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Open Access
Primus Inter PARES: First among equals—practical strategies for young adult PAtient RESearch partners (PARES) by young adult PARES
(2024-05-08) Rao, Sandy; Dimitropoulos, Gina; Jardine, Rae; Quickstad, Julien; Satam, Laetitia; Qureshi, Mohammad; Bui, Thyra; Todorova, Antoaneta A.; Tumaneng, Ysabelle; Suthakaran, Abitha; Dalley, Kaiden; Smith, Stacie; Patten, Scott B.
Abstract Background This manuscript is coauthored by 15 young adult Patient RESearch partners (PARES) with lived and living mental health experiences and three institutional researchers across Canada involved in a patient-oriented research (POR) study called the HEARTS Study: Helping Enable Access and Remove Barriers To Support for Young Adults with Mental Health-Related Disabilities. We share our reflections, experiences and lessons learned as we grapple with the field of POR for its lack of clarity, hierarchical structures, internalized ableism, and accessibility challenges, among others. To mitigate the difficulties of POR, we started by laying the groundwork for equality by embracing the principle of Primus Inter Pares: First Among Equals as the foundation of our approach. In this way, we began with what we know for certain: the inherent worth and dignity of young adults as equal partners, recognizing their expertise, worldviews, creativity, and capacity to contribute meaningfully and intentionally to the research that affects their lives and futures. Main Body The manuscript underscores the need to reconceptualize meaningful engagement in POR, advocating a shift from traditional, biased paradigms that fail to address the complexities faced by young adults with mental illness. It introduces what we have termed Adaptive and Differential Engagement, underscoring the necessity of tailoring participation to individual preferences and circumstances alongside a Tripartite Compensation model that promotes fair and holistic remuneration in research collaborations. Then we discuss the approaches we have conceptualized, such as Equitable Dialogue, Trust Architecture, Community Continuum, Unity in Diversity, Shared Stewardship, and Agile Frameworks that collectively aim to overcome barriers like language intimidation, power imbalances, framework fatigue, consultation burnout, trust deficits, and systemic discrimination and exclusion. The manuscript does not seek to prescribe any universal or standardized solutions; in fact, it seeks the opposite. Instead, it offers a thoughtful and transparent contribution to the POR canon, providing resources for young adults eager to engage in research and institutional researchers aspiring to collaborate with them. Conclusion This manuscript is a product of our collective learning and critical self-evaluation. By integrating theoretical insights with practical strategies, we present a justice-oriented blueprint for an inclusive and egalitarian approach to POR. We advocate for applications of POR that are responsive to the individualized contexts of young adult PARES, ensuring their perspectives are central to the research with the resources to take the lead should they choose.
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Open Access
Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas
(2024-05-08) Ghimire, Anukul; Shah, Samveg; Chauhan, Utkarsh; Ibrahim, Kwaifa S.; Jindal, Kailash; Kazancioglu, Rumeyza; Luyckx, Valerie A.; MacRae, Jennifer M.; Olanrewaju, Timothy O.; Quinn, Robert R.; Ravani, Pietro; Shah, Nikhil; Thompson, Stephanie; Tungsanga, Somkanya; Vachharanjani, Tushar; Arruebo, Silvia; Caskey, Fergus J.; Damster, Sandrine; Donner, Jo-Ann; Jha, Vivekanand; Levin, Adeera; Malik, Charu; Nangaku, Masaomi; Saad, Syed; Tonelli, Marcello; Ye, Feng; Okpechi, Ikechi G.; Bello, Aminu K.; Johnson, David W.
Abstract Background There is a lack of contemporary data describing global variations in vascular access for hemodialysis (HD). We used the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to highlight differences in funding and availability of hemodialysis accesses used for initiating HD across world regions. Methods Survey questions were directed at understanding the funding modules for obtaining vascular access and types of accesses used to initiate dialysis. An electronic survey was sent to national and regional key stakeholders affiliated with the ISN between June and September 2022. Countries that participated in the survey were categorized based on World Bank Income Classification (low-, lower-middle, upper-middle, and high-income) and by their regional affiliation with the ISN. Results Data on types of vascular access were available from 160 countries. Respondents from 35 countries (22% of surveyed countries) reported that > 50% of patients started HD with an arteriovenous fistula or graft (AVF or AVG). These rates were higher in Western Europe (n = 14; 64%), North & East Asia (n = 4; 67%), and among high-income countries (n = 24; 38%). The rates of > 50% of patients starting HD with a tunneled dialysis catheter were highest in North America & Caribbean region (n = 7; 58%) and lowest in South Asia and Newly Independent States and Russia (n = 0 in both regions). Respondents from 50% (n = 9) of low-income countries reported that > 75% of patients started HD using a temporary catheter, with the highest rates in Africa (n = 30; 75%) and Latin America (n = 14; 67%). Funding for the creation of vascular access was often through public funding and free at the point of delivery in high-income countries (n = 42; 67% for AVF/AVG, n = 44; 70% for central venous catheters). In low-income countries, private and out of pocket funding was reported as being more common (n = 8; 40% for AVF/AVG, n = 5; 25% for central venous catheters). Conclusions High income countries exhibit variation in the use of AVF/AVG and tunneled catheters. In low-income countries, there is a higher use of temporary dialysis catheters and private funding models for access creation.
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Open Access
Harmonization of clinical practice guidelines for primary prevention and screening: actionable recommendations and resources for primary care
(2024-05-06) Fernandes, Carolina; Campbell-Scherer, Denise; Lofters, Aisha; Grunfeld, Eva; Aubrey-Bassler, Kris; Cheung, Heidi; Latko, Katherine; Tink, Wendy; Lewanczuk, Richard; Shea-Budgell, Melissa; Heisey, Ruth; Wong, Tracy; Yang, Huiming; Walji, Sakina; Wilson, Margo; Holmes, Elizabeth; Lang-Robertson, Kelly; DeLonghi, Christina; Manca, Donna P.
Abstract Background Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations. We describe the process used to harmonize high-quality cancer and chronic disease prevention and screening (CCDPS) CPGs to update the BETTER program. Methods A review of CPG databases, repositories, and grey literature was conducted to identify international and Canadian (national and provincial) CPGs for CCDPS in adults 40–69 years of age across 19 topic areas: cancers, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, hepatitis C, obesity, osteoporosis, depression, and associated risk factors (i.e., diet, physical activity, alcohol, cannabis, drug, tobacco, and vaping/e-cigarette use). CPGs published in English between 2016 and 2021, applicable to adults, and containing CCDPS recommendations were included. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and a three-step process involving patients, health policy, content experts, primary care providers, and researchers was used to identify and synthesize recommendations. Results We identified 51 international and Canadian CPGs and 22 guidelines developed by provincial organizations that provided relevant CCDPS recommendations. Clinical recommendations were extracted and reviewed for inclusion using the following criteria: 1) pertinence to primary prevention and screening, 2) relevance to adults ages 40–69, and 3) applicability to diverse primary care settings. Recommendations were synthesized and integrated into the BETTER toolkit alongside resources to support shared decision-making and care paths for the BETTER program. Conclusions Comprehensive care requires the ability to address a person’s overall health. An approach to identify high-quality clinical guidance to comprehensively address CCDPS is described. The process used to synthesize and harmonize implementable clinical recommendations may be useful to others wanting to integrate evidence across broad content areas to provide comprehensive care. The BETTER toolkit provides resources that clearly and succinctly present a breadth of clinical evidence that providers can use to assist with implementing CCDPS guidance in primary care.
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Embargo
Regulation of Fatty Acid Biosynthesis by Protein Phosphorylation of the α-CT Subunit of ACCase in Arabidopsis thaliana
(2024-04-30) Wong, Lana; Moorhead, Gregory; Zaremberg, Vanina; Burkinshaw, Brianne
Reversible protein phosphorylation, the most common post-translational modification, is essential in mediating most cellular functions in living organisms. With recent advances in omics-based technologies and its applications to studying the phosphoproteome of particular organisms, many previously uncharacterized phosphoproteins, protein kinases and protein phosphatases have been identified. Shewanella-like protein phophatase 1 (SLP1), a novel Arabidopsis thaliana protein phosphatase localized to the chloroplast, is a protein of interest as it is predicted to play an antagonistic role to the constitutively active chloroplast localized kinase, casein kinase 2α4 (CK2α4). Through a quantitative mass spectrometry based phosphoproteomics study carried out by previous members of the Moorhead Lab, many putative substrates of AtSLP1 were identified, one of them being the alpha-carboxyltransferase (α-CT) subunit of heteromeric acetyl-CoA carboxylase (htACCase). HtACCase catalyzes the first committed step of de novo fatty acid biosynthesis, and like AtSLP1, is chloroplast localized. HtACCase has been known to interact with the chloroplast envelope membrane through association with an integral membrane protein, however, the identity of this protein has been a mystery until recently. Carboxyltransferase interactors (CTIs), a group of small plastidal proteins of the inner chloroplast envelope have been identified to interact with the α-CT subunit of htACCase in a light-dependent manner. The focus of the research presented here was to characterize α-CT as a substrate of both CK2α4 and SLP1 and to determine the role of protein phosphorylation in lipid metabolism. Here, initial steps were taken in employing phosphospecific antibodies against the S741 site on α-CT, with immunoblot analysis confirming previous findings from a phosphoproteomics study indicating hyperphosphorylation of α-CT in the absence of SLP1. To explore the relationship between protein phosphorylation and the membrane partitioning of ACCase with CTI, recombinant proteins were cloned for subsequent protein-protein interaction studies. By studying the effects of this post-translational modification, we will gain a better understanding of the role of protein phosphorylation in regulating fatty acid biosynthesis, which will ultimately uncover new ways to increase bio-oil production in crops.
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Open Access
A Thematic Analysis of New Graduate Nurse Related Posts on TikTok
(2024-04-24) Mei, Carol; Jackson, Jennifer; Risling, Tracie; Radford, Scott; Devey Burry, Robin
New graduate nurses (NGNs) are entering the nursing workforce with enthusiasm, vigour, and current evidenced based knowledge (Murray et al., 2019). Negative experiences within the first two years of practice can lead to NGN attrition (Chernomas et al., 2010; García‐Martín et al., 2021; Kim & Shin, 2020; Parker et al., 2014). Due to the popularity of social media, many NGNs are sharing their experiences in practice on the social networking platform, TikTok. Using Braun and Clarkes’ (2006, 2021a) reflexive thematic analysis, my study answered the research question, “How is the NGN experience of transition to practice portrayed on TikTok?” I generated three themes that depicted the transition to practice experience on TikTok: The NGN as an Individual, The NGN as a Clinical Nurse, and The NGN as a Professional. The results of my study demonstrated a gradual progression in the NGNs comfort within their new nursing scope. As NGNs entered practice, they were eager to begin their career, but many did not demonstrate an understanding regarding the complexities of the nursing profession. As a result, majority of the NGNs felt unprepared for practice. NGNs with RN preceptors had more positive experiences within their transition to practice as compared to those that did not. These findings have implications for future practice. NGNs should be prepared at the university level for the initial challenges of transition. Additionally, nurse managers should cultivate a supportive environment and use pairing processes for RN preceptors and NGNs to aid in their transition to clinical practice.