Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults:a Systematic Review

Background: The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. Methods: An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. Results: Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. Conclusions: The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. Registration: PROSPERO registration number: CRD42022379584.</p

Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults : a Systematic Review

Background: The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. Methods: An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. Results: Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. Conclusions: The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity

Hydrothermal fluid flow within a tectonically active rift-ridge transform junction: Tjornes Fracture Zone, Iceland

We investigate the regional fluid flow dynamics in a highly faulted transform area, the Tjornes Fracture Zone in northern Iceland which is characterized by steep geothermal gradients, hydrothermal activity, and strong seismicity. We simulate fluid flow within the Tjornes Fracture Zone using a high-resolution model that was based on the available geological and geophysical data and has the aim to represent the complex geological structures and the thermodynamical processes that drive the regional fluid flow in a physically realistic way. Our results show that convective heat flow and mixing of cold and saline seawater with deep hydrothermal fluids controls the large-scale fluid flow. The distribution of faults has a strong influence on the local hydrodynamics by focusing flow around clusters of faults. This explains the nature of isolated upflow zones of hot hydrothermal fluids which are observed in the Tjornes Fracture Zone. An important emergent characteristic of the regional fluid flow in the Tjornes Fracture Zone are two separate flow systems: one in the sedimentary basins, comprising more vigorous convection, and one in the crystalline basement, which is dominated by conduction. These two flow systems yield fundamental insight into the connection between regional hydrothermal fluid flow and seismicity because they form the basis of a toggle switch mechanism that is thought to have caused the hydrogeochemical anomalies recorded at Husavik before and after the 5.8 M earthquake in September 2002.</p

Sequence Variants Linked to Key Traits in Interspecific Crosses between African and Asian Rice

Asian and African rice gene pools vary in many traits that are important in rice breeding. The genetic basis of these differences was evaluated by analysis of important agronomic traits in crosses between African and Asian rice. Trait-associated variants (TAVs) influencing three quantitative agronomic traits, heading date (Hd), tiller number at maturity (T), and 1000 grain weight (TGW), were identified by association analysis of crosses between Asian and African rice. Populations were developed by crossing WAB56-104 (Oryza sativa) and CG14 (Oryza glaberrima). DNA from plants with extremely high or low values for these phenotypes was bulked and sequenced. The reference genome of O. sativa cv Nipponbare was used in general association analysis and candidate gene analysis. A total of 5152 non-synonymous single nucleotide polymorphisms (SNPs) across 3564 genes distinguished the low and the high bulks for Hd, T, and TGW traits; 611 non-synonymous SNPs across 447 genes were found in KEGG pathways. Six non-synonymous SNPs were found in the sequences of LOC107275952, LOC4334529, LOC4326177, LOC107275432, LOC4335790, and LOC107275425 genes associated with Hd, T, and TGW traits. These genes were involved in: abscisic-acid biosynthesis, carotenoid biosynthesis, starch and sucrose metabolism, and cytokinin biosynthesis. Analysis of 24 candidate genes associated with Hd, T, and TGW traits showed seven non-synonymous variations in the sequence of Hd3a and Ehd2 from the Hd genes (not in a KEGG pathway), D10 and D53 from the T genes (strigolactones biosynthetic pathway), and Gn1a and GIF1 from the TGW genes (cytokinin biosynthetic and starch and sucrose metabolism pathways). This study identified significant differences in allele frequencies supported by high sequence depth in analysis of bulks displaying high and low values for these key traits. These trait-associated variants are likely to be useful in rice improvement

Designing a Lifestyle Program for Adolescents from Middle Eastern Backgrounds

Halting the rise in the prevalence of overweight and obesity among adolescents is a key priority, to ensure healthy behaviours are entrenched and co-morbidities minimised during this transitory period into adulthood. Moreover, the burden of overweight and obesity is not equally distributed, but concentrated in ethnic minorities from socially disadvantaged backgrounds, including adolescents from Middle Eastern backgrounds. While a plethora of efforts have been dedicated to tackling the obesity pandemic in children, co-designed, culturally responsive and equity-based responses to shift the ethnic and socio-economic gradient of obesity and generate population-level differences have been scarce. Acknowledging the need for upstream policies to mitigate and ‘close the gap’, grassroots efforts are still important to understand and serve at-risk communities and help translate research to priority populations. Hence, this thesis seeks to produce the formative research to inform the co-design of a lifestyle program that is championed by the Middle Eastern community in New South Wales, Australia, for the prevention of overweight and obesity in adolescents