Exploring the implementation of a novel community pharmacist-led support service for people living with severe and persistent mental illness.

BACKGROUND: Community pharmacists are well-placed to promote and provide mental health medication management services. However, literature evaluating the impact of pharmacy services in supporting people living with severe and persistent mental illness (SPMI) is currently limited. An individualised, goal-oriented pharmacist-led support service that focused on improving the physical and mental health of consumers living with SPMI, namely the PharMIbridge intervention, was provided to consumer participants as part of the PharMIbridge Randomised Controlled Trial (RCT). OBJECTIVE(S): To explore the experiences of the participants who delivered and supported the implementation of the PharMIbridge intervention and propose ideas and supports needed for broader implementation and sustainability of pharmacist-led support services for people living with SPMI. METHODS: Interviews and focus group discussions were undertaken with PharMIbridge pharmacists and mentors, respectively. Audio-recordings were de-identified and transcribed verbatim. Data analysis was conducted using an iterative, inductive approach. The key themes identified were furthered divided into subthemes. Subthemes were then mapped to the EPIS (Exploration, Preparation, Implementation and Sustainment) framework. RESULTS: Data were collected from one focus group involving six RCT mentors and 16 semi-structured interviews with community pharmacists. Five overarching themes emerged: "Training needs", "Pharmacist integration within the healthcare system", "Environmental factors", "Attitudes and behaviour" and "Pharmacy operations". Twelve subthemes were mapped to EPIS phases "Preparation", "Implementation" and "Sustainment" and EPIS constructs "Outer" context, "Inner" context and "Bridging" factors. CONCLUSION: Adequate remuneration and supports to encourage healthcare professional collaboration are necessary to establish and sustain functioning, integrated pharmacy mental health services. A shift in pharmacy business and workflow models is necessary to support community pharmacies to implement mental health services. In addition, there is a need to promote psychological support services to ensure that pharmacists are well supported while delivering pharmacy mental health services.

A k-mer-based bulked segregant analysis approach to map seed traits in unphased heterozygous potato genomes.

High-throughput sequencing-based methods for bulked segregant analysis (BSA) allow for the rapid identification of genetic markers associated with traits of interest. BSA studies have successfully identified qualitative (binary) and quantitative trait loci (QTLs) using QTL mapping. However, most require population structures that fit the models available and a reference genome. Instead, high-throughput short-read sequencing can be combined with BSA of k-mers (BSA-k-mer) to map traits that appear refractory to standard approaches. This method can be applied to any organism and is particularly useful for species with genomes diverged from the closest sequenced genome. It is also instrumental when dealing with highly heterozygous and potentially polyploid genomes without phased haplotype assemblies and for which a single haplotype can control a trait. Finally, it is flexible in terms of population structure. Here, we apply the BSA-k-mer method for the rapid identification of candidate regions related to seed spot and seed size in diploid potato. Using a mixture of F1 and F2 individuals from a cross between 2 highly heterozygous parents, candidate sequences were identified for each trait using the BSA-k-mer approach. Using parental reads, we were able to determine the parental origin of the loci. Finally, we mapped the identified k-mers to a closely related potato genome to validate the method and determine the genomic loci underlying these sequences. The location identified for the seed spot matches with previously identified loci associated with pigmentation in potato. The loci associated with seed size are novel. Both loci are relevant in future breeding toward true seeds in potato.

Are SMART goals fit-for-purpose? Goal planning with mental health service-users in Australian community pharmacies.

Goal planning is an important element in brief health interventions provided in primary healthcare settings, with specific, measurable, achievable, realistic/relevant, and timed (SMART) goals recommended as best practice. This study examined the use of SMART goals by Australian community pharmacists providing a brief goal-oriented wellbeing intervention with service-users experiencing severe and persistent mental illnesses (SPMIs), in particular, which aspects of SMART goal planning were incorporated into the documented goals. Goal data from the PharMIbridge Randomized Controlled Trial (RCT) were used to investigate how community pharmacists operationalized SMART goals, goal quality, and which SMART goal planning format aspects were most utilized. Goals were evaluated using the SMART Goal Evaluation Method (SMART-GEM) tool to determine how closely each documented goal met the SMART criteria. Goals were also categorized into five domains describing their content or purpose. Descriptive analysis was used to describe the SMART-GEM evaluation results, and the Kruskal-Wallis H test was used to compare the evaluation results across the goal domains. All goals (n = 512) co-designed with service-users (n = 156) were classified as poor quality when assessed against the SMART guidelines for goal statements, although most goals contained information regarding a specific behaviour and/or action (71.3% and 86.3%, respectively). Less than 25% of goals identified how goal achievement would be measured, with those related to lifestyle and wellbeing behaviours most likely to include measurement information. Additionally, the majority (93.5%) of goals lacked details regarding monitoring goal progress. Study findings raise questions regarding the applicability of the SMART goal format in brief health interventions provided in primary healthcare settings, particularly for service-users experiencing SPMIs. Further research is recommended to identify which elements of SMART goals are most relevant for brief interventions. Additionally, further investigation is needed regarding the impact of SMART goal training or support tools on goal quality.

Supervision of the mental health lived experience workforce in Australia: A scoping review.

The mental health Lived Experience workforce (also referred to as peer workforce) is growing rapidly internationally and within Australia. Peer workers are increasingly employed within multi- and inter-disciplinary teams, often directly supervised by mental health professionals such as nurses. Professional supervision has been identified as fundamental for implementing a sustainable peer workforce, but significant gaps in the literature remain, in particular, an understanding of appropriate supervision practices. This scoping review synthesized academic and grey literature on Lived Experience supervision in Australia, exploring current thoughts on best practices. Four electronic databases were searched, and grey literature was located via Google Advanced searches, contacting Lived Experience experts and conducting web-based desktop searches of key mental health organization websites. Thematic analysis identified and described key characteristics in relation to how supervision is conceptualized and operationalized. Eight peer-reviewed and 46 grey literature documents describing supervision and supervisory practices were analysed. Of these studies, 26 were Lived Experience-led. Analysis revealed four key themes: (i) defining peer supervision, (ii) variability in understanding the purpose of supervision, (iii) approaches to supervision and the need for choice and flexibility, and (iv) qualities and skills of the supervisor. Additionally, the establishment of a national professional organization for peer workers was highlighted to protect the authenticity of Lived Experience roles and develop an effective workforce. Clearly, a sustainable Lived Experience workforce cannot develop in isolation, and mental health nurses, as important allies in mental healthcare, need to work alongside, plan and advocate for appropriate supervision practices for this emerging workforce.

Experiences of goal planning in Australian community pharmacy settings for people experiencing mental illness: A qualitative study.

BACKGROUND: Person-centred goal planning is increasingly being incorporated into healthcare interventions. People experiencing severe and persistent mental illnesses (SPMIs) have high levels of co-occurring health conditions, reducing their life expectancy when compared with the general population. As medications are commonly used in the treatment of SPMIs, community pharmacists are well-placed to support the health and wellbeing of this population. OBJECTIVES: To examine pharmacists' and service users' experiences of goal planning as a component of a community pharmacy-based health intervention for people experiencing SPMIs (PharMIbridge intervention). METHODS: This study utilised a qualitative exploratory approach with an interpretive description method. Semistructured interviews were undertaken with community pharmacists (n = 16) and service user participants (n = 26) who had participated in pharmacist support services for people experiencing SPMIs (PharMIbridge intervention). RESULTS: Four themes relating to goal planning were identified. First, goal planning provided purpose and motivation for participation in the intervention. Planning realistic goals was important but often challenging. Both pharmacists and service users highlighted the relational aspects of goal planning and how strong relationships supported positive behaviour change and outcomes. Finally, individualised and flexible approaches were important aspects of the intervention, ensuring goals were meaningful to service users. CONCLUSIONS: The findings from this study identified positive outcomes from the inclusion of goal-planning processes in a community pharmacy-based health intervention. Further research regarding tools, strategies or training that could support future goal-planning interventions in primary healthcare is needed. PATIENT OR PUBLIC CONTRIBUTION: The PharMIbridge randomised controlled trial research team included lived experience members and was overseen by an expert panel that included members with a lived experience of mental illness and representatives from key organisations. The training provided to pharmacists was co-designed and co-delivered by the researchers and lived experience representatives, and pharmacists were supported by lived experience mentors. Service user participants were invited to participate in the interviews through a number of pathways (e.g., at the completion of the intervention, flyers). Those interested were provided with the full study participant information and provided with a $30 gift voucher at the conclusion of the interview.

Refining a taxonomy of goals planned between mental health consumers and community pharmacists.

BACKGROUND: People living with severe and persistent mental illnesses are more likely to experience co-morbid health conditions. Health-related behavior change can be promoted by the use of goal planning within community pharmacy settings. OBJECTIVES: To trial and refine a recently developed taxonomy to categorize goals co-designed between community pharmacists and people living with severe and persistent mental illnesses. This study also compared the data to the previously published taxonomy data to determine if the taxonomy could be applied across a range of mental health conditions. METHODS: The published goal taxonomy was refined using data from a cluster randomized controlled trial (PharMIbridge). Community pharmacists provided an individualized support service using goal planning with people living with severe and persistent mental illnesses. Goals were categorized using the existing taxonomy and inconsistencies were used to modify and refine the taxonomy. Additionally, participant characteristics and categorization of goals were compared with results from the previous study. RESULTS: 512 goals were reported by 158 consumer participants and categorized into five domains that included a diverse range of health behaviors (e.g., relationships, diet). Minor refinements to the taxonomy were made by replacing, adding or removing categories/descriptors. CONCLUSIONS: Significant overlap between the goals of participants and the existing taxonomy was found, supporting the application of the taxonomy across different mental health conditions.

Infective endocarditis and oral surgery input before cardiac surgery: time to prick the paradigm of pre-cardiac surgery assessments?

Purpose To review current practice regarding oral surgery input for patients awaiting cardiac valvular surgery and who are at risk of infective endocarditis (IE) in the context of the COVID-19 pandemic, and to stimulate debate around the indications for pre-operative oral surgery assessment. It also opens the way to developing a new research-based approach which is patient-centred, safe, effective and efficient.Methods A desk-top based patient review was undertaken between 27 March 2020 and 1 July 2022 to record the outcome of patients undergoing cardiac valvular surgery in Northern Ireland, following the revision of the referral guidelines for oral surgery intervention. Data were collected for all cardiac referrals to the oral surgery on-call service in the Royal Victoria Hospital, Belfast. Complications were recorded at two weeks, two months, and six months post-surgery, using Northern Ireland Electronic Care Records.Results In total, 67 cardiac patients were identified between 27 March 2020 and 1 July 2022: 65.7% of patients were male and had an average age of 68, while the female patients had an average age of 61. The mean interval of date of cardiology referral to surgery date was 9.7 working days, with 36% of patients referred within five days of the planned surgery date. Moreover, 39% had valvular surgery in combination with another type of cardiac surgery. No complications linked to dental aetiology were noted.Conclusions This paper raises questions about the advisability of oral surgery input before cardiac surgery for anything other than pain relief, management of acute dental sepsis, or IE whose source has been identified as an oral commensal. The COVID-19 pandemic has presented an opportunity to review current practice and open the way to developing a new approach which is patient-centred, safe, effective and efficient.

Implementing a randomised controlled trial through community pharmacies to support people living with severe and persistent mental illness: Lessons learnt during the COVID-19 pandemic.

Public health orders were introduced in many countries, including Australia, during the COVID-19 pandemic to reduce the spread of the virus. However, for many people this led to an exacerbation of mental health symptoms, particularly those living with severe or persistent mental illness (SPMI). Additionally, the conduct of clinical research was severely impacted during the pandemic, with many difficulties encountered in the conduct of clinical trials. This paper describes the COVID-related impacts experienced during the implementation of a randomised controlled trial (RCT) testing the effectiveness of a community pharmacist-led support service for people living with SPMI in Australia (the PharMIbridge RCT), and the strategies used to successfully implement the RCT. Australian public health orders led to interstate border closures, stay-at-home orders and work-from-home requirements, resulting in necessary changes to allow for the continuation of the RCT including; changes to trial regions, transferring some training materials online while delaying face-to-face (F2F) training components, delays in pharmacy and consumer recruitment, encouraging telehealth service delivery and extensions to timelines with existing funding. Having a solution-focussed and flexible approach, while still ensuring critical trial protocol elements were adhered to, such as providing opportunities for F2F skills-based training for pharmacists, as well as F2F site visits from researchers and mentors to support trial implementation, resulted in high pharmacy and consumer participant retention through to trial conclusion. Future planning for RCTs should consider possible pandemic-related risks and rapid responses from approval bodies to ensure researchers can be agile and adapt to ensure successful trial completion.

Oestrous cycle affects emergence from anaesthesia with dexmedetomidine, but not propofol, isoflurane, or sevoflurane, in female rats.

BACKGROUND: Although sex differences in anaesthetic sensitivity have been reported, what underlies these differences is unknown. In rodents, one source of variability in females is the oestrous cycle. Here we test the hypothesis that the oestrous cycle impacts emergence from general anaesthesia. METHODS: Time to emergence was measured after isoflurane (2 vol% for 1 h), sevoflurane (3 vol% for 20 min), dexmedetomidine (50 µg kg-1 i.v., infused over 10 min), or propofol (10 mg kg-1 i.v. bolus) during proestrus, oestrus, early dioestrus, and late dioestrus in female Sprague-Dawley rats (n=24). EEG recordings were taken during each test for power spectral analysis. Serum was analysed for 17ß-oestradiol and progesterone concentrations. The effect of oestrous cycle stage on return of righting latency was assessed using a mixed model. The association between righting latency and serum hormone concentration was tested by linear regression. Mean arterial blood pressure and arterial blood gases were assessed in a subset of rats after dexmedetomidine and compared in a mixed model. RESULTS: Oestrous cycle did not affect righting latency after isoflurane, sevoflurane, or propofol. When in the early dioestrus stage, rats emerged more rapidly from dexmedetomidine than in the proestrus (P=0.0042) or late dioestrus (P=0.0230) stage and showed reduced overall power in frontal EEG spectra 30 min after dexmedetomidine (P=0.0049). 17ß-Oestradiol and progesterone serum concentrations did not correlate with righting latency. Oestrous cycle did not affect mean arterial blood pressure or blood gases during dexmedetomidine. CONCLUSIONS: In female rats, the oestrous cycle significantly impacts emergence from dexmedetomidine-induced unconsciousness. However, 17ß-oestradiol and progesterone serum concentrations do not correlate with the observed changes.

The Wheel of Well-being: Impact of a community training programme on individual well-being in Australia.

ISSUES ADDRESSED: Well-being intervention frameworks may help improve well-being. The Wheel of Well-being (WoW) is designed to empower individuals to understand and use the WoW framework for themselves, their communities and in workplaces. This paper evaluates the well-being impacts on participants of a well-being capacity building programme using WoW, in Australia. METHODS: The programme collected quantitative data from participants at two time points, once at the beginning of the programme (Time 1) and on the final session (Time 2). Surveys assessed well-being outcomes as well as life satisfaction, knowledge and understanding of well-being and behavioural changes. RESULTS: Results of a total of 162 participants were included in this evaluation of the programme across nine cohorts. Between Time 1 and Time 2 the participants saw a small, but significant increase in well-being scores, with no difference between age groups. The number of participants regarded as having a "High" well-being score increased from 11% to 24%. Increases in knowledge, understanding and the implementation of actions and behaviours to improve well-being were also observed. CONCLUSION: This evaluation provides evidence that participation in a short, intensive WoW programme can positively impact well-being, behaviour and knowledge and understanding regarding well-being. This suggests WoW may be an effective framework around which individuals can improve their well-being. SO WHAT?: Consideration should be given to the implementation of comprehensive health promotion frameworks, including WoW, to improve the well-being of individuals. Further evaluation is needed to see if improved well-being is maintained over longer time periods.

The development of a taxonomy to support goal setting between mental health consumers and community pharmacists.

BACKGROUND: Goal setting is widely used in mental healthcare, yet there is limited information about goal development between community pharmacists and people experiencing mental health conditions. OBJECTIVES: i) To review goals developed in partnership between Australian community pharmacists and people experiencing depression/anxiety, and ii) categorize goals and develop a taxonomy. METHODS: Community pharmacists (n = 142) who had completed a mental health training program provided an individualized medication support service and documented goal planning for 350 people experiencing anxiety and/or depression. Goals were reviewed using a general inductive content analysis to develop themes which were then grouped, categorized, and coded. This involved three researchers in different phases of the coding, repeated review and redrafting of the taxonomy, and inter-rater reliability consistency checks. RESULTS: The goals (n = 749) represented a diverse range of health behaviors and outcomes (e.g., medication adherence, relationships, leisure activities). The resulting taxonomy involved five overarching domains: improved health; satisfaction with life; manage physical illnesses; manage mental health; and use of medicines. CONCLUSIONS: Pharmacists have a role in providing person-centered care and addressing social determinants of health by considering factors that contribute to a person's overall wellbeing. While further testing is necessary, the taxonomy is valuable for pharmacists unfamiliar with supporting goal development with people experiencing anxiety and/or depression.

Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb post Stroke (RHOMBUS II): protocol of a feasibility randomised controlled trial.

INTRODUCTION: Upper limb (UL) rehabilitation is most effective early after stroke, with higher doses leading to improved outcomes. For the stroke survivor, the repetition may be monotonous. For clinicians, providing a clinically meaningful level of input can be challenging. As such, time spent engaged in UL activity among subacute stroke survivors remains inadequate. Opportunities for the stroke survivor to engage with UL rehabilitation in a safe, accessible and engaging way are essential to improving UL outcomes following stroke. The NeuroBall is a non-immersive virtual reality (VR) digital system designed for stroke rehabilitation, specifically for the arm and hand. The aim of the Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb post Stroke study is to determine the safety, feasibility and acceptability of the NeuroBall as a rehabilitation intervention for the UL in subacute stroke. METHODS AND ANALYSIS: A feasibility randomised controlled trial (RCT) will compare the NeuroBall plus usual care with usual care only, in supporting UL rehabilitation over 7 weeks. Twenty-four participants in the subacute poststroke phase will be recruited while on the inpatient or early supported discharge (ESD) stroke pathway. Sixteen participants will be randomised to the intervention group and eight to the control group. Outcomes assessed at baseline and 7 weeks include gross level of disability, arm function, spasticity, pain, fatigue and quality of life (QoL). Safety will be assessed by recording adverse events and using pain, spasticity and fatigue scores. A parallel process evaluation will assess feasibility and acceptability of the intervention. Feasibility will also be determined by assessing fidelity to the intervention. Postintervention, semistructured interviews will be used to explore acceptability with 12 participants from the intervention group, four from the usual care group and with up to nine staff involved in delivering the intervention. ETHICS AND DISSEMINATION: This trial has ethical approval from Brunel University London's Research Ethics Committee 25257-NHS-Oct/2020-28121-2 and the Wales Research Ethics Committee 5 Bangor (Health and Care Research Wales) REC ref: 20/WA/0347. The study is sponsored by Brunel University London. CONTACT: Dr Derek Healy, Chair, University Research Ethics committee (Derek.healy@brunel.ac.uk). Trial results will be submitted for publication in peer-reviewed journals, presented at national and international conferences and distributed to people with stroke. TRIAL REGISTRATION NUMBER: ISRCTN11440079; Pre-results.

Goal planning in mental health service delivery: A systematic integrative review.

Introduction: Goal planning is routinely employed in mental health service delivery to identify priorities for treatment and support the achievement and evaluation of outcomes. Previous systematic reviews of the literature have focused on the use of goal planning in a range of physical and cognitive disability settings, but there is a lack of information regarding how goal planning is used in mental healthcare. Aims: This systematic integrative review aimed to understand the types of goals, effectiveness of goal planning, the experience of goal planning and barriers and facilitators to effective goal planning in mental healthcare settings. Methods: Five databases were systematically searched using key terms related to mental health AND goal planning. The search was supplemented through citation chaining. Due to the heterogeneity of the studies, a narrative synthesis approach to data analysis was undertaken. Results: Fifty-four studies were identified through the search of the literature following the PRISMA guidelines. Data was systematically extracted and thematically organized. There was a high level of heterogeneity among the studies, originating from a range of countries and with diverse characteristics and focus. Four themes emerged from the data analysis and included: (i) goal planning as a central aspect of interventions; (ii) types of goals planned; (iii) factors that influenced goal planning and/or attainment; and (iv) collaboration and concordance in goal planning. Conclusion: This review found some support for the use of goal planning to improve outcomes in mental healthcare although there was no identified standardized approach to the use of goal planning. Individualized, recovery-oriented and collaborative goal planning was recommended but not always used in practice. Further research to understanding the most appropriate skills and training needed to support collaborative and effective goal planning is needed. Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020220595].

Practitioners' experiences of deteriorating personal hygiene standards in people living with depression in Australia: A qualitative study.

Functional impairment in people diagnosed with depression is common, although the domain of personal hygiene and grooming has received limited attention in the scholarly literature. While issues concerning personal hygiene and grooming by those experiencing depression have been reported in personal narratives, they are rarely included in symptom lists or treatment guidelines, or as an outcome indicator in research studies. The aim of this research was to better understand how mental health practitioners assessed, understood and worked with, service users diagnosed with depression who had previously exhibited declining personal hygiene and grooming standards. In-depth interviews (n = 16) explored the views of professionals experienced in this area of mental health practice. A qualitative descriptive methodology was utilised. Findings indicated that for some service users, personal hygiene and grooming issues were an integral aspect of their depression, which negatively impacted recovery, particularly in areas concerned with overall functioning, mood, social and vocational engagement, motivation, self-worth and esteem, and engagement with treatment. Study results supported the benefits of a person-centred approach to assess, engage with and intervene effectively when a decline in personal hygiene and grooming was noted. However, lack of pertinent research is a barrier to appropriately assessing specific skill or performance difficulties when declining standards are observed. This impedes the provision of interventions which might support the person to develop and maintain of personal hygiene routines, which conform to socially acceptable standards. Difficulties with personal hygiene and grooming presented both a barrier to recovery and an opportunity for timely and salient intervention. Further investigation is needed to build the research evidence needed to develop appropriate and acceptable interventions, and to inform effective treatment strategies.

Pharmacist-led interventions for people living with severe and persistent mental illness: A systematic review.

OBJECTIVE: People living with severe and persistent mental illness experience poorer physical health, often due to medication and preventable lifestyle factors, and exacerbated by barriers to accessing healthcare services. Pharmacists are well-positioned to improve the physical and mental health of this population. However, little is known about pharmacists' current practices when providing services to this population nor the impact of pharmacist-led interventions on consumer health outcomes. We undertook a systematic review to identify, describe and assess the effectiveness of pharmacist-led interventions for supporting people living with severe and persistent mental illness and the impact on consumer outcomes. METHODS: MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Scopus, Cochrane Library, International Pharmaceutical Abstracts and ProQuest Dissertations and Theses were searched between January 1990 and April 2020. Full-text studies exploring pharmacist-led interventions in any setting for people living with severe and persistent mental illness were included. A risk of bias assessment was conducted. RESULTS: A total of 37 studies were included. More than half of the pharmacist interventions were multifaceted. The most common components of pharmacist-led interventions included education and/or patient counselling, providing recommendations to healthcare professionals and conducting medication reviews. Multifaceted interventions demonstrated improvements in clinical outcomes, whereas single interventions focused mostly on consumer-reported outcomes. The methodological quality of included studies was moderate-to-high risk of bias and there was considerable heterogeneity in the study design, interventions described, and outcomes reported. CONCLUSION: There is evidence that pharmacist-led interventions improve consumer-reported and clinical outcomes for people living with severe and persistent mental illness. Pharmacists are capable and have a role in supporting people living with severe and persistent mental illness, either individually or as interprofessional collaborators with other healthcare professionals. Future research should attempt to better understand which particular intervention components have the greatest impact and also evaluate the implementation and long-term sustainability of such interventions.

Wheel of Wellbeing (WoW) health promotion program: Australian participants report on their experiences and impacts.

BACKGROUND: Community-based mental health promotion programs focus on improving individual and community wellbeing by strengthening resilience and building capacity to support positive health outcomes. The Wheel of Wellbeing (WoW) is an example of such a program, promoting activities that support social engagement and positive emotions within a holistic framework underpinned by positive psychology. WoW is intended to be flexibly implemented in each community, training community members who implement behaviour change activities in their local community, workplace and educational settings. METHOD: This study aimed to understand the opinions and experiences of a sample of individuals who had participated in a range of WoW training programs; documenting the impact on participant behaviours and professional practices, and how the WoW framework was subsequently employed within their communities. Using Ripple Effects Mapping evaluation processes to guide a focus group, nine WoW training participants collectively reflected on the program impacts, generating consensus themes and a mind map. Mind map qualitative data were entered into XMIND mapping software and reviewed with the focus group transcription and field notes. RESULTS: Thematic analysis identified three themes: increased community involvement and engagement (strengthening community connections); improved health, emotions and behaviour (motivating change to health behaviours); and flexible resources which could be utilised in a range of settings (easily incorporated in the existing organisational cultures). CONCLUSIONS: The results of this study support the premise that the WoW framework can be an effective framework for guiding wellbeing promotion activities, with participants championing a 'ripple effect' across individual, family, friendship, professional and community networks.

Exploring goal planning in mental health service delivery: a systematic review protocol.

INTRODUCTION: Goal planning is widely recognised as an integral part of mental health service delivery and an important element in supporting recovery. Goal planning identifies priorities for treatment through discussion and negotiation between service users and health practitioners. Goal planning enhances motivation, directs effort, and focuses the development of strategies and treatment options to improve recovery outcomes and promote service users' ownership of the recovery process. While goal planning is a common practice in mental health settings, evidence regarding its impact on treatment outcomes is lacking. This paper outlines a protocol for a systematic review that aims to explore the types of goals planned, experiences of service users and practitioners, and the effectiveness of goal planning as a mental health intervention. METHODS AND ANALYSIS: A systematic search will be conducted during March 2021 by searching Medline, CINAHL, Embase, Scopus and PsycINFO electronic databases to answer the following questions: (1) What types of goals are being developed within mental healthcare?; (2) What is the evidence for the effectiveness of goal planning on health and well-being for mental health service users?; (3) What are the experiences of mental health service users and their treating healthcare practitioners in relation to goal planning?; and (4) What are the barriers and facilitators to effective goal planning in mental health settings? Two independent researchers will screen the articles, selecting literature that meets criteria. All literature, regardless of study design that involves adult participants, with a mental illness and reporting on goal planning will be considered for inclusion. Data will be extracted from all eligible articles regardless of study design and summarised in a table. Appropriate quality assessment and data synthesis methods will be determined based on included study designs. ETHICS AND DISSEMINATION: No ethics approval is required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42020220595.

Living in the endosymbiotic world of Wolbachia: A centennial review.

The most widespread intracellular bacteria in the animal kingdom are maternally inherited endosymbionts of the genus Wolbachia. Their prevalence in arthropods and nematodes worldwide and stunning arsenal of parasitic and mutualistic adaptations make these bacteria a biological archetype for basic studies of symbiosis and applied outcomes for curbing human and agricultural diseases. Here, we conduct a summative, centennial analysis of living in the Wolbachia world. We synthesize literature on Wolbachia's host range, phylogenetic diversity, genomics, cell biology, and applications to filarial, arboviral, and agricultural diseases. We also review the mobilome of Wolbachia including phage WO and its essentiality to hallmark reproductive phenotypes in arthropods. Finally, the Wolbachia system is an exemplar for discovery-based science education using biodiversity, biotechnology, and bioinformatics lessons. As we approach a century of Wolbachia research, the interdisciplinary science of this symbiosis stands as a model for consolidating and teaching the integrative rules of endosymbiotic life.

Adnexal Torsion: Review of Radiologic Appearances.

Adnexal torsion is the twisting of the ovary, and often of the fallopian tube, on its ligamental supports, resulting in vascular compromise and ovarian infarction. The definitive management is surgical detorsion, and prompt diagnosis facilitates preservation of the ovary, which is particularly important because this condition predominantly affects premenopausal women. The majority of patients present with severe acute pain, vomiting, and a surgical abdomen, and the diagnosis is often made clinically with corroborative US. However, the symptoms of adnexal torsion can be variable and nonspecific, making an early diagnosis challenging unless this condition is clinically suspected. When adnexal torsion is not clinically suspected, CT or MRI may be performed. Imaging has an important role in identifying adnexal torsion and accelerating definitive treatment, particularly in cases in which the diagnosis is not an early consideration. Several imaging features are characteristic of adnexal torsion and can be seen to varying degrees across different modalities: a massive, edematous ovary migrated to the midline; peripherally displaced ovarian follicles resembling a string of pearls; a benign ovarian lesion acting as a lead mass; surrounding inflammatory change or free fluid; and the uterus pulled toward the side of the affected ovary. Hemorrhage and absence of internal flow or enhancement are suggestive of ovarian infarction. Pertinent conditions to consider in the differential diagnosis are a ruptured hemorrhagic ovarian cyst, massive ovarian edema, ovarian hyperstimulation, and a degenerating leiomyoma. Online supplemental material is available for this article. ©RSNA, 2021.