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Cameron D, Wilson A, Mendham A, Wingard S, Kropinyeri R, Scriven T, Kerrigan C, Spaeth B, Stranks S, Kaambwa B, Ullah S, Worley P, Ryder C. Knowledge interface co-design of a diabetes and metabolic syndrome initiative with and for Aboriginal people living on Ngarrindjeri country. Public Health Pract (Oxf) 2024; 7:100496. [PMID: 38681115 PMCID: PMC11047281 DOI: 10.1016/j.puhip.2024.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 05/01/2024] Open
Abstract
Objectives This research program involves two phases to identify enablers and barriers to diabetes care for Aboriginal people on Ngarrindjeri country; and co-design a strength-based metabolic syndrome and Type 2 Diabetes (T2D) remission program with the Ngarrindjeri community. Study design A study protocol on qualitative research. Methods The study will recruit Aboriginal people living on Ngarrindjeri country above 18 years of age with a diagnosis of metabolic syndrome or T2D. Recruitment for phases one and two will occur through the Aboriginal Health Team at the Riverland Mallee Coorong Local Health Network. The lived experiences of T2D will be explored with 10-15 Aboriginal participants, through an Aboriginal conversational technique called 'yarning' (60-90 min) in phase 1. Elders and senior community representatives (n = 20-30) will participate in four co-design workshops (2-4 h) in phase 2. Qualitative data will be transcribed and thematically analysed (NVivo version 12). The analysis will focus on protective factors for the Cultural Determinants of Health. Ethics approval was obtained from Aboriginal Health Research Ethics Committee in South Australia (04-22-1009), and Flinders University Human Research Ethics Committee (5847). Results This work will be used to pilot the co-designed diabetes remission trial. Outcomes will be published in peer-reviewed journals, presented at conferences, focusing on following best practice guidelines from the Australian Institute of Aboriginal and Torres Strait Islander Studies and National Health and Medical Research Council. Research translation will occur through digital posters, manuals, and infographics. Conclusions The findings will be summarised to all Aboriginal organisations involved in this study, along with peak bodies, stakeholders, Aboriginal Services, and interested participants.
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Affiliation(s)
- D. Cameron
- Moorundi Aboriginal Community Controlled Health Service, Murray Bridge, Australia
| | - A. Wilson
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - A.E. Mendham
- Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, South Australia Health, Australia
| | - S. Wingard
- Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, South Australia Health, Australia
| | - R. Kropinyeri
- Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, South Australia Health, Australia
| | - T. Scriven
- Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, South Australia Health, Australia
| | | | - B. Spaeth
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - S. Stranks
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Southern Adelaide Diabetes and Endocrine Services, South Australia Health, Adelaide, Australia
| | - B. Kaambwa
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - S. Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - P. Worley
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Riverland Academy of Clinical Excellence (RACE), Riverland Mallee Coorong Local Health Network, South Australia Health, Australia
| | - C. Ryder
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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Lawn S, Shelby-James T, Manger S, Byrne L, Fuss B, Isaac V, Kaambwa B, Ullah S, Rattray M, Gye B, Kaine C, Phegan C, Harris G, Worley P. Evaluation of lived experience Peer Support intervention for mental health service consumers in Primary Care (PS-PC): study protocol for a stepped-wedge cluster randomised controlled trial. Trials 2024; 25:319. [PMID: 38745299 PMCID: PMC11094922 DOI: 10.1186/s13063-024-08165-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers. METHODS This stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3-4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site's involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site's involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention. DISCUSSION This mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715.
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Affiliation(s)
- Sharon Lawn
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
- Lived Experience Australia, PO Box 96, 5048, Brighton, Australia
| | - Tania Shelby-James
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Sam Manger
- Lifestyle Medicine, James Cook University, James Cook University LPO, 150 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - Louise Byrne
- School of Management, RMIT, GPO Box 2476, Melbourne, VIC, 3001, Australia
| | - Belinda Fuss
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Vivian Isaac
- Faculty of Science and Health, Charles Sturt University, Albury, NSW, 2640, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Megan Rattray
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Bill Gye
- Community Mental Health Australia, PO Box 668, Rozelle, NSW, 2039, Australia
| | - Christine Kaine
- Lived Experience Australia, PO Box 96, 5048, Brighton, Australia
| | - Caroline Phegan
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Geoff Harris
- Mental Health Coalition of South Australia, Suite 2/195 North Terrace, Adelaide, SA, 5000, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Patel M, Zhang Y, Xiao MF, Worley P, Moghekar A. Neuronal pentraxin 2 correlates with neurodegeneration but not cognition in idiopathic normal pressure hydrocephalus (iNPH). Neurol Neurochir Pol 2024; 58:47-53. [PMID: 38393959 DOI: 10.5603/pjnns.98212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
AIM OF THE STUDY Neuronal pentraxin-2 (NPTX2) is a synaptic protein responsible for modulating plasticity at excitatory synapses. While the role of NPTX2 as a novel synaptic biomarker in cognitive disorders has been elucidated recently, its role in idiopathic normal pressure hydrocephalus (iNPH) is not yet understood. CLINICAL RATIONALE FOR STUDY To determine if NPTX2 predicts cognition in patients with iNPH, and whether it could serve as a predictive marker for shunt outcomes. MATERIAL AND METHODS 354 iNPH patients underwent cerebrospinal fluid drainage (CSF) as part of the tap test or extended lumbar drainage. Demographic and clinical measures including age, Evans Index (EI), Montreal Cognitive Assessment (MoCA) score, Functional Activities Questionnaire (FAQ) score, and baseline and post-shunt surgery Timed Up and Go (TUG) test scores were ascertained. CSF NPTX2 concentrations were measured using an ELISA. CSF β-amyloid 1-40 (Aβ1-40), β-amyloid 1-42 (Aβ1-42), and phosphorylated tau-181 (pTau-181) were measured by chemiluminescent assays. Spearman's correlation was used to determine the correlation between CSF NPTX2 concentrations and age, EI, MoCA and FAQ, TUG, Aβ1-40/Aβ1-42 ratio, and pTau-181 concentrations. Logistic regression was used to determine if CSF NPTX2 values were a predictor of short-term improvement post-CSF drainage or long-term improvement post-shunt surgery. RESULTS There were 225 males and 129 females with a mean age of 77.7 years (± 7.06). Average CSF NPTX2 level in all iNPH patients was 559.97 pg/mL (± 432.87). CSF NPTX2 level in those selected for shunt surgery was 505.61 pg/mL (± 322.38). NPTX2 showed modest correlations with pTau-181 (r = 0.44, p < 0.001) with a trend for Aβ42/Aβ40 ratio (r = -0.1, p = 0.053). NPTX2 concentrations did not correlate with age (r = -0.012, p = 0.83) or MoCA score (r = 0.001, p = 0.87), but correlated negatively with FAQ (r = -0.15, p = 0.019). CONCLUSIONS While CSF NPTX2 values correlate with neurodegeneration, they do not correlate with cognitive or functional measures in iNPH. CSF NPTX2 cannot serve as a predictor of either short-term or long-term improvement after CSF drainage. CLINICAL IMPLICATIONS These results suggest that synaptic degeneration is not a core feature of iNPH pathophysiology.
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Affiliation(s)
- Megha Patel
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Yifan Zhang
- Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Mei-Fang Xiao
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Paul Worley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States.
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Soldan A, Oh S, Ryu T, Pettigrew C, Zhu Y, Moghekar A, Xiao MF, Pontone GM, Albert M, Na CH, Worley P. NPTX2 in Cerebrospinal Fluid Predicts the Progression From Normal Cognition to Mild Cognitive Impairment. Ann Neurol 2023; 94:620-631. [PMID: 37345460 PMCID: PMC10543570 DOI: 10.1002/ana.26725] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE This study examined whether cerebrospinal fluid (CSF) baseline levels of the synaptic protein NPTX2 predict time to onset of symptoms of mild cognitive impairment (MCI), both alone and when accounting for traditional CSF Alzheimer's disease (AD) biomarker levels. Longitudinal NPTX2 levels were also examined. METHODS CSF was collected longitudinally from 269 cognitively normal BIOCARD Study participants (mean baseline age = 57.7 years; mean follow-up = 16.3 years; n = 77 progressed to MCI/dementia). NPTX2 levels were measured from 3 correlated peptides using quantitative parallel reaction monitoring mass spectrometry. Levels of Aβ42 /Aβ40 , p-tau181 , and t-tau were measured from the same CSF specimens using Lumipulse automated electrochemiluminescence assays. RESULTS In Cox regression models, lower baseline NPTX2 levels were associated with an earlier time to MCI symptom onset (hazard ratio [HR] = 0.76, SE = 0.09, p = 0.023). This association was significant for progression within 7 years (p = 0.036) and after 7 years from baseline (p = 0.001). Baseline NPTX2 levels improved prediction of time to MCI symptom onset after accounting for baseline AD biomarker levels (p < 0.01), and NPTX2 did not interact with the CSF AD biomarkers or APOE-ε4 genetic status. In linear mixed effects models, higher baseline p-tau181 and t-tau levels were associated with higher baseline levels of NPTX2 (both p < 0.001) and greater rates of NPTX2 declines over time. INTERPRETATION NPTX2 may be a valuable prognostic biomarker during preclinical AD that provides additive and independent prediction of MCI onset among individuals who are cognitively normal. We hypothesize that NPTX2-mediated circuit homeostasis confers resilience during the early phase of AD. ANN NEUROL 2023;94:620-631.
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Affiliation(s)
- Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sungtaek Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Taekyung Ryu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Corinne Pettigrew
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yuxin Zhu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mei-Fang Xiao
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory M. Pontone
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chan-Hyun Na
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Paul Worley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD
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Roh SE, Xiao M, Delgado A, Kwak C, Savonenko A, Bakker A, Kwon HB, Worley P. Sleep and circadian rhythm disruption by NPTX2 loss of function. bioRxiv 2023:2023.09.26.559408. [PMID: 37808783 PMCID: PMC10557648 DOI: 10.1101/2023.09.26.559408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Sleep and circadian rhythm disruption (SCRD) is commonly observed in aging, especially in individuals who experience progressive cognitive decline to mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, precise molecular mechanisms underlying the association between SCRD and aging are not fully understood. Orexin A is a well-characterized "sleep neuropeptide" that is expressed in hypothalamic neurons and evokes wake behavior. The importance of Orexin is exemplified in narcolepsy where it is profoundly down-regulated. Interestingly, the synaptic immediate early gene NPTX2 is co-expressed in Orexin neurons and is similarly reduced in narcolepsy. NPTX2 is also down-regulated in CSF of some cognitively normal older individuals and predicts the time of transition from normal cognition to MCI. The association between Orexin and NPTX2 is further evinced here where we observe that Orexin A and NPTX2 are highly correlated in CSF of cognitively normal aged individuals and raises the question of whether SCRD that are typically attributed to Orexin A loss of function may be modified by concomitant NPTX2 down-regulation. Is NPTX2 an effector of sleep or simply a reporter of orexin-dependent SCRD? To address this question, we examined NPTX2 KO mice and found they retain Orexin expression in the brain and so provide an opportunity to examine the specific contribution of NPTX2 to SCRD. Our results reveal that NPTX2 KO mice exhibit a disrupted circadian onset time, coupled with increased activity during the sleep phase, suggesting difficulties in maintaining states. Sleep EEG indicates distinct temporal allocation shifts across vigilance states, characterized by reduced wake and increased NREM time. Evident sleep fragmentation manifests through alterations of event occurrences during Wake and NREM, notably during light transition periods, in conjunction with an increased frequency of sleep transitions in NPTX2 KO mice, particularly between Wake and NREM. EEG spectral analysis indicated significant shifts in power across various frequency bands in the wake, NREM, and REM states, suggestive of disrupted neuronal synchronicity. An intriguing observation is the diminished occurrence of sleep spindles, one of the earliest measures of human sleep disruption, in NPTX2 KO mice. These findings highlight the effector role of NPTX2 loss of function as an instigator of SCRD and a potential mediator of sleep disruption in aging.
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Affiliation(s)
- Seung-Eon Roh
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Meifang Xiao
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ana Delgado
- Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Chuljung Kwak
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Alena Savonenko
- Department of Neuroanatomy, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Arnold Bakker
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Hyung-Bae Kwon
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Paul Worley
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Galbally M, Watson SJ, Coleman M, Worley P, Verrier L, Padmanabhan V, Lewis AJ. Rurality as a predictor of perinatal mental health and well-being in an Australian cohort. Aust J Rural Health 2023; 31:182-195. [PMID: 36251362 PMCID: PMC10946854 DOI: 10.1111/ajr.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Perinatal emotional well-being is more than the presence or absence of depressive and anxiety disorders; it encompasses a wide range of factors that contribute to emotional well-being. This study compares perinatal well-being between women living in metropolitan and rural regions. DESIGN Prospective, longitudinal cohort. PARTICIPANTS/SETTING Eight hundred and six women from Victoria and Western Australia recruited before 20 weeks of pregnancy and followed up to 12 months postpartum. MAIN OUTCOME MEASURES Rurality was assessed using the Modified Monash Model (MM Model) with 578 in metropolitan cities MM1, 185 in regional and large rural towns MM2-MM3 and 43 in rural to remote MM4-MM7. The Structured Clinical Interview for DSM-IV (SCID-IV) was administered at recruitment to assess depression, and symptoms of depression and anxiety were measured using the Edinburgh Post-natal Depression Scale and the State and Trait Anxiety Scale, respectively. Other measures included stressful events, diet, exercise, partner support, parenting and sleep. RESULTS The prevalence of depressive disorders did not differ across rurality. There was also no difference in breastfeeding cessation, exercise, sleep or partner support. Women living in rural communities and who also had depression reported significantly higher parenting stress than metropolitan women and lower access to parenting activities. CONCLUSIONS Our study suggests while many of the challenges of the perinatal period were shared between women in all areas, there were important differences in parenting stress and access to activities. Furthermore, these findings suggest that guidelines and interventions designed for perinatal mental health should consider rurality.
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Affiliation(s)
- Megan Galbally
- School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
- Health Futures InstituteMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Stuart J. Watson
- School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
- Health Futures InstituteMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Mathew Coleman
- The Rural Clinical School of WAUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Telethon Kids InstitutePerth's Children HospitalPerthWestern AustraliaAustralia
| | - Paul Worley
- Riverland Academy of Clinical ExcellenceRiverland Mallee Coorong Local Health NetworkMurray BridgeSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Leanda Verrier
- Women and Newborn Health ServiceKing Edward Memorial Hospital for WomenSubiacoWestern AustraliaAustralia
| | | | - Andrew J. Lewis
- Institute of Health and Well‐beingFederation UniversityBallaratVictoriaAustralia
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Ryder C, Wingard S, Cameron D, Kerrigan C, Worley P, Spaeth B, Stranks S, Kaambwa B, Ullah S, Wang J, Wilson A. Community co-design to target diabetes and metabolic syndrome in Australian Indigenous peoples. Nat Med 2023; 29:292-293. [PMID: 36755164 DOI: 10.1038/s41591-022-02174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- C Ryder
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. .,Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia. .,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. .,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - S Wingard
- Riverland Mallee Coorong Local Health Network, South Australia Health, Murray Bridge, South Australia, Australia
| | - D Cameron
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Riverland Mallee Coorong Local Health Network, South Australia Health, Murray Bridge, South Australia, Australia
| | - C Kerrigan
- Coorong Medical Centre, Meningie, South Australia, Australia
| | - P Worley
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Riverland Mallee Coorong Local Health Network, South Australia Health, Murray Bridge, South Australia, Australia
| | - B Spaeth
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - S Stranks
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Southern Adelaide Diabetes and Endocrine Services, South Australia Health, Adelaide, South Australia, Australia
| | - B Kaambwa
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - S Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - J Wang
- Department of NanoEngineering, University of California San Diego, San Diego, CA, USA
| | - A Wilson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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Champion W, Eske H, Frahn S, McLeod J, Olesnicky A, Phegan C, Sims C, Worley P. Enhancing the local workforce outcomes for rural LICs: what is the role of the local health service in leading innovation in medical education? Rural Remote Health 2023; 23:8182. [PMID: 36802793 DOI: 10.22605/rrh8182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION It is now 25 years since the Riverland health service began its partnership with Flinders University to create the Parallel Rural Community Curriculum (PRCC) in rural South Australia. What started as a workforce program quickly became a successful disruptive technology for broader pedagogy in medical education. Despite more graduates of the PRCC choosing rural practice compared with their urban rotation-based colleagues, local medical workforce crises have persisted. METHODS In February 2021, the Local Health Network decided to implement the National Rural Generalist Pathway in its local region. It created the Riverland Academy of Clinical Excellence (RACE) as its vehicle for taking responsibility for training its own health professional workforce. RESULTS RACE has increased the region's medical workforce by over 20% in 1 year. It gained accreditation as a provider of junior doctor and advanced skills training and recruited five interns (all of whom had previously undertaken 1-year rural clinical school placements), six second year and above doctors, and four advanced skills registrars. RACE has linked with GPEx Rural Generalist registrars and formed a Public Health Unit from those registrars who also have MPH qualifications. RACE and Flinders University are expanding teaching facilities in the region and enabling medical students to complete their MD in the region. DISCUSSION Health services can facilitate vertical integration of rural medical education, supporting a full pathway to rural practice. Providing length of training contracts is proving attractive for junior doctors who are interested in establishing a rural home base for their training.
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Affiliation(s)
- Wayne Champion
- Riverland Mallee Coorong Local Health Network, Murray Bridge, SA, Australia
| | - Hamish Eske
- Riverland Mallee Coorong Local Health Network, Murray Bridge, SA, Australia
| | - Sharon Frahn
- Riverland Mallee Coorong Local Health Network, Murray Bridge, SA, Australia
| | - James McLeod
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Andrew Olesnicky
- Riverland Mallee Coorong Local Health Network, Murray Bridge, SA, Australia
| | - Caroline Phegan
- Riverland Mallee Coorong Local Health Network, Murray Bridge, SA, Australia
| | | | - Paul Worley
- Riverland Mallee Coorong Local Health Network, Murray Bridge, SA, Australia
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Kim NS, Ringeling FR, Zhou Y, Nguyen HN, Temme SJ, Lin YT, Eacker S, Dawson VL, Dawson TM, Xiao B, Hsu KS, Canzar S, Li W, Worley P, Christian KM, Yoon KJ, Song H, Ming GL. CYFIP1 Dosages Exhibit Divergent Behavioral Impact via Diametric Regulation of NMDA Receptor Complex Translation in Mouse Models of Psychiatric Disorders. Biol Psychiatry 2022; 92:815-826. [PMID: 34247782 PMCID: PMC8568734 DOI: 10.1016/j.biopsych.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Gene dosage imbalance caused by copy number variations (CNVs) is a prominent contributor to brain disorders. In particular, 15q11.2 CNV duplications and deletions have been associated with autism spectrum disorder and schizophrenia, respectively. The mechanism underlying these diametric contributions remains unclear. METHODS We established both loss-of-function and gain-of-function mouse models of Cyfip1, one of four genes within 15q11.2 CNVs. To assess the functional consequences of altered CYFIP1 levels, we performed systematic investigations on behavioral, electrophysiological, and biochemical phenotypes in both mouse models. In addition, we utilized RNA immunoprecipitation sequencing (RIP-seq) analysis to reveal molecular targets of CYFIP1 in vivo. RESULTS Cyfip1 loss-of-function and gain-of function mouse models exhibited distinct and shared behavioral abnormalities related to autism spectrum disorder and schizophrenia. RIP-seq analysis identified messenger RNA targets of CYFIP1 in vivo, including postsynaptic NMDA receptor (NMDAR) complex components. In addition, these mouse models showed diametric changes in levels of postsynaptic NMDAR complex components at synapses because of dysregulated protein translation, resulting in bidirectional alteration of NMDAR-mediated signaling. Importantly, pharmacological balancing of NMDAR signaling in these mouse models with diametric Cyfip1 dosages rescues behavioral abnormalities. CONCLUSIONS CYFIP1 regulates protein translation of NMDAR and associated complex components at synapses to maintain normal synaptic functions and behaviors. Our integrated analyses provide insight into how gene dosage imbalance caused by CNVs may contribute to divergent neuropsychiatric disorders.
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Affiliation(s)
- Nam-Shik Kim
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francisca Rojas Ringeling
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland; Gene Center, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ying Zhou
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ha Nam Nguyen
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephanie J Temme
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu-Ting Lin
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen Eacker
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Valina L Dawson
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ted M Dawson
- Institute for Cell Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo Xiao
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kuei-Sen Hsu
- Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Stefan Canzar
- Gene Center, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Weidong Li
- Bio-X Institutes, Key Laboratory for the Genetics of Development and Neuropsychiatric Disorders, Shanghai Jiao Tong University, Shanghai, China
| | - Paul Worley
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kimberly M Christian
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ki-Jun Yoon
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Hongjun Song
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cell and Developmental Biology, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Institute for Regenerative Medicine, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Epigenetics Institute, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Guo-Li Ming
- Department of Neuroscience, Mahoney Institute for Neurosciences, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cell and Developmental Biology, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Institute for Regenerative Medicine, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School for Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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10
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Yang L, Ottenheijm R, Worley P, Freichel M, Camacho Londoño JE. Reduction in SOCE and Associated Aggregation in Platelets from Mice with Platelet-Specific Deletion of Orai1. Cells 2022; 11:cells11203225. [PMID: 36291093 PMCID: PMC9600098 DOI: 10.3390/cells11203225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Calcium signalling in platelets through store operated Ca2+ entry (SOCE) or receptor-operated Ca2+ entry (ROCE) mechanisms is crucial for platelet activation and function. Orai1 proteins have been implicated in platelet’s SOCE. In this study we evaluated the contribution of Orai1 proteins to these processes using washed platelets from adult mice from both genders with platelet-specific deletion of the Orai1 gene (Orai1flox/flox; Pf4-Cre termed as Orai1Plt-KO) since mice with ubiquitous Orai1 deficiency show early lethality. Platelet aggregation as well as Ca2+ entry and release were measured in vitro following stimulation with collagen, collagen related peptide (CRP), thromboxane A2 analogue U46619, thrombin, ADP and the sarco/endoplasmic reticulum Ca2+-ATPase (SERCA) inhibitor thapsigargin, respectively. SOCE and aggregation induced by Thapsigargin up to a concentration of 0.3 µM was abrogated in Orai1-deficient platelets. Receptor-operated Ca2+-entry and/or platelet aggregation induced by CRP, U46619 or thrombin were partially affected by Orai1 deletion depending on the gender. In contrast, ADP-, collagen- and CRP-induced aggregation was comparable in Orai1Plt-KO platelets and control cells over the entire concentration range. Our results reinforce the indispensability of Orai1 proteins for SOCE in murine platelets, contribute to understand its role in agonist-dependent signalling and emphasize the importance to analyse platelets from both genders.
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Affiliation(s)
- Linlin Yang
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Roger Ottenheijm
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Paul Worley
- The Solomon H. Snyder Department of Neuroscience, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Marc Freichel
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
- Correspondence: (M.F.); (J.E.C.L.)
| | - Juan E. Camacho Londoño
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
- Correspondence: (M.F.); (J.E.C.L.)
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Lock Ngiyampaa MJ, McMillan Wiradjuri F, Warne Oglala Lakota D, Bennett Gamilaraay B, Kidd Ngāpuhi J, Williams Bkejwanong N, Martire JL, Worley P, Hutten-Czapski P, Saurman E, Matthews Quandamooka V, Walke Bundjalung E, Edwards Worimi D, Owen Nurrunga And Ngarrendjeri J, Browne J, Roberts R. ICIRAS: Research and reconciliation with indigenous peoples in rural health journals. Aust J Rural Health 2022; 30:550-558. [PMID: 35859346 PMCID: PMC9543535 DOI: 10.1111/ajr.12905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/26/2022] [Indexed: 01/22/2023] Open
Abstract
Aim We aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications. Context This is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals—the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health—recognised that Indigenous peoples' identity could be embedded in authorship details. Approach An environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is ‘nothing about Indigenous people, without Indigenous people’ in rural health research publications. Conclusion Improving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call‐to‐action for research journals and institutions to rigorously improve publication governance that signals “Editing with IndigenUs and for IndigenUs”.
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Affiliation(s)
- Mark J Lock Ngiyampaa
- Faculty of Health, School of Public Health, Girra Maa Indigenous Health Discipline, University of Technology Sydney, Sydney, NSW, Australia
| | - Faye McMillan Wiradjuri
- Faculty of Medicine and Health, School of Population, Aboriginal and Torres Strait Islander Health, University of New South Wales, Samuels Building University of NSW, Sydney, NSW, Australia
| | | | - Bindi Bennett Gamilaraay
- First Nations Health, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Qld, Australia
| | - Jacquie Kidd Ngāpuhi
- Maori Advancement Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Paul Worley
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | | | - Emily Saurman
- Broken Hill University Department of Rural Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Veronica Matthews Quandamooka
- Centre for Research Excellence: Strengthening Systems for Indigenous Health Care Equity (CRE- STRIDE), University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Emma Walke Bundjalung
- Centre for Research Excellence: Strengthening Systems for Indigenous Health Care Equity (CRE- STRIDE), University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Dave Edwards Worimi
- Digital Mental Health, University Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | | | - Jennifer Browne
- Institute for Health Transformation, Deakin University, Geelong, Vic., Australia
| | - Russell Roberts
- School of Business, Charles Sturt University, Bathurst, NSW, Australia
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Lock MJ, McMillan F, Warne D, Bennett B, Kidd J, Williams N, Martire JL, Worley P, Hutten-Czapski P, Saurman E, Mathews V, Walke E, Edwards D, Owen J, Browne J, Roberts R. Indigenous Cultural Identity of Research Authors Standard: research and reconciliation with Indigenous Peoples in rural health journals. Rural Remote Health 2022; 22:7646. [PMID: 35858524 DOI: 10.22605/rrh7646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The Indigenous Cultural Identity of Research Authors Standard (ICIRAS) is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously recognised in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination. Reflecting on these broader movements, the editorial teams of three rural health journals - Rural and Remote Health, the Australian Journal of Rural Health, and the Canadian Journal of Rural Medicine - adopted a policy of 'Nothing about Indigenous Peoples, without Indigenous Peoples'. This meant changing practices so that Indigenous Peoples' identity could be embedded in authorship credentials - such as in the byline. An environmental scan of literature about the inclusion of Indigenous Peoples in research revealed many ways in which editorial boards of journals could improve their process to signal to readers that Indigenous voices are included in rural health research publication governance. Improving the health and wellbeing of Indigenous peoples worldwide requires high-quality research evidence. This quality benchmark needs to explicitly signal the inclusion of Indigenous authors. The ICIRAS is a call to action for research journals and institutions to rigorously improve research governance and leadership to amplify the cultural identity of Indigenous peoples in rural health research.
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Affiliation(s)
- Mark John Lock
- Girra Maa Indigenous Health Discipline, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2700, Australia; and Australian Journal of Rural Health
| | - Faye McMillan
- Aboriginal and Torres Strait Islander Health, School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Donald Warne
- Family and Community Medicine, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202-9037, USA
| | - Bindi Bennett
- First Nations Health, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Qld 4229, Australia
| | - Jacquie Kidd
- Maori Advancement Clinical Sciences, Department of Nursing, Auckland University of Technology, East Auckland City, New Zealand
| | - Naomi Williams
- School of Social Work, University of Windsor, Windsor, Ontario N9B 3P4, Canada
| | | | - Paul Worley
- Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, PO Box 346, Murray Bridge, SA 5253, Australia; and Prideaux Centre for Research in Health Professions Education, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Peter Hutten-Czapski
- Canadian Journal of Rural Medicine, Northern Ontario School of Medicine, Haileybury, ON, Canada
| | - Emily Saurman
- Broken Hill University Department of Rural Health, University of Sydney, PO BOX 457, Broken Hill, NSW 2880, Australia
| | - Veronica Mathews
- Centre for Research Excellence: Strengthening Systems for Indigenous Health Care Equity (CRE- STRIDE), University Centre for Rural Health, University of Sydney, Lismore, NSW 2480, Australia
| | - Emma Walke
- Centre for Research Excellence: Strengthening Systems for Indigenous Health Care Equity (CRE- STRIDE), University Centre for Rural Health, University of Sydney, Lismore, NSW 2480, Australia
| | - Dave Edwards
- Digital Mental Health, University Centre for Rural Health, University of Sydney, Lismore, NSW 2480, Australia
| | - Julie Owen
- Australian Aboriginal & Torres Strait Islander Operations, Library for All, Brisbane, Qld 4101, Australia
| | - Jennifer Browne
- Institute for Health Transformation, Deakin University, Geelong, Vic. 3220, Australia
| | - Russell Roberts
- Health Services Research Group, Charles Sturt University, Orange, NSW 2800, Australia
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13
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Padley J, Gonzalez-Chica D, Worley P, Morgan K, Walters L. Contemporary Australian socio-cultural factors and their influence on medical student rural career intent. Aust J Rural Health 2022; 30:520-528. [PMID: 35384122 PMCID: PMC9542073 DOI: 10.1111/ajr.12866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To understand how contemporary socio-cultural factors may impact medical students' rural career intent. DESIGN Cross-sectional study using data from the national Federation of Rural Australian Medical Educators survey. PARTICIPANTS/SETTING Medical students across 18 Australian universities who completed a full academic year of clinical training in rural areas in 2019. MAIN OUTCOME MEASURE(S) Preferred location of practice post-training reported to be either: (i) a major city; (ii) a regional area or large town; or (iii) a small rural location. RESULTS In total, 626 students completed the survey (70.1% response rate). A small rural location was the most preferred location of practice after graduation for 28.3% of the students (95% CI 21.6-36.0). Four socio-cultural factors were positively associated with a preference for a rural career location: poor health status of rural people, motor vehicle traffic congestion in cities, rural generalist training opportunities in the state and the Royal Flying Doctor Service. Other socio-cultural factors, including specialists' under-employment, Medicare freeze effect on doctors' income, bullying/sexual harassment in hospitals, climate change/natural disasters or recognised rural health personalities did not influence the investigated outcome. CONCLUSIONS Our findings indicate a novel association between contemporary socio-cultural factors and rural career intention in a cohort of Australian rural clinical school students. These findings advocate for further consideration of research exploring socio-cultural factors shaping rural career intent and workforce outcomes.
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Affiliation(s)
- James Padley
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - David Gonzalez-Chica
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Paul Worley
- Prideaux Centre for Research in Health Professions Education, Adelaide, South Australia, Australia
| | - Katrina Morgan
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
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Lock M, McMillan F, Bennett B, Martire JL, Warne D, Kidd J, Williams N, Worley P, Hutten-Czapski P, Roberts R. Position statement: Research and reconciliation with Indigenous peoples in rural health journals. Aust J Rural Health 2022; 30:6-7. [PMID: 35043514 DOI: 10.1111/ajr.12834] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mark Lock
- Deakin University, Melbourne, VIC, Australia
| | - Faye McMillan
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Bindi Bennett
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | | | - Donald Warne
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Jacquie Kidd
- Department of Nursing, Auckland University of Technology, Auckland, New Zealand
| | | | - Paul Worley
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, SA, Australia
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15
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Lock MJ, Beverley McMillan AMF, Bennett B, Martire JL, Warne D, Kidd J, Williams NG, Roberts R, Worley P, Hutten-Czapski P. Position statement: Research and reconciliation with Indigenous People in rural health journals. Can J Rural Med 2022; 27:3-4. [PMID: 34975107 DOI: 10.4103/cjrm.cjrm_67_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lock MJ, McMillan F, Bennett B, Martire JL, Warne D, Kidd J, Williams N, Roberts R, Worley P, Hutten-Czapski P. Position statement: research and reconciliation with Indigenous Peoples in rural health journals. Rural Remote Health 2022; 22:7353. [PMID: 35042369 DOI: 10.22605/rrh7353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mark John Lock
- School of Heath & Social Development, Faculty of Health, Deakin University, Melbourne; and Australian Journal of Rural Health
| | - Faye McMillan
- Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bindi Bennett
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Qld 4229, Australia
| | | | - Donald Warne
- Family and Community Medicine, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202-9037, USA
| | - Jacquie Kidd
- Department of Nursing, Auckland University of Technology, East Auckland City, New Zealand
| | - Naomi Williams
- School of Social Work, University of Windsor, Windsor, Ontario N9B 3P4, Canada
| | | | - Paul Worley
- Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, PO Box 346, Murray Bridge, SA 5253, Australia; and Prideaux Centre for Research in Health Professions Education, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
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Lock (Ngiyampaa) M, McMillan (Wiradjuri) F, Warne (Oglala Lakota) D, Bennett (Gamilaraay) B, Kidd (Ngāpuhi) J, Williams (Bkejwanong) N, Martire (Australian settler) J, Worley P, Hutten-Czapski P, Saurman E, Matthews (Quandamooka) V, Walke (Bundjalung) E, Edwards (Worimi) D, Owen (Nurrunga and Ngarrendjeri) J, Browne J, Roberts R. Indigenous cultural identity of research authors standard: Research and reconciliation with Indigenous peoples in rural health journals. Can J Rural Med 2022; 27:104-110. [DOI: 10.4103/cjrm.cjrm_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gardiner FW, Rallah-Baker K, Dos Santos A, Sharma P, Churilov L, Donnan GA, Davis SM, Quinlan F, Worley P. Indigenous Australians have a greater prevalence of heart, stroke, and vascular disease, are younger at death, with higher hospitalisation and more aeromedical retrievals from remote regions. EClinicalMedicine 2021; 42:101181. [PMID: 34765955 PMCID: PMC8573152 DOI: 10.1016/j.eclinm.2021.101181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to determine whether heart, stroke, and vascular disease (HSVD) prevalence and emergency primary evacuation (EPE), hospitalisation, and mortality differ by patient characteristics. METHODS An Australian-wide incidence population based study, with prospective data collected form the 1 July 2019 to the 30 October 2020. FINDINGS Indigenous Australians reported significantly higher prevalence of HSVD at 229.0 per-1000 as compared to 152.0 per-1000 non-Indigenous Australians: risk ratio 1.5 (95% CI 1.2-1.8). 583 remote patients received an EPE for HSVD, consisting of 388 (66.6%; 95% CI: 62.6-70.4) males and 195 (33.0%; 95% CI: 29.6-37.4) females. There were 289 (49.6%; 95% CI 45.4- 53.7) patients who identified as Indigenous, and 294 (50.4%; 95% CI 46.3- 54.6) as non-Indigenous. The mean Indigenous age during EPE was 48.0 (95% CI 45.9-50.1) years old, significantly lower than the non-Indigenous mean age of 55.6 (95% CI 53.8-57.4). Indigenous patients hospitalised for HSVD were younger, the majority younger than 65 years (n=21175; 73.7% 95% CI 73.2-74.2) as compared to non-Indigenous patients (n= 357654; 33.1% 95% CI 33.0-33.15). When adjusted for HSVD prevalence, remote Indigenous patients had a higher hospitalisation rate as compared to non-remote Indigenous patients (rate ratio: 1.6; 95% CI 1.3-2.0) and remote non-Indigenous patients (rate ratio: 1.2; 95% CI 1.0-1.5). More Indigenous patients died of HSVD before the age of 65 years (n=1875; 56.5% 95% CI 54.8-58.2) as compared to non-Indigenous patients (n= 16161; 10.6% 95% CI 10.45-10.8). INTERPRETATION Indigenous Australians have a higher prevalence, and younger age during EPE, and hospitalisation for HSVD than non-Indigenous Australians. FUNDING This is a self/internally-funded study, with the lead organisation being the Royal Flying Doctor Service (RFDS) of Australia. For the duration of the study period, the RFDS provided in-kind support including one full-time equivalent (FTE) and resources (office space, computer, research software, and office equipment). There was no external funding source that had a role in study design or data analysis or interpretation.
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Affiliation(s)
- Fergus W Gardiner
- The Royal Flying Doctor Service, Canberra, Australia
- Corresponding author. Dr Fergus W Gardiner, Royal Flying Doctor Service, Level 2, 10-12 Brisbane Avenue, Barton ACT 2600 Australia
| | - Kristopher Rallah-Baker
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Angela Dos Santos
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | | | - Leonid Churilov
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Geoffrey A Donnan
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Stephen M. Davis
- Department of Medicine (Austin Health), The University of Melbourne, Victoria Australia
| | - Frank Quinlan
- The Royal Flying Doctor Service, Canberra, Australia
| | - Paul Worley
- Riverland Mallee Coorong Local Health Network, Murray Bridge, Australia
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Couper I, Worley P. Researching 'others'. Rural Remote Health 2021; 21:6819. [PMID: 34210146 DOI: 10.22605/rrh6819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ian Couper
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Paul Worley
- Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, PO Box 346, Murray Bridge, SA 5253, Australia; Prideaux Centre for Research in Health Professions Education, Flinders University, GPO Box 2100, Adelaide , SA 5001, Australia; and Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Lleó A, Carmona-Iragui M, Videla L, Fernández S, Benejam B, Pegueroles J, Barroeta I, Altuna M, Valldeneu S, Xiao MF, Xu D, Núñez-Llaves R, Querol-Vilaseca M, Sirisi S, Bejanin A, Iulita MF, Clarimón J, Blesa R, Worley P, Alcolea D, Fortea J, Belbin O. VAMP-2 is a surrogate cerebrospinal fluid marker of Alzheimer-related cognitive impairment in adults with Down syndrome. Alzheimers Res Ther 2021; 13:119. [PMID: 34183050 PMCID: PMC8240298 DOI: 10.1186/s13195-021-00861-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is an urgent need for objective markers of Alzheimer's disease (AD)-related cognitive impairment in people with Down syndrome (DS) to improve diagnosis, monitor disease progression, and assess response to disease-modifying therapies. Previously, GluA4 and neuronal pentraxin 2 (NPTX2) showed limited potential as cerebrospinal fluid (CSF) markers of cognitive impairment in adults with DS. Here, we compare the CSF profile of a panel of synaptic proteins (Calsyntenin-1, Neuroligin-2, Neurexin-2A, Neurexin-3A, Syntaxin-1B, Thy-1, VAMP-2) to that of NPTX2 and GluA4 in a large cohort of subjects with DS across the preclinical and clinical AD continuum and explore their correlation with cognitive impairment. METHODS We quantified the synaptic panel proteins by selected reaction monitoring in CSF from 20 non-trisomic cognitively normal controls (mean age 44) and 80 adults with DS grouped according to clinical AD diagnosis (asymptomatic, prodromal AD or AD dementia). We used regression analyses to determine CSF changes across the AD continuum and explored correlations with age, global cognitive performance (CAMCOG), episodic memory (modified cued-recall test; mCRT) and CSF biomarkers, CSF Aβ42:40 ratio, CSF Aβ1-42, CSF p-tau, and CSF NFL. P values were adjusted for multiple testing. RESULTS In adults with DS, VAMP-2 was the only synaptic protein to correlate with episodic memory (delayed recall adj.p = .04) and age (adj.p = .0008) and was the best correlate of CSF Aβ42:40 (adj.p = .0001), p-tau (adj.p < .0001), and NFL (adj.p < .0001). Compared to controls, mean VAMP-2 levels were lower in asymptomatic adults with DS only (adj.p = .02). CSF levels of Neurexin-3A, Thy-1, Neurexin-2A, Calysntenin-1, Neuroligin-2, GluA4, and Syntaxin-1B all strongly correlated with NPTX2 (p < .0001), which was the only synaptic protein to show reduced CSF levels in DS at all AD stages compared to controls (adj.p < .002). CONCLUSION These data show proof-of-concept for CSF VAMP-2 as a potential marker of synapse degeneration that correlates with CSF AD and axonal degeneration markers and cognitive performance.
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Affiliation(s)
- Alberto Lleó
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Maria Carmona-Iragui
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Laura Videla
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Susana Fernández
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Bessy Benejam
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Barcelona Down Medical Center, Fundació Catalana Síndrome de Down, Barcelona, Spain
| | - Jordi Pegueroles
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Isabel Barroeta
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Miren Altuna
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Silvia Valldeneu
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Mei-Fang Xiao
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Desheng Xu
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Raúl Núñez-Llaves
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Marta Querol-Vilaseca
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Sònia Sirisi
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Alexandre Bejanin
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - M Florencia Iulita
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
| | - Jordi Clarimón
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Rafael Blesa
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Paul Worley
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Daniel Alcolea
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Juan Fortea
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain
| | - Olivia Belbin
- Memory Unit and Biomedical Research Institute Sant Pau (IIB Sant Pau), Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, c/Sant Quintí, 77-79, 08025, Barcelona, Spain.
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031, Madrid, Spain.
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O'Sullivan B, Chater B, Bingham A, Wynn-Jones J, Couper I, Hegazy NN, Kumar R, Lawson H, Martinez-Bianchi V, Randenikumara S, Rourke J, Strasser S, Worley P. A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries. Front Med (Lausanne) 2020; 7:594728. [PMID: 33330559 PMCID: PMC7729061 DOI: 10.3389/fmed.2020.594728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem. Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period. Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type. Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of "grow your own" strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.
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Affiliation(s)
- Belinda O'Sullivan
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Bruce Chater
- Faculty of Medicine, Rural Clinical School, University of Queensland, Theodore, QLD, Australia
| | - Amie Bingham
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - John Wynn-Jones
- Keele Medical School, Keele University, Keele, United Kingdom
| | - Ian Couper
- Ukwanda Center for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Nagwa Nashat Hegazy
- Medical Education and Human Resources Center, Faculty of Medicine, Menoufia University, Shibin el Kom, Egypt
| | - Raman Kumar
- Family Medicine Practitioner, DOC24 Family Practice Clinic, Ghaziabad, India
| | - Henry Lawson
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | | | - James Rourke
- Center for Rural Health Studies, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Sarah Strasser
- Faculty of Medicine, Rural Clinical School, University of Queensland, Toowoomba, QLD, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Abstract
INTRODUCTION The allied health workforce is one of the largest workforces in the health industry. It has a critical role in cost-effective, preventative health care, but it is poorly accessible in rural areas worldwide. This review aimed to inform policy and research priorities for increasing access to rural allied health services in Australia by describing the extent, range and nature of evidence about this workforce. METHODS A scoping review of published, peer-reviewed rural allied health literature from Australia, Canada, the USA, New Zealand and Japan was obtained from six databases (February 1999 - February 2019). RESULTS Of 7305 no-duplicate articles, 120 published studies were included: 19 literature reviews, and 101 empirical studies from Australia (n=90), Canada (n=8), USA (n=2) and New Zealand (n=1). Main themes were workforce and scope (n=9), rural pathways (n=44), recruitment and retention (n=31), and models of service (n=36). Of the empirical studies, 83% per cent were cross-sectional; 64% involved surveys; only 7% were at a national scale. Rural providers were shown to have a breadth of practice, servicing large catchments with high patient loads, requiring rural-specific skills. Most rural practitioners had rural backgrounds, but rural youth faced barriers to accessing allied health courses. Rural training opportunities have increased in Australia but predominantly as short-term placements. Rural placements were associated with increased likelihood of rural work by graduates compared with discipline averages, and high quality placement experiences were linked with return. Recruitment and retention factors may vary by discipline, sector and life stage but important factors were satisfying jobs, workplace supervision, higher employment grade, sustainable workload, professional development and rural career options. Patient-centred planning and regional coordination of public and private providers with clear eligibility and referral to pathways facilitated patient care. Outreach and telehealth models may improve service distribution although require strong local coordination and training for distal staff. CONCLUSION Evidence suggests that more accessible rural allied health services in Australia should address three key policy areas. First, improving rural jobs with access to senior workplace supervision and career options will help to improve networks of critical mass. Second, training skilled and qualified workers through more continuous, high quality rural pathways is needed to deliver a complementary workforce for the community. Third, distribution depends on networked service models at the regional level, with viable remuneration, outreach and telehealth for practice in smaller communities. More national-scale, longitudinal, outcomes-focused studies are needed using controlled designs.
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Affiliation(s)
- Belinda G O'Sullivan
- Rural Clinical School, Faculty of Medicine, University of Queensland, PO Box 9009, Toowoomba, Qld 3550, Australia
| | - Paul Worley
- Prideaux Centre for Research in Health Professions Education, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
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Segin S, Berlin M, Richter C, Medert R, Flockerzi V, Worley P, Freichel M, Camacho Londoño JE. Cardiomyocyte-Specific Deletion of Orai1 Reveals Its Protective Role in Angiotensin-II-Induced Pathological Cardiac Remodeling. Cells 2020; 9:cells9051092. [PMID: 32354146 PMCID: PMC7290784 DOI: 10.3390/cells9051092] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
Pathological cardiac remodeling correlates with chronic neurohumoral stimulation and abnormal Ca2+ signaling in cardiomyocytes. Store-operated calcium entry (SOCE) has been described in adult and neonatal murine cardiomyocytes, and Orai1 proteins act as crucial ion-conducting constituents of this calcium entry pathway that can be engaged not only by passive Ca2+ store depletion but also by neurohumoral stimuli such as angiotensin-II. In this study, we, therefore, analyzed the consequences of Orai1 deletion for cardiomyocyte hypertrophy in neonatal and adult cardiomyocytes as well as for other features of pathological cardiac remodeling including cardiac contractile function in vivo. Cellular hypertrophy induced by angiotensin-II in embryonic cardiomyocytes from Orai1-deficient mice was blunted in comparison to cells from litter-matched control mice. Due to lethality of mice with ubiquitous Orai1 deficiency and to selectively analyze the role of Orai1 in adult cardiomyocytes, we generated a cardiomyocyte-specific and temporally inducible Orai1 knockout mouse line (Orai1CM–KO). Analysis of cardiac contractility by pressure-volume loops under basal conditions and of cardiac histology did not reveal differences between Orai1CM–KO mice and controls. Moreover, deletion of Orai1 in cardiomyocytes in adult mice did not protect them from angiotensin-II-induced cardiac remodeling, but cardiomyocyte cross-sectional area and cardiac fibrosis were enhanced. These alterations in the absence of Orai1 go along with blunted angiotensin-II-induced upregulation of the expression of Myoz2 and a lack of rise in angiotensin-II-induced STIM1 and Orai3 expression. In contrast to embryonic cardiomyocytes, where Orai1 contributes to the development of cellular hypertrophy, the results obtained from deletion of Orai1 in the adult myocardium reveal a protective function of Orai1 against the development of angiotensin-II-induced cardiac remodeling, possibly involving signaling via Orai3/STIM1-calcineurin-NFAT related pathways.
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Affiliation(s)
- Sebastian Segin
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany; (S.S.); (M.B.); (C.R.); (R.M.); (M.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Michael Berlin
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany; (S.S.); (M.B.); (C.R.); (R.M.); (M.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Christin Richter
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany; (S.S.); (M.B.); (C.R.); (R.M.); (M.F.)
| | - Rebekka Medert
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany; (S.S.); (M.B.); (C.R.); (R.M.); (M.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Veit Flockerzi
- Experimentelle und Klinische Pharmakologie und Toxikologie, Universität des Saarlandes, 66421 Homburg, Germany;
| | - Paul Worley
- The Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, MD 21205, USA;
| | - Marc Freichel
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany; (S.S.); (M.B.); (C.R.); (R.M.); (M.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Juan E. Camacho Londoño
- Pharmakologisches Institut, Ruprecht-Karls-Universität Heidelberg, INF 366, 69120 Heidelberg, Germany; (S.S.); (M.B.); (C.R.); (R.M.); (M.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-54-86863; Fax: +49-6221-54-8644
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Bartlett M, Couper I, Poncelet A, Worley P. Correction to: The do's, don'ts and don't knows of establishing a sustainable longitudinal integrated clerkship. Perspect Med Educ 2020; 9:128. [PMID: 32107727 PMCID: PMC7138762 DOI: 10.1007/s40037-020-00570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Unfortunately information regarding the disclaimer of Paul Worley's affiliation is missing from the original article. Please find the information here:Paul Worley is affiliated to the Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, Australia. He is the ….
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Affiliation(s)
- Maggie Bartlett
- Education in General Practice, Dundee University School of Medicine, Dundee, UK.
| | - Ian Couper
- Faculty of Medicine and Health Sciences , Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ann Poncelet
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Paul Worley
- Department of Health, GPO Box 9848, 2601, Canberra, Australian Capital Territory, Australia
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, Australia
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Affiliation(s)
- Paul Worley
- Prideaux Centre for Research in Health Professions Education, Flinders University, GPO Box 2100, Adelaide , SA 5001, Australia
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Bartlett M, Couper I, Poncelet A, Worley P. The do's, don'ts and don't knows of establishing a sustainable longitudinal integrated clerkship. Perspect Med Educ 2020; 9:5-19. [PMID: 31953655 PMCID: PMC7012799 DOI: 10.1007/s40037-019-00558-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program. METHOD All four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do's, Don'ts and Don't Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline. RESULTS The final set of 18 Do's, Don'ts and Don't Knows is presented with an appraisal of the evidence for each one. CONCLUSION Implementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don't Knows, in particular the question of how cost-effectiveness is best measured.
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Affiliation(s)
- Maggie Bartlett
- Education in General Practice, Dundee University School of Medicine, Dundee, UK.
| | - Ian Couper
- Faculty of Medicine and Health Sciences, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ann Poncelet
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Paul Worley
- Department of Health, GPO Box 9848, 2601, Canberra, Australian Capital Territory, Australia
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Affiliation(s)
- Lucie Walters
- Adelaide Rural Clinical School, University of Adelaide, Mount Gambier, Australia
| | - Paul Worley
- Prideaux Centre for Health Professions Education, Flinders University, Adelaide, Australia
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
- National Rural Health Commissioner, Australian Government, Canberra, Australia
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Galasko D, Xiao M, Xu D, Smirnov D, Salmon DP, Dewit N, Vanbrabant J, Jacobs D, Vanderstichele H, Vanmechelen E, Worley P. Synaptic biomarkers in CSF aid in diagnosis, correlate with cognition and predict progression in MCI and Alzheimer's disease. Alzheimers Dement (N Y) 2019; 5:871-882. [PMID: 31853477 PMCID: PMC6911971 DOI: 10.1016/j.trci.2019.11.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Amyloid, Tau, and neurodegeneration biomarkers can stage Alzheimer's Disease (AD). Synaptic biomarkers may help track cognition. METHODS In cognitively normal controls, Mild Cognitive Impairment (MCI) and AD, we investigated CSF biomarkers in relation to cognitive measures and as predictors of cognitive and global decline. RESULTS There were 90 normal controls (mean age 73.0, 58% women), 57 MCI (mean age 74.3, 35% women), and 46 AD (mean age 70.7, 41% women). CSF Aβ1-42 and Neuronal Pentraxin 2 (NPTX2) were decreased, and CSF Tau, neurogranin, and SNAP25 increased in AD versus controls. Aβ1-42/Tau or NPTX2/Tau discriminated AD and controls best. NPTX2/Tau correlated strongly with cognition in AD and MCI and predicted a 2-3-year decline. We replicated findings in the ADNI cohort. DISCUSSION CSF synaptic biomarkers, particularly NPTX2, which regulates synaptic homeostasis, relate to cognition and predict progression in AD beyond Aβ1-42 and Tau. This is relevant for prognosis and clinical trials.
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Affiliation(s)
- Douglas Galasko
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - Meifang Xiao
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Desheng Xu
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Denis Smirnov
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | - David P. Salmon
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
| | | | | | | | | | | | | | - Paul Worley
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Roh SE, Xiao M, Zhuo J, Savonenko A, Worley P. Circadian regulation of the immediate early gene Neuronal Pentraxin 2 secretion: in vivo imaging study. IBRO Rep 2019. [DOI: 10.1016/j.ibror.2019.07.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Soldan A, Moghekar A, Walker KA, Pettigrew C, Hou X, Lu H, Miller MI, Alfini A, Albert M, Xu D, Xiao MF, Worley P. Resting-State Functional Connectivity Is Associated With Cerebrospinal Fluid Levels of the Synaptic Protein NPTX2 in Non-demented Older Adults. Front Aging Neurosci 2019; 11:132. [PMID: 31231205 PMCID: PMC6568192 DOI: 10.3389/fnagi.2019.00132] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
Intrinsic functional connectivity of large-scale brain networks has been shown to change with aging and Alzheimer’s disease (AD). These alterations are thought to reflect changes in synaptic function, but the underlying biological mechanisms are poorly understood. This study examined whether Neuronal Pentraxin 2 (NPTX2), a synaptic protein that mediates homeostatic strengthening of inhibitory circuits to control cortical excitability, is associated with functional connectivity as measured by resting-state functional magnetic resonance imaging (rsfMRI) in five large-scale cognitive brain networks. In this cross-sectional study, rsfMRI scans were obtained from 130 older individuals (mean age = 69 years) with normal cognition (N = 113) and Mild Cognitive Impairment (N = 17); NPTX2 was measured in the same individuals in cerebrospinal fluid (CSF). Higher levels of NPTX2 in CSF were associated with greater functional connectivity in the salience/ventral attention network, based on linear regression analysis. Moreover, this association was stronger among individuals with lower levels of cognitive reserve, as measured by a composite score (comprised of years of education, reading, and vocabulary measures). Additionally, higher connectivity in the salience/ventral attention network was related to better performance on a composite measure of executive function. Levels of NPTX2 were not associated with connectivity in other networks (executive control, limbic, dorsal attention, and default-mode). Findings also confirmed prior reports that individuals with MCI have lower levels of NPTX2 compared to those with normal cognition. Taken together, the results suggest that NPTX2 mechanisms may play a central role among older individuals in connectivity within the salience/ventral attention network and for cognitive tasks that require modulation of attention and response selection.
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Affiliation(s)
- Anja Soldan
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Keenan A Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Corinne Pettigrew
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Xirui Hou
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Hanzhang Lu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Michael I Miller
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Alfonso Alfini
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Marilyn Albert
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Desheng Xu
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mei-Fang Xiao
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Paul Worley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Abstract
Introduction: The early part of this century saw an unprecedented growth in number and size of Australian medical schools. There was some partnering of the new schools with existing programs. Griffith, Deakin and Curtin Universities leased an established curriculum from Flinders University. Nature and rationale for curriculum leasing: The new schools had short startup times and leasing a curriculum enabled them to appoint key staff, develop facilities and meet accreditation requirements in a timely way. However, the lease arrangements were costly and the curriculum was largely determined before the Dean and key staff appointments. Outcomes of leasing: There was differential adoption of the leased curriculum. The first two years of the courses at Flinders were transferred with little change. The final two years of predominantly clinical studies were developed differently. This is explained through Michael Fullan's work on context in educational change. The context of the clinical years of the courses involved negotiations with local health services and other schools using those health services. The advantage of the leasing arrangements was that the new schools could proceed through early development and accreditation, while having time and opportunity to negotiate a clinical curriculum that engaged local health services and fulfilled the new schools' missions.
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Affiliation(s)
- David Prideaux
- a Prideaux Centre for Research in Health Professions Education Flinders University , Adelaide , Australia
| | - Julie Ash
- a Prideaux Centre for Research in Health Professions Education Flinders University , Adelaide , Australia
| | - Simon Broadley
- b School of Medicine , Griffith University, Gold Coast , Australia
| | - Brendan Crotty
- c Faculty of Health , Deakin University , Geelong , Australia
| | | | - Judy Searle
- b School of Medicine , Griffith University, Gold Coast , Australia
| | - Jon Watson
- e School of Medicine , Deakin University , Geelong , Australia
| | - Lindon Wing
- f School of Medicine , Flinders University , Adelaide , Australia
| | - Paul Worley
- f School of Medicine , Flinders University , Adelaide , Australia
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Worley P, Lowe M, Notaras L, Strasser S, Kidd M, Slee M, Williams R, Noutsos T, Wakerman J. The Northern Territory Medical Program - growing our own in the NT. Rural Remote Health 2019; 19:4671. [PMID: 31129974 DOI: 10.22605/rrh4671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
CONTEXT The Northern Territory (NT) is characterised by major health inequalities. A high proportion of the population is Indigenous, with poor socioeconomic conditions and a high burden of disease. The small NT population - 1% of the total Australian population - is dispersed over one-sixth of Australia's land mass. Given this very low population density and the geographical isolation of many small communities, access to services is often difficult. Medical workforce recruitment and retention have been persistent problems. Prior to 2011, NT residents who aspired to study medicine had to leave the NT. This was the only Australian state or territory that did not have the capacity for students to complete an entire medical degree within the jurisdiction. This article describes the development, implementation and outcomes of the Northern Territory Medical Program (NTMP), which commenced in Darwin in 2011. This was a major development of the Flinders University distributed program, which aimed to develop the medical workforce for the challenging NT environment. ISSUES Based on evidence regarding the importance of selection in achieving rural workforce outcomes, and a national priority to graduate more Indigenous Australian doctors, NT residents and Indigenous applicants to the NTMP were prioritised in the selection process. Aspiring doctors would not now have to move interstate to study. The curriculum of Flinders University, based in Adelaide, South Australia, would be contextualised to the NT. The NTMP was developed and implemented in collaboration with Charles Darwin University, the major university in the NT. LESSONS LEARNED Some of the lessons learned may be useful to others contemplating the delivery of a distributed program that includes a full medical program in a remote area. These include: Leadership at the highest levels of the university is crucial. Expect faculty turnover and avoid single person vulnerabilities. Actively engage local clinicians. Ensure a strong focus on new or alternative selection processes that are able to predict progression. Provide preparatory skills and support for students, especially Indigenous students, with non-science backgrounds. Appreciate and accommodate the community and family pressures experienced by some Indigenous students. Anticipate that the first pioneering cohort of students will not be typical of future cohorts, and work with them to adapt the curriculum, teaching and selection methods. Whilst exemplary telecommunications are needed, some elements of the curriculum will be able to be delivered far better locally than at the larger campus. Do not underestimate the level of student and staff support required both locally and centrally. Develop a 'network' rather than a 'hub and spoke' model. The network may include multiple dispersed placement sites, requiring infrastructure, staffing and ongoing support. The 'new kid' will mean the 'older sibling' will change for the better and use the small size and agility to explore innovations. Focus on the goals. We wanted to contribute to improved economic, social and health outcomes for NT residents by developing an appropriately prepared medical workforce, thereby eliminating the need to recruit doctors from interstate and overseas, and by graduating more Indigenous doctors - potential medical leaders for Australia. Build your expectation for success based on past successes in innovation. Flinders University was able to build on its experience in developing the first 4-year medical program in Australia.
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Affiliation(s)
- Paul Worley
- Prideaux Centre for Research in Health Professions Education, Flinders University, GPO Box 2100, Adelaide , SA 5001, Australia
| | - Michael Lowe
- c/o Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0820, Australia
| | - Leonard Notaras
- National Critical Care and Trauma Response Centre, Royal Darwin Hospital, PO Box 41326, Casuarina, NT 0811, Australia
| | - Sarah Strasser
- University of Queensland Rural Clinical School, Faculty of Medicine, The University of Queensland, 152 West St, Toowoomba, Qld 4350, Australia
| | - Michael Kidd
- Department of Family & Community Medicine, University of Toronto, Canada
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, GPO Box 2100, Adelaide , SA 5001, Australia
| | - Rhys Williams
- Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Tina Noutsos
- College of Medicine and Public Health, Flinders University and NT Department of Health, Royal Darwin Hospital, PO Box 41326, Casuarina, NT 0811, Australia
| | - John Wakerman
- Flinders Northern Territory, Centre for Remote Health, PO Box 4066, Alice Springs, NT 0871, Australia
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Steward O, Matsudaira Yee K, Farris S, Pirbhoy PS, Worley P, Okamura K, Okuno H, Bito H. Delayed Degradation and Impaired Dendritic Delivery of Intron-Lacking EGFP- Arc/ Arg3.1 mRNA in EGFP-Arc Transgenic Mice. Front Mol Neurosci 2018; 10:435. [PMID: 29445324 PMCID: PMC5797788 DOI: 10.3389/fnmol.2017.00435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022] Open
Abstract
Arc is a unique immediate early gene (IEG) whose expression is induced as synapses are modified during learning. Newly-synthesized Arc mRNA is rapidly transported throughout dendrites and localizes near recently activated synapses. Arc mRNA levels are regulated by rapid degradation, which is accelerated by synaptic activity in a translation-dependent process. One possible mechanism is nonsense-mediated mRNA decay (NMD), which depends on the presence of a splice junction in the 3'UTR. Here, we test this hypothesis using transgenic mice that express EGFP-Arc. Because the transgene was constructed from Arc cDNA, it lacks intron structures in the 3'UTR that are present in the endogenous Arc gene. NMD depends on the presence of proteins of the exon junction complex (EJC) downstream of a stop codon, so EGFP-Arc mRNA should not undergo NMD. Assessment of Arc mRNA rundown in the presence of the transcription inhibitor actinomycin-D confirmed delayed degradation of EGFP-Arc mRNA. EGFP-Arc mRNA and protein are expressed at much higher levels in transgenic mice under basal and activated conditions but EGFP-Arc mRNA does not enter dendrites efficiently. In a physiological assay in which cycloheximide (CHX) was infused after induction of Arc by seizures, there were increases in endogenous Arc mRNA levels consistent with translation-dependent Arc mRNA decay but this was not seen with EGFP-Arc mRNA. Taken together, our results indicate: (1) Arc mRNA degradation occurs via a mechanism with characteristics of NMD; (2) rapid dendritic delivery of newly synthesized Arc mRNA after induction may depend in part on prior splicing of the 3'UTR.
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Affiliation(s)
- Oswald Steward
- Reeve-Irvine Research Center, University of California, Irvine, Irvine, CA, United States
- Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, United States
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, United States
| | - Kelly Matsudaira Yee
- Reeve-Irvine Research Center, University of California, Irvine, Irvine, CA, United States
- Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, United States
| | - Shannon Farris
- Reeve-Irvine Research Center, University of California, Irvine, Irvine, CA, United States
- Department of Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, United States
| | - Patricia S. Pirbhoy
- Reeve-Irvine Research Center, University of California, Irvine, Irvine, CA, United States
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
| | - Paul Worley
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kohji Okamura
- Department of Systems BioMedicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hiroyuki Okuno
- Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Haruhiko Bito
- Department of Neurochemistry, University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Worley P. Why do we persist with teaching students in antagonistic unrepresentative learning environments? Education for Primary Care 2018; 29:11-12. [DOI: 10.1080/14739879.2017.1416494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paul Worley
- Department of Health, National Rural Health Commissioner, Canberra, Australia
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Teodorczuk A, Yardley S, Patel R, Rogers GD, Billett S, Worley P, Hirsh D, Illing J. Medical education research should extend further into clinical practice. Med Educ 2017; 51:1098-1100. [PMID: 29024150 DOI: 10.1111/medu.13459] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Asrani K, Sood A, Torres A, Georgess D, Phatak P, Kaur H, Dubin A, Talbot CC, Elhelu L, Ewald AJ, Xiao B, Worley P, Lotan TL. mTORC1 loss impairs epidermal adhesion via TGF-β/Rho kinase activation. J Clin Invest 2017; 127:4001-4017. [PMID: 28945203 DOI: 10.1172/jci92893] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 08/02/2017] [Indexed: 12/14/2022] Open
Abstract
Despite its central position in oncogenic intracellular signaling networks, the role of mTORC1 in epithelial development has not been studied extensively in vivo. Here, we have used the epidermis as a model system to elucidate the cellular effects and signaling feedback sequelae of mTORC1 loss of function in epithelial tissue. In mice with conditional epidermal loss of the mTORC1 components Rheb or Rptor, mTORC1 loss of function unexpectedly resulted in a profound skin barrier defect with epidermal abrasions, blistering, and early postnatal lethality, due to a thinned epidermis with decreased desmosomal protein expression and incomplete biochemical differentiation. In mice with mTORC1 loss of function, we found that Rho kinase (ROCK) signaling was constitutively activated, resulting in increased cytoskeletal tension and impaired cell-cell adhesion. Inhibition or silencing of ROCK1 was sufficient to rescue keratinocyte adhesion and biochemical differentiation in these mice. mTORC1 loss of function also resulted in marked feedback upregulation of upstream TGF-β signaling, triggering ROCK activity and its downstream effects on desmosomal gene expression. These findings elucidate a role for mTORC1 in the regulation of epithelial barrier formation, cytoskeletal tension, and cell adhesion, underscoring the complexity of signaling feedback following mTORC1 inhibition.
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Affiliation(s)
| | | | | | - Dan Georgess
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pornima Phatak
- Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | | | | | | | | | - Andrew J Ewald
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Oncology, and
| | - Bo Xiao
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul Worley
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tamara L Lotan
- Department of Pathology and.,Department of Oncology, and
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Husain N, Yuan Q, Yen YC, Pletnikova O, Sally DQ, Worley P, Bichler Z, Shawn Je H. TRIAD3/RNF216 mutations associated with Gordon Holmes syndrome lead to synaptic and cognitive impairments via Arc misregulation. Aging Cell 2017; 16:281-292. [PMID: 27995769 PMCID: PMC5334534 DOI: 10.1111/acel.12551] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/26/2022] Open
Abstract
Multiple loss-of-function mutations in TRIAD3 (a.k.a. RNF216) have recently been identified in patients suffering from Gordon Holmes syndrome (GHS), characterized by cognitive decline, dementia, and movement disorders. TRIAD3A is an E3 ubiquitin ligase that recognizes and facilitates the ubiquitination of its target for degradation by the ubiquitin-proteasome system (UPS). Here, we demonstrate that two of these missense substitutions in TRIAD3 (R660C and R694C) could not regulate the degradation of their neuronal target, activity-regulated cytoskeletal-associated protein (Arc/Arg 3.1), whose expression is critical for synaptic plasticity and memory. The synaptic deficits due to the loss of endogenous TRIAD3A could not be rescued by TRIAD3A harboring GHS-associated missense mutations. Moreover, we demonstrate that the loss of endogenous TRIAD3A in the mouse hippocampal CA1 region led to deficits in spatial learning and memory. Finally, we show that these missense mutations abolished the interaction of TRIAD3A with Arc, disrupting Arc ubiquitination, and consequently Arc degradation. Our current findings of Arc misregulation by TRIAD3A variants suggest that loss-of-function mutations in TRIAD3A may contribute to dementia observed in patients with GHS driven by dysfunctional UPS components, leading to cognitive impairments through the synaptic protein Arc.
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Affiliation(s)
- Nilofer Husain
- Signature Program in Neuroscience and Behavioral Disorders; Duke-NUS Medical School Singapore; 8 College Road Singapore 169857 Singapore
| | - Qiang Yuan
- Signature Program in Neuroscience and Behavioral Disorders; Duke-NUS Medical School Singapore; 8 College Road Singapore 169857 Singapore
| | - Yi-Chun Yen
- Signature Program in Neuroscience and Behavioral Disorders; Duke-NUS Medical School Singapore; 8 College Road Singapore 169857 Singapore
| | - Olga Pletnikova
- Department of Pathology; Johns Hopkins University School of Medicine; Baltimore MD 21205 USA
| | - Dong Qianying Sally
- Behavioral Neuroscience Laboratory; National Neuroscience Institute; 11 Jalan Tan Tock Seng 308433 Singapore Singapore
| | - Paul Worley
- Solomon H. Snyder Department of Neuroscience; Johns Hopkins University School of Medicine; Baltimore MD 21205 USA
| | - Zoë Bichler
- Signature Program in Neuroscience and Behavioral Disorders; Duke-NUS Medical School Singapore; 8 College Road Singapore 169857 Singapore
- Behavioral Neuroscience Laboratory; National Neuroscience Institute; 11 Jalan Tan Tock Seng 308433 Singapore Singapore
| | - H. Shawn Je
- Signature Program in Neuroscience and Behavioral Disorders; Duke-NUS Medical School Singapore; 8 College Road Singapore 169857 Singapore
- Department of Physiology; Yong Loo Lin School of Medicine; National University of Singapore; Singapore 117597 Singapore
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Castelo-Branco L, Finucane P, Marvão P, McCrorie P, Ponte J, Worley P. Global sharing, local innovation: Four schools, four countries, one curriculum. Med Teach 2016; 38:1204-1208. [PMID: 27248161 DOI: 10.1080/0142159x.2016.1181731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Many internal and external obstacles, must be overcome when establishing a new medical school, or when radically revising an existing medical curriculum. AIMS Twenty-five years after the Flinders University curriculum was introduced as the first graduate-entry medical programme (GEMP) in Australia, we aim at describing how it has been adopted and adapted by several other schools, in Australia and in Europe (UK, Ireland, and Portugal). METHOD/RESULTS This paper reports on the experience of four schools establishing a new medical school or new curriculum at different times and in different settings. CONCLUSIONS We believe that these experiences might be of interest to others contemplating a similar development.
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Affiliation(s)
| | - Paul Finucane
- b Graduate-Entry Medical School, University of Limerick , Limerick , Ireland
| | - Pedro Marvão
- c Graduate Entry Medical School, University of Algarve , Faro , Portugal
- g Manchester Medical School, The University of Manchester , Manchester , UK
| | | | - José Ponte
- c Graduate Entry Medical School, University of Algarve , Faro , Portugal
| | - Paul Worley
- e Prideaux Centre for Research in Health Professions Education, Flinders University , Adelaide , Australia
- f South Australian Health and Medical Research Institute , Adelaide , Australia
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Mahoney S, Worley P, Parry H, Clarke S. Urban general practice and medical education: Academic outcomes from a unique urban, longitudinal integrated community-based program. Aust Fam Physician 2016; 45:754-757. [PMID: 27695727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND In 2009, Flinders University established an urban, community-based, longitudinal integrated program providing medical students extended placements that offered continuities of patient care, clinical supervision and peer group. OBJECTIVE The aim of this research was to analyse academic outcomes of the new placement program. METHODS The results of all students undertaking Year 3 exams from 2011 to 2014 were collected and analysed. The Years 1 and 2 exam results for students in the new program were also analysed. RESULTS Students in the new placement program achieved significantly higher grades than those who undertook the traditional rotations program, with aver-age scores of 69.05, compared with 66.45 (P = 0.03). Analysis of average class ranking for students who undertook the new program showed a statistically significant improvement from 59th in class to 48th in class (P = 0.03). DISCUSSION This evaluation shows that an urban, community-based, longitudinal integrated clerkship centred in general practice provides at least academically equivalent outcomes to traditional rotations-based programs.
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Affiliation(s)
- Sarah Mahoney
- MBBS, is Senior Lecturer, Flinders University and Academic Coordinator, Onkaparinga Clinical Education Program, Adelaide, South Australia
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Seymour-Walsh A, Worley P, Vnuk A, Grantham H. The art of education: Why do we teach skills the way we do? Resuscitation 2016. [DOI: 10.1016/j.resuscitation.2016.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Worley P, Couper I, Strasser R, Graves L, Cummings BA, Woodman R, Stagg P, Hirsh D. A typology of longitudinal integrated clerkships. Med Educ 2016; 50:922-32. [PMID: 27562892 DOI: 10.1111/medu.13084] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/14/2015] [Accepted: 03/14/2016] [Indexed: 05/13/2023]
Abstract
CONTEXT Longitudinal integrated clerkships (LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time-limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution-specific studies. OBJECTIVES This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. METHODS Data on all LIC and LIC-like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student-years of LIC-like curricula. RESULTS Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC-like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. CONCLUSIONS Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context.
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Affiliation(s)
- Paul Worley
- Prideaux Centre for Research in Health Professions Education, School of Medicine, Flinders University, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Lisa Graves
- Department of Family and Community Medicine, School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Beth-Ann Cummings
- Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatics, Flinders University, Adelaide, South Australia, Australia
| | - Pamela Stagg
- Centre for Remote Health, School of Medicine, Flinders University, Darwin, Australia
| | - David Hirsh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Seymour-Walsh A, Worley P, Vnuk A, Grantham H. Is the common approach to teaching ALS skills cost-effective? Resuscitation 2016. [DOI: 10.1016/j.resuscitation.2016.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pálsdóttir B, Barry J, Bruno A, Barr H, Clithero A, Cobb N, De Maeseneer J, Kiguli-Malwadde E, Neusy AJ, Reeves S, Strasser R, Worley P. Training for impact: the socio-economic impact of a fit for purpose health workforce on communities. Hum Resour Health 2016; 14:49. [PMID: 27523088 PMCID: PMC4983779 DOI: 10.1186/s12960-016-0143-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/28/2016] [Indexed: 05/04/2023]
Abstract
Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.
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Affiliation(s)
- Björg Pálsdóttir
- Training for Health Equity Network, New York, United States of America
| | - Jean Barry
- Consultant Nursing and Health Policy, International Council of Nurses, Geneva, Switzerland
| | - Andreia Bruno
- International Pharmaceutical Federation, The Hague, Netherlands
| | - Hugh Barr
- Centre for the Advancement of Interprofessional Education (CAIPE), London, United Kingdom
| | - Amy Clithero
- Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico United States of America
| | - Nadia Cobb
- Office for the Promotion of Global Healthcare Equity, Division of Physician Assistant Studies, University of Utah School of Medicine, Salt Lake City, Utah United States of America
| | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
- The Network: Towards Unity for Health, Ghent, Belgium
| | - Elsie Kiguli-Malwadde
- African Center for Global Health and Social Transformation (ACHEST), Kampala, Uganda
| | | | - Scott Reeves
- Interprofessional Research, Centre for Health and Social Care Research, Kingston University and St George’s, University of London, London, United Kingdom
| | - Roger Strasser
- Northern Ontario School of Medicine, Lakehead and Laurentian Universities, Sudbury and Thunder Bay, Canada
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Strasser R, Worley P, Cristobal F, Marsh DC, Berry S, Strasser S, Ellaway R. Putting communities in the driver's seat: the realities of community-engaged medical education. Acad Med 2015; 90:1466-70. [PMID: 26017354 DOI: 10.1097/acm.0000000000000765] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
"Community" has featured in the discourse about medical education for over half a century. This discourse has explored relationships between medical education programs and communities in community-oriented medical education and community-based medical education and, in recent years, has extended to community-engaged medical education (CEME). This Perspective explores the developing focus on "community" in medical education, describes CEME as a concept, and presents examples of CEME in action at Flinders University School of Medicine (Australia), the Northern Ontario School of Medicine (Canada), and Ateneo de Zamboanga University School of Medicine (Philippines).The authors describe the ways in which CEME, which features active community participation, can improve medical education while meeting community needs and advancing national and international health equity agendas. They suggest that CEME can redefine student learning as taking place at the center of the partnership between communities and medical schools. They also consider the challenges of CEME and caution that criteria for community engagement must be sensitive to cultural variations and to the nature of the social contract in different sociocultural settings.The authors argue that CEME is effective in producing physicians who choose to practice in rural and underserved areas. Further research is required to demonstrate that CEME contributes to improved health, and ultimately health equity, for the populations served by the medical school.
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Affiliation(s)
- Roger Strasser
- R. Strasser is dean, Northern Ontario School of Medicine, Sudbury and Thunder Bay, Ontario, Canada. P. Worley is dean, Flinders University School of Medicine, Adelaide, Australia. F. Cristobal is dean, Ateneo de Zamboanga University School of Medicine, Zamboanga, the Philippines. D.C. Marsh is deputy dean, Northern Ontario School of Medicine, Sudbury, Ontario, Canada. S. Berry is associate professor, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada. S. Strasser is former associate dean, Flinders University, Northern Territory, Darwin, Australia. R. Ellaway is assistant dean, Curriculum and Planning, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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Seymour-Walsh A, Worley P, Vnuk A, Grantham H. Is patient morbidity and mortality improved with a skill teaching strategy embedded in learning theory? Resuscitation 2015. [DOI: 10.1016/j.resuscitation.2015.09.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Targa L, Couper I, Worley P. A new ally for the promotion of better rural health in Latin America. Rural Remote Health 2014. [DOI: 10.22605/rrh3376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Targa LV, Couper I, Worley P. A new ally for the promotion of better rural health in Latin America. Rural Remote Health 2014; 14:3376. [PMID: 25474751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
| | - Ian Couper
- Centre for Rural Health, University of the Witwatersrand, Wits Medical School, Parktown, South Africa.
| | - Paul Worley
- Flinders University School of Medicine, Adelaide, South Australia, Australia.
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Worley P, Schuwirth LWT. Opinion versus value; local versus global: what determines our future research agenda? Med Educ 2014; 48:1040-1042. [PMID: 25307630 DOI: 10.1111/medu.12574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Heddle W, Roberton G, Mahoney S, Walters L, Strasser S, Worley P. Challenges in transformation of the "traditional block rotation" medical student clinical education into a longitudinal integrated clerkship model. Educ Health (Abingdon) 2014; 27:138-42. [PMID: 25420974 DOI: 10.4103/1357-6283.143744] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Longitudinal integrated clerkships (LIC) in the first major clinical year in medical student training have been demonstrated to be at least equivalent to and in some areas superior to the "traditional block rotation" (TBR). Flinders University School of Medicine is starting a pilot changing the traditional teaching at the major Academic Medical Centre from TBR to LIC (50% of students in other locations in the medical school already have a partial or full LIC programme). METHODS This paper summarises the expected challenges presented at the "Rendez-Vous" Conference in October 2012: (a) creating urgency, (b) training to be a clinician rather than imparting knowledge, (c) resistance to change. RESULTS We discuss the unexpected challenges that have evolved since then: (a) difficulty finalising the precise schedule, (b) underestimating time requirements, (c) managing the change process inclusively. DISCUSSION Transformation of a "block rotation" to "LIC" medical student education in a tertiary academic teaching hospital has many challenges, many of which can be anticipated, but some are unexpected.
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Affiliation(s)
- William Heddle
- School of Medicine, Flinders University, Bedford Park, South Australia and Darwin, Northern Territory, Australia
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Worley P, Shuler M. Solving the mystery of memory. Cerebrum 2014; 2014:2. [PMID: 25009692 PMCID: PMC4087188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The word "memory" is derived from the ancient Greek myth of Mnemosyne, the mother of the Muses, who was "said to know everything, past, present, and future." Memory is essential to our existence, and one of neuroscience's primary missions is to understand how the brain processes memory and to improve treatments for Alzheimer's disease, traumatic brain injury, drug addiction, and the many other afflictions associated with disrupted memory. Our article traces scientists' progress in understanding memory over the last 15 years.
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