The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged study).

BACKGROUND: This study estimated the prevalence of evidence-based care received by a population-based sample of Australian residents in long-term care (LTC) aged ≥ 65 years in 2021, measured by adherence to clinical practice guideline (CPG) recommendations. METHODS: Sixteen conditions/processes of care amendable to estimating evidence-based care at a population level were identified from prevalence data and CPGs. Candidate recommendations (n = 5609) were extracted from 139 CPGs which were converted to indicators. National experts in each condition rated the indicators via the RAND-UCLA Delphi process. For the 16 conditions, 236 evidence-based care indicators were ratified. A multi-stage sampling of LTC facilities and residents was undertaken. Trained aged-care nurses then undertook manual structured record reviews of care delivered between 1 March and 31 May 2021 (our record review period) to assess adherence with the indicators. RESULTS: Care received by 294 residents with 27,585 care encounters in 25 LTC facilities was evaluated. Residents received care for one to thirteen separate clinical conditions/processes of care (median = 10, mean = 9.7). Adherence to evidence-based care indicators was estimated at 53.2% (95% CI: 48.6, 57.7) ranging from a high of 81.3% (95% CI: 75.6, 86.3) for Bladder and Bowel to a low of 12.2% (95% CI: 1.6, 36.8) for Depression. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators. CONCLUSIONS: This is the first study of adherence to evidence-based care for people in LTC using multiple conditions and a standardised method. Vulnerable older people are not receiving evidence-based care for many physical problems, nor care to support their mental health nor for end-of-life care. The six conditions in which adherence with indicators was less than 50% could be the focus of improvement efforts.

Effectiveness of interventions to prevent or reverse pre-frailty and frailty in middle-aged community dwelling adults: A systematic review.

INTRODUCTION: Frailty, marked by diminished physiological capacity and higher health risks, is less understood in middle-aged individuals (40-65 years) than older adults. This review synthesises intervention studies for pre-frailty and frailty in this demographic, assessing effectiveness, feasibility, and implementation factors including participant experience and cost-effectiveness. METHOD: Registered on the Open Science Framework and adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the template for intervention description and replication (TIDieR) guidelines, this review searched six databases for interventions targeting middle-aged adults. Dual screening, data extraction, risk assessment, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) certainty evaluation were conducted. Findings were narratively synthesized due to heterogeneity. RESULTS: Eight studies (2018-2023) with 2838 participants were included. Resistance training and multicomponent exercise reduced frailty; though, not always significantly. Low-intensity exercises and education-based interventions yielded mixed results, suggesting a need for further research. Positive participant experiences and cost-effectiveness of interventions such as resistance training and educational interventions supports their feasibility. Varying quality, methodologies and levels of bias indicated a need for more rigorous future research. DISCUSSION: This review reveals an evidence gap in middle-aged frailty interventions. Multicomponent interventions and resistance training showed promise, but their comparative effectiveness remains uncertain. Educational and low-intensity interventions need further research to establish their effectiveness. The findings diverge from those in older adults, emphasising the need for age-specific approaches. Future studies should employ higher-quality methods and explore emerging technologies to enhance intervention effectiveness for pre-frailty and frailty in middle-aged adults.

Outcomes of a trial of an age-friendly dining initiative: Dining Co.

OBJECTIVES: With the rise of age-friendly cities and communities, increasing attention is being paid to coproducing age-friendly guidelines with older people and community stakeholders. Little is known however about age-friendly guidelines for dining establishments. METHODS: A three-stage study to develop general and contextualised requirements for an age-friendly dining experience was conducted in the City of Onkaparinga, South Australia. The first stage involved older people in co-designing aspects of an age-friendly dining experience. Subsequently, the second and third stage coproduced, trialed and evaluated age-friendly initiatives with two dining venues. RESULTS: Through co-design, seven domains of an age-friendly dining experience were identified (Menu, Affordability, Dementia Awareness, Venue, Feeling Welcome, Special Offerings and Assistance), alongside an overarching desire for a 'meaningful' dining experience. Differences in health and socioeconomic status of diners underpinned the differences needed to ensure an age-friendly dining experience and highlight the importance of contextualisation for the local population. The trial demonstrated positive outcomes for both older diners and venues. DISCUSSION: The environment, value and logistics of dining out are important to older people when making choices about dining in the community. The elements of an age-friendly dining experience presented in this study are a useful starting point for contextualisation to other local settings.

Machine learning models for identifying pre-frailty in community dwelling older adults.

BACKGROUND: There is increasing evidence that pre-frailty manifests as early as middle age. Understanding the factors contributing to an early trajectory from good health to pre-frailty in middle aged and older adults is needed to inform timely preventive primary care interventions to mitigate early decline and future frailty. METHODS: A cohort of 656 independent community dwelling adults, aged 40-75 years, living in South Australia, undertook a comprehensive health assessment as part of the Inspiring Health cross-sectional observational study. Secondary analysis was completed using machine learning models to identify factors common amongst participants identified as not frail or pre-frail using the Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP). A correlation-based feature selection was used to identify factors associated with pre-frailty classification. Four machine learning models were used to derive the prediction models for classification of not frail and pre-frail. The class discrimination capability of the machine learning algorithms was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score and accuracy. RESULTS: Two stages of feature selection were performed. The first stage included 78 physiologic, anthropometric, environmental, social and lifestyle variables. A follow-up analysis with a narrower set of 63 variables was then conducted with physiologic factors associated with the FFP associated features removed, to uncover indirect indicators connected with pre-frailty. In addition to the expected physiologic measures, a range of anthropometric, environmental, social and lifestyle variables were found to be associated with pre-frailty outcomes for the cohort. With FFP variables removed, machine learning (ML) models found higher BMI and lower muscle mass, poorer grip strength and balance, higher levels of distress, poor quality sleep, shortness of breath and incontinence were associated with being classified as pre-frail. The machine learning models achieved an AUC score up to 0.817 and 0.722 for FFP and CFS respectively for predicting pre-frailty. With feature selection, the performance of ML models improved by up to + 7.4% for FFP and up to + 7.9% for CFS. CONCLUSIONS: The results of this study indicate that machine learning methods are well suited for predicting pre-frailty and indicate a range of factors that may be useful to include in targeted health assessments to identify pre-frailty in middle aged and older adults.

Appropriate and acceptable health assessments for people experiencing homelessness.

BACKGROUND: Appropriate and acceptable recruitment strategies and assessment tools are essential to determine the health needs for people experiencing homelessness. Based on a systematic review and known feasible community-based health assessments for people who are not homeless, a set of health assessments were trialled with people experiencing homelessness. METHODS: Participants were recruited via support agencies. They completed a health risk assessment, demographic and self-report health questionnaires, and objective assessments across 17 domains of health. RESULTS: Fifty-three participants (43.3% female, mean age 49.1 years) consented and completed 83-96% of assessments. Consent was reversed for assessments of grip, foot sensation, body measures (11%), and walking (30%), and initially refused for stress, sleep, cognition (6%); balance, walk test (9%) and oral examination (11%). There was one adverse event. Most assessments were both appropriate and acceptable. Some required modification for the context of homelessness, in particular the K10 was over-familiar to participants resulting in memorised responses. Recruitment strategies and practices must increase trust and ensure participants feel safe. CONCLUSIONS: This set of health assessments are appropriate and acceptable for administration with people experiencing homelessness. Outcomes of these assessments are essential to inform public and primary health service priorities to improve the health of people experiencing homelessness.

Designing clinical indicators for common residential aged care conditions and processes of care: the CareTrack Aged development and validation study.

BACKGROUND: People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. OBJECTIVE: In this study (CareTrack Aged, CT Aged), we aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes in aged care. METHODS: Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multiround modified Delphi process to develop a consensus on what constitutes appropriate care. RESULTS: From 139 CPGs, 5609 recommendations were used to draft 630 indicators. Clinical experts (n = 41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment; bladder and bowel problems; cognitive impairment; depression; dysphagia and aspiration; end of life/palliative care; hearing and vision; infection; medication; mobility and falls; nutrition and hydration; oral and dental care; pain; restraint use; skin integrity and sleep. CONCLUSIONS: The suite of CT Aged clinical indicators can be used for research and assessment of the quality of care in individual facilities and across organizations to guide improvement and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.

Inertial Sensor Reliability and Validity for Static and Dynamic Balance in Healthy Adults: A Systematic Review.

Compared to laboratory equipment inertial sensors are inexpensive and portable, permitting the measurement of postural sway and balance to be conducted in any setting. This systematic review investigated the inter-sensor and test-retest reliability, and concurrent and discriminant validity to measure static and dynamic balance in healthy adults. Medline, PubMed, Embase, Scopus, CINAHL, and Web of Science were searched to January 2021. Nineteen studies met the inclusion criteria. Meta-analysis was possible for reliability studies only and it was found that inertial sensors are reliable to measure static standing eyes open. A synthesis of the included studies shows moderate to good reliability for dynamic balance. Concurrent validity is moderate for both static and dynamic balance. Sensors discriminate old from young adults by amplitude of mediolateral sway, gait velocity, step length, and turn speed. Fallers are discriminated from non-fallers by sensor measures during walking, stepping, and sit to stand. The accuracy of discrimination is unable to be determined conclusively. Using inertial sensors to measure postural sway in healthy adults provides real-time data collected in the natural environment and enables discrimination between fallers and non-fallers. The ability of inertial sensors to identify differences in postural sway components related to altered performance in clinical tests can inform targeted interventions for the prevention of falls and near falls.

Attaining and assessing the Australian interprofessional learning competencies.

Interprofessional collaboration is critical for optimal healthcare. Preparing for a collaborative, practice-ready workforce, the Interprofessional Learning Competencies (IPLCs) were adopted for accreditation of Australian entry-level health, nursing and medical tertiary training programs. In order to meet new accreditation standards, activities which facilitate and assess IPLC attainment must be identified. Interprofessional education programs have not evaluated student interprofessional learning activities using the Australian IPLCs. This project evaluates students' experiences of the IPLCs during 'Inspiring Health,' a community-based interprofessional placement, and determines whether reflections can effectively assess IPLC attainment. Forty-nine students from seven Flinders University health and social science programs completed written reflections about four self-selected IPLCs. The results indicated that students had opportunities to attain all the IPLCs. Their reflections were analyzed using thematic analysis. Three themes were identified: the processes by which students learned, the outcomes of their learning, and the factors that influenced their learning. Ultimately, these findings describe a beneficial community-based interprofessional learning activity for attainment of the Australian IPLCs and provide evidence that student reflections can be used to assess the Australian IPLCs.

Overuse injuries in runners of different abilities-a one-year prospective study.

The aim of this prospective study was to investigate differences in participant characteristics, previous injury, running dynamics during a long-distance run, and training between injured and uninjured runners in runners of different abilities. Center-of-mass acceleration data were collected during a long-distance overground run. Runners were then divided into four groups (elite, advanced, intermediate and slow) based on their finishing time. Participants completed training diaries and were monitored for 1 year. Seventy-six runners completed the prospective study with 39 (51.3%) sustaining a running injury (44% elite, 42% advanced, 54% intermediate, 59% slow). Differences between injured and uninjured runners within each group related to injury included: (1) elite injured runners ran with longer contact times and (2) more slow injured runners reported an injury in previous year, were heavier, had higher body mass and body mass index, ran with lower step frequencies, and ran a greater weekly distance. Advanced injured runners exhibited fatigue changes in step regularity and peak braking during the run that may be related to injury. These findings suggest that runners of different abilities may have different factors related to injury however due to the small sample sizes in the groups this needs to be explored further.

Dermal thickness and echogenicity using DermaScan C high frequency ultrasound: Methodology and reliability testing in people with and without primary lymphoedema.

BACKGROUND: DermaScan C high frequency ultrasound was investigated for image capture and analysis of dermal measures in people with and without primary lymphoedema. METHOD: Three repeated images were taken at six sites in people without lymphoedema (NLO). Intra-rater reliability was assessed by taking three sets of measures on images from 10 people and inter-session reliability by capturing three images, lifting the probe from the skin in between. Methods were adjusted, and repeated images from four sites were taken in people with primary lymphoedema (PLO) and reliability re-assessed. RESULTS: Intra-rater reliability in NLO and PLO for echogenicity measures were excellent (NLO ICC(3,1) : .989; PLO .997) across all sites and specific to each site (calf: ICC(3,1) : .989; and foot: ICC(3,1) : .999, respectively). Inter-session reliability was moderate for NLO (ICC(3,1) : .727), improving after method modifications for PLO (ICC(3,1) : .916). When investigated by site, inter-session reliability was good in the foot (ICC(3,1) : .811) and moderate in the calf (ICC(3,1) : .616). Mean thickness analysed by site resulted in good inter-session reliability only in the foot (ICC(3,1) .838). CONCLUSION: Intra-rater reliability was excellent using the DermaScan C for dermal measures in people with primary lymphoedema. Inter-session reliability required particular attention to method and gain settings.

Health Literacy Among Canadian Men Experiencing Prostate Cancer.

The objective was to describe the health literacy of a sample of Canadian men with prostate cancer and explore whether sociodemographic and health factors were related to men's health literacy scores. A sample of 213 Canadian men (M age = 68.71 years, SD = 7.44) diagnosed with prostate cancer were recruited from an online prostate cancer support website. The men completed the Health Literacy Questionnaire along with demographic, comorbidity, and prostate cancer treatment-related questions online. Of the 5-point scales, men's health literacy scores were highest for "Understanding health information enough to know what to do" (M = 4.04, SD = 0.48) and lowest for "Navigating the health care system" (M = 3.80, SD = 0.58). Of the 4-point scales, men's scores were highest for "Feeling understood and supported by health care professionals" (M = 3.20, SD = 0.52) and lowest for "Having sufficient information to manage my health" (M = 2.97, SD = 0.46). Regression analyses indicated that level of education was positively associated with health literacy scores, and men without comorbidities had higher health literacy scores. Age and years since diagnosis were unrelated to health literacy. Support in health system navigation and self-management of health may be important targets for intervention.

Preventive chemotherapy reverses covert, lymphatic-associated tissue change in young people with lymphatic filariasis in Myanmar.

OBJECTIVES: This longitudinal comparative study investigated the effect of preventive chemotherapy (PC) on covert tissue changes associated with lymphatic filariasis (LF) among young people living in an LF-endemic area in Myanmar. METHODS: Tissue compressibility and extracellular free fluid in the lower limbs of people aged 10-21 years were measured using indurometry and bioimpedance spectroscopy (BIS). Baseline measures were taken in October 2014, annual mass drug administration (MDA) of PC was delivered in December, and in March 2015 further PC was offered to LF-positive cases who had missed MDA. Follow-up measures were taken in February and June 2015. RESULTS: A total of 50 antigen-positive cases and 46 antigen-negative controls were included. Self-reported PC consumption was 60.1% during 2014 MDA and 66.2% overall. At second follow-up, 24 of 34 cases and 27 of 43 controls had consumed PC. Significant and clinically relevant between-group differences at baseline were not found post-PC. Bayesian linear mixed models showed a significant change in indurometer scores at both calves for antigen-positive cases who consumed any PC (dominant calf: -0.30 [95% CI -0.52, -0.07], P < 0.05 and non-dominant calf: -0.35 [95% CI -0.58, -0.12], P < 0.01). Changes in antigen-negative participants or those not consuming PC were not significant. CONCLUSION: This study is the first attempt to use simple field-friendly tools to track fluid and tissue changes after treatment of asymptomatic people infected with LF. Results suggested that PC alone is sufficient to reverse covert lymphatic disturbance. Longer follow-up of larger cohorts is required to confirm these improvements and whether they persist over time. These findings should prompt increased efforts to overcome low PC coverage, which misses many infected young people, particularly males, who are unaware of their infection status, unmotivated to take PC and at risk of developing lymphoedema. Indurometry and BIS should be considered in assessment of lymphatic filariasis-related lymphedema.

OBJECTIFS: Cette étude comparative longitudinale a investigué l'effet de la chimiothérapie préventive (CP) sur les modifications tissulaires cachées associées à la filariose lymphatique (FL) chez les jeunes vivant dans une zone d'endémie pour la FL au Myanmar. MÉTHODES: La compressibilité des tissus et le liquide libre extracellulaire dans les membres inférieurs des personnes âgées de 10 à 21 ans ont été mesurés par indurométrie et spectroscopie de bioimpédance (BIS). Les mesures de base ont été prises en octobre 2014, la distribution en masse de médicament (DMM) annuelle a été administrée en décembre et en mars 2015, et une CP additionnelle a été offerte aux cas positifs pour la FL qui avaient manqué la DMM. Des mesures de suivi ont été prises en février et juin 2015. RÉSULTATS: 50 cas positifs pour l'antigène et 46 témoins négatifs ont été inclus. L'administration de CP auto-déclarée était de 60,1% durant la DMM de 2014 et de 66,2% au total. Au deuxième suivi, 24 des 34 cas et 27 des 43 témoins avaient pris la CP. Des différences significatives et cliniquement pertinentes entre les groupes au départ n'ont pas été trouvées après la CP. Les modèles mixtes linéaires bayésiens ont montré un changement significatif des scores d'indurometrie aux deux mollets pour les cas positifs pour l'antigène qui prenaient une CP (mollet dominant: -0,30 [IC95%: -0,52, -0,07], p <0,05, mollet non dominant: - 0,35 [IC95%: -0,58, -0,12], p <0,01). Les changements chez les participants négatifs pour l'antigène ou ceux qui ne prenaient pas de CP n'étaient pas significatifs. CONCLUSION: Cette étude est la première tentative d'utilisation d'outils simples, conviviaux sur le terrain, pour suivre les modifications du tissu conjonctif après le traitement de personnes asymptomatiques infectées par la FL. Les résultats suggèrent que la CP seule est suffisante pour inverser les modifications lymphatiques cachées. Un suivi plus long de plus grandes cohortes est nécessaire pour confirmer ces améliorations et déterminer si elles persistent ou non. Ces résultats devraient inciter à redoubler d'efforts pour surmonter la faible couverture en CP, qui rate beaucoup de jeunes infectés, en particulier les hommes, qui ne sont pas au courant de leur statut d'infection, qui ne sont pas motivés pour prendre une CP et risquent de développer un lymphœdème. L'indurométrie et la BIS devraient être considérées dans l'évaluation du lymphoedème associé à la filariose lymphatique.

Asynchrony between ant seed dispersal activity and fruit dehiscence of myrmecochorous plants.

PREMISE OF THE STUDY: Phenological mismatch has received attention in plant-pollinator interactions, but less so in seed dispersal mutualisms. We investigated whether the seasonal availability of myrmecochorous seeds is well matched to the seasonal activity patterns of seed-dispersing ants. METHODS: We compared seasonal timing of seed removal by a keystone seed-dispersing ant, Aphaenogaster rudis, and fruit dehiscence of several species of plants whose seeds it disperses in a deciduous forest in southern Ontario, Canada. We examined the timing of elaiosome "robbing" by the nonnative slug Arion subfuscus and tested whether seed removal by ants declines in response to supplementation with additional elaiosome-bearing seeds (ant "satiation"). KEY RESULTS: Seed removal from experimental depots peaked early in the season for all plant species and correlated with temperature. In contrast, elaiosome robbing by slugs increased late in the season and thus may disproportionately affect plants with late-dehiscing fruits. Ant colonies removed seeds at similar rates regardless of seed supplementation, indicating that satiation likely does not impact seasonal patterns of seed dispersal in this system. Fruits of the five myrmecochorous plant species in our study dehisced at discrete intervals throughout the season, with minimal overlap among species. Peak dehiscence did not overlap with peak seed removal for any plant species. CONCLUSIONS: Fruit dehiscence of myrmecochorous plants and peak ant seed dispersal activity occur asynchronously. Whether future climate warming will shift ant and plant phenologies in ways that have consequences for seed dispersal remains an open question.

Health deficits in community dwelling adults aged 40 to 75 years.

BACKGROUND: Middle and older years are associated with age related health deficits but how early this begins and progresses is poorly understood. Better understanding is needed to address early decline and support healthier ageing outcomes. METHODS: Seemingly healthy, community dwelling adults aged 40 to 75 years were recruited via local council and business networks. They completed online surveys about sleep quality, distress and physical activity, and two hours of objective testing of physiologic and anthropometric measures, mobility, cognition, grip strength, foot sensation, dexterity and functional hearing. Analysis compared outcomes for age, gender, and age and gender groups with population norms for 21 health assessments. The total number of non-compliant tests for each participant was calculated by summing the number of non-compliant tests, and the frequency of these scores across the sample was reported. Gender and age effects were tested using ANOVA models. Combined age and gender categories were used for subsequent logistic regression modelling, with females aged 40-49 years being the default comparator. RESULTS: Of 561 participants (67% female; mean age 60 years (SD 10.3)), everyone had at least one deficit and median deficits was 5 (IQR 2). More than 50% of participants did not meet anthropometric and exercise norms, while 30 to 40% had reduced functional hearing and cognition. Overall, men performed worse and deficits increased with age particularly for physical activity, audiology, mobility, anthropometry, oximetry and foot sensation. Heart rate, body temperature and dyspnoea were the only variables where compliance was within 95% of expected values. Multiple areas of functional decline were found in people aged in their 40s and 50s. CONCLUSIONS: The health deficits identified are mostly mutable hence identification and interventions to address the multi-system functional decline in people as young as 40 has the capacity to ensure healthier ageing.

Contemporaneous patient and health professional views of patient-centred care: a systematic review.

OBJECTIVE: To understand the domains of agreement and disagreement, related to person-centred care, between the patient and healthcare professional during a shared episode of care. DESIGN: A systematic review following the PRISMA protocol searched PubMed (Medline), CINAHL, PsychInfo and Scopus using keywords for health professionals, patients and patient-centred care. A descriptive-interpretive method was used to identify domains described in the person-centred care framework. SETTING: Research conducted in all healthcare settings (inpatient, outpatient, community) were included. PARTICIPANTS: Research which presented the contemporaneous perspectives of a health professional and the person they were providing services to were included. INTERVENTION(S): Research regarding the delivery of any type of health service was included. MAIN OUTCOME MEASURE(S): The person-centred care framework which includes Structure, Process and Outcome as measures for implementing person-centred care was used to interpret and summarize the data. RESULTS: After title and abstract screening against inclusion and exclusion criteria, 15 of 1,406 studies were critically appraised. High levels of contemporaneous agreement were identified for easily accessible, supportive and accommodating environments, where information sharing occurred. Contemporaneous agreement occurred most often between patients and healthcare professionals in the importance of sharing information across all geographical settings, with greatest disagreement of patient involvement in the European and American hospital environments. CONCLUSIONS: Greater understanding of the context of information sharing and drivers for management preferences may support shared decision-making and increase satisfaction. More information regarding contemporaneous experiences of healthcare episodes is required to further inform patient-centred care practices and optimize health outcomes.

First year allied health student transition to a regional university.

OBJECTIVE: Students from regional and remote backgrounds are more likely to stay and work in regional and remote locations. Health students transition and retention at university impacts the retainment of a competent rural health workforce. This study aimed to examine the perceptions of allied health students as they reflected upon their first six weeks at university and identified strategies which enhanced these experiences. DESIGN: A cross-sectional study. Surveys were administered to students who then completed a reflection exercise. Data were analysed using Pearson correlation coefficient and chi-squares. SETTING: An Australian regional university. PARTICIPANTS: First year occupational therapy, physiotherapy and speech pathology students. MAIN OUTCOME MEASURES: Factors influencing the first 6 weeks at university. RESULTS: One hundred and forty-three students participated. Homesickness was the major challenge in transitioning to university life. Subthemes identified were adjusting to being away from home, adjusting to university culture and the mature-aged student. Specific issues included a lack of familiarity with university campuses and services, being unprepared for the workload and confusion while learning new skills. CONCLUSION: Orientation week activities assist students transition into university and age-appropriate and family-friendly activities should be considered for mature-age students. All students were found to benefit from support to address economic pressures and skill development focusing on coping with university workload. The development of regional university policy including these strategies is likely to enhance student success.

Compression garment service model: Facilitating access to compression garments through workforce and service redesign.

PROBLEM: Patients in Queensland have had difficulty in accessing lymphoedema services, particularly in rural and remote locations. DESIGN: The aim was to trial and evaluate a compression garment service model, to provide care for patients with lymphoedema closer to their homes. The service model trialled compression garment, selection, fitting and monitoring services for stabilised malignancy-related lymphoedema undertaken by generalist therapists. SETTING: Ten Hospital and Health Services in the Queensland public sector. KEY MEASURES FOR IMPROVEMENTS: The patients would have access to safe, quality services closer to their homes. STRATEGIES FOR CHANGE: The generalists were supported by telehealth coaching and supervision by lymphoedema therapists, an education program, resources and governance processes. EFFECTS OF CHANGE: Compression garment selection, fitting and monitoring by generalists (physiotherapists and occupational therapists without Level 1 Lymphoedema training), as defined in the service model, was safe, effective and evaluated positively by patients and health professionals. There was increased access to compression garment services provided by generalist therapists in rural and remote locations. LESSONS LEARNED: The service model implemented has the capacity to address workforce and service provision issues. It provides resources, education and training for clinicians to improve access to the provision of compression garment services.

Stigma in Male Depression and Suicide: A Canadian Sex Comparison Study.

Stigma in men's depression and suicide can restrict help-seeking, reduce treatment compliance and deter individuals from confiding in friends and family. In this article we report sex comparison findings from a national survey of English-speaking adult Canadians about stigmatized beliefs concerning male depression and suicide. Among respondents without direct experience of depression or suicide (n = 541) more than a third endorsed the view that men with depression are unpredictable. Overall, a greater proportion of males endorsed stigmatizing views about male depression compared to female respondents. A greater proportion of female respondents endorsed items indicating that men who suicide are disconnected, lost and lonely. Male and female respondents with direct personal experience of depression or suicide (n = 360) strongly endorsed stigmatizing attitudes toward themselves and a greater proportion of male respondents indicated that they would be embarrassed about seeking help for depression.

Genenames.org: the HGNC resources in 2013.

The HUGO Gene Nomenclature Committee situated at the European Bioinformatics Institute assigns unique symbols and names to human genes. Since 2011, the data within our database has expanded largely owing to an increase in naming pseudogenes and non-coding RNA genes, and we now have >33,500 approved symbols. Our gene families and groups have also increased to nearly 500, with ∼45% of our gene entries associated to at least one family or group. We have also redesigned the HUGO Gene Nomenclature Committee website http://www.genenames.org creating a constant look and feel across the site and improving usability and readability for our users. The site provides a public access portal to our database with no restrictions imposed on access or the use of the data. Within this article, we review our online resources and data with particular emphasis on the updates to our website.

Prevalence of neurogenic heterotopic ossification in traumatic head- and spinal-injured patients admitted to a tertiary referral hospital in Australia.

A study was undertaken to investigate the prevalence of neurogenic heterotopic ossification (NHO) in patients with traumatic brain injury (TBI) or traumatic spinal cord injury (TSCI) admitted to nonspecialized units. Methods consisted of a retrospective audit of patients, using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) coding system, admitted to The Townsville Hospital with TBI/TSCI between July 1, 2006, and December 31, 2012. Fifty-eight patients with length of stay of 60 days or longer were admitted to The Townsville Hospital with TBI/TSCI over this period with mean age of 60 years (range, 31-87 years); 55 were TBI and 3 were TSCI patients. Three thousand one hundred fourteen TBI/TSCI patients with length of stay of less than 60 days and mean age of 43 years (range, 18-93 years) were also identified (2903 were TBI and 211 were TSCI patients). Overall, none had a diagnosis of NHO; 6 patients, identified by the ICD-10-AM codes, with a diagnosis of heterotopic ossification did not have an associated TBI/TSCI. Findings of 0% of NHO prevalence in TSCI/TBI patients admitted to the large tertiary referral hospital suggest that NHO may have been missed, possibly because of the TSCI/TBI ICD-10-AM codes, not being specifically designed for documentation of the TBI/TSCI complications. If NHO remains undiagnosed in nonspecialized units because of the method of coding, it may increase functional limitation in already compromised individuals.