Exploring Cognitively Loaded Physical Activity Compared With Control to Improve Global Cognitive Function in Older Community-Dwelling Adults With Mild Cognitive Impairment: Systematic Review With Meta-Analysis.

OBJECTIVE: A systematic review with a meta-analysis explored effects of cognitively loaded physical activity interventions on global cognition in community-dwelling older adults (≥65 years of age) experiencing mild cognitive impairment (MCI), compared to any control. METHODS: A literature search was conducted in 4 databases (MEDLINE [OvidSP], PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials [Wiley]) from inception until January 30, 2018. The meta-analysis was conducted with Review Manager 5.3. RESULTS: Six randomized controlled trials (RCTs) with 547 participants were identified. The interventions ranged from 4 to 52 weeks. Baseline and initial follow-up assessments were used. The primary pooled analysis of all RCTs demonstrated a nonsignificant trivial effect (standardized mean difference [SMD] 0.07, 95% confidence interval [CI] -0.44 to 0.58) favoring the intervention. In pooled subanalysis of 4 RCTs (n = 405) using the same global cognition measure (Mini-Mental State Examination) and duration of intervention >12 weeks, the intervention group achieved a small but significant improvement for global cognition (SMD 0.45, 95% CI 0.14 to 0.75). CONCLUSION: When all the RCTs were pooled, the effect of cognitively loaded physical activity intervention on global cognitive function in older adults with MCI remained unclear. The subgroup analysis provides translation evidence for future RCT study designs.

Curvature sensing using a hybrid polycarbonate-silica multicore fiber.

We report on the development of a novel hybrid glass-polymer multicore fiber integrating three 80 µm polyimide-coated silica fibers inside a 750 µm polycarbonate cladding. By inscribing an array of distributed FBGs along each segment of silica fiber prior to the hybrid fiber drawing, we demonstrate a curvature sensor with an unprecedented precision of 296 pm/m-1 around 1550 nm, about 7 times more sensitive than sensors based on standard 125 µm multicore fibers. As predicted by theory, we show experimentally that the measured curvature is insensitive to temperature and strain. Also, a more precise equation to describe the curvature on a simple bending setup is presented. This new hybrid multicore fiber technology has the potential to be extended over several kilometers and can find high-end applications in 3D shape sensing and structural health monitoring.

Fostering global primary care research: a capacity-building approach.

The Alma Ata and Astana Declarations reaffirm the importance of high-quality primary healthcare (PHC), yet the capacity to undertake PHC research-a core element of high-quality PHC-in low-income and middle-income countries (LMIC) is limited. Our aim is to explore the current risks or barriers to primary care research capacity building, identify the ongoing tensions that need to be resolved and offer some solutions, focusing on emerging contexts. This paper arose from a workshop held at the 2019 North American Primary Care Research Group Annual Meeting addressing research capacity building in LMICs. Five case studies (three from Africa, one from South-East Asia and one from South America) illustrate tensions and solutions to strengthening PHC research around the world. Research must be conducted in local contexts and be responsive to the needs of patients, populations and practitioners in the community. The case studies exemplify that research capacity can be strengthened at the micro (practice), meso (institutional) and macro (national policy and international collaboration) levels. Clinicians may lack coverage to enable research time; however, practice-based research is precisely the most relevant for PHC. Increasing research capacity requires local skills, training, investment in infrastructure, and support of local academics and PHC service providers to select, host and manage locally needed research, as well as to disseminate findings to impact local practice and policy. Reliance on funding from high-income countries may limit projects of higher priority in LMIC, and 'brain drain' may reduce available research support; however, we provide recommendations on how to deal with these tensions.

New Zealand general practice registrars' views on their academic learning needs during vocational training: online survey.

Most doctors working in New Zealand general practice undertake vocational training through the Royal New Zealand College of General Practitioners. We aimed to explore general practice registrar views on their academic learning needs during and following vocational training. An online survey of all current NZ GP trainees in 2019 was completed by 314 registrars (54% response rate). The majority (88%, 275/314) were completing RNZCGP Fellowship only, and of these half (55%, 152/275) were planning a further postgraduate qualification. A minority (12%, 33/275) indicated a desire to undertake a masters or PhD degree. Almost all (99%, 310/314) intended to work in general practice; 9% (8/314) intending to also work as rural hospital doctors. The five most common areas of interest for further training were clinical skills (68%), practice-based teaching (66%), specific clinical conditions (63%), age or life-stage specific (47%) and non-clinical areas (41%). There is a considerable gap between completing RNZCGP Fellowship, intending to undertake further (formal postgraduate) education and actually enrolling. This is concerning given the need for lifelong learning and critical evaluation of practice and health service delivery. The future New Zealand general practice workforce needs GPs to be diverse and highly skilled members or leaders of expert teams.

Primary care financing: a systematic assessment of research priorities in low- and middle-income countries.

INTRODUCTION: Financing of primary healthcare (PHC) is the key to the provision of equitable universal care. We aimed to identify and prioritise the perceived needs of PHC practitioners and researchers for new research in low- and middle-income countries (LMIC) about financing of PHC. METHODS: Three-round expert panel consultation using web-based surveys of LMIC PHC practitioners, academics and policy-makers sampled from global networks. Iterative literature review conducted in parallel. First round (Pre-Delphi survey) elicited possible research questions to address knowledge gaps about financing. Responses were independently coded, collapsed and synthesised to two lists of questions. Round 2 (Delphi Round 1) invited panellists to rate importance of each question. In Round 3 (Delphi Round 2), panellists ranked questions in order of importance. RESULTS: A diverse range of PHC practitioners, academics and policy-makers in LMIC representing all global regions identified 479 knowledge gaps as potentially critical to improving PHC financing. Round 2 provided 31 synthesised questions on financing for rating. The top 16 were ranked in Round 3e to produce four prioritised research questions. CONCLUSIONS: This novel exercise created an expansive and prioritised list of critical knowledge gaps in PHC financing research questions. This offers valuable guidance to global supporters of primary care evaluation and implementation, including research funders and academics seeking research priorities. The source and context specificity of this research, informed by LMIC practitioners and academics on a global and local basis, should increase the likelihood of local relevance and eventual success in implementing the findings.

Research gaps in the organisation of primary healthcare in low-income and middle-income countries and ways to address them: a mixed-methods approach.

INTRODUCTION: Since the Alma-Ata Declaration 40 years ago, primary healthcare (PHC) has made great advances, but there is insufficient research on models of care and outcomes-particularly for low-income and middle-income countries (LMICs). Systematic efforts to identify these gaps and develop evidence-based strategies for improvement in LMICs has been lacking. We report on a global effort to identify and prioritise the knowledge needs of PHC practitioners and researchers in LMICs about PHC organisation. METHODS: Three-round modified Delphi using web-based surveys. PHC practitioners and academics and policy-makers from LMICs sampled from global networks. First round (pre-Delphi survey) collated possible research questions to address knowledge gaps about organisation. Responses were independently coded, collapsed and synthesised. Round 2 (Delphi round 1) invited panellists to rate importance of each question. In round 3 (Delphi round 2), panellists ranked questions into final order of importance. Literature review conducted on 36 questions and gap map generated. RESULTS: Diverse range of practitioners and academics in LMICs from all global regions generated 744 questions for PHC organisation. In round 2, 36 synthesised questions on organisation were rated. In round 3, the top 16 questions were ranked to yield four prioritised questions in each area. Literature reviews confirmed gap in evidence on prioritised questions in LMICs. CONCLUSION: In line with the 2018 Astana Declaration, this mixed-methods study has produced a unique list of essential gaps in our knowledge of how best to organise PHC, priority-ordered by LMIC expert informants capable of shaping their mitigation. Research teams in LMIC have developed implementation plans to answer the top four ranked research questions.

Primary Care Research Priorities in Low-and Middle-Income Countries.

PURPOSE: To identify and prioritize the needs for new research evidence for primary health care (PHC) in low-and middle-income countries (LMICs) about organization, models of care, and financing of PHC. METHODS: Three-round expert panel consultation of LMIC PHC practitioners and academics sampled from global networks, via web-based surveys. Iterative literature review conducted in parallel. Round 1 (pre-Delphi survey) elicited possible research questions to address knowledge gaps about organization and models of care and about financing. Round 2 invited panelists to rate the importance of each question, and in round 3 panelists provided priority ranking. RESULTS: One hundred forty-one practitioners and academics from 50 LMICs from all global regions participated and identified 744 knowledge gaps critical to improving PHC organization and 479 for financing. Four priority areas emerged: effective transition of primary and secondary services, horizontal integration within a multidisciplinary team and intersectoral referral, integration of private and public sectors, and ways to support successfully functioning PHC professionals. Financial evidence priorities were mechanisms to drive investment into PHC, redress inequities, increase service quality, and determine the minimum necessary budget for good PHC. CONCLUSIONS: This novel approach toward PHC needs in LMICs, informed by local academics and professionals, created an expansive and prioritized list of critical knowledge gaps in PHC organization and financing. It resulted in research questions, offering valuable guidance to global supporters of primary care evaluation and implementation. Its source and context specificity, informed by LMIC practitioners and academics, should increase the likelihood of local relevance and eventual success in implementing research findings.

Legitimate participation of medical students in community attachments.

INTRODUCTION: Social theories of learning consider learning and thinking as social activities. These activities may occur within a community of practice. Communities of practice may position learners as legitimate peripheral participants. This study tests whether legitimate peripheral participation provides an overarching theory to assist in evaluating learning and teaching of medical students undertaking short primary care attachments. METHODS: A questionnaire was delivered to all Year 4 students at the University of Auckland in 2015. A deductive content analysis was undertaken on the data utilising a categorisation matrix. Legitimate peripheral participation theory was used to develop the categorisation matrix. RESULTS: Three broad themes explained legitimate peripheral participation by medical students undertaking a short primary care attachment. These three themes were 'hospitality,' 'collegiality' and 'responsibility.' CONCLUSION: Legitimate peripheral participation, in the context of undergraduate primary health care attachments, appears to depend upon positive social activities between students and health professionals and patients. Using legitimate peripheral participation as a theory to underpin evaluations of general practice attachments it is possible to determine improvements in the learning and teaching experience of medical students.

Atmospheric Carbon Mineralization in an Industrial-Scale Chrysotile Mining Waste Pile.

Magnesium-rich minerals that are abundant in ultramafic mining waste have the potential to be used as a safe and permanent sequestration solution for carbon dioxide (CO2). Our understanding of thermo-hydro-chemical regimes that govern this reaction at an industrial scale, however, has remained an important challenge to its widespread implementation. Through a year-long monitoring experiment performed at a 110 Mt chrysotile waste pile, we have documented the existence of two distinct thermo-hydro-chemical regimes that control the ingress of CO2 and the subsequent mineral carbonation of the waste. The experimental results are supported by a coupled free-air/porous media numerical flow and transport model that provides insights into optimization strategies to increase the efficiency of mineral sequestration at an industrial scale. Although functioning passively under less-than-optimal conditions compared to laboratory-scale experiments, the 110 Mt Thetford Mines pile is nevertheless estimated to be sequestering up to 100 tonnes of CO2 per year, with a potential total carbon capture capacity under optimal conditions of 3 Mt. Annually, more than 100 Mt of ultramafic mine waste suitable for mineral carbonation is generated by the global mining industry. Our results show that this waste material could become a safe and permanent carbon sink for diffuse sources of CO2.