Improving Bacterial Metagenomic Research through Long-Read Sequencing.

Metagenomic sequencing analysis is central to investigating microbial communities in clinical and environmental studies. Short-read sequencing remains the primary approach for metagenomic research; however, long-read sequencing may offer advantages of improved metagenomic assembly and resolved taxonomic identification. To compare the relative performance for metagenomic studies, we simulated short- and long-read datasets using increasingly complex metagenomes comprising 10, 20, and 50 microbial taxa. Additionally, we used an empirical dataset of paired short- and long-read data generated from mouse fecal pellets to assess real-world performance. We compared metagenomic assembly quality, taxonomic classification, and metagenome-assembled genome (MAG) recovery rates. We show that long-read sequencing data significantly improve taxonomic classification and assembly quality. Metagenomic assemblies using simulated long reads were more complete and more contiguous with higher rates of MAG recovery. This resulted in more precise taxonomic classifications. Principal component analysis of empirical data demonstrated that sequencing technology affects compositional results as samples clustered by sequence type, not sample type. Overall, we highlight strengths of long-read metagenomic sequencing for microbiome studies, including improving the accuracy of classification and relative abundance estimates. These results will aid researchers when considering which sequencing approaches to use for metagenomic projects.

Promoting effective interprofessional collaborative practice in the primary care setting: recommendations from Queensland physiotherapy private practitioners.

BACKGROUND: Physiotherapy private practitioners represent a growing proportion of Australia's primary care workforce; however, they face significant barriers in integrating seamlessly within interprofessional teams. Historically, the landscape of primary care in Australia has been one where many physiotherapists work in monoprofessional private practice facilities at dispersed locations, potentially limiting collaborative and coordinated care. The aim of this study was to investigate strategies recommended by physiotherapists to promote effective interprofessional collaborative practice (IPCP) within the Australian private practice setting. METHODS: Using interpretive description as the guiding methodological framework, semi-structured interviews were conducted with 28 physiotherapists in 10 private practice sites in Queensland, Australia. RESULTS: Data analysis produced three themes that characterised physiotherapy private practitioners' recommendations to improve IPCP: (a) the need for improved funding and compensation, particularly addressing the limitations of the Medicare Chronic Disease Management program; (b) the development of integrated and secure digital communication systems to facilitate better information exchange; and (c) prioritising professional development and training to enhance collaboration. CONCLUSIONS: This research lays the groundwork for informed policy making to advance person-centred care and support the integration of services in the Australian healthcare system. The findings from this study indicate that promoting effective IPCP in physiotherapy private practice requires a comprehensive strategy that addresses systemic funding and compensation issues, enhances digital communication systems and optimises interprofessional education and training.

Physiotherapy private practitioners' opinions regarding interprofessional collaborative practice: A qualitative study.

Physiotherapy private practitioners comprise a growing proportion of Australia's primary care workforce, yet their views and experiences of interprofessional collaborative practice (IPCP) are poorly documented. The aim of this study was to explore Australian physiotherapy private practitioners' opinions regarding IPCP. Twenty-eight semi-structured interviews were conducted with physiotherapists in 10 private practice sites in Queensland, Australia. Interviews were analyzed using reflexive thematic analysis. Data analysis produced five themes that characterized physiotherapists' perceptions of IPCP: (a) quality of care considerations; (b) not a one-size-fits-all approach; (c) the need for effective interprofessional communication; (d) fostering a positive work culture; and (e) fear of losing clientele. The findings from this study suggest that physiotherapy private practitioners value IPCP because it can deliver superior client outcomes, can strengthen interprofessional relationships, and has the potential to enhance the professional reputation of the organizations within which they work. Physiotherapists also claimed that IPCP can contribute to poor client outcomes when performed inappropriately, while some reported approaching interprofessional referrals with caution following instances of lost clientele. The mixed views toward IPCP in this study highlight the need to explore the facilitators and barriers to IPCP in the Australian physiotherapy private practice setting.

Environmental surface monitoring as a noninvasive method for SARS-CoV-2 surveillance in community settings: Lessons from a university campus study.

Environmental testing of high-touch objects is a potential noninvasive approach for monitoring population-level trends of SARS-CoV-2 and other respiratory viruses within a defined setting. We aimed to determine the association between SARS-CoV-2 contamination on high-touch environmental surfaces, community level case incidence, and university student health data. Environmental swabs were collected from January 2022 to November 2022 from high-touch objects and surfaces from five locations on a large university campus in Florida, USA. RT-qPCR was used to detect and quantify viral RNA, and a subset of positive samples was analyzed by viral genome sequencing to identify circulating lineages. During the study period, we detected SARS-CoV-2 viral RNA on 90.7 % of 162 tested samples. Levels of environmental viral RNA correlated with trends in community-level activity and case reports from the student health center. A significant positive correlation was observed between the estimated viral gene copy number in environmental samples and the weekly confirmed cases at the university. Viral sequencing data from environmental samples identified lineages concurrently circulating in the local community and state based on genomic surveillance data. Further, we detected emerging variants in environmental samples prior to their identification by clinical genomic surveillance. Our results demonstrate the utility of viral monitoring on high-touch environmental surfaces for SARS-CoV-2 surveillance at a community level. In communities with delayed or limited testing facilities, immediate environmental surface testing may considerably inform epidemic dynamics.

Joining Forces against Antibiotic Resistance: The One Health Solution.

Antibiotic resistance is a significant global health concern that affects both human and animal populations. The One Health approach acknowledges the interconnectedness of human health, animal health, and the environment. It emphasizes the importance of collaboration and coordination across these sectors to tackle complex health challenges such as antibiotic resistance. In the context of One Health, antibiotic resistance refers to the ability of bacteria to withstand the efficacy of antibiotics, rendering them less effective or completely ineffective in treating infections. The emergence and spread of antibiotic-resistant bacteria pose a threat to human and animal health, as well as to the effectiveness of medical treatments and veterinary interventions. In particular, One Health recognizes that antibiotic use in human medicine, animal agriculture, and the environment are interconnected factors contributing to the development and spread of antibiotic resistance. For example, the misuse and overuse of antibiotics in human healthcare, including inappropriate prescribing and patient non-compliance, can contribute to the selection and spread of resistant bacteria. Similarly, the use of antibiotics in livestock production for growth promotion and disease prevention can contribute to the development of antibiotic resistance in animals and subsequent transmission to humans through the food chain. Addressing antibiotic resistance requires a collaborative One Health approach that involves multiple participants, including healthcare professionals, veterinarians, researchers, and policymakers.

Antigen test swabs are comparable to nasopharyngeal swabs for sequencing of SARS-CoV-2.

Viral genomic surveillance has been integral in the global response to the SARS-CoV-2 pandemic. Surveillance efforts rely on the availability of representative clinical specimens from ongoing testing activities. However, testing practices have recently shifted due to the widespread availability and use of rapid antigen tests, which could lead to gaps in future monitoring efforts. As such, genomic surveillance strategies must adapt to include laboratory workflows that are robust to sample type. To that end, we compare the results of RT-qPCR and viral genome sequencing using samples from positive BinaxNOW COVID-19 Antigen Card swabs (N = 555) to those obtained from nasopharyngeal (NP) swabs used for nucleic acid amplification testing (N = 135). We show that swabs obtained from antigen cards are comparable in performance to samples from NP swabs, providing a viable alternative and allowing for the potential expansion of viral genomic surveillance to outpatient clinic as well as other settings where rapid antigen tests are often used.

An exploration of factors influencing physiotherapists' involvement in student clinical education.

BACKGROUND: The demand for physiotherapy student clinical placements is increasing in many countries, including Australia, and there is continued reliance on physiotherapists to assume the student clinical educator role. Exploring factors influencing physiotherapists' decision to be involved in clinical education is essential to maintaining and building clinical education capacity for the future. OBJECTIVE: To explore factors influencing Australian physiotherapists' decision to be involved in student clinical education. METHODS: A qualitative study using data collected from a valid and reliable online survey tool. Respondents were physiotherapists representing public and private workplaces across varied geographical settings in Australia. Data were thematically analyzed. RESULTS: Surveys were completed by 170 physiotherapists. Most respondents were employed in hospital (81/170, 48%) and private (53/170, 31%) settings in metropolitan locations (105/170, 62%). Six themes representing factors influencing physiotherapists' involvement in student clinical education were identified, including perceptions of: professional duty, personal benefits or gains, suitability of workplace, support requirements, role related challenges, and readiness to be a clinical educator. CONCLUSION: Many factors influence physiotherapists' decisions to assume the clinical educator role. This study could assist clinical education stakeholders to provide practical and targeted strategies to overcome challenges, and optimize support, for physiotherapists in the clinical educator role.

A national survey of urinary incontinence in professional Team England female athletes.

OBJECTIVES: To investigate the prevalence of urinary incontinence in Team England female athletes participating in the 2018 Commonwealth Games, the self-imposed lifestyle modifications used to manage symptoms in training and competition and the impact on performance. STUDY DESIGN: This was a Cross-Sectional Survey. All Team England female athletes participating in 2018 Commonwealth Games were asked to complete a structured questionnaire regarding symptoms and management of urinary incontinence. Chi-squared statistical analysis was applied to relevant data. RESULTS: 103 athletes were included. 52 % reported experiencing urinary incontinence (38 % in training vs 27 % in competition X2 = 2.68, p0.13). Highest rates of incontinence were seen in cycling and gymnastics, with lowest rates of incontinence in swimming and rugby. In sports requiring form fitting garments, 64 % did not feel they could wear a pad in training, compared with 19 % in sports with less form-fitting clothing. In competition, 75 % of athletes wearing form-fitting clothing did not feel they could wear a pad, compared with 24 % of those with less form-fitting attire (X2 = 16.9, p < 0.001 in training; X2 = 24.04, p = <0.001 in competition). 11 % of athletes reported reducing fluid intake to reduce urinary incontinence in training and 8 % reported doing this in competition. Only 3 % of athletes reported that their performance is affected by urinary incontinence. CONCLUSION: Prevalence of urinary incontinence is higher in athletes than in the general population. Tight-fitting sportswear is a barrier to athletes using pads to manage urinary incontinence. Athletes may reduce fluid intake to reduce urinary leakage in training and competition, which may affect performance. However, few athletes report that urinary incontinence has an impact overall.

A Survey of Parents' and Carers' Perceptions of Parenting a Child With Developmental Dysplasia of the Hip.

PURPOSE: To explore parents' and carers' perceptions of parenting a child with developmental dysplasia of the hip (DDH). METHODS: A retrospective analysis of a questionnaire of parents and carers of children with hip dysplasia. Data analysis was guided by qualitative content analysis. RESULTS: There were 753 responses describing a range of parenting experiences. Three themes emerged: arduous parenting , detailed the parenting challenges, both practical and emotional posed by the management of DDH; insufficient understanding , described the social disconnection experienced by the respondents due to a lack of empathy from others; inconsistent guidance , encompassed respondents' reliance on health professionals for information and support, yet frustration at variability in the management of DDH. CONCLUSIONS: Overall, having to care for a child with DDH has a negative effect on the practice of parenting. Health professionals can support parenting and provide consistent education to assist parents' understanding of the complex nature of DDH management. What this study adds to the evidence: Despite a good prognosis, the diagnosis of hip dysplasia has a negative effect on of parenting. Parents and carers of children with hip dysplasia rely on the support of health professionals but find the associated loss of parenting autonomy distressing.

Mapping Simulated-Based Learning Experiences Incorporated Into Professional Placements in Allied Health Programs: A Scoping Review.

SUMMARY STATEMENT: Emerging literature continues to demonstrate the use of innovative practices such as simulated-based learning experiences to prepare students for professional placements. This scoping review aimed to provide a broad overview of how simulated-based learning experiences have been implemented within or immediately before the professional practice placements of entry-level allied health programs. Four databases (MEDLINE, EMCARE, CINAHL, and Scopus) were searched up to August 2020. Kirkpatrick's evaluation framework was used to categorize outcomes, and the Simulation-Based Research Extension for the CONSORT statement was used to appraise the quality of simulation reporting. The search revealed 6584 unique abstracts with 321 full-text articles reviewed. Forty-eight studies met the inclusion criteria. This review has shown a clear trend toward using simulation within or immediately before the professional practice placements of allied health programs. Using Kirkpatrick's evaluation framework, most studies reported on student reaction (level 1) and learning (level 2) obtained during the simulation experience. There was limited evidence showing how the benefits gained in simulation translated to the clinical environment (level 3) or impacted the organization (level 4). Further research is required to review the optimal proximity of simulation to allied health professional placements and how gains are obtained from simulation transition to the clinical environment. In addition, more consistent reporting of simulation methodologies and evaluation methods are needed to strengthen the evidence base.

Delivering introductory physiotherapy clinical placements incorporating simulated learning experiences in rural settings.

OBJECTIVE: To investigate the delivery, in rural settings, of introductory physiotherapy clinical placements incorporating simulation and describe the impact of these placements on the uptake of longer-term rural immersion opportunities. DESIGN: Retrospective cohort design. SETTING: The University of Newcastle and the University of Newcastle Department of Rural Health (UONDRH), New South Wales, Australia. PARTICIPANTS: Data from undergraduate physiotherapy students were included. INTERVENTION: Second-year University of Newcastle physiotherapy students undertake an introductory placement which includes one week of simulated learning followed by a two-week traditional health care placement. Supervisor training and active promotion of placements were undertaken to increase the capacity of rural sites to deliver these placements, including both simulation and immersion components. MAIN OUTCOME MEASURE(S): Data relating to numbers of students undertaking introductory placements and final-year rural immersion experiences in the UONDRH between 2012 and 2020 were described. A simple review of the placement strategy was also undertaken. RESULTS: Introductory placements incorporating simulation were successfully implemented in the UONDRH settings and have continued annually. Physiotherapy staff in the UONDRH have been upskilled and have supported local clinicians to increase their supervisory capacity. The proportion of students undertaking introductory placements supported by the UONDRH has increased considerably as has the number of students completing full-year rural immersion experiences in the UONDRH. CONCLUSIONS: Delivering introductory physiotherapy placements incorporating simulation in rural settings was feasible and this strategy leads to increased placement capacity. Early rural clinical placement opportunities can increase students' uptake of longer-term rural immersion experiences which, in turn, can positively influence rural practice intentions.

Exploring the Lived Experience of Parenting a Child with Developmental Dysplasia of the Hip.

Aim: Parenting a child with a health issue such as hip dysplasia (DDH) can be complicated and stressful. We aimed to explore in depth, the lived experience of parenting a child with DDH.Methods: Guided by phenomenology of practice, six mothers and one father of children with DDH were engaged in semi-structured interviews about their parenting experiences. Data were audio-recorded, transcribed verbatim and analyzed thematically.Results: Two themes emerged. Surrendering the parenting prerogative, which described participants' accounts of losing parenting autonomy while needing to rely on others to meet the needs of their child. The second theme; Struggling to adjust day-to-day, described the impact that DDH had on parenting and how participants struggled daily to meet the needs of their child.Conclusion: The management of DDH impacted both the emotional and practical aspects of parenting. Health professionals are ideally placed to support the parenting of children with DDH, but need to understand the parents' particular needs to provide this support empathetically.

Allied health professionals' perceptions of interprofessional collaboration in primary health care: an integrative review.

This integrative review synthesizes research studies in order to explore the perceptions of allied health professionals regarding interprofessional collaboration in primary health care. A comprehensive literature search was conducted using three electronic databases and a manual search of the Journal of Interprofessional Care. The Crowe Critical Appraisal Tool was used to assess the quality of included papers. Study findings were extracted, critically examined and grouped into themes. Twelve studies conducted in six different countries met the inclusion criteria. Thematic analysis revealed five themes: (1) shared philosophy; (2) communication and clinical interaction; (3) physical environment; (4) power and hierarchy; and (5) financial considerations. This review has identified diverse key elements related to interprofessional collaboration in primary health care, as perceived by allied health professionals. Opportunity for frequent, informal communication appeared essential for interprofessional collaboration to occur. Allied health professionals working in close proximity to health practitioners from other professions had more regular interprofessional interactions than those who were geographically separated. Co-location of multiple primary health care services within the same physical space may offer increased opportunities for interprofessional collaboration. Future research should avoid reporting on allied health professionals in primary health care collectively, and isolate data to the individual professions. Direct observational methods are warranted to investigate whether allied health professionals' perceptions of interprofessional collaboration align with their actual clinical interactions in primary health care settings.

The characteristics of Queensland private physiotherapy practitioners' interprofessional interactions: a cross-sectional survey study.

Effective interprofessional collaboration (IPC) contributes to superior patient outcomes, facilitates cost-efficient health care, and increases patient and practitioner satisfaction. However, there is concern that IPC may be difficult to implement in clinical settings that do not conform to formal team-based processes, such as mono-professional physiotherapy private practice facilities. The aim of this study was to describe the characteristics of private physiotherapy practitioners' interprofessional interactions, including their experiences and perceptions regarding IPC. A custom developed cross-sectional online survey instrument was used to collect data from physiotherapists employed in private practice facilities in Queensland, Australia. In all, 49 (20% response rate) physiotherapists completed the survey. Only a small proportion (14%) indicated that their interprofessional interactions were a daily occurrence, and less than one-third of all respondents (31%) participated in formal, multi-professional face-to-face planned meetings. Most participants (76%) reported a moderate-to-high level of satisfaction regarding their interprofessional interactions. Despite low self-reported levels of interprofessional activity and other data indicating that IPC is necessary for holistic patient care, this study shows that physiotherapists were predominately satisfied when interacting with health practitioners from various professional backgrounds. Further research is required to inform the implementation of robust strategies that will support sustainable models of IPC in physiotherapy private practice.

Osteoporosis in Older Adults.

Osteoporosis and osteoporosis-related fractures are common causes of morbidity and mortality in older adults. Healthy adults should be counseled about measures to prevent osteoporosis. Women should be screened for osteoporosis beginning at age 65. Screening for osteoporosis in men should be considered when risk factors are present. Appropriate screening intervals are controversial. Women and men with osteoporosis should be offered pharmacologic therapy. Choice of therapy should be based on safety, cost, convenience, and other patient-related factors. Bisphosphonates are a first-line therapy for many patients with osteoporosis. Other treatments for osteoporosis include denosumab, teriparatide, abaloparatide, romosozumab, and selective estrogen receptor modulators.

Burnout and Self Care for Palliative Care Practitioners.

Burnout is common in physicians who care for patients with serious illness, with rates greater than 60% in some studies. Risk factors for burnout include working on small teams and/or in small organizations, working longer hours and weekends, being younger than 50 years, burdensome documentation requirements, and regulatory issues. Personal factors that can protect against burnout include mindfulness, exercise, healthy sleep patterns, avoiding substance abuse, and having adequate leisure time. Institutional and work factors that can buffer against burnout include working on adequately staffed teams, having a manageable workload, and minimally burdensome electronic health record documentation.

Development of Subspecialty-Specific Reporting Milestones for Hospice and Palliative Medicine Fellowship Training in the U.S.

Continuing the transition to competency-based education, Hospice and Palliative Medicine (HPM) fellowship programs began using context-free reporting milestones (RMs) for internal medicine subspecialties in 2014 but quickly recognized that they did not reflect the nuanced practice of the field. This article describes the development of 20 subspecialty-specific RMs through consensus group process and vetting by HPM educators. A workgroup of content experts used an iterative consensus building process between December 2017 and February 2019 to draft new RMs and create a supplemental guide that outlines the intent of each RM, examples of each developmental trajectory, assessment methods, and resources to guide educators. Program directors, program coordinators, and designated institutional officers were contacted directly to solicit feedback. Most respondents agreed or strongly agreed that each RM represented a realistic progression of knowledge, skills, and behaviors, and that the set of milestones adequately discriminated between meaningful levels of competency. Similarly, respondents felt that the supplemental guide was a useful resource. The result is a set of carefully developed and broadly vetted RMs that represent a progression of development for HPM physicians during one year of clinical fellowship training.

Physiotherapy clinical education in Australia: an exploration of clinical educator characteristics, confidence and training requirements.

Objectives The aim of this study was to describe physiotherapists' involvement, confidence and training needs in the provision of student clinical education (CE) in Australia. Methods A valid and reliable cross-sectional online survey instrument was used to collect data from physiotherapists employed in public and private healthcare facilities in Australia. Survey questions included participant personal and professional characteristics, participation in CE-related continuing professional development (CPD) and confidence in components of CE. Results In all, 170 (34%) physiotherapists (mean age 37 years; mean years clinical experience 13 years) completed the survey. Most participants (68%) were currently involved in CE, over half (56%) had completed CE-related CPD and many (56%) reported a need for more CPD. Participants with no previous CE experience were less confident (P≤0.05) in all components of CE. Participants with less clinical experience were less confident in managing challenging students (P=0.003), multiple students (P=<0.001) and competing workplace and education duties (P=<0.001). Conclusions Physiotherapists with varying professional characteristics were involved in CE. Although many participants had attended CE-related CPD, many reported that more training was required. Future training for clinical educators should be tailored to participants' level of experience and focus on the components of CE in which they feel least confident. What is known about the topic? The ability of physiotherapists to confidently assume a clinical educator role may affect their willingness to be clinical educators in the future and the students' perceptions of clinical placement quality. CPD relating to CE may help prepare physiotherapists for the clinical educator role. What does this paper add? There is a lack of information regarding physiotherapists' involvement in CE, completion of CE-related CPD or perceived levels of confidence in various aspects of the clinical educator role, such as placement organisation, teaching, assessment and the provision of feedback. This study describes the involvement of physiotherapists in CE in Australia, including their demographic and professional characteristics, participation in CE-related CPD and confidence in various components of CE. What are the implications for practitioners? Several recommendations regarding future CE-related CPD have resulted from this study, including tailoring CPD to the needs of physiotherapists based on their level of clinical or CE experience, focusing CPD on the aspects of CE in which physiotherapists feel least confident and raising the awareness of and improving accessibility to CPD opportunities in this area.

Physical activity of rurally residing children with a disability: A survey of parents and carers.

BACKGROUND: Children residing in rural areas face unique barriers to physical activity participation. Further, while children with a disability who reside in metropolitan areas face barriers hindering physical activity, rurally residing children with a disability may face the augmented combination of these barriers that could have negative health implications. Parents are often the key advocates for children with disabilities and are likely to have valuable insight into the opportunities and barriers to physical activity for their child. OBJECTIVE: The aim of this study was to investigate parents' perceptions of physical activity opportunities for their child with a disability in a rural area. METHODS: A mixed method survey examining parent's perceptions of their child's physical activity and possible barriers to participation was mailed to rurally residing parents of children with a disability. Quantitative data were analyzed descriptively using frequencies and proportions. Qualitative data were analyzed using qualitative content analysis. RESULTS: There were 34 completed surveys, a response rate of 37%. Participants' responses indicated 74% of children were not meeting daily recommendations of physical activity. Participation barriers including emotional, physical and environmental issues. Three main themes emerged from qualitative data; segregation, access to facilities and resources and barriers specific to the child. CONCLUSION: The children in this study were from rural areas and face similar barriers to children in metropolitan areas. However, they are also confronted with the same barriers children without a disability in rural areas face, participating in physical activity. This may have detrimental effects on their health and development.