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Care Planning Across the Health System:Intersectoral Application of the interRAI Assessment System
No full textOlder adults living with frailty and multimorbidity interact with multiple care providers and health settings, resulting in fragmented care and information discontinuity. Standardized assessments potentiate integrated care by communicating consistent measures of health information between sectors and providers. We use a pragmatic case example of a theoretical medically complex older adult to illustrate use of interRAI standardized assessments throughout the health journey. The case example represents the assessment findings of a patient accessing care through primary care, the emergency department, home/community care and long-term care. A suite of assessment instruments embedded with decision support algorithms guides nursing care decisions, while a common language and standardized assessment items support effective communication and collaboration among the health team. Successful adoption of integrated and comprehensive assessment tools requires training, engagement, and time to embed processes into practice. interRAI assessments enable integration through a common language, aligning successive assessments across the care continuum.</p
The economic and environmental sustainability of digital commons:Lessons from the 2023 Debian project survey
Get PDFDigital commons are shared information and knowledge resources such as data, software and cultural content. They are produced and managed for collective use, and to be modified and redistributed as needed. Using results from a 2023 survey of the Debian community, this new DCPC report addresses question such as: Is the free, libre and open source software or FLOSS development model economically sustainable? What role can FLOSS play in the transition to more environmentally sustainable production and consumption? With the benefit of hindsight, the first survey of the Debian community, carried out in 2016, whose preliminary results were published in 2017 in the Journal of Peer Production, represented the first manifestation of a core DCPC program of work: to empirically map which categories of workers (e.g., firm employees, foundation employees, researchers, volunteers, etc) were performing which duties in the digital commons production process, with a view to increasing the recognition of these commons and these voluntary workers by industry and society.The 2023 edition had a more clearly militant intent than its predecessor, as it also sought to investigate community opinion about the predatory practices and environmental sustainability of large IT firms as well as about alternative models. A key finding is the rejection by the community of the use of restrictive licences to incentivise environmental action (e.g., preventing entities that engage in unsustainable environmental practices from using Debian). Other interesting findings can be drawn from comments responding to the question ‘Are the main obstacles to reducing environmental impacts in your workplace economic (for example, their cost), organisational (for example, lack of support from management), technical (for example, difficulty of implementation)?’ These detailed responses allow us to understand the extent and ramifications of the obstacles
Consensus derived client outcomes and clinician actions for youth online chat mental health services:a Delphi study
No full textIntroduction: Online chat services have increased mental health care access for young people (12–25 years), yet their effectiveness remains unclear. This is partly due to a lack of consensus about primary client outcomes and clinician actions facilitating positive service outcomes. This study sought to identify (a) outcomes most important for young people accessing mental health support via online chat, and (b) clinician actions most relevant to achieving these outcomes. Method: A comprehensive list of potential outcomes and actions was developed through literature review and consultation with youth online chat service providers. A three-round Delphi study was conducted with three panels of youth, researchers, and clinicians (n = 100; 84% retention rate), primarily from Australia and Ireland. Consensus was reached if ≥75% of participants within at least two panels rated an outcome/action as very important or essential. Results: Eleven client outcomes reached consensus: Feeling heard and validated; Reduced distress; Increased help-seeker capacity; Feeling safe; Optimism and hope; Connection with clinician and service; Feeling better; Reduced hopelessness; Reduced overwhelm; Increased coping; and Goals, answers and direction. Fifteen clinician actions reached consensus: Manage risk; Respect diversity; Validation; Welcoming environment; Active listening; Manage distress; Compassion; Checking in; Give choice; Youth friendly; Set expectations and focus; Provide resources; Holistic approach; Highlight strengths; and Problem-solving. Conclusions: The identified client outcomes and clinician actions offer preliminary guidance for monitoring and evaluating youth online chat support. Future research should test and refine these domains within service contexts to inform robust measurement tool development for evaluating youth online chat services.</p
“And we feel success” – Participant reflections of a multi-component group reablement program for people with dementia and their care partners
Get PDFBackground Australia's National Dementia Action Plan 2024-2034 highlights the challenging post-diagnostic journey often faced by people with dementia and care partners. A novel multidisciplinary, multicomponent program was designed to address this gap as an outpatient clinic at a rehabilitation hospital. The ?SPICE Program? (Sustainable Personalised Interventions for Cognition, Care, and Engagement) is delivered in small groups and individual appointments by allied health professionals over twelve-weeks. Program components include Cognitive Stimulation Therapy, the Care Of People with Dementia (COPE?) Program, care partner education, exercise and dietetics. This study presents analysis of the experiences and perspectives of participants who completed SPICE during 2022-2024. Method Semi-structured interviews were audio-recorded after program completion. Transcripts were grouped and underwent content analysis by four researchers to identify codes and themes driven from a line of enquiry that prompted for self-reported changes and program feedback. Result Participants for each of the first ten SPICE Programs included up to seven people with dementia (n = 60, M=79yrs; 42% female) and their care partners (n = 58; M=75yrs; 67%female) living in the community. People with dementia shared themes of SPICE being ?stimulating and useful? with social ?connections?, ?enjoyment? and increased ?confidence? through new friendships with peers and staff. Care partners reported positive changes in their loved one with similar themes of ?connection?, ?enjoyment?, ?being understood?, as well as enhancements in physical and social capacity. Self-reflection by care partners involved themes of ?belonging?, ?sharing and learning together', increased ?understanding? and caring ?breakthroughs?. Conclusion Self-reported and proxy-reflections on the SPICE program highlight the positive experiences and wellbeing impacts for a majority of participants. The group context offered important opportunities for social connection for participants, acting as a catalyst that enhanced potential benefits in other domains of well-being. Findings extend the evidence for wider availability of early post-diagnostic care in Australia with further research needed to develop implementation guidelines for comparable programs
Oral Health in Individuals with Severe Mental Illness on Second-Generation Antipsychotics—A Scoping Review
No full textIntroduction: There has been a significant increase in antipsychotic usage, particularly belonging to second-generation antipsychotics (SGAs), in the management of severe mental illnesses (SMIs) over the past few decades, but their impact on oral health is unclear. This review evaluated the oral side effects of the SGAs used in managing SMIs. Methods: A PRISMA-guided scoping review was conducted, using predefined criteria and relevant word combination in Medline (PubMed), Embase, Scopus and Cochrane databases. Eligible studies were assessed for study type, population demographics, antipsychotic medication usage, oral diseases and conditions, and their outcomes. Primary outcomes were explicitly studied oral conditions or diseases, and secondary outcomes were broader oral or general “treatment-emergent adverse effects.”. Results: Twelve studies met the inclusion criteria for the primary outcomes and 13 for the secondary outcomes. The most reported primary outcomes were salivary gland dysfunction (hypofunction, three studies; hypersalivation, two studies), dental caries (positive association, three studies; no association, one study), and periodontal disease (five studies). Secondary outcomes included dysgeusia and oral hypoesthesia (six studies). Discussion: SGAs significantly compromise oral health, particularly through salivary gland and sensory dysfunction, highlighting the need for up-to-date guidelines on routine oral screening and preventive care.</p
Sociodemographic Factors and Presentation Features of Individuals Seeking Mental Health Care in Emergency Departments:A Retrospective Cohort Study
No full textEmergency Department (ED) presentations for Mental Health (MH) help-seeking have been rising rapidly, with EDs as the main entry point for most individuals in Australia. The objective of this retrospective cohort study was to analyse the sociodemographic and presentation features of people who sought mental healthcare in two EDs located in a regional coastal setting in New South Wales (NSW), Australia from 2016 to 2021. This article is a part of a broader research study on the utilisation of machine learning in MH. The objective of this study is to identify the factors that lead to the admission of individuals to an MH inpatient facility when they seek MH care in an ED. Data were collected using existing records and analysed using descriptive univariate analysis with statistical significance between the two sites was determined using Chi squared test, p < 0.05. Two main themes characterise dominant help-seeking dynamics for MH conditions in ED, suicidal ideation, and access and egress pathways. The main findings indicate that suicidal ideation was the most common presenting problem (38.19%). People presenting to ED who ‘Did not wait’ or ‘Left at own risk’ accounted for 10.20% of departures from ED. A large number of presentations arrived via the ambulance, accounting for 45.91%. A large proportion of presentations are related to a potentially life-threatening condition (suicidal ideation). The largest proportion of triage code 1 ‘Resuscitation’ was for people with presenting problem of ‘Behavioural Disturbance’. Departure and arrival dynamics need to be better understood in consultation with community and lived experience groups to improve future service alignment with the access and egress pathways for emergency MH care.</p
Explainable Human-centered Traits from Head Motion and Facial Expression Dynamics
No full textWe explore the efficacy of multimodal behavioral cues for explainable prediction of personality and interview-specific traits. We utilize elementary head-motion units named kinemes, atomic facial movements termed action units and speech features to estimate these human-centered traits. Empirical results confirm that kinemes and action units enable discovery of multiple trait-specific behaviors while also enabling explainability in support of the predictions. For fusing cues, we explore decision and feature-level fusion, and an additive attention-based fusion strategy which quantifies the relative importance of the three modalities for trait prediction. Examining various long-short term memory (LSTM) architectures for classification and regression on the MIT Interview and First Impressions Candidate Screening (FICS) datasets, we note that: (1) Multimodal approaches outperform unimodal counterparts, achieving the highest PCC of 0.98 for Excited-Friendly traits in MIT and 0.57 for Extraversion in FICS; (2) Efficient trait predictions and plausible explanations are achieved with both unimodal and multimodal approaches, and (3) Following the thin-slice approach, effective trait prediction is achieved even from two-second behavioral snippets. Our implementation code is available at: https://github.com/deepsurbhi8/Explainable_Human_Traits_ Prediction.</p
Running Low:A Seasonal Analysis of Micronutrient Deficiencies on External-Load Measures in Elite Female Rugby League Players
No full textIron and vitamin D are essential for physiological mechanisms underpinning physical capacities characterizing team-sport performance. Yet, the impact of iron deficiency on physical capacities beyond endurance is not clear. Purpose: The purpose of this study was to assess variations in seasonal micronutrient concentrations and how iron deficiency impacts external-load measures in elite female rugby league players. Methods: Iron and vitamin D status were measured in 28 players (age 24 [4] y, body mass 76 [11] kg) across 3 time points of the 17-week National Rugby League Women’s season. Physical demands were evaluated using external-load measures (eg, total distance, PlayerLoad) for training and competition. Linear mixed-effects models were employed to assess the effect of change in serum ferritin concentration on external-load measures. Effect sizes with 95% CIs were calculated to interpret the magnitude of difference in change in indices and performance outcomes between iron-deficient and iron-sufficient players.Results: Iron-deficiency prevalence ranged from 26% to 57% across the season, and <22% of players were vitamin D deficient at each time point. Weak to strong positive associations (R 2 = .3–.6) were observed between all external-load measures and moderating variables (serum ferritin, week, position, and athlete). However, these associations were largely attributable to the contribution of week and position. Differences in load measures between iron-deficient and iron-sufficient players were mostly trivial to small.Conclusions: Iron status of elite female rugby league players had little effect on most workload measures within this cohort. However, longitudinal monitoring is warranted to identify how external-load measures are affected individually in response to fluctuations in serum ferritin.</p
Elevations in D-dimer levels in patients with Plasmodium infections:a systematic review and meta-analysis
No full textD-dimer, a byproduct of cross-linked fibrin degradation, arises during the fibrinolysis process, breaking down blood clots in circulation. This systematic review and meta-analysis aimed to synthesize evidence of D-dimer alteration in people with malaria, including variations in disease severity. The systematic review was registered in PROSPERO with registration number CRD42024528245. Searches were performed in EMBASE, Scopus, MEDLINE, PubMed, Nursing & Allied Health Premium, and Journals@Ovid on March 25, 2024, to identify original studies that reported D-dimer in patients with Plasmodium infections. The methodological quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Thematic synthesis and meta-analysis were carried out to synthesize the findings of the included studies. A total of 24 studies were included in the review out of 1,115 records identified. According to the evaluated studies, patients with Plasmodium infections had higher D-dimer levels. A meta-analytic evaluation of D-dimer levels between patients with and without Plasmodium infections revealed a significant elevation of D-dimer in patients with infection, with high heterogeneity (SMD = 2.11, 95% CI = 0.59; 3.64, P = 0.007, I² = 98%, 6 studies, 1,418 participants, random-effects model). However, no significant alterations in D-dimer levels were observed following the comparison between patients with severe and uncomplicated malaria, also with high heterogeneity (SMD = 2.54, 95% CI = -1.60; 6.68, P = 0.23, I² = 99%, 3 studies, 595 participants). The findings suggested that malaria patients have significantly higher D-dimer levels compared to non-malarial individuals. However, there was no significant difference in D-dimer levels between severe and uncomplicated malaria cases. These results highlight the potential of D-dimer as a biomarker for Plasmodium infections, but its clinical utility requires further validation. Future studies should prioritize standardizing D-dimer measurement methods, including assay types, threshold values, and sample types, to ensure consistent and reliable application in clinical settings. Additionally, large, multicentric cohorts are needed to establish robust guidelines for incorporating D-dimer into malaria management practices. Further research should also explore the role of D-dimer in the pathogenesis of Plasmodium infections to deepen our understanding of their clinical significance.</p
Reconceptualizing vaccine nationalism: A multi-perspective analysis on security, technology, and global competition
Get PDFIn this perspective paper, we argue that the broader economic, political, and geo-strategic considerations leading to a nationalist approach in the development, deployment, and use of COVID-19 vaccines remain largely unexplored in the existing literature. We propose to expand and reframe the current discourse on vaccine nationalism (VN). This involves examining nationalist practices and policies beyond merely securing vaccine access during the global COVID-19 vaccine shortage. We seek to identify the core characteristics of this nationalist approach to COVID-19 vaccines by drawing on existing nationalism literature. We then examine the root causes of vaccine nationalism from three distinctive yet interrelated perspectives, each aimed at uncovering its root causes: national security, technological catch-up, and rising geo-strategic competition in technology and ideology. Notably, our analysis of VN draws extensively on the vaccine-related policies and practices observed in China. By considering these perspectives and their interplay, we contend that a more holistic and nuanced understanding of vaccine nationalism can be achieved