Search

BackgroundPrior research suggests that physicians' personal experience with breastfeeding may influence their attitudes toward breastfeeding. This phenomenon has not been explored in well-newborn care physician leaders, whose administrative responsibilities often include drafting and approval of hospital breastfeeding and formula supplementation policies.MethodsWe conducted a mixed-methods study, surveying physicians in the Better Outcomes through Research for Newborns (BORN) network. We examined physician attitudes toward recommending breastfeeding and their breastfeeding experience. Qualitative analysis was conducted on responses to the question: "How do you think your breastfeeding experience influences your clinical practice?"ResultsOf 71 participants, most (92%) had a very positive attitude toward breastfeeding with 75% of respondents reporting personal experience with breastfeeding. Of these, 68% had a very positive experience, 25% had a somewhat positive experience, and 6% had a neutral experience. Four themes emerged with respect to the effect of breastfeeding experience on practice: (1) empathy with breastfeeding struggles, (2) increased knowledge and skills, (3) passion for breastfeeding benefits, and (4) application of personal experience in lieu of evidence-based medicine, particularly among those who struggled with breastfeeding.ConclusionsWell-newborn care physician leaders reported positive attitudes about breastfeeding, increased support toward breastfeeding persons, and a perception of improved clinical lactation skills. Those who struggled with breastfeeding reported increased comfort with recommending formula supplementation to their own patients. Medical education about evidence-based breastfeeding support practices and provision of lactation support to physicians has the potential to affect public health through improved care for the patients they serve.

Students with disabilities continue to experience barriers to accessing tertiary (i.e., postsecondary) education in Australia. Using the principles of Universal Design for Learning (UDL) may help educators proactively address barriers through the design of more accessible and inclusive educational experiences. However, at present, references to UDL appear in only a small number of Australian educational policies and tertiary institute websites, and few tertiary educators use UDL in practice. In this article, we describe how a team of educators, learning designers, accessibility advocates, and people with disabilities from multiple institutions across Australia collaborated to co-create a free, accessible eLearning program to build workforce knowledge and skill in UDL. We first describe how the advisory group was established, how the Knowledge to Action cycle was used to guide the activities of the advisory group, and the evaluation framework that was used to assess the outcomes of the eLearning program. We share potential future activities to raise awareness of UDL and influence policy and practice in local contexts and propose directions for future work in this area.

Abstract Background This correlative study aimed to examine how the different primary care models (physicians in solo practice, physicians in collaborative practice, physicians and nurse practitioners in collaborative practice, after-hours clinics, community centers, or emergency rooms) were associated with their capability to offer timely access to their patients. The data collected from the primary care provider’s perspective was to complete the New Brunswick Health Council results on patients’ perspective. Methods A convenience sample of 120 primary care providers (33 physicians in solo practice, 33 physicians in collaborative practice, 27 providers in collaborative practice with nurse practitioners, 2 providers working in after-hours clinics, and 10 providers in Emergency departments) responded to an online survey about their primary care models and accessibility. We used the Statistical Package for Social Sciences software to run correlations, independent t-tests and Fisher’s exact tests to compare timely access to care between variable groups. Results A positive correlation was observed between patient load (or the number of patients under a primary care provider’s practice), age and years of experience. However, the patient load did not translate to more timely access to care. However, a statistically significant difference (p = 0.032) was observed when primary care providers kept appointment slots available for daily urgent requests. When a primary care provider booked all available appointment slots, only 85% of them could offer timely appointments (in 5 days or less), compared to 97% who could deliver it when appointment slots were left open in their daily schedule. The primary care model (solo vs. collaboration), the use of health technologies and the type of provider did not significantly influence timely access to care. In contrast, the primary care providers who reported teleworking (or working remotely) were less likely to offer timely access to care. Conclusion Timely access to care is not always available to patients, even those with a primary care provider. Certain organizational practices may improve access to care and should be integrated into primary care in New Brunswick and elsewhere in Canada.

Abstract Background Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a challenging disease pattern and has gained increasing scientific and public interest in recent years due to the Corona pandemic and Long-Covid. The aim of this study was to investigate (1) medical students’ health-related control beliefs, (2) students’ awareness and views about ME/CFS at the beginning of their medical education, and (3) to examine whether there are correlations between students’ health-related control beliefs and their views about ME/CFS. Methods A cross-sectional online-survey was conducted in October 2020 with all new medical students at the Ludwig Maximilian University of Munich and the Technical University Munich. Results A total of 251 students completed the survey, representing a response rate of 27.0% (251/929). The examined health related locus of control of the students was predominantly internal oriented. Students’ awareness about ME/CFS at the beginning of their medical education were found to be low: 46,8% (117/250) of the students surveyed disagreed that they have heard or read about ME/CFS and 81,6% (204/250) disagreed that they feel sufficiently well informed about the disease. A possible correlation between students’ health-related locus of control and their views regarding ME/CFS-specific issues was found: The higher the students’ internal locus of control, the less they favored a strict separation of mental and physical suffering in medical practice, the less they believed that psychological causes for an illness should only be sought when no physically objective causes could be found, and the less they agreed that there is no indication for therapy if a disease is not objectively detectable. Conclusions As ME/CFS is a medical challenge and increasingly relevant in medical practice, the fact that 50% of medical students have never heard of this disease underscores the need for awareness and education. We found that the majority students in the sample largely have an internal health related locus of control. They rate their own influence on their health higher than those with an externally oriented control conviction.

Background: As clinical trials involving implantable neural devices (INDs) increase in frequency and attract greater public attention, it is paramount to ensure they are conducted in alignment with fundamental ethical guidelines. Particular focus must be placed on the often underexplored aspect of trial termination for INDs. Objective: To systematically review the ethical challenges encountered in clinical trials for INDs at the juncture of trial termination. Methods: We conducted a rapid review using PubMed with two specific search queries, including all publications addressing ethical issues in the context of IND clinical trials. Priority was given to publications focusing on the end of treatment or the discontinuation of clinical studies or trials. Results: We identified three primary groups of ethical challenges: patient-centric challenges, challenges faced by the research and physician team, and manufacturer-related issues. Further analysis highlights the importance of initiating early, transparent discussions regarding trial cessation protocols, ensuring that all stakeholders—patients, healthcare providers, researchers, and manufacturers—are equitably considered. Additionally, we found a discrepancy between current discontinuation strategies and international ethical guidelines. To address this, we emphasize the ethical obligation to establish comprehensive exit strategies that align with the principles in the Declaration of Helsinki and the CIOMS/WHO guidelines. Conclusion: Our findings highlight the need for increased attention to the ethical and practical aspects of exit strategies and encourage further empirical research to address gaps in current practices. This would ensure that the discontinuation of IND trials is handled with ethical rigor, prioritizing the interests and well-being of all stakeholders involved.

Borehole thermal energy storage (BTES) systems have garnered significant attention owing to their efficacy in storing thermal energy for heating and cooling applications. Accurate modeling is paramount for ensuring the precise design and operation of BTES systems. This study conducts a sensitivity analysis of BTES modeling by employing a comparative investigation of five distinct parameters on a wedge-shaped model, with implications extendable to a cylindrical configuration. The parameters examined included two design factors (well spacing and grout thermal conductivity), two operational variables (charging and discharging rates), and one geological attribute (soil thermal conductivity). Finite element simulations were carried out for the sensitivity analysis to evaluate the round-trip efficiency, both on a per-cycle basis and cumulatively over three years of operation, serving as performance metrics. The results showed varying degrees of sensitivity across different models to changes in these parameters. In particular, the round-trip efficiency exhibited a greater sensitivity to changes in spacing and volumetric flow rate. Furthermore, this study underscores the importance of considering the impact of the soil and grout-material thermal conductivities on the BTES-system performance over time. An optimized scenario is modelled and compared with the base case, over a comparative assessment based on a 10-year simulation. The analysis revealed that, at the end of the 10-year period, the optimized BTES model achieved a cycle efficiency of 83.4%. This sensitivity analysis provides valuable insights into the merits and constraints of diverse BTES modeling methodologies, aiding in the selection of appropriate modeling tools for BTES system design and operation.

Introduction: As little is known about who uses specialty mental health clinics for persons with intellectual disabilities, this study aimed to identified caregiver concerns, clinical characteristics, and the relationship between these two constructs for referrals to such a clinic. Methods: Qualitative and quantitative analyses were applied to data derived from an intake questionnaire of all individuals referred to a specialty clinic in Canada over one year. Results: The dataset consisted of 149 persons (55.7% male; 37.6% with autism; mean age: 28.8 years [SD: 13.2]). The two overarching categories of caregiver concerns were about: (1) aspects of clinic service, especially medication questions; and (2) specific emotional, behavioral, and diagnostic concerns, especially regarding emotional states. Caregivers of persons with autism had higher odds of medication concerns, but few other significant relationships were found. Conclusions: Further investigations about emotional difficulties and medication concerns, inclusive of perspectives of persons with intellectual disabilities, are needed.

Remote Education Tutors (RETs) enact crucial roles in Australian distance schooling, by living with families who reside in geographically isolated locations and supporting their school age children's learning. As part of a larger research project, this paper presents a study of four RETs derived from semi-structured interviews conducted in their respective home schoolrooms. Informed conceptually by Bronfenbrenner's socio-ecological systems theory (1979, 1986), the thematic analysis generated four substantive themes related to the participants' lives and work: pedagogical competencies; healthy relational dynamics; optimism with a solution focus; and substantive occupation. More broadly, the RETs contribute indispensably to the educational success and the lifestyle sustainability of the school age children with whom they work, yet currently there is no formal recognition of that contribution, just as there is no viable career pathway for RETs seeking to become qualified teachers. Accordingly, they are as occupationally invisible as the remote living families whom they serve.

In recent years, English-language voluntourism (EVT) has grown in popularity, with many conceptualizing it as a form of cultural exchange between English speaking volunteers and members of a non-English speaking host community. This article explores relationships between and within volunteers and host groups of an EVT program in Lima, Peru. Using a postcolonial analytical framework, we explore how bringing together voluntourists and members of host communities from different socioeconomic backgrounds can reinforce inequality and difference between groups, even when framed as a "cultural exchange." Presenting the idea of "worlds within worlds," we argue that EVT, and the diffusion of English as a foreign "world" language, underscore an unequal and postcolonial dynamic between actors and the "worlds" from which they originate, both internationally and intra-nationally. In this way, EVT as cultural exchange creates a microcosm for maintaining wider systemic structures and inequalities.

Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.

Fracture injection/shut-in tests are commonly used to measure the state of stress in the subsurface. Injection creates a hydraulic fracture (or in some cases, opens a preexisting fracture), and then the pressure after shut-in is monitored to identify fracture closure. Different interpretation procedures have been proposed for estimating closure, and the procedures sometimes yield significantly different results. In this study, direct, in-situ strain measurements are used to observe fracture reopening and closure. The tests were performed as part of the EGS Collab project, a mesoscale project performed at 1.25 and 1.5 km depth at the Sanford Underground Research Facility. The tests were instrumented with the SIMFIP tool, a double-packer probe with a high-resolution three-dimensional borehole displacement sensor. The measurements provide a direct observation of the fracture closure signature, enabling a high-fidelity estimate of the fracture closure stress (ie, the normal stress on the fracture). In two of the four tests, injection created an opening mode fracture, and so the closure stress can be interpreted as the minimum principal stress. In the other two tests, injection probably opened preexisting natural fractures, and so the closure stress can be interpreted as the normal stress on the fractures. The strain measurements are compared against different proposed methods for estimating closure stress from pressure transients. The shut-in transients are analyzed with two techniques that are widely used in the field of petroleum engineering – the ‘tangent’ method and the ‘compliance’ method. In three of the four tests, the tangent method significantly underestimates the closure stress. The compliance method is reasonably accurate in all four tests. Closure stress is also interpreted using two other commonly-used methods – ‘first deviation from linearity’ and the method of (Hayashi and Haimson, 1991). In comparison with the SIMFIP data, these methods tend to overestimate the closure stress, evidently because they identify closure from early-time transient effects, such as near-wellbore tortuosity. In two of the tests, microseismic imaging provides an independent estimate of the size of the fracture created by injection. When combined with a simple mass balance calculation, the SIMFIP stress measurements yield predictions of fracture size that are reasonably consistent with the estimates from microseismic. The calculations imply an apparent fracture toughness 2-3x higher than typical laboratory-derived values.

The premutation of the fragile X messenger ribonucleoprotein 1 (FMR1) gene is characterized by an expansion of the CGG trinucleotide repeats (55 to 200 CGGs) in the 5 untranslated region and increased levels of FMR1 mRNA. Molecular mechanisms leading to fragile X-premutation-associated conditions (FXPAC) include cotranscriptional R-loop formations, FMR1 mRNA toxicity through both RNA gelation into nuclear foci and sequestration of various CGG-repeat-binding proteins, and the repeat-associated non-AUG (RAN)-initiated translation of potentially toxic proteins. Such molecular mechanisms contribute to subsequent consequences, including mitochondrial dysfunction and neuronal death. Clinically, premutation carriers may exhibit a wide range of symptoms and phenotypes. Any of the problems associated with the premutation can appropriately be called FXPAC. Fragile X-associated tremor/ataxia syndrome (FXTAS), fragile X-associated primary ovarian insufficiency (FXPOI), and fragile X-associated neuropsychiatric disorders (FXAND) can fall under FXPAC. Understanding the molecular and clinical aspects of the premutation of the FMR1 gene is crucial for the accurate diagnosis, genetic counseling, and appropriate management of affected individuals and families. This paper summarizes all the known problems associated with the premutation and documents the presentations and discussions that occurred at the International Premutation Conference, which took place in New Zealand in 2023.

Abstract Wildlife harbour a diverse range of microorganisms that affect their health and development. Marsupials are born immunologically naïve and physiologically underdeveloped, with primary development occurring inside a pouch. Secretion of immunological compounds and antimicrobial peptides in the epithelial lining of the female’s pouch, pouch young skin, and through the milk, are thought to boost the neonate’s immune system and potentially alter the pouch skin microbiome. Here, using 16S rRNA amplicon sequencing, we characterised the Tasmanian devil pouch skin microbiome from 25 lactating and 30 non-lactating wild females to describe and compare across these reproductive stages. We found that the lactating pouch skin microbiome had significantly lower amplicon sequence variant richness and diversity than non-lactating pouches, however there was no overall dissimilarity in community structure between lactating and non-lactating pouches. The top five phyla were found to be consistent between both reproductive stages, with over 85% of the microbiome being comprised of Firmicutes, Proteobacteria, Fusobacteriota, Actinobacteriota, and Bacteroidota. The most abundant taxa remained consistent across all taxonomic ranks between lactating and non-lactating pouch types. This suggests that any potential immunological compounds or antimicrobial peptide secretions did not significantly influence the main community members. Of the more than 16,000 total identified amplicon sequence variants, 25 were recognised as differentially abundant between lactating and non-lactating pouches. It is proposed that the secretion of antimicrobial peptides in the pouch act to modulate these microbial communities. This study identifies candidate bacterial clades on which to test the activity of Tasmanian devil antimicrobial peptides and their role in pouch young protection, which in turn may lead to future therapeutic development for human diseases.

Abstract Digital health is increasingly promoting open health data. Although this open approach promises a number of benefits, it also leads to tensions with Indigenous data sovereignty movements led by Indigenous peoples around the world who are asserting control over the use of health data as a part of self-determination. Digital health has a role in improving access to services and delivering improved health outcomes for Indigenous communities. However, we argue that in order to be effective and ethical, it is essential that the field engages more with Indigenous peoples´ rights and interests. We discuss challenges and possible improvements for data acquisition, management, analysis, and integration as they pertain to the health of Indigenous communities around the world.

The development of the water reuse sector within the European Union (EU) varies considerably. In 2020, Portugal, Spain, Italy, Greece, France and Cyprus had the most comprehensive regulations for the reuse of reclaimed water for agriculture. The approval of a common regulation by the EU Parliament and the Council in May 2020 (which came into effect in June 2023) elicits the question of how each country will comply with it. This review compares (i) national regulations to the 2020 European Regulation, (ii) existing projects with respect to their performance in terms of water quality and (iii) raises a debate about the role of the EU Regulation in fostering water reuse at the EU level. The European Regulation will probably strengthen consumer confidence as common minimum requirements are now required. However, the issues related to micropollutants, disinfection by-products or possible changes in the water quality downstream of the compliance point are not fully considered by the EU Regulation. Moreover, other techno-economic obstacles to be overcome include the distance between the production of treated water and agricultural needs, the low economic competitiveness of reclaimed water and the implementation of the multi-barrier approach. HIGHLIGHTS The EU Regulation harmonises standards and procedures for water reuse: some countries need to adapt their regulations and current projects.; It is not necessarily a driver for the development of this practice.; The main challenges are associated with the economic competitiveness of reclaimed wastewater, risk management planning, the sharing of responsibilities and the implementation of the multi-barrier approach.;

Remote Education Tutors (RETs) are central to the delivery of distance schooling in Australia and are accountable for the face-to face supervision and educational support of students. They act as the government mandated adult supervisors of Australian primary and secondary school students enrolled in distance education, including geographically isolated learners. This paper draws on statistical data from a national survey (N = 575) that was designed to map the perceptions of Australian RETs. These data confirmed that RETs act as a conduit between the distance schooling teacher and student, and that their role requires complex capabilities to be performed within a structured framework. Time restrictions with competing demands present a constant challenge to the RETs' work satisfaction. Constraining this occupation is the reality that there is no formal qualification available for RETs. Without specific credentialling, it appears that the RETs' (in)visible role risks being overlooked as a substantive educational occupation.

Abstract Conservation breeding programs are an effective approach to addressing biodiversity loss. Captive populations are managed to maintain genetic diversity, yet there remains an “implementation gap” in effectively translating molecular genetic data into management. Technological advancements are facilitating rapid generation of genetic data, increasing accessibility for breeding programs. In 2010, Frankham and colleagues proposed a six‐stage process for establishing successful conservation breeding and release programs. Here, we describe the conservation breeding program for the critically endangered Bellinger River turtle (Myuchelys georgesi) and characterize the value of genetic sampling for informing management actions. By generating a chromosome‐level genome and population genetic data, we investigated past and present diversity and assessed relatedness among captive founders. We present a framework modeled on Frankham and colleagues six stages to assist managers in implementing genetic data into actionable conservation strategies. This framework, and worked case study, for managers aims to better guide implementation of genetic approaches into conservation breeding programs.

This proof-of-concept evaluation demonstrates that next-generation sequencing-based liquid biopsy can detect genomic alterations in the blood of cats with cancer and the absence of such alterations in the blood of presumably cancer-free cats. Two cats with cytologically confirmed lymphoma and nine presumably cancer-free cats were included in this analysis. Whole blood was collected from each subject and samples were subjected to DNA extraction, library preparation, and next-generation sequencing. Both cancer-diagnosed subjects had somatic copy number variants (a “cancer signal”) identified in cell-free DNA, suggesting the current presence of cancer in these subjects. All nine presumably cancer-free subjects had unremarkable genomic profiles, suggesting the absence of cancer in these subjects. Liquid biopsy using next-generation sequencing of cell-free DNA allows for blood-based detection of cancer-associated genomic alterations in cats. Such technology has the potential to offer considerable utility in veterinary medicine, particularly for the non-invasive prioritization of small cell intestinal lymphoma versus inflammatory bowel disease in cats with gastrointestinal signs. This study lays the foundation for future studies to fully validate this type of testing for use in clinical practice.

Introduction: Sacrococcygeal teratomas (SCTs) and jejunoileal atresias are both rare (1 in 35,000–40,000 births and 1 in 5000 births, respectively). We present a case of a concomitant diagnosis of a cystic sacrococcygeal teratoma and a jejunoileal atresia. Case presentation: A twenty-week screening ultrasound identified a cystic pelvic mass (5.5 x 2.8 × 2.2 cm), dilated bowel, and mild polyhydramnios in an otherwise healthy G1P0 woman. Fetal magnetic resonance image showed a multiseptated presacral cystic mass suspicious for an internal sacrococcygeal teratoma and dilated bowel, thought to represent dilated ascending and transverse colon. Scheduled delivery at 39 weeks of gestation was uncomplicated. Postnatal ultrasound and MRI were consistent with prenatal findings. Given the rarity of both congenital anomalies and no known association between SCTs and jejunoileal atresia, the prenatal bowel dilation was thought to be due to partial obstruction secondary to the SCT. The baby thus underwent SCT resection on day-of-life 2. Ongoing obstruction after resection prompted a contrast enema which demonstrated a microcolon with reflux into the terminal ileum but no reflux into more dilated proximal loops concerning for intestinal atresia. On day-of-life 5, the baby underwent exploratory laparotomy which identified a type-2 ileal atresia, and a primary anastomosis was performed. The patient had an uneventful recovery and was discharged home on day-of-life 22. Conclusion: Prenatal findings of dilated bowel should prompt providers to have a high index of suspicion for jejunoileal atresia, even if other diagnoses exist.

Career development learning is increasingly emphasized as a curricular strategy to prepare students for their post-compulsory school transitions to further study or employment. Educators require career development frameworks and resources to support students' reflective learning. The present research tested a hypothesized Career Education and Development Framework (CEDF) comprising eight factors: The understanding of self; opportunities; influences; goal setting; decision-making; taking action; reflecting/reviewing; and confidence. The hypothesized framework was tested by confirmatory factor analysis (CFA) using data from two independent studies with samples (n = 567, n = 272) of senior secondary school students from different schools and jurisdictions. In addition to acceptable overall fit, invariance testing revealed consistency across gender on most factors.

Abstract Background Increased inflammation caused by SARS-CoV-2 infection can lead to severe coronavirus disease 2019 (COVID-19) and long-term disease manifestations. The mechanisms of this variable long-term immune activation are poorly defined. One feature of this increased inflammation is elevated levels of proinflammatory cytokines and chemokines. Autoantibodies targeting immune factors such as cytokines, as well as the viral host cell receptor, angiotensin-converting enzyme 2 (ACE2), have been observed after SARS-CoV-2 infection. Autoantibodies to immune factors and ACE2 could interfere with normal immune regulation and lead to increased inflammation, severe COVID-19, and long-term complications. Methods Here, we deeply profiled the features of ACE2, cytokine, and chemokine autoantibodies in samples from patients recovering from severe COVID-19. We measured the levels of immunoglobulin subclasses (IgG, IgA, IgM) in the peripheral blood against ACE2 and 23 cytokines and other immune molecules. We then utilized an ACE2 peptide microarray to map the linear epitopes targeted by ACE2 autoantibodies. Results We demonstrate that ACE2 autoantibody levels are increased in individuals with severe COVID-19 compared with those with mild infection or no prior infection. We identify epitopes near the catalytic domain of ACE2 targeted by these antibodies. Levels of autoantibodies targeting ACE2 and other immune factors could serve as determinants of COVID-19 disease severity, and represent a natural immunoregulatory mechanism in response to viral infection. Conclusions These results demonstrate that SARS-CoV-2 infection can increase autoantibody levels to ACE2 and other immune factors. The levels of these autoantibodies are associated with COVID-19 disease severity.