bluuebunny/crossref_metadata_2025 huggingface dataset:
207 ’You can get that on a treadmill, but it’s just not the same kind of thing’. Experiences of VI parkrunners in local green spaces
Authors: Ryan Joan
Published: September 2024

Purpose

Access to green spaces is acknowledged to benefit health and wellbeing, but people who are vision impaired (VI) have poorer access both to green spaces and to physical activity. This presentation will explore the experiences of VI participants at parkrun, a mainstream community led 5km event which takes place outdoors.

Methods

This research is part of a wider qualitative study on the experiences of VI participants at parkrun in Ireland. Nine semi structured interviews were carried out on adults with VI who participated at parkrun. Thematic analysis on the data was carried out using the processes of Braun and Clarke.

Results

Participants attributed experiences of being outside in nature to feelings of improved wellbeing, both in terms of their biological health but also improved psychosocial wellbeing and rehabilitation. Being outside in nature, with facilitation and social interaction provided by volunteer sighted guides and fellow parkrunners, was found to enhance the experience of physical activity and the individual agency of the participants.

Discussion

People who are VI face barriers to physical activity in general but also in accessing nature. In addition to the restrictions placed on them by their VI, ableist cultural assumptions of who is welcomed into nature act as further barriers. Participation in the events enhanced the individual agency of the VI participants whereby they could easily access physical activity opportunities in nature and they were incentivised to continue to do so.

Conclusion

This research demonstrates the value VI participants at parkrun placed on their access to physical activity in local green spaces. It demonstrates how a volunteer led community initiative enhanced health and wellbeing for VI participants by prioritising their inclusion in their mainstream outdoor events.

Support

This research is part of a PhD studentship at TU Dublin. Financial Assistance in the form of fees was provided by Topcon and Vision Sports Ireland.
35 Associations between transport modes and site-specific cancers: A Systematic review and meta-analysis
Authors: Thu Win , Woodward Alistair , Cavadino Alana , Tin Sandar Tin
Published: September 2024

Purpose

Transport choices may influence cancer risks through their effects on physical activity levels, sedentary time, and environmental pollution. This review synthesizes existing evidence on the associations of specific transport modes with risks of site-specific cancers.

Methods

Relevant literature was searched up to 17th February 2023 in PubMed, Embase, and Scopus, and results were meta-analyzed for cancer sites where two or more studies were identified.

Results

27 eligible studies (11 cohort, 15 case-control, and 1 case-cohort) were identified, which reported the associations with 10 site-specific cancers (breast, endometrial, colorectal, testicular, prostate, ovarian, lung, renal, liver, gallbladder and biliary tract). In meta-analysis, 10 Metabolic Equivalent of Task hour increment in transport-related physical activity per week (∼ 150 minutes of walking or 90 minutes of cycling for commute) was associated with a 7% reduction in risk for endometrial cancer (95% CI: 0.89 – 0.98), 5% reduction for colorectal cancer (95% CI: 0.91 – 0.99) and 2% reduction for breast cancer (95% CI: 0.89 – 0.996). Compared to motorized modes, cycling was associated with a lower risk of overall cancer incidence and mortality.

Conclusion

Active transport appears to reduce cancer risk, but evidence for cancer sites other than colorectum, breast, and endometrium is currently limited.
179 Physical activity and physical function in survivors of critical illness after hospital discharge: A prospective, observational study
Authors: Costley Jill , Wilson Jason , Green Natasha , Bradley Judy , McAuley Danny , Blackwood Bronagh , O’neill Brenda
Published: September 2024

Purpose

Survivors of critical illness often experience persistent physical, functional and/or cognitive impairments (i.e. Post-Intensive Care Syndrome). Currently, there is very limited rehabilitation provided as part of standard care for this population. Evaluation of physical activity (PA) and function, and the feasibility of collecting data, specifically in people after critical illness could provide insights into their activity levels after critical illness. The aim was to assess and describe PA and function in the year following hospital discharge in patients who have been mechanically ventilated in intensive care.

Methods

A prospective, observational study. (Ethical approval/REC Reference: 17/N1/0115). Patients discharged from hospital following intensive care unit (ICU) admission were invited to attend up to four assessments: within 2 weeks, 6 weeks, 6 months and 1 year, following hospital discharge. Seven-day accelerometer-based PA (daily step count), modified shuttle walk test (MSWT) and handgrip strength (HGS) were assessed at each timepoint. Results were compared against research guidelines and normative data.

Results

Participants (n = 14) were: age: 53.9 ± 14.5 years; sex: 8 male/6 female; ICU length of stay: 9.00 days (IQR: 4.50 days); mechanical ventilation duration: 58.50hrs (IQR: 132.75hrs); Acute Physiologic Chronic Health Evaluation: 15.36 ± 8.51. There were several challenges with data collection e.g. participants using mobility aids could not perform MSWT. Participants performed below research guidelines/normative values for mean daily steps (763 – 7744 steps), MSWT (40 – 800m), and HGS (8 – 52kg) across the 12-month study period.

Conclusions

In the year following hospital discharge, PA and function varied among ICU survivors and remained low. Assessments using accelerometry and handgrip dynamometry were feasible. A more consistently administered test is needed to evaluate exercise capacity across the recovery continuum in this heterogenic population. These findings could be used to guide future development of personalised rehabilitation interventions and goal-setting in this population. Patients have also highlighted that they feel that the provision of physical rehabilitation could support their recovery.

Support/Funding Source

The Department of Employment and Learning with Seed Funding from the Northern Ireland Clinical Research Facility.
112 Promoting Physical Activity in Workplaces: The Integral Role of Well-being Management
Authors: Malvela Miia , Laakkonen Reetta , Aura Ossi , Hussi Tomi
Published: September 2024

Purpose

The primary purpose of the research was to find out how employers in Finland support physical activity at workplaces and how physical activity is related to the management of well-being at work. In the new government program in Finland, physical activity is integrated as a part of developing work ability and well-being at work.

Methods

The Adults on the Move program conducted the Finnish barometer on physical activity at workplaces. The research was carried out by interviewing 300 employers representing five industries and 1100 employees. The role of the management practices on activity of worksite physical activity was analyzed using regression analysis. Indicators were formed from the data.

Results

In the barometer, questions were related to physical activity as well as to the management of well-being at work. The basic decisions of well-being management are setting the goal, making the plan, and deciding the responsibility of the supervisors.

The results showed that the implementation of physical activity at workplaces is strongly linked to the quality of well-being management. When all three basic decisions of well-being management are implemented, the action to increase physical activity is carried out most effectively:

• Most diverse task-specific physical activity solutions are in use,

• Physical activity is taken into account in remote work,

• Physical activity suppors recovery,

• Physical activity is part of the cooperation with occupational health care,

• Physical activity is included in supervisor coaching and training and further in personnel development discussions.

Conclusions

The level of well-being management is thus related to the implementation and diversity of physical activity at workplaces. Basic management decisions were more commonly made in large organizations. The management of small and medium-sized companies needs training on physical activity and well-being at work, so that the means of physical activity for the personnel would be optimal and high-quality. In this way, work ability and well-being at work are increased through physical activity.

Funding

Adults on the Move Program, Ministry of Education and Culture.
159 Qualitative insights into the skills development, health outcomes, and school experience of adolescent peer-leaders of a physical activity programme in second level schools
Authors: McNally Kathleen , Murtagh Elaine , Ng Kwok , Grady Caera , Woods Catherine
Published: September 2024

Purpose

The Active School Flag (ASF) is a whole-of-school, physical activity (PA) programme in Ireland. At second level, student leadership is central to ASF, as adolescents aged 15–16 years in Transition Year (TY), are peer-leaders (PL) of ASF in their school. TY is a one-year programme unique to Ireland, that provides adolescents with skills and personal development opportunities. PLs receive leadership training and have a dedicated weekly class to plan the delivery of whole-of-school PA events and surveys. This study explored the impact on PL skills development, health outcomes, and school experience.

Methods

In April and May 2023, focus groups were conducted with PL (n = 33, 67% female) in eight schools during their second year of ASF. PL were asked about their experience of implementing ASF.

Data were analysed using reflexive thematic analysis informed by Braun and Clarke, (2019). Five themes and 29 subthemes were generated.

Results

Themes included: (1) Enhanced personal development through ASF, (2) ASF builds community in the school, (3) Value and recognition of ASF in the school community, (4) Without ASF school would be plainer, (5) PL experience of their participation in ASF.

Findings demonstrate the impact of key ASF intervention components on PL skills, health, and school experience. PL developed transferable skills including verbal and written communication (theme 1) through dissemination of whole-of-school survey results and sharing PA messages with school members. Shared leadership training supported PL to feel part of a group (theme 2) and facilitated a comfortable social and learning environment (theme 4). Attending ASF weekly timetabled class stimulated a positive mood among PL (theme 5). Although PL felt school members supported them (theme 3) during whole-of-school PA events, some PL experienced anxiety and frustration working with school members (theme 5).

Conclusions

Results provide valuable information to inform school staff and management how leading ASF can influence adolescents, including developing transferable skills, enhancing social and mental health, and supporting a positive school experience.

These insights highlight the potential impact of a whole-school PA programme on a broad range of outcomes, demonstrating the added value of student-led initiatives.

Funding Source

Mayo Education Centre, Healthy Ireland
S03 Including older adults in health enhancing physical activity: Learning lessons from implementing an evidence-based falls prevention intervention in different healthcare contexts and countries
Authors: Horgan Frances
Published: September 2024

The Falls Management Exercise program (FaME) is proven to reduce falls and their consequences, and increase habitual physical activity and independence up to two years post-intervention in older people at risk of falls. Many complex and interacting factors influence the availability and delivery of FaME, and its uptake and adherence by participants. Implementation studies in the UK have identified ways to increase the availability of FaME and have helped us identify its essential components for effectiveness, and the adaptable components to suit local needs. This symposium will take us through the journey from original trials, through large UK implementation studies, to the current Irish evaluation study, showing how lessons learned are being used to adapt FaME to local contexts and needs.

Project description

FaME was developed and tested in the 1990's, and its implementation in the UK has been explored more recently. FaME is not widely available, and when it is, the PhISICAl Implementation Study showed it is often shortened or missing key fidelity components (eg. retraining getting up from the floor or promoting home exercise). With local commissioners, Instructors, and participants, the FLEXi implementation study identified why commissioners support FaME, its delivery and cost, and strategies to sustain FaME's fidelity and quality.

Informed by these studies, we are now establishing and evaluating FaME in Ireland. Using early sites as case-studies, we aim to optimise reach and equity, maintain effectiveness and appropriateness, and find suitable physical activity options for people after FaME.

Conclusions

FaME improves physical activity for those where normally physical activity declines over time. The studies we will present will bring us from initial trials and intervention design, through to implementation of FaME fitting within local contexts and needs. It will show how FaME impacts habitual physical activity and independence while adapting to local priorities and service contexts.
S03-2: Lessons learned about the implementation and scalability of Fame in the UK
Authors: Orton Elizabeth , Skelton Dawn , Ventre Jodi P , Manning Fay , Mahmoud Aseel
Published: September 2024

Purpose: Whilst trials have shown that FaME can reduce falls and increase physical activity, it is still not routinely available across the UK. Where it is available, it is often adapted, though the impact of adaptations has not been described. The conditions necessary for FaME’s spread are not well understood. We undertook two studies that examined ‘real world' commissioning and delivery of FaME. The PhISICAl study described its effectiveness and fidelity in ethnically and geographically diverse populations, and the FLEXi study identified factors important for its spread and adoption in different commissioning landscapes, and important mechanisms for quality maintenance.

In the PhISICAl study (n = 361) FaME was associated with improvements in balance confidence (Confbal p < 0.001), fear of falling (FES-I p < 0.001), Functional Reach (p < 0.001), Turn 180o (p = 0.008) and Timed Up and Go (TUG p < 0.001) at the end of the programme versus baseline. However, improvements were not maintained at 6 months after programme completion (follow-up). Total minutes of moderate to vigorous physical activity per week was significantly higher at follow-up versus baseline (median 46 minutes, 95% CI 0-161, p = 0.047) and there was a non-significant reduction in falls at the end of FaME versus baseline (IRR 0.76, 95% CI 0.48-1.21). Up to 78% of fidelity and 84% of quality criteria were met.

In the FLEXI study (n = 596), univariate analyses showed significant improvements in Confbal (p < 0.001), falls (in the previous 3 months, p < 0.001) and TUG (p < 0.001) at programme completion vs baseline. Participants also reported wellbeing benefits and valued social opportunities. Programmes varied in duration and aspects of delivery and newer programmes or those with quality assurance systems in place showed higher fidelity and quality. A national community of practice forum was used to help improve programme fidelity and quality. Factors important for the spread and adoption of FaME included its perceived fit with decision-makers, their own personal experiences and the strength of its evidence base.

Learning has led to the development and refinement of an implementation toolkit for FaME and the establishment of a new implementation body – the National FaME Implementation Team (N-FIT) which supports the spread and implementation of FaME across the UK.
S09-1: The Experiences of People with Disabilities in Sport & Physical Activity
Authors: Purcell Robert
Published: September 2024

Purpose

In April 2022, over 1.1 million people reported having experienced at least one long-lasting condition or disability (Census, 2022). Research has highlighted that people with disabilities in Ireland are far less likely to be active than those without a disability with a difference of 28% vs 48% playing sport on a regular basis (Irish Sports Monitor (ISM), 2022). This difference is also apparent in children, the Children’s Sport Participation and Physical Activity Study (CSPPA, 2022) reported that primary school children with disabilities are less likely to meet physical activity guidelines than those without a disability (15% vs 24%). Additionally, there were significantly lower rates of overall community and school sport participation amongst students with disabilities (primary: 92%, post-primary: 77%) compared to those without disabilities (primary: 97%; post-primary: 87%).

Methods

To understand this difference, Active Disability Ireland undertook research to explore the lived experience of youths with disabilities, and their parents/guardians, regarding physical activity. The consultation involved a phenomenological approach utilising a mixed methodology of surveys and semi-structured interviews with the goal of opening discussion spaces for youths with disabilities and their guardians to share their experiences, challenges and needs in leading active and healthy lifestyles. Participants were invited to be part of a youth forum to continue providing valuable insights.

Results

Our results suggest that for young people with disabilities, physical activity is seen as particularly important as well as enjoyable. However, only 27 % agreed that they find it easy to take part in physical activity. A lack of opportunities, a lack of self-confidence and having no-one to take part with were commonly cited as major barriers to participation. Parents/guardians also expressed difficulties such as a lack of suitable places or facilities, a lack of support/understanding from people working in the sector and a worry about their child not being able to take part.

Conclusions

Programmes and policies to address the barriers found in this study may address current inequalities and contribute to reducing the disability gradient in sports participation.

Support/Funding Source

Active Disability Ireland, Sport Ireland
S10-3: Promoting biking in secondary schools – evaluating the bikepool project
Authors: Abu-Omar Karim , Fleuren Tobias , Till Maike , Sommer Raluca , Ziemainz Heiko
Published: September 2024

Purpose

Teaching children and adolescents how to bike safely in traffic is a key skill that supports active mobility and contributes to decarbonizing the transport sector. Within the paradigm of transformative science, it is important to focus efforts on supporting practice-based projects that operate well in real-live, but lack scientific evaluation of their potential effectiveness.

Bikepool, a project that evolved out of practice, is run by a volunteer organization and has been scaled to over 166 schools in the past 12 years. Despite its success, there has been no assessment of its potential effects on pupils, teachers, and the school environment. This presentation highlights an evaluation study set to begin in mid-2024.

Methods

The planned evaluation study uses a mixed method approach and builds on the methodology of co-production and participation. Qualitative interviews with teachers will be conducted in 15 schools. Pupils will take part in designing the evaluation. A quantitative survey will assess the potential effects of bikepool in all schools.

Results

Bikepool provides schools with bikes, safety equipment, a bike repair shop, and vocational training for teachers. The project’s evaluation, grounded in transformative science, follows three phases: (1) understanding the project and mutual learning between researchers and project staff, (2) co-creating an evaluation plan with project staff and pupils, and (3) collecting and analyzing data. Researchers will support the project in optimizing its work and identifying ways to scale the project to additional schools.

Conclusion

Practice-based projects demonstrating real-live applicability and a high reach offer an excellent opportunity for transformative science. Supporting such projects to assess and optimize their effectiveness and help them scale can increase their public health impact. At the same time, the paradigm of transformative science is still evolving and practical experience on how to make use of it is still lacking.

Funding

The project is funded by Verein der Freunde und Förderer des Bikepool Hessen e.V.
S14 Physical activity promotion in healthcare settings: Designing and implementing physical activity referral schemes
Authors: Geidl Wolfgang , Stoutenberg Mark
Published: September 2024

Purpose

This symposium will share findings, expertise and experiences from different countries on the design and implementation of physical activity referral schemes (PARS).

Description

Physical activity promotion by healthcare professionals is a key strategy to increase population physical activity levels. This strategy has been outlined in the World Health Organisation’s (WHO) ‘Global Action Plan on Physical Activity’ (GAPPA) and the ‘Physical activity strategy for the WHO European Region 2016-2025‘. PARS are a promising intervention that allow healthcare professionals to advocate for physical activity and integrate its promotion into routine clinical care.

PARS are a heterogeneous group of interventions. Simpler PARS, for example, may consist only of a written description, while more complex PARS might include different healthcare professionals working together systematically, applying several behaviour change techniques in combination with physical activity practice, to connect patients to community resources. There is currently no consensus on the optimal PARS approach and implementation strategies. Implementers need specific knowledge, skills and methods; however, implementation is also influenced by structural and context-related factors in the healthcare system. Accordingly, a successful implementation of PARS needs co-productive capacity building within healthcare systems and proper support for healthcare professionals.

The symposium includes four contributions (3 research-oriented and 1 practise-oriented) related to the design and implementation of PARS in different countries.

 1) EUPAP Feasibility Study. Practice transfer of a HEPA prescription model to other nine EU countries. From theory to practice. Sebastià Mas-Alòs

 2) The association of physical activity referral scheme’ components with physical activity level, scheme uptake and adherence rates: a systematic review, meta-analysis with meta-regression. Wolfgang Geidl

 3) The adoption and implementation of a physical activity referral pathway integrated into a major U.S. health system. Mark Stoutenberg

 4) Designing a physical activity pathway in healthcare model for Irish Health Services. Sarah O’Brien

This symposium will provide guidance on the development of PARS and future successful implementation in other healthcare settings.
Health-Related Quality of Life Outcomes With Etrasimod Treatment in Patients With Ulcerative Colitis: A Post Hoc Analysis of Data From ELEVATE UC 52 and ELEVATE UC 12
Authors: Armuzzi Alessandro , Rubin David T , Schreiber Stefan , Panés Julian , Fellmann Marc , Bartolome Lauren , Gruben David , Goetsch Martina , Bhattacharjee Abhishek , Chaparro María , Dubinsky Marla C
Published: September 2024

Background

Etrasimod is an oral, once-daily (QD), selective sphingosine 1-phosphate1,4,5 receptor modulator for the treatment of moderately to severely active ulcerative colitis (UC). Here, we evaluate the impact of etrasimod 2 mg QD on health-related quality of life (HRQoL) in patients with UC.

Methods

This post hoc analysis used data from the Phase 3 randomized controlled trials, ELEVATE UC 52 and ELEVATE UC 12. HRQoL measures included: Inflammatory Bowel Disease Questionnaire (IBDQ), 36-Item Short Form Survey (SF-36), and Work Productivity and Activity Impairment Questionnaire: Ulcerative Colitis (WPAI:UC) completed at baseline, Week 12 (both trials), and Week 52 (ELEVATE UC 52 only). For IBDQ analyses, patients were stratified by prior exposure to biologics/Janus kinase inhibitors (JAKi) and baseline modified Mayo score (MMS; 4-6 or 7-9).

Results

Generally, significantly greater proportions of patients receiving etrasimod (N = 527) vs placebo (N = 260) achieved IBDQ remission (IBDQ total score ≥170) and IBDQ response (IBDQ total score increase from baseline ≥16), with significant improvement in all IBDQ domain scores at Week 12 and maintained through Week 52. Significant differences in IBDQ remission and IBDQ response rates between etrasimod and placebo were more consistent among biologic/JAKi-naive patients vs those who were biologic/JAKi-experienced and in those with baseline MMS 7-9 vs 4-6. Significant improvements were observed in several SF-36 domain and summary scores and WPAI:UC domain scores at Week 12 and Week 52.

Conclusions

Etrasimod 2 mg QD demonstrated significant and clinically meaningful improvements across multiple HRQoL measures, including WPAI, vs placebo.

Clinical Trial Registration

ClinicalTrials.gov: NCT03945188; NCT03996369
Dietary curcumin supplementation enhances growth performance and anti-inflammatory functions by modulating gut microbiota, microbiota-derived metabolites, and expression of inflammation-related genes in broilers
Authors: Chen Xinyu , Li Fei , Xu Xingyu , Wang Lijun , Yu Yichen , Yan Jie , Shan Xuemei , Zhang Rui , Xing Hua , Zhang Tangjie , Du Min , Pan Shifeng
Published: September 2024

Curcumin (CUR) is a natural polyphenolic substance that has been widely used since ancient times for its multiple beneficial functions. However, whether CUR affects the growth performance of broilers by altering gut microbiota and metabolite and the underlying mechanism are largely unknown. This study was conducted to evaluate the effect of dietary CUR supplementation on growth performance, anti-inflammatory function, intestinal morphology and barrier, cecum microbiota, and metabolite profile of broilers. Sixty-one-day-old male broilers were randomly divided into the control group (CON, fed a control diet) and the CUR group (fed a control diet supplemented with 200 mg/kg CUR) after 2 d of adaptation. Results showed that after feeding to 52-d-old, compared with CON broilers, the CUR broilers showed improved feed utilization efficiency and growth performance. Furthermore, the CUR broilers showed an improved intestinal morphology, which was demonstrated by a lower crypt depth in the jejunum. The 16S rRNA gene sequencing and non-targeted metabonomics (LC-MS/MS) analysis results showed that the cecum microbiota ecology and function were significantly improved, and the abundance of beneficial flora and metabolites were increased, while the harmful bacteria and metabolites were significantly decreased. In addition, RT-qPCR results showed that CUR significantly reduced inflammatory responses, promoted the formation of the mucosal barrier and enhanced digestion, absorption, and transport of lipids and glucose-related gene expression in the intestine. These above findings demonstrated that dietary CUR supplementation improved growth performance, intestinal morphology, and anti-inflammatory functions, mainly by manipulating cecum microbiota and microbiota-derived metabolites, which provides a credible explanation for the growth-promoting effect and anti-inflammatory functions of CUR and aids our understanding of the mechanisms underlying.
Evaluating sampling techniques for quantifying Asiatic garden beetle (Maladera formosae) (Coleoptera: Scarabaeidae) infestations in commercial mint
Authors: Sturr Connor E , Richmond Douglas S , Long Elizabeth Y
Published: September 2024

The Asiatic garden beetle, Maladera formosae Brenske (AGB), has become a significant pest of commercial mint fields in northern Indiana. Larval feeding on mint roots can cause stunted growth and plant death when densities are high. Sampling approaches that provide reliable estimates of larval densities in mint have not been established, leaving farmers without the knowledge necessary to implement integrated pest management (IPM) strategies. To address this knowledge gap, we evaluated strategies for estimating AGB larval densities and plant performance in commercial mint systems. We used 2 sampling methods to collect larval density and plant performance data from 3 mint fields and conducted simulations to optimize sampling intensity (accuracy and precision) and sampling scheme (random vs. systematic) using these data. Additionally, we examined the sensitivity and efficiency of each sampling method. Compared to the cup-cutter method, the quadrat method provided the most accurate and precise estimates of larval density and plant performance, with ≤ 7 samples required per 0.2 ha. Quadrat excavation was also more sensitive, increasing the probability of detecting AGB larvae within a 32 m2 plot by 76.7%, and requiring significantly less time to survey an equivalent volume of soil for AGB larvae. When the quadrat method was employed, random sampling schemes provided below-ground biomass estimates that were significantly closer to the true mean of the sampling area. The results of this research will facilitate the development of IPM decision-making tools for farmers and support future research for AGB and other soil insect pests affecting mint production.
Disparities in the availability of and access to neuro-oncology trial-supporting infrastructure in the United States
Authors: Kim Yeonju , Armstrong Terri S , Gilbert Mark R , Celiku Orieta
Published: September 2024

We conducted an extensive assessment and quantification of the reach of the oncology clinical trial-supporting infrastructure in the United States. Although our primary focus was on identifying avenues to expand the reach of neuro-oncology clinical trials, we considered infrastructure layers with important implications for broader cancer research and care. Specifically, we examined the geographic, population, and socioeconomic reach of national collaboratives (including more than 1500 institutions); more than 600 academic oncology and neurosurgery training programs; and networks of more than 25 000 individual neuro-oncology, neurosurgery, and general oncology (including hematology, medical, and gynecological oncology; surgical oncology; and radiation oncology) clinicians. Our study found that more than 57% of the US population lacks direct access to trial-supporting infrastructure. More than 71% of the locations with infrastructure are urban, and more than 72% are in socioeconomically advantaged areas. Our findings reveal critical disparities in oncology care access, and we suggest actionable strategies to optimize and expand the existing infrastructure’s reach.
A logical characterization of constant-depth circuits over the reals
Authors: Barlag Timon , Vollmer Heribert
Published: September 2024

In the eighties, Immerman showed that the class of languages definable by first-order formulae coincides with the class of languages decidable by unbounded fan-in Boolean circuits of constant depth and polynomial size. We show an analogous result for real-valued computation, i.e. we define circuits of unbounded fan-in operating over real numbers and show that families of such circuits of polynomial size and constant depth decide exactly those sets of vectors of reals that can be defined in first-order logic on real valued structures. Our characterization holds both non-uniformly as well as for many natural uniformity conditions.
Explanatory Methods in Psychiatry
Authors: Aftab Awais , McHugh Paul R.
Published: September 2024

Paul R. McHugh, MD, is University Distinguished Service Professor of Psychiatry at Johns Hopkins University School of Medicine. He was Henry Phipps Professor and Director of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and Psychiatrist-in-Chief at Johns Hopkins Hospital for 26 years. He is also inaugural Director of the Paul R. McHugh Program for Human Flourishing. He is the author of many books, most popularly of The Perspectives of Psychiatry (co-written with Phillip Slavney; Johns Hopkins University Press, 1998), which presents a conceptual framework for the proper evaluation and understanding of psychiatric disorders. Building on the philosophical work of forerunners such as Adolf Meyer and Karl Jaspers, the Perspectives approach identifies four explanatory methods underlying the practice of the profession: the perspectives of disease, dimensions, behaviours, and life stories. We explore these ideas and their continued relevance in this interview.
Global Psychiatry’s Crisis of Values
Authors: Aftab Awais , Pūras Dainius
Published: September 2024

Dainius Pūras, MD, is a Lithuanian psychiatrist and human rights advocate. He is Professor of Child and Adolescent Psychiatry and Public Mental Health at Vilnius University, Lithuania. He served as the United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of health from 2014 to 2020. Pūras has campaigned for more than 30 years to reform public health policies and services for individuals with mental health conditions, disabilities, and other vulnerable groups. His reports to the UN as Special Rapporteur have criticized the excessive systemic reliance on biomedical approaches and coercive practices in psychiatry across the world, advocating for a much-needed emphasis on approaches based on public health and human rights. This interview discusses human rights and public health approaches in psychiatry, coercive practices in medicine, the significance of service user movement, and the challenges facing global mental health.
Uniportal, Percutaneous Microdiscectomy with Annulo-nucleoplasty
Authors: Eldon Erica R. , Hunter Corey W.
Published: September 2024

Low back pain resulting from degenerative disk disease or contained lumbar disk herniation (CLDH) is challenging and may require surgical intervention to resolve. Percutaneous microdiscectomy with or without annulo-nucleoplasty is a minimally invasive method for reducing CLDH. This chapter presents uniportal, percutaneous microdiscectomy with annulo-nucleoplasty using the Disc-FX® System (Elliquence®, Baldwin, NY). The technique has been shown to reduce postoperative complications, to reduce hospital stay, and to lead to shorter rehabilitation and early return to work, and therefore to reduce the cost of treatment. The chapter reviews the relevant anatomy, pathology, efficacy, and detailed instruction for percutaneous microdiscectomy with annulo-nucleoplasty using the Disc-FX® System.
Minimally Invasive Posterior Lumbar Fusion—A New Approach to a Standard Procedure
Authors: Myers Behnam , Abd-Elsayed Alaa
Published: September 2024

For decades, posterolateral fusion has been one of the most common spine procedures for treating debilitating pain. Early versions of the procedure date back to over a century ago, but since then there have been innovations in the technology for, and approach to, the procedure. Up until recently, the procedure was only performed in an open approach, which requires a large incision and extensive dissection, along with significant soft tissue debridement. Advances in surgical devices now allow for posterolateral fusion to be completed quickly and effectively through a minimally invasive approach. Physicians can now offer patients a less invasive surgical solution with minimal blood loss, less scarring, and decreased healing time. The procedure may be performed in either a hospital or a surgery center setting, and patients can be discharged the same day.
Spinal Tumor Ablation
Authors: Sack Andrew , Sukumaran Harry
Published: September 2024

Spinal tumor ablation using radiofrequency energy is a minimally invasive procedure for the treatment of painful vertebral tumors. It has several advantages over external beam radiation therapy, especially the opportunity to perform simultaneous vertebral augmentation when pathologic vertebral fracture is present. This chapter reviews evidence demonstrating the procedure’s safety and efficacy. The technique and commonly used equipment are also discussed.
Sacroiliac Joint Fusion—Lateral Approach
Authors: Falowski Steven M.
Published: September 2024

The sacroiliac joint (SIJ) has been estimated to contribute to pain in as many as 38% of cases of low back pain. A lateral or posterior/posterior oblique approach to surgical sacroiliac joint fixation is supported by the literature. Level 1 evidence is very supportive of minimally invasive lateral options for improving pain and function and maintaining a low adverse event profile in the treatment of the SIJ.
Percutaneous Spinal Cord Stimulator Trial
Authors: Potere Bethany , Hussain Nasir , Deer Timothy , Abd-Elsayed Alaa
Published: September 2024

Spinal cord stimulation (SCS) is an emerging treatment for chronic pain patients who have failed conservative therapies. SCS applies the gate control theory to modulate pain signals in the dorsal spinal cord. SCS is best used for patients with persistent back pain, chronic regional pain syndrome, and limb ischemia, in whom it has been demonstrated to lead to improved pain control and improvement in quality of life. Prior to permanent stimulator implantation, a trial is performed under fluoroscopic guidance. This chapter highlights the indications, procedure, evidence, and postoperative management of patients undergoing spinal cord stimulator trial placement.
Peripheral Nerve Stimulator Implantation
Authors: Zhou Steven , Hussain Nasir , Deer Timothy , Abd-Elsayed Alaa
Published: September 2024

Peripheral nerve stimulation at its core is the electrical modulation of nerves to alter function. As a growing tool in the field of chronic pain, neuromodulation devices have quickly moved toward the periphery to directly target nerves of interest. The potential is vast, allowing for direct stimulation of peripheral nerves to alter pain sensation. While much research and work remain to bring this technology to the mainstream of interventional pain treatment, clinicians are increasingly able to provide efficacious pain control with fewer side effects. This chapter highlights the clinical use, indications, procedural approaches, and evidence for the use of peripheral nerve stimulation.
Dorsal Root Ganglion Stimulation
Authors: Engle Alyson M. , Hagedorn Jonathan M. , Deer Timothy Ray
Published: September 2024

Dorsal root ganglion (DRG) neurostimulation devices are FDA approved therapy for patients whom fails conservative pain management. Patients with refractory neuropathic pain are ideal candidates for DRG neurostimulation therapy. Neuromodulation of target DRG achieves analgesia through electrical stimulation that affects pain pathways. Early progress originally targeted dorsal column electrical stimulation, more commonly referred to as spinal cord stimulation. Advances in the field took place to achieve more targeted pain control by selectively neuromodulating the pathologic dorsal root ganglion. This chapter will focus on neurostimulation of the dorsal root ganglion.
Interrogation
Authors: Bulger Jeffrey W.
Published: September 2024

There are significant ethical considerations regarding interrogation practices, particularly regarding healthcare professionals. Interrogation violates the principle of patient autonomy (informed consent) because it is not a decisional choice for the person being questioned. The practitioner is bound by the professional principles of beneficence (do good) and nonmaleficence (do no harm), along with the obligation to maximize the patient’s best interests, making it imperative that practitioners not participate in or associate with any activities that promote physical or psychological harm. Using lies, false evidence, and manipulation in interrogation also violates human dignity and civil rights, calling into question such practices’ justice (be fair). The practitioner is obligated to oppose, expose, and report any abusive or coercive interrogations to authorities that have the power to intervene, investigate, and adjudicate.
Student Patient Care
Authors: Bulger Jeffrey W.
Published: September 2024

The obligation of practitioners to teach, mentor, and induct students into the art of healing is a professional and moral responsibility. The patient–practitioner relationship is critical in good patient care, and students’ involvement must only occur with full disclosure and the patient’s informed consent. The patient’s autonomous informed consent, the practitioner’s beneficent provision of care with the avoidance of maleficent harm, and the public’s legislative authority to only authorize licensed practitioners to practice healthcare must always be respected. Unlicensed students must not make independent healthcare judgments, prescribe drugs, or write orders, and they must not be misrepresented when being introduced to the patient. The student must always be under the supervision of the attending practitioner and must not cross the line of practicing medicine without a license. Students must respect the public trust and recognize the privilege of being in the healthcare profession.
National strategies and plans for the prevention of suicide
Authors: Manoel Bertolote José
Published: September 2024

In 1996, the United Nations (UN) published a seminal document jointly produced by the World Health Organization (WHO) and the Economic and Social Council (ECOSOC) of the UN on ‘Suicide Prevention: Guidelines for the Formulation and Implementation of National Strategies’. In this document, suicide was recognized as a major ‘social and economic problem affecting several nations’. The document was the product of a meeting organized in 1993 by the UN and the WHO, held in Calgary and Banff, Canada, with participants and observers from 13 countries. It was the first time the UN and the WHO declared, based on the best evidence available at the time, that suicide was a major public health problem that deserved not only sanitary, but also political, attention. This chapter will cover the national strategies and plans for the prevention of suicide that are undertaken in some countries around the world.
Research
Authors: Burgoyne Laura L. , Simmons Scott W. , Cyna Allan M.
Published: September 2024

Any anaesthetist can, through an iterative process and the assistance of an experienced instructor, learn to take a clinical question through to publication. One of the greatest communication challenges for researchers is responding to a journal after a paper has been reviewed. Draft manuscripts are rarely accepted on first submission, and persistence is required to see research through to publication. Addressing reviewer comments not only allows the manuscript to be published but almost always improves it. It is important to accept the reviewers’ point of view, because even if you disagree with them, their comments can nearly always be utilized as a basis for a constructive response. However, it is okay to disagree politely, objectively, and concisely, clarifying any issues in the response and draft manuscript. A would-be researcher responding to feedback from a journal will be better placed by having gone through the process themselves as a reviewer.
Administrators
Authors: Simmons Scott W.
Published: September 2024

Applying the concepts of ‘GREAT’ and ‘LAURS’ the clinician manager can optimize working with administrators to achieve mutually beneficial outcomes, underpinned by a philosophy of seeking common ground and positive-sum gains. Directors of Anaesthesia can be thrust into the affray in the seemingly obscure and somewhat confronting world of the CEO. Communication techniques can be applied in conflict diagnosis and resolution. Readily transferable negotiation skills provide possible approaches to what are everyday problems of managing staffing shortages and interpersonal conflict. The importance of attention to detail not only in regard to content, but also the setting and mode of communication requires being succinct and taking into account fiscal considerations, as well as acknowledging and effectively managing the personal emotional impact that commonly accompanies high-level, high-stakes interactions.
Associations Between Sleep Disorders and Treatment Response in Service Members With Post-traumatic Stress Symptoms: A Secondary Outcome Analysis
Authors: Abanes Jane J , Raiciulescu Sorana
Published: September 2024

Introduction

Compared with the civilian population, a higher rate of reported sleep apnea exists among military service members resulting in inadequate sleep. Those who experience chronic sleep deprivation may suffer from debilitating problems that may compromise military mission readiness and unit safety. The purpose of the study on which this secondary outcome analysis was based was to evaluate the effect of manual standardized stress acupuncture as an adjunct therapy to an abbreviated form of cognitive behavioral therapy for insomnia for sleep disturbances in post-deployment service members. The aim of this secondary outcome analysis was 2-fold: (1) to assess the relationship between sleep disorder symptoms and post-traumatic stress symptoms (PSS) and (2) to determine if the presence of sleep disorder symptoms influenced the effects of acupuncture and cognitive behavioral therapy as compared to cognitive behavior therapy only on PSS) in post-deployment military service members.

Materials and Methods

The study was a 2-arm, single-center, randomized controlled trial approved by the Naval Medical Center San Diego and the Vanderbilt University Institutional Review Board. It was conducted at the U.S. Naval Hospital in Okinawa, Japan. Participants were active duty service members from all military branches who were stationed in Okinawa. Two measures were used to analyze the data: the Global Sleep Assessment Questionnaire (GSAQ) and the Post-traumatic Stress Disorder Checklist. A Pearson correlation coefficient was calculated to determine the relationship between sleep disorder symptoms (i.e., 11 pre-intervention GSAQ symptoms) and PSS treatment outcomes (i.e., PCL and PTSD clusters).

Results

Results indicated associations between the GSAQ components and PCL total and PTSD cluster scores. Findings showed that the presence of sleep disorder symptoms influenced PSS treatment response in post-deployment military service members.

Conclusions

Results from this secondary outcome analysis showed associations between GSAQ components (i.e., excessive daytime sleepiness, working conditions causing inadequate sleep, involuntary movements in sleep, and sadness or anxiousness) and PCL total and PTSD cluster scores (i.e., avoidance, negative cognition and mood, avoidance, and hyperarousal). Furthermore, sleep disorder symptoms such as having stressful working conditions (e.g., shift work), probable obstructive sleep apnea, insomnia, anxiety, and depression influenced PSS treatment responses. This study provided information on the major contribution of sleep disorder symptoms in the treatment of PSS through self-report. Future researchers should consider the use of physiologic measures to further understand the mechanisms of how sleep disorder symptoms affect treatment responses in service members with PSS. Implications for this study may assist clinicians in determining effective PSS treatments for those with OSA and insomnia.