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Background Brucellosis, as a serious zoonotic infectious disease, has been recognized as a re-emerging disease in the developing countries worldwide. In china, the incidence of brucellosis is increasing each year, seriously threatening the health of humans as well as animal populations. Despite a quite number of diagnostic methods currently being used for brucellosis, innovative technologies are still needed for its rapid and accurate diagnosis, especially in area where traditional diagnostic is unavailable. Methodology/Principal findings In this study, a total of 22 B cell linear epitopes were predicted from five Brucella outer membrane proteins (OMPs) using an immunoinformatic approach. These epitopes were then chemically synthesized, and with the method of indirect ELISA (iELISA), each of them displayed a certain degree of capability in identifying human brucellosis positive sera. Subsequently, a fusion protein consisting of the 22 predicted epitopes was prokaryotically expressed and used as diagnostic antigen in a newly established brucellosis testing method, nano-ZnO modified paper-based ELISA (nano-p-ELISA). According to the verifying test using a collection of sera collected from brucellosis and non-brucellosis patients, the sensitivity and specificity of multiepitope based nano-p-ELISA were 92.38% and 98.35% respectively. The positive predictive value was 98.26% and the negative predictive value was 91.67%. The multiepitope based fusion protein also displayed significantly higher specificity than Brucella lipopolysaccharide (LPS) antigen. Conclusions B cell epitopes are important candidates for serologically testing brucellosis. Multiepitope fusion protein based nano-p-ELISA displayed significantly sensitivity and specificity compared to Brucella LPS antigen. The strategy applied in this study will be helpful to develop rapid and accurate diagnostic method for brucellosis in human as well as animal populations., Author summary Brucellosis is one of the most important zoonosis in the world and has caused tremendous economic losses in agriculture and animal husbandry in many countries. Developing rapid, sensitive and specific diagnostic methods is very important for early detection and treatment of brucellosis patients. In this study, a novel diagnostic technique, nano-ZnO modified paper ELISA, was established. The antigen used in this technique was a fusion protein containing multiple B cell epitopes, which were predicted from Brucella major outer membrane proteins such as Bp26, Omp31, Omp16, Omp2b and Omp25. Comparing to traditional LPS antigen, this multiepitope based antigen displayed considerably higher sensitivity and higher specificity in laboratory. With the strategy described in this paper, more efficient epitopes and protein antigen can be identified in the future. Currently, LPS antigen is only prepared from live Brucella, while protein antigen can be produced in large quantities in prokaryotic expression system. In addition to nano-p-ELISA, this protein antigen can also be used for development other methods such as fluorescent polarization assay (FPA) and immunochromatographic assay (ICA) to meet the varied demand for brucellosis testing.

This white paper documents the consensus opinion of the Artificial Intelligence Surgery (AIS) task force on Artificial Intelligence (AI) Ethics and the AIS Editorial Board Study Group on Ethics on the ethical considerations and current trustworthiness of artificial intelligence and autonomous actions in surgery. The ethics were divided into 6 topics defined by the Task Force: Reliability of robotic and AI systems; Respect for privacy and sensitive data; Use of complete and representative (i.e., unbiased) data; Transparencies and uncertainties in AI; Fairness: are we exacerbating inequalities in access to healthcare?; Technology as an equalizer in surgical education. Task Force members were asked to research a topic, draft a section, and come up with several potential consensus statements. These were voted on by members of the Task Force and the Study Group, and all proposals that received > 75 % agreement were adopted and included in the White Paper.

In "Joint EANM/SNMMI/ESTRO Practice Recommendations for the Use of 2-[18F]FDG-PET/CT External Beam Radiation Treatment Planning in Lung Cancer V1.0" clinical indications for PET-CT in (non-)small cell lung cancer are highlighted and selective nodal irradiation is discussed. Additionally, concepts about target definition, target delineation and treatment evaluation are reviewed. (C) 2022 Published by Elsevier B.V.

Social interactions have large effects on individual physiology and fitness. In the immediate sense, social stimuli are often highly salient and engaging. Over longer time scales, competitive interactions often lead to distinct social ranks and differences in physiology and behavior. Understanding how initial responses lead to longer-term effects of social interactions requires examining the changes in responses over time. Here we examined the effects of social interactions on transcriptomic signatures at two times, at the end of a 45-minute interaction and 4 hours later, in female Polistes fuscatus paper wasp foundresses. Female P. fuscatus have variable facial patterns that are used for visual individual recognition, so we separately examined the transcriptional dynamics in the optic lobe and the non-visual brain. Results demonstrate much stronger transcriptional responses to social interactions in the non-visual brain compared to the optic lobe. Differentially regulated genes in response to social interactions are enriched for memory-related transcripts. Comparisons between winners and losers of the encounters revealed similar overall transcriptional profiles at the end of an interaction, which significantly diverged over the course of 4 hours, with losers showing changes in expression levels of genes associated with aggression and reproduction in paper wasps. On nests, subordinate foundresses are less aggressive, do more foraging and lay fewer eggs compared to dominant foundresses and we find losers shift expression of many genes in the non-visual brain, including vitellogenin, related to aggression, worker behavior, and reproduction within hours of losing an encounter. These results highlight the early neurogenomic changes that likely contribute to behavioral and physiological effects of social status changes in a social insect., Author summary Aggressive interactions often create inequalities–some individuals win while others lose. Winning versus losing can lead to large physiological differences between individuals, including different neurogenomic profiles between winners and losers. How this information about contest outcome leads to distinct neurogenomic profiles is poorly understood. Here we examine gene expression in response to aggressive social encounters in paper wasps, which naturally form dominance hierarchies on their nests in the wild. Shortly following encounters winners and losers have similar expression profiles, likely because similar mechanisms are engaged by social experiences. Four hours later, we find divergent neurogenomic profiles between winners and losers, with losers showing larger shifts in expression compared to winners. Many of the most dynamically expressed genes have been previously associated with dominance and caste differences in paper wasps showing how a single interaction can engage many of the same genomic networks that are involved in mediating more dramatic differences in queen-worker behavioral differences are also involved in responses shortly following social interactions.

Although regression models play a central role in the analysis of medical research projects, there still exist many misconceptions on various aspects of modeling leading to faulty analyses. Indeed, the rapidly developing statistical methodology and its recent advances in regression modeling do not seem to be adequately reflected in many medical publications. This problem of knowledge transfer from statistical research to application was identified by some medical journals, which have published series of statistical tutorials and (shorter) papers mainly addressing medical researchers. The aim of this review was to assess the current level of knowledge with regard to regression modeling contained in such statistical papers. We searched for target series by a request to international statistical experts. We identified 23 series including 57 topic-relevant articles. Within each article, two independent raters analyzed the content by investigating 44 predefined aspects on regression modeling. We assessed to what extent the aspects were explained and if examples, software advices, and recommendations for or against specific methods were given. Most series (21/23) included at least one article on multivariable regression. Logistic regression was the most frequently described regression type (19/23), followed by linear regression (18/23), Cox regression and survival models (12/23) and Poisson regression (3/23). Most general aspects on regression modeling, e.g. model assumptions, reporting and interpretation of regression results, were covered. We did not find many misconceptions or misleading recommendations, but we identified relevant gaps, in particular with respect to addressing nonlinear effects of continuous predictors, model specification and variable selection. Specific recommendations on software were rarely given. Statistical guidance should be developed for nonlinear effects, model specification and variable selection to better support medical researchers who perform or interpret regression analyses.

Summary The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. Introduction The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. Methods The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation’s Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. Results and Conclusion The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.

ispartof: ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY vol:11 issue:1 pages:89-90 ispartof: location:China status: published

Various data sharing platforms are being developed to enhance the sharing of cohort data by addressing the fragmented state of data storage and access systems. However, policy challenges in several domains remain unresolved. The euCanSHare workshop was organized to identify and discuss these challenges and to set the future research agenda. Concerns over the multiplicity and long-term sustainability of platforms, lack of resources, access of commercial parties to medical data, credit and recognition mechanisms in academia and the organization of data access committees are outlined. Within these areas, solutions need to be devised to ensure an optimal functioning of platforms.

Publisher Copyright: © 2022 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology. Background: Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication. Objectives: This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision-making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate-to-severe AD. Methods: Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two-round Delphi process, they reached full or partial consensus on 37 statements. Results: Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non-systemic therapy. Systemic therapy should achieve long-term disease control and reduce short-term interventions. Recommended are cyclosporine A for short-term use (all ages) and dupilumab or methotrexate for long-term use (ages ≥6 years). Consensus was not reached on the best long-term systemics for children aged 2–6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real-world data will become available. Conclusions: This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate-to-severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.

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IL-23 is a key cytokine in the pathogenesis of spondyloarthritides, including PsA and axial spondyloarthritis, as well as related conditions, such as psoriasis and IBD. Genetic associations, animal models and translational studies in humans demonstrate the key role played by IL-23, especially when coupled with downstream overexpression of IL-17 via stimulation of T helper 17 (Th17) and other cells by IL-23. Whereas IL-23 inhibition has shown clear-cut benefit in psoriasis and peripheral manifestations of PsA, trials of IL-23 inhibitors have failed in the treatment of ankylosing spondylitis. More recently, exploratory data from PsA patients with axial symptoms suggests that improvement may occur, but needs confirmation in dedicated axial spondyloarthritis (axSpA) trials. Hypotheses for these apparently conflicting findings about IL-23 inhibition in various forms of spondylitis are discussed.

Long non-coding RNAs (lncRNAs) are a heterogeneous group of transcripts that lack protein coding potential and display regulatory functions in various cellular processes. As a result of their cell- and cancer-specific expression patterns, lncRNAs have emerged as potential diagnostic and therapeutic targets. The accurate characterization of lncRNAs in bulk transcriptome data remains challenging due to their low abundance compared to protein coding genes. To tackle this issue, we describe a unique short-read custom lncRNA capture sequencing approach that relies on a comprehensive set of 565,878 capture probes for 49,372 human lncRNA genes. This custom lncRNA capture approach was evaluated on various sample types ranging from artificial high-quality RNA mixtures to more challenging formalin-fixed paraffin-embedded tissue and biofluid material. The custom enrichment approach allows the detection of a more diverse repertoire of lncRNAs, with better reproducibility and higher coverage compared to classic total RNA-sequencing.

Background In 2005, Bangladesh, India and Nepal agreed to eliminate visceral leishmaniasis (VL) as a public health problem. The approach to this was through improved case detection and treatment, and controlling transmission by the sand fly vector Phlebotomus argentipes, with indoor residual spraying (IRS) of insecticide. Initially, India applied DDT with stirrup pumps for IRS, however, this did not reduce transmission. After 2015 onwards, the pyrethroid alpha-cypermethrin was applied with compression pumps, and entomological surveillance was initiated in 2016. Methods Eight sentinel sites were established in the Indian states of Bihar, Jharkhand and West Bengal. IRS coverage was monitored by household survey, quality of insecticide application was measured by HPLC, presence and abundance of the VL vector was monitored by CDC light traps, insecticide resistance was measured with WHO diagnostic assays and case incidence was determined from the VL case register KAMIS. Results Complete treatment of houses with IRS increased across all sites from 57% in 2016 to 70% of houses in 2019, rising to >80% if partial house IRS coverage is included (except West Bengal). The quality of insecticide application has improved compared to previous studies, average doses of insecticide on filters papers ranged from 1.52 times the target dose of 25mg/m2 alpha-cypermethrin in 2019 to 1.67 times in 2018. Resistance to DDT has continued to increase, but the vector was not resistant to carbamates, organophosphates or pyrethroids. The annual and seasonal abundance of P. argentipes declined between 2016 to 2019 with an overall infection rate of 0.03%. This was associated with a decline in VL incidence for the blocks represented by the sentinel sites from 1.16 per 10,000 population in 2016 to 0.51 per 10,000 in 2019. Conclusion Through effective case detection and management reducing the infection reservoirs for P. argentipes in the human population combined with IRS keeping P. argentipes abundance and infectivity low has reduced VL transmission. This combination of effective case management and vector control has now brought India within reach of the VL elimination targets., Author summary Visceral Leishmaniasis (VL), also known as kala-azar, is a major parasitic disease in South Asia (Indian subcontinent), with 85% of the disease incidence in India. Historically VL had been controlled and almost eliminated with Indoor Residual Spraying (IRS) using dichlorodiphenyltrichloroethane (DDT). However, reinitiating this approach in 2015 failed due to high insecticide resistance in the sand fly vector and poor IRS quality, meaning that VL elimination targets were not met. To improve this the National Vector Borne Disease Control Programme changed to an effective insecticide, alpha-cypermethrin and altered the mode of application to compression pumps. Sentinel sites were established to monitor the entomological indicators, these showed the positive impact of these changes from 2016 to 2019. During this period the overall incidence of disease has decreased, and India is now on track to reach it’s target incidence for VL of less than 1/1000 people at the sub-district (block) level.

Background The European Commission is funding projects that aim to establish data-sharing platforms. These platforms are envisioned to enhance and facilitate the international sharing of cohort data. Nevertheless, broad data sharing may be restricted by the lack of adequate recognition for those who share data. Objective The aim of this study is to describe in depth the concerns about acquiring credit for data sharing within epidemiological research. Methods A total of 17 participants linked to European Union–funded data-sharing platforms were recruited for a semistructured interview. Transcripts were analyzed using inductive content analysis. Results Interviewees argued that data sharing within international projects could challenge authorship guidelines in multiple ways. Some respondents considered that the acquisition of credit for articles with extensive author lists could be problematic in some instances, such as for junior researchers. In addition, universities may be critical of researchers who share data more often than leading research. Some considered that the evaluation system undervalues data generators and specialists. Respondents generally looked favorably upon alternatives to the current evaluation system to potentially ameliorate these issues. Conclusions The evaluation system might impede data sharing because it mainly focuses on first and last authorship and undervalues the contributor’s work. Further movement of crediting models toward contributorship could potentially address this issue. Appropriate crediting mechanisms that are better aligned with the way science ought to be conducted in the future need to be developed.

The highly contagious nature of SARS-CoV-2 has led to several studies on the transmission of the virus. A little studied potential fomite of great concern in the community is currency, which has been shown to harbor microbial pathogens in several studies. Since the onset of the COVID-19 pandemic, many businesses in the United States have limited the use of banknotes in favor of credit cards. However, SARS-CoV-2 has shown greater stability on plastic in several studies. Herein, the stability of SARS-CoV-2 at room temperature on banknotes, money cards and coins was investigated. In vitro studies with live virus suggested SARS-CoV-2 was highly unstable on banknotes, showing an initial rapid reduction in viable virus and no viral detection by 24 hours. In contrast, SARS-CoV-2 displayed increased stability on money cards with live virus detected after 48 hours. Environmental swabbing of currency and money cards on and near the campus of Brigham Young University supported these results, with no detection of SARS-CoV-2 RNA on banknotes, and a low level on money cards. However, no viable virus was detected on either. These preliminary results suggest that the use of money cards over banknotes in order to slow the spread of this virus may be ill-advised. These findings should be investigated further through larger environmental studies involving more locations.

Despite significant advances in the research domain of continuous twin screw granulation, limited information is currently available on the impact of raw material properties, especially considering batch-to-batch variability. The importance of raw material variability and subsequent mitigation of the impact of this variability on the manufacturing process and drug product was recently stressed in the Draft Guidance for Industry on Quality Considerations for Continuous Manufacturing by the U.S. Food and Drug Administration (FDA). Therefore, this study assessed the impact of microcrystalline cellulose (MCC) batch-to-batch variability and process settings in a continuous twin screw wet granulation and semi-continuous drying line. Based on extensive raw material characterization and subsequent principal component analysis, raw material variability was quantitatively introduced in the design of experiments approach by means of t1 and t2 scores. L/S ratio had a larger effect on critical granule attributes and processability than screw speed and drying time. A large impact of the t1 and t2 scores was found, indicating the importance of raw material attributes. For the studied formulation, it was concluded that MCC batches with a low water binding capacity, low moisture content and high bulk density generated granules with the most desirable quality attributes. Additionally, an innovative and quantitative approach towards mitigating batch-to-batch variability of raw materials was proposed, which is also applicable for additional excipients and APIs., Graphical abstract Unlabelled Image

Background: Cancer-related cognitive impairment (CRCI) is a prevalent source of comprised quality of life in cancer survivors. This study evaluated the efficacy of Emotional Freedom Techniques (EFT) on self-reported CRCI (sr-CRCI). Methods: In this prospective multicentre randomised wait-list controlled study (ClinicalTrials.gov Identifier: NCT02771028), eligible cancer survivors had completed curative treatment, were 18 years or older and screened positive for sr-CRCI with > 43 on the Cognitive Failures Questionnaire (CFQ). Participants were randomised to the immediate treatment group (ITG) or wait-list control (WLC) group, based on age (< or > 65 years), gender, treatment (chemotherapy or not), and centre. The ITG started to apply EFT after inclusion and performed this for 16 weeks. The WLC group could only start the application of EFT after 8 weeks of waiting. Evaluations took place at baseline (T0), 8 weeks (T1) and 16 weeks (T2). The primary outcome was the proportion of patients with sr-CRCI according to the CFQ score. Findings: Between October 2016 and March 2020, 121 patients were recruited with CFQ > 43 indicating sr-CRCI. At T1, the number of patients scoring positive on the CFQ was significantly reduced in the ITG compared to the WLC group (40.8% vs. 87.3% respectively; p

Since the innovation of our new half-piece elastometric respirator, this type of filtering facepiece respirator (FFR) has been used widely in Thailand. Decontamination methods including ultraviolet C (UVC) germicidal irradiation and 70% alcohol have been implemented to decontaminate these respirators. We then examined the inactivation potential of different decontamination processes on porcine epidemic diarrhea virus (PEDV) and numerous bacterial strains, most of which were skin-derived. To enable rigorous integrity of the masks after repeated decontamination processes, fit tests by the Bitrex test, tensile strength and elongation at break were also evaluated. Our results showed that UVC irradiation at a dose of 3 J/cm2 can eradicate bacteria after 60 min and viruses after 10 min. No fungi were found on the mask surface before decontamination. The good fit test results, tensile strength and elongation at break were still maintained after multiple cycles of decontamination. No evidence of physical degradation was found by gross visual inspection. Alcohol (70%) is also an easy and effective way to eradicate microorganisms on respirators. As the current pandemic is expected to continue for months to years, the need to supply adequate reserves of personnel protective equipment (PPE) and develop effective PPE reprocessing methods is crucial. Our studies demonstrated that the novel silicone mask can be safely reprocessed and decontaminated for many cycles by UVC irradiation, which will help ameliorate the shortage of important protective devices in the COVID-19 pandemic era.

Acknowledgements: We thank Veronica Phillips, Assistant Librarian, University of Cambridge Medical Library, for her help developing the search strategy., Background Introduction of risk stratification within population-based cancer screening programmes has the potential to optimise resource allocation by targeting screening towards members of the population who will benefit from it most. Endorsement from healthcare professionals is necessary to facilitate successful development and implementation of risk-stratified interventions. Therefore, this review aims to explore whether using risk stratification within population-based cancer screening programmes is acceptable to healthcare professionals and to identify any requirements for successful implementation. Methods We searched four electronic databases from January 2010 to October 2021 for quantitative, qualitative, or primary mixed methods studies reporting healthcare professional and/or other stakeholder opinions on acceptability of risk-stratified population-based cancer screening. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Data were analysed using the Joanna Briggs Institute convergent integrated approach to mixed methods analysis and mapped onto the Consolidated Framework for Implementation Research using a ‘best fit’ approach. PROSPERO record CRD42021286667. Results A total of 12,039 papers were identified through the literature search and seven papers were included in the review, six in the context of breast cancer screening and one considering screening for ovarian cancer. Risk stratification was broadly considered acceptable, with the findings covering all five domains of the framework: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. Across these five domains, key areas that were identified as needing further consideration to support implementation were: a need for greater evidence, particularly for de-intensifying screening; resource limitations; need for staff training and clear communication; and the importance of public involvement. Conclusions Risk stratification of population-based cancer screening programmes is largely acceptable to healthcare professionals, but support and training will be required to successfully facilitate implementation. Future research should focus on strengthening the evidence base for risk stratification, particularly in relation to reducing screening frequency among low-risk cohorts and the acceptability of this approach across different cancer types.

The World Health Organization created the International Classification of Functioning, Disability and Health (ICF) to provide a common framework to understand and describe functioning and disability. To make the ICF more applicable for everyday use, an ICF core set can be developed. We are going to reduce the entire ICF of 1400 categories to essential categories that can be used in a specific health context. These ICF core sets are created through a scientific process based on preparatory studies and the involvement of a multidisciplinary group of experts. The aim of this project is the development of an internationally accepted, evidence-based and valid ICF core set for irreversible vision loss. This article describes the process that is followed in detail and invites stakeholders to participate in the development.

The design optimization of mechanisms is promising as it results in more energy-efficient machines without compromising performance. However, machine builders do not apply state-of-the-art methods, as these algorithms require case-specific theoretical analysis. Moreover, the design synthesis approaches in the literature predominantly utilize heuristic optimizers, leading to suboptimal local minima. This paper introduces a widely applicable workflow, guaranteeing the global optimum. The constraints describing the feasible region of the possible designs are essential to find the global optimum. Therefore, kinematic analysis of the point-to-point planar four-bar mechanism is discussed. Within the feasible design space, objective value samples were generated through the CAD multi-body software. These motion simulations determine the required torque to fulfill the movement for a combination of design parameters. This replaces the cumbersome analytic derivation of the torque. This paper introduces sparse interpolation techniques to avoid brute force sampling of the design space. The advantage of this approach is that it is easily scalable to more design parameters, as the interpolation method minimizes the number of necessary samples. This paper explains the mathematical background of our developed interpolation approach. However, a step-by-step procedure is introduced to allow the employment of the interpolation technique by machine designers without the necessity to understand the underlying mathematics. Finally, the mathematical expression, obtained from the interpolation, enables applying global optimizers. In a case study of an emergency ventilator mechanism with three design parameters, 1870 CAD motion simulations allowed reducing the RMS torque of the mechanism by 67%.

Phonological awareness is the ability to correctly recognize and manipulate phonological structures. The role of phonological awareness in reading development has become evident in behavioral research showing that it is inherently tied to measures of phonological processing and reading ability. This has also been shown with ERP research that examined how phonological processing training can benefit reading skills. However, there have not been many attempts to systematically review how phonological awareness itself is developed neurocognitively. In the present review, we screened 224 papers and systematically reviewed 40 papers that have explored phonological awareness and phonological processing using ERP methodology with both typically developing and children with reading problems. This review highlights ERP components that can be used as neurocognitive predictors of early developmental dyslexia and reading disorders in young children. Additionally, we have presented how phonological processing is developed neurocognitively throughout childhood, as well as which phonological tasks can be used to predict the development of phonological awareness prior to developing reading skills. Neurocognitive measures of early phonological processing can serve as supplemental diagnostic sources to behavioral measures of reading abilities because they show different aspects of phonological sensitivity when compared to behavioral measures.

The aim of this scoping review is to outline the published literature on exercise-based treatment methods used in the rehabilitation of dysphagia secondary to an acquired brain injury across the lifespan. This will be used to identify intervention differences and gaps between adult and paediatric populations and guide discussions with clinicians about what rehabilitative approaches might be applicable for further trials in paediatrics. For the purposes of this study cerebral palsy is included in the definition of acquired brain injury. Methods: Scoping Review: The review will follow the five stages included when conducting a scoping review as outlined by Arksey & O’Malley, 2015 Inclusion Criteria 1. Children and adults of any age. 2. Participants with dysphagia secondary to an acquired brain injury including but not restricted to: Stroke, traumatic and non-traumatic brain injury, cerebral palsy, brain neoplasm, autoimmune disorders. 3. Direct oropharyngeal exercises. These are defined as exercises involving the oropharyngeal musculature with the aim of changing participant swallowing physiology. These include, but are not be restricted to, strength-based exercises (e.g. effortful swallow, Mendelsohn manoeuvre), respiratory coordination exercises (e.g. expiratory muscle strength training), skill-based programmes (e.g. BiSSKiT protocol) 4. Exercise protocols that use external devices as an adjunct to rehabilitation (e.g. biofeedback technology / electrical stimulation / oral appliances). Exclusion Criteria 1. Dysphagia arising from other causes such as head and neck cancers, structural abnormalities, idiopathic myopathies, genetic or inherited conditions. 2. Children with a primary aversive or sensory behavioural feeding difficulties which prevent them from wanting to eat and drink. 3. Interventions involving pharmaceutical management (e.g. Botox); cortical stimulation (e.g. repetitive transcranial stimulation); peripheral stimulation in isolation (e.g. pharyngeal electrical stimulation); surgery or alternative treatments (acupuncture) will not be included in this review. There may be scope for analysing these interventions in a future scoping review. 4. Compensatory strategies which do not involve adaptation of the oro-pharyngeal musculature. For example, the chin tuck manoeuvre or texture / taste modifications. 5. External compensatory equipment 6. Animal studies. Information Sources: The breadth of a scoping review means that multiple data sources can be considered, over and above what would typically be included in a systematic review (30). As a method of ensuring robust data is reviewed, the following inclusion and exclusion criteria will be applied to the type of information sources obtained in this review. Inclusion: · Case reports, case series, experimental studies, randomised control trials, observational studies.. Exclusion: · Commentaries, opinion pieces and systematic reviews will be excluded, but their reference lists will be reviewed for appropriate references that fulfil the outlined criteria. · Articles not written or available in English; · Where a full text article cannot be obtained using University access, the 1st author will be contacted. If no copy is made available prior to final analysis, then the paper will be excluded. · Articles will need to report sufficient treatment information including treatment type, dosage and intensity. Articles without sufficient protocol information as outlined will be excluded. · As this review aims to identify recent evidence, papers dated before 2005 will not be included. Databases to be searched Initial searches will be conducted via the following electronic databases: Table 1: Electronic databases Platform Databases EBSCOhost Medline PubMed CINAHL Plus Ovid Online AMED Cochrane Database of Systematic Reviews The principal reviewer will hand-search reference lists of included articles and relevant articles will be included. Grey literature identified via social media, open access thesis, conference proceeding abstracts, dissertations or from clinical experts in this field will also be considered if they meet the outlined inclusion/exclusion criteria. Search Strategy: The search strategy has been developed with the Institute of Child Health, University College London librarian. Identified terms will be searched within the medical subject heading (MeSH), followed by a keyword search for each database. Two searches will be run, on each database to ensure no papers including the child population are excluded. Search one includes search terms for level 1, 2, 3 and this search will be repeated with level 4 search terms added. A record of the number of articles found on each database will be made. Table 2: Search strategy levels Level 1: Rehabilitation exp Rehabilitation/ OR Stroke Rehabilitation/ OR rehabilitation.fs OR rehabilitat* Level 2: Dysphagia “Deglutition Disorders/” OR “deglutition disorder*” OR swallow* OR dysphagia Level 3: Brain Injury “Brain Injuries/” OR “Brain Damage, Chronic/” OR “Brain Neoplasms/” OR Stroke/ OR “Cerebral Palsy/” OR infarc* OR embolism OR h?emorrhag* OR aneurysm* OR anoxi* OR hypoxi* OR isch?emi*OR thrombos* OR occlus* OR bleed* OR concuss* OR TBI OR ABI OR OR “brain neoplasm*” OR “brain cancer*” OR “brain tumo?r*” OR “intracranial neoplasm*” OR “cerebral palsy” OR “spastic diplegia” OR stroke OR “cerebrovascular accident*” OR “cerebral vascular accident*” OR “brain vascular accident*” OR CVA Level 4: Paediatric Adolescent/ OR Child/ OR Infant/ OR Pediatrics/ OR Disabled Children/ OR p?ediatric* or child* or infant* or adolescen* OR toddler* OR school* OR schoolchild* OR teen* OR youth* OR “young person*” OR “young people*” OR juvenile* Study Selection The primary reviewer will run the initial searches and export the titles and abstracts into Rayyan QCRI (35). Duplicate copies will be deleted. The reviewer will then screen the title and abstracts of each paper for inclusion or exclusion. Two further reviewers will each check 10 % of these decisions using the Rayyan online software. Reviewers will be blinded to decisions. Conflicts and further questions will be discussed and clarified, and a majority decision will be taken if these conflicts cannot be resolved. A record of decisions will be kept on Rayyan QCRI. If there is a disagreement greater than 20 % then a second reviewer will screen all papers. Data extraction Following initial screening, whole text articles for included articles will be sought. The following data will be extracted from each article and collated by the primary researcher: Title; methodology; participant demographics; baseline aetiology; outcome measures. Details of exercise protocol will also be extracted including type of exercises, dosage, intensity and format. This data will be reviewed and analysed against the outlined inclusion / exclusion criteria by the primary researcher. Two further reviewers will each check 20 % of these decisions. A majority decision will be taken if there is a disagreement between reviewers. If there is a disagreement greater than 20 % then a second reviewer will screen all papers. Rayyan QCRI online software will be used to record the final decisions. Results Data Presentation and Dissemination: Data will be separated into studies involving children under the age of 18 years old and adults 18 years and above. Based on the pilot literature review and experience in clinical practice, it is anticipated that certain sub-groups of treatments will be found. These include: 1. Exercises in isolation targeting the oral / pharyngeal or respiratory systems used in swallowing 2. Exercises combined with biofeedback 3. Exercises used in conjunction with electrical stimulation The number of articles in each area and the type of data source will be presented in written and visual format. Comparison between literature in adult and child populations will then be made and discussed. Although the specific rigor of each paper will not be discussed in detail, information about the level of each review paper (e.g. randomised control trial / case report) will be made. The inclusion criteria and protocol design of each paper will also be analysed in order to determine the possibility of trialing certain methods with a new population. For example, trialing a method used in adult post-stroke dysphagia with children with cerebral palsy.

BACKGROUND: Previous research highlights the need for effective lifestyle interventions for men. Hockey Fans in Training (Hockey FIT) was developed as a pragmatic healthy lifestyle program tailored to men with overweight or obesity. This paper overviews the rationale, program details, and design of a recently completed cluster randomized controlled trial (RCT) of Hockey FIT. Participant engagement and baseline characteristics are also described. METHODS: The RCT evaluated the effectiveness, cost-effectiveness, and implementation of Hockey FIT. Forty-two sites in Canada and the United States were randomized to either the Hockey FIT intervention group or wait-list control group. Participants were men, aged 35-65 years, with a body mass index (BMI) ≥27 kg/m RESULTS: The design of the cluster RCT incorporates evaluations of participant health outcomes, program implementation, and broader healthcare system impact. In the RCT, 1397 participants were assessed for eligibility and 997 were enrolled. Most participants heard about the program through social media or hockey team emails. Participants averaged 49 years of age, had BMI values of 35.3 kg/m CONCLUSION: The intended audience for Hockey FIT was recruited successfully, however, targeted recruitment to better engage diverse populations is warranted. This paper affords a useful outline for evaluating future lifestyle interventions tailored to men. This trial was registered on August 17, 2018 with ClinicalTrials.gov (identifier: NCT03636282).

COVID-19 proved that primary care (PC) providers have an important role in managing health emergencies, such as epidemics. Little is known about the preparedness of primary care practice infrastructure to continue providing high quality care during this crisis. The aim of this paper is to describe the perceived limitations to the infrastructure of PC practices during COVID-19 and to determine the factors associated with a higher likelihood of infrastructural barriers in providing high quality care. This paper presents the results of an online survey conducted between November 2020 and November 2021 as a part of PRICOV-19 study. Data from 4974 practices in 33 countries regarding perceived limitations and intentions to make future adjustments to practice infrastructure as a result of the COVID-19 pandemic were collected. Approximately 58% of practices experienced limitations to the building or other practice infrastructure to provide high-quality and safe care during the COVID-19 pandemic, and in 54% making adjustments to the building or the infrastructure was considered. Large variations between the countries were found. The results show that infrastructure constraints were directly proportional to the size of the practice. Better pandemic infection control equipment, governmental support, and a fee-for-service payment system were found to be associated with a lower perceived need for infrastructural changes. The results of the study indicate the need for systematic support for the development of practice infrastructure in order to provide high-quality, safe primary care in the event of future crises similar to the COVID-19 pandemic.

Authors Dr Edelweiss Aldasoro 1 edelweissaldasoro@integratedcarefoundation.org Lydia O’Sullivan 2,3 lydia.osullivan@ucdconnect.ie Áine O’Brien 4 aineobrien2018@gmail.com Dr Clíona McGovern 2 cliona.mcgovern@ucd.ie Dr Maeve Nolan 5 maeve.nolan@nrh.ie Professor Áine Carroll 1, 2,5 aine.carroll@nrh.ie 1 International Foundation for Integrated Care 2 School of Medicine, University College Dublin 3 Health Research Board-Trials Methodology Research Network 4 School of Health Sciences, National University of Ireland, Galway 5 National Rehabilitation Hospital, Dun Laoghaire Corresponding author: Dr Edelweiss Aldasoro International Foundation for Integrated Care Annexe Offices, Linton Road, Oxford, OX2 6UD, England Title Protocol for a Rapid Systematic Review: How can an ethical decision-making tool compliment and assist healthcare decisions in a pandemic? Abstract The COVID-19 pandemic has placed unprecedented pressures on healthcare systems throughout the world. There is a move from patient centred provision to practices primarily guided by considerations of public health well-being. Asked to respond to this crisis in an equitable, reasonable and proportionate way, the adherence of health services personnel to a ‘duty of care’ continues to alter in response to the evolving impact of this pandemic. Unique and challenging ethical issues have been raised as a direct result of COVID-19. These include prioritising access to health care resources, conflicts for health care workers weighing up work obligations and family responsibilities and the implementation of measures to reduce the spread of the disease, while protecting the rights of the individual to free movement. The objective of this rapid review is to identify and assess the available international literature regarding ethical frameworks and decision making to inform the development of a comprehensive ethical framework in Ireland. This framework will aim to support health care professionals, administrators and managers when making decisions regarding the allocation of limited healthcare resources in emergency situations, such a pandemic. Keywords Ethics; Ethical framework; Scarce resources; Pandemic; COVID-19; Coronavirus Introduction Rationale for this Rapid Review The COVID-19 pandemic has placed unprecedented pressures on healthcare systems throughout the world 1 2. In Ireland, as in many neighbouring European countries, there is a move from patient centred provision to practices primarily guided by considerations of public health well-being. Asked to respond to this crisis in an equitable, reasonable and proportionate way, health services personnel adherence to a ‘duty of care’ continues to alter on a realisation of impact of this pandemic. Drawn from experiences in Italy and Spain, such pandemics are catastrophic on healthcare systems, outstripping resources (i.e. protective equipment), and creating a shortage of personnel and of life-saving equipment 3 4. Faced with increasing number of patients requiring acute care, ethical decisions are being made on how to allocate resources and to identify patients who have the most favourable chance of survival. Unique and challenging ethical issues have been raised as a direct result of COVID-19. These include prioritising access to health care resources, obligations of health care workers considering risk to their own health and the implementation of measures to reduce the spread of the disease, while protecting the rights of the individual to free movement. In this context front-line clinicians (including administrators/managers) are looking for ethical decision-making tools that provide key-knowledge sharing opportunities and compliment clinical decisions on patient care pathways; as speedily – but proportionately and fairly; as possible. However, it is recognised that presently no national collaborative effort is taking place to determine appropriate practices or protocols for use in Ireland. This challenging situation calls for an ethical framework and decision-making tool to guide healthcare professionals, administrators and managers when allocating scare resources, such as manpower, personal protective equipment, ventilators etc. Given the unprecedented and emerging nature of the COVID-19 pandemic, there are currently no published systematic reviews summarising the available literature on this subject. Objective of the review The objective of this rapid review is to identify and assess the available international literature regarding ethical frameworks and decision making to inform the development of a comprehensive ethical framework in Ireland. This framework will aim to support health care professionals, administrators and managers when making decisions regarding the allocation of limited healthcare resources in emergency situations, such a pandemic. PICO Problem: In a context of acute healthcare resource limitation , how should limited health resources be rationed or fairly allocated in the healthcare setting? Context includes e.g. national emergency, epidemic, pandemic. Limitations include manpower and healthcare equipment etc. Intervention(s): An ethical framework to support decision-making processes to ensure that the maximum benefit is gained from the available resources in a fair and equitable manner. Comparator(s): Not applicable for this review. Outcome(s): 1. Maximise the protection of patient’s rights to healthcare. 2. Minimise the risk of treatment withdrawal based on unethical reasoning. 3. Support for healthcare professionals, administrators and managers making difficult decisions regarding resource allocation. Methods A rapid systematic review methodology was selected given the time sensitive nature of this project. Rapid reviews have been shown to identify and evaluate the relevant evidence similar to a full systematic review. This Rapid Review protocol was compiled following consultation with the Cochrane COVID-19 Rapid Review Workflow and protocol template. The protocol was reviewed for completeness and transparency using the PRISMA-P Checklist 5. The protocol is not eligible for registration on the PROSPERO database, as the question of interest is an ethical framework, and not a clinical outcome for participants. Eligibility Criteria Articles will be included if they meet the following Inclusion/Exclusion Criteria. Inclusion Criteria: papers will be included if they contain at least two of these three concepts: • Acute Resource Limitation or similar • Rationing / Allocation / Decision-making or similar • Ethical perspective Exclusion Criteria: papers with the following concepts will be excluded if they contain one or more of these concepts: • Accident and Emergency Services • In-flight emergencies • Clinical research taking place during humanitarian emergencies • Ethics in clinical research • Communication strategies • Informed consent • Other clinical emergencies which are not outbreaks/disasters/pandemics • No abstract • Books which were not open access No limits with regard to language will be applied. All study type and article types will be considered, including exploratory qualitative studies, reflective studies, opinion pieces, philosophical pieces. Information Sources Medline, EMBASE and Google Scholar have been selected as the electronic databases. A search of references, relevant Grey Literature, including LitCovid will be also undertaken. National and International Ethical Frameworks which the authors were aware of will also be included. Due to time constraints, authors of individual papers will not be contacted to collect additional information or to request full text of papers. Search Strategy Following an initial scoping search and consultation with an experienced Health Sciences Librarian, the following search terms were agreed upon and will be used to search within the title or abstract: Search string Key words 1 ((“Coronavirus” OR “Covid19” OR “epidemic” OR “outbreak” OR “pandemic“ OR “humanitarian emergency” OR “catastrophes” OR “disaster”) 2 (“Resources” OR “Resource Allocation” OR “Rationing” OR “Shortage” OR “Personal Protective Equipment” “Ventilator” OR “Triage” OR “Withholding”) 3 (“Ethics” OR “Morality” OR “Ethical framework” OR “Health equity” OR “Decision making”). 4 1 AND 2 AND 3 5 Limit Jan 2000 to 6th April 2020 No limits with regard to language will be applied. For Medline and EMBASE, the following limits will be applied: • Humans • Time period January 2000 to 6th April 2020 Within Google Scholar, the first 200 entries will be included. Study Records Data Management and Selection Process All identified papers will be exported to Zotero and duplicates will be excluded. All remaining papers will be imported to Rayaan to undergo review. Two blinded members of the team (LOS and AOB) will independently screen Titles and Abstracts of all of the papers according to the above Inclusion and Exclusion Criteria using Rayaan. Once Title/Abstract screening is complete, a third member of the team (EA) will resolve discrepancies in the screening decisions. Due to time constraints, three members of the team (EA, LOS, AOB) will each review a portion of the full texts. Papers will be excluded if: • The full text is not available • Doesn’t contain any principles relevant to an ethical framework • The topic relates solely to triage procedures in pandemics/disasters • The topic relates to legal aspects, rather than ethical ones • They contains only a case study / case studies • They only give a brief summary of the main ethical approaches, with no details • The topic relates only to pandemic planning Data Items Data extraction will be completed using a customised data extraction form. Due to time constraints, three members of the team (EA, LOS, AOB) will each extract following data from a portion of the papers selected for analysis: • Lead author • Year of publication of paper • Ethical principles relevant to an ethical framework • Synonyms of the named ethical principle • Related ethical principles • Example(s) of a scenario where the ethical principle applies The screening and selection process will be reported in the form of the PRISMA 2009 Flowchart. Outcomes and Prioritisation The following outcomes will be sought using a qualitative review of the selected papers: • Ethical principles which apply in pandemic situation where resources are scarce • Ethical frameworks already in place for pandemic situations where resources are scarce • Examples of scenarios where these ethical principles or frameworks apply • Examples of how the identified ethical principles relate to or clash with each other No outcome (ethical principle or framework)) will be prioritised over another. Risk of bias in individual studies Due to the nature of this Rapid Review (qualitative review of ethical principles and guidelines), no formal risk of bias assessment will be conducted. Data Synthesis Following data extraction, a constant comparative approach will be employed to evaluate the data. A group consensus will then be sought regarding the appropriateness and applicability of the identified ethical principles and frameworks. Meta-bias(es) Not applicable Confidence in cumulative Evidence Not applicable Data Availability Data will be made available upon request. Reporting Guidelines Not applicable. Author Contributions EA: Data curation; Formal analysis; Investigation; Methodology; Project Administration; Writing – Original Draft Preparation LOS: Data curation; Formal analysis; Investigation; Methodology; Project Administration; Writing – Review and Editing AOB: : Data curation; Formal analysis; Investigation; Methodology; Project Administration; Writing – Review and Editing CMcG: Conceptualization; Project Administration; Methodology; Funding Acquisition; Writing – Review and Editing MN: Conceptualization; Project Administration; Methodology; Writing – Review and Editing AC: Conceptualization; Project Administration; Methodology; Funding Acquisition; Writing – Review and Editing Competing Interests The authors of this Rapid Review have no competing interests to disclose. Grant Information This Rapid Review will be supported by funding from the National Rehabilitation Hospital, Dun Laoghaire. The National Rehabilitation Hospital had no role in the development of this protocol. Acknowledgements The Rapid Review Team would like to acknowledge Mr Diarmuid Stokes, Health Sciences Librarian who provided guidance on the search strategy. The Rapid Review Team also acknowledge the Cochrane COVID-19 Rapid Review Workflow and their protocol template, both of which were used for reference and guidance when writing this protocol. References 1. Emanuel EJ, Persad G, Upshur R, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. New England Journal of Medicine 2020 doi: 10.1056/NEJMsb2005114 2. Prevention CDC. Strategies for optimizing the supply of N95 respirators. Atlanta, USA, 2020. 3. Vergano M, Berolini G, A G. Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments, in Exceptional, Resources-Limited Circumstances: Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care, 2020. 4. Mounk Y. The extraordinary decisions facing Italian doctors: The Atlantic, 2020. 5. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 2015;4(1):1. doi: 10.1186/2046-4053-4-1

BACKGROUND: Factors influencing the implementation of communication partner training (CPT) with familiar partners of people with aphasia (PWA) have previously been documented using disparate approaches. To date there has been no synthesis of these factors using a common theoretical framework. Investigating CPT implementation factors using a common theoretical framework may further our understanding of universal barriers and guide future development of tailored, theoretically informed implementation strategies. AIMS: (1) To determine the perceived and/or observed barriers and facilitators to implementing CPT with familiar partners of adults with aphasia; (2) to map extracted barriers and facilitators to a common theoretical framework; (3) to synthesize extracted barriers and facilitators; and (4) to identify potential implementation strategies to address the most frequently identified barriers and facilitators. METHODS & PROCEDURES: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, CINAHL, Web of Science) were systematically searched in April 2021. Empirical qualitative and/or quantitative research studies reporting barriers/facilitators to speech-language therapists (SLTs) implementing CPT with familiar partners of adults with aphasia were included. The search was limited to English or French articles with no date limit applied. Methodological quality of included studies was assessed using the Mixed-Methods Appraisal Tool (MMAT). A framework and content analysis was then conducted to extract and synthesize the implementation factors in alignment with the Theoretical Domains Framework (TDF), followed by a theoretically informed mapping exercise to identify potential implementation strategies. RESULTS & MAIN CONTRIBUTION: The database searches yielded 2115 studies. Following screening, 17 studies were included in the review. Overall, the included studies had good methodological quality. Extracted implementation factors were classified as barriers, facilitators or mixed (i.e., both) and aligned with 13 of the 14 TDF domains, plus two additional domains: 'carer perspectives on the CPT intervention' and 'patient/carer characteristics'. Synthesized data revealed eight key theoretical domains: Environmental context and resources; Social influences; Beliefs about consequences; Skills; Memory, attention and decision-making; Knowledge; Beliefs about capabilities; and Reinforcement. Within each domain, the research team identified common categories and developed illustrative examples of theoretically informed implementation strategies. CONCLUSIONS & IMPLICATIONS: This systematic review and theory-informed synthesis of previously reported CPT implementation factors enabled the identification of key barriers to SLTs delivering this best practice. This led to proposed implementation strategies that should be validated, refined and evaluated in future research involving stakeholders who have contextual understanding of implementing CPT. WHAT THIS PAPER ADDS: What is already known on the subject CPT of familiar partners of PWA is an effective intervention that is inconsistently used in clinical settings. Factors influencing CPT implementation have previously been identified, but using disparate approaches and frameworks. A synthesis of these factors articulated around a common framework is currently not available. What this paper adds to existing knowledge This paper provides a theory-informed synthesis of previously reported barriers and facilitators to SLTs implementing CPT with familiar partners of PWA. It highlights key factors influencing the uptake of this best practice and includes suggestion of implementation strategies to address them. What are the potential or actual clinical implications of this work? The key influencing factors and proposed implementation strategies reported in this paper may support stakeholders in the future design of tailored and theoretically informed implementation strategies aiming to improve the delivery of familiar CPT in their setting.

Background: Several studies have discussed the importance of self-compassion in reducing anxiety, stress, and negative emotions for oneself. However, little research has been undertaken regarding the effectiveness of including self-compassion and outcomes for parents and their children. Aim and objective:To examine and explore the research evidence for the influence of self-compassion education and training upon parents and families.Methods: This systematic review will utilize the Joanna Briggs Institute (JBI) systematic review methodology. A three-stage comprehensive search of at least five electronic databases including Medline, Embase, PsychoInfo, Emcare and Cochrane library, as well as Grey literature,will be conducted. Two independent reviewers will review the title and abstract of each paper to determine inclusion; all included papers will be appraised using the standardized critical appraisal instruments for evidence of effectiveness developed by JBI. This review will consider studies that include parents, mothers, fathers, family/families and expectant parents.Studies investigating education or training will be included, i.e., programs, workshops, seminars or sessions provided by all health care professionals/health and social workers/counsellors, psychologists, nurses, midwives, meditation practitioners, and mindfulness trainers.In addition, this review will consider studies that evaluate or measure any type of self-compassion education or training, i.e., programs, workshops, seminars, sessions targeted for parents, mothers, fathers, family/families or expectant parents.Self-compassion education or training may be provided face-to-face, one-to-one, group work, webinar, digital or online,programs, workshops, parental education classes or simulation classes, seminars, sessions.This review will include any randomized controlled trials, quasi-experimental studies, cohort studies and case-controlled studies, before and after studies, and mixed-method studies.Studies will only be considered if they include the following outcome measures: measuring self-compassion (self-kindness, common humanity, mindfulness), fear of compassion and any outcome for health and wellbeing of parents/families,and these will be reported in a column in the summary table of all included studies. Results:The review outcomes will be reported on both continuous and dichotomous scales, where possible findings will be pooled for reporting using JBI tools. Conclusions: The findings of this systematic review will guide further research on developing, designing, facilitating and evaluating self-compassion education and training programs, workshops, sessions for parents and families.PROSPERO registration: This systematic review title is registered at the International Prospective Register of Systematic Reviews: CRD42021225021.

Introduction Ostomies are defined as surgically created openings or canals that make a path between the inner of an organ and the outer environment. They are intended to minimize problems that temporarily or permanently disable a segment of the body, seeking to maintain the function of the organ affected by pathologies or trauma. 1,2 Ostomies can be permanent or temporary and, depending on the affected organ, receive different names and specific care. In the present study, the research interest is around eliminatory ostomies with eliminatory function, which are ileostomies and colostomies (ascending, transverse, descending and sigmoid), which are categorized as intestinal ostomies. 3 The national literature regarding the epidemiological data of individuals with ostomies, in general, is still incipient and needs further investigation, however, it is estimated that about one million and 400 thousand surgeries for making ostomies are performed per year in Brazil. According to the Ostomy Associations of America, approximately 100,000 to 130,000 new surgical procedures for making an ostomy are performed in the United States of America (USA), with colostomy being the most made.4,5,6 This data, in particular, is in line with the results of a study carried out in Brazil on the profiles of ostomies in relation to location, which demonstrated a greater predominance of intestinal ostomies, particularly colostomy and ileostomy.7 In this context, it is considered that the increase in the number of neoplasms and gastrointestinal diseases evidenced in the morbidity profile of the population increases the number of people who need intestinal stomas as a therapeutic strategy and, therefore, in view of the risks, there is an increase the susceptibility to complications, namely: hernias, retractions, necrosis, infections, fistulas, more common in colostomy.8 Complications are divided into complications in the ostomy or skin peristomia. In addition, they are also divided in relation to the period of appearance, which can be immediate (within the first 24 hours after the ostomy is made), early (up to 1 week after the ostomy is made) or late (after 1 week, extending up to months after hospital discharge)9,10 Complications related to intestinal stomas are described in the literature in several studies, being frequent in the lives of patients who have newly made stomas. 1,2,11 The rate of complications related to ostomy in the USA is from 21 to 70%.6 In Brazil, an investigation on the perceptions of the quality of care of patients with ostomy, that 71% of patients with ileostomies and 43% of patients with colostomy had complications. 12 Data show rates from 70% to 80% for the development of some complication in patients with ostomies. It is estimated that a person in this condition has the experience of at least one complication up to the second year after confection. 13,14 Complications, in general, are caused by several factors, including the difficulty in self-care in relation to the stoma, the presence of more than one stoma, the high-output stoma. There are also factors related to the approach to surgery, such as emergency surgery, containment sutures, laparoscopic approach, which are more prone to complications. The characteristics of size, shape and height of the stoma influence differently on skin adhesion, which can generate contact with effluents and increase the risk of complications. 13 In addition, in the case of late complications, the presence of comorbidities, especially obesity and high intramuscular pressure, which can result in prolapses and parastomy hernia. 15 In view of this panorama of ostomies and their complications, it is considered that the qualification of nurses and the use of instruments that can help in the early identification of risk factors and in the proper management of complications are essential in improving their professional performance, with potential impact on patient fitness and well-being. 16 After hospital discharge, the specialist nurse is responsible for inspecting the ostomy and the peristomy region to assess aspects of the ostomy in relation to color, shape, size, humidity, presence of exudate or other substances, pain and skin lesions. Thus, the late postoperative period, established one week after surgery, is considered an essential time to monitor the patient and their needs and to minimize and prevent complications.17 When critically reflecting on the care provided by nurses in managing the care of patients with ostomies, in particular with a focus on the management of complications, it is pointed out that nurses, regardless of their specialist status, should provide assistance to this patient in different care settings, in the hospital or out-of-hospital context. Thus, nursing care in the presence of complications should prevent the worsening of the condition of the ostomy, the skin peristomia and its functionality. On the other hand, inadequate management can lead to consequences that worsen the patient's quality of life, bring psychosocial impacts, the need for surgical interventions and the use of complementary materials. 10 Therefore, the absence of follow-up by a qualified professional in the postoperative period can lead the patient to develop peristomia complications and their consequences.13 Therefore, there is a responsibility of health professionals in actions against complications, in view of the reduction of their occurrence and rapid reversal in their validity, aspects that should be enhanced by the presence of professionals prepared for this demand in the services, especially the experts.18 In view of the shortage of specialized professionals in health services, it is assumed that the construction of an assessment instrument, as a health care technology, can help nurses' decision-making in the field of care for patients with functional intestinal ostomy. eliminatory with late complications, guiding nursing care during the management of such complications. In this context, it is assumed that the construction of an assessment instrument will help nurses' decision-making in the field of care for patients with intestinal ostomy with an eliminatory function with complications, helping to guide nursing care during the management of such complications based on scientific evidence. This type of technology has the potential to contribute to knowledge in the area for general practitioners and to directly impact the nursing care provided to clients with this specific need at various levels of health care. Therefore, it is necessary to know the scope of knowledge present in the literature about late complications and the nursing approaches to them, in order to identify and report the scientific evidence that can support the proposition of a health care technology on this topic. Therefore, the objective is: To map the existing knowledge about complications and actions related to nursing therapy in patient care with complications related to intestinal ostomies with eliminatory function. Review questions What are the late complications in eliminatory intestinal ostomies? What is the nursing care for people with late complications in intestinal ostomies with eliminatory function? Population Patients with intestinal ostomies with eliminatory function. Concept Nursing care in the face of late complications of intestinal ostomies with eliminatory function. Context Any context. Type of study We will use primary papers found in predefined databases according to specific eligibility criteria. Furthermore, this scope review will include data found in the grey literature, such as protocols, guidelines, and manuals. Our focus lies in articles that approaches late complications in intestinal ostomies and nursing management to these complications will be considered. For our search in the databases, we will adopt theme-pertinent descriptors and keywords in three languages: Portuguese, English, and Spanish. As for the grey literature, we will search through databanks of theses, and websites of reference entities in the Enterostomal Therapy fields. Languages will also be limited to Portuguese, English, and Spanish, and there will be no time restriction in terms of data production. Yet, whenever there are updates on guidelines/manuals, we will use only the most recent version. Methods This review follows the Joanna Briggs Institute’s (JBI) methodology for scope reviewing, and adopts the 2020 JBI Manual for Evidence Synthesis. 19 Search strategy Firstly, we have searched through databases in order to identify descriptors or keywords for the development of this study (Appendix I). Later on, we will search for scientific papers in these databases: Literature of Latin America and the Caribbean (LILACS), National Library of Medicine (Medline via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Spanish Bibliographic Index of the Health Sciences (IBECS), SciVerse Scopus (SCOPUS), Embase, and Web of Science. After crossing the descriptors and the keywords in each of the selected bases, we will apply initial filters of “complete text”, “paper”, and language. Appendix II features an example of the strategy that we will use for this scope review. We will search for grey literature evidence in the CAPES Theses and Dissertations Catalogue, in documents available at websites of official institutions, in guidelines and manuals of both national, and international institutions. We will also search in reference entities in the stomatherapy fields in order to find materials on complications and actions related to intestinal ostomies (Appendix III). Study selection We will import every selected paper into the Mendeley Reference Manager, and remove all duplicates. Firstly, we will submit the papers to an exploratory reading of their title and/or abstract by a reviewer, in order to decide whether they fit in the study’s theme and, thus, should be selected. Texts that adhere to the theme of the investigation will be fully read by two reviewers separately, and will be thoroughly analyzed according to the eligibility criteria. Afterwards, we will compare the reviewers’ selections, and, if there is any divergence, we will resolve them by means of consensual discussion, or of a third senior reviewer. Lastly, the studies that have been fully read and excluded for not meeting the inclusion criteria will be counted, and we will systematize the reasons for exclusion in an appendix of the final report. This report will also describe the search process, and the paper selection through the PRISMA Flowchart. Data extraction Data will be extracted by a tool of data collection developed for this review, and two reviewers will participate in this process with the support of the software Microsoft Excel®. Collected data will provide us with information about the studies on drug labelling in Intensive Care, Emergency, and Anesthetic Units. We will control the year of publication, the authorship, the country of publication, the title of the paper, the language, the type of study, the number and the profile of the participants, type of complication, management/care for the complication, results (if applicable). We might contact authors of specific papers if additional information be necessary. Furthermore, we may modify the tool of data collection throughout the investigation, if the analyzed papers highlight the need for additional information (Appendix IV). Data mapping We will present the extracted data in tableaux (Appendix V), and thus characterize, assemble, synthetize, and describe the findings of this review. Hence, after mapping the results, we will correlate them to the goals of this investigation. The information identified will be relevant for understanding which complications occur in the late postoperative period and what actions the nurse can take to manage the complication. Funding There is no funding for this investigation. References 1. MIRANDA SM, Luz MHBA, Sonobe HM, Andrade EMLR, Moura ECC. Caracterização Sociodemográfica e Clínica de Pessoas com Estomia em Teresina. Rev Estima, v. 14, n. 1, 2016. Disponível em: https://www.revistaestima.com.br/estima/article/view/117 2. AZEVEDO C, Faleiro JC, Ferreira MA, Oliveira SP, Mata RF da, Carvalho, EC de. Intervenções de enfermagem para alta de paciente com estomia intestinal: revisão integrativa. Rev Cubana de Enfermería, Vol. 30, Núm. 2,2014. Disponível em: http://www.revenfermeria.sld.cu/index.php/enf/article/view/404 3. LIMA VS, Azevedo NAA, Guimarães JMX, Pereira MM, Neto JA, Souza LM, Pequeno AMC, Sousa MC. Produção de vídeo educacional: estratégia de formação docente para o ensino na saúde. Rev Eletron Comun Inf Inov Saúde. 2019 abr.-jun.;13(2):428-38. http://dx.doi.org/10.29397/reciis.v13i2.1594 4. CERQUEIRA LCN, Cacholi SAB, Nascimento VS da, Koeppe, GBO, Torres, VCP, Oliveira PP. Caracterização clínica e sociodemográfica de pessoas estomizadas atendidas em um centro de referências. Revista Rene. Ed.21, e42145. DOI: 10.15253/2175-6783.20202142145. 2020. 5. BARBOSA MR, Simon BS, Tier CG, Garcia RP, Siniak DS, Rodrigues SO. Profile of people with stomas from a municipal health service in Southern of Brazil. ESTIMA Braz J Enterostomal Ther. 2018; 16:e1318. doi: http://dx.doi.org/10.30886/ estima.v16.465_PT 6. MURKEN DR, BLEIER JIS. Ostomy-Related Complications. Clinic in Colon and Rectal Surgery. Vol. 32, No. 3, 2019. Disponível em: 10-1055-s-0038-1676995.pdf (nih.gov). Acesso em: 10/01/2021. 7. LOPES MV, SILVA VM, ARAÚJO TL. Métodos de pesquisa para validação clínica de conceitos diagnósticos. In: NANDA Internacional Inc; Herdman TH, Carvalho EC, organizadores. PRONANDA - Programa de Atualização em Diagnósticos de Enfermagem - Conceitos Básicos. Porto Alegre: Artmed; 2013. p.85-129. 8. KRISHNAMURTY D, BLATNIK J, MUTCH M. Stoma Complications. Clinics in Colon and Rectal Surgery, 30(3), 193–200. doi:10.1055/s-0037-1598160, 2017. 9. PAULA MAB, CESARETTI IUR. Como cuidar de pessoas com estomias complicadas. In: Estomaterapia em foco e o cuidado especializado. São Caetano do Sul, SP: Yendis Editora, 2014. p.170-182 10. SANTOS VLCG, CESARETTI IUR. Assistência em estomaterapia: cuidando de pessoas com estomia. São Paulo: Editora Atheneu, 2015. 11. MELLOTI LF, Bueno, IM, Silveira GV, Da silva MEN, Fedosse E. Characterization of patients with ostomy treated at a public municipal and regional reference center. J Coloproctol. 2013; 33(2):70–4. Disponível em: http://www.scielo.br/pdf/jcol/v33n2/2237-9363-jcol-33-02-070.pdf. 12. PERSSON E, Gustavsson B, Hellstrom AL, Lappas G, Hultén L. Ostomy patients’ perceptions of quality of care. J ady Nurs. 2005;49(1): 51-58. 13. PINTO IES, Queirós SMM, Queirós CDR, Da Silva CRR, Santos CSVB, Brito MAC. Fatores de risco associados ao desenvolvimento de complicações do estoma de eliminação e da pele periestomal. Revista de Enfermagem Referência. ISSNe: 2182.2883. Serie IV, n°15, p, 155-166. 2017. Disponível em: https://www.redalyc.org/journal/3882/388255693019/html/. 14. Nunes MLG, SANTOS VLCG. Instrumentos de avaliação das complicações na pele periestoma: revisão integrativa. Aquichan. 2018, 18(2):477-491. DOI: 10.5294/aqui.2018. 15. AMBER PC, Kurz NR, Nitschke C, Odeh SF, Moslein G, Zirngibl H. Intestinal Ostomy. Deutsches Ärzteblatt International; Vol. 115; p. 182-7. 2018. Disponível em: https://pubmed.ncbi.nlm.nih.gov/29607805/ 16. Moura RRA, Moraes JT, Guimarães EAA. Avaliação dos serviços de atenção à saúde das pessoas com estomias: estudo de casos múltiplos. Revista Rene. Ed. 19. DOI: 10.15253/2175-6783.20181932961. 2018. 17. Gomes B, Martins SS. A pessoa Estomizada: Análise das Prática Educativas de Enfermagem. Rev Estima, v. 14, n. 3, 2016. Disponível em: https://www.revistaestima.com.br/index.php/estima/article/view/410. 18. Perissotto S, Breder JSC, Zulian LR, Oliveira VX de, Silveira NI da, Alexandre NMC. Ações de enfermagem para prevenção e tratamento de complicações em estomias intestinais: revisão integrativa.ESTIMA, Braz. J. Enterostomal Ther., São Paulo, v17, e0519, 2019. https://doi.org/10.30886/estima.v17.638_PT 19. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020.

Older adults (≥65 years) are the fastest growing population group. Thus, ensuring nutritional well-being of the ‘over-65s’ to optimise health is critically important. Older adults represent a diverse population – some are fit and healthy, others are frail and many live with chronic conditions. Up to 78% of older Irish adults living independently are overweight or obese. The present paper describes how these issues were accommodated into the development of food-based dietary guidelines for older adults living independently in Ireland. Food-based dietary guidelines previously established for the general adult population served as the basis for developing more specific recommendations appropriate for older adults. Published international reports were used to update nutrient intake goals for older adults, and available Irish data on dietary intakes and nutritional status biomarkers were explored from a population-based study (the National Adult Nutrition Survey; NANS) and two longitudinal cohorts: the Trinity-Ulster and Department of Agriculture (TUDA) and the Irish Longitudinal Study on Ageing (TILDA) studies. Nutrients of public health concern were identified for further examination. While most nutrient intake goals were similar to those for the general adult population, other aspects were identified where nutritional concerns of ageing require more specific food-based dietary guidelines. These include, a more protein-dense diet using high-quality protein foods to preserve muscle mass; weight maintenance in overweight or obese older adults with no health issues and, where weight-loss is required, that lean tissue is preserved; the promotion of fortified foods, particularly as a bioavailable source of B vitamins and the need for vitamin D supplementation.

STUDY QUESTION What information and support should be offered to donors, intended parents and donor-conceived people, in general and in consideration of the availability of direct-to-consumer genetic testing and matching services? SUMMARY ANSWER For donors, intended parents and donor-conceived offspring, recommendations are made that cover information needs and informed consent, psychosocial implications and disclosure. WHAT IS KNOWN ALREADY Trends indicate that the use of donor-assisted conception is growing and guidance is needed to help these recipients/intended parents, the donors and offspring, navigate the rapidly changing environment in which donor-assisted conception takes place. STUDY DESIGN, SIZE, DURATION A working group (WG) collaborated on writing recommendations based, where available, on evidence collected from a literature search and expert opinion. Draft recommendations were published for stakeholder review and adapted where relevant based on the comments received. PARTICIPANTS/MATERIALS, SETTING, METHODS Papers retrieved from PUBMED were included from 1 January 2014 up to 31 August 2020, focusing on studies published since direct-to-consumer genetic testing has become more widespread and accessible. The current paper is limited to reproductive donation performed in medically assisted reproduction (MAR) centres (and gamete banks): donation outside the medical context was not considered. MAIN RESULTS AND THE ROLE OF CHANCE In total, 32 recommendations were made for information provision and support to donors, 32 for intended parents and 27 for donor-conceived offspring requesting information/support. LIMITATIONS, REASONS FOR CAUTION The available evidence in the area of reproductive donation is limited and diverse with regards to the context and types of donation. General conclusions and recommendations are largely based on expert opinion and may need to be adapted in light of future research. WIDER IMPLICATIONS OF THE FINDINGS These recommendations provide guidance to MAR centres and gamete banks on good practice in information provision and support but should also be considered by regulatory bodies and policymakers at a national and international level to guide regulatory and legislative efforts towards the protection of donors and donor-conceived offspring. STUDY FUNDING/COMPETING INTEREST(S) The development of this good practice paper was funded by European Society of Human Reproduction and Embryology (ESHRE), covering expenses associated with the WG meetings, the literature searches and dissemination. The WG members did not receive any payment. The authors have no conflicts of interest to declare. DISCLAIMER This document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. The recommendations should be used for informational and educational purposes. They should not be interpreted as setting a standard of care, or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. †ESHRE pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.

Preprints allow researchers to make their findings available to the scientific community before they have undergone peer review. Studies on preprints within bioRxiv have been largely focused on article metadata and how often these preprints are downloaded, cited, published, and discussed online. A missing element that has yet to be examined is the language contained within the bioRxiv preprint repository. We sought to compare and contrast linguistic features within bioRxiv preprints to published biomedical text as a whole as this is an excellent opportunity to examine how peer review changes these documents. The most prevalent features that changed appear to be associated with typesetting and mentions of supporting information sections or additional files. In addition to text comparison, we created document embeddings derived from a preprint-trained word2vec model. We found that these embeddings are able to parse out different scientific approaches and concepts, link unannotated preprint–peer-reviewed article pairs, and identify journals that publish linguistically similar papers to a given preprint. We also used these embeddings to examine factors associated with the time elapsed between the posting of a first preprint and the appearance of a peer-reviewed publication. We found that preprints with more versions posted and more textual changes took longer to publish. Lastly, we constructed a web application (https://greenelab.github.io/preprint-similarity-search/) that allows users to identify which journals and articles that are most linguistically similar to a bioRxiv or medRxiv preprint as well as observe where the preprint would be positioned within a published article landscape., Preprints allow researchers to make their findings available to the scientific community before they have undergone peer review This study analyzes the full text content of the bioRxiv preprint repository, identifying field-specific patterns and changes that occur during publication, and providing a search tool that can identify the published papers that are most similar to a given bioRxiv or medRxiv preprint.

Background Neglected tropical diseases (NTDs) primarily affect the poorest populations, often living in remote, rural areas, urban slums or conflict zones. Arboviruses are a significant NTD category spread by mosquitoes. Dengue, Chikungunya, and Zika are three arboviruses that affect a large proportion of the population in Latin and South America. The clinical diagnosis of these arboviral diseases is a difficult task due to the concurrent circulation of several arboviruses which present similar symptoms, inaccurate serologic tests resulting from cross-reaction and co-infection with other arboviruses. Objective The goal of this paper is to present evidence on the state of the art of studies investigating the automatic classification of arboviral diseases to support clinical diagnosis based on Machine Learning (ML) and Deep Learning (DL) models. Method We carried out a Systematic Literature Review (SLR) in which Google Scholar was searched to identify key papers on the topic. From an initial 963 records (956 from string-based search and seven from a single backward snowballing procedure), only 15 relevant papers were identified. Results Results show that current research is focused on the binary classification of Dengue, primarily using tree-based ML algorithms. Only one paper was identified using DL. Five papers presented solutions for multi-class problems, covering Dengue (and its variants) and Chikungunya. No papers were identified that investigated models to differentiate between Dengue, Chikungunya, and Zika. Conclusions The use of an efficient clinical decision support system for arboviral diseases can improve the quality of the entire clinical process, thus increasing the accuracy of the diagnosis and the associated treatment. It should help physicians in their decision-making process and, consequently, improve the use of resources and the patient’s quality of life., Author summary Neglected tropical diseases (NTDs) primarily affect the poorest populations, often living in remote, rural areas, urban slums or conflict zones. Arboviruses are a significant NTD category spread by mosquitoes. Dengue, Chikungunya, and Zika are three arboviruses that affect a large proportion of the population in Latin and South America. The clinical diagnosis of these arboviral diseases is a difficult task due to the concurrent circulation of several arboviruses which present similar symptoms and, sometimes, inaccurate test results. In this paper, we present the state of the art of studies investigating the automatic classification of arboviral diseases based on Machine Learning (ML) and Deep Learning (DL) models. Results show that current research is focused on the classification of Dengue, primarily using tree-based ML algorithms. The use of an efficient clinical decision support system for arboviral diseases can improve the quality of the entire clinical process, thus increasing the accuracy of the diagnosis and the associated treatment. It should help physicians in their decision-making process and, consequently, improve the use of resources and the patient’s quality of life.

Extensive research shows that residential segregation has severe health consequences for racial and ethnic minorities. Most research to date has operationalized segregation in terms of either poverty or race/ethnicity rather than a synergy of these factors. A novel version of the Index of Concentration at the Extremes (ICERace-Income) specifically assesses racialized economic segregation in terms of spatial concentrations of racial and economic privilege (e.g., wealthy white people) versus disadvantage (e.g., poor Black people) within a given area. This multidimensional measure advances a more comprehensive understanding of residential segregation and its consequences for racial and ethnic minorities. The aim of this paper is to critically review the evidence on the association between ICERace-Income and health outcomes. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a rigorous search of academic databases for papers linking ICERace-Income with health. Twenty articles were included in the review. Studies focused on the association of ICERace-Income with adverse birth outcomes, cancer, premature and all-cause mortality, and communicable diseases. Most of the evidence indicates a strong association between ICERace-Income and each health outcome, underscoring income as a key mechanism by which segregation produces health inequality along racial and ethnic lines. Two of the reviewed studies examined racial disparities in comorbidities and health care access as potential explanatory factors underlying this relationship. We discuss our findings in the context of the extant literature on segregation and health and propose new directions for future research and applications of the ICERace-Income measure.

The burden of cardiometabolic diseases is increasing worldwide. Early detection of high-risk individuals is essential for appropriate diagnosis, better treatment outcomes, quality of life and lower health related costs. Aims: The overall aim of this thesis is to investigate the possible associations between plasma proneurotensin (Pro-NT) and risk of cardiovascular disease (CVD), type 2 diabetes (T2D), impaired glucose regulation, as well as diet-induced obesity in different study populations. As Pro-NT appears to be a novel risk marker for cardiometabolic morbidity and mortality, we also wanted to study the effects of dietary fat intake on circulating plasma Pro-NT and triglyceride levels. This thesis is based on epidemiological data from three population-based cohorts, The Malmö Preventive Project (MPP), The Malmö Diet and Cancer study- Cardiovascular Cohort (MDC-CC) and The MEDIM cohort (impact of Migration and Ethnicity on Diabetes in Malmö). Paper I, in this cohort including an elderly population, we identified that Pro-NT predicts incident CVD in both genders, but incident T2D in women only, after 5.4 years of follow up. Paper II, in a population based cohort of Iraqi and Swedish born men and women, higher Pro-NT levels were observed both in the Iraqi- vs Swedish-born group. However, elevated plasma Pro-NT was associated with impaired glucose regulations assessed as insulin secretion and action and HbA1c in the Iraqi-population only. Paper III, we found prompt increases in plasma Pro-NT every hour for four hours, after an oral lipid load in healthy individuals. Post-lipid rise of circulating plasma Pro-NT correlated with the changes in plasma triglyceride levels, irrespective of cream and olive oil. Paper IV, in this longitudinal study, we identified that high Pro-NT levels predicted all-cause mortality (ACM) and cause- specific mortalities (CSM) due to CVD, gastrointestinaltract (GIT) diseases, mental and behavioral diseases, and diseases of unspecific causes, in both gender. Conclusion: This thesis shows that circulating Pro-NT is a biomarker that in an elderly population predicts CVD in both gender, but T2D in women only . Irrespective of gender, Pro-NT predicts ACM and CSM. Pro-NT is more strongly associated with impaired glucose regulation in a Middle Eastern immigrant population and may partly explain the increased T2D in this group. Furthermore, oral lipid intake increases Pro-NT levels, which facilitates triglyceride increase in blood in healthy individuals, supporting intestinal lipid absorption as being one key action of Pro-NT.

Background & methods National protests in the summer of 2020 drew attention to the significant presence of police in marginalized communities. Recent social movements have called for substantial police reforms, including “defunding the police,” a phrase originating from a larger, historical abolition movement advocating that public investments be redirected away from the criminal justice system and into social services and health care. Although research has demonstrated the expansive role of police to respond a broad range of social problems and health emergencies, existing research has yet to fully explore the capacity for health insurance policy to influence rates of arrest in the population. To fill this gap, we examine the potential effect of Medicaid expansion under the Affordable Care Act (ACA) on arrests in 3,035 U.S. counties. We compare county-level arrests using FBI Uniform Crime Reporting (UCR) Program Data before and after Medicaid expansion in 2014–2016, relative to counties in non-expansion states. We use difference-in-differences (DID) models to estimate the change in arrests following Medicaid expansion for overall arrests, and violent, drug, and low-level arrests. Results Police arrests significantly declined following the expansion of Medicaid under the ACA. Medicaid expansion produced a 20–32% negative difference in overall arrests rates in the first three years. We observe the largest negative differences for drug arrests: we find a 25–41% negative difference in drug arrests in the three years following Medicaid expansion, compared to non-expansion counties. We observe a 19–29% negative difference in arrests for violence in the three years after Medicaid expansion, and a decrease in low-level arrests between 24–28% in expansion counties compared to non-expansion counties. Our main results for drug arrests are robust to multiple sensitivity analyses, including a state-level model. Conclusions Evidence in this paper suggests that expanded Medicaid insurance reduced police arrests, particularly drug-related arrests. Combined with research showing the harmful health consequences of chronic policing in disadvantaged communities, greater insurance coverage creates new avenues for individuals to seek care, receive treatment, and avoid criminalization. As police reform is high on the agenda at the local, state, and federal level, our paper supports the perspective that broad health policy reforms can meaningfully reduce contact with the criminal justice system under historic conditions of mass criminalization.

Knowledge management is positioned as an enabler of ICH Q10, and the visibility and availability of product and process knowledge across the entire pharmaceutical product lifecycle is vital to the sustained success of an organization and to the effectiveness of an organization’s pharmaceutical quality system as defined by ICH Q10. This paper illustrates where knowledge management has a role to play within each product lifecycle phase. This paper goes on to further define phase-appropriate KM methods and tools to help address these needs and create end-to-end product and process knowledge visibility and availability.

Evidence exists regarding the impact of flourishing in individuals living with chronic pain, but there are currently no reviews which collate the literature on flourishing in adolescents living with chronic pain and their parents. Therefore, the aim of this scoping review was to map and review the current literature, to document how flourishing is defined and understood in the literature, and to identify gaps in the field. Six databases were searched (Web of Science, Medline, Embase, APA PsycNet and the Cochrane Central Register of Controlled Trials). In addition, a limited gray literature search was conducted. The resulting data were collated and reported in relation to the review questions, by examining the included papers to search for the presence of flourishing. Database searches resulted in 7326 papers after duplicate removal, with eight remaining papers being assessed for full-text eligibility. Following full-text screening, a final four papers were included in the review. Within the papers, flourishing was defined in relation to commonalities of benefit finding, enhanced maturity and growth, and social support. Gaps in the literature and directions for future research are considered. This review suggests that there is a dearth of knowledge and research regarding flourishing among adolescents living with chronic pain and their parents, despite aspects of flourishing identified in limited literature. This warrants further investigation.

Background The ligaments in the knee are prone to injury especially during dynamic activities. The resulting instability can have a profound impact on a patient’s daily activities and functional capacity. Musculoskeletal knee modelling provides a non-invasive tool for investigating ligament force-strain behaviour in various dynamic scenarios, as well as potentially complementing existing pre-planning tools to optimise surgical reconstructions. However, despite the development and validation of many musculoskeletal knee models, the effect of modelling parameters on ligament mechanics has not yet been systematically reviewed. Objectives This systematic review aimed to investigate the results of the most recent studies using musculoskeletal modelling techniques to create models of the native knee joint, focusing on ligament mechanics and modelling parameters in various simulated movements. Data sources PubMed, ScienceDirect, Google Scholar, and IEEE Xplore. Eligibility criteria for selecting studies Databases were searched for articles containing any numerical ligament strain or force data on the intact, ACL-deficient, PCL-deficient, or lateral extra-articular reconstructed (LER) knee joints. The studies had to derive these results from musculoskeletal modelling methods. The dates of the publications were between 1 January 1995 and 30 November 2021. Method A customised data extraction form was created to extract each selected study’s critical musculoskeletal model development parameters. Specific parameters of the musculoskeletal knee model development used in each eligible study were independently extracted, including the (1) musculoskeletal model definition (i.e., software used for modelling, knee type, source of geometry, the inclusion of cartilage and menisci, and articulating joints and joint boundary conditions (i.e., number of degrees of freedom (DoF), subjects, type of activity, collected data and type of simulation)), (2) specifically ligaments modelling techniques (i.e., ligament bundles, attachment points, pathway, wrapping surfaces and ligament material properties such as stiffness and reference length), (3) sensitivity analysis, (4) validation approaches, (5) predicted ligament mechanics (i.e., force, length or strain) and (6) clinical applications if available. The eligible papers were then discussed quantitatively and qualitatively with respect to the above parameters. Results and discussion From the 1004 articles retrieved by the initial electronic search, only 25 met all inclusion criteria. The results obtained by aggregating data reported in the eligible studies indicate that considerable variability in the predicted ligament mechanics is caused by differences in geometry, boundary conditions and ligament modelling parameters. Conclusion This systematic review revealed that there is currently a lack of consensus on knee ligament mechanics. Despite this lack of consensus, some papers highlight the potential of developing translational tools using musculoskeletal modelling. Greater consistency in model design, incorporation of sensitivity assessment of the model outcomes and more rigorous validation methods should lead to better agreement in predictions for ligament mechanics between studies. The resulting confidence in the musculoskeletal model outputs may lead to the development of clinical tools that could be used for patient-specific treatments.

This study assesses the practices and views of Scottish dairy farmers relating to pasture-based and indoor systems. There are the debates about the environmental, economic and animal welfare implications of these systems. Indoor dairy farming is a contentious practice among the public. While this controversy is sometimes represented as a lack of public understanding, there is a need for more research on farmers’ views to facilitate discussion in the industry. A survey was posted to 909 dairy farmers in Scotland with questions about their grazing practices and attitudes to grazing and indoor systems. 254 surveys were completed, online and in paper form. There was a 26% response rate to the paper version of the survey. The results showed that 19% of respondents housed some or all the cows all year-round. 68% agreed or strongly agreed that cows should graze for part of the year and 51% agreed or strongly agreed that welfare was better if cows grazed for part of the year. These views coexisted with the view that management was more important than the type of system for determining profitability or welfare outcomes (83% and 82% strongly agree or agree respectively). Respondents whose system involved grazing and respondents who had spent longer in farming were moderately more likely to agree that cows should have access to pasture, and slightly less likely to agree that management was more important than system for determining welfare outcomes. The results indicate that the picture is more complicated than the public rejecting indoor dairy farming and those in the industry accepting it. The results showed that a majority preference for cows to graze co-existed with the view that management was more important than system. In terms of industry and policy recommendations, the research suggests that measures should be taken to safeguard farmers’ ability to graze through for instance research and advisory support on grazing; ensuring different systems are not penalised in the development of dairy sector environmental measures and recommendations; and potentially supply chains that financially rewards farmers for grazing.

Introduction Pure Neural Leprosy (PNL) is a rare clinical form of leprosy in which patients do not present with the classical skin lesions but have a high burden of the disability associated with the disease. Clinical characteristics and follow up of patients in PNL are still poorly described in the literature. Objective This paper aims to describe the clinical, electrophysiological and histopathological characteristics of PNL patients, as well as their evolution after multidrug therapy (MDT). Methods Fifty-two PNL patients were selected. Clinical, nerve conduction studies (NCS), histopathological and anti-PGL-1serology were evaluated. Patients were also assessed monthly during the MDT. At the end of the MDT, all of the patients had a new neurological examination and 44 were submitted to another NCS. Results Paresthesia was the complaint most frequently reported by patients, and in the neurological examination the most common pattern observed was impairment in sensory and motor examination and a mononeuropathy multiplex. Painful nerve enlargement, a classical symptom of leprosy neuropathy, was observed in a minority of patients and in the motor NCS axonal injuries, alone or in combination with demyelinating features, were the most commonly observed. 88% of the patients did not present any leprosy reaction during MDT. There was no statistically significant difference between the neurological examinations, nor the NCS pattern, performed before and after the MDT. Discussion The classical hallmarks of leprosy neuropathy are not always present in PNL making the diagnosis even more challenging. Nerve biopsy is an important tool for PNL diagnosis as it may guide therapeutic decisions. This paper highlights unique characteristics of PNL in the spectrum of leprosy in an attempt to facilitate the diagnosis and management of these patients., Author summary Neuropathy is responsible for most of the disability associated with leprosy disease. The pure neural leprosy (PNL), in spite of being a rare clinical presentation of that, has some singular characteristics that are still poorly studied. In this study, we selected 52 patients at the diagnosis to describe their clinical, neurophysiological and histopathological presentation patterns as well as their evolution during the multidrug therapy (MDT). We confirmed that sensitive symptoms were the most commonly described by PNL patients but neural pain is rare. Also confirmed that mononeuropathy mutiplex was the most common pattern observed at neurological examination and at the nerve conduction studies at the moment of the diagnosis. However we showed that painful nerve enlargement other cardinal signs of leprosy, besides the skin lesions, is not common in this group of patients, There was no statistically significant difference between the neurological examination and NCS performed before and after the MDT.During the MDT88.4% of the patients did not have any leprosy reaction. This may suggest that that MDT was effective in stopping disease progression. Our results highlight the difficulties in the diagnosis of PNL and the progression following MDT in an attempt to prevent further disability in PNL patients.

The aim of this article is to assess both the economic and social value of balneotherapy and spa tourism, being the first paper in carrying out this analysis. The study has been conducted in Maresme, a region of Catalonia, Spain. On the one hand, an Input-Output (IO) model with a Social Accounting Matrix (SAM) has been carried out to assess the economic value. On the other hand, a Cost-Benefit Analysis (CBA) has been used to monetise the social value in this region, taking into account, among other concepts, direct and indirect health profits, given that balneotherapy helps to alleviate various diseases. The results show that whereas the economic multiplier is 1.529 considering the direct and indirect effects and 1.712 taking into account also the induced effects, which are similar to health and medical tourism multipliers, social value generates additional positive value, given that the cost-benefit ratio is 1.858. The theoretical implications of the paper as well as the findings’ implications for policy so as to encourage investments in spa tourism are discussed.

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.

SUMMARY Over the last decade, the focus of clinical implant research shifted from predominately survival orientated to peri-implant health and patient-centred outcomes. A stable peri-implant bone level is a prerequisite to achieve long-term implant success. Peri-implant bone level is affected by patient-, implant-, and site-specific factors. In addition, the success of an implant treatment could also be determined by the improvement in Oral Health-Related Quality of Life (OHRQoL). The introduction (Chapter 1) scrutinizes and clarifies the current literature focusing on these factors. The existing literature gives an ambiguous effect of implant-related and site-specific factors on peri-implant bone stability, showing the need for more research. Chapter 2 presents the aims of this dissertation. This thesis's first two literature studies (Chapter 3 and 4) systematically assessed the available scientific evidence. The assessment focused on whether commonly used biological parameters correspond to long-term outcomes of implant survival and reported peri-implantitis prevalence. Additionally, it also examined whether long-term peri-implant bone loss is affected by implant surface roughness. The clinical studies in this thesis (Chapter 5, 6, and 7) aimed to evaluate the effect of implant related factors such as implant micro-design (implant surface roughness), macro-design (microthreads and implant-abutment connection), and site-specific factors (soft-tissue thickness) on long-term peri-implant bone stability and peri-implant health. Additionally, we paid attention to the Oral Health-Related Quality of Life in patients restored with mandibular implant-retained overdentures. Chapter 3 (Study I) is a critical review of the literature published between 2011 and 2017, regarding the biological peri-implant parameters bleeding on probing, probing pocket depth, and bone loss. The search algorithm highlighted 4,173 papers available for further analysis, 255 papers for full article reading, and 41 fulfilled the inclusion criteria. In these 41 articles, 15 different case definitions for peri-implantitis were used. The reported prevalence of peri-implantitis ranged between 0% and 39.7%, with an overall mean weighted implant survival rate of 96.9% (89.9% - 100%). Based on 8,182 implants, the overall weighted mean bone loss was 1.1 mm after a loading time ranging from 5 to 20 years. The mean bone loss did not correlate with the reported prevalence of peri-implantitis, and the diagnostic parameters mean probing pocket depth and mean bleeding on probing. Moreover, the reported peri-implantitis prevalence did not correlate with mean probing pocket depth. However, a strong correlation was found between the reported prevalence of peri-implantitis and bleeding on probing. The survival rate showed a substantial correlation with function time, showing minor implant loss over time. We concluded that the case definition for peri-implantitis varied significantly between studies, indicating that an unambiguous definition based on a specified threshold for bone loss is not agreed upon in the literature. Chapter 4 (Study II) scrutinized the literature on long-term peri-implant bone loss and the relation with implant surface roughness and patient-related factors such as smoking and history of periodontitis. Implant systems are categorised based on the surface roughness expressed in Sa-value; minimally rough (Sa value: 0.5 – 1 μm), moderately rough (Sa value: 1 – 2 μm), and rough (Sa value: > 2 μm). In implant dentistry's early days, only minimally rough and microporous titanium plasma-sprayed rough implant systems were available. However, over time several implant modifications were done by sandblasting, acid-etching, anodic oxidation, or hydroxyapatite coating resulting in a moderately rough implant system. These modifications improved the osteoconductive and osteoinductive properties of the implant. The surface of the moderately rough implant system showed better blot cloth stabilisation, enhanced production of biological mediators, stimulate osteogenic maturation leading to higher bone-to-implant contact, and increased bonding strength of the bone to the implant. On the other hand, rougher implant systems are linked to increased bacterial adhesion with a higher risk of being affected by peri-implantitis. The search yielded 2,566 studies and 156 were selected for further reading. Only 87 reported information about surface roughness of the implants and mean bone loss after at least five years of function. In these papers in total 15,695 implants were inserted in 6,755 patients. The average weighted survival rate for these implants was 97.3% after at least 5 years of function. If 3 mm bone loss was used as a threshold to quantify peri-implantitis, less than 5% of the implants were affected. Regarding implant surface roughness, the systematic review suggests that peri-implant bone loss around minimally rough implant systems was statistically significantly less than the moderately rough and rough implant systems. No statistically significant difference was observed between moderately rough and rough implant systems. The meta-analyses showed less average peri-implant bone loss around smoother surfaces. However, due to the heterogeneity of the papers and the multifactorial cause for bone loss, the impact of surface roughness alone seems somewhat limited and of minimal clinical importance. In addition, the meta-analysis showed that smoking and history of periodontitis increased the risk for bone loss. Chapter 5 (Study III) includes two prospective split-mouth studies. Both studies included edentulous patients in need of a two-implant-supported overdenture in the mandible. The first part of Study III described the effect of the site-specific factor ‘soft-tissue thickness’ on crestal bone remodeling and peri-implant health. Twenty-six patients received two moderately rough implants. According to the manufacturer's guidelines, the control implant was installed equicrestally. The test implant was placed below crestal level to ensure at least 3 mm space for biologic width establishment on the abutment part. Initially, 26 patients were treated with one equicrestally and one subcrestally placed implant. After 36 months, 24 patients were available for follow-up. The second part of Study III determined the effect of implant surface roughness on crestal bone remodeling. As concluded in Study II, crestal bone loss might be related to the implant surface roughness. The existing literature suggests higher survival rates for moderately rough implants compared to minimally rough implants. On the other hand, recent literature and the findings of Study II suggest that implants with a minimally rough surface yield less long-term crestal bone loss. An implant with a hybrid surface combines the benefit of a moderately rough implant body and a minimally rough implant neck. To determine the effect of implant surface roughness on crestal bone loss, 23 patients received two implants: an implant with a moderately rough surface (Sa value: 1.3 μm) and a hybrid implant with a minimally rough coronal neck of 3 mm (Sa value: 0.9 μm) combined with a moderately rough body (Sa value: 1.3 μm). Apart from the difference in implant surface roughness, the two implants were identical. After 36 months, 21 patients were available for follow-up. The implant survival rate was 100% after 36 months. No differences were observed in crestal bone remodeling between the hybrid and moderately rough implant. However, initial bone remodeling was affected by initial soft tissue thickness because the equicrestal implants had implant threads exposed above bone level. Anticipating the biological width re-establishment by adapting the vertical position of the implant in relation to the available soft tissue thickness may prevent that implant threads are not fully covered by peri-implant bone. However, long-term follow-up of the study is necessary to determine the influence of early implant surface exposure and implant surface roughness on crestal bone loss, biological parameters, and implant survival. Study III also included Oral Health-Related Quality of Life for edentulous patients restored with a two-implant-supported mandibular overdenture. This patient-centred outcome was assessed with the Oral Health Impact Profile-14 (OHIP-14). The study concluded that a two-implant-supported mandibular overdenture in comparison with a conventional removable denture yields a significant improvement in the quality of life. Chapter 6 (Study IV) presented the five-year follow-up of the first part of study III, determining the effect of soft tissue thickness on crestal bone remodeling and peri-implant health. Twenty-four patients were available for the five-year follow-up. The survival rate was 100%, and only one implant showed a mean bone level higher than 2 mm. During initial bone remodeling equicrestal placement yielded 0.68 mm additional surface exposure compared to subcrestal placement. Afterwards, bone level and peri-implant health were comparable in both treatment conditions and stable up to five years. Hence, Study IV concluded that adapting the vertical position of the implant concerning the soft tissue thickness prevents early implant surface exposure caused by initial bone remodeling. However, in a well-maintained population, this has no impact on long-term prognosis. In addition, the Oral Health-Related Quality of Life was assessed using the Oral Health Impact Profile-14 (OHIP-14), concluding a stable Oral Health-Related Quality of Life over time. Chapter 7 (Study V) determines the effect of implant neck (microthreaded versus non-microthreaded) as well as the type of connection (internal conical versus external flat-to-flat) on peri-implant bone stability and peri-implant health. According to the literature, peri-implant bone loss is minimized on implants with microthreaded neck design and internal type of abutment connection, albeit that many clinical studies are biased due to confounding factors. Twenty-five patients were treated with a maxillary implant-supported bar-retained overdenture on four different implant types. Each patient received one implant with an internal connection with microthreads (I MT), one with an internal connection without microthreads (I NMT), one with an external connection with microthreads (E MT), and one with an external connection without microthreads (E NMT). Other design features, as well as surgical and prosthetic protocol, were consistent. After at least 36 months, the survival rate was 96%. It was concluded that the implant-abutment connection type (internal vs external) and the implant neck design (microthreaded vs non-microthreaded) have no clinical effect on peri-implant bone remodeling, peri-implant bone level after the initial remodeling. Furthermore, it also had no clinical effect on peri-implant health parameters, at least when implants are installed according to soft tissue thickness. Chapter 8 is the general discussion and includes clinical and future research recommendations. In addition, it highlights the social relevance of the undertaken scientific work in conjunction with a personal reflection. This PhD thesis concludes that: 1. Various peri-implantitis definitions are used in the literature, and reporting of biological parameters is often incomplete. Consistent reporting of peri-implantitis is required for scientific purposes as well as for clinical practice. 2. The peri-implantitis prevalence based on various case definitions did not correlate with the diagnostic parameters ‘mean probing pocket depth’, ‘mean bleeding on probing’, and ‘mean bone loss’. The survival rate showed a substantial correlation with function time, but implant loss over time is low. 3. In the current literature, less than 5% of the implants showed bone loss above 3 mm after at least five years in function. This result was independent of surface or implant brand, suggesting that currently reported peri-implantitis prevalence is exaggerated. 4. Rough implant systems are more prone to crestal bone loss. However, the multifactorial cause for bone loss and the heterogeneity of the studies make it difficult to draw firm conclusions. Nevertheless, more papers show less bone loss in favour of minimally rough implant systems. 5. Co-factors such as smoking or a history of periodontal disease increase the risk of bone loss. 6. The implant neck design (microthreaded vs non-microthreaded) has no influence on peri-implant bone remodeling when implants are installed in relation to soft tissue thickness allowing the formation of a 3 to 4 mm biological seal. 7. The implant-abutment connection type (internal vs external) has no influence on peri-implant bone remodeling when implants are installed in relation to soft tissue thickness allowing the formation of a 3 to 4 mm biological seal. 8. Implant surface roughness (minimally rough vs moderately rough) influences peri-implant bone remodeling nor additional bone loss when implants are installed in relation to soft tissue thickness allowing the formation of a 3 to 4 mm biologic seal. 9. Peri-implant health parameters (probing pocket depth, bleeding on probing, and plaque score) are not affected by implant design, surface texture, or abutment-connection features when implants are installed in relation to soft tissue thickness. 10. Anticipating biologic width re-establishment by adapting the vertical position of the implant in relation to the available soft tissue thickness may prevent initial peri-implant bone loss. 11. In a well-maintained population, the effect of early implant surface exposure caused by initial bone remodeling on peri-implant bone stability and biological parameters seems to be limited. 12. Implant-supported mandibular overdentures significantly improve the quality of life, with little biological complications and a high survival rate of the implants.

T In many machine learning classification problems, datasets are usually of high dimensionality and therefore require efficient and effective methods for identifying the relative importance of their attributes, eliminating the redundant and irrelevant ones. Due to the huge size of the search space of the possible solutions, the attribute subset evaluation feature selection methods are not very suitable, so in these scenarios feature ranking methods are used. Most of the feature ranking methods described in the literature are univariate methods, which do not detect interactions between factors. In this paper, we propose two new multivariate feature ranking methods based on pairwise correlation and pairwise consistency, which have been applied for cancer gene expression and genotype-tissue expression classification tasks using public datasets. We statistically proved that the proposed methods outperform the state-of-the-art feature ranking methods Clustering Variation, Chi Squared, Correlation, Information Gain, ReliefF and Significance, as well as other feature selection methods for attribute subset evaluation based on correlation and consistency with the multi-objective evolutionary search strategy, and with the embedded feature selection methods C4.5 and LASSO. The proposed methods have been implemented on the WEKA platform for public use, making all the results reported in this paper repeatable and replicable

Background Ward-Based Outreach Teams’ (WBOTs) use of mobile technologies can promote better quality and improved health services for populations in low- and middle-income countries. However, the implementation of such systems is fraught with threats to sustainability. Purpose The purpose of this study was to gain a deeper understanding of users’ views and experiences of the implementation of mHealth in a selected sub-district in North West Province, South Africa. Methods The study was qualitative, exploratory and descriptive. Data were collected from community health workers (CHWs) (n = 24) and outreach team leaders (OTLs) (n = 4) who used mobile devices loaded with the Mobenzi application through semi-structured focus group interviews, using an interview guide. Creswell’s stages of thematic analysis were used for data analysis, and codes, categories and themes were validated with the participants. Results Three themes emerged from the findings, namely the transition from a paper-based system to an electronic system; the use of the application; and reverting to paper-based documentation. The findings revealed that WBOTs considered the mHealth application as useful, easy to use, and supportive to their workflow. They experienced some technical challenges and lamented the inaccessibility of technicians. The mobile initiative’s termination caused distress among the participants, especially CHWs who had to revert to paper-based documentation to capture community health data. OTLs were concerned about the quality of health data being captured in the absence of the application. Conclusions The study concluded that community-based health care programmes that use WBOTs and mHealth technologies are essential in strengthening the health care system. WBOTs are facilitators for improving access to health care. Policy-makers and district managers will gain useful insights if they engage application users in discussions regarding future mobile health interventions for household and community-based care.

Background Work to control the gambiense form of human African trypanosomiasis (gHAT), or sleeping sickness, is now directed towards ending transmission of the parasite by 2030. In order to supplement gHAT case-finding and treatment, since 2011 tsetse control has been implemented using Tiny Targets in a number of gHAT foci. As this intervention is extended to new foci, it is vital to understand the costs involved. Costs have already been analysed for the foci of Arua in Uganda and Mandoul in Chad. This paper examines the costs of controlling Glossina palpalis palpalis in the focus of Bonon in Côte d’Ivoire from 2016 to 2017. Methodology/Principal findings Some 2000 targets were placed throughout the main gHAT transmission area of 130 km2 at a density of 14.9 per km2. The average annual cost was USD 0.5 per person protected, USD 31.6 per target deployed of which 12% was the cost of the target itself, or USD 471.2 per km2 protected. Broken down by activity, 54% was for deployment and maintenance of targets, 34% for tsetse surveys/monitoring and 12% for sensitising populations. Conclusions/Significance The cost of tsetse control per km2 of the gHAT focus protected in Bonon was more expensive than in Chad or Uganda, while the cost per km2 treated, that is the area where the targets were actually deployed, was cheaper. Per person protected, the Bonon cost fell between the two, with Uganda cheaper and Chad more expensive. In Bonon, targets were deployed throughout the protected area, because G. p. palpalis was present everywhere, whereas in Chad and Uganda G. fuscipes fuscipes was found only the riverine fringing vegetation. Thus, differences between gHAT foci, in terms of tsetse ecology and human geography, impact on the cost-effectiveness of tsetse control. It also demonstrates the need to take into account both the area treated and protected alongside other impact indicators, such as the cost per person protected., Author summary Sleeping sickness is a fatal disease in Africa caused by trypanosomes transmitted by the bite of infected tsetse flies. The World Health Organization has set the absence of new infections as a goal for 2030. To achieve this, screening and treatment of patients is supplemented by tsetse control. Tiny Targets are small insecticide-impregnated panels of blue cloth and black netting which attract and kill tsetse. To maintain the momentum in these last stages of eliminating the disease, it is important to understand the costs of vector control. This paper presents the results of two years’ cost monitoring in Bonon, an area covering 130 km2, home to 120,000 people. Since 2016, ~2,000 Tiny Targets have been deployed annually at a cost of USD 471 per km2 per year. Bonon is a degraded forested area and a relatively high number of targets was required as tsetse are present throughout. Nevertheless, the cost comes to only USD 0.5 per person protected per year. Compared to operations using Tiny Targets in Uganda and Chad, the cost was higher per km2 protected, reflecting the need to place targets throughout the area, but low per person protected compared to Chad, highlighting the need to use a range of comparators.

Background Coronavirus (COVID-19) has severely impacted lifestyles worldwide. Responses to COVID-19 have intentionally restricted the factors that encourage regular and frequent PA; opportunity, capability and motivation. However, the effects of these restrictions are likely to have differed by gender and age and different intensities of PA. This rapid review builds on previous evidence by synthesising the global impact of COVID-19 on adult PA through specific intensities and types of PA and evaluating this by gender and age. Methods A rapid systematic search of seven electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, Academic Search Complete, APA PsycInfo, and APA PsycArticles) was performed from December 2019 to January 2021. Studies investigating adult change in PA, exercise or sedentary behaviour due to COVID-19 were included. Results From an initial database search identifying 3,863 articles, 66 remained for synthesis after applying eligibility criteria. Results demonstrate decreases among all intensities and types of PA—walking (6 out of 7 papers), moderate-only (5 out of 6 papers), vigorous-only (5 out of 6 papers) and MVPA (4 out of 5 papers); as well as overall PA (14–72% participants reported a decrease). Reflecting that COVID-19 responses were designed to have universal effects, they also achieved whole-society decreases in PA behaviour, accented in older age groups. Conclusion There is a universal need to address the low levels of PA post-COVID-19. The consequences of decreased PA across all intensities has powerful, potentially recoverable, impacts. Universal declines have implications for public health officials and PA advocates for post-COVID-19 initiatives to promote PA.

Healthcare is an indispensable part of human life and chronic illnesses like cardiovascular diseases (CVD) have a deeply negative impact on the healthcare sector. Since the ever-growing population of chronic patients cannot be managed at hospitals, therefore, there is an urgent need for periodic monitoring of vital parameters and apposite treatment of these patients. In this paper, an Internet of Medical Things (IoMT) -based remote patient monitoring system is proposed which is based on Artificial Intelligence (AI) and edge computing. The primary focus of this paper is to develop an embedded prototype that can be used for remote monitoring of cardiovascular patients. The system will continuously monitor physiological parameters like body temperature, heart rate, and blood oxygen saturation, and then report the health status to the authenticated users. The system employs edge computing to perform multiple functionalities including health status inference using a Machine Learning (ML) model which makes predictions on real-time data, alert notifications in case of an emergency, and transferring data between the sensor network and the cloud. A web-based application is developed for the depiction of raw data and ML results and to provide a direct communication channel between the patient and the doctor. The ML module achieved an accuracy of 96.26% on the test set using the K-Nearest Neighbors (KNNs) algorithm. This solution aims to address the sense of emergency due to the alarming statistics that highlight the mortality rate of cardiovascular patients. The project will enable a smart option based on IoT and ML to improve standards of living and prove crucial in saving human lives.

Constructing a graphical model of the relationship between physical activity and cognitive function based on a systematic review of prospective evidence Citation: Thomas Campbell, Jessica Whyte, Karl Ferguson, Breda Cullen Background: Elucidating modifiable factors that may confer protection against cognitive decline is an important area of investigation. Physical activity (PA) represents one such factor and has generated substantial evidence regarding its protective benefit. However, in epidemiological research the presence of multiple covariates has posed challenges to obtaining unconfounded estimates of associations between exposure and outcome variables. Causal diagrams, or Directed Acyclic Graphs (DAGs), have emerged as promising tools for addressing these challenges and improving the planning and specification of statistical analyses. This review aims to utilise a recently developed research method for constructing DAGs in a robust and systematic way: Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAGs) (Ferguson, 2019). The method will be applied to observational studies of the relationship between PA and cognitive decline, and the resulting DAG will be used to inform empirical analysis of UK Biobank data (a very large cohort study), in a separate paper. Review Question(s): (a) What clinical and sociodemographic factors, and health behaviours, do the included studies report as being associated with cognitive function/impairment and/or physical activity? (b) How do the studies vary with regard to the covariates included, how these are adjusted for, and the conclusions of the study? Reporting framework: This systematic review will be conducted and reported according to Conducting Systematic Reviews and Meta-analyses of Observational Studies of Etiology (COSMOS-E) (Dekkers et al., 2019). Searches A systematic search of literature will be conducted using the following electronic databases: • Medline on the Ovid platform • Embase on the Ovid platform • PsycINFO on the EBSCOhost (EBSCO) platform In the event that the searches performed on these databases are not sufficiently sensitive (as would be indicated by known relevant papers not being captured), the CINAHL database on EBSCOhost and Web of Science platform may be incorporated to the search strategy. The search terms will incorporate medical subject headings (MeSH terms) which will be adapted for compatibility within each database. The terms used will be based on the following key terms: - Physical activity OR Exercise OR Physical fitness OR Activity level AND - Cognitive Function OR Cognitive Dysfunction OR Cognitive Decline OR Cognitive Aging OR Cognitive Impairment OR Neuropsychological Tests OR Alzheimer’s Disease OR Dementia AND - Longitudinal studies OR Prospective OR Cohort Where applicable the search terms will be modified to include truncation and wildcard characters. Searches will be restricted to English Language publications from 01.01.2005 to 01.07.2020. Additional hand-searching of the reference lists of recent relevant review papers will also be applied. The sensitivity of the search strategy will be tested by checking whether a sample of papers known to be relevant are detected by the search. Types of study to be included Inclusion criteria Longitudinal cohort studies (prospective design). Exclusion criteria Cross-sectional studies, case-control studies, retrospective studies, intervention studies & review papers. Condition or domain being studied Cognitive function as demonstrated by performance on objective cognitive tests. Where the outcome is measured categorically as impaired versus unimpaired, the threshold for impairment will be as defined by study authors but will at a minimum require performance to be one standard deviation below the mean of a healthy comparison group. Population Community dwelling adults, free of cognitive impairment before the period of exposure to physical activity began and aged ≥45