Search

Healthcare-associated infections (HAIs) remain a global health challenge, and have elevated rates in Sub-Saharan Africa. HAIs impact patients and their families by causing illness, prolonged hospital stay, potential disability, excess costs and, sometimes, death. The costs of HAIs are increasing due to spreading antimicrobial resistance. A major risk factor for HAIs is lack of water, sanitation and hygiene (WASH); environmental cleaning and healthcare waste management. In Sub-Saharan Africa, these services are lacking in at least 50% of healthcare facilities. To estimate the costs associated with HAIs at national level in 14 countries in Sub-Saharan Africa. Economic methodologies were employed to estimate the medical costs, productivity losses and value of premature death from HAIs, drawing on national statistics and published studies to populate the economic model. In 2022, the number of HAIs was estimated at 4.8 million, resulting in 500,000 deaths. Health-related economic losses amounted to US$13 billion per year, equivalent to 1.14% of combined gross domestic product and US$15.7 per capita. Healthcare costs were US$500 per HAI, and represented 5.6% of total health expenditure. The costs of providing basic WASH were US$0.91 per capita, which, if they reduced HAIs by 50%, would result in benefit–cost ratios of 1.6 (financial healthcare savings alone) and 8.6 (all economic benefits). HAIs have a major health and economic burden on African societies, and a significant proportion can be prevented. It is critical that health policy makers and practitioners dedicate policy space, resources and training to address HAIs. [ABSTRACT FROM AUTHOR]

Professionals working with children, including nurses and midwives, are foundational to effectively safeguarding children from maltreatment. However, little is known about the full nature and scope of nurses' and midwives' roles in safeguarding children in Australia presenting barriers to effective workforce preparation and support. This study reports an inductive analysis of qualitative responses (n = 51 Round 1, n = 17 Round 2) from a two-round Delphi study. The Delphi study aimed to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children, and this manuscript presents findings of an inductive analysis of qualitative responses beyond the scope of the Delphi study. Participants were Australian nurses and midwives (n = 51, n = 17) from diverse child-focussed settings. Nurses and midwives experienced many factors outside of their control that restricted their capacity to safeguard children. Influences included high workloads, burnout, lack of support, poor collaboration, structural barriers and inaccessible services for children. Nurses and midwives are advocates for children but experienced many factors preventing them from effectively safeguarding children. Future approaches to reducing child maltreatment must be underpinned by support for frontline professionals to promote workforce capacity and sustainability. Despite nurses' and midwives' best intentions, their attempts to prevent and respond to child maltreatment were hampered by systemic factors beyond their control. This study highlighted the need to address broader influences on nursing and midwifery practice to reduce the impacts of child maltreatment and support children to thrive. • Nurses and midwives are core to safeguarding children from maltreatment. • Factors outside nurses' and midwives' control reduced their capacity to safeguard. • Challenges included burnout, poor collaboration and structural barriers. • Future approaches to safeguarding must prioritise broader systemic issues. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has posed an unprecedented challenge to healthcare systems globally. Personal protective equipment has played a fundamental role in protecting healthcare workers and patients, but its effectiveness in reducing hospital-acquired infections (HAIs) during the pandemic remains a subject of debate. To conduct a synthesis and meta-analysis of the best available evidence of the prevalence of HAIs using a before/after approach. A three-step search strategy was undertaken to locate published and unpublished studies. A search was performed in MEDLINE, CINAHL, Embase, PsycINFO, and Google Scholar. Screening of studies, data extraction and critical appraisal were performed by four independent reviewers. Meta-analysis was conducted using Review Manager. The review is reported in accordance with PRISMA and JBI guidelines for systematic reviews. Fifteen studies were included in the review. Three studies indicated a statistically significant increase in the number of positive cultures during the COVID-19 period compared to the pre-COVID-19 period. Pooled data showed a non-significant decrease in the number of patients with positive cultures in the COVID-19 period compared to pre-COVID-19. There were no significant differences in various bacterial infections except for a significant decrease in respiratory infections. Pooled data for central line-associated bloodstream infections (CLABSIs) indicated a significant increase during the COVID-19 period, but one study reported an increase in CLABSI incidence. The evidence from this review demonstrates a mixed impact of the COVID-19 pandemic precautions on HAIs. [ABSTRACT FROM AUTHOR]

Determining when to recommend a change in treatment regimen due to insufficient improvement is a common challenge in therapeutics. In a sample of 7215 patients with major depressive disorder treated with transcranial magnetic stimulation (TMS) and with PHQ-9 scores before, during and after the course, 3 groups were identified based on number of acute course sessions: exactly 36 sessions (N = 3591), more than 36 sessions (N = 975), and less than 36 sessions (N = 2649). Two techniques were used to determine thresholds for percentage change in PHQ-9 scores at assessments after 10, 20, and 30 sessions that optimized prediction of endpoint response status: the Youden index and fixing the false positive rate at 10%. Positive and negative predictive values were calculated to assess the accuracy of identifying final nonresponders and responders, respectively. There was greater accuracy in predicting final response than nonresponse, especially in the groups that had at least 36 sessions. Substantial proportions of patients with low levels of early improvement were classified as responders at the end of treatment. The findings should be validated with clinician ratings using a more comprehensive depression severity scale. Manifesting clinical improvement early in the TMS course is strongly predictive of final status as a responder, while lack of early improvement is a relatively poor indicator of final nonresponse status. The predictive value of lack of early symptomatic improvement is too low to make reliable recommendations regarding changes in treatment regimen. • Signal detection methods were used to determine the power of early clinical improvement to predict TMS outcomes in a sample of 7215 MDD patients. • Novel methods were used to empirically determine improvement cutpoints on the PHQ-9 after 10, 20, and 30 sessions. • In patients who received 36 or more sessions, early improvement was highly predictive of ultimate responder status. • Lack of early improvement was a relatively poor predictor of final nonresponder status. • Clinicians can be confident that early improvement augers ultimate response, but lack of early benefit has considerably lesser predictive value. [ABSTRACT FROM AUTHOR]

The number of sessions in an acute TMS course for major depressive disorder (MDD) is greater than in the earlier randomized controlled trials. To compare clinical outcomes in groups that received differing numbers of TMS sessions. From a registry sample (N = 13,732), data were extracted for 7215 patients treated for MDD with PHQ-9 assessments before and after their TMS course. Groups were defined by number of acute course treatment sessions: 1–19 (N = 658), 20–29 (N = 616), 30–35 (N = 1375), 36 (N = 3591), 37–41 (N = 626), or >41 (N = 349) and compared in clinical outcomes at endpoint and at fixed intervals (after 10, 20, 30, and 36 sessions). The impact of additional treatments beyond 36 sessions was also examined. Groups that received fewer than 30 sessions had inferior endpoint outcomes than all other groups. PHQ-9 symptom reduction was greatest in the group that ended treatment at 36 sessions. The extended treatment groups (>36 sessions) differed from all other groups by manifesting less antidepressant response early in the course and had a slower but steady rate of improvement over time. Extending treatment beyond 36 sessions was associated with further improvement without evidence of a plateau. In real-world practice, there are strong relations between the number of TMS sessions in a course and the magnitude of symptom reduction. Courses with less than 30 sessions are associated with diminished benefit. Patients with longer than standard courses typically show less initial improvement and a more gradual trajectory, but meaningful benefit accrues with treatment beyond 36 sessions. • In a study of 7215 MDD patients, there were powerful associations between number of TMS sessions and effectiveness. • The average trajectory was rapid improvement over the first 10 sessions then a markedly slower but steady rate. • Patients with long TMS courses had reduced benefit after 10 sessions but steady improvement thereafter. • There was no evidence in group data that the antidepressant effects of TMS plateau with additional treatment. • The additional treatments given to patients with long TMS courses were associated with substantial clinical improvement. [ABSTRACT FROM AUTHOR]

A patient experience survey was undertaken for patients completing radiotherapy at the three Northwest of England Radiotherapy Providers. A previously reported National Radiotherapy Patient Experience Survey was adapted and undertaken in the Northwest of England. Quantitative data was analysed to establish trends. Frequency distribution was applied to appraise the number of participants selecting each of the pre-determined responses. Thematic analysis of free text responses was conducted. The questionnaire received 653 responses from the 3 providers across seven departments. Thematic analysis revealed 3 themes; logistics, information and operational. The results indicate that the majority of patients are satisfied with their treatment and care. Patients' responses indicate areas for improvements. Expectancy theory states that an individual's satisfaction is related to the difference between expected service and the service received. Consequently, when reviewing services and developing improvement it is important to understand patients' expectations. This regional survey starts to capture what people receiving radiotherapy expect from the service and the professionals delivering their treatment. This survey responses make a case for reviewing the information provision pre and post radiotherapy. This includes clarifying the understanding of consent for treatment including the intended benefits and potential late effects. There is an argument to offer information sessions prior to radiotherapy to achieve more relaxed and informed patients. A recommendation from this work is for the radiotherapy community undertake a national radiotherapy patient experience survey, facilitated via the 11 Radiotherapy ODNs. A national radiotherapy survey has multiple benefits to inform improvements in practice. This includes benchmarking services against national averages. This approach is aligned with the principles of the service specification in terms of reducing variation and increasing quality. [ABSTRACT FROM AUTHOR]

As an essential component of service delivery, radiotherapy clinical trials were championed within the NHS England service specifications. A call for a 15% increase in research and clinical trial activity, alongside a demand for equity of access for patients with cancer subsequently ensued. National understanding of current radiotherapy clinical trials operational practices is absent, but essential to help establish the current provision required to support the development of a strategic plan for implementation of NHS England's specifications. A cross-sectional survey was developed by a multi-disciplinary team and distributed to therapeutic radiography clinical trial leads across the UK to ascertain the current provision of radiotherapy clinical trials only, including workforce resources and the trials management processes to establish a benchmark and identify potential barriers, enablers, and opportunities to increase access to clinical trials. Thirty-two complete responses were obtained equating to 49% of the total UK NHS departments and 74% of those departments invited. Four key findings were identified: 1) research strategy and systems, 2) participation and activity in radiotherapy clinical trials, 3) access to clinical trials at alternative departments and 4) facilitators & barriers. Overarchingly a lack of radiotherapy clinical trials strategy or supported processes were apparent across the UK, aggravating existing barriers to trial activity. It is essential for radiotherapy clinical trials to be embedded in to departmental and Trust strategy, this will help to ensure the processes and resources required for trial delivery are not only in place, but also recognised as imperative and important for patients with cancer as radiotherapy treatment delivery. Failure to address the barriers or build upon the facilitators may result in UK radiotherapy departments facing challenges in achieving the 15% increase in radiotherapy clinical trial activity. [ABSTRACT FROM AUTHOR]

Tropical agroforestry systems support the wellbeing of millions of subsistence farmers. Owing to their ecosystem services, these agricultural systems are often advocated in government, policy, and literature as a potential adaptation to climate change measure despite emerging evidence that agroforestry systems could succumb to climate change. While the agroecological impacts of climate change on tropical agroforests are becoming increasingly apparent, few studies investigate the impacts on farmers' wellbeing. This study empirically analyses how a potentially warmer and drier future climate could affect the wellbeing of subsistence farmers in a homegarden agroforestry system. We employed a space-for-time climate analogue analysis approach based on the variation in altitude proxying for changes in climate on the lower southeast slopes of Mt Kilimanjaro to examine the climate effect on provisioning ecosystem services and farmers' wellbeing. To guide our study, we developed an interdisciplinary framework for understanding how changes in climate pressures can impact farmers within tropical agroforests by considering effects on the system's social and ecological components, ecosystem services, and farmers' wellbeing. A mixed-method approach was used to statistically analyse the variation in farming households' wellbeing in the homegardens and qualitatively understand the underlying mechanisms. Overall, the change in climate conditions reduced the homegarden's natural capital stock, e.g., livestock fodder, and productivity, negatively affecting farmers' wellbeing. For example, farmers under the warmer and drier climate conditions were less likely to consume the three daily meals required for a good life (OR = 0.441, P < 0.05). Farmers who supplemented their homegarden crop production using dryland agriculture were less vulnerable to climate effects. However, this strategy relies on farmers' sustained access to expensive productive assets, i.e., agrochemicals and farmland, which could become challenging under climate change. Our findings are significant because 1) they indicate that farmers' wellbeing could decline under climate change, and 2) they evidence that tropical agroforestry systems can still be vulnerable to climate effects despite their advocacy in climate adaptation scholarship. We suggest that policymakers utilise current climate financing oppertunities to assist farmers in adapting their homegarden to climate change, for example, by establishing climate-resilient fodder and crops. [Display omitted] • Climate analogue analysis projected the climate impacts on farmers in homegardens. • Climate change reduced the homegarden's natural capital stock and crop yield. • These impacts reduced farmers' wellbeing, mostly through poorer nutrition. • Farmers' livestock were vulnerable to climate-related declines in fodder. • A combined dryland-homegarden production system can reduce farmers' vulnerability. [ABSTRACT FROM AUTHOR]

• A relapsing disease course occurred in 64.6 % of MOGAD patients. • The first relapse occurred most frequently (68.6 %) within the first year. • The first relapse can still occur after ≥5 years in 19.6 % of MOGAD patients. • Relapse predictors were onset <9 years, severe pleocytosis, and meningoencephalitis. • Immunotherapy with scheduled immunoglobulins was associated with fewer relapses. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) may have a monophasic or relapsing disease course. To date, factors that may predict a relapsing disease course remain largely unknown and only limited data exist regarding the efficacy of different utilized immunotherapy regimens at preventing or reducing relapses. To assess the characteristics, predictors, and immunotherapy of relapsing MOGAD. This multicenter retrospective analysis included all MOGAD cases at the University of Florida, Baylor College of Medicine and the University of California San Diego with minimum follow-up time of 6 months. Cox proportional hazards regression analyses, corrected for age and sex, were performed to evaluate hazard ratios (HR) of predictors of a relapsing disease course and to compare relapse hazards for utilized immunotherapies. The majority of included participants (51/79 [64.6 %]) had a relapsing course, and of these individuals, 68.6 % (35/51) experienced their first relapse within the first year. However, 10/51 (19.6 %) participants experienced their first relapse ≥5 years (5–15 years) after the initial presentation. Predictors of a relapsing course were CSF pleocytosis (>150 cells/mm3; HR 3.3 [1.18 – 9.24]; p = 0.023), a pediatric disease onset at age < 9 years (HR 2.69 [1.07–6.75]; p = 0.035), and an initial presentation with the clinical syndrome of meningoencephalitis (HR 3.42 [1.28 – 9.17]; p = 0.015),. In participants with a relapsing course, 13/24 (54.2 %) patients remained relapse-free on rituximab, 4/8 (50 %) on mycophenolate mofetil, and 11/14 (78.6 %) on scheduled immunoglobulins. Patients treated with immunoglobulins had significantly fewer relapses compared to patients treated with other immunotherapies (HR: 0.1 [0.2 – 0.63]; p = 0.014). In our cohort, the majority of MOGAD patients relapsed. The initial relapse occurred most frequently within the first year, but first relapses also took place over a decade after the initial presentation. Prepubertal onset, severe CSF pleocytosis, and the clinical syndrome of meningoencephalitis may be predictors of a relapsing course. Of the currently available off-label steroid-sparing treatments, scheduled immunoglobulins may be the most effective in relapse prevention. [ABSTRACT FROM AUTHOR]

A cognitive aid is a tool used to help people accurately and efficiently perform actions. Similarly themed cognitive aids may be collated into a manual to provide relevant information for a specific context (eg, operating room emergencies). Expert content and design are paramount to facilitate the utility of a cognitive aid, especially during a crisis when accessible memory may be limited and distractions may impair task completion. A cognitive aid does not represent a rigid approach to problem-solving or a replacement for decision-making. Successful cognitive aid implementation requires dedicated training, access, and culture integration. Here the authors present a set of evidence-based cognitive aids for thoracic anesthesia emergencies developed by a Canadian thoracic taskforce. [ABSTRACT FROM AUTHOR]

To construct a conceptual model of comprehensive care for Indonesian children with Human Immunodeficiency Virus. A qualitative constructivist grounded theory design. Purposive sampling was used to interview 12 children with Human Immunodeficiency Virus and 8 family members with the age of the children ranged from 9 to 18 years, and 23 health professionals, including general practitioners, paediatric specialists, nurses, midwife, and nutritionist from public health centres and provincial hospitals in East Java, Indonesia. Data was analysed using constant comparative coding methods, theoretical sensitivity, memo writing, and diagramming to facilitate the development of the substantive theory. Exploring the perspectives of the participants has revealed the need to enhance the delivery of comprehensive care across the continuum, because HIV care and services for children was sub-optimal. Understanding children's needs and preferences forms the foundation of the development of a framework for the comprehensive care of children with HIV consisting of child-centred care and social support, delivered by integration and coordination of care through a healthcare service. The conceptual model provides new knowledge and has the capacity to bring together optimal care across the continuum addressing the challenges of fragmentation of care for children and their families. The model informs that children with HIV not only need pharmacotherapy, but also other care interventions depending on their individual needs, preferences, and age. Implementing the model may help to resolve such problems, to improve collaborative practice and enhance children's participation, thereby promoting children's health outcomes. • Constructionist ground theory in the study of Indonesian children with HIV • The conceptual model of comprehensive care enhances understanding of children and adolescent's needs and preferences about the components of HIV care interventions and services • Child-centred care and support with integration and coordination of care are components of the model addressing the fragmentation of care. [ABSTRACT FROM AUTHOR]

Fisheries based on short lived species are notoriously difficult to manage using traditional effort or catch quota controls. Such fisheries are often characterised by high fecundity, requiring only a small spawning stock to potentially produce a large biomass the following year. This stock, or at least its availability, is driven by unpredictable environmental conditions to a large extent, with the available biomass depleted over the fishing season though both natural and fishing mortality. In most instances, management of these fisheries has focused on ensuring sufficient escapement at the end of the season to allow sufficient recruitment the following year. Catch-rate triggers are one such management tool to determine when fishing should cease. In this study, the use of such triggers in the banana prawn sub-fishery of the Australian Northern Prawn Fishery are assessed. The fishery has an explicit objective of achieving maximum economic yield, and the triggers are set on an economic basis during the season based on price and cost information provided by the industry. The in-season estimates provided by industry were highly correlated with information derived retrospectively through an economic survey, with the industry-provided estimates generally resulting in a more conservative (i.e., higher) break-even catch-rate level. It is the profit maximising behaviour of the fishers, however, that results in the greatest benefits, with most boats leaving the fishery before the trigger catch-rate is reached. The catch-rate trigger operates more as a "safety-net" for the fishery, and possibly a nudge encouraging vessels to maximise their profits given their individual cost structures. [ABSTRACT FROM AUTHOR]

One of the most destructive invasive pests worldwide is the whitefly, Bemisia tabaci MEAM1. The Florida vegetable crop market, worth millions of dollars annually, suffers major losses because of whitefly injury. Spirotetramat is frequently used by Florida vegetable crop growers to control whitefly nymphs. A previous study based on maximum dose bioassays indicated that MEAM1 populations in Florida may be developing resistance to spirotetramat. Thus, the long-term efficacy of this active ingredient depends on the development of baseline susceptibility data and the continued monitoring of MEAM1 populations' susceptibility. In the present study, 16 populations of whiteflies collected in south Florida were tested for resistance to spirotetramat through serial dilution bioassays designed to test whitefly nymphs. The field populations' responses were compared with a susceptible MEAM1 laboratory colony. Median lethal concentrations (LC 50) and resistance ratios (RRs) were quantified to determine MEAM1 resistance levels. Among the populations tested, 12.5% remained relatively susceptible (3–4 RR) to spirotetramat. Low to moderate resistance was found in 56% of the populations (16–58 RR). Over 30% of the populations tested were highly or extremely resistant (126–795 RR). Overall, the variable susceptibility of spirotetramat in some field populations indicates that resistance to this insecticide has developed in certain regions of south Florida. This is the first report of spirotetramat resistance in the United States. These results will directly refine management recommendations for spirotetramat use in areas where MEAM1 populations exhibit resistance. • This study represents the first report of B. tabaci resistance to spirotetramat in the United States. • 12.5% of the populations were susceptible to spirotetramat, and the remaining populations had low to extreme resistance. • Resistance patterns may be influenced by local agricultural practices, with variations in different counties and crops. • Results underscore the need for region-specific IPM strategies to combat escalating resistance to spirotetramat. [ABSTRACT FROM AUTHOR]

Estrogen-related-receptor α (ERRα) plays a critical role in the transcriptional regulation of cellular bioenergetics and metabolism, and perturbations in its activity have been associated with metabolic diseases. While several coactivators and corepressors of ERRα have been identified to date, a knowledge gap remains in understanding the extent to which ERRα cooperates with coregulators in the control of gene expression. Herein, we mapped the primary chromatin-bound ERRα interactome in mouse liver. RIME (Rapid Immuno-precipitation Mass spectrometry of Endogenous proteins) analysis using mouse liver samples from two circadian time points was used to catalog ERRα-interacting proteins on chromatin. The genomic crosstalk between ERRα and its identified cofactors in the transcriptional control of precise gene programs was explored through cross-examination of genome-wide binding profiles from chromatin immunoprecipitation-sequencing (ChIP-seq) studies. The dynamic interplay between ERRα and its newly uncovered cofactor Host cell factor C1 (HCFC1) was further investigated by loss-of-function studies in hepatocytes. Characterization of the hepatic ERRα chromatin interactome led to the identification of 48 transcriptional interactors of which 42 were previously unknown including HCFC1. Interrogation of available ChIP-seq binding profiles highlighted oxidative phosphorylation (OXPHOS) under the control of a complex regulatory network between ERRα and multiple cofactors. While ERRα and HCFC1 were found to bind to a large set of common genes, only a small fraction showed their colocalization, found predominately near the transcriptional start sites of genes particularly enriched for components of the mitochondrial respiratory chain. Knockdown studies demonstrated inverse regulatory actions of ERRα and HCFC1 on OXPHOS gene expression ultimately dictating the impact of their loss-of-function on mitochondrial respiration. Our work unveils a repertoire of previously unknown transcriptional partners of ERRα comprised of chromatin modifiers and transcription factors thus advancing our knowledge of how ERRα regulates metabolic transcriptional programs. • RIME analysis in liver identifies 42 previously unknown chromatin-bound ERRα interactors. • OXPHOS at the center of a transcriptional hub governed by ERRα and multiple cofactors. • ERRα and HCFC1 co-occupy a specific set of promoters enriched for OXPHOS genes. • HCFC1 cooperates with ERRα in the control of mitochondrial respiration. [ABSTRACT FROM AUTHOR]

• The study found three long-term adherence trajectories of oral disease-modifying agents (DMAs) in multiple sclerosis (MS). • The study found there was no difference in annualized relapse rates (ARR) across the three DMAs. • Adherence trajectory grouped as rapid decliners had a higher ARR than completely adherent patients. • The type of oral DMAs did not moderate the relationship between ARR and the adherence trajectory groups. Real-world effectiveness can vary across oral disease-modifying agents (DMAs) and their adherence trajectories in patients with multiple sclerosis (MS). However, previous studies have not considered longitudinal adherence patterns while evaluating oral DMAs. This study aimed to evaluate the association of oral DMAs and their adherence trajectories with annualized relapse rate (ARR) in patients with MS. This retrospective observational cohort study based on the 2015–2019 MarketScan Commercial Claims and Encounters Database involved continuous enrolled adults (18–64 years) with ≥1 MS diagnosis (ICD-9/10-CM:340/G35) and ≥ 1 oral DMA prescription. Patients were grouped into incident fingolimod (FIN), teriflunomide (TER), and dimethyl fumarate (DMF) users based on the index DMA with a one-year washout period. Annual DMA adherence trajectories based on the monthly Proportion of Days Covered (PDC) one year after treatment initiation were identified using Group-Based Trajectory Modeling (GBTM). The validated claims-based ARR was evaluated during the one-year follow-up period using generalized boosted model-based inverse probability treatment weights with negative binomial regression model. The study cohort consisted of 994 MS patients who initiated with FIN (23.0%), TER (22.3%), and DMF (54.7%) during the study period. GBTM grouped eligible patients into three adherence trajectories: complete adherers (59.2%), slow decliners (23.8%), and rapid decliners (17.0%). The proportion of complete adherers varied across the oral DMAs (FIN: 67.1%, TER: 55.4%, and DMF: 57.4%). The negative binomial regression modeling revealed that, while there was no difference in ARR across the three DMAs, rapid decliners (adjusted incidence rate ratio[aIRR]: 1.6, 95% CI: 1.1–2.4) had a higher rate of relapses compared to completely adherent patients. The type of oral DMAs did not moderate the relationship between ARR and the adherence trajectory groups. Adherence trajectories classified as rapid decliners were associated with a higher ARR than complete adherers after adjusting for their type of oral DMAs. Longitudinal medication adherence patterns are critical in reducing relapse rates in MS. [ABSTRACT FROM AUTHOR]

It has been suggested that sequential bilateral (SBL) TMS, combining high frequency, left dorsolateral prefrontal cortex (DLPFC) stimulation and low frequency, right DLPFC stimulation, is more effective than unilateral TMS. To contrast treatment outcomes of left unilateral (LUL) and SBL protocols. Registry data were collected at 111 practice sites. Of 10,099 patients, 3,871 comprised a modified intent-to-treat (mITT) sample, defined as a primary MDD diagnosis, age ≥18, and PHQ-9 completion before TMS and at least one PHQ-9 assessment after baseline. The mITT sample received high frequency (10 Hz) LUL TMS exclusively (N = 3,327) or SBL TMS in at least 90% of sessions (N = 544). Completers (N = 3,049) were responders or had received ≥20 sessions and had an end of acute treatment PHQ-9 assessment. To control for site effects, a Matched sample (N = 653) included Completers at sites that used both protocols. To control for selection bias, the SBL group was also compared to a Restricted LUL group, drawn from sites where no patient switched to SBL after substantial exposure to LUL TMS. Secondary analyses were conducted on CGI-S ratings. The LUL group had superior outcomes compared to the SBL group for multiple PHQ-9 and CGI-S continuous and categorical measures in the mITT, Completer and Matched samples, including in the specified primary analyses. However, outcome differences were not observed when comparing the Restricted LUL and SBL groups. Within SBL protocols, the LUL-RUL order had superior outcomes compared to the RUL-LUL order in all CGI-S, but not PHQ-9, measures. While limited by the naturalistic design, there was no evidence that SBL TMS was superior to LUL TMS. The sequential order of RUL TMS followed by LUL TMS may have reduced efficacy compared to LUL TMS followed by RUL TMS. • Sequential bilateral (SBL) TMS is frequently used in routine clinical practice despite the lack of an evidence base. • High frequency left unilateral (HF-LUL) treatment was compared to SBL across several treatment cohorts to minimize site/selection bias. • There was no evidence of that SBL TMS was superior to LUL TMS in any analysis. • Sequential low frequency right unilateral followed by HF-LUL may have reduced efficacy compared to left followed by right. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Optimizing organ yield (number of organs transplanted per donor) is a potentially modifiable way to increase the number of organs available for transplant. Models to predict the expected deceased donor organ yield have been developed based on ordinary least squares regression and logistic regression. However, alternative modeling methodologies incorporating machine learning may have superior performance compared with conventional approaches. We evaluated the predictive accuracy of 14 machine learning models for predicting overall organ yield in a cross-validation procedure. The models were parameterized using data from the Organ Procurement and Transplantation Network database from 2000 to 2018. The inclusion criteria for the study were adult deceased donors between 18 and 84 years of age that had at least 1 organ procured for transplantation. A total of 89,520 donors met the inclusion criteria. Their mean (standard deviation) age was 44 (15) years, and approximately 58% were male. Our cross-validation analysis showed that a tree-based gradient boosting model outperformed the remaining 13 models. Compared with the currently used prediction models, the gradient boosting model improves prediction accuracy by reducing the mean absolute error between 3 and 11 organs per 100 donors. Our analysis demonstrated that the gradient boosting methodology had the best performance in predicting overall deceased donor organ yield and can potentially serve as an aid to assess organ procurement organization performance. [ABSTRACT FROM AUTHOR]

This study developed and piloted the first online training package to support implementation and delivery of brief smoking cessation interventions for therapeutic radiographers in four radiotherapy departments in England. A previously reported systematic literature review and data analysis from the previously reported pre-focus group questionnaire and focus groups enabled the development of an online training package. The questionnaire was repeated by the participating therapeutic radiographers following completion of the training resource (n = 31). The results of the comparative questions from the pre and post questionnaires were analysed using the Statistical Package for Social Sciences (SPSS Version 24). In total, 43 therapeutic radiographer participants completed the pre-questionnaire and 31 participants continued to complete the post questionnaire, having completed the online training package. The previously conducted focus groups identified several barriers to the delivery of smoking cessation, that were addressed through the development of an online training package. Following the completion of the training; therapeutic radiographers had increased knowledge and confidence regarding smoking cessation, the number of therapeutic radiographers who believe that smoking cessation is part of their role increased and therapeutic radiographers more routinely have conversations about smoking cessation. The training resource improved therapeutic radiographers' knowledge and confidence and increased awareness of the role of the therapeutic radiographer in the provision of smoking cessation interventions. Challenges remain that continue to prevent some therapeutic radiographers from delivering smoking cessation interventions and strong leadership and implementation of strategy and guidance is essential to ensure wider implementation. Recording and measuring impact of interventions remains an area to be addressed, alongside cultural changes and reassurance around the therapeutic relationship. This training tool has proven to be effective in the sample within this study and should be disseminated and evaluated more widely across radiotherapy provision within the United Kingdom. [ABSTRACT FROM AUTHOR]

Primary febrile neutropenia (FN) prophylaxis with ciprofloxacin or granulocyte-colony stimulating factors (G-CSF) is recommended with docetaxel-cyclophosphamide (TC) chemotherapy for early-stage breast cancer (EBC). A pragmatic randomised trial compared the superiority of G-CSF to ciprofloxacin and a cost-utility analysis were conducted. EBC patients receiving TC chemotherapy were randomised to ciprofloxacin or G-CSF. The primary outcome was a composite of FN and non-FN treatment-related hospitalisation. Secondary outcomes included; rates of FN, non-FN treatment-related hospitalisation, chemotherapy dose reductions/delays/discontinuations. Primary analysis was performed with the intention to treat population. Cost-utility analyses were conducted from the Canadian public payer perspective. 458 eligible patients were randomised: 228 to ciprofloxacin and 230 to G-CSF. For the primary endpoint there was non-statistically significant difference (Risk difference = −6.7%, 95%CI = −13.5%–0.1%, p = 0.061) between ciprofloxacin patients (46,20.2%) and G-CSF (31,13.5%). Patients receiving ciprofloxacin were more likely to experience FN (36/228, 15.8% vs 13/230, 5.7%) than patients receiving G-CSF (p < 0.001). Non-FN treatment-related hospitalisation occurred in 40/228 (17.5%) of ciprofloxacin patients vs 28/230 (12.2%) of G-CSF patients (p = 0.12). There were no differences in other secondary outcomes. G-CSF was associated with an incremental cost-effectiveness ratio of C$1,760,796 per one quality-adjusted life year gained. The primary endpoint of superiority of G-CSF over ciprofloxacin was not demonstrated. While there were reduced FN rates with G-CSF, there were no differences in chemotherapy dose delays/reductions or discontinuations. With the commonly used willingness to pay value of C$50,000/QALY, G-CSF use was not cost-effective compared to ciprofloxacin and deserves scrutiny from the payer perspective. • Primary febrile neutropenia (FN) prophylaxis is indicated for docetaxel-cyclophosphamide (TC) chemotherapy. • In this multicentre trial 458 breast cancer patients receiving TC chemotherapy were randomised to ciprofloxacin or to G-CSF. • For the primary endpoint of FN and non-FN treatment-related hospitalizations, G-CSF was not superior over ciprofloxacin. • While there were reduced FN rates with G-CSF, the incremental cost-effectiveness ratio was C$1,760,796 per one QALYWALY gained. [ABSTRACT FROM AUTHOR]

To estimate feasibility, usability and efficacy of a mobile parenting app (Rx for Success ; RxS) to enhance reading guidance provided to parents of young children during well-visits. This trial was conducted at a clinic serving primarily families of Hispanic ethnicity and low-socioeconomic status (SES) where Reach Out and Read (ROR) is standard practice. It involved 252 parent-child dyads in 2 age groups (~6-months old, ~18-months old) randomized during well-visits to receive RxS or a children's book modeling alternatives to screen time (Control) by research coordinators. RxS involves videos, activities and "push" messages. Follow-up assessments were conducted approximately 6 months later, including impression and use, shared reading behaviors, child language and screen time. A total of 217 dyads completed both visits (110 RxS, 107 Control). Time to introduce RxS was under 3 minutes and 32% of parents experienced largely minor performance issues. Parent impression of RxS was favorable for both age groups at baseline and follow-up, though use was infrequent, attributable to a desire for more relevant and updated content. Significant findings favoring RxS included shared reading as a favorite activity, more frequent shared reading reported at 12 months and higher language scores at 24 months. Screen time was equivalent between cohorts, exceeding American Academy of Pediatrics guidelines. A mobile app introduced to parents of young children from low-SES backgrounds was feasible during well-visits, rated as helpful, and effective to enhance shared reading at younger and language at older ages. While a potentially impactful enhancement to ROR, features needing improvement were identified. [ABSTRACT FROM AUTHOR]

• Degenerative cervical myelopathy is a major cause of disability. • Surgery is the mainstay of treatment, but there is significant variation in approach. • This was an international survey of spine surgeons. • We found that approach is decided on a case by case basis. • However, posterior approaches are favoured. • Further study required to assess need for fusion in addition to laminectomy. Degenerative cervical myelopathy (DCM) results from compression of the cervical spine cord as a result of age related changes in the cervical spine, and affects up to 2% of adults, leading to progressive disability. Surgical decompression is the mainstay of treatment, but there remains significant variation in surgical approaches used. This survey was conducted in order to define current practice amongst spine surgeons worldwide, as a possible prelude to further studies comparing surgical approaches. Methods: An electronic survey was developed and piloted by the investigators using SurveyMonkey. Collected data was categorical and is presented using summary statistics. Where applicable, statistical comparisons were made using a Chi-Squared test. The level of significance for all statistical analyses was defined as p < 0.05. All analysis, including graphs was performed using R (R Studio). Results: 127 surgeons, from 30 countries completed the survey; principally UK (66, 52%) and North America (15, 12%). Respondents were predominantly Neurosurgeons by training (108, 85%) of whom 84 (75%) reported Spinal Surgery as the principal part of their practice. The majority indicated they selected their surgical procedure for multi-level DCM on a case by case basis (62, 49%). Overall, a posterior approach was more popular for multi-level DCM (74, 58%). Region, speciality or annual multi-level case load did not influence this significantly. However, there was a trend for North American surgeons to be more likely to favour a posterior approach. Conclusions: A posterior approach was favoured and more commonly used to treat multi-level DCM, in an international cohort of surgeons. Posterior techniques including laminectomy, laminectomy and fusion or laminoplasty appeared to be equally popular. [ABSTRACT FROM AUTHOR]

Objective: To assess whether a citywide structured book-sharing program (NICU Bookworms) designed to promote reading to infants while admitted in the neonatal intensive care unit (NICU) would increase parental reading behaviors (≥3-4 days/week) in the NICU and after discharge home, including high-risk parents who do not themselves enjoy reading.Study Design: The NICU Bookworms program comprised staff training, parent education, and building a literacy-rich environment. In this quasi-experimental intervention study, parents of medically high-risk NICU graduates <6 months of age were administered a questionnaire at their first NICU follow-up clinic visit. The survey incorporated questions from the StimQ-I READ subscale to assess home reading environment and shared reading practices.Results: A total of 317 infants were enrolled, 187 in an unexposed comparison group and 130 in the intervention group. Parents exposed to Bookworms were significantly more likely to read ≥3-4 days per week while in the NICU (34.5% vs 51.5%; P = .002; aOR, 2.2; 95% CI, 1.2-4.0), but reading at home did not differ (67.9% vs 73.1%; P = .28; aOR, 0.99; 95% CI, 0.5-1.8). However, among parents who did not themselves enjoy reading, frequency was significantly higher both in the NICU (18.4% vs 46.1%; P = .009; aOR, 5.0; 95% CI, 1.2-21.5) and at home (36.9% vs 70%; P = .003; aOR, 3.7; 95% CI, 1.1-12.9). A qualitative thematic analysis found that Bookworms decreased parental stress, enhanced bonding, and supported positive parent-infant interactions.Conclusions: A book-sharing intervention in the NICU increased parent-reported reading aloud during hospitalization and among parents disinclined to read for pleasure, both in the NICU and following discharge. This change may have been mediated by enhancement of parent-infant interactions. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to compare one-year mortality in patients undergoing cardiac surgery with volatile anesthesia or total intravenous anesthesia (TIVA). Secondary objectives were to compare in-hospital and 30-day mortality, postoperative levels of creatine kinase (CK-MB) and cardiac troponin, and durations of tracheal intubation, intensive care unit (ICU) and hospital stays. Systematic review and meta-analysis of randomized controlled trials (RCTs). International, multi-institution centers. Adults patients undergoing heart surgery. Volatile anesthesia and TIVA. Meta-analysis found no statistically significant difference between patients receiving TIVA and volatile anesthesia in one-year mortality (n = 6440, OR = 1.22, 95% CI 0.97 to 1.54, p = 0.09, Z = 1.67, I2 = 0%), troponin (n = 3127, SMD = 0.26, 95% CI -0.01 to 0.52, p = 0.05, Z = 1.92, I2 = 90%) and CK-MB concentration 24h postoperatively (n = 1214, SMD = 0.10, 95% CI -0.17 to 0.36, unadjusted p = 0.48, Z = 0.71, I2 = 79%), or time to tracheal extubation (n = 1059, SMD = 0.10, 95% CI -0.28 to 0.49, p = 0.60, Z = 0.53, I2 = 88%). The durations of ICU stay (n = 2003, SMD = 0.29, 95% CI 0.01 to 0.57, p = 0.04, Z = 2.05, I2 = 88%) and hospital stay (n = 1214, SMD = 0.42, 95% CI 0.10 to 0.75, p = 0.01, Z = 2.53, I2 = 91%) were shorter in the volatile anesthetic compared to TIVA group. No significant differences in mortality (in-hospital, 30-day, 1-year), troponin and CK-MB concentrations 24 h postoperatively, or time to tracheal extubation were found between patients who had volatile anesthesia or TIVA. Compared to TIVA, volatile anesthesia was associated with shorter durations of hospital and ICU stays. [ABSTRACT FROM AUTHOR]

Transcranial magnetic stimulation (TMS) is an effective treatment for major depressive disorder (MDD). The rest time between pulse trains is the inter-train interval (ITI). Since 2016, some TMS clinicians have adopted a stimulation protocol with shorter ITIs than were used in regulatory clinical trials. To contrast treatment outcomes with the Standard TMS protocol (38.5 min per session) and the "Dash" protocol, which, at the shortest ITI, has a session duration of 18.75 min. Registry data were collected at 103 practice sites. Of 7759 participants, 5010 were included in an intent-to-treat (ITT) sample, defined as a primary MDD diagnosis, age ≥ 18, and completion of the PHQ-9 before TMS and with at least one PHQ-9 assessment after baseline. Completers (N = 3814) were responders or had received ≥ 20 sessions and had an end of acute treatment PHQ-9 assessment. Within the ITT sample, 613 patients were treated with the Standard NeuroStar 38-min protocol and 1493 patients with the new Dash protocol. CGI-S ratings were obtained in smaller samples. Treatment outcomes were also examined in subgroups considered Completers, as well as the subgroups who met criteria for Full Adherence to the Standard or Dash protocol parameters. In the ITT, Completer, and Fully Adherent samples, response (58–72%) and remission (28–53%) rates were notably high across PHQ-9 and CGI-S ratings. The Standard and Dash protocols did not differ in number of treatment sessions, and both manifested strong antidepressant effects. The Standard and Dash protocols did not meaningfully differ in efficacy. • "Inter-train interval" (ITI) is the period of rest between magnetic pulse trains in a TMS protocol. • ITI was fixed at 26 s in regulatory clinical trials leading to the FDA clearance of the first TMS device for MDD. • A newer "Dash" protocol has variable ITI of 11–25 s, reducing standard 10 Hz treatment time from 37.5 min to as short as 18.75 min. • Data from a large TMS Registry were used to compare dash versus standard protocol outcomes. • Both protocols yielded marked antidepressant effects without meaningful differences in efficacy. [ABSTRACT FROM AUTHOR]

Despite triple antiemetic therapy use for breast cancer patients receiving emetogenic chemotherapy, nausea remains a clinical challenge. We evaluated adding olanzapine (5 mg) to triple therapy on nausea control in patients at high personal risk of chemotherapy-induced nausea and vomiting (CINV). This multi-centre, placebo-controlled, double-blind trial randomized breast cancer patients scheduled to receive neo/adjuvant chemotherapy with anthracycline-cyclophosphamide or platinum-based chemotherapy to olanzapine (5 mg, days 1–4) or placebo. Primary endpoint was frequency of self-reported significant nausea, repeated for all cycles of chemotherapy. Secondary endpoints included: duration of nausea, overall total control of CINV, Health Related Quality of Life (HRQoL) using FLIE questionnaire, use of rescue mediation and treatment-related adverse events. 218 eligible patients were randomised to placebo (105) or olanzapine (113). From days 0–5 following each cycle of chemotherapy, 41.3% (95%CI: 36.1–46.7%) of patients in the placebo group reported significant nausea compared to 27.7% (95%CI: 23.2–32.4%) in the olanzapine group (p = 0.001). Across all cycles of chemotherapy, patients receiving olanzapine experienced a statistically significant improvement in HRQoL (p < 0.001). Grade 1/2 sedation was the most commonly side effect reported at 40.8% in the placebo group vs. 54.1% with olanzapine (p < 0.001). In patients at high personal risk of CINV, the addition of olanzapine 5 mg daily to standard antiemetic therapy significantly improves the control of nausea, HRQoL, with no unexpected toxicities. • Double-blind trial evaluated the addition of olanzapine to triple therapy in patients at high personal risk of CINV. • Adding 5 mg olanzapine was associated with significantly improved nausea control with no unexpected toxicities. • Olanzapine plus triple therapy should be considered standard of care for breast cancer patients at high risk of CINV. [ABSTRACT FROM AUTHOR]

Background: Disease modifying agents (DMAs) are used to reduce relapses and decrease disability progression in Multiple Sclerosis (MS) patients. However, limited national level data exists regarding the prescribing patterns for MS, especially after the introduction of oral DMAs.Objective: This study examined the prescribing patterns and trends of DMAs using national level data and determined the factors associated with prescribing DMAs among MS patients in the United States.Methods: This cross-sectional study utilized 2006-2015 National Ambulatory Medical Care Survey (NAMCS) data to examine office-based visits involving MS (ICD-9-CM code 340). Descriptive weighted analyses were performed to assess the prescribing patterns of DMAs. Multivariable logistic regression model within the conceptual framework of Andersen Behavioral Model was used to determine the factors associated with prescribing of DMAs among MS patients.Results: An estimated 8.5 million (95% Confidence Interval [CI] 7.01-10.09 million) MS patient visits were identified from 2006 to 2015. During the ten-year study period, 3.84 million (45%) MS visits involved prescribing of DMAs. The majority of DMA prescriptions were injectables (78%), followed by infusions (11%) and orals (11%). Oral DMAs use increased (from 11% in 2010-2011 to 40% in 2014-2015), whereas the use of injectable DMAs decreased (from 96% in 2006-2007 to 52% in 2014-2015) during the study period. Multivariable analyses revealed that predisposing (age and region) and enabling (physician specialty) factors were significantly associated with prescribing of DMAs among MS patients. Visits to neurologists (Odds Ratio [OR] 6.61, 95% CI 3.66-11.93) were associated with higher odds of being prescribed with DMAs.Conclusion: During the ten-year study period, increasing use of oral DMAs and declining use of injectable DMAs was observed. Both predisposing and enabling factors influenced the prescribing of DMAs. With increasing availability of oral DMAs, the DMAs use is likely to increase among MS patients. [ABSTRACT FROM AUTHOR]

Background: Currently no national standards exist for the prevention of surgical site infection (SSI) in cardiac surgery. SSI rates range from 1% to 8% between centres.Aim: The aim of this study was to explore and characterize variation in approaches to SSI prevention in the UK and the Republic of Ireland (ROI).Methods: Cardiac surgery centres were surveyed using electronic web-based questionnaires to identify variation in SSI prevention at the level of both institution and consultant teams. Surveys were developed and undertaken through collaboration between the Cardiothoracic Interdisciplinary Research Network (CIRN), Public Health England (PHE) and the National Cardiac Benchmarking Collaborative (NCBC) to encompass routine pre-, intra- and postoperative practice.Findings: Nineteen of 38 centres who were approached provided data and included responses from 139 consultant teams. There was no missing data from those centres that responded. The results demonstrated substantial variation in over 40 aspects of SSI prevention. These included variation in SSI surveillance, reporting of SSI infection rates to external bodies, utilization of SSI risk prediction tools, and the use of interventions such as sternal support devices and gentamicin impregnated sponges.Conclusion: Measured variation in SSI prevention in cardiac centres across the UK and ROI is evidence of clinical uncertainty as to best practice, and has identified areas for quality improvement as well as knowledge gaps to be addressed by future research. [ABSTRACT FROM AUTHOR]

Gynae-Radiotherapy places exceptional psychosocial and physical burdens on patients. Technological developments and associated acute toxicity and survival outcomes have improved, however holistic support has not kept pace. Digital technologies have potential to enhance support and patient experience. The project aimed to co-create a prototype of a digital health intervention that could serve the needs of women living with and beyond treatment for gynaecological cancer. A multi-disciplinary and co-creation approach was adopted. Four workshops were held, comprising of a number of activities to support participants' expression of views and facilitate discussion. Methods included word cloud generation, prompt cards, empathy maps and persona creation, domain storylines and requirements identification. Support drops off dramatically once treatment is completed. Patients struggled to adjust to their 'new normal' and felt unprepared for changes post-treatment. Patients felt overwhelmed with leaflets yet wanted instant access to reliable and relevant information in one place, better information on late side effects and improved communication about sexual health and sexuality. Reassurance through a digital intervention was viewed positively and specific ideas for achieving this were suggested through: Sharing experiences; targeted practical advice; peer support and advice/support for significant others. The co-creation of a prototype generated further discussion and an interactive prototype was developed. Based on workshop findings it is believed that the intervention could provide life-long support for women living with and beyond cancer. Increased focus is needed on the late effects of radiotherapy, specifically in supporting psychosocial wellbeing. Co-creation is a rewarding and fulfilling activity that met numerous aims beyond those of the project. It is recommended that mixed staff-patient groups are developed and adopted in more informal ways for the improvement of services. [ABSTRACT FROM AUTHOR]

Nurses working with children often encounter child maltreatment. Nurses' roles in mandatory reporting are well-documented, but less is known about additional ways nurses respond to child maltreatment. This is important because children experiencing less extreme maltreatment may have unmet needs without receiving a child protection intervention. This paper reports one key finding from a qualitative study exploring nurses' perceptions and experiences of keeping children safe from maltreatment. Specifically, it reports nurses' perspectives of their relational skills used to support children experiencing maltreatment. Qualitative inductive thematic analysis followed by a secondary analysis using a social constructionist framework. Data were collected through in-depth, semi-structured interviews and data saturation was achieved. Transcripts were inductively analysed with support of NVivo software. Registered nurses (n = 21) working with children in Australia. Nurses saw relational practice as core to addressing child maltreatment. Key themes were: 1) 'Walking the line': relationships in the context of surveillance, 2) 'You are a good mum': focusing on the positives and 3) Seeing and being the voice of the child. Nurses are uniquely positioned to identify and respond to child maltreatment through relational practices. Nurses maintained therapeutic relationships with parents to ensure ongoing access to vulnerable children. Although nurses recognised the importance of a child-centred approach, its enactment was varied and required ongoing critical reflection. This highlights the importance of supporting nurses to develop, maintain and continually improve their relational practices to enhance outcomes for children. • Nurses used skilled relational practices to address child maltreatment. • Nurses built relationships with parents to promote children's safety. • Tensions arise between child-centredness and preservation of relationships • Complexity of nurses' practices need to be recognised and supported. [ABSTRACT FROM AUTHOR]

Stable and mature vascular formation is a current challenge in engineering functional tissues. Transient, non-viral gene delivery presents a unique platform for delivering genetic information to cells for tissue engineering purposes and to restore blood flow to ischemic tissue. The formation of new blood vessels can be induced by upregulation of hypoxia-inducible factor-1α (HIF-1), among other factors. We hypothesized that biodegradable polymers could be used to efficiently deliver the HIF-1α gene to human adipose-derived stromal/stem cells (hASCs) and that this treatment could recruit an existing endogenous endothelial cell population to induce angiogenesis in a 3D cell construct in vitro. In this study, end-modified poly(β-amino ester) (PBAE) nanocomplexes were first optimized for transfection of hASCs and a new biodegradable polymer with increased hydrophobicity and secondary amine structures, N'-(3-aminopropyl)-N,N-dimethylpropane-1,3-diamine end-modified poly(1,4-butanediol diacrylate-co-4-amino-1-butanol), was found to be most effective. Optimal PBAE nanocomplexes had a hydrodynamic diameter of approximately 140 nm and had a zeta potential of 30 mV. The PBAE polymer self-assembled with HIF-1α plasmid DNA and treatment of hASCs with these nanocomplexes induced 3D vascularization. Cells transfected with this polymer-DNA complex were found to have 106-fold upregulation HIF-1α expression, an approximately 2-fold increase in secreted VEGF, and caused the formation of vessel tubules compared to an untransfected control. These gene therapy biomaterials may be useful for regenerative medicine. Not only is the formation of stable vasculature a challenge for engineering human tissues in vitro, but it is also of valuable interest to clinical applications such as peripheral artery disease. Previous studies using HIF-1α to induce vascular formation have been limited by the necessity of hypoxic chambers. It would be advantageous to simulate endogenous responses to hypoxia without the need for physical hypoxia. In this study, 3D vascular formation was shown to be inducible through non-viral gene delivery of HIF-1α with new polymeric nanocomplexes. A biodegradable polymer N'-(3-aminopropyl)-N,N-dimethylpropane-1,3-diamine end-modified poly(1,4-butanediol diacrylate-co-4-amino-1-butanol) demonstrates improved transfection of human adipose-derived stem cells. This nanobiotechnology could be a promising strategy for the creation of vasculature for tissue engineering and clinical applications. Image, graphical abstract [ABSTRACT FROM AUTHOR]

There is a growing awareness among governments, communities, and health care agencies of the need to evaluate roles and competencies in disaster nursing. A validated instrument was developed to evaluate nurses' competencies for disaster response. A psychometric evaluation study was developed in 2 stages: 1) content and face validity, and 2) verification of feasibility and reliability with test-retest. Competencies were extracted from the Framework of Disaster Nursing Competencies published by the International Council of Nurses. The participants included 8 experts in emergencies and disasters who were nurses with a PhD and had more than 2 years of experience with education or clinical practice in emergencies or disasters, and 326 nurses from a mobile emergency care service in southern Brazil. The data analysis used a content validity index and intraclass correlation coefficients. The psychometric properties of the instrument included reliability assessed with Cronbach alpha, feasibility and test-retest reliability assessed with t tests and intraclass correlation coefficients, and factor analysis. The overall evaluation of the instrument yielded an intraclass correlation coefficient of 0.92 (SD = 0.04), and the mean content validity index was acceptable at 0.88 (SD = 0.12). Out of 51 items, 41 were validated and organized in 3 domains according to factor analysis: 1) care of the community; 2) care of the individual and family; and 3) psychological support and care of vulnerable populations. The instrument demonstrated good internal consistency (Cronbach α = 0.96) and adequate test-retest reliability (intraclass correlation coefficient >0.7). The Nurses' Disaster Response Competencies Assessment Questionnaire showed good internal consistency, adequate reproducibility, and appropriate feasibility for use to evaluate nurses' competencies for disaster response. [ABSTRACT FROM AUTHOR]

Nurses who work in regional and rural hospitals face unique challenges to disaster preparedness and response. Geographical location and isolation, decreased resources and subsequent workforce, along with organizational and financial restraints are some of the hurdles these individuals and communities face [1,2]. The Disaster Preparedness Evaluation Tool was applied a population of Regional and Rural Emergency Nurses in New South Wales. Thirty-two nurses participated in this study. Their level of disaster preparedness was at a moderate level for knowledge, skills and preparation for disaster management. Their experiences broadly mirrored those found in earlier research. Results highlighted the nature of and delivery of continuing professional development in relation to disaster preparedness; mechanisms to encourage emergency department nurses to develop personal and family preparedness plans (to improved disaster preparedness); increased training in relation to psychological assessment of patients, and identification of biological agent signs and symptoms. [ABSTRACT FROM AUTHOR]

The prevalence of prediabetes and type 2 diabetes (T2D) is increasing in adolescents worldwide. Most studies have focused on the clinical features, treatment, and complications for adolescents and so the need to generate insight into the risk factors and prevalence of undiagnosed prediabetes and T2D in adolescents across the globe remains. Relevant articles that were published from 2007 up to and including January 2017 were identified through electronic searches of CINAHL, Cochrane, Medline, PsycInfo, PubMed, Scopus, Web of Science, and Sociological Abstracts (Proquest). Four independent researchers examined the articles for eligibility. Sixteen studies were included that investigated the risk and prevalence of undiagnosed prediabetes and T2D in adolescents aged 12–19. The most commonly measured risk factors included obesity/overweight, family history, and ethnicity. Other studies measured risk factors associated with insulin resistance, including hypertension, acanthosis nigricans, and dyslipidemia. Prevalence of undiagnosed prediabetes and T2D varied among regions globally with rates ranging from 3.3 to 14.3% and 0.1 to 2.2%, respectively. Undiagnosed prediabetes and T2D and the associated risk factors are prevalent in many regions in countries worldwide, significantly impacting adolescents and their families. Future research is required to inform interventions aimed at preventative measures for early screening and detection of prediabetes and T2D in adolescents, as well as the development of multi-disciplinary teams that include pediatric nurses and the specialized care they provide. • Prevalence of prediabetes and T2DM is increasing in adolescents. • Common measured risk factors are obesity/overweight, family history, and ethnicity. • This review found rates of undiagnosed prediabetes/T2DM from 3.3 to 14.3 and 0.1 to 2.2%. [ABSTRACT FROM AUTHOR]

Patients who qualify for bariatric surgery are increasingly experiencing co-morbid conditions, which often require management through the use of immunosuppressive agents, such as corticosteroids, tumor necrosis factor-alpha inhibitors, or other immunomodulators, which may increase the risk of infection or wound healing complications. Perioperative management of these agents in bariatric surgery is challenging because of the lack of research in this patient population. With the use of immunosuppressive agents on the rise, the effects of these medications must be understood, both the risks posed in the perioperative period, and the benefit their sustained use may have for co-morbidity management. To describe the safety of immunosuppressive agents prior to bariatric surgery. United States of America. A systematic review was conducted to answer these questions about commonly encountered immunosuppressive agents. This review includes information from 37 studies to present recommendations and reasoning for the discontinuation and postoperative reinitiation of immunosuppressive agents including, tumor necrosis alpha factor-a inhibitors, methotrexate, and more. Research addressing complications of these medications in patients undergoing bariatric surgery is sparse. Information from abdominal or general surgical complications may serve as a basis for conservative recommendations. Data specific to each agent or class are presented below. The use of these agents may be critical for patients' chronic disease management, and the consequences of their impact should be considered by bariatric surgeons. While their immune system effects ultimately lead to disease management, each agent must be handled individually due to the varying effects and the potential for perioperative untoward effects. [ABSTRACT FROM AUTHOR]

The international CHIPS Trial (Control of Hypertension In Pregnancy Study) enrolled 987 women with chronic (75%) or gestational (25%) hypertension. Pre-eclampsia developed in 48%; women remained on their allocated BP control and delivered an average of two weeks later. 'Less tight' control (target diastolic BP 100 mmHg) achieved BP that was 6/5mmHg higher (p < 0.001) than 'tight' control (target diastolic 85 mmHg, BP achieved 133/85 mmHg). 'Less tight' (vs. 'tight') control resulted in similar adverse perinatal outcomes (31.5% vs. 30.7%; p = 0.84) that balanced birthweight < 10th percentile (16.1% vs. 19.8%; p = 0.14) against preterm birth (35.6% vs. 31.5%; p = 0.18). 12-month follow-up revealed no compelling evidence for developmental programming of child growth. However, 'less tight' (vs. 'tight') control resulted in more severe maternal hypertension (40.6% vs. 27.5%; p < 0.001), and more women with platelets < 100 × 109/L (4.3% vs. 1.6%; p = 0.02) or symptomatic elevated liver enzymes (4.3% vs. 1.8%; p = 0.03), with no difference in serious maternal complications (3.7% vs. 2.0%; p = 0.17). Labetalol was the drug of choice. Methyldopa did not result in inferior outcomes. Post-hoc, severe hypertension, independent of pre-eclampsia, was associated with heightened increased risk of adverse outcomes, and in 'less tight' control, of serious maternal complications. At no gestational age at initiation of BP control was 'less tight' superior to 'tight'. Women in both groups were equally satisfied with care. 'Less tight' control tended to be more expensive by CAD$6000 (p =0.07) based on neonatal care costs. Collectively, CHIPS publications have provided evidence that women with non-severe pregnancy hypertension should receive 'tight' BP control achieved by a simple algorithm. [ABSTRACT FROM AUTHOR]

To explore the preferences of pediatricians for key factors around the implementation of universal routine screening guidelines for major depressive disorder in adolescent patients in a primary care setting. Semi-structured qualitative interviews were conducted with U.S. pediatricians. Participants were recruited by convenience sampling and snowball sampling. Qualitive data were summarized using thematic analysis to identify themes relevant to preferences around implementing screening strategies for adolescent patients. Recruitment ended upon reaching thematic saturation when no new themes were revealed. Of the 14 participants, 11 identified as female, 3 male, 10 white, and 4 Asian. Top themes among pediatrician participants were around the screening modality (14/14 participants), screening validity (14/14), time barriers (14/14), and confidentiality barriers (12/14). Less frequently mentioned themes by pediatricians were workplace coordination and logistics (7/14), alternative starting ages for screening (7/14), more frequent screenings than annual screenings (3/14), and additional clinical training regarding depression diagnosis and treatment (2/14). Pool of interviewed participants was limited by diversity in terms of geography, race/ethnicity, or practice settings. To promote the uptake of universal routine screening of adolescent major depression, pediatricians expressed it was important to address key implementation factors regarding the screening modality, screening validity, time constraints, and confidential care concerns in a primary care delivery context. Findings could be used to inform the development of implementation strategies to facilitate depression screening in primary care. Future research is needed to quantitively assess decisions and tradeoffs that pediatricians make when implementing universal screening to support adolescent mental health. • Barriers exist to screening adolescent patients routinely in a primary care setting. • Pediatricians are in a valuable position to treat adolescents with major depression. • We explored pediatricians' preferences around universal routine depression screening. • Pediatricians identified key factors that were influential to screening decisions. [ABSTRACT FROM AUTHOR]

• We provide a typology of communities based on their access to common-pool resources. • The influence of capitals and climatic shocks on livelihoods is spatially variable. • The type of community modifies livelihood opportunities and coping strategies. • Climatic shocks drive precarious livelihoods, except in best-connected communities. Spatial factors, such as environmental conditions, distance to natural resources and access to services can influence the impacts of climate change on rural household livelihood activities. But neither the determinants of precarious livelihoods nor their spatial context has been well understood. This paper investigates the drivers of livelihood precariousness using a place-based approach. We identify five community types in rural regions of the Mahanadi Delta, India; exurban, agro-industrial, rainfed agriculture, irrigated agriculture and resource periphery by clustering three types of community capitals (natural, social and physical). Based on this typology, we characterise the associations between precarious livelihood activities (unemployment or engagement in agricultural labour) with agricultural shocks and household capitals. Results demonstrate that, the type of community influences the impact of agricultural shocks on livelihoods as four of the five community types had increased likelihoods of precarious livelihoods being pursued when agricultural shocks increased. Our research demonstrates that the bundle of locally available community capitals influences households' coping strategies and livelihood opportunities. For example, higher levels of physical capital were associated with a lower likelihood of precarious livelihoods in agro-industrial communities but had no significant impact in the other four. Results also indicate that agricultural shocks drive livelihood precariousness (odds ratios between 1.03 and 1.07) for all but the best-connected communities, while access to household capitals tends to reduce it. Our results suggest that poverty alleviation programmes should include community typologies in their approach to provide place-specific interventions that would strengthen context-specific household capitals, thus reducing livelihood precariousness. [ABSTRACT FROM AUTHOR]

Immersive virtual reality is an advancing technology that has the potential to change the traditional pedagogical approaches to teaching tertiary nursing and midwifery students. The application of immersive virtual reality in nursing and midwifery education may be a novel, accessible method for information provision and skill acquisition, however little is known of the extent of immersive virtual reality technology integration into tertiary nursing and midwifery programs. The purpose of this review is to identify the application and integration of immersive virtual reality within nursing and midwifery tertiary education programs. A scoping review based on the Joanna Briggs Institute methodology for scoping reviews was undertaken. An a priori review protocol and eligibility criterion was developed with the protocol subject to review a posteriori following first round screening. An electronic search of ten databases was conducted in January 2018. A total of n = 506 non-duplicate records were identified and subjected to level one and level two screening. The search strategy and screening process identified n = 2 articles that were quality checked and included for review. There is currently a paucity of quality published literature on the application and/or integration of immersive virtual reality into nursing and midwifery tertiary education. Immersive virtual reality has the potential to increase competence and confidence for students providing accessible and repeatable learning opportunities in a fail-safe environment. There is a need for educators to be involved in the conceptualisation, design, integration and research of immersive virtual reality technology into undergraduate nursing and midwifery programs. [ABSTRACT FROM AUTHOR]

Plastic debris is a major global threat to marine ecosystems and species. However, our knowledge of this issue may be incomplete due to a lack of a standardized method for quantifying ingested ultrafine particles (1 μm – 1 mm) in wildlife. This study provides the first quantification of ultrafine plastic in seabirds using chemical and biological digestion treatments to extract plastic items from seabird gizzards. The alkaline agent, potassium hydroxide, outperformed the enzyme corolase, based on cost and efficiency (e.g., digestion time). Ultrafine plastics were observed in 7.0% of Flesh-footed Shearwater (Ardenna carneipes) gizzards collected from Lord Howe Island, Australia and accounted for 3.6% of all plastic items recovered (13 out of 359 items). Existing methods for extracting ingested plastic from seabirds do not account for ultrafine particles, therefore our results indicate current seabird plastic loads, and the associated physical and biological impacts, are underestimated. Flesh-footed Shearwater gizzard containing a significant quantity of ingested plastic (detailed in chart). Macro- and micro-plastics recovered from the proventriculus of the same bird are shown in the background. Unlabelled Image • Potassium hydroxide digested shearwater tissue rapidly and affordably. • Ultrafine plastics (1 mm–1 μm) were observed in 7.0% of shearwater gizzards. • Ultrafine plastics accounted for 3.6% of debris recovered from shearwaters. [ABSTRACT FROM AUTHOR]

Abstract Introduction Tobacco smoking during and post radiotherapy is associated with increased treatment toxicity and increased cancer related mortality. Routine delivery of smoking cessation advice is inconsistent in practice. This study identifies the key barriers and facilitators to the provision of effective smoking cessation conversations in radiotherapy practice. Methods A baseline questionnaire (n = 43) was used to identify current practice, barriers and facilitators to smoking cessation in radiotherapy and to inform a topic guide for follow up focus groups (n = 5). Ethical approval was obtained through the 4 NHS trusts and the Health Research Authority. Focus group transcription was coded by two researchers. Results Therapeutic Radiographers initiate health behaviour conversations with patients; there are a number of factors that facilitate the likelihood of a health behaviour conversation; indication that a patient smokes anatomical site and presence of acute effects. Key barriers to smoking cessation provision include; lack of training, limited knowledge, limitations as a result of poor clinical infrastructure, local culture and perceptions that patients do not prioritise smoking cessation during treatment. Conclusion Therapeutic Radiographers have the motivation to provide smoking cessation advice, however they require further training to develop knowledge and skills in relation to benefits of smoking cessation and cessation strategies. Therapeutic Radiographers also expect that patients will respond negatively to smoking cessation advice, and that this might be damaging to the therapeutic relationship. Departmental culture and trust infrastructure can also significantly inhibit the provision of smoking cessation in radiotherapy practice and further support to implement NICE guidance is required. Highlights • Therapeutic Radiographers show desire for improvements within their practice. • Therapeutic Radiographers fear upsetting the patient during smoking cessation advice. • Therapeutic Radiographers worry about damaging the therapeutic relationship with patients. • There is a clear need for a Therapeutic Radiographer specific training package. [ABSTRACT FROM AUTHOR]

Promising efficacy results of chimeric antigen receptor (CAR) T-cell therapy have been tempered by safety considerations. Our objective was to comprehensively summarize the efficacy and safety of CAR-T cell therapy in patients with relapsed or refractory hematologic or solid malignancies. MEDLINE, Embase, and the Cochrane Register of Controlled Trials (inception – November 21, 2017). Interventional studies investigating CAR-T cell therapy in patients with malignancies were included. Our primary outcome of interest was complete response (defined as the absence of detectable cancer). Two independent reviewers extracted relevant data, assessed risk of bias, and graded the quality of evidence using established methods. A total of 42 hematological malignancy studies and 18 solid tumor studies met were included (913 participants). Of 486 evaluable hematologic patients, 54.4% [95% CI, 42.5%-65.9%] experienced complete response in 27 CD19 CAR-T cell therapy studies. Of 65 evaluable hematologic patients, 24.4% [95% CI, 9.4%-50.3%] experienced complete response in seven non-CD19 CAR-T cell therapy studies. Cytokine release syndrome was experienced by 55.3% [95% CI, 40.3%-69.4%] of patients and neurotoxicity 37.2% [95% CI, 28.6%-46.8%] of patients with hematologic malignancies. Of 86 evaluable solid tumor patients, 4.1% [95% CI, 1.6%-10.6%] experienced complete response in eight CAR-T cell therapy studies. Limitations include heterogeneity of study populations, as well as high risk of bias of included studies. There was a strong signal for efficacy of CAR-T cell therapy in patients with CD19+ hematologic malignancies and no overall signal in solid tumor trials published to date. These results will help inform patients, physicians, and other stakeholders of the benefits and risks associated with CAR-T cell therapy. • CAR-T cell therapy is most effective in DLBCL and CD19-positive ALL patients. • There is limited evidence of efficacy of CAR-T cell therapy in solid malignancies. • This study provides a comprehensive summary of the efficacy CAR-T cell therapy. [ABSTRACT FROM AUTHOR]

Systematic reviews are the most common form of knowledge synthesis and remain a cornerstone of the practice of evidence-based medicine. They offer enhanced rigor and validity relative to traditional narrative review articles by reducing bias and increasing objectivity. In answering focused research questions, systematic reviews are directly applicable to clinical practice as well as the development of clinical guidelines and the identification of knowledge gaps, which may drive future primary research directions. Typically, such a rigorous process necessarily requires substantive time to carefully and systematically identify, screen, and synthesize all relevant available primary research on a topic. Further, other knowledge synthesis methods have emerged to address the varying needs of decision makers with respect to condensed timelines and more diverse research questions, as well as to allow incorporation of already synthesized evidence into reviews. These alternative methods include rapid reviews, scoping reviews, and overviews of systematic reviews, which are being used with increasing frequency by clinicians, decision-makers, and researchers. We encourage clinicians and researchers in nuclear medicine and other imaging sciences to acquire a greater familiarity with these methods and to consider them in clinical decision making, the development of clinical guidelines, and the planning of future research activities. [ABSTRACT FROM AUTHOR]