A neurologic ICU early mobility protocol increased highest neurologic ICU mobility and discharge home and decreased length of stay, but did not improve quality metrics or psychological profile.

Introduction: Rapid scale-up of antiretroviral therapy (ART) in the context of financial and health system constraints has resulted in calls to maximize efficiency in ART service delivery. Adopting differentiated care models (DCMs) for ART could potentially be more cost-efficient and improve outcomes. However, no study comprehensively projects the cost savings across countries. We model the potential reduction in facility-level costs and number of health workers needed when implementing two types of DCMs while attempting to reach 90-90-90 targets in 38 sub-Saharan African countries from 2016 to 2020.Methods: We estimated the costs of three service delivery models: (1) undifferentiated care, (2) differentiated care by patient age and stability, and (3) differentiated care by patient age, stability, key vs. general population status, and urban vs. rural location. Frequency of facility visits, type and frequency of laboratory testing, and coverage of community ART support vary by patient subgroup. For each model, we estimated the total costs of antiretroviral drugs, laboratory commodities, and facility-level personnel and overhead. Certain groups under four-criteria differentiation require more intensive inputs. Community-based ART costs were included in the DCMs. We take into account underlying uncertainty in the projected numbers on ART and unit costs.Results: Total five-year facility-based ART costs for undifferentiated care are estimated to be US$23.33 billion (95% confidence interval [CI]: $23.3–$23.5 billion). An estimated 17.5% (95% CI: 17.4%–17.7%) and 16.8% (95% CI: 16.7%–17.0%) could be saved from 2016 to 2020 from implementing the age and stability DCM and four-criteria DCM, respectively, with annual cost savings increasing over time. DCMs decrease the full-time equivalent (FTE) health workforce requirements for ART. An estimated 46.4% (95% CI: 46.1%–46.7%) fewer FTE health workers are needed in 2020 for the age and stability DCM compared with undifferentiated care.Conclusions: Adopting DCMs can result in significant efficiency gains in terms of reduced costs and health workforce needs, even with the costs of scaling up community-based ART support under DCMs. Efficiency gains remained flat with increased differentiation. More evidence is needed on how to translate analyzed efficiency gains into implemented cost reductions at the facility level.

These data from studies of neurocritically ill patients demonstrate that patients with primary neurologic diagnoses can meet diagnostic criteria for delirium and that delirious features may predict relevant untoward clinical outcomes. There is a need for ongoing investigations regarding delirium in these complicated neurocritically ill patients.

Photovoice is increasingly lauded as one of a number of emergent research methodologies designed to be empowering for participants. In this paper, we explore the findings from a photovoice study with 15 queer and trans youth in a small urban centre in Ontario, Canada and some of the challenges faced in navigating photovoice ethics when working with a marginalized community that must grapple with dilemmas of visibility and representation in their daily lives. This paper identifies some practical considerations in confronting issues of representation in photovoice research, and reflects on the interaction of the research study with participants' ongoing negotiation of power imbalances in their daily lives.

Purpose -This study sought to gain a better understanding of the general life experiences of lesbian, gay, bisexual and transgender (LGBT) newcomer youth, situated within the broader context of their lives post-migration. The purpose of this paper is to explore the nature of various forms of oppression experienced by LGBT newcomers and offers recommendations for transforming services to better serve the complex needs of this marginalized population. Design/methodology/approach -The Teens Resisting Urban Trans/Homophobia (TRUTH) project was comprised of ten focus groups with 70 youth (aged 14-29) living in the Greater Toronto Area (GTA). Another three focus groups were conducted with 13 GTA service providers and teachers working with LGBT youth, in addition to one key informant interview. For this paper, the authors drew from a subset of the data including four newcomer-specific focus groups in which there were 39 youth who identified as refugees or immigrants, as well as key informant interviews with four youth (three of whom also participated in focus groups) and one service provider. Participants were asked about "what homophobia and transphobia meant to them", "where they experienced it", "in what forms", and "how it impacted their daily lives". Findings -The experiences of LGBT newcomer youth in this study involved a complex negotiation of multiple systems of oppression. Youth described experiences of homophobia and racism within interpersonal relationships, in the LGBT community, in their respective diasporic communities, in social service encounters and during the immigration/refugee process. Barriers for LGBT refugee youth included difficulties finding work and accessing health care, as well as the additional burden of proving their sexual orientation during refugee claimant hearings. Research limitations/implications -While the combination of focus groups and key informant interviews is a strength in this study, it also presents challenges for analysis. In focus groups, it is not always clear who is speaking; because of this, the authors were sometimes unable to differentiate between refugee and immigrant youth (or those without status) in our focus groups, making it often unclear which perspective or experience youth were speaking to. Another limitation was the dominance of the "cisgender gay male voice" in our conclusions. Lesbian and bisexual women were present in fewer numbers and the sample only included three trans youth. Practical implications -The findings reveal systemic discrimination on the basis of race and sexual orientation that illuminate injustices within Canadian society and systems that can enhance the efforts of those working in policy and service environments. Focused anti-homophobia and anti-racism training, and the implementation of policies designed to enhance accessibility, could improve service provision for newcomer LGBT youth. Furthermore, in order to facilitate a more just settlement process, a broader understanding of sexual identity, gender identity, and gender expression is ...