Cross-Sectional Associations between Nutrient Intake and Tooth Decay in Older Australian Men: The Concord Health and Ageing in Men Project.

Poor nutrition is a risk factor for dental decay in younger people. However, except for sugar, it is unclear if this is true in older age groups. The aim of this study was to analyze the possible associations between overall dietary intake of nutrients and diet quality and the presence of dental decay in community-dwelling older men. A cross-sectional analysis of a longitudinal study with a standardized validated diet history assessment and comprehensive oral health examination in 520 community-dwelling men (mean age: 84 years) participating in the Concord Health and Ageing in Men Project. Nutrient reference values were used to determine if individual micronutrients and macronutrients were meeting recommendations. Acceptable macronutrient distribution ranges (AMDRs) were attained for fat and carbohydrate intakes and were incorporated into a dichotomous variable to determine if the participants were consuming a high fat-low carbohydrate diet. Diagnosis of coronal caries was based on visual criteria and inspection and was completed on each of the five coronal surfaces. Root surface caries was textual changes across four root surfaces. This diagnosis was used to categorize participants by the presence and severity of coronal and root caries. The adjusted logistic regression showed not meeting the recommended intakes for thiamin (odds ratio [OR]: 2.32 95% confidence interval [CI] 1.15-4.67), and zinc (OR: 3.33, 95% CI: 1.71-6.48) were associated with presence of severe root decay. Adjusted analysis also showed that participants who were outside the recommended AMDR for fat (OR: 0.61, 95% CI: 0.38-0.98) and those who consumed a high fat and low carbohydrate diet (OR: 0.56, 95% CI: 0.35-0.91) were less likely to have coronal tooth decay. Our study shows associations between micronutrients and macronutrients and coronal and root surface decay. Although this study cannot prescribe causality or be generalized to all older adults, diet has a possible association with dental decay in older men.

Random-effects substitution models for phylogenetics via scalable gradient approximations.

Phylogenetic and discrete-trait evolutionary inference depend heavily on an appropriate characterization of the underlying character substitution process. In this paper, we present random-effects substitution models that extend common continuous-time Markov chain models into a richer class of processes capable of capturing a wider variety of substitution dynamics. As these random-effects substitution models often require many more parameters than their usual counterparts, inference can be both statistically and computationally challenging. Thus, we also propose an efficient approach to compute an approximation to the gradient of the data likelihood with respect to all unknown substitution model parameters. We demonstrate that this approximate gradient enables scaling of sampling-based inference, namely Bayesian inference via Hamiltonian Monte Carlo, under random-effects substitution models across large trees and state-spaces. Applied to a dataset of 583 SARS-CoV-2 sequences, an HKY model with random-effects shows strong signals of nonreversibility in the substitution process, and posterior predictive model checks clearly show that it is a more adequate model than a reversible model. When analyzing the pattern of phylogeographic spread of 1441 influenza A virus (H3N2) sequences between 14 regions, a random-effects phylogeographic substitution model infers that air travel volume adequately predicts almost all dispersal rates. A random-effects state-dependent substitution model reveals no evidence for an effect of arboreality on the swimming mode in the tree frog subfamily Hylinae. Simulations reveal that random-effects substitution models can accommodate both negligible and radical departures from the underlying base substitution model. We show that our gradient-based inference approach is over an order of magnitude more time efficient than conventional approaches.

Random-effects substitution models for phylogenetics via scalable gradient approximations.

Phylogenetic and discrete-trait evolutionary inference depend heavily on an appropriate characterization of the underlying character substitution process. In this paper, we present random-effects substitution models that extend common continuous-time Markov chain models into a richer class of processes capable of capturing a wider variety of substitution dynamics. As these random-effects substitution models often require many more parameters than their usual counterparts, inference can be both statistically and computationally challenging. Thus, we also propose an efficient approach to compute an approximation to the gradient of the data likelihood with respect to all unknown substitution model parameters. We demonstrate that this approximate gradient enables scaling of sampling-based inference, namely Bayesian inference via Hamiltonian Monte Carlo, under random-effects substitution models across large trees and state-spaces. Applied to a dataset of 583 SARS-CoV-2 sequences, an HKY model with random-effects shows strong signals of nonreversibility in the substitution process, and posterior predictive model checks clearly show that it is a more adequate model than a reversible model. When analyzing the pattern of phylogeographic spread of 1441 influenza A virus (H3N2) sequences between 14 regions, a random-effects phylogeographic substitution model infers that air travel volume adequately predicts almost all dispersal rates. A random-effects state-dependent substitution model reveals no evidence for an effect of arboreality on the swimming mode in the tree frog subfamily Hylinae. Simulations reveal that random-effects substitution models can accommodate both negligible and radical departures from the underlying base substitution model. We show that our gradient-based inference approach is over an order of magnitude more time efficient than conventional approaches.

Impact of the COVID-19 pandemic on daily life, mood, and behavior of adults with Down syndrome.

BACKGROUND: The Down syndrome population has been disproportionately affected by Coronavirus 2019 (COVID-19) in terms of experiencing severe illness and death. Societal efforts to curb the spread of COVID-19 may also have taken a heavy toll on the daily lives of individuals with Down syndrome. OBJECTIVE/HYPOTHESIS: The goal of the study was to understand how the COVID-19 pandemic has altered daily life (including residence, employment, and participation in adult disability day programs) and influenced the mood and behavior of adults with Down syndrome. METHODS: Between September 2020 and February 2021, caregivers of 171 adults with Down syndrome (aged 22-66 years) located across the United States and in the United Kingdom enrolled in the Alzheimer's Biomarker Research Consortium on Down Syndrome (ABC-DS) completed a survey. RESULTS: The residence of 17% of individuals was altered, and 89% of those who had been employed stopped working during the pandemic. One-third (33%) of individuals were reported to be more irritable or easily angered, 52% were reported to be more anxious, and 41% were reported to be more sad/depressed/unhappy relative to prepandemic. The majority of changes in mood and behavior were of modest severity. CONCLUSIONS: The COVID-19 pandemic has had widespread effects on the daily life and mood and behavior of adults with Down syndrome. In the short term, caregivers and providers should be prepared to help adults with Down syndrome with changes in daily routines, residence, employment, or adult disability day programs as society shifts away from COVID-19 safety protocols.

Sex differences associate with late microbiome alterations after murine surgical sepsis.

BACKGROUND: Sepsis-induced gut microbiome alterations contribute to sepsis-related morbidity and mortality. Given evidence for improved postsepsis outcomes in females compared with males, we hypothesized that female mice maintain microbiota resilience versus males. METHODS: Mixed-sex C57BL/6 mice underwent cecal ligation and puncture (CLP) with antibiotics, saline resuscitation, and daily chronic stress and were compared with naive (nonsepsis/no antibiotics) controls. For this work, the results of young (3-5 months) and old (18-22 months) adult mice were analyzed by sex, independent and dependent of age. Mice were sacrificed at days 7 and 14, and 16S rRNA gene sequencing was performed on fecal bacterial DNA. α and ß diversity were determined by Shannon index and Bray-Curtis with principal coordinate analysis, respectively. False discovery rate (FDR) correction was implemented to account for potential housing effect. RESULTS: In control mice, there was no difference in α or ß diversity between male and female mice (FDR, 0.76 and 0.99, respectively). However, male mice that underwent CLP with daily chronic stress had a decrease in microbiota α diversity at 7 days post-CLP (Shannon FDR, 0.005), which was sustained at 14 days post-CLP (Shannon FDR, 0.001), compared with baseline. In addition, male mice maintained differences in ß diversity even at day 14 compared with controls (FDR, <0.0001). In contrast, female mice had a decreased microbiota α diversity (Shannon FDR, 0.03) and ß diversity (FDR, 0.02) 7 days post-CLP but recovered their α and ß diversity by post-CLP day 14 (Shannon FDR, 0.5, and FDR, 0.02, respectively). Further analysis of females revealed that only young female mice were not different (ß diversity) post-CLP day 14 to controls. CONCLUSION: Although sepsis-induced perturbations of the intestinal microbiota occur initially in both male and female C57BL/6 mice, females demonstrate different microbiota by day 14. This may be seen primarily in younger females. This difference in recovery may play a role in outcome differences between sexes after sepsis.

Pre- and Posttherapy Risk Factors for Vasculopathy in Pediatric Patients With Craniopharyngioma Treated With Surgery and Proton Radiation Therapy.

PURPOSE: Vasculopathy (VAS) is a significant complication associated with radiation therapy in patients treated for brain tumors. We studied the type, location, severity, timing, and resolution of VAS in children with craniopharyngioma treated with proton radiation therapy (PRT) and evaluated predictors of stenosis (STN) using a novel patient and imaging-based modeling approach. METHODS AND MATERIALS: Children with craniopharyngioma (n = 94) were treated with 54 Gy relative biological effectiveness PRT in a clinical trial, NCT01419067. We evaluated VAS type, location, severity, and resolution. VAS events were segmented and related to their location, operative corridor, PRT dose, and vascular territory to facilitate mixed effect logistic regression modeling of spatial predictors of STN events. RESULTS: Forty-five (47.9%) patients had 111 instances of confirmed VAS (pre-PRT n = 37, 33.3%). The median time to post-PRT VAS was 3.41 years (95% confidence interval, 1.86-6.11). STN events were observed post-PRT in 23.4% (n = 22) of patients. Post-PRT VAS was detected by cerebral angiogram in 9.6% (n = 9), severe in 4.3% (n = 4), and compensated on perfusion in 2.1% (n = 2). Revascularization was required for 5 (5.3%) patients. Postsurgical, pre-PRT VAS, and PRT dose to unperturbed vessels were predictive of STN. The effect of PRT on STN was negligible within the surgical corridor. CONCLUSIONS: VAS often precedes PRT and was the strongest predictor of post-PRT STN. The adverse effect of PRT on STN was only apparent in unperturbed vasculature beyond the operative corridor.

Does the coronavirus disease 2019 (COVID-19) vaccination rate among healthcare personnel reflect their community? An evaluation of a multistate healthcare system.

Coronavirus disease 2019 (COVID-19) vaccination rates of a large health system reflected their respective service areas but varied by work role. Nurse vaccination rates were higher (56.9%) and rates among nursing support personnel were lower (38.6%) than those of their communities (51.7%; P < .001). Physician vaccination rates were highest (71.6%) and were not associated with community vaccination levels.

Association between diabetes and keratoconus-a systematic review and meta-analysis.

PURPOSE: To assess the association between diabetes mellitus and keratoconus. METHODS: PubMed, Google Scholar, Web of Science, and Scopus databases were searched for literature on the association between diabetes and keratoconus. The last literature search was conducted on April 4, 2021. A secondary form of the literature search was conducted by manually scanning the reference list of retrieved eligible articles. Included studies were cohort, case-control, or cross-sectional study design that used odds ratio or risk ratio to evaluate the relationship between keratoconus and diabetes. Egger's test was used to assess the presence of publication bias. The quality of eligible studies was assessed using the Newcastle-Ottawa Scale. RESULTS: Nine studies (six case-control and three cohort studies) published between 2000 and 2021 were included. The total number of keratoconus patients and controls were 27,311 and 53,732. respectively. Meta-analysis revealed no significant association between diabetes mellitus and keratoconus; the pooled odds ratio was 0.87 (95% confidence interval: 0.66-1.14; p = 0.314). There was significant heterogeneity (Q (df = 7) = 33.36, p < 0.001;I2 = 79.01, p < 0.001). Age of participants (p < 0.0001), study design (p < 0.001), and sample size (p = 0.024) were significant sources of heterogeneity. There was no evidence of publication bias. CONCLUSION: The current meta-analysis revealed no significant association between diabetes mellitus and keratoconus. Well-designed longitudinal prospective studies are, however, needed to investigate any association between diabetes mellitus and keratoconus.

Glial-Specific Deletion of Med12 Results in Rapid Hearing Loss via Degradation of the Stria Vascularis.

Mediator protein complex subunit 12 (Med12) is a core component of the basal transcriptional apparatus and plays a critical role in the development of many tissues. Mutations in Med12 are associated with X-linked intellectual disability syndromes and hearing loss; however, its role in nervous system function remains undefined. Here, we show that temporal conditional deletion of Med12 in astrocytes in the adult CNS results in region-specific alterations in astrocyte morphology. Surprisingly, behavioral studies revealed rapid hearing loss after adult deletion of Med12 that was confirmed by a complete abrogation of auditory brainstem responses. Cellular analysis of the cochlea revealed degeneration of the stria vascularis, in conjunction with disorganization of basal cells adjacent to the spiral ligament and downregulation of key cell adhesion proteins. Physiologic analysis revealed early changes in endocochlear potential, consistent with strial-specific defects. Together, our studies reveal that Med12 regulates auditory function in the adult by preserving the structural integrity of the stria vascularis.SIGNIFICANCE STATEMENT Mutations in Mediator protein complex subunit 12 (Med12) are associated with X-linked intellectual disability syndromes and hearing loss. Using temporal-conditional genetic approaches in CNS glia, we found that loss of Med12 results in severe hearing loss in adult animals through rapid degeneration of the stria vascularis. Our study describes the first animal model that recapitulates hearing loss identified in Med12-related disorders and provides a new system in which to examine the underlying cellular and molecular mechanisms of Med12 function in the adult nervous system.

Genome Sequences of Gordonia Bacteriophages Jodelie19, BlingBling, and Burnsey.

Jodelie19, BlingBling, and Burnsey are bacteriophages identified using host bacteria of the genus Gordonia Jodelie19 is a lytic phage found in Gordonia rubripertincta NRRL B-16540. The temperate phage BlingBling and lytic phage Burnsey were both isolated using the host bacterium Gordonia terrae 3612.

Life Positions and Depression: The Role of Convictions.

Life Position, one of the central concepts in Transactional Analysis, is a person's convictions about the worth of the self and others-a basic psychological stand, which is deeply ingrained. There are four Life Positions: "I'm OK-You're OK", "I'm OK-You're not OK", "I'm not OK-You're OK", and "I'm not OK-You're not OK". Contradicting Berne's theory of only one depressive position ("I'm not OK-You're OK"), past findings showed that both "I'm not OK-You're OK" and "I'm not OK-You're not OK" positions relate to depression, with the "I'm not OK-You're not OK" position relating to depression more strongly than the "I'm not OK-You're OK" position. The disparity between Berne's original theorizing of depression and the empirical findings may support an alternative conceptualization of the depressive's Life Position, which was the theoretical gap of this research. This research aimed to investigate the differences in how each Life Position relates to depression, and how the underlying convictions of Life Position predict depression. The Life Position Scale and Center for Epidemiologic Studies Depression Scale were filled in by individuals of the general population. Post hoc analysis revealed that the "I'm not OK-You're not OK" position related most to depression, followed by the "I'm not OK-You're OK" position, the "I'm OK-You're not OK" position, and finally the "I'm OK-You're OK" position. The results also showed that both negative convictions of the self and others contributed significantly to depression, but the former predicted depression more than the latter. Applications of these findings into theoretical and therapy settings were explored.

Septic Stability? Gut Microbiota in Young Adult Mice Maintains Overall Stability After Sepsis Compared to Old Adult Mice.

BACKGROUND: Older adults have worse outcomes after sepsis than young adults. Additionally, alterations of the gut microbiota have been demonstrated to contribute to sepsis-related mortality. We sought to determine if there were alterations in the gut microbiota with a novel sepsis model in old adult mice, which enter a state of persistent inflammation, immunosuppression, and catabolism (PICS), as compared with young adult mice, which recover with the sepsis model. METHODS: Mixed sex old (∼20 mo) and young (∼4 mo) C57Bl/6J mice underwent cecal ligation and puncture with daily chronic stress (CLP+DCS) and were compared with naive age-matched controls. Mice were sacrificed at CLP+DCS day 7 and feces collected for bacterial DNA isolation. The V3-V4 hypervariable region was amplified, 16S rRNA gene sequencing performed, and cohorts compared. α-Diversity was assessed using Chao1 and Shannon indices using rarefied counts, and ß-diversity was assessed using Bray-Curtis dissimilarity. RESULTS: Naive old adult mice had significantly different α and ß-diversity compared with naive adult young adult mice. After CLP+DCS, there was a significant shift in the α and ß-diversity (FDR = 0.03 for both) of old adult mice (naive vs. CLP+DCS). However, no significant shift was displayed in the microbiota of young mice that underwent CLP+DCS in regards to α-diversity (FDR = 0.052) and ß-diversity (FDR = 0.12), demonstrating a greater overall stability of their microbiota at 7 days despite the septic insult. The taxonomic changes in old mice undergoing CLP+DCS were dominated by decreased abundance of the order Clostridiales and genera Oscillospira. CONCLUSION: Young adult mice maintain an overall microbiome stability 7 days after CLP+DCS after compared with old adult mice. The lack of microbiome stability could contribute to PICS and worse long-term outcomes in older adult sepsis survivors. Further studies are warranted to elucidate mechanistic pathways and potential therapeutics.

Audiovisual Modules to Enhance Informed Consent in the ICU: A Pilot Study.

Obtaining informed consent for commonly performed ICU procedures is often compromised by variability in communication styles and inadequate verbal descriptions of anatomic concepts. The objective of this study was to evaluate the efficacy of an audiovisual module in improving the baseline knowledge of ICU procedures among patients and their caregivers. DESIGN: Prospective, observational study. SETTING: Forty-eight-bed adult surgical ICU at a tertiary care center. SUBJECTS: Critically ill surgical patients and their legally authorized representatives. INTERVENTIONS: An audiovisual module describing eight commonly performed ICU procedures. MEASUREMENTS AND MAIN RESULTS: Fifty-nine subjects were enrolled and completed an 11-question pre- and postvideo test of knowledge regarding commonly performed ICU procedures and a brief satisfaction survey. Twenty-nine percent had a healthcare background. High school was the highest level of education for 37% percent of all subjects. Out of 11 questions on the ICU procedure knowledge test, subjects scored an average 8.0 ± 1.9 correct on the pretest and 8.4 ± 2.0 correct on the posttest (p = 0.055). On univariate logistic regression, having a healthcare background was a negative predictor of improved knowledge (odds ratio, 0.185; 95% CI, 0.045-0.765), indicating that those with a health background had a lower probability of improving their score on the posttest. Among subjects who did not have a healthcare background, scores increased from 7.7 ± 1.9 to 8.3 ± 2.1 (p = 0.019). Seventy-five percent of all subjects indicated that the video was easy to understand, and 70% believed that the video improved their understanding of ICU procedures. CONCLUSIONS: Audiovisual modules may improve knowledge and comprehension of commonly performed ICU procedures among critically ill patients and caregivers who have no healthcare background.

Rural clinical school dental graduates views on rural and metropolitan employment.

INTRODUCTION: There is a maldistribution of dental professionals working in rural and remote regions of Australia. This study investigates dental graduates from a newly established rural clinical school (RCS) at Charles Sturt University (CSU), New South Wales, Australia, and records graduates' workforce locations and views on working in both metropolitan and rural practice. MATERIALS AND METHODS: In late 2015 to early 2016, CSU graduates of 2013 and 2014 were asked to complete a telephone interview related to their employment choices. Thirty-nine interviews (68% of contactable graduates) were completed. Qualitative framework analysis was applied to identify trends and themes. RESULTS: More than half of the graduates were working rurally, with 67% working full-time and 77% in private practice. Key influencing factors on graduates related to rural employment were as follows: family and personal relationships, developing clinical skills, rural community, lifestyle, professional support, mentorship, job availability, full-time employment and financial incentives. Key barriers to working rurally included leaving family and friends, small patient base, low salary, partner factors, and professional and personal isolation. CONCLUSION: More than half of the CSU graduates were working in rural communities, demonstrating initially positive rural workforce outcomes. Reasons for choosing to work rurally were complex and spanned a broad spectrum of social, personal, professional development and support, community, economic, environmental and lifestyle factors. Future workforce strategies should apply a broad multifactorial approach to consider the complex interrelated employment factors. Furthermore, increased evaluation is required of the CSU programme, with increased workforce outcomes and exploration of employment retention factors.

Oral health and cognitive status in the Concord Health and Ageing in Men Project: A cross-sectional study in community-dwelling older Australian men.

BACKGROUND: Several studies have examined the relationship between cognition and oral health in older populations. To further understand this relationship, we examined the associations between cognitive function, chewing capacity and the number of teeth present in community-dwelling older males in Australia. METHODS: Data were obtained from cross-sectional analysis of fourth wave of the Concord Health and Ageing in Men Project (CHAMP). Participants were 369 community-dwelling males aged 78 years or over. Cognitive function was measured utilising the Mini-Mental State Examination (MMSE). Chewing capacity was determined on ability to chew food items of different textures, and oral health data were collected. Ordinal regression was used to analyse associations between MMSE (four categories) and chewing capacity and number of natural teeth present. RESULTS: Overall, 67.5% of participants reported that they could chew all 11 listed food items. Participants with fewer than 20 teeth were statistically significantly more likely to have cognitive impairment (unadjusted odds ratio (OR) 1.87; 95% confidence interval (CI) 1.25-2.79, adjusted OR 1.62; 95% CI 1.07-2.43). Participants with limited chewing capacity were also more likely to have cognitive impairment (unadjusted OR 1.91; 95% CI 1.25-2.94, adjusted OR 1.61; 95% CI 1.03-2.49). CONCLUSIONS: This study suggests either that older men with fewer than 20 natural teeth and those with limited chewing capacity are more likely to have an associated cognitive impairment or that those with cognitive impairment are more likely to have fewer teeth and limited chewing capacity. Further longitudinal studies should clarify these relationships.

Use of intravenous magnesium sulfate among patients with acute myocardial infarction in China from 2001 to 2015: China PEACE-Retrospective AMI Study.

OBJECTIVE: In 2001, Chinese guidelines for the care of acute myocardial infarction (AMI) included a new recommendation against the routine use of magnesium. We studied temporal trends and institutional variation in the use of intravenous magnesium sulfate in nationally representative samples of individuals hospitalised with AMI in China between 2001 and 2015. METHODS: In an observational study (China PEACE-Retrospective Study) of AMI care, we used a two-stage, random sampling strategy to create a nationally representative sample of 28 208 patients with AMI at 162 Chinese hospitals in 2001, 2006, 2011 and 2015. The main outcome is use of intravenous magnesium sulfate over time. RESULTS: We identified 24 418 patients admitted for AMI, without hypokalaemia, in the four study years. Over time, there was a significant initial decrease in intravenous magnesium sulfate use, from 32.1% in 2001 to 17.1% in 2015 (p<0.001 for trend). The decline was greater in the Eastern (from 33.3% to 16.5%) and Western (from 34.8% to 17.2%) regions, as compared with the Central region (from 25.9% to 18.1%), with little difference between rural and urban areas. The proportion of hospitals using intravenous magnesium sulfate did not change over time (from 81.3% to 77.9%). The median ORs, representing hospital-level variation, were 6.03 in 2001, 3.86 in 2006, 4.26 in 2011 and 4.72 in 2015. Intravenous magnesium sulfate use was associated with cardiac arrest at admission and receipt of reperfusion therapy, but no hospital-specific characteristics. CONCLUSIONS: Despite recommendations against its use, intravenous magnesium sulfate is used in about one in six patients with AMI in China. Our findings highlight the need for more efficient mechanisms to stop using ineffective therapies to improve patients' outcomes and reduce medical waste. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT01624883).

Associations between oral health and depressive symptoms: Findings from the Concord Health and Ageing in Men Project.

OBJECTIVE: To investigate whether poorer oral health, tooth loss and lower usage of dental services are associated with depressive symptoms in older Australian men. METHODS: Cross-sectional study of data collected from participants of the Concord Health and Ageing in Men Project. Depressive symptoms were evaluated by the Geriatric Depression Scale. Chewing capacity was estimated by ability to chew 11 food items. RESULTS: The prevalence of depressive symptoms was 17.5%. Self-evaluated oral health, chewing capacity and the number of natural and decayed teeth were associated with depressive symptoms. After adjusting for multiple confounders, chewing capacity (PR 1.93; 95% CI 1.34-2.79) and decayed teeth (PR 1.68; 95% CI 1.03-2.75) maintained a significant association with depressive symptoms. CONCLUSION: The direction of causality between oral health and depression is unclear; however, oral health may contribute to depression in older Australian men and depressive symptoms may limit chewing capacity and be aggravated by untreated dental decay.

The workforce outcomes of dental graduates from a metropolitan school 'Rural Clinical Placement Program' versus a 'Rural Clinical School'.

INTRODUCTION: This study compares the workplace decisions from University of Sydney (USYD) dental graduates who participated in a 1-month voluntary Rural Clinical Placement Program (RCPP), USYD graduates who did not participate in the RCPP (non-RCPP), and with graduates who qualified from a dental Rural Clinical School (RCS) at Charles Sturt University (CSU). METHODOLOGY: From mid-2015, USYD students who graduated between 2009 and 2013, and CSU graduates from 2013 to 2014, were requested to complete a telephone interview related to employment choices. For USYD, 135 interviews were completed (63% of contactable graduates) and for CSU, 39 interviews (68%). Mixed methods were applied to analyse the data. RESULTS: For USYD, 33% of RCPP participants were working rurally compared with 18% of the non-RCPP, whilst 54% of CSU graduates were working rurally. For USYD, the self-reported influence of the RCPP on the graduates' employment decisions was a significant predictor of rural employment. For CSU, country of birth and employment status were weakly associated with rural employment. Across the three cohorts, key employment factors were as follows: job availability, family, personal relationships, good mentorship, clinical training, partner factor and lifestyle. In addition, both the RCPP and CSU graduates showed greater interest and awareness of rural employment than the non-RCPP. CONCLUSION: The CSU RCS and USYD RCPP are leading to positive rural employment outcomes, and it is clear that the provision of a rural experience is influencing graduates to work rurally. Further investigation of the CSU program is required to fully assess its impact and to provide longitudinal workforce information.