The role of collaborative decision-making in discharge planning: Perspectives from patients, family members and health professionals.

AIM: To explore discharge planning with a range of key stakeholders in subacute care, including consumers. DESIGN: Qualitative descriptive study. METHODS: Patients (n = 16), families (n = 16), clinicians (n = 17) and managers (n = 12) participated in semi-structured interviews or focus groups. Following transcription, data were analysed thematically. RESULTS: The overarching facilitator of effective discharge planning was collaborative communication, leading to shared expectations by all stakeholders. Collaborative communication was underpinned by four key themes: patient- and family-centred decision-making, early goal setting, strong inter- and intra-disciplinary teamwork, and robust patient/family education. CONCLUSION: Effective planning for discharge from subacute care is enabled by shared expectations and collaborative communication between key stakeholders. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Effective discharge planning processes are underpinned by effective inter- and intra-disciplinary teamwork. Healthcare networks should foster environments that promote effective communication between and within multidisciplinary team members as well as with patients and their families. Applying these principles to discharge planning may assist in reducing length of stays and rates of preventable readmissions post-discharge. IMPACT: This study addressed a lack of knowledge about effective discharge planning in Australian subacute care. It found that collaborative communication between stakeholders was an overarching facilitator of effective discharge planning. This finding impacts subacute service design and professional education. REPORTING METHOD: COREQ guidelines were followed in reporting this study. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution in the design, data analysis or preparation of the manuscript.

Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives.

BACKGROUND: Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. METHODS: A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed. RESULTS: Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). CONCLUSIONS: These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention.

Deep conservation and co-option of programmed cell death facilitates evolution of alternative phenotypes at multiple biological levels.

Alternative phenotypes, such as polyphenisms and sexual dimorphisms, are widespread in nature and appear at all levels of biological organization, from genes and cells to morphology and behavior. Yet, our understanding of the mechanisms through which alternative phenotypes develop and how they evolve remains understudied. In this review, we explore the association between alternative phenotypes and programmed cell death, a mechanism responsible for the elimination of superfluous cells during development. We discuss the ancient origins and deep conservation of programmed cell death (its function, forms and underlying core regulatory gene networks), and propose that it was co-opted repeatedly to generate alternative phenotypes at the level of cells, tissues, organs, external morphology, and even individuals. We review several examples from across the tree of life to explore the conditions under which programmed cell death is likely to facilitate the evolution of alternative phenotypes.

Evaluating old truths: Final adult size in holometabolous insects is set by the end of larval development.

For centuries, it has been understood that the final size of adult holometabolous insects is determined by the end of the larval stage, and that once they transform to adults, holometabolous insects do not grow. Despite this, no previous study has directly tested these "old truths" across holometabolous insects. Here, we demonstrate that final adult size is set at the end of the last larval stage in species representing each of the four orders of holometabolous insects: the fruit fly Drosophila melanogaster (Diptera), the tobacco hornworm Manduca sexta (Lepidoptera), the dung beetle Onthophagus taurus (Coleoptera), and the Florida carpenter ant Camponotus floridanus (Hymenoptera). Furthermore, in both D. melanogaster and C. floridanus, we show that the size of adult individuals fluctuates but does not significantly change. Therefore, our study finally confirms these two basic assumptions in the biology of insects, which have for centuries served as the foundation for studies of insect growth, size, and allometry.

Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study.

BACKGROUND: Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries. OBJECTIVE: With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR). METHODS: A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire. RESULTS: A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR. CONCLUSIONS: This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.

Readiness, acceptance and use of digital patient reported outcome in an outpatient clinic.

Use of digital patient-reported outcomes is being introduced in care of chronic conditions, including Inflammatory Bowel Disease. The aim is to supplement face-to-face follow-up sessions through symptom screening, and to inform follow-up through questions about mental health and quality of life. However, little is known about who is using this as intended. This study aimed to map differences between users and non-users among people with IBD and explore the mechanisms behind. We administered a questionnaire including the Readiness and Enablement Index for Health Technology (ReadHy) and the Service User Technology Acceptability Questionnaire (SUTAQ) to all people with IBD registered at Silkeborg Regional Hospital. Comparison between users and non-users and cluster analysis was conducted. Effect size (Cohen's d) was used to estimate magnitude of difference between groups. The user and non-user groups differed most strongly by level of emotional distress (d = 0.45). Cluster analysis of the ReadHy scales showed profiles have different sets of difficulties and reservations towards digital solutions. These difficulties correlated moderately with SUTAQ dissatisfaction and low acceptability. The dimensions of ReadHy may help to better understand particular needs of people with IBD when accessing digital PROs, which may lead to higher acceptability and improved quality of care.

Digital patient-reported outcomes in inflammatory bowel disease routine clinical practice: the clinician perspective.

BACKGROUND: Use of digital health services, such as digital patient-reported outcomes, depends on many different human factors as well as digital design solutions. One factor is clinicians' attitude towards the system, their reasoning behind the using system and their perceptions of patients' ability to engage with digital health systems. This study aimed to explore hospital clinicians' attitudes towards digital patient-reported outcomes used in the routine care and treatment of inflammatory bowel disease, and to explore the potential role of clinicians' attitudes in influencing patients' use of digital patient-reported outcomes. RESULTS: Twelve clinicians using digital patient-reported outcome assessments in the care of inflammatory bowel disease were interviewed about their experiences of, and perspectives on, using this service. Most participants supported the use of digital patient-reported outcome assessments in the care of most patients. Participants reported that most patients found the digital solution easy to use. They perceived digital patient-reported outcomes to have three main purposes: prioritising resources; improving patients' quality of life; and improving quality of care. The patient-clinician relationship was of great importance to participants. Participants varied in their intention to use digital PRO, as some viewed the system as a positive but optional add-on for patients, whilst others intended to use the system with all eligible patients. CONCLUSION: Clinicians' general support of using digital patient-reported outcomes might facilitate their use among patients with inflammatory bowel disease. The participants saw benefits in doing so for patients, clinicians and the wider health service. Clinicians' attitudes towards the use of digital PRO in the care of their patients may influence patients' uptake of health service.

New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19-A Large Postmortem and Clinical Analysis.

Critically ill COVID-19 patients are at high risk for venous thromboembolism (VTE), namely deep vein thrombosis (DVT) and/or pulmonary embolism (PE), and death. The optimal anticoagulation strategy in critically ill patients with COVID-19 remains unknown. This study investigated the ante mortem incidence as well as postmortem prevalence of VTE, the factors predictive of VTE, and the impact of changed anticoagulation practice on patient survival. We conducted a consecutive retrospective analysis of postmortem COVID-19 (n = 64) and non-COVID-19 (n = 67) patients, as well as ante mortem COVID-19 (n = 170) patients admitted to the University Medical Center Hamburg-Eppendorf (Hamburg, Germany). Baseline patient characteristics, parameters related to the intensive care unit (ICU) stay, and the clinical and autoptic presence of VTE were evaluated and statistically compared between groups. The occurrence of VTE in critically ill COVID-19 patients is confirmed in both ante mortem (17%) and postmortem (38%) cohorts. Accordingly, comparing the postmortem prevalence of VTE between age- and sex-matched COVID-19 (43%) and non-COVID-19 (0%) cohorts, we found the statistically significant increased prevalence of VTE in critically ill COVID-19 cohorts (p = 0.001). A change in anticoagulation practice was associated with the statistically significant prolongation of survival time (HR: 2.55, [95% CI 1.41-4.61], p = 0.01) and a reduction in VTE occurrence (54% vs. 25%; p = 0.02). In summary, in the autopsy as well as clinical cohort of critically ill patients with COVID-19, we found that VTE was a frequent finding. A change in anticoagulation practice was associated with a statistically significantly prolonged survival time.

Patient perspectives on digital patient reported outcomes in routine care of inflammatory bowel disease.

BACKGROUND: Digital patient reported outcomes are used increasingly in daily care and treatment of inflammatory bowel disease. Their purpose includes increased focus on patient wellbeing, reduction in avoidable follow-up consultations and increased patient self-management. However, implementation issues occur and studies indicate patients may have concerns, particularly regarding having fewer face-to-face consultations. This study aims to explore patients' perspectives of use and non-use of digital patient reported outcomes and to understand the mechanisms underpinning patient reluctance to engage with this health technology. RESULTS: Sixteen patients with inflammatory bowel disease at a regional hospital in Denmark were interviewed about their experiences of, and perspectives on, digital patient reported outcomes. A certain level of eHealth literacy was found to be a fundamental condition for use, while other factors were barriers or facilitators for use of digital PROs. Patients' main concerns were about potential consequences for their care and relationship with the clinic. Most patients in stable remission were satisfied with the hospital being a "life-line" if their symptoms worsened, and perceived digital patient reported outcomes to be an efficient tool to establish that "life-line". Patients with severe symptoms and a high degree of emotional distress related to their disease valued the potential for digital patient reported outcomes to increase their clinicians' focus on mental health and extra-intestinal symptoms. CONCLUSION: This study found that if patients had sufficient digital literacy, they perceived digital patient reported outcomes to be a useful replacement for face-to-face consultations. However, they were concerned about digital patient reported outcomes' effect on the patient-clinician relationship and its ability to detect worsening of symptoms. These concerns may be mitigated by good patient-clinician relationships, and the option for patients to maintain direct telephone contact with their gastroenterology specialist.

'Digital patient reported outcomes' refer to systems by which health professionals collect health information from patients between consultations, mostly via self-completed online questionnaires. This approach aims to support treatment and disease management, and reduce avoidable face-to-face consultations between doctor and patient. However, patients may have concerns about using digital systems to communicate with their clinicians, particularly regarding having fewer face-to-face consultations. To find out more, we interviewed sixteen patients at an Inflammatory Bowel Disease outpatient clinic in Denmark, where digital Patient Reported Outcomes have been used since 2017. We found out that patients needed to have enough familiarity with technology to be able to use these online systems. Patients were worried about how this new way of communicating with the clinic affected their care and their relationship with their doctors and nurses. People with Inflammatory Bowel Disease can have long periods of time with very little disease activity, and in these stable periods, a lot of patients found that a digital Patient Reported Outcomes system was a good way to stay in touch with the clinic and keep reporting their symptoms online­ as long as they still had the possibility of contacting the clinic by telephone if needed. During disease flare-ups, patients believed that digital patient reported outcomes' could be used to give broader insight into their health situation, and trusted their clinicians to use their self-reported data to improve their care.

The origin of wing polyphenism in ants: An eco-evo-devo perspective.

The evolution of eusociality, where solitary individuals integrate into a single colony, is a major transition in individuality. In ants, the origin of eusociality coincided with the origin of a wing polyphenism approximately 160 million years ago, giving rise to colonies with winged queens and wingless workers. As a consequence, both eusociality and wing polyphenism are nearly universal features of all ants. Here, we synthesize fossil, ecological, developmental, and evolutionary data in an attempt to understand the factors that contributed to the origin of wing polyphenism in ants. We propose multiple models and hypotheses to explain how wing polyphenism is orchestrated at multiple levels, from environmental cues to gene networks. Furthermore, we argue that the origin of wing polyphenism enabled the subsequent evolution of morphological diversity across the ants. We finally conclude by outlining several outstanding questions for future work.

Factors influencing sweet drink consumption among preschool-age children: A qualitative analysis.

ISSUE ADDRESSED: Consumption of high sugar foods and drinks are key risk factors for childhood obesity and dental decay. Sweet drinks are the single greatest contributor to the free sugars consumed by Australian children. Little is known about the factors influencing consumption of sweet drinks, particularly among preschool-age children. METHODS: Focus groups and semi-structured interviews conducted with parents and grandparents (n = 25) residing in different socio-economic areas across metropolitan and regional Victoria, Australia. Thematic analysis identified the factors influencing sweet drink consumption, which were then aligned with the socio-ecological model. RESULTS: At an individual level, health knowledge, health beliefs, and parenting skills and confidence influenced drink choices. At the social level, peer and family influence, and social and cultural norms emerged as influential. At the environmental level, sweet drink availability, targeted marketing, drink prices and settings-based policies influenced drink choices. Strategies identified by participants to support healthier drink choices included health education at the individual level; positive role modelling at the social level; and restricting unhealthy marketing, improved access to water, decreased availability of sweet drinks and price modification at the environmental level. CONCLUSION: Sweet drink consumption among preschool-age children is influenced by multiple factors across all domains of the socio-ecological model. Parents and grandparents are calling for education, healthy environments and supportive policies. SO WHAT?: In contrast to common rhetoric, children's sweet drink consumption is often influenced by factors beyond parental control. A multi-component strategy is required to support parents and grandparents in their efforts to make healthy choices for their children.

Implementing a healthy food retail policy: a mixed-methods investigation of change in stakeholders' perspectives over time.

OBJECTIVES: To investigate (i) changes in stakeholder commitment and (ii) perceptions of the purpose, challenges and benefits of healthy food and beverage provision in community sports settings during the stepwise implementation of a healthy beverage policy. DESIGN: Convergent, parallel, mixed-methods design complemented (i) repeat semi-structured interviews with council stakeholders (n 17 interviews, n 6 interviewees), with (ii) repeat quantitative stakeholder surveys measuring Commitment to Organisational Change; (iii) weekly sales data examining health behaviour and revenue effects (15 months pre-intervention; 14 months post-intervention); (iv) customer exit surveys (n 458); and (v) periodic photographic audits of beverage availability. Interviews were analysed inductively. Stakeholder surveys, sales data, customer surveys and audits were analysed descriptively. SETTING: Four local government-owned sports and recreation centres in Melbourne, Australia, completed a 3-month trial to increase the availability of healthy beverages and decrease the availability of unhealthy beverages in food outlets. PARTICIPANTS: Interviews were conducted with council managers and those involved in implementation (September 2016-October 2017). Customers were surveyed (September-October 2017). RESULTS: Interviews and surveys indicated that stakeholders' commitment to policies varied such that, over time, optimism that changing beverage availability could increase the healthiness of customers' purchases became more widespread among interviewees. Stakeholder focus generally progressed from anticipatory concern to solutions-focused discussions. Sales, audit and customer survey data supported interview findings. CONCLUSIONS: We found a general increase in optimism regarding policy outcomes over time during the implementation of a healthy beverage policy. Stepwise trials should be further explored as an engagement tool within community retail settings.

Defining discharge-readiness from subacute care from all stakeholders' perspectives: a systematic review.

PURPOSE: Research to date has focused on clinicians' views on patients' discharge readiness from acute hospital settings.This study aims to synthesise the literature on discharge readiness from sub-acute (rehabilitation) hospital settings from all stakeholders' perspectives. METHODS: Electronic databases (MEDLINE, CINAHL, Ageline, AMED and Global Health) were systematically searched for post-2000 publications on discharge readiness of adult inpatients in sub-acute settings. After screening, quantitative and qualitative studies were assessed for bias using the Downs and Black checklist and McMaster critical assessment tool respectively, and narrative analysis conducted. RESULTS: From the 3516 papers identified, 23 were included in the review. Overall quality of articles was rated as adequate. Narrative synthesis identified three main themes: the importance of functional outcomes; confounding factors impact on discharge destination and length of stay and barriers and facilitators to discharge. CONCLUSION: Despite limited literature defining sub-acute patients' discharge-readiness from all stakeholders' perspectives, synthesis of available findings identified major themes for consideration when determining when a patient is ready to leave hospital. Limitations include the heterogeneity of the studies located impacted on data extraction and quality appraisal.IMPLICATIONS FOR REHABILITATIONDischarging patients from hospital is complex, discharge too early may lead to poor medical outcomes or readmission, while discharge too late may increase the risk of hospital-based adverse events.Multiple factors need to be considered when considering the discharge readiness of an inpatient.Ensuring adequate social support is key to maximising transition from hospital to home.Combining the use of functional outcome measures with clinical decision-making allows for quantifying readiness for discharge.

Impact of Axial Eye Size on Retinal Microvasculature Density in the Macular Region.

Mechanical tissue stresses are important contributors to the increased risk of sight-threatening pathology in larger, more myopic eyes. The contribution of altered ocular vasculature to the development of this pathology is less well defined. The current study investigated the impact of eye size on the superficial vasculature of the macula. Subjects (n = 104) aged 18-50, with no history of ocular or vascular disease, or myopia control, were recruited from university staff and student populations in Australia and Hong Kong. Refractive error, ocular size, retinal morphology and vascular morphology were quantified through open field autorefraction, ocular biometry and ocular coherence tomography angiography. Morphology of the superficial retinal capillary plexus was assessed over a 3 × 3 mm fovea-centred area. Perfusion area and vessel length densities were analysed relative to axial eye length and retinal thickness. A significant inverse association was found between axial length and vascular density measures (perfusion area density r2 = 0.186, p < 0.001; and vessel length density r2 = 0.102, p = 0.001). Perfusion area and vessel length densities were reduced by 5.8% (p = 0.001) in the longest, relative to the shortest, eyes. The aggregated ganglion cell layer inner plexiform layer thickness was also inversely associated with eye size (r2 = 0.083, p = 0.003), and reduced, by 8.1% (p < 0.001), in the longest eyes. An inverse association of eye size and superficial retinal vasculature density, that is not simply explained by retinal expansion or image magnification factors, was confirmed. These data support the hypothesis that ongoing metabolic challenges may underlie the development of myopia-related and -associated pathology in larger eyes.

A qualitative exploration of the content and face validity of preference-based measures within the context of dementia.

BACKGROUND: Assessing the cost-effectiveness of interventions for people with dementia, based on cost per quality-adjusted life years (QALYs) gained, requires that the measures used to derive QALYs are preference-based whilst also being valid, feasible to use, comprehensible and acceptable for people with dementia. The aim of this study was to assess the content and face validity of six preference-based measures (PBMs) within the context of dementia. METHODS: Qualitative focus groups and interviews were conducted with community-dwelling individuals with mild dementia and carers of people with dementia. After exploring participants' understanding of 'quality of life' (QoL), six PBMs were assessed for content and face validity: two measures assessing health-related QoL (EQ-5D-5L and AQoL-8D); two covering broader aspects of capability wellbeing and social care-related QoL (ICECAP-O and ASCOT); and two dementia-specific QoL measures (DEMQOL-U and AD-5D). A random mix of one health-related QoL measure, one wellbeing measure, and one dementia-specific measure was explored in each session. All sessions were audiotaped and transcribed verbatim. Data were analysed thematically. RESULTS: Nine individuals with mild dementia and 17 carers of people with dementia participated across 4 focus groups and 10 interviews. Participants perceived 9 broad QoL domains as relevant to them: Activity, Autonomy, Cognition, Communication, Coping, Emotions, End-of-Life, Physical Functioning, and Relationships. These domains had limited overlap with the content of the six PBMs. Assessment of face validity was summarized into eight themes: (1) ambiguous questions, (2) double -barrelled questions, (3) difficult/abstract questions, (4) judgemental/confronting questions, (5) lack of relevance and comprehensiveness, (6) response options, (7) layout/format and (8) proxy-response. There was no clear preference for one of the six measures explored; participants identified advantages and disadvantages across all measures. Although particularly designed for individuals with dementia, dementia-specific QoL measures were not always favoured over non-specific measures. CONCLUSION: Given the shortcomings of PBMs identified in this study, further empirical comparative analyses are necessary to guide the selection of PBMs for future dementia research.

The Association between Health Literacy and Self-Rated Health Amongst Australian University Students.

Health literacy is the capacity to understand, access, and effectively utilize health information and healthcare to make informed health decisions. This cross-sectional study uses the multi-dimensional Health Literacy Questionnaire (HLQ) to investigate associations between demographic characteristics, self-rated health and health literacy among students (n = 932) in two Australian universities. We used Pearson's chi-square to determine differences in self-rated health between demographic groups, Cohen's defect Sizeto measure differences in HLQ scale scores between demographic groups, and logistic regression to determine associations between HLQ scores and self-rated health. A clear association was found between self-rated health and health literacy: as health literacy increased, so did self-rated health. Findings also demonstrate lower health literacy for culturally and linguistically diverse students, and those studying Arts compared to Health degrees. Lower self-rated health was correlated with HLQ scales including being less active in managing one's own health, having less social support for one's health, possessing insufficient health information and lower confidence in navigating the healthcare system. This study provides a comprehensive picture of potentially vulnerable students and identifies strategies for supporting their health endeavors while studying at university.

A hemipteran insect reveals new genetic mechanisms and evolutionary insights into tracheal system development.

The diversity in the organization of the tracheal system is one of the drivers of insect evolutionary success; however, the genetic mechanisms responsible are yet to be elucidated. Here, we highlight the advantages of utilizing hemimetabolous insects, such as the milkweed bug Oncopeltus fasciatus, in which the final adult tracheal patterning can be directly inferred by examining its blueprint in embryos. By reporting the expression patterns, functions, and Hox gene regulation of trachealess (trh), ventral veinless (vvl), and cut (ct), key genes involved in tracheal development, this study provides important insights. First, Hox genes function as activators, modifiers, and suppressors of trh expression, which in turn results in a difference between the thoracic and abdominal tracheal organization. Second, spiracle morphogenesis requires the input of both trh and ct, where ct is positively regulated by trh As Hox genes regulate trh, we can now mechanistically explain the previous observations of their effects on spiracle formation. Third, the default state of vvl expression in the thorax, in the absence of Hox gene expression, features three lateral cell clusters connected to ducts. Fourth, the exocrine scent glands express vvl and are regulated by Hox genes. These results extend previous findings [Sánchez-Higueras et al., 2014], suggesting that the exocrine glands, similar to the endocrine, develop from the same primordia that give rise to the trachea. The presence of such versatile primordia in the miracrustacean ancestor could account for the similar gene networks found in the glandular and respiratory organs of both insects and crustaceans.

Implementing empowerment-based Lay Health Worker programs: a preliminary study.

Lay Health Worker (LHW) programs have been shown to be effective in engaging community members in health promotion. While successful LHW program implementation requires an understanding of factors influencing program effectiveness, evidence informing such understanding is lacking for empowerment and ecological theory-based LHW programs. This descriptive study explores how enablers and barriers, identified from LHW literature apply (from the LHWs' perspective) in the context of implementing an empowerment and ecological theory-based LHW model in Melbourne, Victoria. A qualitative case study was carried out. Data were collected from participating LHWs (n = 11) via anonymized online activity logs (n = 7) and semi-structured interviews (n = 7). Deductive-inductive thematic analysis was guided by five a priori themes identified from the literature: community relationships; intrinsic traits, values and motivations; capacity building; program design; and work conditions. Data supported the enablers and barriers to program effectiveness and implementation reported by previous research. Subthemes identified the importance of the LHW bridging role; the empowerment model; integrating the program; and program inclusiveness. This research contributes to the growing practice literature regarding how to effectively implement diverse LHW models in diverse settings. It also contributes to social ecological and complex systems-based health promotion practice evidence in suggesting LHWs to be potentially useful elements which may add to the effectiveness of ecologically based health promotion interventions.

Barriers to first time parent groups: A qualitative descriptive study.

First-time parents' groups are offered to new parents in Australia to support their transition to parenthood. Not all parents avail of the service, some cease attendance, and fathers are under-represented. In the present descriptive, qualitative study, we examined first-time mothers' perspectives on the barriers to parental participation in the groups. Semi-structured interviews were conducted with a sample of eight first-time mothers in a regional city in Victoria, Australia. Interviews revealed groups were perceived as sites strongly reinforcing traditional social norms of parenting. From this central theme, six gendered subthemes emerged as barriers to attendance. Barriers to mothers included non-normative mothering narratives, such as experiencing stillbirth or having a disabled child, perceived dissonance in parenting ethos, and group size. Barriers to fathers, as perceived by mothers, included groups as female spaces, dads as a minority, and female gatekeeping. A multi-faceted approach is required to change the common perception that groups are for mothers only. Groups need to be more inclusive of different parenting experiences and philosophies. Segregated groups might better address the needs of both parents. Further research is required to capture fathers' perspectives.