Developmental perturbation in human embryos: Clinical and biological significance learned from time-lapse images.

Background: Time-lapse technology (TLT) has gained widespread adoption worldwide. In addition to facilitating the undisturbed culture of embryos, TLT offers the unique capability of continuously monitoring embryos to detect spatiotemporal changes. Although these observed phenomena play a role in optimal embryo selection/deselection, the clinical advantages of introducing TLT remain unclear. However, manual annotation of embryo perturbation could facilitate a comprehensive assessment of developmental competence. This process requires a thorough understanding of embryo observation and the biological significance associated with developmental dogma and variation. This review elucidates the typical behavior and variation of each phenomenon, exploring their clinical significance and research perspectives. Methods: The MEDLINE database was searched using PubMed for peer-reviewed English-language original articles concerning human embryo development. Main findings: TLT allows the observation of consecutive changes in embryo morphology, serving as potential biomarkers for embryo assessment. In assisted reproductive technology laboratories, several phenomena have not revealed their mechanism, posing difficulties such as fertilization deficiency and morula arrest. Conclusion: A profound understanding of the biological mechanisms and significance of each phenomenon is crucial. Further collaborative efforts between the clinical and molecular fields following translational studies are required to advance embryonic outcomes and assessment.

Osmotic priming-induced cryotolerance uncovers rejuvenation of grapevine cell cultures: morphogenetic changes and gene expression pattern highlighting enhanced embryogenic potential.

Cryopreservation is a reliable technique for the long-term storage and preservation of embryogenic cells, maintaining their viability without loss of their embryogenic capacity. However, the large-scale conservation of grapevine embryogenic lines in cryobanks remains limited. A significant challenge is understanding somatic cell rejuvenation. Here, we investigate the encapsulation/dehydration and encapsulation/vitrification for cryopreserving embryogenic material. Cell rejuvenation and enhanced embryogenic competence were observed after cryopreservation, as evidenced through structural cellular changes observed by histology and electron scanning microscopy. Results showed that cryopreserved samples of 110-Richter, Riesling, and Tempranillo using encapsulation/dehydration had better survival rates, averaging 81%, 62%, and 48%, respectively, while encapsulation/vitrification yielded lower survival rates, averaging 58%, 42%, and 32%, respectively. Cryopreservation also improved post-thaw recovery and regeneration efficiency assessed through regrowth of proembryogenic masses and somatic embryo conversion reaching 54-72% against 11-17% in control samples. Cryopreservation triggered changes in gene expression patterns and exhibited considerable increase at genotype-specific basis of 1.5- to 4.5-fold in SERK1, BBM, and WOX associated to embryogenic competence as well as in ChitIV and LEA involved in stress response. Membrane stability index, hydrogen peroxide, and proline contents were used as indicators of oxidative stress uncovering a key role of an osmotic trans-priming effect leading to cryotolerance. Our finding highlighted that cryopreservation enhances embryogenic capacity in senescent callus and probably acts as a screening process allowing safe maintenance of proembryogenic cells and promoting their recovery. This study provides a high throughput innovation to set up cryolines for cell rejuvenation of grapevine and other important plant species.

Culturally responsive care in haemodialysis: A scoping review.

AIM: To describe how clinicians provide culturally responsive care to culturally diverse people with kidney failure in haemodialysis centres. BACKGROUND: Culturally diverse individuals receiving in-centre maintenance haemodialysis have unique cultural needs. Unmet cultural needs can impair and profoundly affect their experiences. Given culturally responsive care has the potential to enhance the experiences of culturally diverse people, it is vital to understand how clinicians provide culturally responsive care. METHOD: A scoping review was undertaken using Arksey and OMalleys framework. Five databases: Medline and CINAHL Complete (EBSCO), PsycINFO, Embase (OVID) and ProQuest Theses and Dissertation databases were searched for research literature published in English between 1990 and 2023. Narrative synthesis was used to synthesise the data. RESULTS: From the 17,271 records screened, 17 papers reporting 14 studies met the inclusion criteria. Narrative synthesis revealed two themes: (i) communication enablers and barriers including linguistic differences, professional and lay interpreter use; and (ii) the importance of culture, which encompassed acknowledging cultural priorities, accommodating cultural food preferences and access to cultural training. CONCLUSION: While competing priorities associated with haemodialysis may be a challenge for clinicians, recognising the significance of cultural care needs and accommodating them in care is important. Demonstrating respect towards cultural diversity and providing person-centred care by facilitating the unique cultural needs of people with kidney failure in haemodialysis is imperative. RELEVANCE TO CLINICAL PRACTICE: Culturally responsive care is complex and multidimensional. Individuals' cultural care needs should be acknowledged, respected, and accommodated in care. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. The study protocol was registered in the Open Science Framework. https://osf.io/uv8g3.

A dimensional analysis of experienced intensive care unit nurses' clinical decision-making for bleeding after cardiac surgery.

BACKGROUND: Bleeding following cardiac surgery is common and serious, yet a gap persists in understanding how experienced intensive care nurses identify and respond to such complications. AIM: To describe the clinical decision-making of experienced intensive care unit nurses in addressing bleeding after cardiac surgery. STUDY DESIGN: This qualitative study adopted the Recognition-Primed Decision Model as its theoretical framework. Thirty-nine experienced nurses from four adult intensive care units participated in semi-structured interviews based on the critical decision method. The interviews explored their clinical judgements and decisions in bleeding situations, and data were analysed through dimensional analysis, an alternative to grounded theory. RESULTS: Participants maintained consistent vigilance towards post-cardiac surgery bleeding, recognizing it through a haemorrhagic dimension associated with blood loss and chest drainage and a hypovolemic dimension focusing on the repercussions of reduced blood volume. These dimensions organized their understanding of bleeding types (i.e., normal, medical, surgical, tamponade) and necessary actions. Their decision-making encompassed monitoring bleeding, identifying the cause, stopping the bleeding, stabilizing haemodynamic and supporting the patient and family. Participants also adapted their actions to specific circumstances, including local practices, professional autonomy, interprofessional dynamics and resource availability. CONCLUSIONS: Nurses' decision-making was shaped by their personal attributes, the patient's condition and contextual circumstances, underscoring their expertise and pivotal role in anticipating actions and adapting to diverse conditions. The concept of actionability emerged as the central dimension explaining their decision-making, defined as the capability to implement actions towards specific goals within the possibilities and constraints of a situation. RELEVANCE TO CLINICAL PRACTICE: This study underscores the need for continual updates to care protocols to align with current evidence and for quality improvement initiatives to close existing practice gaps. Exploring the concept of actionability further, developing adaptability-focused educational programmes, and understanding decision-making intricacies are crucial for informing nursing education and decision-support systems.

Meiotic maturation failure in primary ovarian insufficiency: insights from a bovine model.

PURPOSE: Oocytes from women presenting primary ovarian insufficiency (POI) generate viable embryos at a lower rate than non-POI women, but the mechanisms responsible for the lower oocyte quality remain elusive. Due to the scarcity of human oocytes for research, animal models provide a promising way forward. We aimed at investigating the molecular events characterizing final maturation in POI oocytes in a well-defined POI-like bovine model. METHODS: Single-cell RNA-sequencing of bovine control and POI-like, GV, and MII oocytes (n = 5 per group) was performed. DEseq2 was used to identify differentially expressed genes. Further, a Gene set enrichment analysis and a transcriptomic meta-analysis between bovine and human oocytes were performed. RESULTS: In control cows, we found 2223 differentially expressed genes between the GV and MII stages. Specifically, the affected genes were related to RNA processing and transport, protein synthesis, organelle remodeling and reorganization, and metabolism. The meta-analysis with a set of young human oocytes at different maturation stages revealed 315 conserved genes through the GV-MII transition in cows and humans, mostly related to meiotic progression and cell cycle. Gene expression analysis between GV and MII of POI-like oocytes showed no differences in terms of differentially expressed genes, pointing towards a substantial failure to properly remodel the transcriptome in the POI model, and with the clustering analysis indicating that the cow's genetic background had a higher impact than the oocyte's maturation stage. CONCLUSION: Overall, we have identified and characterized a valuable animal model of POI, paving the way to identifying new molecular mechanisms involved in POI.

Evolutionary biology of social expertise.

There is increasing evidence that competent handling of social interactions among conspecifics has positive effects on individual fitness. While individual variation in social competence has been appreciated, the role of long-term experience in the acquisition of superior social skills has received less attention. With the goal of promoting further research, we integrate knowledge across disciplines to assess social expertise, defined as the characteristics, skills and knowledge allowing individuals with extensive social experience to perform significantly better than novices on a given social task. We focus on three categories of social behaviour. First, animals can gain from adjusting social behaviour towards individually recognised conspecifics that they interact with on a regular basis. For example, there is evidence that some territorial animals individually recognise their neighbours and modify their social interactions based on experience with each neighbour. Similarly, individuals in group-living species learn to associate with specific group members based on their expected benefits from such social connections. Individuals have also been found to devote considerable time and effort to learning about the spatial location and timing of sexual receptivity of opposite-sex neighbours to optimise reproduction. Second, signallers can enhance their signals, and receivers can refine their response to signals with experience. In many birds and insects, individuals can produce more consistent signals with experience, and females across a wide taxonomic range can adaptively adjust mating preferences after perceiving distinct male signals. Third, in many species, individuals that succeed in reproducing encounter the novel, complex task of caring for vulnerable offspring. Evidence from a few species of mammals indicates that mothers improve in providing for and protecting their young over successive broods. Finally, for social expertise to evolve, heritable variation in social expertise has to be positively associated with fitness. Heritable variation has been shown in traits contributing to social expertise including social attention, empathy, individual recognition and maternal care. There are currently limited data associating social expertise with fitness, most likely owing to sparse research effort. Exceptions include maternal care, signal refinement, and familiarity with neighbours and group members. Overall, there is evidence that individuals in many species keep refining their social skills with experience throughout life. Hence we propose promising lines of research that can quantify more thoroughly the development of social expertise and its effects on fitness.

Development of an instrument to measure the competencies of health professionals in the process of evidence-based healthcare: A Delphi study.

AIMS: To identify and reach consensus on dimensions and criteria of a competence assessment instrument for health professionals in relation to the process of evidence-based healthcare. DESIGN: A two-round Delphi survey was carried out from April to June 2023. METHODS: Consensus was sought from an expert panel on the instrument preliminarily established based on the JBI Model of Evidence-Based Healthcare and a rapid review of systematic reviews of relevant literature. The level of consensus was reflected by the concentration and coordination of experts' opinions and percentage of agreement. The instrument was revised significantly based on the combination of data analysis, the experts' comments and research group discussions. RESULTS: Sixteen national and three international experts were involved in the first-round Delphi survey and 17 experts participated in the second-round survey. In both rounds, full consensus was reached on the four dimensions of the instrument, namely evidence-generation, evidence-synthesis, evidence-transfer and evidence-implementation. In round-one, the instrument was revised from 77 to 61 items. In round-two, the instrument was further revised to have 57 items under the four dimensions in the final version. CONCLUSION: The Delphi survey achieved consensus on the instrument. The validity and reliability of the instrument needs to be tested in future research internationally. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Systematic assessment of nurses and other health professionals' competencies in different phases of evidence-based healthcare process based on this instrument provides implications for their professional development and multidisciplinary team collaboration in evidence-based practice and better care process and outcomes. IMPACT: This study addresses a research gap of lacking an instrument to systematically assess interprofessional competencies in relation to the process of EBHC. The instrument covers the four phases of EBHC process with minimal criteria, highlighting essential aspects of ability to be developed. Identification of health professionals' level of competence in these aspects helps strengthen their capacity accordingly so as to promote virtuous EBHC ecosystem for the ending purpose of improving global healthcare outcomes. REPORTING METHOD: This study was reported in line with the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution.

First impressions: Do faces with scars and palsies influence warmth, competence and humanization?

A glance is enough to assign psychological attributes to others. Attractiveness is associated with positive attributes ('beauty-is-good' stereotype). Here, we raise the question of a similar but negative bias. Are people with facial anomalies associated with negative personal characteristics? We hypothesized that biases against faces with anomalies arise because of negative stereotypes (less warmth and competence) and forms of dehumanization (animalistic and mechanistic). We enrolled 1493 mTurk participants (N = 1306 after exclusion) to assess 31 traits of photographed people using 60 pairs of photographs of the same person before and after plastic surgery. Half anomalous faces had a scar and the other half had a palsy. To calculate warmth and competence, we conducted a principal components analysis of the 31 attributes. Animalistic dehumanization was assessed by averaging reverse-scored ratings corresponding to moral sensibility and rationality/logic, and mechanistic dehumanization by averaging across reverse-scored ratings corresponding to emotional responsiveness and interpersonal warmth. We found that both kinds of anomalous faces were seen as less warm, competent and were dehumanized. Our findings suggest that an 'anomalous-is-bad' stereotype generalizes regardless of the aetiology of the anomaly. This effect may be related to a reverse halo effect, that is, the horn effect.

Is Culex modestus a New Usutu virus vector?

Usutu virus is an emerging pathogen transmitted by mosquitoes. Culex modestus mosquitoes are widespread in Europe, but their role in disease transmission is poorly understood. Recent data from a single infectious mosquito suggested that Culex modestus could be an unrecognized vector for Usutu virus. In this study, our aim was to corroborate this finding using a larger sample size. We collected immature Culex modestus from a reedbed pond in Flemish Brabant, Belgium, and reared them in the laboratory until the third generation. Adult females were then experimentally infected with Usutu virus in a blood meal and incubated at 25 °C for 14 days. The presence of Usutu virus in the saliva, head and body of each female was determined by plaque assay and quantitative real-time reverse-transcription polymerase chain reaction (qRT-PCR). The transmission efficiency was 54% (n = 15/28), confirming that Belgian Culex modestus can experimentally transmit Usutu virus.

Measurement of basic psychological needs for physical activity participation for college students with intellectual disabilities: A validation study.

BACKGROUND: Measurement instruments to understand self-determined motivation towards physical activity among college students with intellectual disabilities are needed to develop programs to support physical and psychological health and well-being. The purpose of the current study was to validate a modified questionnaire measuring basic psychological needs towards physical activity among college students with intellectual disabilities. METHODS: A total of 108 college students with intellectual disabilities completed the modified questionnaire. Validity and reliability of the questionnaire was examined. RESULTS: Confirmatory factor analysis demonstrated a six-factor model had good model fit. Cronbach's alpha values showed acceptable reliability evidence of the instrument as a whole, although some alpha values in subdomains of the instrument were below acceptable values. CONCLUSION: The modified questionnaire was found to have acceptable validity evidence. Further studies are needed with refinement of answer options and the addition of more questions to increase reliability.

Perceived competence and related factors affecting the development of the clinical competence of nursing students at two university sites in Namibia: a cross-sectional study.

BACKGROUND: Ensuring that nursing students graduate with the required clinical competence in nursing is a global challenge. To address this challenge, several studies have looked at various aspects of competency and competency development, however there is scanty evidence on factors affecting development of clinical competency in nursing students. Therefore the, purpose of this study was to investigate nurses' perceived competence and related factors affecting the development of clinical competence of nursing students at two university sites in Namibia. METHODS: A cross-sectional design was utilised. Simple random sampling was applied and 272 nursing students at two university campuses in Namibia were selected. An online questionnaire was used. Data were collected between April and May, 2022, over a period of six weeks, and were analysed using Statistical Package of Social Sciences (SPSS) version 27. Chi-square and Spearman correlations were used to assess the associations and correlations, respectively, among the variables. Logistic regression was used to assess the factors associated with the development of clinical competence using a p-value < 0.05 confidence interval. RESULTS: Forty-seven percent (47%) of the students were found to be competent while more than half (53%) were not. A Chi-square test found a statistically significant difference between students studying at different campuses and between different year levels (p = < .05). A regression analysis showed that nursing educators' competence (ß = .128; p = .36) had a positive influence on nursing students' competence levels, unlike the mode of learning (ß = -.140; p = .013), which negatively predicted the development of clinical competence. No significant relationship was found between the development of clinical competence and teaching approaches, assessment, feedback, constructive alignment, theory-practice gap and reflective practice (p = ˃.05). CONCLUSION: Educator's competence levels and the mode of learning were the two major factors that were more likely to influence the development of clinical competence among nursing students. Therefore, it is recommended that nursing training institutions prioritise the development of educators' competence and apply various modes of learning to enhance development of nursing students' competence.

Integrating mixed reality preparation into acute coronary syndrome simulation for nursing students: a single-group pretest-posttest study.

BACKGROUND: Timely and effective intervention within the 'golden hour'-the critical first 90 min after the symptom onset-is crucial for initiating life-saving treatment and reducing mortality in acute coronary syndrome (ACS). This highlights the need for nursing students to be proficient in ACS care, emphasizing the importance of preparatory training. This study enhanced traditional simulation methods by integrating a mixed reality (MR) preparation step, offering a more immersive learning experience. We aimed to evaluate the effectiveness of integrating MR preparation into ACS simulation education, focusing on enhancements in knowledge, self-confidence in learning, and self-efficacy in learning. Additionally, we examined performance, practice immersion, and satisfaction to comprehensively evaluate the MR application. METHODS: One-group pretest-posttest design was implemented in a convenience sample of thirty-nine senior nursing students from a university in South Korea in August 2022. We developed a simulation program integrating MR preparation into ACS simulation (IMRP-ACSS), which was validated through expert review for content validity. The students participated in the simulation program over six hours across two days, including a 40-minute individual session of MR-based simulation preparation using head-mounted displays (the HoloLens 2). Individual changes in knowledge, self-confidence in learning, and self-efficacy in learning evaluated by the survey were analyzed using paired t-tests. Additionally, group performance assessed using the checklist was analyzed. Immersion and satisfaction were measured with a tool and a 10-point Likert scale, respectively. RESULTS: Individually, participants demonstrated significantly increased knowledge (t = 11.87, p < .001), self-confidence in learning (t = 7.17, p < .001), and self-efficacy in learning (t = 4.70, p < .001) post-education. Group performance yielded a mean score of 56.43/70 ± 7.45. Groups scored higher in electrocardiogram interpretation, patient safety, and heparin administration. Participants reported a practice immersion level of 37.82/50 ± 9.13 and expressed satisfaction with the program, achieving an average score of 8.85/10 ± 1.35. CONCLUSION: Integrating MR preparation into ACS simulation enhanced nursing students' knowledge, self-confidence in learning, and self-efficacy in ACS care, providing a replicable and immersive learning experience. This method is an effective addition to nursing education, preparing students through comprehensive, technology-enhanced training.

The core competencies of a health education teacher.

Teachers play a crucial role in students' learning and in the development of health literacy. Hence, the aim of this study was to identify the core competencies needed for teachers of health education in supporting student learning. A three-round Delphi study was carried out over an 8-week period, through consultation with 25 Finnish experts in health education. An open-ended question was used to identify the core competencies for school health educators. The data were analysed using inductive content analysis. In subsequent rounds, experts were asked to assess the importance of the identified competencies on a 7-point Likert scale, and finally to rank the most important competencies. In total, 52 competencies were identified and categorized into eight core competence domains. Thereafter, 40 competencies were assessed and selected for the third round, in which the experts ranked the 15 most important competencies, encompassing four core domains, i.e. pedagogic and subject-specific didactic, social and emotional, content knowledge and continuous professional development. Other domains of competence identified in the present study were ethical competence, competence in school health promotion, contextual competence and professional well-being competence. The study defines health education teacher core competencies and domains, and the information can be used in teacher education programmes, for developing teaching and for teachers' self-evaluation.

The Simulated Physiological Oocyte Maturation (SPOM) System Enhances Cytoplasmic Maturation and Oocyte Competence in Cattle.

In vitro embryo production is a widely applied technique that allows the expansion of genetics and accelerated breeding programs. However, in cattle, this technique still needs improvement in order to reach quality and pregnancy rates comparable to in vivo-derived embryos. One of the limitations of this technique is related to in vitro maturation, where a heterogeneous population of oocytes is harvested from follicles and cultured in vitro in the presence of gonadotropic hormones to induce maturation. As a result, oocytes with different degrees of competence are obtained, resulting in a decrease in the quality and quantity of embryos obtained. A novel system based on the use of cyclic adenosine monophosphate (cAMP) modulators was developed to enhance bovine oocyte competence, although controversial results were obtained depending on the in vitro embryo production (IVP) system used in each laboratory. Thus, in the present work, we employed a reported cAMP protocol named Simulated Physiological Oocyte Maturation (SPOM) under our IVP system and analysed its effect on cytoplasmic maturation by measuring levels of stress-related genes and evaluating the activity and distribution of mitochondria as a marker for cytoplasmic maturation Moreover, we studied the effect of the cAMP treatment on nuclear maturation, cleavage, and blastocyst formation. Finally, we assessed the embryo quality by determining the hatching rates, total cell number per blastocyst, cryopreservation tolerance, and embryo implantation. We found that maturing oocytes in the presence of cAMP modulators did not affect nuclear maturation, although they changed the dynamic pattern of mitochondrial activity along maturation. Additionally, we found that oocytes subjected to cAMP modulators significantly improved blastocyst formation (15.5% vs. 22.2%, p < 0.05). Blastocysts derived from cAMP-treated oocytes did not improve cryopreservation tolerance but showed an increased hatching rate, a higher total cell number per blastocyst and, when transferred to hormonally synchronised recipients, produced pregnancies. These results reflect that the use of cAMP modulators during IVM results in competent oocytes that, after fertilisation, can develop in more blastocysts with a better quality than standard IVM conditions.

Use of Smart Glasses (Assisted Reality) for Western Australian X-ray Operators' Continuing Professional Development: A Pilot Study.

Previous studies have explored use of smart glasses in telemedicine, but no study has investigated its use in teleradiography. The purpose of this study was to implement a six-month pilot program for Western Australian X-ray operators (XROs) to use smart glasses to obtain assisted reality support in their radiography practice from their supervising radiographers, and evaluate its effectiveness in terms of XROs' competence improvement and equipment usability. Pretest-posttest design with evaluation of the XROs' competence (including their X-ray image quality) and smart glasses usability by XROs in two remote centers and their supervising radiographers from two sites before and after the program using four questionnaire sets and X-ray image quality review was employed in this experimental study. Paired t-test was used for comparing mean values of the pre- and post-intervention pairs of 11-point scale questionnaire and image quality review items to determine any XROs' radiography competence improvements. Content analysis was used to analyze open questions about the equipment usability. Our study's findings based on 13 participants (11 XROs and 2 supervising radiographers) and 2053 X-ray images show that the assisted reality support helped to improve the XROs' radiography competence (specifically X-ray image quality), with mean post-intervention competence values of 6.16-7.39 (out of 10) and statistical significances (p < 0.001-0.05), and the equipment was considered effective for this purpose but not easy to use.

An Observational Cross-Sectional Analysis of the Correlation between Clinical Competencies and Clinical Reasoning among Italian Registered Nurses.

Ability, knowledge, aptitude, and skill are the terms identified in the literature as the attributes of the concept of clinical competence. This implies that in order to act competently in their own context, the nurse must be able to make decisions which mainly depend on the ability to put clinical reasoning into practice. However, the evaluation of clinical reasoning in the various clinical-care activities of nursing competence is a necessary operation to prevent routine attitudes. From the perspective of an assessment of nursing competences, the aim of this study is to validate the relationship between the degree of competence recognized in a specific clinical setting and the amount of clinical reasoning executed by nurses. The study design was a cross-sectional observational design, following the guidelines of the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) of observational studies. Both the Italian Nurse Competence Scale and the Nurse Clinical Reasoning Scale were used. The data was collected between 25 January and 5 March 2022. Four hundred twenty-four clinical nurses participated by completing and returning the questionnaires. The instruments underwent assessment to ensure internal consistency and test-retest reliability. Their validity was tested with the validity of known content, construct, and groups. This is supported by statistically significant correlations between the different variables examined and the scores of the different dimensions of the Italian Nurse Competence Scale and the Italian Nurse Clinical Reasoning Scale. The data collected showed an excellent average level of competencies and clinical reasoning, M = range of 72.24 and 63.93, respectively. In addition, we observed satisfactory scores across all dimensions of I-NCS (significance range: 0.000-0.014) and I-NCRS (significance range: 0.000-0.004). The understanding and development of clinical reasoning has also brought out new aspects that require further research. This study provides a fresh perspective on the correlation between clinical competences and clinical reasoning, representing a novel attempt to analyze their relationship.

Training in Cultural Competence for Mental Health Care: A Mixed-Methods Study of Students, Faculty, and Practitioners from India and USA.

Although the need to train clinicians to provide effective mental health care to individuals from diverse backgrounds has been recognized worldwide, a bulk of what we know about training in cultural competence (CC) is based on research conducted in the United States. Research on CC in mental health training from different world populations is needed due to the context-dependent nature of CC. Focusing on India and USA, two diverse countries that provide complementary contexts to examine CC, we explored graduate students', practicing clinicians', and faculty members' perspectives regarding CC training they received/provided and future training needs using mixed-methods. The data were collected using focus groups (n = 25 groups total: 15 in India, 11 in USA), and a survey (n = 800: 450 in India, 350 in USA). Our data highlight the salient social identities in these countries, and the corresponding constituents of CC training. Participants in India described a practical emphasis to their CC training (e.g., learning about CC through life experiences and clinical practice experiences) more so than through coursework, whereas participants in USA described varying levels of coursework related to CC along with practice. Participants in both countries considered enormity of CC as a challenge, while those in the US also identified CC training limited to a white, straight, male perspective, hesitancy in engaging with diversity topics, and limited time and competence of the faculty. Strengths of CC training in India and USA are mutually informative in generating recommendations for enhancing the training in both countries.

A novel experiential work-based learning model in paediatric secondary care using entrustable professional activities to develop clinical knowledge and communication skills.

BACKGROUND: Initial education and training standards for pharmacists in Great Britain require early clinical exposure to patients using experiential work-based learning. However, there is poor evidence of this approach in some settings, such as paediatric care. The aim of this study was therefore to explore a novel model of experiential work-based learning for student pharmacists in a paediatric setting. METHODS: Fourth-year student pharmacists enrolled on a Master of Pharmacy programme were allocated five three-hour placement sessions at a paediatric hospital. Sessions consisted of a briefing, ward activities, scaffolded consultations with children and their carers, followed by a debriefing session with a clinical supervisor. Data were collected relating to the ward, patient details, student reported activities, learning outcomes and if follow up was required by a member of the clinical team. Data were cleaned, quality checked, then descriptive statistical analysis and inductive content analysis were conducted. MAIN FINDINGS: Seventy-four students took part in 28 individual sessions and 233 consultations were recorded. Consultations included a best-possible medical history (76%, n = 177), a satisfactory drug history (45%, n = 104), or discussed hospital discharge (11%, n = 26). Students were exposed to patients with diagnosed acute conditions (41%, n = 96) and chronic conditions (33%, n = 76), as well as children awaiting diagnosis (13%, n = 30). Students reported learning about the pathology, diagnosis and symptoms of paediatric conditions (48%, n = 81), medicines used in children (24%, n = 41), patient experiences of recieving care (15%, n = 25), carer experiences (2%, n = 3), the hospital environment (2%, n = 4), career progression (2%, n = 4), and experiences of social care (11%, n = 18). Findings were synthesised with existing entrustable professional activities from the literature to generate novel EPAs specific to paediatric settings. CONCLUSIONS: A paediatric setting offers a suitable environment to host experiential work-based learning in pharmacy education. Standards of initial education and training which require pharmacists to prescribe in Great Britain must recognise the importance of exposure to the health needs and experiences of children, young people's and carers prior to graduation.