade found in the Central Pacific Ocean. This clade extended from Fiji in the west to French Polynesia in the east and the atolls of Palmyra and Tarawa (Kiribati) in the north. Our assessment of genetic diversity and population structure in these regions will assist with management decisions for the species.

Abstract Background Nutrition is recognized as playing an important role in the metabolic syndrome (MetS), but the dietary components involved are unclear. We aimed to investigate nutrition factors in relation to MetS and its progression in older adults over a follow-up period of 5.4 years. Methods Community-dwelling adults (≥ 60y) from the Trinity-Ulster-Department-of-Agriculture study, sampled at baseline (2008–12) and follow-up (2014–18; n 953), were classified as ‘with MetS’ by having three or more of: waist circumference (≥ 102 cm, males; ≥ 88 cm, females); HDL-cholesterol (

Abstract Background Acoustic telemetry has become a fundamental tool to monitor the movement of aquatic species. Advances in technology, in particular the development of batteries with lives of > 10 years, have increased our ability to track the long-term movement patterns of many species. However, logistics and financial constraints often dictate the locations and deployment duration of acoustic receivers. Consequently, there is often a compromise between optimal array design and affordability. Such constraints can hinder the ability to track marine animals over large spatial and temporal scales. Continental-scale receiver networks have increased the ability to study large-scale movements, but significant gaps in coverage often remain. Methods Since 2007, the Integrated Marine Observing System’s Animal Tracking Facility (IMOS ATF) has maintained permanent receiver installations on the eastern Australian seaboard. In this study, we present the recent enhancement of the IMOS ATF acoustic tracking infrastructure in Queensland to collect data on large-scale movements of marine species in the northeast extent of the national array. Securing a relatively small initial investment for expanding receiver deployment and tagging activities in Queensland served as a catalyst, bringing together a diverse group of stakeholders (research institutes, universities, government departments, port corporations, industries, Indigenous ranger groups and tourism operators) to create an extensive collaborative network that could sustain the extended receiver coverage into the future. To fill gaps between existing installations and maximise the monitoring footprint, the new initiative has an atypical design, deploying many single receivers spread across 2,100 km of Queensland waters. Results The approach revealed previously unknown broad-scale movements for some species and highlights that clusters of receivers are not always required to enhance data collection. However, array designs using predominantly single receiver deployments are more vulnerable to data gaps when receivers are lost or fail, and therefore “redundancy” is a critical consideration when designing this type of array. Conclusion Initial results suggest that our array enhancement, if sustained over many years, will uncover a range of previously unknown movements that will assist in addressing ecological, fisheries, and conservation questions for multiple species.

Abstract Self-supervised pretraining has been observed to be effective at improving feature representations for transfer learning, leveraging large amounts of unlabelled data. This review summarizes recent research into its usage in X-ray, computed tomography, magnetic resonance, and ultrasound imaging, concentrating on studies that compare self-supervised pretraining to fully supervised learning for diagnostic tasks such as classification and segmentation. The most pertinent finding is that self-supervised pretraining generally improves downstream task performance compared to full supervision, most prominently when unlabelled examples greatly outnumber labelled examples. Based on the aggregate evidence, recommendations are provided for practitioners considering using self-supervised learning. Motivated by limitations identified in current research, directions and practices for future study are suggested, such as integrating clinical knowledge with theoretically justified self-supervised learning methods, evaluating on public datasets, growing the modest body of evidence for ultrasound, and characterizing the impact of self-supervised pretraining on generalization.

BACKGROUND: The impact of undernutrition in dogs with protein-losing enteropathy (PLE) caused by inflammatory enteritis, intestinal lymphangiectasia, or both and which variables are most predictive of outcome are unknown. OBJECTIVES: Develop an undernutrition screening score (USS) for use at the time of diagnosis of PLE in dogs, which is predictive of outcome. ANIMALS: Fifty-seven dogs with PLE prospectively recruited from 3 referral hospitals in the United Kingdom. METHODS: An USS based on the presence and severity of 5 variables: appetite, weight loss, and body, muscle, and coat condition and scored out of 15, with higher scores reflecting worse undernutrition, was calculated at the time of diagnosis. Follow-up information was obtained for at least 6 months. RESULTS: Dogs that failed to achieve clinical remission within 6 months had higher USS at diagnosis compared with dogs that achieved remission (median, 7.5; range, 2-14 and median, 5; range, 0-14, respectively). The USS at diagnosis gave an area under the receiver operating characteristic curve (AUC) of 0.656 for predicting nonclinical remission within 6 months, whereas a score consisting of just epaxial muscle loss and coat condition resulted in a larger AUC of 0.728. CONCLUSIONS AND CLINICAL IMPORTANCE: Of the 5 variables assessed in the USS, a combination of epaxial muscle loss and coat condition was most predictive of not achieving clinical remission within 6 months in dogs with PLE. Additional studies will help determine the effect of changes in USS and the 5 associated variables after diagnosis on outcome variables in these dogs.

Iconicity, or the resemblance between form and meaning, is often ascribed to a special status and contrasted with default assumptions of arbitrariness in spoken language. But does iconicity in spoken language have a special status when it comes to learnability? A simple way to gauge learnability is to see how well something is retrieved from memory. We can further contrast this with guessability, to see (1) whether the ease of guessing the meanings of ideophones outperforms the rate at which they are remembered; and (2) how willing participants' are to reassess what they were taught in a prior task--a novel contribution of this study. We replicate prior guessing and memory tasks using ideophones and adjectives from Japanese, Korean, and Igbo. Our results show that although native Cantonese speakers guessed ideophone meanings above chance level, they memorized both ideophones and adjectives with comparable accuracy. However, response time data show that participants took significantly longer to respond correctly to adjective--meaning pairs--indicating a discrepancy in a cognitive effort that favored the recognition of ideophones. In a follow-up reassessment task, participants who were taught foil translations were more likely to choose the true translations for ideophones rather than adjectives. By comparing the findings from our guessing and memory tasks, we conclude that iconicity is more accessible if a task requires participants to actively seek out sound-meaning associations.

Medical knowledge is evolving rapidly and expanding exponentially. The lifespan of information is now only 70 days, and a deluge of knowledge is predicted, driven by advances in information technology, artificial intelligence, the availability of large datasets, scientific progress, and international collaboration. Continuing Professional Development (CPD), including lifelong learning for doctors, is essential for ensuring safe patient care. CPD requirements for doctors vary amongst different countries and are associated with significant international controversies. This article presents the experience of the Royal College of Physicians of Ireland, aiming to underscore the importance of investing in CPD to enhance patient care and physician well-being. The article also highlights how CPD strengthens the ability to address various challenges in healthcare, from clinical well-being to national imperatives for improved health, care quality, and cost reduction. Finally, it emphasizes that CPD is an investment in both patients and staff and requires promotion and support to succeed.Ongoing international research is necessary to: explore doctors' attitudes towards the regulation of professional competence; identify barriers to participation and propose solutions to enhance engagement; assess the effectiveness of education, including its impact on patient and public health outcomes; bolster public trust, patient safety, and care quality; and, additionally, identify challenges related to future CPD requirements and healthcare service advancements.