Child health nurses' perceptions of the Family Community-based Assistance Resourcing and Education program in contemporary practice: a qualitative study.

BACKGROUND: The Family Community-based Assistance Resourcing and Education Program (FCP) is a nurse home visiting program that was introduced in Queensland two decades ago to redress health inequalities for infants from families experiencing specific social stressors. Locally adapted versions of this home visiting program are still in use, but have not been evaluated. This study examined child health nurse perceptions of the adapted FCP in one regional Queensland health service. METHODS: A qualitative descriptive exploratory study using two focus groups (conducted May 2019) with Child Health Nurses who delivered the FCP was conducted. Transcripts of digital recordings were analysed using Braun and Clarke's (2006) six-step framework for guided thematic analysis. RESULTS: A total of 16 Child Health Nurses participated in the study, with a mean of 10years' experience with the program. Data analysis generated 12 themes organised under three domains: 'Establishing the relationship with families', 'What works in practice' and 'We could do it better'. Participants cited flexibility, expert input and in-home delivery as key program benefits. However, narrow eligibility criteria, poor screening for perinatal anxiety and resourcing constraints were identified as limitations. CONCLUSIONS: This study is the first to measure Child Health Nurses' perceptions of an adapted FCP. It sheds light on their 'practice wisdom', including the program's ability to meet the needs of families with social vulnerabilities. The study supports prior calls for home visiting programs to be evaluated against clearly stated program intentions. Participant insights have been shared to inform practice and program implementation both locally and as part of Queensland's First 2000Days health service delivery reform agenda.

Pre-eclampsia training needs of midwives in a Ghanaian tertiary hospital: A cross-sectional study.

AIM: This study aimed to assess the specific clinical and non-clinical training needs of midwives and determine their preferred approach to enhancing performance. BACKGROUND: Pre-eclampsia remains one of the leading causes of maternal deaths in low and middle-income countries. Pre-eclampsia-related deaths may be due to reduced midwifery knowledge and inadequate management. Therefore, a training needs assessment is vital in identifying gaps in practice, especially, in poorly resourced settings for maximal use of training resources. DESIGN: A hospital-based cross-sectional study. SETTING: The largest tertiary hospital in Ghana. METHODS: An online version of the validated WHO Hennessy-Hicks Training Needs Analysis questionnaire was used to assess midwives' training needs on the management of pre-eclampsia. The tool has good psychometric properties and was used to assess 1) midwives' confidence in performing tasks, 2) the importance of the task to their role and 3) their preferred performance improvement approach. Data analysis adhered to the guidelines specified in the Hennessy-Hicks Training Needs Analysis Questionnaire and the priority training requirements of the midwives were assessed through descriptive statistics and a series of independent t-tests. RESULTS: Among the 250 midwives who responded, most possessed 1-5 years of experience (74.7 %). All 28 tasks were viewed by midwives as essential responsibilities in pre-eclampsia management. Midwives had the greatest need for training in research/audit and clinical skills domains respectively (p < 0.001, 95 % confidence interval: 1.08-1.47, Cohen's-D = 1.27; and p < 0.001, 95 % confidence interval: 0.69-1.06, Cohen's-D = 0.87). The foremost primary training necessity, as recognised by midwives, was undertaking health promotion activities, including antenatal health education (MD= 0.43, 95 % confidence interval: 0.29-0.57). Training courses were identified as the preferred approach to address training needs and improve overall proficiency. CONCLUSION: Midwives in Ghana require comprehensive training covering research and clinical-based competencies to improve pre-eclampsia management. Considering the pivotal role of Ghanaian midwives in safeguarding maternal well-being, there is a compelling need to enhance the calibre of midwifery services. These findings can guide stakeholders in countries with comparable healthcare contexts in creating effective, resource-efficient training programs that avoid counterproductivity, ultimately supporting national initiatives to enhance pre-eclampsia management and the quality of care.

Clinical deterioration as a nurse sensitive indicator in the out-of-hospital context: A scoping review.

AIMS: To explore and summarise the literature on the concept of 'clinical deterioration' as a nurse-sensitive indicator of quality of care in the out-of-hospital context. DESIGN: The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review and the JBI best practice guidelines for scoping reviews. METHODS: Studies focusing on clinical deterioration, errors of omission, nurse sensitive indicators and the quality of nursing and midwifery care for all categories of registered, enrolled, or licensed practice nurses and midwives in the out-of-hospital context were included regardless of methodology. Text and opinion papers were also considered. Study protocols were excluded. DATA SOURCES: Data bases were searched from inception to June 2022 and included CINAHL, PsychINFO, MEDLINE, The Allied and Complementary Medicine Database, EmCare, Maternity and Infant Care Database, Australian Indigenous HealthInfoNet, Informit Health and Society Database, JSTOR, Nursing and Allied Health Database, RURAL, Cochrane Library and Joanna Briggs Institute. RESULTS: Thirty-four studies were included. Workloads, education and training opportunities, access to technology, home visits, clinical assessments and use of screening tools or guidelines impacted the ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting. CONCLUSIONS: Little is known about the work of nurses or midwives in out-of-hospital settings and their recognition, reaction to and relay of information about patient deterioration. The complex and subtle nature of non-acute deterioration creates challenges in defining and subsequently evaluating the role and impact of nurses in these settings. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Further research is needed to clarify outcome measures and nurse contribution to the care of the deteriorating patient in the out-of-hospital setting to reduce the rate of avoidable hospitalisation and articulate the contribution of nurses and midwives to patient care. IMPACT: What Problem Did the Study Address? Factors that impact a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting are not examined to date. What Were the Main Findings? A range of factors were identified that impacted a nurse's ability to recognise, relay information and respond to clinical deterioration in the out-of-hospital setting including workloads, education and training opportunities, access to technology, home visits, clinical assessments, use of screening tools or guidelines, and avoidable hospitalisation. Where and on whom will the research have an impact? Nurses and nursing management will benefit from understanding the factors that act as barriers and facilitators for effective recognition of, and responding to, a deteriorating patient in the out-of-hospital setting. This in turn will impact patient survival and satisfaction. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines guided this review. The PRISMA-Scr Checklist (Tricco et al., 2018) is included as (supplementary file 1).Data sharing is not applicable to this article as no new data were created or analysed in this study." NO PATIENT OR PUBLIC CONTRIBUTION: Not required as the Scoping Review used publicly available information.

Midwives' experiences of providing pre-eclampsia care in a low- and middle-income country - A qualitative study.

PROBLEM: Like other low- and middle-income countries, Ghana has high maternal mortality stemming from pre-eclampsia. Ghanaian midwives are frontline service providers of emergency care in obstetric complications and have the greatest potential to maximise pre-eclampsia outcomes. Little is known about the potential barriers and challenges to midwives' capacity to provide quality care in pre-eclampsia in Ghana. Therefore, we aimed to explore and gain insights into midwives' experiences of pre-eclampsia care including their knowledge, skills, and psychological aspects such as midwives' resilience. BACKGROUND: There is a rising global incidence of pre-eclampsia. Quality midwifery care in inter-professional collaborative practice is crucial to reducing pre-eclampsia-related morbidity and mortality. METHODS: A qualitative descriptive exploratory study. In-depth semi-structured interviews (n = 35) were performed in 2021 and analysed by thematic analysis. FINDINGS: There were three main themes. 1) Competence and Confidence in care; midwives provided timely and appropriate care based on sound knowledge and skills; they explained how pre-eclampsia care was organised within a multidisciplinary context and described collaborative working amongst midwives for mutual learning and support. 2) Emotional concerns and empathy; midwives' described fulfillment in achieving positive pre-eclampsia outcomes. In contrast, maternal loss was distressing and traumatic. 3) Call for improved care resources for pre-eclampsia; midwives recommended expansion of continuing professional development opportunities, appropriate infrastructure, resources, tailored public education, and a review of pre-service education to support their participation in pre-eclampsia care. CONCLUSION: To improve the quality of care in pre-eclampsia, midwives should be capacitated, systems should promptly address barriers, and prioritise midwives' emotional well-being.

An analysis of legislation and policies that guide maternity leave decision making in Australian midwifery students.

Objective There are no guidelines to assist midwifery academics or students in determining the optimal time to return to their educational programs following pregnancy. Rather, students need to navigate balancing new motherhood with the pressures of returning to their clinical midwifery placement and completing their statutory requirements to meet the Australian Midwife Accreditation Standards before the end of their program. The aim of this study was to seek best practice information that provides guidance to academics supporting midwifery students returning to study after maternity leave. Methods An analysis of contemporary Australian legislation, workforce guidelines, professional association statements, and university policies was undertaken to determine what guidance is available to assist midwifery academics in providing advice to midwifery students about the optimal time to return to their studies following birth. This document analysis was performed during 2021-2022 and followed Altheide and Schneider's 12 step process divided into five stages to clarify best practice advice for midwifery academics to provide guidance to students returning to study after maternity leave. Results Policy documents that refer to pregnancy confirm women have legal rights, and there is clear guidance on maternity leave; however, advice for midwifery students on the optimum time to return to study and clinical placements after birth is missing from the result of this document analysis search. Conclusion Transition to motherhood during the postnatal period is an important time. Clear national guidelines are needed to provide support and recommendations regarding a safe and optimal time to return to study and placement.

Calm after the storm? Similar patterns of genetic variation in a riverine foundation species before and after severe disturbance.

In summer 2011, Tropical storms Lee and Irene caused an estimated 90% decline of the submersed aquatic plant Vallisneria americana Michx. (Hydrocharitaceae) in the Hudson River of New York (USA). To understand the genetic impact of such large-scale demographic losses, we compared diversity at 10 microsatellite loci in 135 samples collected from five sites just before the storms with 239 shoots collected from nine sites 4 years after. Although 80% of beds sampled in 2011 lacked V. americana in 2015, we found similar genotypic and genetic diversity and effective population sizes in pre-storm versus post-storm sites. These similarities suggest that despite local extirpations concentrated at the upstream end of the sampling area, V. americana was regionally resistant to genetic losses. Similar geographically based structure among sites in both sampling periods suggested that cryptic local refugia at previously occupied sites facilitated re-expansion after the storms. However, this apparent resistance to disturbance may lead to a false sense of security. Low effective population sizes and high clonality in both time periods suggest that V. americana beds were already small and had high frequency of asexual reproduction before the storms. Dispersal was not sufficient to recolonize more isolated sites that had been extirpated. Chronic low diversity and reliance on asexual reproduction for persistence can be risky when more frequent and intense storms are paired with ongoing anthropogenic stressors. Monitoring genetic diversity along with extent and abundance of V. americana will give a more complete picture of long-term potential for resilience.

Models of clinical supervision of relevance to remote area nursing & primary health care: A scoping review.

INTRODUCTION: Nurses in remote primary health care settings work in difficult conditions, in isolated and disadvantaged communities, and often must work beyond their scope to provide advanced assessments and treatments to support the community. Therefore, remote area nurses require support to develop their skills and knowledge to work safely within their full scope of practice. Clinical supervision is widely used in health professions for this purpose; however, models of supervision for nursing have not been implemented or evaluated within remote primary health care settings. OBJECTIVE: The purpose of this study was to search the literature to source suitable clinical supervision models that could pertain to the remote area nursing context. DESIGN: An initial search of the literature found no clinical supervision models developed for remote or isolated practice nurses so a scoping review was conducted searching for publications related to advanced practice generalist health practitioners in primary health care, including practice nurses, nurse practitioners and general practitioners. This was seen as a suitable substitute because the phenomena of interest were the model of supervision rather than the specific skills or knowledge being developed. FINDINGS: The scoping review search yielded 251 articles from 5 journal databases of which 11 articles met the inclusion criteria. Each clinical supervision model was described and synthesised using qualitative description. The 11 models of clinical supervision had differing formats including; individual and group clinical supervision, in-person, telephone, medical records review and video case study. DISCUSSION: Whilst several models were described in the literature, none were directly transferrable to the remote area context. The absence of supervision for cultural safety was significant. There was a variety of modes including face-to-face, virtual, individual and group proposed. Cultural considerations were lacking in all of the models. CONCLUSION: Our study recommends a hybrid clinical supervision model suitable for consultation and validation through pilot testing with remote area nurses. There is potential for this model to be used globally in isolated contexts due to the option of virtual participation.

A socioecological description of the influencing factors to midwives' management of preeclampsia in a Ghanaian tertiary hospital.

INTRODUCTION: In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives' practice and the complex factors that influence the delivery of maternal healthcare. AIM: This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives' provision of preeclampsia care using a socioecological model. METHODS: Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke's six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy. RESULTS: Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives' knowledge of preeclampsia; midwives' self-efficacy; midwives' skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues' work attitudes. Hierarchical decision-making and staff views of women's risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system. CONCLUSION: Multi-faceted factors play a significant role in midwives' management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

FIRST REPORTS OF LIGULA INTESTINALIS AND A SCHISTOCEPHALUS SP. INFECTING SMALL-BODIED FISH IN NEW BRUNSWICK, CANADA.

Morphological characteristics and DNA sequencing were used to identify plerocercoids of a Schistocephalus sp. infecting slimy sculpin (Cottus cognatus) from northern New Brunswick and plerocercoids of Ligula intestinalis infecting blacknose dace (Rhinichthys atratulus) in Fundy National Park (FNP, New Brunswick). To our knowledge, no previous publications documented either cestode from New Brunswick, Canada. Blacknose dace represent a new host record for L. intestinalis. Identifications were made based on the presence or absence of segmentation and sequencing partial nicotinamide adenine dinucleotide dehydrogenase subunit 1 (ND1; mitochondrial DNA) and/or partial cytochrome c oxidase subunit 1 (COI; mitochondrial DNA). Plerocercoids from blacknose dace in FNP were identified as Ligula intestinalis based on >99% nucleotide identity with COI for this species in the NCBI GenBank database. Plerocercoids in slimy sculpin from northern New Brunswick were identified as a Schistocephalus sp. based on high nucleotide identity with congenerics in the NCBI GenBank database. The absence of GenBank entries with sufficient high percent identity to our specimens, and potential species hybrids in this genus, prevents species-level identification of Schistocephalus sp. plerocercoids currently. The absence of previous documentation of these cestodes might reflect recent environmental change promoting the transmission of these parasites that can modulate host fish behavior, induce sterility of host fishes, and contribute to epizootics.

Measuring success: program fidelity of Queensland's child health home visiting services. A document analysis.

BACKGROUND: The Family CA.R.E. (Community-based Assistance Resourcing and Education) program was introduced in Queensland two decades ago. It aimed to redress health inequalities for infants from families experiencing specific social stressors. The program has been locally adapted over time and has not been evaluated against the original program. This study assessed the extent to which selected hospital and health services in Queensland, Australia have modified the original Family C.A.R.E. METHODS: Altheide's model was used to facilitate a critical document analysis of policies and guidelines for adapted Family C.A.R.E. home visiting programs in use by hospital and health services (target n =7). RESULTS: Five of seven eligible services provided service model documentation. There was low alignment with the original Family C.A.R.E. program across four of the five participating services. While the program delivered within Service 4 was highly aligned to the structure and intent of the original model, variation to the program was still evident. Importantly, four of the five participating programs were not collecting evaluation measures. CONCLUSIONS: Health services have adapted the original Family C.A.R.E program format to 'fit' the local service environment but have largely failed to collect data to facilitate evaluation. Inability to evaluate the program leads to uncertainty about program success and benefits as well as any unintended consequences for families engaging in unevaluated home visiting programs. This study highlights the importance of monitoring program fidelity and evaluating success given the potential ramifications for this vulnerable cohort and for health service delivery.

Differences in Habitual and Maximal Gait Velocity Across Age Groups: A Cross-Sectional Examination.

Prior work, primarily focusing on habitual gait velocity, has demonstrated a cost while walking when coupled with a cognitive task. The cost of dual-task walking is exacerbated with age and complexity of the cognitive or motor task. However, few studies have examined the dual-task cost associated with maximal gait velocity. Thus, this cross-sectional study examined age-related changes in dual-task (serial subtraction) walking at two velocities. Participants were classified by age: young-old (45-64 years), middle-old (65-79 years), and oldest-old (≥80 years). They completed single- and dual-task walking trials for each velocity: habitual (N = 217) and maximal (N = 194). While no significant Group × Condition interactions existed for habitual or maximal gait velocities, the main effects for both condition and age groups were significant (p < .01). Maximal dual-task cost (p = .01) was significantly greater in the oldest-old group. With age, both dual-task velocities decreased. Maximal dual-task cost was greatest for the oldest-old group.

Contribution of Glial Cells to Polyglutamine Diseases: Observations from Patients and Mouse Models.

Neurodegenerative diseases are broadly characterized neuropathologically by the degeneration of vulnerable neuronal cell types in a specific brain region. The degeneration of specific cell types has informed on the various phenotypes/clinical presentations in someone suffering from these diseases. Prominent neurodegeneration of specific neurons is seen in polyglutamine expansion diseases including Huntington's disease (HD) and spinocerebellar ataxias (SCA). The clinical manifestations observed in these diseases could be as varied as the abnormalities in motor function observed in those who have Huntington's disease (HD) as demonstrated by a chorea with substantial degeneration of striatal medium spiny neurons (MSNs) or those with various forms of spinocerebellar ataxia (SCA) with an ataxic motor presentation primarily due to degeneration of cerebellar Purkinje cells. Due to the very significant nature of the degeneration of MSNs in HD and Purkinje cells in SCAs, much of the research has centered around understanding the cell autonomous mechanisms dysregulated in these neuronal cell types. However, an increasing number of studies have revealed that dysfunction in non-neuronal glial cell types contributes to the pathogenesis of these diseases. Here we explore these non-neuronal glial cell types with a focus on how each may contribute to the pathogenesis of HD and SCA and the tools used to evaluate glial cells in the context of these diseases. Understanding the regulation of supportive and harmful phenotypes of glia in disease could lead to development of novel glia-focused neurotherapeutics.

Nurturing our new midwives: A qualitative enquiry of mentor's experiences of supporting new graduate midwives working in continuity of care models.

PROBLEM: Limited opportunity exists for new graduates in Australia to be employed in continuity of care midwifery models. AIM: To explore the perspectives of midwifery mentors supporting new graduate midwives employed in continuity of care models. METHODS: An interpretive, qualitative study was conducted. Semi-structured interviews and focus groups with senior midwifery staff who mentored new graduate midwives during their transition to practice within a continuity of care model were undertaken. Digitally recorded and transcribed verbatim, data were thematically analysed. Data collection ceased once theoretical saturation had been achieved. NVIVO software was used to assist with coding and data management. FINDINGS: Twelve mentors participated. Mentors provided valuable feedback to optimise the supportive mechanisms to enable the success of the rotation of new graduate midwives in continuity of care models during their transition to practice period. Three key themes were constructed, including: Getting it right in the first place; Nurturing our new midwives; and The cultural void. DISCUSSION: Consistent with the wider literature, effective implementation, sound support structures and wider acceptance of new graduate midwives transitioning to practice within continuity of care models is crucial to its success and sustainability. CONCLUSION: Mentors are responsible to nurture, respect and guide new midwives through this crucial period, as they transition from midwifery student to registered midwife. Mentors believe in the transition of new graduate midwives in continuity of care models.

What do we know about midwives' transition from clinical practice to higher education teaching roles? A scoping review.

OBJECTIVE: The aim of this review was to examine the literature to identify what is known about midwives' experiences as academics and their perspectives of transition from clinical practice to university. INTRODUCTION: Literature on health care practitioners, particularly nurses' transition from clinical experts to novice teachers suggests the transition to academia is challenging.Challenges reported by research studies have identified stress, uncertainty, and lack of a supportive and structured transition. There was a dearth of primary research evidence of midwives' perspectives. METHODS: A scoping review using the Johanna Briggs Institute three step approach was employed. First, an initial limited search of Google Scholar and CINAHL was undertaken to identify articles on the topic. Second, the text words contained in the titles and abstracts of relevant articles and the index terms used to describe the articles were used to develop a complete search strategy in databases: EMBASE, MIDIRS, Scopus and PubMed. Finally, a manual search of the reference lists of all included sources of evidence was manually searched for additional studies. RESULTS: Ten papers that included midwives as the participants were located from Australia, The United Kingdom (UK) and the United States of America (USA) between 2006 and 2022. Analysis of the findings led to three themes: Theme 1: Challenges associated with the transition; Theme 2: Dichotomy of identity; and Theme 3: Fear of losing clinical credibility. CONCLUSION: In most studies midwives formed a subset of the sample meaning that the voices of midwifery academics are minimised by the experiences of other health practitioners. However, in depth details were located from four personal reflections which identified that transition from clinical practice to academia can result in a duality of roles while individuals come to terms with their new reality and overcome their fear of losing credibility as clinicians. New academics from health tend to hold onto their identity as clinicians rather than adopting their new persona as academics. Fear of losing credibility stems from the need to maintain competence for continued professional registration as clinicians. Further research is needed which focuses on midwives as the target sample to validate the research evidence from this scoping review.

A Novel Digital Digit-Symbol Substitution Test Measuring Processing Speed in Adults At Risk for Alzheimer Disease: Validation Study.

BACKGROUND: Assessing cognitive constructs affected by Alzheimer disease, such as processing speed (PS), is important to screen for potential disease and allow for early detection. Digital PS assessments have been developed to provide widespread, efficient cognitive testing, but all have been validated only based on the correlation between test scores. Best statistical practices dictate that concurrent validity should be assessed for agreement or equivalence rather than using correlation alone. OBJECTIVE: This study aimed to assess the concurrent validity of a novel digital PS assessment against a gold-standard measure of PS. METHODS: Adults aged 45-75 years (n=191) participated in this study. Participants completed the novel digital digit-symbol substitution test (DDSST) and the Repeatable Battery for the Assessment of Neuropsychological Status coding test (RBANS-C). The correlation between the test scores was determined using a Pearson product-moment correlation, and a difference in mean test scores between tests was checked for using a 2-tailed dependent samples t test. Data were analyzed for agreement between the 2 tests using Bland-Altman limits of agreement and equivalency using a two one-sided t tests (TOST) approach. RESULTS: A significant moderate, positive correlation was found between DDSST and RBANS-C scores (r=.577; P<.001), and no difference in mean scores was detected between the tests (P=.93). Bias was nearly zero (0.04). Scores between the tests were found to display adequate agreement with 90% of score differences falling between -22.66 and 22.75 (90% limits of agreement=-22.91 to 22.99), and the scores were equivalent (P=.049). CONCLUSIONS: Analyses indicate that the DDSST is a valid digital assessment of PS. The DDSST appears to be a suitable option for widespread, immediate, and efficient PS testing. TRIAL REGISTRATION: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/ct2/show/NCT04559789.

The effect of a digital health coaching and health education protocol on cognition in adults at-risk for Alzheimer's.

Several modifiable lifestyle factors have been linked to cognitive ability and the risk of developing Alzheimer's disease and related dementias (ADRD). Health coaching (HC) is an intervention that addresses lifestyle factors associated with cognition. The effectiveness of an HC protocol was evaluated and compared with a health education (HE) intervention, representing the current standard of care, in a sample of 216 adults between the ages of 45 and 75 years who were at-risk for developing ADRD. Outcomes examined were global cognition, neuropsychological cognition, and Alzheimer's risk. HC participants received personalized coaching from a health coach focusing on nutrition, physical activity, sleep, stress, social engagement, and cognitive activity. HE participants received biweekly education materials focusing on the same modifiable lifestyle factors addressed by HC. Participants were assessed at baseline and again 4 months later. Self-reported global cognition scores improved only in the HC group (16.18 to 15.52, p = .03) and neuropsychological cognitive ability improved in the HE group (104.48 to 108.76, p < .001). When non-adherence in the HC group was accounted for, however, the mean change in neuropsychological score was similar between groups (p > .05), self-reported global cognition demonstrated an even larger mean improvement in the HC group (16.20 to 15.41, p = .01), and the HC group saw an improvement in ADRD protective risk score (- 10.39 to - 11.45, p = .007). These results indicate that HC and HE can both improve cognition, but HC may be more effective and may yield increased protection against ADRD risk.

Acute Citrulline-Malate Supplementation Increases Total Work in Short Lower-Body Isokinetic Tasks for Recreationally Active Females During Menstruation.

ABSTRACT: Gills, JL, Spliker, B, Glenn, JM, Szymanski, D, Romer, B, Lu, H-C, and Gray, M. Acute citrulline-malate supplementation increases total work in short lower-body isokinetic tasks for recreationally active females during menstruation. J Strength Cond Res 37(6): 1225-1230, 2023-Citrulline-malate (CM) exhibits acute ergogenic benefits through nitric oxide production (NO) and augmentation of vasodilatory properties. Nitric oxide is upregulated by estrogen and may influence CM's ergogenic efficacy in women. Therefore, the objective of this study was to evaluate the acute effects of CM supplementation on lower-body isokinetic performance in recreationally active women. Nineteen women (23.5 ± 3.1 years; 164.8 ± 7.0 cm; 61.9 ± 27.4 kg; 28.8 ± 8.1% body fat) completed 2 randomized, double-blind, crossover trials consuming CM (8 g CM + 12 g dextrose) or placebo (12 g dextrose). For testing trials, subjects were in the menstruating portion of the follicular phase of their menstrual cycle. Subjects performed a 5-repetition isokinetic leg extension protocol (5RP) followed by a 50-repetition isokinetic leg extension protocol (50RP), 60 minutes after supplement consumption. Repeated measures analysis of variance analysis showed that CM significantly increased total work completed, relative total work, and total work during maximum repetition compared with placebo ( p < 0.05); but no significant performance differences existed between trials for peak torque production ( p = 0.14) for the 5RP. No significant differences were identified between trials for peak torque production ( p = 0.69 ) or total work ( p = 0.33) completed during the 50RP. CM increased total work completed during the 5RP, but provided no ergogenic benefit during the 50RP in recreationally active menstruating women. CM amplifies power-based resistance exercise performance in women during the follicular phase of the menstrual cycle, potentially because of depressed estrogen levels. Additional research is needed to identify timing efficacy of CM to increase sport performance during each phase of the menstrual cycle.

The impact of three-dimensional visualisation on midwifery students' application of knowledge of the third stage of labour to practice: Qualitative findings of a pilot randomised controlled trial.

PROBLEM: Complex physiological processes are often difficult for midwifery students to comprehend when using traditional teaching and learning approaches. Online resources for midwifery education are limited. BACKGROUND: Face to face instructional workshops using simulation have had some impact on improving understanding. However, in the 21st century new technologies offer the opportunity to provide alternative learning approaches. Virtual and artificial realities have been shown to increase confidence in decision making during clinical practice. AIM: Explore the impact of using three-dimensional (3D) visualisation in midwifery education, on student's application, when educating women about the birth of the placenta, and membranes. METHODS: Face to face individual interviews were performed, to collect deep, meaningful experiences of students, learning about the third stage of labour. FINDINGS: Prior clinical experiences impacted on student's ability to articulate how they would discuss birth of the placenta and membranes, and the process of haemostasis with women. DISCUSSION: The narrative findings of this pilot study identified ways that students traditionally learn midwifery, through theory, and clinical practice. Interview narratives illustrated how midwifery students who had previous experiences of witnessing birth, had superior ability to discuss the third stage of labour with women. While students with limited birth experiences, found the 3DMVR assisted them in their understanding of the physiology of the third stage of labour. CONCLUSION: In an environment of increasing technological advances, clinical placements remain an essential component of midwifery education.

Reliability and Validity of the 30-15 Intermittent Field Test With and Without a Soccer Ball.

Objective: The purpose of this study was to examine the reliability and validity of the 30-15 Intermittent Field Test (30-15IFT) with and without a ball. Methods: Twenty-four collegiate female soccer players (19.46 ± 1.22 years; 167.01 ± 7.23 cm; 60.95 ± 7.84 kg) performed 1 trial of the Yo-Yo Intermittent Recovery (YYIR) test, 3 trials of the 30-15IFT, and 3 trials of the 30-15IFT with a ball (30-15IFT-B), separated by a minimum 48 hours. Maximal intermittent running velocity (VIFT), heart rate at exhaustion (HRpeak), and rating of perceived exertion (RPE) were collected. Results: Intraclass correlation coefficients (ICCs) between trials demonstrated good reliability during the 30-15IFT in VIFT (ICC = 0.88) and HRpeak (ICC = 0.89), in addition to the 30-15IFT-B VIFT (ICC = 0.83) and HRpeak (ICC = 0.87). VIFT was significantly reduced in 30-15IFT-B (15.82 km h-1) compared to 30-15IFT (17.52 km h-1; p < .001), regardless of trial. HR and RPE were significantly greater in 30-15IFT compared to 30-15IFT-B (p < .05). Estimated maximal oxygen consumption (VO2max) YYIR and estimated VO2max of 30-15IFT and 30-15IFT-B was very strongly (r = 0.82) and strongly (r = 0.68) correlated. Conclusion: The 30-15IFT is considered valid and reliable and the 30-15IFT-B was reliable in female soccer players.

Critical thinking development in undergraduate midwifery students: an Australian validation study using Rasch analysis.

BACKGROUND: Well-developed critical thinking skills are required to provide midwifery care that is safe, evidence-based, and woman-centred. A valid, reliable tool to measure is required the application of critical thinking in midwifery practice. The Carter Assessment of Critical Thinking in Midwifery (CACTiM) has previously been psychometrically assessed using classical methods at a single site. This study aims to further evaluate the properties of CACTiM tools using Rasch analysis in a diverse group of midwifery students and preceptors.  METHODS: The CACTiM tools were completed by undergraduate midwifery students studying at three Australian universities and their preceptors. Midwifery students' critical thinking was evaluated separately through student self-assessment and preceptor assessment and then matched. Rasch analysis was used to evaluate the validity of the tools.  RESULTS: Rasch analysis confirmed both the preceptor and student CACTiM tools demonstrated good reliability and unidimensionality. The items can differentiate between students' ability to apply critical thinking in midwifery practice. Person reliability and item reliability were above .92 for both scales indicating excellent reliability and internal consistency. Several improvements were identified to the tools, including enhanced wording to some items, and reduction to a 5-point Likert scale. Through analysis of lower-scoring items, midwifery programs can identify curricula enhancements. CONCLUSION: The CACTiM student and preceptor tools are valid and reliable measures of critical thinking in midwifery practice. The tools can assess students' critical thinking abilities and identify areas for development for individuals and across student cohorts through curricula enhancements.