Community Living

Patient-centered outcomes are increasingly recognized by the transplant community as a key component to improving knowledge and patient counseling, and long-term outcomes after living kidney or liver donation are not well understood. With efforts underway to follow living donors and donor candidates long term, it is critical that living donors and candidates drive the process of patient-centered data collection. Living donors on the Scientific Registry of Transplant Recipients' Living Donor Steering Committee were engaged to brainstorm and prioritize which data elements should be captured. Committee members identified long-term lab values, difficulty with normal activities, and diagnosis of chronic kidney or liver disease as critical long-term outcomes. Additional high-priority elements included short-term lab values, deaths related to donation, mortality among donors compared to nondonors, hospital readmissions, costs and physical limitations related to donation, and whether a donor would donate again. Finally, living donors wanted to know the risk of organ failure among donors compared to nondonors. This prioritization exercise provided valuable insights from living donors to help determine key themes and discrete data elements that should be prioritized for long-term collection and reporting to living donors and living donor candidates.

Abstract This article considers the making of an archive of environmental activism through the life histories of 100 campaigners involved in environmental protest, projects and policy-making in the UK since the early 1970s. It explores the challenge of representing the diversity of the environmental movement during this period, the value of oral history in illuminating the experience of campaigning and the career trajectories of activists, and the wider significance of the National Life Stories model of oral history. Such national archives can provide vital resources for intergenerational conversation, new thinking and new forms of action designed to make a better world.

Objective: This study measures the quality of recovery for patients scheduled for elective surgery and compares general and spinal anesthesia on the QoR-15 score. Method: prospective, parallel, cross sectional study in which 160 patients with class I, II ASA status were scheduled for elective abdominal surgeries. 80 patients received general anesthesia, while 80 patients received spinal anesthesia. After acquiring informed written consents, the Kurdish version of the QoR-15 score questionnaire was filled out preoperatively and 24 hr postoperatively. Result: In 160 patients, Spinal anesthesia is better than general anesthesia regarding a 24-hour postoperative total QoR-15 score median (124 versus 114.5), respectively, with a p-value of 0.008. Males had a significantly better postoperative quality of recovery, and obesity had a negligibly opposite effect. Conclusion: Spinal anesthesia is better than general anesthesia for abdominal surgeries in terms of early quality of recovery as tested by the QoR-15.

What explains why people choose to stay or emigrate in the face of slow-onset climate change? We leverage an original survey of prospective migrants who are exceptionally vulnerable to threats from climate change, but who possess the freedom to legally migrate to another country with relative protection from environmental degradation. Using a conjoint experiment, we assess subjects’ latent preferences before they depart by asking them the circumstances under which they would be more likely to move, given a set of randomly varying conditions representing migration push and pull factors. Our findings show that direct climate risks play a minimal role in prospective migrant decisions, with family- and health-related considerations being much stronger drivers. Our results ground climate mobility more firmly in the context of other migration and mobility decisions, and question widespread concern about the potential for slow-onset environmental degradation to directly produce massive flows, a significant consideration for future climate refugee programs.

This study reveals a significant AI knowledge gap between undergraduate and postgraduate medical students, highlighting the need for targeted AI education. The findings can inform curriculum development and policies to prepare medical students for the AI-driven future of healthcare. Further research should explore the long-term impact of AI education on clinical practice.

Glandular trichomes are implicated in direct and indirect defense of plants. However, the degree to which glandular and non-glandular trichomes have evolved as a consequence of herbivory remains unclear, because their heritability, their association with herbivore resistance, their trade-offs with one another, and their association with other functions are rarely quantified. We conducted a phylogenetic comparison of trichomes and herbivore resistance against the generalist caterpillar, Heliothis virescens, among tarweed species (Asteraceae: Madiinae) and a genetic correlation study comparing those same traits among maternal half-sibs of three tarweed species. Within a tarweed species, we found no evidence that herbivore growth rate decreased on tarweed individuals or maternal sib groups with more glandularity or denser trichomes. However, tarweed species with more glandularity and fewer non-glandular trichomes resulted in slower-growing herbivores. Likewise, a trade-off between glandular and non-glandular trichomes was apparent among tarweed species, but not among individuals or sib groups within a species. Our results suggest that this key herbivore does not select for trichomes as a direct defense in tarweed species. However, trichomes differed substantially among species and likely affect herbivore pressure on those species. Our results demonstrate that trade-offs among plant traits, as well as inference on the function of those traits, can depend on scale.

This study aimed to determine how patients trade-off the benefits and risks of two different types of procedures used to treat heart valve disease (HVD). It also aimed to determine patients'preferences for HVD treatments (predicted uptake)and the relative importance of each treatment attribute. A discrete choice experiment (DCE) was conducted in Australia and Japan with patients who required a heart valve procedure. Patients were stratified into three categories: no prior procedure experience, minimally invasive procedure experienceand invasive procedure experience. DCE attributes included risk of mortality; risk of stroke; needing dialysis; needing a new pacemaker; valve durability; independence 1 month after surgery; and out-of-pocket expenses. Participants chose between two hypothetical labelled approaches to therapy ('invasive procedure' and 'minimally invasive procedure'), with a separate opt-out included. A mixed multinomial logitmodel was used to analyse preferences. The DCE was completed by 143 Australian and 206 Japanese patients. Both populations demonstrated an overall preference for the minimally invasive procedure over the invasive procedure. All attributes tested significantly predicted choice and were important to patient decision-making. However, patients'choices were most influenced by the durability of the valve and the likelihood of independence postprocedure, irrespective of their prior procedure experience. Differences in preference were observed between Australian and Japanese patients; valve durability was the most important attribute among Australian patients, while Japanese patients emphasised regaining independence postsurgery. Risk of mortality was less important relative to other key attributes in Japan; however, it remained significant to the model. HVD patients prefer a minimally invasive procedure over an invasive procedure, irrespective of prior treatment experience. Key attributes contributing to treatment preferences are valve durability and faster recovery. These results can be used to help inform healthcare decision-makers about what features of heart valve procedures patients value most. People with lived experience of HVD were included in multiple stages of the design phase of this research. First, patients and doctors were consulted by taking part in qualitative interviews. The qualitative interviews helped inform which treatment attributes to include in the DCEbased on what was important to those with lived experience and those who help make treatment decisions on behalf of patients. Qualitative interview participants also assisted with the framing of questions in the online survey to ensure the terminology was patient-friendly and relevant to those with lived experience. Following qualitative interviews, the DCE attribute list was agreed on in expert consultation with a steering committee, which included patient representatives and treating physicians (interventional cardiologists, cardiothoracic surgeons). The survey was also pilot tested with a small sample of patients and minor adjustments were made to the wording to ensure it was appropriate and meaningful to those with lived experience of HVD.

The Living Atlases project, facilitated by the Global Biodiversity Information Facility (GBIF) and the Atlas of Living Australia (ALA), has successfully operated for more than a decade, establishing collaborations with over 30 countries who have implemented ALA components within their respective environments. Over this period, technological advancements and the prevalence of cloud platforms have transformed the landscape of infrastructure management. In this presentation, we will explore innovative approaches to streamline the installation process of ALA, capitalizing on the benefits offered by cloud platforms and cutting-edge technologies. Furthermore, ALA has maintained a strong collaborative partnership with GBIF over the past four years, focusing on data ingestion pipelines and, more recently, engaging in shared user interface (UI) development. These improvements aim to enhance the maintainability of ALA modules, enabling organizations to leverage the advantages provided by cloud-based solutions and novel technologies.

This paper describes the initial development of a mental health rehabilitation curriculum for Australian mental health settings and for psychiatrists and trainees wishing to develop specialist skills in mental health rehabilitation. Members of the Section of Social Cultural and Rehabilitation Psychiatry (SSCRP) established an expert working group under the auspices of the RANZCP. Existing college training resources were reviewed, and a gap analysis was conducted to guide development of new training modules. A tiered curriculum structure was created that allows a staged development of rehabilitation knowledge, skills and attitudes required to be a specialist in mental health rehabilitation. An introductory module was developed to establish the principles of modern mental health rehabilitation. Most of the curriculum was based on existing resources that are relevant to rehabilitation practice. Finalisation of a draft for review was undertaken with the assistance of the RANZCP education project advisors and curriculum experts. As a national body responsible for training psychiatric registrars and maintenance of training for psychiatrists, the RANZCP is well situated to train the specialist medical mental health workforce required to lead rehabilitation services in Australia. The RANZCP mental health rehabilitation curriculum will provide a platform to train the skilled workforce that will enable these services to be fully realised.

Stunting is a major nutritional problem caused by many factors such as socio-economic conditions, birth order, maternal nutrition during pregnancy and lack of nutritional intake for babies. In the case of East Java, one of the districts that has a higher stunting rate compared to the provincial and national levels in 2021 is Mojokerto Regency, especially in Kuripansari Village, Pacet District. As an effort to overcome this problem, outreach and training activities were carried out regarding the processing of superfood wild plants, namely plants or food that have a high nutritional density, are easy to find and have no economic value, as an alternative to help meet the nutritional needs of pregnant women and toddlers as well as to reduce the risk of stunting. The targets of the socialization and training program for processing wild superfood plants are PKK women (Family Welfare Programme) and elementary school children in Kuripansari Village. For PKK women, the activities carried out include the introduction and processing of superfood wild plants to enrich the availability of affordable side dishes and delicious, highly nutritious food at the household level. In elementary school children, activities carried out include socialization about nutrition and the introduction of superfood wild plants as alternative healthy and nutritious foods or snacks. The expected target is that the community can know the types of superfood wild plants and can use them to meet their nutritional needs. The results of the activities show that the outreach and training carried out have helped increase the participants' knowledge and skills in processing wild superfood plants. The advice given in this activity is the need for further assistance in the processing of superfood wild plants so that it not only has an impact on nutritional problems and stunting, but can also have an impact on the community's economy through activity development programs, for example in the form of cultivation and marketing of superfood wild plant food products. as well as educational tourism activities.