'We country women need advocacy': Birthing narratives from the Western Australian Wheatbelt region.

INTRODUCTION: This study describes the experiences of eight mothers from the Wheatbelt region of Western Australia who shared their stories of travelling and/or temporarily relocating for birth. OBJECTIVE: The aim of this study was to describe rural and remote Western Australian mothers' experiences of travelling long distances and/or relocating to give birth. DESIGN: This study was based on Crotty's four elements of qualitative research. This study was underpinned by a constructivist epistemology, a feminist theoretical lens and a narrative approach using semistructured, story-based interviews. Participants narrated their stories of birthing away from home by telephone interview. FINDINGS: Five major themes were identified utilising thematic analysis. These were (1) feeling forgotten in the system, (2) accessibility and choice, (3) compounded social isolation, (4) doing it hard: financial and logistical challenges and (5) building strength: advocating for myself and baby. DISCUSSION: Mothers' stories were reflective of current and historical failures of rural maternal health policy, including widespread closures of rural birthing hospitals. Mothers described the logistical barriers they faced with little support and suggested multiple solutions that would improve their experiences. CONCLUSION: Mothers faced significant obstacles which impeded their access to equitable maternal healthcare. This study highlights the complexities of birthing as a rural mother and the need to address maternal health inequities between rural and metropolitan women.

"My life's not my own": A qualitative study into the expectations of head and neck cancer carers.

INTRODUCTION: Cancers that originate from the upper aerodigestive tract are collectively known as head and neck cancer. The most common are squamous cell carcinomas of the oropharynx, larynx, and oral cavity. Head and neck cancer patients experience significant physical and psychological changes because of the disease and treatment. There is a substantial strain on family carers who have extensive responsibilities over most aspects of the patient's life. The aim of the study was to understand the perspectives of being an HNC carer and their perceived expectations of the role. METHODS: The study adopted a qualitative research design with a social constructionist epistemology. Interviews were conducted with 20 carers who were currently caring for someone diagnosed with head and neck cancer. RESULTS: Three overarching themes were identified: taking responsibility for the patient's nutrition, navigating a new and different relationship, and "my life's not my own." Participants felt responsible for ensuring the patient was eating and became increasingly frustrated when the patient was unable to intake food. Carers prioritised the patients' needs at the expense of their own, and several came to resent the role. CONCLUSION: Carers' expectations of their role informed how they approached giving care. Carers need to be supported from diagnosis and encouraged to prioritise their own wellbeing.

'Torn in two': Experiences of Mothers Who Are Pregnant when Their Child Is Diagnosed With Cancer.

Mothers of children diagnosed with cancer have been shown to experience high rates of psychological distress and poor physical health. Pregnancy further increases the healthcare needs of mothers due to the marked physiological changes and psychological adaptations. Our study aimed to explore the experiences of mothers who were pregnant and/or had a baby while their older child was receiving treatment for cancer. Our study employed a qualitative description methodology using semi-structured interviews. Participants were recruited from across Australia via notices on social media sites and the distribution of flyers. The sample comprised 13 mothers who were pregnant and/or had a baby and had a child diagnosed with cancer who was under 17 years old. Thematic analysis was used to analyse the data from which six themes were identified: (1) an impossible balancing act, (2) mother's health and well-being, (3) creating certainty: birthing plans, (4) a bit of sunshine and a time to rest, (5) challenges of caring for the baby and (6) an unenviable position: doing my best versus feeling guilty. Our study demonstrates the additional challenges faced by mothers who are pregnant while their child is receiving cancer treatment. There is a need for a comprehensive and coordinated program that provides pregnant mothers with practical and psychological support. The implementation of such a program has the potential to improve health outcomes for all family members, particularly the mother and their newborn.

Issues affecting nurses' capability to use digital technology at work: An integrative review.

BACKGROUND: Digital capability, that is the ability to live, work, participate and thrive in a digital world, is imperative for nurses because increasingly nurses' work and patient outcomes are influenced by technology. AIM: To evaluate and synthesise the evidence regarding the development of digital capability in nurses and the strategies that support effective integration of digital skills into the workplace. DESIGN: Whittemore and Knafl's methodology, following the preferred reporting items for systematic reviews (PRISMA) guidelines. DATA SOURCES: CINAHL, Embase, PsychINFO, Medline (Ovid) and PubMed databases were searched for articles published in English from 2008-2019. Search terms included; digital capabil*, digital literacy, informatics, nursing informatics, health informatics, nurs*, knowledge, knowledge integration, competency, continuing education, nursing skills, workplace and work environment. REVIEW METHODS: A total of 35 studies were retrieved for quality assessment by two reviewers using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI-MAStARI and JBI-QARI). Minimum essential criteria and scores were agreed prior to appraisal. RESULTS: The 17 studies included comprised quantitative (n = 7), qualitative (n = 8) and mixed methods (n = 2). Integration of digital capability in nurses' workplaces is dependent on user proficiency and competence (theme 1). Nurses use technology to access data at the point of care, specifically accessing evidence to guide care (theme 2a) as well as accessing the medical records (theme 2b). Nurses have several concerns related to the use of technology at point of care (theme 3), some of which can be resolved through investment for implementation (theme 4). CONCLUSIONS: There are key attributes of digitally proficient nurses. Nurses with these attributes are more inclined to use digital technology in their work. Involvement of the nurses as end users in the development of digital systems to ensure they are fit for purpose, alongside investment in professional development opportunities for nurses to develop digital capability, should be prioritised.

Student Nurses' Digital Literacy Levels: Lessons for Curricula.

The rapid uptake of technology is changing the way health professionals provide care to patients and communities. While this presents opportunities to improve, enhance, and positively transform care and treatment, graduates must have the requisite knowledge, skills, and attitudes to make effective use of the technology and data available to them. This research explored nursing students' self-reported digital literacy levels. We undertook a student survey at one university in Australia, utilizing the validated Self-Assessment Nursing Informatics Competencies Scale-SF30 instrument. Overall, 90% of students rated their basic computer knowledge and skills as at least "competent" including performing basic troubleshooting, using the Internet, and conducting online literature searches. However, only 55% of students considered their overall applied computer skills as at least "competent," which included using applications for diagnostic coding and to extract data from clinical data sets. Students have digital literacy in everyday settings; however, their ability to translate this into practice is limited, restricting their access to and use of digital tools in the workplace. Our findings provide the opportunity to address practice issues related to digital literacy and to embed appropriate content in curricula to enable the delivery of improved patient care and the appropriate use of data in various settings.

The role of thermal balneotherapy in the treatment of obese patient with knee osteoarthritis.

Osteoarthritis (OA) is the most common form of arthritis clinically characterized by joint pain, functional limitation, and reduced quality of life. Several studies have shown a clear link between obesity and higher risk of knee OA. According to the multifactorial OA pathogenesis, the management of this condition requires a multidisciplinary approach. The objective of this study is to evaluate hydrokinesitherapy effects in thermal setting in obese patients with knee OA. Fifty-three patients were assessed for eligibility, of which 33 refused the treatment, while 10 patients dropped out after the enrollment for personal reasons or inability to adhere to the program. Ten patients (8 females, 2 males, mean age of 59.4 years) with obesity (range BMI 30-45 kg/m2) and knee OA (II-III grade of Kellgren-Lawrence scale) treated with hydrokinetic therapy in thermal water (two sessions per week for 8 consecutive weeks) completed the study. Primary outcome measure was pain (VAS). Secondary outcomes were clinical knee evaluation (range of motion-ROM, lower-limb muscle strength), WOMAC, and Lequesne Algofunctional Index. Patellar tendon and peri-articular soft tissue ultrasound evaluation and gait analysis at baseline (T0), at the end of treatment (T1), and at 6 months of follow-up (T2) were performed. Significant decrease on VAS pain during walking on a flat surface and going up/down stairs was reached from baseline at T1 (p = 0.0039; p = 0.0098) and was maintained at T2 (p = 0.00954) exclusively for VAS pain during walking on a flat surface. WOMAC score showed a significant reduction between T0 and T1 (p = 0.0137) and between T0 and T2 (p = 0.006438), as ROM evaluations. Kinematic path assessment did not show significant results in individual gait steps, except for the space-time variables of the average speed and the values of ground reaction force (GRF) obtained with force platforms. Hydrokinesitherapy in thermal environment in obese patients with knee OA may determine pain relief, joint function improvement, and walking speed increase until 6 months of follow-up.

Avoiding controversy: Considerations for point-of-view nursing simulations.

Point-of-view simulations involve participants engaging in simulation to experience what it might be like to live with a health condition or disability. These types of simulations have been used frequently in nurse education as a valuable pedagogical tool, as research has shown that student engagement with point-of-view simulations increases student empathy. However, point-of-view simulations have also been problematised by disability community members and scholars researching in the disability space, as ableist and culturally unsafe. This manuscript explores recommendations for, and criticisms of, point-of-view simulations and offers considerations to address these concerns.

Continuity or team-teaching approach for midwifery education? An exploratory qualitative study of student and academic preferences.

BACKGROUND: The content of midwifery courses is very similar across universities. The teaching approach is not, with universities adopting a variety of pedagogical methods. AIM: To explore views of midwifery students, midwifery academics and senior academic managers comparing a continuity approach where one main academic provides the majority of midwifery content plus pastoral care compared with a team-teaching approach of midwifery education where lecturers change throughout the course. METHODS: Semi-structured interviews and focus groups were used to discover thoughts, benefits and disadvantages of two teaching approaches. Data were analysed using thematic analysis. FINDINGS: Midwifery students and academics valued relationship building, consistency of advice and assessment expectations of the continuity approach but also appreciated a variety of teaching styles and content found in the team-teaching approach. Senior academic managers favoured a team-teaching approach due to workload concerns. DISCUSSION: Continuity and team-teaching pedagogical approaches offer different advantages. Continuity in midwifery education may provide students with a meaningful trusting relationship with their teacher and consistency of information, which could aid learning. A team-teaching approach provides students with diversity of teaching styles and midwifery 'stories'. A combination of both pedagogies offering both a mix of teachers and a named 'go-to' mentor might help meet student requirements for both continuity and variety. CONCLUSION: Relationship building, consistency and trust, were all evident in the continuity approach whereas the team-teaching approach was considered to be a more sustainable workload model.

Epidemiology of dermatophytoses: retrospective analysis from 2005 to 2010 and comparison with previous data from 1975.

Dermatophyte infections are extremely frequent worldwide and their epidemiological features vary according to the geographical area and have changed in the last decades. We studied the spectrum of dermatophytoses by means of a retrospective analysis involving 6,133 patients referred to the Mycology Service of the Dermatology Clinic of Policlinico Hospital - University of Bari, Italy during the period 2005-2010. The most frequent clinical forms were tinea unguium (39.2% of the total dermatophytoses), tinea corporis (22.7%) and tinea pedis (20.4%). There was a predominance of women for tinea unguium and corporis and of men for tinea pedis and especially tinea cruris. T. rubrum was the prevalent causative agent, implicated in 64% of total cases, followed by M. canis (14%) and T. mentagrophytes (10%). The retrospective evaluation of epidemiological data collected at our Clinic since 1975 showed a gradual decrease in the frequency of tinea cruris, tinea corporis, and tinea capitis over time. On the contrary, during the past two decades, there has been a progressive increase in the frequency of tinea pedis and especially of tinea unguium. In parallel with this changing pattern, the frequency of isolation of T. rubrum has shown a continuous increase during the last 35 years, whereas a progressive decline of the etiological role of T. violaceum, M. canis and even more of E. floccosum has been noted.

Immune Disregulation in Cutaneous Squamous Cell Carcinoma of Patients with Recessive Dystrophic Epidermolysis Bullosa: A Single Pilot Study.

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is one of the most devastating complications of recessive dystrophic epidermolysis bullosa (RDEB). We recently demonstrated a reduction in immune cell peritumoral infiltration in RDEB patients with cSCC, together with a reduction in CD3+, CD4+, CD68+ and CD20 lymphocytes as compared to primary and secondary cSCC in patients without RDEB. Recently, new molecules, such as high mobility group box 1 (HMGB1), T cell immunoglobulin, mucin domain 3 (TIM-3) and Heme oxygenase-1 (HO-1), have been shown to play a role in antitumoral immunity. OBJECTIVE: Patients with RDEB are known to be at increased risk of developing skin cancers, including the dreaded squamous cell carcinoma of the. Tendentially, cSCCs that arise in the context of EBDR are more aggressive and lead to statistically significant bad outcomes compared to cSCCs developed on the skin of patients without EBDR. In an attempt to study the microenvironment of these lesions, we conducted an immunohistochemical analysis study of proteins that could be actively involved in the genesis of this type of malignant neoplasms. METHODS: In this retrospective study, the OH1-HMGB1-TIM3 activation axis, as correlated to the T lymphocytes cell count, was assessed in biopsy samples from 31 consecutive cases consisting of 12 RDEB patients with cSCC, 12 patients with primary cSCC and 7 RDEB patients with pseudoepitheliomatous cutaneous hyperplasia. Parametric Student's t-test was applied for normally distributed values, such as CD4+ and CD8+, and non-parametric Mann-Whitney test for non-normally distributed values, such as HMGB-1, TIM-3 and HO-1. RESULTS: In RDEB patients with cSCC and with pseudoepitheliomatous hyperplasia, the expression of CD4 T helper lymphocytes was lower than in the peritumoral infiltrate found in primary cSCC. CD8 cytotoxic T lymphocytes were increased in primary cSCC compared to the other two groups. An increased HMGB1 expression was evident in both primary and RDEB cSCC. TIM3 expression was higher in RDEB patients with cSCC compared to the other two groups. A significantly reduced immunohistochemical expression of HO-1 was evident in the tumoral microenvironment of cSCC-RDEB as compared to primary cSCC. CONCLUSIONS: These data suggest that a reduced immune cell peritumoral infiltration in RDEB patients could be responsible, in the complexity of the mechanisms of carcinogenesis and host response, of the particular aggressiveness of the cSCC of RDEB patients, creating a substrate for greater local immunosuppression, which, potentially, can "open the doors" to development and eventual metastasis by this malignant neoplasm.

mRNA booster vaccination protects aged mice against the SARS-CoV-2 Omicron variant.

The SARS-CoV-2 Omicron variant evades vaccine-induced immunity. While a booster dose of ancestral mRNA vaccines effectively elicits neutralizing antibodies against variants, its efficacy against Omicron in older adults, who are at the greatest risk of severe disease, is not fully elucidated. Here, we evaluate multiple longitudinal immunization regimens of mRNA BNT162b2 to assess the effects of a booster dose provided >8 months after the primary immunization series across the murine lifespan, including in aged 21-month-old mice. Boosting dramatically enhances humoral and cell-mediated responses with evidence of Omicron cross-recognition. Furthermore, while younger mice are protected without a booster dose, boosting provides sterilizing immunity against Omicron-induced lung infection in aged 21-month-old mice. Correlational analyses reveal that neutralizing activity against Omicron is strongly associated with protection. Overall, our findings indicate age-dependent vaccine efficacy and demonstrate the potential benefit of mRNA booster immunization to protect vulnerable older populations against SARS-CoV-2 variants.

The mRNA vaccine BNT162b2 demonstrates impaired TH1 immunogenicity in human elders in vitro and aged mice in vivo.

mRNA vaccines have been key to addressing the SARS-CoV-2 pandemic but have impaired immunogenicity and durability in vulnerable older populations. We evaluated the mRNA vaccine BNT162b2 in human in vitro whole blood assays with supernatants from adult (18-50 years) and elder (≥60 years) participants measured by mass spectrometry and proximity extension assay proteomics. BNT162b2 induced increased expression of soluble proteins in adult blood (e.g., C1S, PSMC6, CPN1), but demonstrated reduced proteins in elder blood (e.g., TPM4, APOF, APOC2, CPN1, and PI16), including 30-85% lower induction of TH1-polarizing cytokines and chemokines (e.g., IFNγ, and CXCL10). Elder TH1 impairment was validated in mice in vivo and associated with impaired humoral and cellular immunogenicity. Our study demonstrates the utility of a human in vitro platform to model age-specific mRNA vaccine activity, highlights impaired TH1 immunogenicity in older adults, and provides rationale for developing enhanced mRNA vaccines with greater immunogenicity in vulnerable populations.

Factors that influence international nursing students' experiences and perceptions of their learning environments: a scoping review protocol.

OBJECTIVE: The objective of this review is to explore the research on factors that influence international undergraduate nursing students' experiences and perceptions of their learning environment. INTRODUCTION: International nursing students bring valuable cultural and economic opportunities to universities and health care. It is important that their clinical learning experiences are positive. Factors that influence nursing students' experiences may include cultural and communication differences, diversity related to health care systems, learning and teaching strategies, and programs to improve communication. International nursing students' experiences and perceptions are reported in terms of expressed confidence, perceived competence, and levels of satisfaction. A scoping review is required to identify what is known and to identify the knowledge gaps in this area. INCLUSION CRITERIA: International nursing students are those who are enrolled in an undergraduate nursing program in a higher-education institution in a country other than their own. International students studying vocational nursing and exchange students will be excluded. The learning environment is considered to be one in which any person who may influence patient care learns. Primary research, both qualitative and quantitative methods, published since 1995 in any language that the research team can translate will be included. METHODS: This review follows the JBI methodology for scoping reviews. Data extraction will include the factors influencing students' experiences and the concepts that were explored. Data analysis will include frequencies of concepts and associations between them. Results will be presented in tabular form and mind maps. SCOPING REVIEW REGISTRATION NUMBER: Open Science Framework (osf.io/r4v6q).

Brain Connectivity Modulation After Exoskeleton-Assisted Gait in Chronic Hemiplegic Stroke Survivors: A Pilot Study.

OBJECTIVE: The aim of this study was to investigate electroencephalographic (EEG) connectivity short-term changes, quantified by node strength and betweenness centrality, induced by a single trial of exoskeleton-assisted gait in chronic stroke survivors. DESIGN: Study design was randomized crossover. Electroencephalographic data (64-channel system) were recorded before gait (baseline) and after unassisted overground walking and overground exoskeleton-assisted walking. Coherence was estimated for alpha1, alpha2, and beta frequency ranges. Graph analysis assessed network model properties: node strength and betweenness centrality. RESULTS: Nine participants were included in the final analysis. In the group (four participants) with a left-hemisphere stroke lesion (dominant hemisphere), over the vertex, node strength increased in alpha1, alpha2, and beta bands, and betweenness centrality decreased in alpha2 both after unassisted overground walking and exoskeleton-assisted walking. In the group (five participants) with a right-hemisphere lesion (nondominant hemisphere), node strength increased in alpha1 and alpha2 over the contralesional sensorimotor area and ipsilesional prefrontal area after overground exoskeleton-assisted walking, compared with baseline and unassisted overground walking. CONCLUSION: A single session of exoskeleton training provides short-term neuroplastic modulation in chronic stroke. In participants with a nondominant hemisphere lesion, exoskeleton training induces activations similar to those observed in able-bodied participants, suggesting a role of lesion lateralization in networks' reorganization.

Nurses' perceptions of providing psychosexual care for women experiencing gynaecological cancer.

PURPOSE: To gain insight into how Western Australian nurses conceptualise the provision of psychosexual care for women undergoing gynaecological cancer treatment and how this aligns with nurses globally. METHODS: A qualitative descriptive design was chosen to facilitate insight into nurses' perspectives of their reality. Seventeen nurses working at a tertiary women's hospital in Western Australia participated in one-on-one interviews and were asked to describe their perceptions and identify factors that facilitate or challenge psychosexual care provision. RESULTS: Data analysis revealed five themes affecting the provision of psychosexual care: (1) Nurses use strategies to aid the conversation (subthemes: supporting the woman, facilitating engagement); (2) Women have unique psychosexual needs (subthemes: diversity, receptiveness); (3) Nurses are influenced by personal and professional experience and values (subthemes: confidence, values, making assumptions); (4) Systems within the health service affect care (subthemes: being supported by the system, working as a team); and (5) Society influences attitudes around sexuality. Nurses' views differed around whether these factors had a positive or negative impact on the conversation required to provide this care. CONCLUSIONS: Factors influencing nurses' provision of psychosexual care are multifaceted and differ amongst nurses. Recommended strategies to improve service provision include guidelines and documentation to integrate assessment of psychosexual issues as standard care, encouraging shared responsibility of psychosexual care amongst the multidisciplinary team and implementing education programs focussed on improving nurses' confidence and communication skills.

Quantitative EEG Evaluation During Robot-Assisted Foot Movement.

Passiveand imagined limbmovements induce changes in cerebral oscillatory activity. Central modulatory effects play a role in plastic changes, and are of uttermost importance in rehabilitation. This has extensively been studied for upper limb, but less is known for lower limb. The aim of this study is to investigate the topographical distribution of event-related desynchronization/synchronization(ERD/ERS) and task-relatedcoherence during a robot-assisted and a motor imagery task of lower limb in healthy subjects to inform rehabilitation paradigms. 32-channels electroencephalogram (EEG) was recorded in twenty-one healthy right footed and handed subjects during a robot-assisted single-joint cyclic right ankle movement performed by the BTS ANYMOV robotic hospital bed. Data were acquired with a block protocol for passive and imagined movement at a frequency of 0.2 Hz. ERD/ERS and task related coherence were calculated in alpha1 (8-10 Hz), alpha2 (10.5-12.5 Hz) and beta (13-30 Hz) frequency ranges. During passive movement, alpha2 rhythm desynchronized overC3 and ipsilateral frontal areas (F4, FC2, FC6); betaERD was detected over the bilateral motor areas (Cz, C3, C4). During motor imagery, a significant desynchronization was evident for alpha1 over contralateral sensorimotor cortex (C3), for alpha2 over bilateral motor areas (C3 and C4), and for beta over central scalp areas. Task-related coherence decreased during passive movement in alpha2 band between contralateral central area (C3, CP5, CP1, P3) and ipsilateral frontal area (F8, FC6, T8); beta band coherence decreased between C3-C4 electrodes, and increased between C3-Cz. These data contribute to the understanding of oscillatory activity and functional neuronal interactions during lower limb robot-assisted motor performance. The final output of this line of research is to inform the design and development of neurorehabilitation protocols.

Memory Rehabilitation Strategies in Nonsurgical Temporal Lobe Epilepsy: A Review.

People with temporal lobe epilepsy (TLE) who have not undergone epilepsy surgery often complain of memory deficits. Cognitive rehabilitation is employed as a remedial intervention in clinical settings, but research is limited and findings concerning efficacy and the criteria for choosing different approaches have been inconsistent. We aimed to appraise existing evidence on memory rehabilitation in nonsurgical individuals with temporal lobe epilepsy and to ascertain the effectiveness of specific strategies. A scoping review was preferred given the heterogeneous nature of the interventions. A comprehensive literature search using MEDLINE, EMBASE, CINAHL, AMED, Scholars Portal/PSYCHinfo, Proceedings First, and ProQuest Dissertations and Theses identified articles published in English before February 2016. The search retrieved 372 abstracts. Of 25 eligible studies, six were included in the final review. None included pediatric populations. Strategies included cognitive training, external memory aids, brain training, and noninvasive brain stimulation. Selection criteria tended to be general. Overall, there was insufficient evidence to make definitive conclusions regarding the efficacy of traditional memory rehabilitation strategies, brain training, and noninvasive brain stimulation. The review suggests that cognitive rehabilitation in nonsurgical TLE is underresearched and that there is a need for a systematic evaluation in this population.

Welcome to the techno highway: development of a health assessment CD-ROM and website.

Traditionally teaching nursing students psychomotor skills took place in a laboratory setting; however, recent developments in computer technology have revolutionised how educators can transfer knowledge. To meet the need for an efficient and interactive learning experience a software product was required to educate nursing students about health assessment techniques. This paper presents how existing 'old technology' of a video was given new life by embracing new technology, resulting in development of an interactive CD-ROM with supporting WebCT. This innovation reflects a more flexible approach to learning as it is dynamic, portable, self-paced and more convenient for adult learners especially those in remote areas.

Looking to the future: nursing as a career goal.

Career paths selected by completing nursing students are of significant interest to educators and professional agencies. This paper presents part of a larger study which investigated students' influences and motivations for selecting nursing as a career path. The aim of this study was to identify career goals of completing nursing students, what factors influence these goals, preferred areas in which to work and if aged care is considered a career option. The study employed a cross sectional approach utilizing Ford's (1986) taxonomy of human goals as a theoretical framework. A questionnaire was administered to 25 students in the final semester of their nursing degree. Preliminary findings showed goals for future practice were limited to midwifery and paediatrics whilst elder care was not perceived as a viable career option. Negative images of nurses continue to prevail and implications for nursing are considered. Despite the small sample, the study provides evidence that to provide suitable care for all members of the community it is essential that all career options within the profession are positively promoted.