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Background Older adults with stroke and multimorbidity experience frequent care transitions, which are often poorly coordinated and fragmented. We conducted a pragmatic randomized controlled trial (RCT) to test the implementation and effectiveness of the Transitional Care Stroke Intervention (TCSI), a 6-month, multi-component, evidence-informed intervention to support older adults with stroke and multimorbidity using outpatient stroke rehabilitation services. The TCSI was designed to support self-management, improve health outcomes, and enhance the quality and experience of care transitions. Objective To explore the facilitators and challenges to implementing the TCSI, from the perspective of healthcare providers (HCPs) (n = 12) and Managers (n = 3). Methods Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected from study documents, individual and group interviews conducted with HCPs and a Care Coordinator, and surveys from managers. Data were analyzed using thematic analysis. Results Intervention implementation was facilitated by: a) strong collaborative and interdependent HCP team relationships, b) dedicated resources (funding, staffing) to support intervention delivery, c) training and ongoing support, customized to individual HCP needs, d) organizational readiness, strong leadership, and effective champions, e) structures to facilitate virtual information-sharing, and f) regular monitoring of intervention implementation. Implementation challenges included: a) COVID-19 related challenges (staff turnover, community service disruptions), b) poor communication with community service providers, c) documentation burden (intervention-related), and d) virtual care delivery. Conclusions This research enhances understanding of the diversity of factors influencing implementation of the TCSI, and the conditions under which implementation is more likely to succeed.

Objective To evaluate the impact of Nurse-Family Partnership (NFP), a home-visiting programme, on exploratory maternal outcomes in British Columbia (BC), Canada.Design Pragmatic, parallel arm, randomised controlled trial conducted October 2013–November 2019. Random allocation of participants (1:1) to comparison (existing services) or NFP (plus existing services). Researchers were naïve to allocation.Setting 26 local health areas across four of five BC regional health authorities.Participants 739 young (

Improved bounds on number fields of small degree, Discrete Analysis 2024:19, 24 pp. Each number field $K$, or finite degree extension of $\mathbb Q$, has an associated rational integer, its discriminant $\mathrm{Disc}(K)$, which measures the size of the ring of integers in the field. (More precisely, $\mathrm{Disc}(K)$ is proportional to the square of the volume of the fundamental domain of the ring of integers in $K$, and its prime divisors record the finite number of rational primes that are ramified in the field.) For example, for degree two number fields, a quadratic field $K=\mathbb Q(\sqrt{D})$ with $D$ squarefree has discriminant $\mathrm{Disc}(K)=D$ if $D \equiv 1 \pmod{4}$ and $\mathrm{Disc}(K)=4D$ otherwise. A classical theorem of Hermite states that for each fixed degree $n \geq 2$, and each fixed integer $D$, there are finitely many number fields $K$ of degree $n$ with discriminant $D$. But how many are there? For the example of quadratic fields, there is only one quadratic field with each possible discriminant. But already for degree $n=3$, the problem is quite a bit harder. In general, the _discriminant multiplicity conjecture_ posits that for each degree $n$ and each integer $D$, for every $\epsilon>0$ there are at most $C_\epsilon |D|^\epsilon$ number fields of degree $n$ with discriminant $D$. This problem is related to many other open problems in number theory, and currently remains out of reach for all $n>2$. One can ask instead how many number fields there are of each discriminant, on average. For each degree $n$ and each integer $X\geq 1$, let $N_n(X)$ be the number of number fields (up to isomorphism) of degree $n$ with $|\mathrm{Disc}(X)| \leq X$. A conjecture (sometimes attributed to Linnik) predicts that for each $n \geq 2$, $$N_n(X) \sim c_n X$$ as $X \to \infty$, for a specific constant $c_n$. For degree $n=2$, this is true, and the proof is analogous to counting the number of squarefree integers of absolute value at most $X$. For degrees $n=3,4,5$ this result is also known, and is a highly nontrivial result of Davenport and Heilbronn ($n=3$), Cohen, Diaz y Diaz and Olivier, and Bhargava ($n=4$), and Bhargava ($n=5$). For degrees $n \geq 6$, the conjecture is wide open, and is connected to many difficult questions in number theory. One can at least ask for an upper bound for $N_n(X)$. (Lower bounds are also interesting, and difficult, but have a different flavour.) In 1995, Schmidt proved that $N_n(X)\ll_n X^{\frac{n+2}{4}}$. In 2006, Ellenberg and Venkatesh improved this to $N_n(X) \ll_n X^{\exp{c_1\exp(\sqrt{\log n}}}$ for some constant $c_1$ independent of $n$. In 2020, Couveignes again changed the qualitative shape of the record by proving that $N_n(X) \ll_n X^{c_2 (\log n)^3}$, which was soon after improved by Lemke Oliver and Thorne to $N_n(X) \ll_n X^{c_3 (\log n)^2}$ for a computable constant $c_30$, a power-saving improvement over Schmidt's bound. Independently, Bhargava, Shankar and Wang have achieved a similar power-saving improvement. Such improvements are especially noticeable in the regime of small degrees.

BackgroundThe current landscape of a rapidly aging population accompanied by multiple chronic conditions presents numerous challenges to optimally support the complex needs of this group. Mobile health (mHealth) technologies have shown promise in supporting older persons to manage chronic conditions; however, there remains a dearth of evidence-informed guidance to develop such innovations. ObjectivesThe purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults. MethodsA 5-stage scoping review methodology was used to map the relevant literature published between January 2005 and March 2015 as follows: (1) identified the research question, (2) identified relevant studies, (3) selected relevant studies for review, (4) charted data from selected literature, and (5) summarized and reported results. Electronic searches were conducted in 5 databases. In addition, hand searches of reference lists and a key journal were completed. Inclusion criteria were research and nonresearch papers focused on mHealth technologies designed for use by community-living older adults with at least one chronic condition, or health care providers or informal caregivers providing care in the home and community setting. Two reviewers independently identified articles for review and extracted data. ResultsWe identified 42 articles that met the inclusion criteria. Of these, described innovations focused on older adults with specific chronic conditions (n=17), chronic conditions in general (n=6), or older adults in general or those receiving homecare services (n=18). Most of the mHealth solutions described were designed for use by both patients and health care providers or health care providers only. Thematic categories identified included the following: (1) practices and considerations when designing mHealth technologies; (2) factors that support/hinder feasibility, acceptability, and usability of mHealth technologies; and (3) approaches or methods for evaluating mHealth technologies. ConclusionsThere is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations.

Abstract Background Hybrid models that integrate both in-person and remote health services are increasingly recognized as a promising approach. Nevertheless, research that defines and characterizes these models in children and young people is scarce and essential for establishing guidelines for implementation of hybrid allied health services. This scoping review evaluates four key aspects of hybrid allied health services in children and young people: 1. definitions, 2. service characteristics, 3. outcome measures, and 4. results of hybrid allied health services. Methods Six databases were searched: Medline (Ovid), Embase, CINHAL, Psycinfo, Cochrane CENTRAL, and Web of Science. Of the 9,868 studies potentially meeting the inclusion criteria, 49 studies focused on children and young people. Following full-text review, n = 21 studies were included. Results Terminology used for hybrid allied health services varied across studies which targeted diverse clinical populations and varied in study design, type and frequency of remote and in-person treatments. Over 75% of cases used custom-written software, limiting scalability. All interventions started in-person, possibly to establish a therapeutic alliance and solve technological issues. Most hybrid allied health services (67%) were in mental health, while only a minority involved physical, occupational or speech therapy. The most common outcomes were feasibility and satisfaction, but tools used to measure them were inconsistent. Although 57% of studies demonstrated effectiveness of hybrid allied health services, none measured cost-effectiveness. Discussion Despite the potential of hybrid allied health services for children and young people, the literature remains at a preliminary stage. Standardization of definitions and outcome measures, and clearer reporting of service characteristics and results would likely promote consolidation of hybrid allied health services in children and young people into clinical practice.

Aim/Purpose: This study aims to explore undergraduate IS students' employability skills development while performing their final capstone project during their academic studies. Background: The importance of soft skills in the Information Systems industry is not an arguable fact and has been broadly discussed both in the industry and the academic literature. The ability of professionals to collaborate, communicate, manage time, negotiate, solve problems, make decisions, and self-learning, called employability skills, are essential skills needed in today's industry. The development of these skills during undergraduate studies is essential for graduate students' readiness for work. Methodology: A mixed methods approach was employed using exploratory research de-sign, including qualitative and quantitative approaches. First, a qualitative analysis of 156 reflections was performed, resulting in the conceptual framework of facets. Then, a quantitative analysis of the data was performed to examine the facets and the differences between the stages of the capstone project. Contribution: This study contributes to both academy and industry. The former may use this study's findings to upgrade academy courses and capstone projects in order to raise students' readiness for the industry. The later may learn the approaches the academy use and give appropriate feedback. Findings: The results showed that students' reflections on their motivation, knowledge, and skills (teamwork, time management, and inter-communication) demonstrate the importance of those facets in the process they underwent, especially since the reflections collected were unstructured. Recommendations for Practitioners: Information Systems undergraduate academic programs should develop structured capstone projects to provide the students with a better platform to learn and experience the employability skills the industry requires. Recommendations for Researchers: The study presents a conceptual model based on students' reflections on their experience performing a capstone project. The impact and influence of each of the model's components should be further researched and measured. Impact on Society: Moreover, it is very important to prepare the students for employability by including a "real-life" capstone project at the end of their undergraduate studies to prepare them to be valuable in the workforce, even at their start point as juniors. Future Research: To evaluate the process of employability skills development, a further study can examine students' perceptions prior to the capstone, during, and after to assess the progress and changes. To generalize the results, it would be valuable to investigate whether the findings of this study are consistent across different institutions and disciplines.

Damian Chi Hong Siu, Liat Gafni-Lachter Boston University, Sargent College of Health and Rehabilitation Sciences, Boston, MA, USACorrespondence: Damian Chi Hong Siu, Graduate, Post-professional Occupational Therapy Doctorate, Boston University, Sargent College of Health and Rehabilitation Sciences, 635 Commonwealth Ave, Boston, MA, 02215, USA, Email damiansiu@gmail.comAbstract: Chronic obstructive pulmonary disease (COPD) is a preventable yet widespread and profoundly debilitating respiratory condition, exerting substantial personal and global health ramifications alongside significant economic implications. The first objective of this literature review was to identify reviews the barriers to optimal COPD care, categorizing them into personal patient factors, professional awareness and knowledge, patient-professional relationships, and healthcare service models, including access to care that significantly impacts the quality of COPD management. The second objective was to introduce three approaches for enhancing COPD care outcomes: Self-Management Educational Programs, Health Qigong, and Telehealth service provision, each demonstrating positive effects on COPD patients’ health status. These evidence-based interventions offer promising avenues for enhancing COPD care and patient outcomes. Integrating these approaches into comprehensive COPD management strategies holds potential for improving the well-being and quality of life of individuals living with this chronic condition.Keywords: pulmonary disease, chronic obstructive, health qigong, telehealth, self-management education

Abstract Background This study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on health outcomes, self-management, patient experience, and health and social service use costs in older adults (≥ 55 years) with stroke and multimorbidity (≥ 2 chronic conditions). Methods This pragmatic randomized controlled trial (RCT) included older adults discharged from hospital to community with stroke and multimorbidity using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource to support system navigation. The primary outcome was risk of hospital readmission (all cause) after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service use costs. The intention-to-treat principle was used to conduct the primary and secondary analyses. Results Ninety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). No significant between-group differences were seen for baseline to six-month risk of hospital readmission. Differences favouring the intervention group were seen in the following secondary outcomes: physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58–8.62, p = 0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p = 0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p = 0.005). No between-group differences were found in total healthcare costs or other secondary outcomes. Conclusions Although participation in the TCSI did not impact hospital readmissions, there were improvements in physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs. Challenges associated with the COVID-19 pandemic, including the shift from in-person to virtual delivery, and re-deployment of interventionists could have influenced the results. A larger pragmatic RCT is needed to determine intervention effectiveness in diverse geographic settings and ethno-cultural populations and examine intervention scalability. Trial registration ClinicalTrials.gov Identifier: NCT04278794 . Registered May 2, 2020.

Objective This study aimed to examine the association of midlife fitness and body mass index (BMI) with incident dementia later in life.Design and participants A cohort study of 6428 individuals (mean age 50.9±7.6 years) from the Cooper Center Longitudinal Study.Measures Cardiorespiratory fitness and BMI were assessed twice (1970–1999) during visits to the Cooper Clinic, a preventive medicine clinic in Dallas, Texas. These measures were examined as continuous and categorical variables. As continuous variables, fitness and BMI were examined at baseline (averaged of two examinations) and as absolute change between exams (mean time 2.1±1.8 years). Variables were categorised: unfit versus fit and normal versus overweight/obese. Medicare claims data were used to obtain all-cause dementia incidence (1999–2009). Mean follow-up between midlife examinations and Medicare surveillance was 15.7 ((SD=6.2) years. Multivariable models were used to assess the associations between fitness, BMI and dementia.Results During 40 773 person years of Medicare surveillance, 632 cases of dementia were identified. After controlling for BMI and covariates, each 1-metabolic equivalent increment in fitness was associated with 5% lower (HR 0.95; 95% CI 0.90 to 0.99) dementia risk. In comparison, after controlling for fitness and covariates, each 1 kg/m2 increment in BMI was associated with a 3.0% (HR 1.03; 95% CI 1.00 to 1.07) higher risk for dementia, yet without significance (p=0.051). Similar findings were observed when the exposures were categorised. Changes in fitness and BMI between examinations were not related to dementia. Jointly, participants who were unfit and overweight/obese had the highest (HR 2.28 95% CI 1.57 to 3.32) dementia risk compared with their fit and normal weight counterparts.Conclusion Lower midlife fitness is a risk marker for dementia irrespective of weight status. Being unfit coupled with overweight/obese status might increase one’s risk for dementia even further.

Jansen metaphyseal chondrodysplasia (JMC) is an ultra-rare disorder caused by constitutive activation of parathyroid hormone type 1 receptor (PTH1R). We sought to characterize the craniofacial phenotype of patients with the disease. Six patients with genetically confirmed JMC underwent comprehensive craniofacial phenotyping revealing a distinct facial appearance that prompted a cephalometric analysis demonstrating a pattern of mandibular retrognathia. Oral examination was notable for flat and shallow palate, delayed eruption pattern, and impacted maxillary teeth. Subclinical and/or mild hearing loss was noted in 4 of 5 patients studied. The most common etiology was conductive, likely due to overcrowding of epitympanum which impedes the normal vibration of ossicles to sound. Paranasal sinus obliteration was noted in 5 of 6 patients. Computed tomography (CT) scan evaluation of craniofacial bones revealed bilaterally symmetric expansile lesions with predominant involvement of neural crest cell (NCC)-derived bones. Bilateral narrowing of facial nerve canals, particularly at the labyrinthine segment, was seen in 5 of 6 patients when compared to age-matched controls; 1 patient presented with progressive facial nerve palsy. Sagittal suture craniosynostosis was present in 5 of 6 patients—one of whom had a history of cranial reconstruction for pansynostosis in infancy. All patients demonstrated a significant degree of upper airway stenosis, as well as a more anterior hyoid bone displacement. Two patients had a diagnosis of obstructive sleep apnea. 18F-NaF Positron-emission tomography (PET)-CT revealed increased uptake associated with the skull base and gnathic bones in all patients. In conclusion, this first detailed systematic evaluation of the craniofacial phenotype of patients with JMC demonstrates a distinct and pronounced phenotype that predominantly affects the NCC-derived cranial bones indicating a critical role of PTH1R signaling in their development. These affects can result in significant disease-related morbidity, include hearing loss, nerve compression, craniosynostosis, dentoskeletal malocclusion, and airway compromise; all of which require close monitoring. [ABSTRACT FROM AUTHOR]

Equal peer e-mentoring in digital learning is emerging to promote online students' psychosocial wellness and academic success. The study purposes were (1) to evaluate the effectiveness of one equal peer e-mentoring program and (2) to validate a theoretical model of the interplay between inputs, processes, and outputs of mentoring relationships. Fifty-three graduate occupational therapy students rated their motivation and performance, the support they provided and received, the relationship quality, satisfaction with the e-mentoring program, and career growth. Structural equation modeling was used to test for mediating relationships among these factors. A causal model anchored on the mediating variables of psychosocial support, instrumental support, and relationship quality accounted for 69% of the variance in the mentoring program satisfaction and 34% of career growth variance. In conclusion, equal peer e-mentoring can facilitate student academic and career success. Furthermore, findings validate a theoretical model as an explanatory tool for effective equal peer e-mentoring.

Introduction. Tumor-induced osteomalacia (TIO) is a rare paraneoplastic disorder where patients present with hypophosphatemia, chronic diffuse bone pain, and occasionally fractures. Benign phosphaturic mesenchymal tumors (PMT) are responsible for the TIO and are largely soft tissue tumors. Cases. Two male patients with TIO secondary to PMT were reported—one in the bony scapula and the other in the plantar foot soft tissue. The first case describes a 63-year-old Caucasian male, who sustained an intertrochanteric proximal femur stress fracture and approximately two years of diffuse bone pain and hypophosphatemia. Wide excision of a left scapula boney lesion resulted in immediate resolution of his electrolyte abnormalities and bone pain. Case 2 describes a 58-year-old male with four years of multifocal bone pain and atraumatic fractures. A 68Ga-DOTATATE-positron emission tomography/computed tomography (PET/CT) scan identified a soft tissue tumor in his plantar foot, which was ultimately excised. He also experienced near immediate resolution of his pain and no additional fractures. Conclusion. TIO is a rare condition presenting with chronic multifocal bone pain, stress fractures, and hypophosphatemia. These two cases highlight that the causative tumor may originate in soft tissue or bone. Furthermore, a high index of suspicion, along with fibroblast growth factor-23 testing and DOTATATE-PET/CT localization, can help with diagnosis and minimize treatment delays.

Aim/Purpose: The purpose of this study is to discover usage differences in task performance by students of different cultures, by examining procrastination patterns from a national cultural perspective and exploring the effect of multicultural virtual teamwork on students' individual procrastination. Background: This study aims to examine higher-education entrepreneurial learning in the context of multicultural virtual teamwork, as performed during participation on a Global Entrepreneurship course. Methodology: The methodology consists of quantitative comparative data analytics preceding and subsequent to intercultural team activities. This research is based on analyses of objective data collected by Moodle, the LMS used in the In2It project, in its built-in log system from the Global Entrepreneurship course website, which offers students diverse entities of information and tasks. In the examined course, there were 177 participants, from three different countries: United Kingdom, France and Israel. The students were grouped into 40 multicultural virtual (not face-to-face) teams, each one comprised of participants from at least two countries. The primary methodology of this study is analytics of the extracted data, which was transferred into Excel for cleaning purposes and then to SPSS for analysis. Contribution: This study aims to discover the effects of multicultural teamwork on individual procrastination while comparing the differences between cultures, as there are only a few studies exploring this relation. The uniqueness of this study is using and analyzing actual data of student procrastination from logs, whereas other studies of procrastination in multicultural student teams have measured perceived procrastination, collected using surveys. Findings: The results show statistical differences between countries in procrastination of individual assignments before team working--students from UK were the most procrastinators and Israeli students were the least procrastinators, but almost all students procrastinated. However, the outcome of the teamwork was submitted almost without procrastination. Moreover, procrastination in individual assignments performed after finishing the multicultural teamwork dramatically decreased to 10% of the students' prior individual procrastination. Recommendations for Practitioners: The results from this study, namely, the decline of the procrastination after the multicultural virtual teamwork, can be used by global firms with employees all over the world, working in virtual multicultural teams. Such firms do not need to avoid multicultural teams, working virtually, as they can benefit from this kind of collaboration. Recommendation for Researchers: These results can be also beneficial for academic researchers from different cultures and countries, working together in virtual multicultural teams. Impact on Society: Understanding the positive effect of virtual multicultural teamwork, in mitigating the negative tendency of students from diverse cultures to procrastinate, as concluded in this study, can provide a useful tool for higher education or businesses to mitigate procrastination in teamwork processes. It can also be used as an experiential learning tool for improving task performance and teamwork process. Future Research: The relation between procrastination and motivation should be further examined in relation to multicultural virtual teams. Further research is needed to explore the effect of multicultural virtual teamwork during the teamwork process, and the reasoning for this effect.