Identification of knowledge gaps in whole-genome sequence analysis of multi-resistant thermotolerant Campylobacter spp.

BACKGROUND: Campylobacter spp. is the most frequent cause of bacterial food-borne gastroenteritis and a high priority antibiotic resistant bacterium according to the World Health Organization (WHO). European monitoring of thermotolerant Campylobacter spp. does not reflect the global burden of resistances already circulating within the bacterial population worldwide. METHODS: We systematically compared whole genome sequencing with comprehensive phenotypic antimicrobial susceptibility, analyzing 494 thermotolerant Campylobacter poultry isolates from Vietnam and Germany. Any discrepancy was checked by repeating the wet lab and improving the dry lab part. Selected isolates were additionally analyzed via long-read Oxford Nanopore technology, leading to closed chromosomes and plasmids. RESULTS: Overall, 22 different resistance genes and gene variants (e. g. erm(B), aph(3')-IIIa, aph(2'')-If, catA, lnu(C), blaOXA, sat4) and point mutations in three distinct genes (gyrA, 23S rRNA, rpsL) associated with AMR were present in the Campylobacter isolates. Two AMR genes were missing in the database and one falsely associated with resistance. Bioinformatic analysis based on short-read data partly failed to identify tet(O) and aadE, when the genes were present as duplicate or homologous gene variants. Intriguingly, isolates also contained different determinants, redundantly conferring resistance to chloramphenicol, gentamicin, kanamycin, lincomycin and streptomycin. We found a novel tet(W) in tetracycline sensitive strains, harboring point mutations. Furthermore, analysis based on assemblies from short-read data was impaired to identify full length phase variable aad9, due to variations of the poly-C tract within the gene. The genetic determinant responsible for gentamicin resistance of one isolate from Germany could not be identified. GyrT86I, presenting the main determinant for (fluoro-)quinolone resistance led to a rare atypical phenotype of ciprofloxacin resistance but nalidixic acid sensitivity. Long-read sequencing predicted AMR genes were mainly located on the chromosome, and rarely on plasmids. Predictions from long- and short-read sequencing, respectively, often differed. AMR genes were often organized in multidrug resistance islands (MDRI) and partially located in proximity to transposase genes, suggesting main mobilization of resistance determinants is via natural transformation and transposition in Campylobacter. CONCLUSIONS: The results of this study suggest that there is frequent resistance gene duplication, mosaicism, and mutation leading to gene variation and truncation in Campylobacter strains that have not been reported in previous studies and are missing from databases. Furthermore, there is a need for deciphering yet unknown resistance mechanisms and resistance spread in thermotolerant Campylobacter spp. that may pose a challenge to global food safety.

New insight into protective effect against oxidative stress and biosynthesis of exopolysaccharides produced by Lacticaseibacillus paracasei NC4 from fermented eggplant.

Fermented eggplant is a traditional fermented food, however lactic acid bacteria capable of producing exopolysaccharide (EPS) have not yet been exploited. The present study focused on the production and protective effects against oxidative stress of an EPS produced by Lacticaseibacillus paracasei NC4 (NC4-EPS), in addition to deciphering its genomic features and EPS biosynthesis pathway. Among 54 isolates tested, strain NC4 showed the highest EPS yield and antioxidant activity. The maximum EPS production (2.04 ± 0.11 g/L) was achieved by culturing in MRS medium containing 60 g/L sucrose at 37 °C for 48 h. Under 2 mM H2O2 stress, the survival of a yeast model Saccharomyces cerevisiae treated with 0.4 mg/mL NC4-EPS was 2.4-fold better than non-treated cells, which was in agreement with the catalase and superoxide dismutase activities measured from cell lysates. The complete genome of NC4 composed of a circular chromosome of 2,888,896 bp and 3 circular plasmids. The NC4 genome comprises more genes with annotated function in nitrogen metabolism, phosphorus metabolism, cell division and cell cycle, and iron acquisition and metabolism as compared to other reported L. paracasei. Of note, the eps gene cluster is not conserved across L. paracasei. Pathways of sugar metabolism for EPS biosynthesis were proposed for the first time, in which gdp pathway only present in few plant-derived bacteria was identified. These findings shed new light on the cell-protective activity and biosynthesis of EPS produced by L. paracasei, paving the way for future efforts to enhance yield and tailor-made EPS production for food and pharmaceutical industries.

Bioactivity responses to changes in mucus-associated bacterial composition between healthy and bleached Porites lobata corals.

This study aims to investigate how bioactivities of the coral surface mucus layer (SML) respond to changes in mucus-associated bacterial communities between bleached and healthy Porites lobata corals in Nha Trang Bay, Vietnam. The findings suggested that significant shift in the mucus-associated bacterial communities were related to changes in coral health states from bleached to healthy P. lobata colonies (p < 0.05), while bacterial compositions were not significantly different across seasons and locations (p > 0.05). Of which 8 genera, Shewanella, Fusibacter, Halodesulfovibrio, Marinifilum, Endozoicomonas, Litoribacillus, Algicola, and Vibrio were present only in the SML of bleached coral while absent in the SML of healthy one. As compared with the bleached SML, the healthy SML demonstrated stronger antibacterial activity against a coral bleaching pathogen, V. coralliilyticus, higher antitumor activity against HCT116 cell accompanied with increased induction of cleaved PARP and accelerated cell nucleic apoptosis and cycle arrest at S and G2/M phases exhibiting several typical characteristics, cell shrinkage, lost cell contact, and apoptotic body formation. Moreover, putative compounds detected at 280 nm in the healthy SML were obviously higher than those in the bleached one, probably they could be bioactive molecules responsible for competitively exclusion of pathogens, Algicola and Vibrio, from the healthy SML.

Marine fish parasites in the Cat Ba Archipelago, Vietnam: the results of 2010-2023 field surveys.

Between 2010 and 2023, a longitudinal study was undertaken to uncover the diversity of the parasite fauna of marine fishes in the Cat Ba Archipelago, a world biosphere reserve, in Vietnam. A total of 1,042 specimens representing 80 different fish species were collected and examined. Of these, 68 fish species, represented by 994 specimens (95.39%), were infected with parasites. A total of 162 parasitic species were discovered, including 54 trematodes, 37 monogeneans, 27 crustaceans, 15 myxozoans, 10 acanthocephalans, 10 nematodes, 7 cestodes, and 2 hirudineans. Over the course of the survey, twenty new species were described, including 7 acanthocephalans and 13 trematodes. Additionally, twenty species were recorded for the first time from the Cat Ba Archipelago and twenty-two species had new host records reported. The prevalence and mean intensity of parasite infection were found to be unaffected by season. These data on the parasitic fauna of Cat Ba Archipelago not only expand our knowledge of the diversity of Vietnam, but also provide strong baseline data for measuring future change resulting from environmental perturbations.

The first maternal genetic study of hunter-gatherers from Vietnam.

The current limitation of ancient DNA data from Vietnam led to the controversy surrounding the prehistory of people in this region. The combination of high heat and humidity damaged ancient bones that challenged the study of human evolution, especially when using DNA as study materials. So far, only 4 k years of history have been recorded despite the 65 k years of history of anatomically modern human occupations in Vietnam. Here we report, to our knowledge, the oldest mitogenomes of two hunter-gatherers from Vietnam. We extracted DNA from the femurs of two individuals aged 6.2 k cal BP from the Con Co Ngua (CCN) site in Thanh Hoa, Vietnam. This archeological site is the largest cemetery of the hunter-gatherer population in Southeast Asia (SEA) that was discovered, but their genetics have not been explored until the present. We indicated that the CCN haplotype belongs to a rare haplogroup that was not detected in any present-day Vietnamese individuals. Further matrilineal analysis on CCN mitogenomes showed a close relationship with ancient farmers and present-day populations in SEA. The mitogenomes of hunter-gatherers from Vietnam debate the "two layers" model of peopling history in SEA and provide an alternative solution for studying challenging ancient human samples from Vietnam.

Development of a framework to support situational tele-mentorship of rural and remote practice.

Situational tele-mentorship refers to the use of technology to provide interactive, two-way communication between an advisor (the mentor) and a novice (mentee) to enhance the management of a dynamic clinical scenario in real-time.This article develops a conceptual framework to support situational tele-mentorship of healthcare professionals working in rural and remote practices by critically exploring the concept of mentorship within medical education literature and applied to healthcare professionals working in more isolated settings.The situational tele-mentorship framework consists of synchronous telecommunication technologies and the problem-solving process. The end-users of the framework are the mentor located centrally and the mentee dealing with a challenging situation at a remote location using communication technology. The problem-solving process' stages are preparation, identification, action, and evaluation. The mentor and mentee use the 5W1H model, which is a summary of the questions of who, what, where, when, why, and how, applied in two-way communication.This framework provides medical teachers and clinicians with a detailed, yet concise exposition of critical elements required to implement situational tele-mentorship. Healthcare providers can also use this framework to help coordinate resources and manage stakeholders in tele-mentoring situations.

Comparative Analysis of Audio Processing Techniques on Doppler Radar Signature of Human Walking Motion Using CNN Models.

Artificial intelligence (AI) radar technology offers several advantages over other technologies, including low cost, privacy assurance, high accuracy, and environmental resilience. One challenge faced by AI radar technology is the high cost of equipment and the lack of radar datasets for deep-learning model training. Moreover, conventional radar signal processing methods have the obstacles of poor resolution or complex computation. Therefore, this paper discusses an innovative approach in the integration of radar technology and machine learning for effective surveillance systems that can surpass the aforementioned limitations. This approach is detailed into three steps: signal acquisition, signal processing, and feature-based classification. A hardware prototype of the signal acquisition circuitry was designed for a Continuous Wave (CW) K-24 GHz frequency band radar sensor. The collected radar motion data was categorized into non-human motion, human walking, and human walking without arm swing. Three signal processing techniques, namely short-time Fourier transform (STFT), mel spectrogram, and mel frequency cepstral coefficients (MFCCs), were employed. The latter two are typically used for audio processing, but in this study, they were proposed to obtain micro-Doppler spectrograms for all motion data. The obtained micro-Doppler spectrograms were then fed to a simplified 2D convolutional neural networks (CNNs) architecture for feature extraction and classification. Additionally, artificial neural networks (ANNs) and 1D CNN models were implemented for comparative analysis on various aspects. The experimental results demonstrated that the 2D CNN model trained on the MFCC feature outperformed the other two methods. The accuracy rate of the object classification models trained on micro-Doppler features was 97.93%, indicating the effectiveness of the proposed approach.

Australian nursing students' perception, knowledge, and attitude towards oral healthcare of older people and associated factors: a national cross-sectional survey.

BACKGROUND: The oral health of many older Australians is poor and associated with many systemic health problems. However, nurses often have a limited understanding of the importance of oral healthcare for older people. This study aimed to investigate Australian nursing students' perception, knowledge, and attitude toward providing oral healthcare for older people and associated factors. METHODS: A cross-sectional study was conducted among final year nursing students studying at accredited nursing programs using an online self-reported 49-item survey. The data were analysed using univariate and bivariate analysis (t-test, ANOVA, Spearman's correlation test). RESULTS: A total of 416 final-year nursing students from 16 accredited programs in Australia completed the survey. Mean scores showed that more than half of the participants felt they lacked confidence (55%, n = 229) and had limited knowledge about oral healthcare for older people (73%, n = 304); however, their attitude towards providing such care was favourable (89%, n = 369). A positive correlation was found between students' confidence in delivering oral healthcare to older people and their perceived knowledge (r = 0.13, p < 0.01). Results revealed a statistically significant positive association between students' experience in providing oral healthcare to older people and students' perception (t = 4.52, p < 0.001), knowledge (t = 2.87, p < 0.01), and attitude (t = 2.65, p < 0.01) mean scores in such care. Nearly 60% (n = 242) of participants received education/training in oral healthcare for older people at university, but this was often for less than one hour. Around 56% (n = 233) believed that the current nursing curriculum did not prepare them to provide effective oral healthcare to older people. CONCLUSION: Findings suggested a need for nursing curricula to be revised to include oral health education and clinical experience. Knowledge of evidence-based oral healthcare by nursing students may improve the quality of oral healthcare for older people.

A qualitative exploration of health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic.

OBJECTIVE: To explore health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic. SETTING: Australia. PARTICIPANTS: Allied health, nursing and medical students with a planned rural or remote placement between February and October 2020. DESIGN: Semi-structured interviews (n = 29) with data thematically analysed. RESULTS: Five main themes emerged from student experiences: (1) 'Do we go? Don't we go? Like how much risk is involved?' related to student concerns regarding acquiring and transmitting COVID-19 on placement; (2) 'We are sort of just standing at the door trying to watch' encompassed student perceptions of missed clinical learning opportunities in response to health and safety measures related to COVID-19; (3) 'I, as a student, sort of fell under the radar' related to student perceptions of suboptimal supervision; (4) 'It was a bit more difficult to engage with that wider community' recognised student feelings of social disconnection and their lack of opportunity for community immersion; and (5) 'We felt like we got something that is more than we expected' emerged from student reflections on training during the pandemic and alternative placements (virtual, simulated and non-clinical) that exceeded expectations for learning. CONCLUSIONS: Although most students were willing and able to undertake their rural or remote placement in some form during the early stages of the pandemic and identified unanticipated learning benefits, students recognised lost opportunities to build clinical skills, become culturally aware and connect with rural communities. It remains unknown how these rural and remote placement experiences will impact rural intention and in turn, rural workforce development.

Fusarium solani PQF9 Isolated from Podocarpus pilgeri Growing in Vietnam as a New Producer of Paclitaxel.

Endophytic fungi are known as an alternative promising source of anticancer drug, paclitaxel, however fungi inhabiting in medicinal plant Podocarpus pilgeri and their paclitaxel production have not been reported to date. In the present study, a total of 15 culturable fungi classified into 5 genera, were successfully recovered from P. pilgeri collected in Vietnam. Screening fungal dichloromethane extracts for anticancer activity revealed that only PQF9 extract displayed potent inhibitory effects on A549 and MCF7 cancer cell lines with IC50 values of 33.9 ± 2.3 µg/mL and 43.5 ± 1.7 µg/mL, respectively. Through PCR-based molecular screening, the isolate PQF9 was found to possess 3 key genes involved in paclitaxel biosynthesis. Importantly, high-performance liquid chromatography quantification showed that fungal isolate PQF9 was able to produce 18.2 µg/L paclitaxel. The paclitaxel-producing fungus was identified as Fusarium solani PQF9 based on morphological and molecular phylogenetic analysis. Intensive investigations by chromatographic methods and spectroscopic analyses confirmed the presence of paclitaxel along with tyrosol and uracil. The pure paclitaxel had an IC50 value of 80.8 ± 9.4 and 67.9 ± 7.0 nM by using cell viability assay on A549 lung and MCF7 breast cancer cells. In addition, tyrosol exhibited strong antioxidant activity by scavenging 2, 2-diphenyl-picrylhydrazyl (DPPH) (IC50 5.1 ± 0.2 mM) and hydroxyl radical (IC50 3.6 ± 0.1 mM). In contrast, no biological activity was observed for uracil. Thus, the paclitaxel-producing fungus F. solani PQF9 could serve as a new material for large-scale production and deciphering paclitaxel biosynthesis. Supplementary Information: The online version contains supplementary material available at 10.1007/s12088-023-01119-z.

Nanodiamond Solid-Phase Extraction and Triton X-114 Cloud Point Separation for Robust Fractionation and Shotgun Proteomics Analysis of the Human Serum Proteome.

Human serum is one of the most attractive specimens in biomarker research. However, its overcomplicated properties have hindered the analysis of low-abundance proteins by conventional mass spectrometry techniques. This work proposes an innovative strategy for utilizing nanodiamonds (NDs) in combination with Triton X-114 protein extraction to fractionate the crude serum to six pH-tuned fractions, simplifying the overall proteome and facilitating protein profiling with high efficiency. A total of 663 proteins are identified and evenly distributed among the fractions along with 39 FDA-approved biomarkers─a remarkable increase from the 230 proteins found in unfractionated crude serum. In the low-abundance protein section, 88 proteins with 7 FDA-approved biomarkers are detected─a marked increase from the 15 proteins (2 biomarkers) observed in the untreated sample. Notably, fractions at pH 11, derived from the aqueous phase of detergent separation, suggest potential applications in rapid and robust serum proteome analysis. Notably, by outlining the excellent properties of NDs for proteomic research, this work suggests a promising extraction protocol utilizing the great compatibility of NDs with streamlined serum proteomics and identifies potential avenues for future developments. Finally, we believe that this work not just improves shotgun proteomics but also opens up studies on the interaction between NDs and the human proteome. Data are available via ProteomeXchange with the identifier PXD029710.

Portable wedge prism scanner for laser surface cleaning of corroded 304L stainless steel.

A compact wedge prism scanner for laser surface cleaning is proposed, wherein the concept of system was studied based on geometric analysis. The final equations for the design express the transposition of the laser beam focal point and scanning radius. The results were verified through comparisons to both Zemax simulation and experiments. There was satisfactory agreement between the equations and Zemax simulation, but slight disagreement with the experiments. Additionally, two main factors of wedge prism scanner in commercial laser removal applications (circumferential overlap and spot overlap) was also discussed and the completely corrosion removal experiment indicated the potential use of our scanner.

Genetic structure and population connection of two Bouyei populations in northern Vietnam based on short tandem repeat analysis.

OBJECTIVES: Genetic characteristics were investigated based on short tandem repeat (STR) data to assess the relationship between two Vietnamese Bouyei populations in Vietnam. METHODS: We collected hair and buccal swab samples from two separate Bouyei populations in the mountainous region of Northern Vietnam, which are the Bo Y in Ha Giang Province and the Tu Di in Lao Cai Province. The study included data of 23 autosomal and 27 Y-chromosome STRs loci of 96 unrelated participants from a total Vietnamese Bouyei population of under 3300 individuals. RESULTS: The results showed that these STR markers are valuable for differentiation of individuals and human genetic studies in Vietnamese Bouyei populations. Genetic analysis indicated that Tu Di and Bo Y people were from the same Bouyei population in China. CONCLUSIONS: The results supported the official historical records of the region and the classification of the Vietnamese government. Furthermore, the genetic data provided in this study will be helpful in investigating the genetic genealogy evolution and settlement or migration patterns of the Bouyei populations in Vietnam.

Mental health and related service use by sex workers in rural and remote Australia: 'there's a lot of stigma in society'.

Sex workers experience risk and protective factors that affect their psychological well-being, yet little is known about sex workers' mental health and their experiences with related services in rural and remote Tasmania, Australia. Semi-structured interviews were conducted with six current or former sex workers with pre-existing mental health problems, and thematic analysis was used to identify their experiences with mental health and related care. Generally, sex work does not contribute to participants' mental health concerns; rather, social exclusion and systemic issues cause psychological harm. Ineffective mental health professionals and the lack of tailored or culturally competent support serve as barriers to care. Significantly, widespread stigma was both a risk factor to participants' mental health and a barrier to help seeking and resulted in isolation and identity concealment. Resilience, self-awareness and social inclusion reduce the psychological impact of exogenous oppression and encourage help seeking. The decriminalisation of sex work could improve sex worker mental health and reduce stigma by normalising sex work.

Phenolic Glycosides from the Leaves of Iodes cirrhosa Turcz. with Cytotoxic and Antimicrobial Effects.

In the present study, 14 phenolic glycosides, including one new neolignan glycoside, iodescirrhoside A (1), three new flavonol glycosides, iodescirrhosides B-D (2-4), and 10 known metabolites were obtained from the methanol extract of Iodes cirrhosa leaves. Structural elucidation was performed by interpretating the 1D- and 2D- NMR, HR-ESI-MS, and CD spectra in comparison with literature data. All compounds were noncytotoxic to LU-1, HepG2, MCF-7, SK-Mel-2, and LNCaP cancer cell lines. Compound 11 significantly inhibited the growth of E. faecalis. In contrast, weak inhibition was observed for 1-9 and 14 against E. faecalis, for 1, 6-8, and 11 against S. aureus, for 6 and 13 against B. cereus, and 2, 4, and 6-9 against C. albicans.

The mitochondrial DNA HVI and HVII sequences and haplogroup distribution in a population sample from Vietnam.

BACKGROUND: Mitochondrial DNA (mtDNA) analysis has been used in forensics and requires well-established population databases for statistical interpretations. However, high-quality mtDNA data from Vietnamese population samples have been limited. AIM: To examine the mtDNA sequences and haplogroup compositions of a Vietnamese population to provide an mtDNA dataset that can further be used to construct a Vietnamese-specific reference database. SUBJECTS AND METHODS: A total of 173 Vietnamese individuals were analysed for two hypervariable regions (HVI and HVII) of mtDNA. Forensic parameters were calculated and haplogroup assignment was performed based on the resulting mtDNA haplotypes. Genetic relationships between the Vietnamese and other Asian populations were investigated through principal component analysis (PCA) and pairwise Fst. RESULTS: The Vietnamese population sample consisted of 145 different haplotypes with a random match probability of 0.96%, a power of discrimination of 0.9904, and a haplotype diversity of 0.9962. The samples were assigned to 83 haplogroups that were commonly reported in Asia. PCA and pairwise Fst revealed close relationships of the Vietnamese population with other Asian populations, especially with populations in proximity. CONCLUSION: The results from this study can contribute to the current genetic information content as a supplementary mtDNA reference dataset for forensic investigations and phylogenetic research.

Structural and genetic insights into a poly-γ-glutamic acid with in vitro antioxidant activity of Bacillus velezensis VCN56.

Poly-γ­glutamic acid (γ­PGA) produced by Bacillus species is a natural biopolymer, which is widely used in various fields including food, pharmaceuticals, and cosmetics. In this study, the screening of 19 Bacillus isolates derived from traditionally fermented foods revealed that Bacillus velezensis VCN56 was the most potent γ­PGA producer. The maximum concentration of crude γ­PGA was 32.9 ± 1.5 g/L in the PGA-3 medium containing glycerol, citric acid, sodium glutamate, NH4Cl, and starch. The resulting γ-PGA was purified and then characterized by HPLC, FTIR, and 1H-NMR analyses. Molecular weight of purified γ­PGA was estimated to be 98 kDa with a polydisperse index of 2.04. Notably, the pure γ­PGA showed significant in vitro antioxidant scavenging activities against 1,1-diphenyl-2-picrylhydrazyl (72.0 ± 1.5%), hydroxyl (81.0 ± 0.6%), and superoxide (43.9 ± 0.8%) radicals at the concentration of 4 mg/mL. Using whole-genome sequencing, the genetic organization of pgs operon responsible for γ­PGA biosynthesis in B. velezensis VCN56 differs from those in other Bacillus genomes. Further genome analysis revealed metabolic pathways for γ-PGA production and degradation. For the first time, the present study provides a better understanding of γ-PGA with a promising antioxidant activity produced by B. velezensis at the phenotypic, biochemical, and genomic levels, which hold potential applications in the foods, cosmetics, and pharmaceutical industries.

'I can't go, I can't afford it': Financial concern amongst health students undertaking rural and remote placements during COVID-19.

INTRODUCTION: As the coronavirus pandemic unfolded during 2020, widespread financial uncertainty emerged amongst university students across the globe. What is not yet clear is how Australian health students were financially impacted during the initial stages of the pandemic and whether this influenced their ability to undertake planned rural or remote placements. OBJECTIVE: To examine (a) financial concern amongst health students during COVID-19, (b) the financial implications of changes to planned rural or remote placements and (c) the impact of these factors on students' ability to undertake placements during the pandemic. DESIGN: Mixed-methods design involving an online survey (n = 1210) and semi-structured interviews (n = 29). Nursing, medical and allied health students with a planned University Department of Rural Health-facilitated rural or remote placement between February and October 2020 were invited to participate. FINDINGS: 54.6% of surveyed students reported financial concern during COVID-19. Financial concern correlated with both changes in financial position and employment, with 36.6% of students reporting a reduction in income and 43.1% of students reporting a reduction in, or cessation of regular employment. Placement changes yielded a range of financial implications. Cancelled placements saved some students travel and accommodation costs, but left others out of pocket if these expenses were prepaid. Placements that went ahead often incurred increased accommodation costs due to limited availability. Financial concern and/or financial implications of placement changes ultimately prevented some students from undertaking their rural or remote placement as planned. DISCUSSION: Many nursing, allied health and medical students expressed financial concern during COVID-19, associated with a loss of regular employment and income. Placement changes also presented unforeseen financial burden for students. These factors ultimately prevented some students from undertaking their planned rural or remote placement. CONCLUSION: Universities need to consider how best to align financially burdensome placements with the personal circumstances of students during periods of economic uncertainty.

Impact of COVID-19 on rural and remote student placements in Australia: A national study.

OBJECTIVE: To investigate students' perceptions of the impact of coronavirus SARS-CoV-2 on rural and remote placements facilitated by 16 University Departments of Rural Health in Australia in 2020. DESIGN: A mixed-method design comprising an online survey and semi-structured interviews. SETTING: Australia. PARTICIPANTS: Allied health, nursing and medical students with a planned University Departments of Rural Health-facilitated rural or remote placement between February and October 2020. INTERVENTION: A planned rural or remote placement in 2020 facilitated by a University Departments of Rural Health, regardless of placement outcome. MAIN OUTCOME MEASURES: Questionnaire included placement outcome (completed or not), discipline of study (nursing, allied health, medicine), and Likert measures of impact to placement (including supervision, placement tasks, location, accommodation, client contact and student learning) and placement experience (overall, support, supervision, university support). Semi-structured interviews asked about placement planning, outcome, decisions, experience and student perceptions. RESULTS: While coronavirus SARS-CoV-2 reportedly impacted on the majority of planned placements, most students (80%) were able to complete their University Departments of Rural Health-facilitated placement in some form and were satisfied with their placement experience. Common placement changes included changes to tasks, setting, supervisors and location. Allied health students were significantly more likely to indicate that their placement had been impacted and also felt more supported by supervisors and universities than nursing students. Interview participants expressed concerns regarding the potential impact of cancelled and adapted placements on graduation and future employment. CONCLUSIONS: The coronavirus SARS-CoV-2 pandemic was reported to impact the majority of University Departments of Rural Health-facilitated rural and remote placements in 2020. Fortunately, most students were able to continue to undertake a rural or remote placement in some form and were largely satisfied with their placement experience. Students were concerned about their lack of clinical learning and graduating on time with adequate clinical competence.

A systematic review of the health and health care of rural sexual and gender minorities in the UK, USA, Canada, Australia and New Zealand.

INTRODUCTION: Lesbian, gay, bisexual, transgender, intersex, queer, and people with a diversity of sexual and gender identities (LGBTIQ+) residing in rural contexts may face additional challenges to attaining wellbeing, yet a comprehensive understanding of these experiences is lacking. The purpose of the systematic review is to address this knowledge gap. The aims of the review are to progress understanding about rural LGBTIQ+ communities with regard to wellbeing, healthcare access and experience, and barriers and facilitators to health care. METHODS: Peer-reviewed literature was searched in PubMed, Academic Search Premier, CINAHL, and PsychInfo databases, while grey literature was searched using Google Advanced Search. Documents produced between 2015 and 2020 in the USA, Canada, Australia, New Zealand, and UK were eligible and reference lists were screened. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to. Relevant data were extracted and synthesized. The quality of the peer-reviewed literature and grey literature was assessed using the Mixed Methods Appraisal Tool and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist, respectively. At each stage of the study selection process, a second author reviewed a sample of 10% of the articles and documents to ensure consistent application of the inclusion criteria. Consultation within the team was used to resolve any discrepancies encountered. RESULTS: The 297 unique peer-reviewed returned records were screened, with 69 full texts assessed for eligibility, resulting in the inclusion of 42 articles. The initial result of 2785 grey documents were similarly screened, resulting in the inclusion of 12 documents. Overall, the included literature was deemed to be of good quality. Synthesis of data resulted in the reporting of findings concerning mental, physical, and sexual wellbeing; healthcare access and experiences with care; and barriers and facilitators to health care for various communities in rural areas. The findings showed rural LGBTIQ+ communities shared many of the health concerns of non-rural LGBTIQ+ communities, as well as encountering similar issues and barriers to the receipt of high-quality appropriate care. However, the evidence also indicates an array of nuanced challenges for communities in rural areas such as a lack of available appropriate providers, and financial and practical barriers concerning the need to travel to obtain the services needed. The intersection of rurality and LGBTIQ+ identity was especially pronounced for rural LGBTIQ+ elders facing potential isolation in the context of declining mobility, service providers experiencing high demand and isolation from professional networks, and for LGBTIQ+ populations negotiating the complexities of disclosure in interactions with health professionals. The latter three findings in particular extend on the existing knowledge base. CONCLUSION: Investment is needed in the design, trialling, and evaluation of tailored models of care, which account for the specific challenges encountered in providing services to rural LGBTIQ+ communities. Such models, should also harness identified facilitators for rural LGBTIQ+ wellbeing, including the use of online technologies. Dedicated study is merited to inform policy and practice for aged care services in rural areas. Further, the development and implementation of strategies to support rural health service providers is warranted.