A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare.

BACKGROUND: Homelessness is associated with significant health disparities. Conventional health services often fail to address the unique needs and lived experience of homeless individuals and fail to include participatory design when planning health services. This scoping review aimed to examine areas of patient experience that are most frequently reported by people experiencing homelessness when seeking and receiving healthcare, and to identify existing surveys used to measure patient experience for this cohort. METHODS: A scoping review was undertaken reported according to the PRISMA-ScR 2020 Statement. Databases were searched on 1 December 2022: MEDLINE, EMBASE, APA PsychINFO and CINAHL. Included studies focused on people experiencing homelessness, healthcare services and patient experience, primary research, published in English from 2010. Qualitative papers and findings were extracted and synthesized against a modified framework based on the National Institute for Health and Care Excellence guidelines for care for people experiencing homelessness, the Institute of Medicine Framework and Lachman's multidimensional quality model. People with lived experience of homelessness were employed as part of the research team. RESULTS: Thirty-two studies were included. Of these, 22 were qualitative, seven quantitative and three mixed methods, from the United States of America (n = 17), United Kingdom (n = 5), Australia (n = 5) and Canada (n = 4). Health services ranged from primary healthcare to outpatient management, acute care, emergency care and hospital based healthcare. In qualitative papers, the domains of 'accessible and timely', 'person-centred', and values of 'dignity and respect' and 'kindness with compassion' were most prevalent. Among the three patient experience surveys identified, 'accessible and timely' and 'person-centred' were the most frequent domains. The least frequently highlighted domains and values were 'equitable' and 'holistic'. No questions addressed the 'safety' domain. CONCLUSIONS: The Primary Care Quality-Homeless questionnaire best reflected the priorities for healthcare provision that were highlighted in the qualitative studies of people experiencing homelessness. The most frequently cited domains and values that people experiencing homelessness expressed as important when seeking healthcare were reflected in each of the three survey tools to varying degrees. Findings suggest that the principles of 'Kindness and compassion' require further emphasis when seeking feedback on healthcare experiences and the domains of 'safety', 'equitable', and 'efficiency' are not adequately represented in existing patient experience surveys.

Extract of Artemisia dracunculus L. Modulates Osteoblast Proliferation and Mineralization.

Thiazolidinediones (TZD) significantly improve insulin sensitivity via action on adipocytes. Unfortunately, TZDs also degrade bone by inhibiting osteoblasts. An extract of Artemisia dracunculus L., termed PMI5011, improves blood glucose and insulin sensitivity via skeletal muscle, rather than fat, and may therefore spare bone. Here, we examine the effects of PMI5011 and an identified active compound within PMI5011 (2',4'-dihydroxy-4-methoxydihydrochalcone, DMC-2) on pre-osteoblasts. We hypothesized that PMI5011 and DMC-2 will not inhibit osteogenesis. To test our hypothesis, MC3T3-E1 cells were induced in osteogenic media with and without PMI5011 or DMC-2. Cell lysates were probed for osteogenic gene expression and protein content and were stained for osteogenic endpoints. Neither compound had an effect on early stain outcomes for alkaline phosphatase or collagen. Contrary to our hypothesis, PMI5011 at 30 µg/mL significantly increases osteogenic gene expression as early as day 1. Further, osteogenic proteins and cell culture mineralization trend higher for PMI5011-treated wells. Treatment with DMC-2 at 1 µg/mL similarly increased osteogenic gene expression and significantly increased mineralization, although protein content did not trend higher. Our data suggest that PMI5011 and DMC-2 have the potential to promote bone health via improved osteoblast maturation and activity.

Combined action observation and motor imagery improves learning of activities of daily living in children with Developmental Coordination Disorder.

Developmental coordination disorder (DCD) is characterised by poor motor coordination, which interferes with the ability to execute activities of daily living (ADLs). Combined action observation and motor imagery (AOMI) involves observing movement videos whilst imagining simultaneously the sensations of executing the same movement. Laboratory-based research indicates that AOMI can help improve movement coordination in children with DCD, but no previous research had investigated the efficacy of AOMI interventions for learning ADLs. This study investigated the efficacy of a home-based, parent-led, AOMI intervention for learning ADLs in children with DCD. Children with confirmed (n = 23) or suspected (n = 5) DCD (total sample n = 28), aged 7-12 years, were assigned to either an AOMI intervention or a control intervention (both n = 14). Participants attempted the following ADLs at pre-test (week 1), post-test (week 4), and retention test (week 6): shoelace tying, cutlery use, shirt buttoning, and cup stacking. Task completion times and movement techniques were recorded. The AOMI intervention produced significantly faster task completion times than the control intervention at post-test for shoelace tying, and significantly improved movement techniques for shoelace tying and cup stacking. Importantly, for children who could not tie shoelaces at pre-test (n = 9 per group), 89% of those following the AOMI intervention learnt the skill successfully by the end of the study, compared to only 44% of those following the control intervention. The findings indicate that home-based, parent-led, AOMI interventions can aid the learning of complex ADLs in children with DCD, and may be particularly effective for facilitating the learning of motor skills that do not currently exist within these children's motor repertoire.

Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy.

Introduction: For people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors. Methods: A Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible. Results: Mean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation). Discussion: These results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.

Transitional forestry in New Zealand: re-evaluating the design and management of forest systems through the lens of forest purpose.

Forestry management worldwide has become increasingly effective at obtaining high timber yields from productive forests. In New Zealand, a focus on improving an increasingly successful and largely Pinus radiata plantation forestry model over the last 150 years has resulted in some of the most productive timber forests in the temperate zone. In contrast to this success, the full range of forested landscapes across New Zealand, including native forests, are impacted by an array of pressures from introduced pests, diseases, and a changing climate, presenting a collective risk of losses in biological, social and economic value. As the national government policies incentivise reforestation and afforestation, the social acceptability of some forms of newly planted forests is also being challenged. Here, we review relevant literature in the area of integrated forest landscape management to optimise forests as nature-based solutions, presenting 'transitional forestry' as a model design and management paradigm appropriate to a range of forest types, where forest purpose is placed at the heart of decision making. We use New Zealand as a case study region, describing how this purpose-led transitional forestry model can benefit a cross section of forest types, from industrialised forest plantations to dedicated conservation forests and a range of multiple-purpose forests in between. Transitional forestry is an ongoing multi-decade process of change from current 'business-as-usual' forest management to future systems of forest management, embedded across a continuum of forest types. This holistic framework incorporates elements to enhance efficiencies of timber production, improve overall forest landscape resilience, and reduce some potential negative environmental impacts of commercial plantation forestry, while allowing the ecosystem functioning of commercial and non-commercial forests to be maximised, with increased public and biodiversity conservation value. Implementation of transitional forestry addresses tensions that arise between meeting climate mitigation targets and improving biodiversity criteria through afforestation, alongside increasing demand for forest biomass feedstocks to meet the demands of near-term bioenergy and bioeconomy goals. As ambitious government international targets are set for reforestation and afforestation using both native and exotic species, there is an increasing opportunity to make such transitions via integrated thinking that optimises forest values across a continuum of forest types, while embracing the diversity of ways in which such targets can be reached.

A neural signature for combined action observation and motor imagery? An fNIRS study into prefrontal activation, automatic imitation, and self-other perceptions.

INTRODUCTION: Research indicates that both observed and imagined actions can be represented in the brain as two parallel sensorimotor representations. One proposal is that higher order cognitive processes would align these two hypothetical action simulations. METHODS: We investigated this hypothesis using an automatic imitation paradigm, with functional near-infrared spectroscopy recordings over the prefrontal cortex during different motor simulation states. On each trial, participants (n = 14) observed a picture of a rhythmical action (instructed action) followed by a distractor movie showing the same or different action. Participants then executed the instructed action. Distractor actions were manipulated to be fast or slow, and instructions were manipulated during distractor presentation: action observation (AO), combined action observation and motor imagery (AO+MI) and observe to imitate (intentional imitation). A pure motor imagery (MI) condition was also included. RESULTS: Kinematic analyses showed that although distractor speed effects were significant under all instructions (shorter mean cycle times in execution for fast compared to slow trials), this imitation bias was significantly stronger for combined AO+MI than both AO and MI, and stronger for intentional imitation than the other three automatic imitation conditions. In the left prefrontal cortex, cerebral oxygenation was significantly greater for combined AO+MI than all other instructions. Participants reported that their representation of the self overlapped with the observed model significantly more during AO+MI than AO. CONCLUSION: Left prefrontal activation may therefore be a neural signature of AO+MI, supporting attentional switching between concurrent representations of self (MI, top-down) and other (AO, bottom-up) to increase imitation and perceived closeness.

Combined action observation and motor imagery: An intervention to combat the neural and behavioural deficits associated with developmental coordination disorder.

Action observation (AO) and motor imagery (MI) have been used separately across different populations to alleviate movement impairment. Recently these two forms of covert motor simulation have been combined (combined action observation and motor imagery; AOMI), resulting in greater neurophysiological activity in the motor system, and more favourable behavioural outcomes when compared to independent AO and MI. This review aims to outline how some of the neural deficits associated with developmental coordination disorder (DCD) are evident during AO and MI, and highlight how these motor simulation techniques have been used independently to improve motor skill learning in children in this population. The growing body of evidence indicating that AOMI is superior to the independent use of either AO and MI is then synthesised and discussed in the context of children with DCD. To conclude, recommendations to optimise the delivery of AOMI for children with DCD are provided and future avenues for research are highlighted.

Mental health nursing practice and Aboriginal and Torres Strait Islander people: an integrative review.

Background: For nearly thirty years, significant concerns have been raised about the public-provided mental health services for Aboriginal and Torres Strait Islander peoples. Staff have been identified as having little understanding of Indigenous culture, and this had resulted in inappropriate treatment. In attempting to understand what specialist knowledge exists to guide mental health nursing practice with Aboriginal and Torres Strait Islander peoples, the authors have turned to published peer-reviewed literature.Methods: The approach chosen to explore this area was an integrative review. This provided a method to identify, analyse, and synthesise a wide range of literature.Results: The available evidence points to the need that treatment planning must be focused on the promotion of social and emotional wellbeing and not simply the treatment of symptoms. It also emphasises the importance of cultural safety informed by awareness and understanding of social, cultural and historical factors that can impact the health and treatment of Aboriginal and Torres Strait Islander peoples. Within the literature, staff reported difficulty in understanding how knowledge about social and emotional wellbeing could translate into practice. Nurses working in mental health contexts reported not feeling adequately prepared for, or confident in this area of practice.Conclusions: There is a paucity of current literature on mental health nursing practice for Aboriginal and Torres Strait Islander peoples, with the literature available not providing clear guidance for effective and meaningful practice.

Motor imagery during action observation enhances imitation of everyday rhythmical actions in children with and without developmental coordination disorder.

Children with developmental coordination disorder (DCD) exhibit deficits both in imitation and motor imagery (MI) compared to typically developing children. Combined action observation and motor imagery (AO + MI) instructions can however enhance automatic imitation in both groups. In the present study we investigated the effects of AO + MI instructions on intentional imitation in children both with (n = 13) and without DCD (n = 12). On each trial participants observed and/or imagined before executing a familiar rhythmical pantomime action. These target actions were either habitually fast (tooth brushing or window wiping) or habitually slow (paint brushing or face washing), in the vertical or horizontal plane. Within each habitual speed, the target action speed was subtly manipulated across trials (fast vs. slow). Instruction condition was manipulated across three blocks of 16 trials: (1) observe before imitating the target action; (2) observe then imagine the action before imitating; (3) observe while imagining the same action before imitating (AO + MI). Kinematic analyses revealed typically developing children imitated the observed cycle times significantly better than children with DCD. A main effect of instruction showed imitation improved for AO + MI compared to the other two instructions. Within-group analyses found a significant advantage in DCD for AO + MI compared to observe then imagine. In typically developing children, imitation was significantly enhanced for AO + MI compared to observe then imitate. Combined AO + MI instructions therefore represent a promising new approach to refining performance of everyday rhythmical actions in children both with and without DCD, with implications for movement therapy and sports training.

Dim Light Exposure or Melatonin Ingestion Lowers a Type 2 Diabetic's Blood Glucose Removal Rate: A Single Case.

The purpose of this case study is to compare a Type 2 diabetic's postprandial glucoregulatory ability under two different room lighting conditions. The subject was a 56-year-old physically active male with well controlled blood glucose levels (HbA1c ≤ 6% for 5 y) from a combination of diet, exercise, and medication. Two hours post evening meal (380 kcal, 18 g fat, 44 g carbohydrate, 12 g protein), a 45 g carbohydrate challenge was given, and blood glucose was measured every 30 minutes for 2.5 hours under three conditions: dim light (<50 lux) (DL), bright light (>40000 lux) (BL), and bright light plus 6 mg melatonin (BLM). Each condition was repeated 3 times over a period of 6 months with each trial a minimum of seven days apart. The area under the average glucose concentration vs. time plot was different between the three conditions (BL = 909 ± 76; DL = 1078 ± 106; and BLM = 1130 ± 45 mmol·min·l-1). Visual inspection of the average blood glucose vs. time plot suggested that DL and BLM displayed very similar patterns and magnitude, with both DL and BLM having the blood glucose concentrations at each time point that are noticeably greater than BL. Additionally, the average (± standard deviation) blood glucose concentrations for DL (8.8 ± 0.9 mmol·l-1) and BLM (9.1 ± 1.1 mmol·l-1) were respectively 18% and 22% greater than BL (7.5 ± 0.5 mmol·l-1). Melatonin and/or dim light can reduce a Type 2 diabetic's glucoregulatory ability.

Motor imagery during action observation enhances automatic imitation in children with and without developmental coordination disorder.

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by uncoordinated movement relative to age. While action observation (AO) and motor imagery (MI) can both independently enhance movement skills in children, we report the first study to assess the effects of combined action observation and motor imagery (AO + MI) on automatic imitation in children aged 7-12 years both with DCD (n = 12) and without DCD (n = 12). On each trial, participants planned to execute an instructed rhythmical action (face washing or paint brushing). Before responding, participants observed a rhythmical distractor showing the same or a different action with a subtle speed manipulation across trials (fast vs. slow). Automatic imitation was quantified as an imitation bias in subsequent response cycle times. Across blocks of trials, participants engaged in AO, MI, or combined AO + MI during the distractor phase or intentionally imitated the distractor speeds. Although there were no between groups differences, combined AO + MI instructions produced a significantly greater imitation bias (115%) than both AO (109%) and MI (109%), with intentional imitation yielding the strongest effects overall (128%). Within groups analyses revealed a significant bias for AO and MI in both groups. Combined AO + MI effects were significantly greater than AO in typically developing children and were greater than both AO and MI in children with DCD. These results demonstrate a clear capacity for different forms of motor simulation in children both with and without DCD. Moreover, combined AO + MI instructions represent an advantageous method for training movements in children with different motor abilities compared with separate AO and MI instructions.

Motor imagery during action observation increases eccentric hamstring force: an acute non-physical intervention.

PURPOSE: Rehabilitation professionals typically use motor imagery (MI) or action observation (AO) to increase physical strength for injury prevention and recovery. Here we compared hamstring force gains for MI during AO (AO + MI) against two pure MI training groups. MATERIALS AND METHODS: Over a 3-week intervention physically fit adults imagined Nordic hamstring exercises in both legs and synchronized this with a demonstration of the same action (AO + MI), or they purely imagined this action (pure MI), or imagined upper-limb actions (pure MI-control). Eccentric hamstring strength gains were assessed using ANOVAs, and magnitude-based inference (MBI) analyses determined the likelihood of clinical/practical benefits for the interventions. RESULTS: Hamstring strength only increased significantly following AO + MI training. This effect was lateralized to the right leg, potentially reflecting a left-hemispheric dominance in motor simulation. MBIs: The right leg within-group treatment effect size for AO + MI was moderate and likely beneficial (d = 0.36), and only small and possibly beneficial for pure MI (0.23). Relative to pure MI-control, effects were possibly beneficial and moderate for AO + MI (0.72), although small for pure MI (0.39). CONCLUSIONS: Since hamstring strength predicts injury prevalence, our findings point to the advantage of combined AO + MI interventions, over and above pure MI, for injury prevention and rehabilitation. Implications for rehabilitation While hamstring strains are the most common injury across the many sports involving sprinting and jumping, Nordic hamstring exercises are among the most effective methods for building eccentric hamstring strength, for injury prevention and rehabilitation. In the acute injury phase it is crucial not to overload damaged soft tissues, and so non-physical rehabilitation techniques are well suited to this phase. Rehabilitation professionals typically use either motor imagery or action observation techniques to safely improve physical strength, but our study shows that motor imagery during observation of Nordic hamstring exercises offers a safe, affordable and more effective way to facilitate eccentric hamstring strength gains, compared with pure motor imagery. Despite using bilateral imagery and observation training conditions in the present study, strength gains were restricted to the right leg, potentially due to a left hemispheric dominance in motor simulation.

Combined action observation and motor imagery therapy: a novel method for post-stroke motor rehabilitation.

Cerebral vascular accidents (strokes) are a leading cause of motor deficiency in millions of people worldwide. While a complex range of biological systems is affected following a stroke, in this paper we focus primarily on impairments of the motor system and the recovery of motor skills. We briefly review research that has assessed two types of mental practice, which are currently recommended in stroke rehabilitation. Namely, action observation (AO) therapy and motor imagery (MI) training. We highlight the strengths and limitations in both techniques, before making the case for combined action observation and motor imagery (AO + MI) therapy as a potentially more effective method. This is based on a growing body of multimodal brain imaging research showing advantages for combined AO + MI instructions over the two separate methods of AO and MI. Finally, we offer a series of suggestions and considerations for how combined AO + MI therapy could be employed in neurorehabilitation.

The integrity of a cholesterol-binding pocket in Niemann-Pick C2 protein is necessary to control lysosome cholesterol levels.

The neurodegenerative disease Niemann-Pick Type C2 (NPC2) results from mutations in the NPC2 (HE1) gene that cause abnormally high cholesterol accumulation in cells. We find that purified NPC2, a secreted soluble protein, binds cholesterol specifically with a much higher affinity (K(d) = 30-50 nM) than previously reported. Genetic and biochemical studies identified single amino acid changes that prevent both cholesterol binding and the restoration of normal cholesterol levels in mutant cells. The amino acids that affect cholesterol binding surround a hydrophobic pocket in the NPC2 protein structure, identifying a candidate sterol-binding location. On the basis of evolutionary analysis and mutagenesis, three other regions of the NPC2 protein emerged as important, including one required for efficient secretion.