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When his once-brilliant granddad succumbs to mental decline and urges him to visit Blackbrick Abbey, young Cosmo is transported through time and learns of his granddad's teenage adventures on the sprawling estate.

Academic libraries are fundamental in promoting equitable access to education but are often overlooked and underfunded. The COVID-19 pandemic amplified these inequities. This study investigates how 39 library deans and directors perceived decision-making by university administration during COVID-19's onset. Open-ended survey questions were sent to deans and directors asking them to describe their experiences working with university administration to adjust library services during the crisis. Some library leaders reported that working closely with other departments strengthened their campus connections. Others commented that disagreement between library personnel and university administration caused discord. Some deans and directors were forced to cut staff funding or felt pressured to reopen, while others were trusted to choose their budget and service priorities. The authors recommend that library leaders be more consistently relied upon for their expertise during university decision-making.

Oscar Dunleavy, a teenager who used to make incredible apple tarts, has gone missing and everyone thinks he is dead, but Oscar's best friend Meg and his little brother Stevie, form a band as they try to figure out what happened to him.

Background The Department of Health of the Government of New Brunswick and Regional Health Authorities elected to implement Stepped Care 2.0 (SC2.0) in 2021, and began with One-at-a-Time (OAAT) therapy in Community Addiction and Mental Health Centres (CAMHCs) to facilitate rapid access to addiction and mental healthcare. This study: 1) explicated the process of implementing OAAT therapy as it aligned to evidence-based implementation frameworks and strategies; 2) assessed readiness for change among providers during the implementation; and 3) evaluated initial client and system outcomes. Methods The process of implementing OAAT therapy within CAMHCs was documented and retrospectively aligned with the Active Implementation Frameworks-Stages of Implementation, Consolidated Framework for Implementation Research, and incorporated strategies endorsed by the Expert Recommendations for Implementing Change. Providers working in CAMHCs completed online asynchronous courses in OAAT therapy and SC2.0, and were recruited to participate in research on perceptions of organizational readiness. Initial outcomes of the implementation were evaluated through client satisfaction surveys administered in CAMHCs and system performance indicators. Results Aligning with implementation stages, key strategies included: 1) continuously monitoring readiness and soliciting stakeholder feedback for iterative improvement; 2) building a representative implementation team with engaged leaders; 3) creating a comprehensive implementation plan on staff training, communication, and system changes; and 4) supporting sustainability. Providers who participated in research ( N  = 170, ~ 50% response rate) agreed that their organization was ready for implementation, and that OAAT therapy delivered within a SC2.0 framework was acceptable, appropriate, and feasible. More than 3,600 OAAT therapy sessions were delivered during the initial implementation stage, and waitlists were reduced by 64.1%. The majority of clients who completed surveys ( N  = 1240, ~ 35% response rate) reported that their OAAT therapy session was helpful, with a minority reporting that additional intervention was needed. Conclusions Thoughtful planning and execution, aligned with evidence-based implementation frameworks and strategies, played an important role in this provincial change initiative. Implementation steps outlined can help inform others looking to enact large-scale change.

Universities worldwide are pausing in an attempt to contain COVID-19's spread. In February 2019, universities in China took the lead, cancelling all in-person classes and switching to virtual classrooms, with a wave of other institutes globally following suit. The shift to online platform poses serious challenges to medical education so that understanding best practices shared by pilot institutes may help medical educators improve teaching. Provide 12 tips to highlight strategies intended to help on-site medical classes moving completely online under the pandemic. We collected 'best practices' reports from 40 medical schools in China that were submitted to the National Centre for Health Professions Education Development. Experts' review-to-summary cycle was used to finalize the best practices in teaching medical students online that can benefit peer institutions most, under the unprecedented circumstances of the COVID-19 outbreak. The 12 tips presented offer-specific strategies to optimize teaching medical students online under COVID-19, specifically highlighting the tech-based pedagogy, counselling, motivation, and ethics, as well as the assessment and modification. Learning experiences shared by pilot medical schools and customized properly are instructive to ensure a successful transition to e-learning.

Balance between benefits and harms of using opioids for the management of chronic noncancer pain (CNCP) must be carefully considered on a case-by-case basis. There is no one-size-fits-all approach that can be executed by prescribers and clinicians when considering this therapy. The aim of this study was to identify barriers and facilitators for prescribing opioids for CNCP through a systematic review of qualitative literature. Six databases were searched from inception to June 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias was rated, and confidence in evidence was graded. Twenty-seven studies reporting data from 599 health care providers were included. Ten themes emerged that influenced clinical decision making when prescribing opioids. Providers were more comfortable to prescribe opioids when (1) patients were actively engaged in pain self-management, (2) clear institutional prescribing policies were present and prescription drug monitoring programs were used, (3) long-standing relationships and strong therapeutic alliance were present, and (4) interprofessional supports were available. Factors that reduced likelihood of prescribing opioids included (1) uncertainty toward subjectivity of pain and efficacy of opioids, (2) concern for the patient (e.g., adverse effects) and community (i.e., diversion), (3) previous negative experiences (e.g., receiving threats), (4) difficulty enacting guidelines, and (5) organizational barriers (e.g., insufficient appointment duration and lengthy documentation). Understanding barriers and facilitators that influence opioid-prescribing practices offers insight into modifiable targets for interventions that can support providers in delivering care consistent with practice guidelines.

Background The workplace has been identified as a priority setting to positively influence individuals’ dietary behaviours. However, a dearth of evidence exists regarding the costs of implementing and delivering workplace dietary interventions. This study aimed to conduct a cost-analysis of workplace nutrition education and environmental dietary modification interventions from an employer’s perspective. Methods Cost data were obtained from a workplace dietary intervention trial, the Food Choice at Work Study. Micro-costing methods estimated costs associated with implementing and delivering the interventions for 1 year in four multinational manufacturing workplaces in Cork, Ireland. The workplaces were allocated to one of the following groups: control, nutrition education alone, environmental dietary modification alone and nutrition education and environmental dietary modification combined. A total of 850 employees were recruited across the four workplaces. For comparison purposes, total costs were standardised for 500 employees per workplace. Results The combined intervention reported the highest total costs of €31,108. The nutrition education intervention reported total costs of €28,529. Total costs for the environmental dietary modification intervention were €3689. Total costs for the control workplace were zero. The average annual cost per employee was; combined intervention: €62, nutrition education: €57, environmental modification: €7 and control: €0. Nutritionist’s time was the main cost contributor across all interventions, (ranging from 53 to 75% of total costs). Conclusions Within multi-component interventions, the relative cost of implementing and delivering nutrition education elements is high compared to environmental modification strategies. A workplace environmental modification strategy added marginal additional cost, relative to the control. Findings will inform employers and public health policy-makers regarding the economic feasibility of implementing and scaling dietary interventions. Trial registration Current Controlled Trials: ISRCTN35108237 . Date of registration: The trial was retrospectively registered on 02/07/2013.

Chronic pain (CP) is a debilitating disease that reduces quality of life, decreases productivity, and has become a primary cause of health care resource consumption. Despite this, many Canadian family physicians have received little formal education in managing CP, making it one of the most challenging areas of practice in primary care. Project Extension for Community Healthcare Outcomes Chronic Pain & Opioid Stewardship St. Joseph's Care Group (Project ECHO-SJCG) is an evidence-based educational program connecting community-based health care providers (HCPs) with an interprofessional team by videoconference to learn about management of CP in rural, remote, and underserved areas. To explore key learning points from cases presented at Project ECHO-SJCG, identify and analyze themes and improve future sessions of continuing professional development for HCPs. We completed a thematic analysis of forty cases and key learning points using the constant comparison method. We also summarized descriptive statistics for patient and provider characteristics. Forty cases were presented by 31 HCPs, who received suggestions focused on assessment and diagnosis, pharmacological and non-pharmacological pain symptom management, interventional management, attention to biopsychosocial factors, and appropriate referral to other HCPs. Project ECHO-SJCG cases allow HCPs to gain a broad knowledge base to evaluate and manage CP in their practice. Identified themes highlight common gaps in HCPs' knowledge and will guide future sessions.

Clinical practice guidelines synthesize the best available evidence and recommend treatments with the intention of enhancing client outcomes. Despite evidence for effectiveness, guideline-recommended treatments are often under-utilized. We conducted a systematic review of six bibliographic databases published prior to May 6, 2020. Qualitative studies that reported on mental healthcare provider perceived barriers and facilitators to the delivery of evidence-based treatments (EBTs) recommended by practice guidelines for the management of depression, anxiety-related disorders, and posttraumatic stress disorder (PTSD) within usual care were eligible. A meta-synthesis approach was used to synthesize barriers and facilitators that were coded in accordance with the Theoretical Domains Framework. Confidence in evidence was graded with the Grading of Recommendation, Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. Eighteen studies that reported on 705 mental healthcare providers (primarily psychologists and social workers) met inclusion criteria. Evidence synthesized pertained primarily to the delivery of (a) cognitive processing therapy (CPT) and prolonged exposure (PE) for the management of PTSD among veterans; and (b) cognitive behavioral therapy (CBT) for the management of depression and anxiety-related disorders. Factors that reliably influenced the delivery of EBTs included the following: (a) knowledge and self-efficacy; (b) anticipation of client outcomes in the presence of complex comorbidity; (c) client preference and readiness to engage in treatment; (d) available time, presence of trained staff, and institutional policies; and (e) availability of professional supports. Findings could influence the delivery of EBTs but must be taken in context with the tripartite model of evidence-based practice. Les lignes directrices cliniques constituent la synthèse des meilleures données probantes disponibles et recommandent des traitements qui amélioreront l'état de santé des patients. Or, même si des éléments probants en démontrent l'efficacité, les traitements recommandés par les lignes directrices sont souvent sous-utilisés. Nous avons donc mené une analyse systématique de six bases de données bibliographiques publiées avant le 6 mai 2020. Les études qualitatives portant sur les obstacles perçus par les professionnels de la santé mentale et sur les éléments facilitateurs de la prestation de traitements fondés sur des données probantes recommandés par les lignes directrices cliniques pour la prise en charge de la dépression, des troubles anxieux et du trouble de stress post-traumatique (TSPT) dans le cadre du régime de soins habituel étaient admissibles à notre analyse systématique. La méthode de la métasynthèse a été utilisée pour résumer les obstacles et les éléments facilitateurs qui ont été codés conformément au Cadre des domaines théoriques. La confiance à l'égard des données probantes a été évaluée au moyen de l'approche GRADE-CERQual (Grading of Recommendation, Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research). Dix-huit études menées auprès de 705 professionnels de la santé mentale (principalement des psychologues et des travailleurs sociaux) répondaient aux critères d'inclusion. Les données probantes couvertes concernaient essentiellement (a) la thérapie du processus cognitif (TPC) et l'exposition prolongée (EP) à ce traitement pour la prise en charge du TSPT chez les vétérans; et (b) la thérapie cognitivo-comportementale (TCC) pour la prise en charge de la dépression et des troubles anxieux. Parmi les facteurs influant sur la prestation de la TPC, notons les suivants : (a) connaissances et auto-efficacité; (b) résultats anticipés sur le plan de la santé en présence de comorbidités complexes; (c) préférence du client et volonté à participer au traitement; (d) temps disponible, présence de personnel formé et politiques institutionnelles; et (e) disponibilité d'éléments de soutien professionnels. Les conclusions pourraient influer sur la prestation de TPC, mais doivent être soupesées dans le contexte du modèle tripartite des pratiques fondées sur des preuves. Public Significance Statement Clinical practice guidelines recommend psychological therapies that are well supported by available evidence for the management of common mental health concerns. There may be systematic reasons why such therapies are not delivered during routine care which could prevent some clients from receiving the best available treatments. We sought to identify factors that make delivering such treatments more or less likely with the hope that this understanding could ultimately improve the delivery of effective mental healthcare among those in need.

Obesity is one of the most invaliding and preventable diseases in the United States. Growing evidence suggests that there are sex differences in obesity in human and experimental animals. However, the specific mechanisms of this disease are unknown. Consequently, there is any particular treatment according to the sex/gender at this time. During the last decade, we observe a rise in the study of adipocyte and the possible mechanisms involved in the different roles of the fat. Furthermore, the effect of sex steroids on the adipocyte is one of the fields that need elucidation. Supporting evidence suggests that sex steroids play an essential role not only in the fat distribution, but also, in its metabolism, proliferation, and function. Thus, using in vitro and in vivo studies will contribute to our fight against this critical health public problem encompassing both sexes. In the present review, we discuss some of the recent advances in the adipocytes and the effect of the sex steroids on the adipose tissue. Also, we propose a new alternative to study the role of sex steroids on adipocyte biology through human adipose-derived stem cells.