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Introduction: Although psychoeducational group interventions are increasingly used for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD), a comprehensive review focused on the feasibility and acceptability indicators of these interventions remains lacking. Furthermore, although previous research has explored various aspects of psychoeducation for ADHD, such as its definition and approaches, limited research has focused on the synthesis for outcome measures and patients' experiences related to these interventions. Therefore, this scoping review aims to map the existing evidence reported on psychoeducational group interventions for adults diagnosed with ADHD. The objective is to provide a comprehensive overview of feasibility indicators, acceptability, and outcome measures used in psychoeducational group interventions. Method: A comprehensive structured literature search on the topic was performed in seven bibliographic databases, and the resulting records were independently screened, and their data extracted by two reviewers. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-S) to ensure the transparency and rigor of this scoping review. Results: The searches yielded 7510 records. Eight studies met the inclusion criteria. These included studies were conducted in European countries and the United States. Among these, six studies used a randomized control design, one an open feasibility trial, and one a pre-post intervention design. All the studies reported some feasibility and acceptability indicators. While all the studies reported on the severity of symptoms of ADHD as an outcome measure, some also reported on outcomes related to psychological or mental-health problems, quality of life, changes in knowledge regarding ADHD, or the level of self-esteem, functioning, and impairment. Conclusion: This scoping review revealed that psychoeducational group interventions are generally acceptable for patients in terms of patient satisfaction with the group intervention. All included studies reported some feasibility indicators, with some reporting good attendance and relatively low dropout rates. Most studies reported positive effects on ADHD and mental health symptoms, suggesting that these interventions are beneficial for adults with ADHD. However, several gaps exist regarding the reporting on the feasibility indicators, acceptability, and outcome measures employed across studies. [ABSTRACT FROM AUTHOR]

The practice of serving students with emotional and behavioral challenges in the United States has been fraught with anxiety, fear, and stress. Fortunately, researchers in the field of emotional and behavioral disorders (EBD) have identified a range of empirically supported interventions to improve outcomes for students with EBD. This study sought to examine the feasibility of TIERS, a special education-based treatment program for students with EBD, in 10 self-contained classrooms. Despite the provision of multiple evidence-based supports for implementation, two and a half years of fidelity data indicated that none of the participating classrooms fully implemented the program as intended. These findings raise at least some concern regarding the practicality of the TIERS program, as designed, for its targeted setting/population. Study limitations and future directions are discussed. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the United States, characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health platforms offer a promising avenue for delivering tailored and on-demand mental health care. Objective: To address the lack of youth mental health services, we created the Science Technology Engineering Math and Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. Methods: The STEMSEL study will involve the implementation and evaluation of Neolth across 4 distinct phases. In phase 1, a comprehensive needs assessment will be conducted across 3 diverse schools, each using a range of teaching methods, including in-person, digital, and hybrid modalities. Following this, in phase 2, school administrators and teachers undergo intensive training sessions on Neolth's functionalities and intervention processes as well as understand barriers and facilitators of implementing a digital mental health program at their respective schools. Phase 3 involves recruiting middle and high school students aged 11-18 years from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, phase 4 will include a year-long pre- and posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Results: Phase 1 was successfully completed in August 2022, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study's completion is scheduled for 2024, with data expected to provide insights into the real-world use of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention's efficacy in addressing the mental health needs of students. Conclusions: The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/59372 [ABSTRACT FROM AUTHOR]

Objective We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICUs) and community hospitals. Study Design Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the 12 statements, scale values ranged from 1 to 5 (1 = strongly disagree; 5 = strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. Results The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6 to 99.0%, with mean scores of 4.4 to 4.7 and median scores of 4.0 to 5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. Conclusion Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable. Key Points Neonatal care providers perceive teleneonatology to be highly acceptable, appropriate, and feasible. Perceptions of teleneonatology do not differ based on professional role or years of experience. Perceptions of teleneonatology are especially high in smaller hospitals with well newborn nurseries. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to explore the feasibility of telehealth-obtained Timed Up and Go (TUG). Methods: The TUG was administered twice during 1 visit. The TUG distance as set up by the participant was compared with the TUG set up by a rater. A second rater scored the TUG virtually, and a third rater scored session recordings twice, 30 days apart. Results: There was a strong and significant correlation between the face-to-face and virtually obtained TUG scores using the patient-identified distances (r = 0.994; 95% confidence interval, 0.957-0.999). Discussion: Virtual TUG measurements are comparable with those measured face-to-face. [ABSTRACT FROM AUTHOR]

To explore the feasibility and acceptability of Proyecto Mariposa, a culturally-tailored survivorship care program for rural Latina breast cancer patients. Single group mixed-method approach. Feasibility of recruitment, intervention and evaluation, and perceptions about the intervention were assessed with 18 rural Latina breast cancer patients from the US/Mexico border region. Pre-post assessments evaluated change in patients' knowledge and concerns about survivorship care, and their self-efficacy about patient-physician interaction and managing chronic disease. Feasibility was generally promising but affected by the COVID-19 outbreak. Participants found the intervention to be acceptable and useful, particularly with regard to information provision and encouraging proactive behavior. There was modest pre-post improvement on self-efficacy for managing disease. This pilot study suggested feasibility and acceptability of Proyecto Mariposa for rural Latina breast cancer patients. Change in outcomes was small indicating the need for research with a larger sample to establish reliable findings. [ABSTRACT FROM AUTHOR]

Half of persons with HIV in the United States (US), many of whom are women, are over age 50. Aging women with HIV (WWH) face unique biopsychosocial challenges, including stigma, the physiological effects of aging, and illness-associated stressors. Resilience interventions can build awareness of such stressors and aid in facilitating the relaxation response; however, no existing interventions specifically cater to the needs of older WWH. The content of the Relaxation Response Resiliency Program, which teaches positive psychology strategies, relaxation techniques, and cognitive behavioral skills, was adapted for older WWH. Thirteen WWH over 50 participated in an open pilot of the adapted intervention to iteratively refine the program and its procedures. Participants attended either 8 or 10 weekly group sessions; three groups were conducted in total. Pre- and post-intervention assessments and qualitative exit interviews were conducted. Among completers, an increase in resilience was observed. Though significance testing was not conducted, social support also increased, and depression, anxiety, and HIV stigma decreased from pre- to post-intervention. Over half of eligible women enrolled; completers reported high satisfaction with the program. However, retention was difficult; six participants withdrew or were lost to follow-up. Mean number of sessions attended was 3.5 in the 8-session group and 5 in the 10-session groups. In this small sample, the adapted intervention led to a clinically meaningful increase in resilience, though recruitment and retention were challenging. Further refinements to the intervention are needed to minimize attrition and increase acceptability before additional testing is initiated. [ABSTRACT FROM AUTHOR]

There is a need for more Registered Dietitian Nutritionists (RDNs) trained to provide nutritional care to older adults with dementia who experience mealtime difficulties. The purpose of this single-arm, pre/post pilot study was to adapt a generalized dementia care curriculum to the learning needs of RDNs who work with individuals with dementia and to determine the feasibility and acceptability of the adapted program. Using an existing evidence-based dementia care curriculum, the research team identified learning objectives and content pertinent to the scope of RDNs. The adapted program was piloted with RDNs who work with older adults with dementia. Twenty-five RDNs registered for the training while 80% (20) attended the training and completed the post-training survey. All participants agreed that the module met the learning needs of RDNs who work with older adults with dementia, the two-hour workshop was a good use of their time, and the experience and skills gained would be useful in their work as an RDN. Implementation costs totaled $1,310. Based on the post-training feedback, the adapted program was deemed feasible and acceptable by RDN participants, who also expressed interest in using the module to train other caregivers on providing mealtime assistance to older adults with dementia. [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

Background: Blood‐borne viruses (BBVs) cause significant morbidity and mortality worldwide. Emergency departments (EDs) offer a point of contact for groups at increased risk of BBVs who may be less likely to engage with primary care. We reviewed the literature to evaluate whether BBV testing in this setting might be a viable option to increase case finding and linkage to care. Methods: We searched PubMed database for English language articles published until June 2019 on BBV testing in EDs. Studies reporting seroprevalence surveys, feasibility, linkage to care, enablers and barriers to testing were included. Additional searches for grey literature were performed. Results: Eight‐nine articles met inclusion criteria, of which 14 reported BBV seroprevalence surveys in EDs, 54 investigated feasibility and acceptability, and 36 investigated linkage to care. Most studies were HIV‐focused and conducted in the USA. Seroprevalence rates were in the range 1.5–17% for HCV, 0.7–1.6% for HBV, and 0.8–13% for HIV. For studies that used an opt‐in study design, testing uptake ranged from 2% to 98% and for opt‐out it ranged from 16% to 91%. There was a wide range of yield: 13–100% of patients received their test result, 21–100% were linked to care, and 50–91% were retained in care. Compared with individuals diagnosed with HIV, linkage to and retention in care were lower for those diagnosed with hepatitis C. Predictors of linkage to care was associated with certain patient characteristics. Conclusions: Universal opt‐out BBV testing in EDs may be feasible and acceptable, but linkage to care needs to be improved by optimizing implementation. Further economic evaluations of hepatitis testing in EDs are needed. [ABSTRACT FROM AUTHOR]

Introduction: The standard of care consolidation therapy for acute myeloid leukemia is high-dose cytarabine or intermediate-dose cytarabine, which are traditionally given inpatient. At Moffitt Cancer Center, we have moved the administration of high-dose cytarabine and intermediate-dose cytarabine to the outpatient setting through the inpatient/outpatient program. To facilitate outpatient administration, high-dose cytarabine and intermediate-dose cytarabine are given in a shorter interval of every 10 h instead of 12 h. The safety of a shorter duration interval of high-dose cytarabine and intermediate-dose cytarabine is unknown. This study aims to assess the safety and feasibility of administering high-dose cytarabine and intermediate-dose cytarabine consolidation therapy in the inpatient/outpatient setting. Methods: This is a retrospective chart review to analyze acute myeloid leukemia patients treated with inpatient/outpatient high-dose cytarabine or intermediate-dose cytarabine consolidation therapy at Moffitt Cancer Center from January 1, 2015, through November 1, 2018. The primary objective was to determine the incidence of hospitalization during the inpatient/outpatient administration of high-dose cytarabine or intermediate-dose cytarabine. Results: Two hundred fifty-three of 255 cycles of high-dose cytarabine/intermediate-dose cytarabine were delivered outpatient over the reviewed time period to 118 patients. No patients receiving outpatient high-dose cytarabine/intermediate-dose cytarabine consolidation required hospitalization during chemotherapy. Our incidence of hospitalization (24%) after chemotherapy is consistent with the reported literature. Through the inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine, 1265 inpatient days were saved with an approximate revenue of $3,135,176 generated in our study period. Conclusion: Inpatient/outpatient administration of high-dose cytarabine and intermediate-dose cytarabine is both safe and feasible. Moving high-dose cytarabine/intermediate-dose cytarabine administration to the outpatient setting resulted in significant additional revenue vs. inpatient administration. [ABSTRACT FROM AUTHOR]

Background: The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic., Objective: The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable., Methods: This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire., Results: Of the 389 participants who enrolled in and completed the study, 380 (98%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1%) of the 239 participants entered full BP routines into the digital app 80% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as "excellent" for domains of perspicuity, efficiency, and dependability and "above average" for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period., Conclusions: The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension., (©Leanne Richardson, Nihal Noori, Jack Fantham, Gregor Timlin, James Siddle, Thomas Godec, Mike Taylor, Charles Baum. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 03.12.2024.)

Background: Given that today's adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions. Objective: The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths. Methods: A comprehensive search of Embase and PubMed identified 7 studies that met the inclusion criteria. Data were extracted by 2 independent reviewers. Results: Of the 7 included studies, half (n=4, 57%) used a randomized control trial design, with equal implementation in school (n=3, 43%) and clinic (n=4, 57%) settings. Studies commonly targeted improvements in diet (n=4, 57%) and physical activity (n=7, 100%), with only 1 (14%) study focused on sedentary behaviors. Just 2 (29%) studies reported the use of behavioral theories or models. Studies focused primarily on youths in early (n=5, 71%) or middle (n=6, 86%) adolescence, and there was limited information reported on socioeconomic status. Only 3 (43%) study conducted formative work, and few (n=3, 43%) reported on acceptability. Only 1 (14%) study reported that materials were available in Spanish and English, and only 1 (14%) study used culturally tailored content. Additionally, 3 (43%) studies used strategies that considered social determinants of health. Conclusions: To increase our understanding of the feasibility and effectiveness of technology-based obesity prevention strategies among Hispanic adolescents, there is a need for more feasibility studies that are theoretically grounded and comprehensively report on feasibility-related outcomes. Future studies should also leverage technology to simultaneously address multiple health behaviors beyond diet and physical activity. The result of this review can be used to guide the development of future technology-based obesity prevention strategies among Hispanic adolescents. [ABSTRACT FROM AUTHOR]

Background: This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR)., Methods: A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022., Results: The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646 mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases., Conclusions: The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Drs. Daisuke Imai, Masaya Yokoyama, Yuzuru Sambommatsu, Seung Duk Lee, Aamir A. Khan, Vinay Kumaran, Muhammad I. Saeed, Hannah Lee, Scott Matherly, Adrian H. Cotterell, Marlon F. Levy, David A. Bruno, and Amit Sharma have no conflicts of interest or financial ties to disclose.

Purpose: There has been rapid growth in the variety and number of real-world data (RWD) sources, as well as the number of regulatory documents that provide guidance for assessing the suitability of RWD sources for pharmacoepidemiology studies. This study aims to assess differences in RWD guidance and variability in current practice for identifying and assessing RWD for studies with regulatory purpose., Methods: Key criteria for feasibility assessment were mapped against relevant regulatory guidance documents across US, EU, and Asia-Pacific regions. An online survey was designed and deployed to International Society for Pharmacoepidemiology members to understand current practice. Findings were summarized and used to inform key considerations and recommendations., Results: Eleven RWD guidance documents were identified and mapped against 14 RWD assessment criteria. Variability was seen across these documents in guidance for these criteria. Between December 2022 and January 2023, 37 survey respondents reported having used RWD for post-marketing commitments (34, 92%) and/or background epidemiology (28, 76%). RWD were mostly identified through literature (33, 89%) and data landscaping (26, 70%); guidance documents referenced included: Food and Drug Administration (20, 54%), European Network for Centres for Pharmacoepidemiology and Pharmacovigilance (17, 46%), European Medical Agency (16, 43%), and Structured Process to Identify Fit-For-Purpose Data (11, 30%). Challenges for conducting feasibility assessments included RWD accessibility, ability to complete validation, and RWD provider responsiveness., Conclusions: Existing guidelines are used extensively by researchers, but key criteria for RWD identification and feasibility assessment are not reflected consistently and challenges remain. Recommendations have been made reflecting study findings., (© 2024 The Author(s). Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.)

Competing Interests: Declaration of competing interest The authors declare no competing interests.

Background: Remote patient monitoring (RPM) has potential in hypertension management, but limited studies have focused on maternal hypertension, especially among vulnerable populations. The objective of this study was to integrate RPM into perinatal care for pregnant patients at elevated risk of hypertensive disorders to show feasibility, acceptability, and safety. Methods: A prospective pilot cohort study was conducted at the University of Mississippi Medical Center 2021-2023. Participants' blood pressure readings were remotely captured and monitored until 8-week postpartum, with timely assessment and intervention. Results: Out of 98 enrollees, 77 utilized RPM, and no maternal or neonatal deaths occurred within 60-day postpartum. High program satisfaction was reported at discharge. Conclusion: This study demonstrates the feasibility and acceptability of RPM for perinatal care in a vulnerable population. Positive outcomes were observed, including high patient satisfaction and no maternal or neonatal deaths. Further research should address patient engagement barriers and develop tailored protocols for improved clinical outcomes.

Cardiorespiratory fitness (CRF) is routinely investigated in diverse populations, including in older adults of varying physical activity levels. Commonly performed maximal exercise testing protocols might be contraindicated and/or inadequate for older individuals who have physical or cognitive impairment. Moreover, early termination of an attempted maximal exercise test could result in underestimation of CRF in this population. The goal of the current study was to compare CRF estimates using the Ekblom-Bak (EB) submaximal exercise test – previously validated in a cohort of Scandinavian adults – versus a subsequent maximal exercise test in a diverse, Midwestern United States cohort. Fifteen generally healthy individuals were included in this study who were either "Young" (25–34 years old) or "Older" (55–75 years old) as well as either sedentary or highly active. Participants completed the EB submaximal exercise test, followed immediately by a maximal exercise test. We found that all 15 individuals were able to successfully perform the EB submaximal testing method. Across the wide range of volumes of maximal oxygen consumption (VO2max; 12–52 ml/kg/min), the EB submaximal estimates of VO2max correlated highly with the maximal test based values (Pearson's r = 0.98), but with a small bias (6 ml/kg/min, 95% limits of agreement −1.06 and −11.29). Our results suggest that the EB submaximal testing method may be useful in identifying wide differences in CRF among a diverse cohort of older adults in the United States, but larger studies will be needed to determine the degree of its accuracy and precision in identifying smaller differences. [ABSTRACT FROM AUTHOR]

Purpose: This article addresses the lack of formal design guidance that supports flexibility within the architectural and engineered systems of manufacturing facilities through the development of a taxonomy and associated terminology. Design/methodology/approach: This research performed a comparative analysis of 15 manufacturing facilities located both within the United States (73 percent of cases) and internationally (27 percent of cases). These case studies provided details on how and where flexibility was incorporated into the design of a manufacturing facility. Specific consideration was given to the primary design features that enabled a decoupling of the facility from the manufacturing process. These design features were then clustered to identify main design strategies that enable flexibility. Findings: By grouping the design features together and creating a common vocabulary, three coherent design approaches for flexible facilities were identified, each having a different potential for responding to short-term and long-term changes. These include general purpose, scalable, and dedicated facilities. Research limitations/implications: By delineating three high-level strategies for early flexible facility design, this research synthesizes a conceptual understanding of flexibility with practical and implementable designs. This synthesis provides an incremental advance to a complex challenge for researchers. It also provides decision support to design teams by aiding in project definition, when flexibility is desirable. This research is primarily limited by the number of cases reviewed. With more cases, additional facility design strategies may be identified. Practical implications: The findings in this research allow for a basic understanding of how a flexible facility can be designed with only limited or vague information about the product and manufacturing processes contained within. The development of terminology associated with each facility design strategy provides standardization for the discussion and implementation of flexibility early in the design process. In doing so, flexible designs become easier to create and more efficient to implement. Originality/value: This research provides the first synthesized approach for considering flexible facility design strategies within the manufacturing sector. [ABSTRACT FROM AUTHOR]

Background: Older adolescence (ages 15–18) is a critical period for experimentation with substance use, especially alcohol. Adolescent drinking poses hazards to physical and mental health, amplifies risk associated with other activities typically initiated during this life stage (e.g., driving, sexual activity), and is associated with adverse outcomes in adolescence and adulthood. Existing preventative interventions are expensive and have questionable long-term efficacy. Digital interventions may represent an accessible and personalized approach to providing preventative intervention content to youth. Methods: This study recruited 29 adolescents aged 16–18 (M = 17.24, SD = 0.74) for a pilot feasibility trial of the MobileCoach-Teen (MC-Teen) smartphone app-based intervention. The study team randomized participants to receive either the alcohol intervention (MC-Teen) or attention control pseudo-intervention (MC-Fit). MC-Teen participants received 12 weeks of content adapted from a prior Swiss-based trial of a preventative alcohol intervention. Participants provided qualitative and quantitative feedback at baseline, via six biweekly surveys during and post-intervention. Results: Both groups rated the application as easy to download (M = 4.31, SD = 0.93; 5-point Likert). All participants completed the baseline survey in less than the estimated time of 10 min (M = 7:42, SD = 2:15) and rated the survey as easy to complete (M = 4.69, SD = 0.60; 5-point Likert). MC-Teen participants favorably assessed application user experience, message user experience, and digital working alliance with application. Qualitative themes included a desire for increased rate/amount and diversity of content, greater representation via coach options, user interface/user experience improvements, and additional features. Conclusion: The MC-Teen intervention is feasible and acceptable based on a pilot feasibility trial with a sample of U.S. adolescents. • Youth participants were able to quickly and easily download the MC-Teen application • 100% of participants reported prior use of a phone password and agreed to maintain use throughout the study • The application consistently delivered intervention content to participants (96% reported receipt across conditions) • Ratings of usability, acceptability, and digital working alliance with app were positive • Qualitative feedback included desire for increased avatar diversity, more personalization, and increased message frequency. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic stress disorder (PTSD) is a common sequela to military sexual trauma (MST) among women veterans. Yoga has shown promise in research examining its benefit for symptoms and sequela of PTSD., Aims: The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of Trauma Center Trauma-Sensitive Yoga (TCTSY) for women veterans with PTSD related to MST., Method: In this feasibility study, the final sample included women veterans ( n = 41) with PTSD related to MST accessing health care in a Veterans Affairs Health Care System in the southeast United States; the majority were African American ( n = 33; 80.5%). Interventions used established protocols of 10 weekly sessions of group TCTSY versus 12 weekly sessions of group Cognitive Processing Therapy (CPT). PTSD was assessed via clinical interview and participant report. Additional data collection included multiple participant-reported outcomes commonly associated with PTSD and psychophysiological measures. We also collected data regarding participant satisfaction and feasibility-related feedback from participants and providers., Results: Feasibility and acceptability were evaluated via demand, practicality, fidelity, and acceptability. This was measured by expressed interest, attendance, program completion, barriers to care and satisfaction with treatment, and satisfaction with interventions and data collection., Conclusions: Results indicate the RCT design and TCTSY implementation were feasible; a full-scale RCT was subsequently conducted to determine efficacy of the experimental intervention. Recommendations for successful research strategies are provided., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. DisclaimerThe contents of this article do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government or the Agency for Healthcare Research and Quality. All authors approved this manuscript and this submission. The authors report no conflicts of interest.

Introduction: Substance use disorders (SUDs) are an ongoing public health crisis in the United States. A large body of research indicates an urgent need for increased training in SUD research and treatment for trainees in mental health service disciplines. The VA Health Care System is well positioned, as the largest trainer and employer of health service psychologists and other mental health professionals, to address the SUD training gap and serve as a leader in training the upcoming health care workforce., Method: To this end, we conducted two pilot studies to (1) examine the feasibility of implementing supplemental SUD training for VA health service trainees, among current VA mental health service providers in psychology, social work, and medical care (N = 37) and (2) the efficacy of a single 2-hour interdisciplinary SUD training seminar for VA health service trainees in mental health (N = 13). The training seminar consisted of several components including lecture, facilitated discussion, and role play, aimed at increasing trainee self-efficacy in assessing and diagnosing SUDs., Results: Findings suggest that current providers are supportive of supplemental SUD training for VA trainees and believe that such training is beneficial for those wishing to pursue a career within the VA Health Care System. Additionally, results suggest that a single session didactic seminar improved trainees' self-reported efficacy in the assessment and referral of veterans diagnosed with SUDs., Conclusions: Overall, the above studies support additional feasibility investigations that would pave the way for successful implementation of widespread SUD training programs across the VA Health Care System and beyond. Successful implementation would then serve to reduce the increasingly critical SUD provider shortage, thus leading to significant public health gains., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Studies with U.S. Muslims have had difficulty recruiting participants. Method: This article, which was part of a larger qualitative study, aimed to describe the effectiveness of targeted recruitment and data collection strategies in Muslim cancer survivors. The purpose of the larger qualitative study was to gain an understanding of the experiences of Muslim cancer survivors in the United States. Four recruitment approaches were implemented to determine timeliness, diversity in respondents, and success in completing the interview. Results: Eighteen Muslim cancer survivors participated (12 males, 6 females). Ten Muslim participants were identified by community leaders, two by posted flyers, four using social media, and two by a physician. No burden was voiced by participants related to length, time, or location of interviews. Discussion: We demonstrated the feasibility of recruiting and interviewing Muslim cancer survivors. Using culturally sensitive approaches is important to encourage recruitment and participation in studies of Muslim cancer survivors. [ABSTRACT FROM AUTHOR]

• Broom Creek Formation is a promising reservoir for CO 2 storage. • North Dakota has a favorable CO 2 management regulatory framework. • Project partners are supportive of carbon capture and storage in central North Dakota. The Energy & Environmental Research Center is investigating the feasibility of safely, permanently, and economically storing 50 million tonnes of CO 2 in central North Dakota, United States, over a 25-year operational period, should a business case for CO 2 storage emerge. The study is part of the U.S. Department of Energy (DOE) National Energy Technology Laboratory CarbonSAFE initiative and addresses the technical and nontechnical challenges of commercially deploying a CO 2 storage project. Evaluation of cores from two stratigraphic test wells demonstrate that the Broom Creek Formation (sandstone) is an excellent candidate for the geologic storage of CO 2 and the overlying Opeche Formation a competent cap rock. [ABSTRACT FROM AUTHOR]

Radon exposure is the second leading cause of lung cancer, yet few Americans test their homes for radon, particularly in rural areas. The academic team and community partners engaged the public library systems in four rural counties to offer digital radon detectors for check-out as a means of increasing the public's access to free radon testing. The check-out procedures and instructional materials were created through an iterative process, and library personnel were educated on radon and home radon testing prior to launching the lending program. Library patrons reported high usability, feasibility, and acceptability of the program. Library patron-staff interactions mainly included discussions about the logistics of radon testing. Given that public libraries are invested in making communities thrive and promoting health, providing library lending programs for radon detectors is a novel, feasible, and acceptable way to reduce the risk of lung cancer in the community. • The radon detector library loan program was designed and evaluated using citizen science methods. • The radon detector library loan program was usable, feasible and acceptable to library patrons. • Library patrons were appreciative of having access to radon detector kits at no cost. • Public libraries can serve as partners to promote the health of communities. • Radon detector loan programs are innovative and attract community members who may not have otherwise utilized the library. [ABSTRACT FROM AUTHOR]

While research increasingly studies how neighborhood contexts influence HIV among gay, bisexual and other men who have sex with men (MSM) populations, to date, no research has used global positioning system (GPS) devices, an innovative method to study spatial mobility through neighborhood contexts, i.e., the environmental riskscape, among a sample of Black MSM. The purpose of this study was to examine the feasibility of collecting two-week GPS data (as measured by a pre- and post-surveys as well as objectively measured adherence to GPS protocol) among a geographically-diverse sample of Black MSM in the Deep South: Gulfport, MS, Jackson, MS, and New Orleans LA (n = 75). GPS feasibility was demonstrated including from survey items, e.g. Black MSM reported high ratings of pre-protocol acceptability, ease of use, and low levels of wear-related concerns. Findings from this study demonstrate that using GPS methods is acceptable and feasible among Black MSM in the Deep South. [ABSTRACT FROM AUTHOR]

Introduction: Magnet-assisted surgery is a new platform within minimally invasive surgery. The Levita™ Magnetic Surgical System, the first magnetic surgical system to receive Food and Drug Administration (FDA) approval, includes a deployable, magnetic grasper and an external magnet that is used to manipulate the grasper within the peritoneal cavity. This system is currently approved for patients undergoing laparoscopic cholecystectomy with a body mass index (BMI) between 21 and 34 kg/m2. Herein, we detail the first United States experience with the Levita™ Magnetic Surgical System during laparoscopic cholecystectomy.Methods: The Levita™ Magnetic Surgical System was used on consecutive patients undergoing laparoscopic cholecystectomy at our institution from June 2016 through November 2016. Only patients undergoing elective surgery and those with a body mass index (BMI) between 21 and 34 kg/m2 were included. Baseline patient characteristics, operative time, and perioperative details were collected.Results: A total of ten patients underwent laparoscopic cholecystectomy with the Levita™ Magnetic Surgical System during the defined study period. The mean age at the time of surgery was 49.0 years and the average BMI of the cohort was 27.6 kg/m2. The average operative time was 64.4 min. There were no perioperative complications. Seven (70.0%) patients were discharged to home on the day of surgery, while the remaining three (30.0%) patients were discharged to home on postoperative day number one. Surgeons reported that the magnetic grasper was easy to use and provided adequate tissue retraction and exposure.Conclusions: The Levita™ Magnetic Surgical System is safe and feasible to use in patients undergoing laparoscopic cholecystectomy. Routine use of this system may facilitate a reduction in the total number of laparoscopic trocars used, leading to less tissue trauma and improved cosmesis. Additional studies are needed to determine the applicability and utility of this system for other general surgery cases. [ABSTRACT FROM AUTHOR]

Objectives: Qigong exercise has been shown to improve physical and psychological well-being in adults with chronic conditions, but little is known about the feasibility and acceptability of engaging in a qigong exercise program in community-dwelling older adults in the United States. The purpose of this study was to explore the feasibility, acceptance, and adherence to an 8-week qigong exercise intervention in community-dwelling American older adults. Design: An exploratory study design. Setting: Two senior centers in southern Connecticut. Subjects: Forty-five community-dwelling older adults aged 65 to 85 years enrolled. Intervention: A supervised 1-h health qigong exercise session twice weekly for 8 weeks. Outcome measures: An investigator-designed questionnaire with seven items that were rated on a 1 to 6 scale, with higher scores indicating better results, and nine open-ended questions were used to obtain data on feasibility and acceptability. Adherence was calculated as the proportion of the 16 planned sessions attended. Results: Of the 45 older adults enrolled, 6 never started and 6 withdrew, with 33 evaluable at the end of the intervention. The mean age of the sample was 74.8 years; the majority were female (84.4%) and white (91.1%). Mean scores on aspects of difficulty, acceptability, suitability, or effectiveness of qigong exercise were all ≥5. Participants identified benefits of qigong exercise, such as calming and relaxing feelings, inner peace, better balance, and flexibility. Attendance rate was 78.8%, with 94% performing qigong exercise at least once weekly outside the class. All participants indicated that they would recommend qigong exercise to others. No adverse events occurred. Conclusion: An 8-week qigong exercise program was feasible, acceptable, and safe for American older adults. Future robust randomized controlled trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) is a common and highly morbid illness. New medications that have much higher cure rates have become the new evidence-based practice in the field. Understanding the implementation of these new medications nationally provides an opportunity to advance the understanding of the role of implementation strategies in clinical outcomes on a large scale. The Expert Recommendations for Implementing Change (ERIC) study defined discrete implementation strategies and clustered these strategies into groups. The present evaluation assessed the use of these strategies and clusters in the context of HCV treatment across the US Department of Veterans Affairs (VA), Veterans Health Administration, the largest provider of HCV care nationally.Methods: A 73-item survey was developed and sent to all VA sites treating HCV via electronic survey, to assess whether or not a site used each ERIC-defined implementation strategy related to employing the new HCV medication in 2014. VA national data regarding the number of Veterans starting on the new HCV medications at each site were collected. The associations between treatment starts and number and type of implementation strategies were assessed.Results: A total of 80 (62%) sites responded. Respondents endorsed an average of 25 ± 14 strategies. The number of treatment starts was positively correlated with the total number of strategies endorsed (r = 0.43, p < 0.001). Quartile of treatment starts was significantly associated with the number of strategies endorsed (p < 0.01), with the top quartile endorsing a median of 33 strategies, compared to 15 strategies in the lowest quartile. There were significant differences in the types of strategies endorsed by sites in the highest and lowest quartiles of treatment starts. Four of the 10 top strategies for sites in the top quartile had significant correlations with treatment starts compared to only 1 of the 10 top strategies in the bottom quartile sites. Overall, only 3 of the top 15 most frequently used strategies were associated with treatment.Conclusions: These results suggest that sites that used a greater number of implementation strategies were able to deliver more evidence-based treatment in HCV. The current assessment also demonstrates the feasibility of electronic self-reporting to evaluate ERIC strategies on a large scale. These results provide initial evidence for the clinical relevance of the ERIC strategies in a real-world implementation setting on a large scale. This is an initial step in identifying which strategies are associated with the uptake of evidence-based practices in nationwide healthcare systems. [ABSTRACT FROM AUTHOR]

Background: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations., Objective: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe., Methods: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies., Results: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients' and service providers' perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity., Conclusions: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery., (©Andrew Goodman, Ray Mahoney, Geoffrey Spurling, Sheleigh Lawler. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 23.06.2023.)

Objectives Home telemental health services have the potential to overcome many individual and systemic barriers to care facing military veterans with posttraumatic stress disorder. However, little is known about the home telemental health-related attitudes and experiences of highly underserved rural or ethnically, racially diverse veterans. This study evaluated whether ethnically/racially diverse U.S. veterans residing in the rural Pacific Islands would find the delivery of evidence-based treatment for posttraumatic stress disorder via home telemental health tablet devices useful and helpful. Method Clinicians located in a central urban location delivered Cognitive Processing Therapy for posttraumatic stress disorder directly into patients’ homes via a tablet device and secure WiFi connection. Pre- and post-treatment measures were collected from a clinical sample of 47 veterans (average age: 49.3 years). Most (74.4%) self-identified as being of ethnic/racial minority background. Attitudinal, satisfaction, and usability scales were collected from home telemental health engaging (n = 29) and non-engaging (n = 18) veterans. Results Ratings on measures of home telemental health comfort, satisfaction with care, and usability were uniformly positive. Veterans were equally open to receiving mental health services at home via home telemental health or in the clinic. In the case of services for a physical problem, however, veterans preferred in-clinic care. Following treatment, veterans’ attitudinal scores increased on items such as “There is enough therapist contact in home telemental health interventions.” However, a small portion of veterans (7%) reported having technical or privacy concerns. Conclusion The provision of evidence-based posttraumatic stress disorder treatment directly into the patients’ homes proved feasible and was well received by the large majority of rural ethnically/racially diverse veterans. [ABSTRACT FROM AUTHOR]

Remote assessments of individuals with a neurological disease via telemedicine have the potential to reduce some of the burdens associated with clinical care and research participation. We aim to evaluate the feasibility of conducting the Montreal Cognitive Assessment remotely in individuals with movement disorders. A pilot study derived from two telemedicine trials was conducted. In total, 17 individuals with movement disorders (8 with Parkinson disease and 9 with Huntington disease) had Montreal Cognitive Assessment examinations evaluated in-person and remotely via web-based video conferencing to primarily determine feasibility and potential barriers in its remote administration. Administering the Montreal Cognitive Assessment remotely in a sample of movement disorder patients with mild cognitive impairment is feasible, with only minor common complications associated with technology, including delayed sound and corrupted imaging for participants with low connection speeds. The Montreal Cognitive Assessment has the potential to be used in remote assessments of patients and research participants with movement disorders. [ABSTRACT FROM AUTHOR]

Introduction: Although systematic reviews represent a source of best evidence to support clinical decision-making, reviews are underutilized by clinicians. Barriers include lack of awareness, familiarity, and access. Efforts to promote utilization have focused on reaching practicing clinicians, leaving unexplored the roles of continuing medical education (CME) directors and faculty in promoting systematic review use. This study explored the feasibility of working with CME directors and faculty for that purpose. Methods: A convenience sample of five academic CME directors and faculty agreed to participate in a feasibility study exploring use in CME courses of systematic reviews from the Agency for Healthcare Research and Quality (AHRQ-SRs). AHRQ-SR topics addressed the comparative effectiveness of health care options. Participants received access to AHRQ-SR reports, associated summary products, and instructional resources. The feasibility study used mixed methods to assess 1) implementation of courses incorporating SR evidence, 2) identification of facilitators and barriers to integration, and 3) acceptability to CME directors, faculty, and learners. Results: Faculty implemented 14 CME courses of varying formats serving 1700 learners in urban, suburban, and rural settings. Facilitators included credibility, conciseness of messages, and availability of supporting materials; potential barriers included faculty unfamiliarity with SRs, challenges in maintaining review currency, and review scope. SR evidence and summary products proved acceptable to CME directors, course faculty, and learners by multiple measures. Discussion: This study demonstrates the feasibility of approaches to use AHRQ-SRs in CME courses/programming. Further research is needed to demonstrate generalizability to other types of CME providers and other systemic reviews. [ABSTRACT FROM AUTHOR]

This paper is adapted from the keynote address from the Eastern Finance Association's 2014 meeting in Pittsburg, Pennsylvania. We highlight a recidivism problem: about 15% of debtors who emerge as continuing entities under Chapter 11, or are acquired as part of the bankruptcy process, ultimately file for bankruptcy protection again (18.25% when considering only those firms which emerge as a continuing, independent entity). We argue that the 'Chapter 22' issue should not be dismissed by the bankruptcy community just because no interested party objects during the confirmation hearing. Applying the Z'-Score model to a large sample of Chapter 11 cases reveals highly different and significant expected survival profiles at emergence. Credible distress prediction techniques can effectively predict the future success of firms emerging from bankruptcy and be used by the bankruptcy court to assess the feasibility of the reorganization plan, a requirement mandated by the Bankruptcy Code. Branch reviews, discusses, and critiques in this follow-up article to Altman's original thesis. [ABSTRACT FROM AUTHOR]

Rationale Intracerebral hemorrhage causes 15% of strokes annually in the United States, and there is currently no effective therapy. Aims and hypothesis This is a clinical trial designed to study the safety, feasibility, and efficacy of a protocol of targeted temperature management to moderate hypothermia in intracerebral hemorrhage patients. Methods The targeted temperature management after intracerebral hemorrhage trial is a prospective, single-center, interventional, randomized, parallel, two-arm (1:1) phase- II clinical trial with blinded end-point ascertainment. Intracerebral hemorrhage patients will be randomized within 18 h of symptom onset to either 72 h of targeted temperature management to moderate hypothermia (32-34°C) followed by a controlled rewarming at of 0·05-0·1°C per hour or 72 h of targeted temperature management to normothermia (36-37°C) using endovascular or surface cooling. Outcomes The primary outcome is the development of serious adverse events possibly and probably related to treatment. Secondary outcomes include in-hospital neurological deterioration between day 0-7, in-hospital mortality, functional outcome measured by the modified Rankin scale at discharge and 90 days, and effect of treatment allocation on cerebral edema and hematoma volume. Discussion Intracerebral hemorrhage remains the most severe form of stroke with limited options to improve survival. As the early resuscitation phase in the intensive care unit represents the greatest opportunity for impact on clinical outcome, it also appears to be the most promising window of opportunity to demonstrate a benefit when investigating aggressive treatments. Conclusion More research of novel therapies to improve outcomes after intracerebral hemorrhage is desperately needed. The results of the targeted temperature management after intracerebral hemorrhage clinical trial may provide additional information on the applicability of targeted temperature management after intracerebral hemorrhage. [ABSTRACT FROM AUTHOR]

Hotel developers and purchasers searching for new opportunities have been advised to consider hotels in university towns because, among other reasons, universities provide a stable source of lodging demand. This study analyzes the performance and stability since 1990 of hotels in 27 cities dominated by a major university. This study finds that lodging demand in university towns is more stable than U.S. averages. This study also evaluates factors that lodging feasibility analysts should consider when studying proposed hotel development or acquisition in markets dominated by a university. Significant predictors of lodging demand include city employment and population trends, as would be expected. Interestingly, university grant funding and graduate student population also should be considered by feasibility analysts because of their strong predictive capability. The results of this study may be generalizable for analysts evaluating university-related lodging demand in general, not just in university towns. [ABSTRACT FROM AUTHOR]

To date, cellulosic ethanol production has not been commercialized in the United States. However, government mandates aimed at increasing second-generation biofuel production could spur exploratory development in the cellulosic ethanol industry. We conducted an in-depth analysis of the fuelshed surrounding a starch-based ethanol plant near York, Nebraska that has the potential for cellulosic ethanol production. To assess the feasibility of supplying adequate biomass for year-round cellulosic ethanol production from residual maize ( Zea mays) stover and bioenergy switchgrass ( Panicum virgatum) within a 40-km road network service area of the existing ethanol plant, we identified ∼14,000 ha of marginally productive cropland within the service area suitable for conversion from annual rowcrops to switchgrass and ∼132,000 ha of maize-enrolled cropland from which maize stover could be collected. Annual maize stover and switchgrass biomass supplies within the 40-km service area could range between 429,000 and 752,000 metric tons (mT). Approximately 140-250 million liters (l) of cellulosic ethanol could be produced, rivaling the current 208 million l annual starch-based ethanol production capacity of the plant. We conclude that sufficient quantities of biomass could be produced from maize stover and switchgrass near the plant to support year-round cellulosic ethanol production at current feedstock yields, sustainable removal rates and bioconversion efficiencies. Modifying existing starch-based ethanol plants in intensive agricultural fuelsheds could increase ethanol output, return marginally productive cropland to perennial vegetation, and remove maize stover from productive cropland to meet feedstock demand. [ABSTRACT FROM AUTHOR]

The cougar Puma concolor was part of the pre-European fauna of the north-eastern USA. It was extirpated in the late 1800s and since the late 1900s there have been discussions concerning its reintroduction to the region. One site considered is Adirondack State Park in northern New York. In 1981 an assessment of the feasibility of returning cougars concluded that the Park had adequate prey and forest cover to support a small population of cougars but that conflicts with humans would cause the demise of this population within 10 years. Thus reintroduction at that time was not advised. Since then knowledge of cougar ecology and how cougars interact with humans has increased substantially. Based on information compiled since the 1980s I conducted a landscape-scale analysis to assess whether cougars could live in the Park. The results indicate that cougars could occupy 15,300–17,000 km2 (61–69%) of the Park, with minimal contact with human habitation. Based on reported cougar densities the Park could support a population of 150–350 cougars. These cougars would consume < 10% of the adult deer population annually and fawn production would be sufficient to replace these losses. Human and road densities in the Park are similar to those of the Black Hills, South Dakota and southern Florida, both of which have viable populations of cougars. I concluded that Adirondack State Park could support a population of cougars. What is now required is the will to bring them back. [ABSTRACT FROM AUTHOR]

To assess the feasibility of conducting empirically supported family-based paediatric obesity group treatment via TeleMedicine. Seventeen families were randomly assigned to one of two conditions (physician visit, TeleMedicine). Measures included feasibility, satisfaction and intervention outcome measures such as BMI percentile, and nutrition and activity behaviours. Measures were completed at baseline, post-treatment and at 1-year follow-up. Analyses indicate that both feasibility and satisfaction data regarding the TeleMedicine intervention were positive. Intervention outcome indicates no change in BMI percentile or nutrition and activity behaviours for either treatment group. A behavioural family-based weight loss intervention delivered via TeleMedicine was well received by both parents and providers. Due to the small sample size, null findings regarding intervention outcome should be interpreted with caution. Future research should focus on methods to increase the impact of this intervention on key outcome variables. [ABSTRACT FROM AUTHOR]

Background: The Accreditation Council for Graduate Medical Education requires that residency programs have an effective plan for assessing their residents' competence. Current evaluation tools used for the assessment of operative competency are subjective, recall based, and do not allow providing formative feedback to the resident. The purpose of this study was to evaluate the feasibility and validity of video-based assessment of endoscopic sinus surgery (ESS) skills. Methods: Five junior (postgraduate year levels 1-3[PGY-1 to -3]) and three senior (PGY-4 and -5) residents were videotaped as they performed ESS on cadavers in the laboratory. Five faculty members watched the recorded videotapes and rated performance using global and checklist assessment tools for ESS. Evaluators were blinded to the identity of the performers. Rating was made feasible by allowing the raters to fast-forward through the tapes when appropriate. Construct validity was calculated by comparing total scores and score on each item of the instrument across the training levels. For all statistical purposes p < 0.05 was considered significant. Results: Results showed construct validity with senior residents performing better than junior residents. It took an average of 20 minutes (range, 7- 39 minutes) to watch and evaluate a video. Interrater reliability, as measured by interclass correlation coefficient across evaluators, was 0.62. Conclusion: The use of videotapes combined with the objective assessment tool is a feasible and valid method for evaluating surgical skills. It has implications for residency programs, because it will increase faculty buy-in and reduce the potential for biased assessment. [ABSTRACT FROM AUTHOR]

Patients at a comprehensive cancer center have participated in a weekly writing program for 7 years. Anecdotal evidence following writing in this clinical setting appeared congruent with the results of expressive writing studies conducted in laboratory settings. To move expressive writing research beyond the laboratory, we evaluated the feasibility of engaging a clinical population in a structured expressive writing task while they waited for an appointment in a cancer clinic. Adult leukemia and lymphoma patients (n = 71) completed a baseline assessment, 20-minute writing task, postwriting assessment, and 3-week follow-up; 88% completed the writing task and 56% completed the follow-up. Participants reported positive responses to the writing, and immediately postwriting about half (49.1%) reported that writing resulted in changes in their thoughts about their illness, while 53.8% reported changes in their thoughts at the 3-week follow-up. Reports of changes in thoughts about illness immediately postwriting were significantly associated with better physical quality of life at follow-up, controlling for baseline quality of life. Initial qualitative analyses of the texts identified themes related to experiences of positive change/transformation following a cancer diagnosis. Findings support the feasibility of conducting expressive writing with a clinical population in a nonlaboratory setting. Cancer patients were receptive to expressive writing and reported changes in the way they thought about their illness following writing. These preliminary findings indicate that a single, brief writing exercise is related to cancer patients' reports of improved quality of life. [ABSTRACT FROM AUTHOR]

The practical application of field or natural leaching to rice straw was evaluated with the goal of improving biomass fuel value. Observations on three rice farms in the Sacramento Valley, California indicated that potassium, chlorine and total ash are leached from rice straw by rainfall regardless of rice variety, grain harvest method, straw arrangement, or stubble length. Leaching of sulfur by natural precipitation was not clearly established. In selected field plots leached straw was successfully collected in spring, even though biomass yields were variable (2.2–3.4 Mg ha−1) and equipment had to operate in difficult conditions. Total costs for collecting leached straw on an area basis ($77.07 ha−1) are 31% higher compared to collecting crude straw in the fall ($58.67 ha−1), due to reduced performance of machinery and addition of field curing operations. Analysis of historical rainfall data for the Sacramento Valley revealed that there is an 85% probability of receiving sufficient rainfall (250 mm or more) for substantial natural leaching of straw during the winter period. The available period for mechanized collection of rice straw after the winter period ranges from 0 to 45 days, depending on drying time needed to accomplish favorable field conditions, and planting date of the next crop. The feasibility of spring collection of rice straw could be improved if straw collection equipment were better equipped to operate under wet field conditions. The commercial implementation of natural leaching of rice straw as a strategy to improve fuel quality depends on a combination of factors that include grain harvest and straw collection practices, rainfall intensity and distribution, and field-specific factors. [Copyright &y& Elsevier]

This paper studies the necessity of the current legislation on the supervision of medical devices in China from the perspectives of strengthening administration according to law, protecting public health, perfecting the legal system of medicine and promoting the development of the medical device industry. This study analyzes and summarizes the legislative experiences and forms in the field of medical device regulation in the United States, the European Union, Japan and other countries and regions, at present, the conditions of carrying out the legislation of medical device supervision in China are quite mature, and some policy suggestions are put forward for the enactment of the law of medical device management in China .

Background: Telenovelas show significant promise as a mode of education that could potentially enhance hospice family caregivers' (HFCG) ability to manage distress or pain for themselves and the care recipient. Objectives: We sought to understand HFCGs' perceived benefits and challenges of NOVELA using the Levels of Kirkpatrick as a conceptual framework. Setting/Subjects: HFCGs from two hospices in the Mid-Atlantic region of the United States. Measurements: Semistructured interviews were conducted to understand perceptions of HFCGs on the benefits and challenges of the NOVELA intervention. Results: Participants ( N  = 20) in our study were mainly homebound, well educated, White female, and adult children of people with advanced cancer who reported mild anxiety and moderate self-efficacy at baseline. Three unique themes were identified: acceptability of NOVELA, usability and relevance of NOVELA, and the effect of NOVELA. According to our conceptual model, the intervention positively affects all three adult learning categories: reaction, learning, and behavior. Conclusion: Our findings suggest that HFCGs support the proposed NOVELA intervention and it appears to be an acceptable educational tool during hospice care (NCT04533594).

Introduction: Few evidence-based options exist for outpatient treatment of patients at risk of suicide, and to-date almost all research has focused on individually delivered psychotherapy. Group therapy for veterans at risk of suicide is a promising alternative., Methods: Thirty veterans receiving care at an urban Veterans Affairs Medical Center in the southern United States were randomized to either care as usual (CAU) or to CAU plus the Collaborative Assessment and Management of Suicide-Group (CAMS-G). Veterans were assessed prior to randomization to condition and at 1, 3, and 6 months post-randomization on a range of suicide-specific measures, burdensomeness, belonging, treatment satisfaction, and group cohesion., Results: Across measures and follow-up assessments, veterans in CAMS-G reported good satisfaction with the intervention, a sense of cohesion with other members of the group, and reduced symptom distress. Veterans in both conditions reported decreases in suicidal ideation and behavior, with CAMS-G participants potentially improving slightly faster., Conclusion: This description of CAMS-G for veterans adds to the growing literature on suicide-specific interventions and supports the need for additional research to determine if wide-spread rollout is justifiable., (© 2021 The American Association of Suicidology. This article has been contributed to by US Government employees and their work is in the public domain in the USA.)

• Social stress and social support were assessed in an epilepsy cannabidiol trial cohort. • Economic stressors were associated with poor overall health. • Patients who experienced stress/stressors reported more social support. • Refinements to social data protocols for participants in cannabidiol trials are needed. Cannabidiol (CBD) trials offer an opportunity to examine social factors that shape outcomes of patients with treatment-resistant epilepsy. Prior research of patients treated with CBD for epilepsy describes financial struggles of these patients/families and the association between socioeconomic status and patient-centered outcomes. However, social determinants of health in this population are still poorly understood, mainly due to data scarcity. This study aimed to establish feasibility of assessing social stress, social support, and religious participation and their associations with outcomes (perceived health, quality of life, and mood) in patients treated with CBD for epilepsy. Data were collected during 2015–2018 through structured face-to face interviews with patients/caregivers in a CBD compassionate access/research program in the southern United States. Adult (ages 19–63; n = 65) and pediatric (ages 8–19; n = 46) patients or their caregivers were interviewed at the time of enrollment in the study. Social stress was assessed with stressful life events, perceived stress, epilepsy-related discrimination, and economic stressors; social support with the Interpersonal Support Evaluation List [ISEL]-12; and religious participation with frequency of religious attendance. The results showed economic stressors to be associated with poor overall health, but no associations were noted between stress, support, and religious participation measures and quality of life or mood. Despite a robust data collection plan, completeness of the data was mixed. We discuss lessons learned and directions for future research and identify potential refinements to social data collection in people with treatment-resistant epilepsy during clinical trials. [ABSTRACT FROM AUTHOR]

Background: Type 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management., Objective: The aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A 1c (HbA 1c ) levels, diabetes care adherence, and quality of life, and (2) the adolescents' overall satisfaction with this intervention., Methods: This pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA 1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses., Results: The final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t 21 =-2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t 24 =2.48, P=.01, d=0.32). HbA 1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t 24 =0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t 23 =0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA 1c levels (F 1,20 =9.74, P<.005; R 2 =0.33). Overall, the adolescents were satisfied with the app intervention., Conclusions: In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects., Trial Registration: ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628., (©Bree Holtz, Katharine M Mitchell, Amanda J Holmstrom, Shelia R Cotten, Julie K Dunneback, Jose Jimenez-Vega, Deborah A Ellis, Michael A Wood. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 14.09.2021.)

In determining whether a new permissible exposure limit is technologically feasible, the Occupational Safety and Health Administration (OSHA) and various courts have used poorly defined criteria such as whether "most employers most of the time" are able to comply with a standard. This vague definition creates problems when employers try to determine the best way to protect their workers and estimate the costs to remain in compliance with the permissible exposure limit. This article proposes a more rigorous approach to determine feasibility. By utilizing the best available statistical methods, employers and rule makers can better understand the variability within existing exposure data to determine the feasibility of new exposure limits. There are several readily available statistical tools that can be used for this purpose. To illustrate these techniques, a subset of data from the foundry industry and analysis from the OSHA respirable crystalline silica rulemaking proceeding are compared to methods published by the National Institute for Occupational Safety and Health in 1977 and a more sophisticated Bayesian approach. The results of this analysis suggest that complying with a new permissible exposure limit is more challenging than what is implied by OSHA's analysis, and calls into question its method of determining compliance. In the same vein, OSHA should move away from assessing compliance based on individual measurements and instead use a statistical approach to determine if a workplace is in compliance. These changes will encourage employers to better characterize occupational exposures, and will ultimately lead to better protection for employees while also providing employers protection from violations due to one-off overexposures.

A growing number of studies within the field of gerontology have included samples recruited from Amazon's Mechanical Turk (MTurk), an online crowdsourcing portal. While some research has examined how younger adult participants recruited through other means may differ from those recruited using MTurk, little work has addressed this question with older adults specifically. In the present study, we examined how older adults recruited via MTurk might differ from those recruited via a national probability sample, the Health and Retirement Study (HRS), on a battery of outcomes related to health and cognition. Using a Latin-square design, we examined the relationship between recruitment time, remuneration amount, and measures of cognitive functioning. We found substantial differences between our MTurk sample and the participants within the HRS, most notably within measures of verbal fluency and analogical reasoning. Additionally, remuneration amount was related to differences in time to complete recruitment, particularly at the lowest remuneration level, where recruitment completion required between 138 and 485 additional hours. While the general consensus has been that MTurk samples are a reasonable proxy for the larger population, this work suggests that researchers should be wary of overgeneralizing research conducted with older adults recruited through this portal.

Background: The water method decreases patient discomfort and sedation requirement. Applicability in non-veteran community settings in the United states (U.S.) has not been reported. Aims: Our aim is to perform a pilot study to establish feasibility of use the water method at 2 community sites. We tested the hypothesis that compared with air insufflation patients examined with the water method would require less sedation without adverse impact on outcomes. Methods: Two performance improvement projects were carried out. consecutive patients who consented to respond to a questionnaire after colonoscopy were enrolled. project 1: The design was single-blinded (patient only); quasi-randomized -- odd days (water), even days (air). colonoscopy was performed by a staff attending. project 2: a supervised trainee performed the reported procedures. In both, patient demographics (age, gender and body mass index), amount of sedation required during colonoscopy and procedure-related variables were recorded. The patients completed a questionnaire that enquired about discomfort during colonoscopy and willingness to repeat the procedure within 24 hours after the procedure. Results: project 1: significantly lower doses of fentanyl and midazolam were used and a higher adenoma detection rate (ADR) was demonstrated in the water group. project 2: 100% cecal intubation rate was achieved by the supervised trainee. Conclusion: This is the first pilot report in the U.S. documenting feasibility of the water method as the principal modality to aid colonoscope insertion in both male and female community patients. In a head-to-head comparison, significant reduction of sedation requirement is confirmed as hypothesized. No adverse impact on outcomes was noted. [ABSTRACT FROM AUTHOR]