bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive factors and risk and protection groups for loneliness in older adults: a population-based study
Authors: Carrasco Pedro Montejo , Crespo David Prada , García Ana Isabel Reinoso , Ibáñez Monserrat Lozano , Rubio Borja Montejo , Montenegro-Peña Mercedes
Published: April 2024

Background

Loneliness is considered a public health problem, particularly among older adults. Although risk factors for loneliness have been studied extensively, fewer studies have focused on the protected and risk groups that these factors configure. Our objective is to analyze the variables and latent factors that predict loneliness in older adults and that enable risk and protected groups to be configured.

Methods

We employed an epidemiological, cross-sectional survey that was carried out on a random sample of 2060 people over 65 years extracted from the census. A structured telephone interview was used to assess mental and physical health, habits, quality of life, and loneliness, applying the COOP-Wonca, Goldberg General Health (GHQ-12), and Barber Questionnaires.

Results

Predictors of loneliness were: mental health, living alone, quality of life, depressive symptoms, low educational level, and some deficiency situations such as having no one to turn to for help. The factors extracted (Factorial Analysis) were: a subjective experience of poor health, objective isolation, and psychological isolation. We established at risk and protected groups (“Decision Tree” procedure), and loneliness was referred to by 73.2% of the people living alone and with poor mental health and quality of life (risk group). By contrast, only 0.8% of people living with others, with good mental health and good quality of life felt loneliness (protected group).

Conclusion

In a well-developed city, subjective and objective factors are associated with loneliness. These factors, especially those associated with at risk or protected groups, must be considered to develop strategies that address loneliness.
DFA-Net: Dual multi-scale feature aggregation network for vessel segmentation in X-ray digital subtraction angiography
Authors: Deng He , Liu Xu , Fang Tong , Li Yuqing , Min Xiangde
Published: April 2024

Even though deep learning is fascinated in fields of coronary vessel segmentation in X-ray angiography and achieves prominent progresses, most of those models probably bring high false and missed detections due to indistinct contrast between coronary vessels and background, especially for tiny sub-branches. Image improvement technique is able to better such contrast, while boosting extraneous information, e.g., other tissues with similar intensities and noise. If incorporating features derived from original and enhanced images, the segmentation performance is improved because those images comprise complementary information from different contrasts. Accordingly, inspired from advantages of contrast improvement and encoding-decoding architecture, a dual multi-scale feature aggregation network (named DFA-Net) is introduced for coronary vessel segmentation in digital subtraction angiography (DSA). DFA-Net integrates the contrast improvement using exponent transformation into a semantic segmentation network that individually accepts original and enhanced images as inputs. Through parameter sharing, multi-scale complementary features are aggregated from different contrasts, which strengthens leaning capabilities of networks, and thus achieves an efficient segmentation. Meanwhile, a risk cross-entropy loss is enforced on the segmentation, for availably decreasing false negatives, which is incorporated with Dice loss for joint optimization of the proposed strategy during training. Experimental results demonstrate that DFA-Net can not only work more robustly and effectively for DSA images under diverse conditions, but also achieve better performance, in comparison with state-of-the-art methods. Consequently, DFA-Net has high fidelity and structure similarity to the reference, providing a way for early diagnosis of cardiovascular diseases.
Prognostic nutritional index as a predictive marker for acute kidney injury in adult critical illness population: a systematic review and diagnostic test accuracy meta-analysis
Authors: Chen Jia-Jin , Lee Tao-Han , Lai Pei-Chun , Chang Chih-Hsiang , Wu Che-Hsiung , Huang Yen-Ta
Published: April 2024

Background

The prognostic nutritional index (PNI), integrating nutrition and inflammation markers, has been increasingly recognized as a prognostic predictor in diverse patient cohorts. Recently, its effectiveness as a predictive marker for acute kidney injury (AKI) in various clinical settings has gained attention. This study aims to assess the predictive accuracy of the PNI for AKI in critically ill populations through systematic review and meta-analysis.

Methods

A systematic review was conducted using the databases MEDLINE, EMBASE, PubMed, and China National Knowledge Infrastructure up to August 2023. The included trials reported the PNI assessment in adult population with critical illness and its predictive capacity for AKI. Data on study characteristics, subgroup covariates, and diagnostic performance of PNI, including sensitivity, specificity, and event rates, were extracted. A diagnostic test accuracy meta-analysis was performed. Subgroup analyses and meta-regression were utilized to investigate the sources of heterogeneity. The GRADE framework evaluated the confidence in the meta-analysis’s evidence.

Results

The analysis encompassed 16 studies with 17 separate cohorts, totaling 21,239 patients. The pooled sensitivity and specificity of PNI for AKI prediction were 0.67 (95% CI 0.58–0.74) and 0.74 (95% CI 0.67–0.80), respectively. The pooled positive likelihood ratio was 2.49 (95% CI 1.99–3.11; low certainty), and the negative likelihood ratio was 0.46 (95% CI 0.37–0.56; low certainty). The pooled diagnostic odds ratio was 5.54 (95% CI 3.80–8.07), with an area under curve of summary receiver operating characteristics of 0.76. Subgroup analysis showed that PNI’s sensitivity was higher in medical populations than in surgical populations (0.72 vs. 0.55; p < 0.05) and in studies excluding patients with chronic kidney disease (CKD) than in those including them (0.75 vs. 0.56; p < 0.01). Overall, diagnostic performance was superior in the non-chronic kidney disease group.

Conclusion

Our study demonstrated that PNI has practical accuracy for predicting the development of AKI in critically ill populations, with superior diagnostic performance observed in medical and non-CKD populations. However, the diagnostic efficacy of the PNI has significant heterogeneity with different cutoff value, indicating the need for further research.
Exploring dietary changes and supplement use among cancer patients in Norway: prevalence, motivations, disclosure, information, and perceived risks and benefits: a cross sectional study
Authors: Kristoffersen Agnete E. , Stub Trine , Nilsen Jorunn V. , Nordberg Johanna Hök , Broderstad Ann Ragnhild , Wider Barbara , Bjelland Mona
Published: April 2024

Background

Cancer is the leading cause of death in Norway, with prostate, breast, lung, and colon cancers being the most prevalent types. Adopting a healthy and varied diet can help reduce cancer risk and recurrence. However, access to dietary counselling remains limited for cancer patients in Norway. This study aimed to investigate the prevalence of dietary supplement use and dietary changes made by cancer patients and survivors. Additionally, it sought to explore the reason(s) for such practices, communication with healthcare providers, sources of information, and reported benefits and potential harms resulting from these changes and supplement use.

Methods

Conducted in collaboration with the Norwegian Cancer Society (NCS), this online cross-sectional study targeted members of their user panel who had either current or previous cancer (n = 706). The study took place in September/October 2021, utilizing a modified cancer-specific version of the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). Out of 468 participants (315 women and 153 men), 67.2% consented to participate. Between-group analyses were conducted using Pearson chi-square tests and Fisher exact tests for categorical variables, while independent sample t-tests were applied for continuous variables.

Results

The majority of the participants (97%) reported making changes to their diet (78%) and/or incorporating dietary supplements (73%) in response to their cancer diagnosis. The primary goal of these changes was to strengthen their body and immune system. Almost half of the participants (49%) reported that they found these changes beneficial and discussed them openly with their healthcare providers, with family physicians being the most common point of discussion (25%). Adverse effects were reported by only a few participants, mostly mild. Information about dietary changes and supplements was primarily sourced from the internet or healthcare providers.

Conclusions

This study highlights that most individuals affected by cancer attribute to dietary adjustment. It also emphasizes the importance of addressing adherence to dietary recommendations and using reliable sources of information. Additionally, the study highlights the potential, yet currently underutilized, role of healthcare professionals in initiating dialogues about dietary interventions to address any unmet needs of patients. Such proactive engagement may contribute to the promotion of reliable sources of information and the prevention of non-evidence-based and potentially harmful diets or supplement adoption.
Comparing code-free deep learning models to expert-designed models for detecting retinal diseases from optical coherence tomography
Authors: Touma Samir , Hammou Badr Ait , Antaki Fares , Boucher Marie Carole , Duval Renaud
Published: April 2024

Background

Code-free deep learning (CFDL) is a novel tool in artificial intelligence (AI). This study directly compared the discriminative performance of CFDL models designed by ophthalmologists without coding experience against bespoke models designed by AI experts in detecting retinal pathologies from optical coherence tomography (OCT) videos and fovea-centered images.

Methods

Using the same internal dataset of 1,173 OCT macular videos and fovea-centered images, model development was performed simultaneously but independently by an ophthalmology resident (CFDL models) and a postdoctoral researcher with expertise in AI (bespoke models). We designed a multi-class model to categorize video and fovea-centered images into five labels: normal retina, macular hole, epiretinal membrane, wet age-related macular degeneration and diabetic macular edema. We qualitatively compared point estimates of the performance metrics of the CFDL and bespoke models.

Results

For videos, the CFDL model demonstrated excellent discriminative performance, even outperforming the bespoke models for some metrics: area under the precision-recall curve was 0.984 (vs. 0.901), precision and sensitivity were both 94.1% (vs. 94.2%) and accuracy was 94.1% (vs. 96.7%). The fovea-centered CFDL model overall performed better than video-based model and was as accurate as the best bespoke model.

Conclusion

This comparative study demonstrated that code-free models created by clinicians without coding expertise perform as accurately as expert-designed bespoke models at classifying various retinal pathologies from OCT videos and images. CFDL represents a step forward towards the democratization of AI in medicine, although its numerous limitations must be carefully addressed to ensure its effective application in healthcare.
Assessment of serum complement level in a sample of patients of idiopathic childhood epilepsy
Authors: Adel Fatema Amr , Ahmed Nahed Salah El Deen , Nassef Ayman Mohammed , El Din Mona Mokhtar Wahid
Published: April 2024

Background

The etiology of epilepsy is still unknown in over a third of cases and a third of patients have seizures resistant to current antiseizure drugs. Most antiseizure drugs work on suppressing seizures, not targeting the underlying pathophysiological mechanisms because these mechanisms are incompletely understood. Understanding the process of epileptogenesis may lead to pathophysiology-driven drug development of more effective treatment. The aim of this study is to assess the role of the immune system in children with epilepsy, using complement as an immune marker.

Results

The serum complement level in the cases group ranged from 1.8 to 4.5 mg/ml, with mean value 2.850 ± 0.646 mg/ml. While in the control group ranged from 2.7 to 26 mg/ml, with mean value 9.208 ± 4.805 mg/ml. The study showed a statistically significant decrease in C3 serum level in cases compared to control group with P-value < 0.001. Also, there was no statistically significant relation between seizure control and serum C3 level.

Conclusion

To conclude, it was found that complement component C3 levels are significantly lower in idiopathic childhood epilepsy patients in relation to control group.
Unnecessary organizational burden: a conceptual framework
Authors: Ginzburg Oren , Weil Stefanie , van Witteloostuijn Arjen
Published: April 2024

This paper investigates the mechanisms that lead organizations to impose unnecessary burdens on their actors. The prevailing narrative in the literature is that unnecessary organizational burden (UOB) is created either on purpose—as a way for an organizational actor to assert control—or inadvertently through the passage of time as layers of policies, rules, and processes accumulate. Based on a wide review of relevant literature, we propose a different explanation: in our conceptual framework, the onset and mitigation of unnecessary burdens are explained, respectively, by organizational decision-makers’ weaknesses and strengths. Our framework combines (1) a typology of unnecessary burdens with (2) a typology of factors influencing the likelihood of UOB mitigation, and (3) a typology of managerial mitigation responses to such burdens. The conceptual framework, and a series of 12 propositions, aim to offer researchers and practitioners a shared language to empirically investigate unnecessary organizational burden, and implement effective solutions.
Non–Small Cell Lung Cancer Metastatic Without Oncogenic Alterations
Authors: Frost Nikolaj , Reck Martin
Published: April 2024

This overview provides a thorough review of current treatment approaches for first-line management of nononcogenic addicted non–small cell lung cancer. We also address pertinent clinical decision-making queries encountered in everyday practice, such as the optimal treatment strategy for PD-L1–high patients, predictive factors for response to immune checkpoint inhibitors (ICI) both in terms of patient and cancer characteristics, the potential benefits of dual checkpoint blockade, and the unresolved issue of safe discontinuation strategies for long-term responders. Around one in five patients falls into this latter category while the majority develop either primary or acquired resistance to ICI-based first-line therapy, necessitating effective subsequent lines of treatment. Docetaxel, with or without combination of antiangiogenic agents, serves as the backbone of treatment, although evidence in the post-ICI setting is limited. Given that an inflamed tumor microenvironment (TME) is crucial for ICI responses, targeting the TME in cases of acquired resistance alongside continued ICI administration appears rational, although clinical trials so far have failed to confirm this hypothesis. Antibody-drug conjugates have emerged as a promising treatment modality, offering the potential for reduced toxicity and improved efficacy by targeting specific cancer antigens. Moreover, several chemotherapy-free approaches are currently under investigation for treatment-naïve patients, including alternative ICI and drugs targeting epitopes on both cancer and immune cells.
Universality of kappa distributions
Authors: Livadiotis George , McComas David J.
Published: April 2024

This paper reveals the universality of the particle energy distribution function, despite the arbitrariness that characterizes the generalized thermodynamic entropic function. We show that the canonical distribution, that is, the distribution function that maximizes this entropy under the constraints of canonical ensemble, is always the same and given by the kappa distribution function. We use the recently developed entropy defect to express the generalized entropic formulation. The entropy defect is a thermodynamic concept that describes the loss of entropy due to the order induced by the presence of correlations. Then we carry out functional analysis to maximize the implicit expression of the generalized entropy. Critically, we show that the Lagrange multipliers have the same exact arbitrariness as the generalized entropic function, allowing us to cancel it out and proving the universality of canonical distribution as the kappa distribution function.
Comparison of Neutrophil Lymphocyte Ratio combined SOFA versus APACHE IV in assessing the Prognosis of Sepsis Patients admitted to Medical Intensive Care Unit
Authors: Reddy Venkat , Kumar Sunil
Published: April 2024

Background Sepsis poses a significant threat in the Medical Intensive Care Unit (MICU), with high morbidity and mortality rates. Accurate prognostic tools are essential for guiding patient management. This study aims to compare the effectiveness of Neutrophil–Lymphocyte Ratio with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) in predicting sepsis outcomes. A prospective cross-sectional design will enrol septic MICU patients, collecting baseline data and scoring systems. Patient outcomes, including mortality and length of MICU stay, will be analyzed using correlation and ROC curve analyses. This study addresses the current gap in direct comparisons of these tools. Results The results of this study are anticipated to reveal significant correlations between the Neutrophil Lymphocyte Ratio combined with SOFA and APACHE IV scores and patient outcomes. Specifically, we expected to observe strong associations between the combined scoring system and mortality rates, length of MICU stay, and the need for organ support. Furthermore, we anticipate that the Neutrophil Lymphocyte Ratio combined with SOFA will demonstrate higher predictive accuracy than APACHE IV to assess prognosis in sepsis patients admitted to the MICU. Conclusion Based on the results obtained from this prospective cross-sectional study, we can draw conclusions regarding the comparative effectiveness of NLR (Neutrophil Lymphocyte Ratio) combined with SOFA and APACHE IV in assessing the prognosis of sepsis in the MICU. We anticipate that the combined scoring system will provide a more accurate prognostic assessment and enable healthcare professionals to make well-informed choices regarding patient care and the distribution of resources. These findings will contribute to building evidence on sepsis and may have implications for improving patient outcomes in the MICU setting.
Case Report: Pre- and post-natal evolution of Kabuki Syndrome due to a novel genetic mutation
Authors: Souayeh Nesrine , MARZOUK Asma , Jelalia Nour , BEN AYED Ikhlas , Ziadi Alaa , TRABELSI Madiha , Bouaziz Asma , Hsayaoui Najeh
Published: April 2024

Kabuki syndrome is a rare condition characterized by intellectual disability, poly-malformative syndrome, and distinctive facial dysmorphia. It also exhibits clinical and biological heterogeneity, with rare and diverse symptoms. Genetic analysis plays a significant role in both positive diagnosis and prognosis. Recently, whole exome sequencing has identified several genes responsible for the disease, notably KMT2D and KDM6A. Studying new mutations in this disease will contribute to understanding the role of these genes in the pathogenesis of Kabuki syndrome. We report a case of a 9-and-a-half-year-old boy, born to non-consanguineous parents, diagnosed with Kabuki syndrome. This article describes the prenatal diagnosis process and the postnatal progression. Genetic analysis revealed a novel missense point mutation in the KMT2D gene, classified as a class 4 missense mutation, responsible for Kabuki syndrome.
A mixed method study to determine the prevalence of childhood obesity and determinants of physical activity and gadgets use amongst school-going children (standard 1st to 10th) from an urban area located in central India
Authors: umekar Sayali , Joshi Dr. Abhishek
Published: April 2024

Introduction The word obesity comes from the Latin “obesus,” which means “pump” or “having eaten oneself fat.” Childhood obesity is a major problem in India. Physical activity is critical for obesity prevention. Childhood Obesity is a proven risk factor for many noncommunicable diseases in adults. Environmental factors, habits, and cultural contexts have influenced the worldwide obesity epidemic. Obesity during childhood can have a comprehensive impact on a child’s overall health, affecting not only their physical well-being, but also their social and emotional development. It can influence confidence levels, social interactions, and even academic performance, leading to reduced quality of life. Aim This study aimed to determine the prevalence of obesity and examine the pattern of physical activity and gadget use among school-going children (1st -10th). Method This was a descriptive cross-sectional study with a mixed-method component that will be conducted in the urban field practice of a tertiary care hospital in central India among school-going children (std1st-std 10th). Quantitative data were collected by house-to-house surveys in systematically selected random households, while in-depth interviews were conducted among parents from randomly selected households. This study aimed to ascertain the frequency of obesity and physical activity patterns and examine parents’ opinions regarding technology use, exercise, and nutrition in their offspring. It will provide insights into the burden of childhood obesity along with appropriate strategies to plan based on the determinants and perceptions identified.
Land deformation due to earthquake in Cianjur, West Java, Indonesia: A multisensor-multitemporal study
Authors: Setiani Putri , Wibowo Adi , Supriatna Supriatna , Ramdani Fatwa
Published: April 2024

Background The Java Island is located in a seismically active region, which makes it vulnerable to earthquakes. On 21 November 2022, an earthquake of magnitude 5.6 struck Java, with its epicentre located in Cianjur, West Java. The earthquake caused significant damage to the buildings and infrastructure in the region, and several injuries and fatalities. Methods In this study, we used multisensor and multitemporal data to investigate the land deformation. Multi-pairs of Sentinel-1 SAR and aerial orthomosaic photos are used. Sentinel-1 SAR data were acquired from the Copernicus Data Space Ecosystem and the SNAP software was used to do inSAR analysis, while aerial orthomosaic data were acquired using DJI Drone Mavic Pro. Results Our results show that the earthquake caused significant land deformation in the area, with surface displacements of up to 9.8 cm and 11 cm for land uplift and land subsidence, respectively. We also found that deformation was primarily concentrated in the south-eastern and north-western parts of the study area. We identified the possibility of an unmapped fault that could trigger earthquakes in the future. Conclusions Our findings highlight the usefulness of radar and remotely sensed optical data in studying the effects of earthquakes. This data can be used to effectively design future disaster response and recovery efforts.
Patient education for individuals with Interstitial Lung Disease: A scoping review.
Authors: Amin Revati , Vaishali K. , Maiya G. Arun , Mohapatra Aswini Kumar , Sinha Mukesh Kumar , Bhat Anup , Bommasamudram Tulasiram , Acharya Vishak , Gore Shweta
Published: April 2024

Objectives Interstitial Lung Disease (ILD) is a severe and rapidly progressing disease with a high fatality rate. Patient education (PE) has been demonstrated to promote long-term adherence to exercise and lifestyle improvements by assisting patients in developing self-management techniques. Our scoping review's goal was to chart out the prevailing level of research about the content, processes, and effectiveness of PE for patients with ILD. Methods The relevant databases were searched using the rules provided by Arksey and O'Malley in 2005 and the Joanna Briggs Institute reviewers' manual 2015: an approach for JBI scoping reviews. Individuals with ILD, published in English between the years of inception and 2020, and describing PE administered by various healthcare practitioners were among the 355 studies found and reviewed. Thirteen studies met these criteria. Results PE delivery process, delivery techniques, quality of life assessments, common PE themes, and healthcare professional participation were all recognized and cataloged. Conclusion Despite the fact that healthcare professionals (physicians, nurses, and physiotherapists) provide PE to patients with ILD regularly, the PE provided varies greatly (contents of PE, process of delivery and delivery techniques). During the scoping review, a significant variation in the themes was addressed. They could not provide any evidence-based specific recommendations for all healthcare practitioners due to the studies' heterogeneity and lack of effectiveness measures.
Effect of high dietary fiber intake on insulin resistance, body composition and weight, among overweight or obese middle-aged women: study protocol for a double-blinded randomized controlled trail.
Authors: Hebbar Suvarna , Umakanth Shashikiran , Thimmappa Latha , Galbao Joniya
Published: April 2024

Background Obesity is a major consequence of malnutrition and significantly contributes to the global burden of chronic diseases. Currently, there are more overweight and obese individuals than underweight individuals. Increased fiber intake can increase insulin sensitivity and fat oxidation. According to research studies, the average dietary fiber consumption is below the recommended value, and the WHO anticipates that the worldwide obesity prevalence has increased in the past ten years. Aim To evaluate the effect of high dietary fiber intake on insulin resistance, body composition, and weight in overweight and obese middle-aged women. Method This hospital-based study evaluated 500 people during phase 1 to identify the prevalence of insulin resistance among overweight and obese middle-aged women. An RCT with intervention and control arms for 180 individuals is being conducted in Phase 2 to determine the effect of increased dietary fiber consumption on insulin resistance, body composition, and weight in overweight or obese middle-aged women. In the intervention group, women were counselled for 15 min and given a tailored food chart including 40 g of fiber. Women in the control arm will receive a typical food care plan with 25 g of fiber, based on their health status. Each engaged woman received fiber nutritional empowerment. Discussion Increasing dietary fiber consumption can improve insulin resistance, body composition, and weight in middle-aged overweight and obese women. Trial registration The Clinical Trials Registry of India (CTRI/2022/01/039074) has registered this study as a clinical trial on January 3, 2022 http://ctri.nic.in
Prevalence of surgical site infection in orthopedic procedures, in an institution in the municipality of Pereira, 2022
Authors: Londoño Rodríguez Isabella , Ocampo López Juliana , López Gómez Katherine , Duque Salazar William , Acevedo Osorio German Oved , Blanco Vanegas Angelica María , Giraldo Ospina Carlos Eduardo
Published: April 2024

Background The acquisition of healthcare-associated infections (HAI) is characterized by developing during the patient’s hospital stay and even after the hospital stay during the recovery period, as long as it is due to factors intrinsic to the hospitalization or medical treatment of the entity, as well as surgical techniques that require prophylactic treatment and medical surveillance. Methods Type and design of research: Quantitative, observational, descriptive, cross-sectional, retrospective. The population and sample is made up of patients who underwent orthopedic surgery in an institution in the municipality of Pereira, between January and December 2022. Results The results showed that there are significant differences between genders in the incidence of certain medical conditions and response to certain treatments. Women appear to be more prone to deep infections, use more chlorhexidine as an antiseptic, and show a higher prevalence of pathologic conditions compared to men. In addition, differences in the distribution of ASA classification and surgical wound type suggest possible health disparities between genders in the context of orthopedic surgery. Conclusions The importance of implementing infection prevention and control strategies adapted to specific contexts is evident. Despite the differences in the risk factors identified, both studies highlight the importance of optimizing antibiotic prophylaxis and adequately managing specific comorbidities to reduce the incidence of postsurgical infections. Furthermore, attention to perioperative surveillance and surgical time management are suggested as key areas to improve surgical outcomes in both cohorts of patients, as they can contribute significantly to the reduction of the incidence of SSIs in patients undergoing orthopedic procedures.
Flip the Script: Rebranding ART and enhancing the U=U message in Malawi and Zimbabwe
Authors: Ngaragari Tom , Hasen Nina , Hermann Montague , Kunaka Nigel , Mkandawire Philip , Nhamo-Murire Mercy , Ferrand Andrea
Published: April 2024

Background Since 2009, global efforts have made significant strides in identifying and treating People Living with HIV (PLHIV), with the number on Antiretroviral Therapy (ART) surpassing 25 million by 2020. However, challenges persist as a substantial number of individuals enrolled in ART, particularly in countries like Zimbabwe and Malawi, are lost to follow-up, impeding the success of HIV response initiatives. Stigma and limited awareness continue to pose barriers to effective HIV management. Methods The methodology centres on identifying compelling messengers to bridge the gap between medical information and lived experiences in sub-Saharan Africa. Grounded in human-centered and co-design approaches, the initiative engages host country governments, stakeholders, influencers, and the target audience to create a globally resonant brand with country-specific adaptations. Results The "Undetectable = Untransmittable" (U=U) movement, founded in 2016, emphasizes that PLHIV with undetectable viral loads cannot transmit the virus, playing a crucial role in dismantling stigma and enhancing HIV prevention efforts. To address the low awareness of U=U in Malawi and Zimbabwe, the collaborative "Flip the Script" project was launched, involving public and various private sectors. This initiative aims to reshape perceptions around ART, presenting it as a key to a normalized, healthy life rather than a symbol of infection. "Flip the Script" seeks to boost ART initiation and re-initiation, promote effective ART use, and encourage viral load testing and result sharing among PLHIV. It also strives for consistent counseling on the prevention benefits of ART by health providers. Conclusions Ultimately, the initiative aims to increase the percentage of PLHIV achieving and sustaining viral suppression, leading to a reduction in HIV incidence. Its success hinges on effectively communicating the U=U message, challenging stigma, and empowering both PLHIV and health providers in the targeted regions.
Modeling the Impact of Community First Responders
Authors: van den Berg Pieter L. , Henderson Shane G. , Jagtenberg Caroline J. , Li Hemeng
Published: April 2024

In community first responder (CFR) systems, traditional emergency service response is augmented by a network of trained volunteers who are dispatched via an app. A central application of such systems is out-of-hospital cardiac arrest (OHCA), where a very fast response is crucial. For a target performance level, how many volunteers are needed, and from which locations should they be recruited? We model the presence of volunteers throughout a region as a Poisson point process, which permits the computation of the response-time distribution of the first-arriving volunteer. Combining this with known survival-rate functions, we deduce survival probabilities in the cardiac arrest setting. We then use convex optimization to compute a location distribution of volunteers across the region that optimizes either the fraction of incidents with a fast response (a common measure in the industry) or patient survival in the case of OHCA. The optimal location distribution provides a bound on the best possible performance with a given number of volunteers. This can be used to determine whether introducing a CFR system in a new region is worthwhile or can serve as a guide for additional recruitment in existing systems. Effective target areas for recruitment are not always obvious because volunteers recruited from one area may be found in various areas across the city depending on the time of day; we explicitly capture this issue. We demonstrate these methods through an extended case study of Auckland, New Zealand.

This paper was accepted by Carri Chan, healthcare management.

Funding: This research was financed in part by the Netherlands Organization for Scientific Research (NWO) in the form of a Rubicon grant (019.172EN.016) to C. J. Jagtenberg and a Veni grant (VI.Veni.191E.005) to P. L. van den Berg. S. G. Henderson and H. Li were supported in part by National Science Foundation [Grant CMMI-2035086]. Vrije Universiteit Amsterdam and Erasmus University received funding from TKI Dinalog [Grant 2023-1-307TKI]. Some of this work has been executed under the TKI Dinalog [Grant 2023-1-307TKI]. Part of this work was completed during a research visit made possible by a [Distinguished Visitor Award] from the University of Auckland.

Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.04024 .
Deep brain stimulation: the current and future potential for people with Parkinson's
Authors: Ramadan Francesca
Published: April 2024

Parkinson's disease is the fastest growing neurological condition in the world with no cure; therefore, choosing the correct treatment to manage the patient's symptoms and prolonging their quality of life is of the utmost importance. Deep brain stimulation, an established methodology involving continuous electrical stimulation to the brain through surgically implanted electrodes, can present an effective option, but careful patient selection is needed to optimise outcomes. Here, Francesca Ramadan presents an overview of the current impact of deep brain stimulation and the ways in which its potential might be maximised in the future.
The NHS Neurology Transformation Programme
Authors: Thomas Sue
Published: April 2024

Neurology service transformation is one of the key policy drivers for 2024. Sue Thomas outlines key issues from a recent transformation meeting that nurses working in neuroscience service delivery need to be familiar with. One of the key elements of successful service delivery is the ability of nurses and nursing to adapt to the new NHS landscape by embracing service integration and working with all service partners. This new policy will evolve throughout the coming months.
Creating joy
Authors: Wright Anna , Mintram Mya , McCarthy Liz
Published: April 2024

In the final part of this digital Practice Insight Supplement, staff at Paint Pots nurseries showcase their practice. For the Author Spotlight column, Anna Wright, Paint Pots ambassador, speaks to Alison Clark about her book exploring slow practice. Mya Mintram explains what brings her joy in her work for the Student Spotlight column, and operations manager Liz McCarthy, describes the changes made in the nurseries to promote joy, for the Working With Families column.
Experiences of learning disability nurses within community nursing teams, working in collaboration with primary care
Authors: Turton Amy , Davis Joe
Published: April 2024

Background:

The approach and understanding of healthcare systems and societies regarding people who have a diagnosis of learning disability (LD) varies across countries; however, it is widely reported that those with LDs report feeling disempowerment and devalued by those working in healthcare. When an individual is devalued, they are more likely to have poorer health outcomes. International human rights laws, such as the Convention on the Rights of Persons with Disabilities, set out an international responsibility to address LD-related inequalities and mistreatment. In England, LD nurses predominantly work within community teams to improve patients living with LDs' holistic access to healthcare and reduce the health inequalities they experience. Exploration of the literature failed to identify any relevant research on the specific role and experiences of the LD nurse within a community team.

Aim:

This study aimed to explore the lived experiences of a LD nurse working with LD patients within a community setting. The research was conducted by an advanced clinical practitioner (ACP).

Method:

Semi-structured interviews were used to gather data from four participants. These interviews were recorded and analysed for themes and repeat experiences. Data were analysed using Braun and Clark's (2006) six step model.

Findings:

LD nurses reported that their patients benefited when they worked collaboratively with primary care.

Discussion:

The LD nurse was shown to improve access to healthcare for people living with a formal diagnosis of LD or intellectual disability. However, the LD community nurse role is not well known or understood. The LD nurse, when working collaboratively with primary care, often becomes a ‘token’ role that is not utilised. Investment in the role is required to ensure it reaches its full potential. The ACP is best placed to lead on these recommendations and contribute to building the research base in this area of expertise. The role is essential in reducing health inequalities and improving holistic healthcare outcomes for adults with a LD living within the community in the UK.

Recommendations:

It is recommended that a LD nurse, primary care pathway and an outcome measure tool for workforce planning are implemented within the LD nurse community setting. Future research within and outside the UK is needed to explore the experiences of LD nurses in other geographical locations.
Outcomes of a consultant physiotherapy upper limb clinic: reducing the patient journey through early access to specialist care
Authors: Tunnicliffe Helen , Wood Richard , Armstrong Alison , Ullah Aamer
Published: April 2024

Background:

Many patients referred into secondary care for a ‘surgical opinion’ do not have a surgical target.

Aims:

An intermediate care consultant physiotherapy upper limb clinic was set up to reduce the patient journey and deliver the right advice/treatment at the first point of assessment.

Method:

A clinic was set up to: enable an expert clinical assessment; deliver education to the patient regarding diagnosis, treatment options and likely outcomes; arrange appropriate imaging; and deliver care on the day (advice, specialist physiotherapy, injection or splinting). This creates a proactive approach to waiting list management and ensures early management for patients.

Results:

Complete data from the first 173 patients seen are presented. A total of 99.5% had treatment delivered on the day. Waiting times were reduced by a mean of 3.5 months for appointment, and 27 weeks for physiotherapy input. All received on-the-day expert physiotherapy advice, exercise programmes and progression advice. Oxford Shoulder Score improved by 17.5 (mean). QuickDASH scores improved by 34.72 (mean). Patient satisfaction was extremely positive.

Conclusion:

The clinic has been successful at shortening the patient journey, reducing the burden on secondary care and delivering best care in a timely manner.
Safe prescribing of oral alendronic acid following hip fracture
Authors: Manderson Claire
Published: April 2024

In the UK, physiotherapists can train as independent prescribers and are working in increasing numbers as advanced clinical practitioners. This case study examines the safe prescribing of oral bisphosphonates following a fragility fracture of the hip and considers this process in the context of the Royal Pharmaceutical Society's competencies (2021) , which were adopted by the Health and Care Professions Council in 2016. Despite these medications being around since the 1960s, their utilisation in the treatment of osteoporosis remains limited, and low levels of patient adherence continues to present a problem. This case study will look at the ways in which these issues can be addressed and identifies areas for future development. It will also describe the process of bone health assessment, offering non-pharmacological approaches as a way to reduce fracture and falls risks. The shared care nature of osteoporosis management will also be considered, with communication and partnership between primary care and secondary care being key in the provision of this treatment.
Opportunities and aspirations of diagnostic radiographers within advanced practice
Authors: House Sophie , Snaith Beverly
Published: April 2024

Background:

Radiography has a strong history of role development. One well-established area is the interpretation (reporting) of diagnostic images. Although perceived by many to operate at the advanced level, increasing clarity within the profession means it is important to ascertain whether individuals understand their level and the potential for development. While prior studies have considered role implementation and impact, there has been limited exploration of individual expectation and aspiration for role development.

Aims:

To ascertain the perspectives of radiographers in established and developing image reporting roles across one imaging network in England, to enable reflection upon role utilisation and aspirations of future development.

Methods:

Radiographers across a single integrated care system in the north of England and working and/or training within projection radiography (X-ray) reporting roles were invited to participate in online focus groups. Anonymous demographic information, including postgraduate qualifications and scope of practice, was also collected.

Results:

This study highlighted varied utilisation of radiographers in image reporting, despite scopes of practice being similar. For the majority, roles were not meeting personal expectations, and lack of clarity was negatively impacting job satisfaction. Challenging clinical environments and staffing deficits were common barriers highlighted.

Conclusion:

Inconsistent implementation has the potential to negatively impact service delivery and capacity. Such variation affects staff satisfaction and morale. Employers should ensure expectations are realistic and that support mechanisms enable consistent development.
Examining advanced clinical practice from the perspective of a trainee advanced clinical practitioner
Authors: Carter Nicole
Published: April 2024

This article discusses advanced clinical practice from the perspective of a trainee advanced clinical practitioner (ACP). The commentary explores the four pillars of advanced practice with respect to the frailty specialty, taking both the author and a trainee ACP into account. The evaluation analyses the historical development of advanced clinical practice and the knowledge, skills and competencies expected at the advanced level. It highlights how support, colleague networking and supervision remain vital to the journey of trainee ACP, and influences the overall wellbeing of, and care given to, the patient.
An Integrated Framework of Online Learning Effectiveness in Institutions of Higher Learning
Authors: Abdullah Nor Liza , Ramdan Mohamad Rohieszan , Ngah Nor Syamaliah , Yin Khoo Yin , Shokory Suzyanty Mohd , Fuad Dayang Rafidah Syariff M. , Yonus Azita
Published: April 2024

In the early stages of adopting online learning, both learners and teachers displayed resistance, but the COVID-19 pandemic has forced a widespread shift to digital learning. To facilitate this transition, there is a growing focus on highlighting the effectiveness of online learning, which directly impacts learning outcomes. This study investigates online learning effectiveness through an integrated framework that considers online assessment practices and online course design as independent variables, with online learning support as a moderating variable. Understanding the effectiveness of online learning is crucial as hybrid learning becomes the "new norm" in education, combining online and offline methods for teaching the digital generation. Using a quantitative research design involving 232 students at Universiti Kebangsaan Malaysia, the study found that online assessment practices and course design significantly influence students perceived learning outcomes in an online learning environment. Additionally, online learning support positively moderates this relationship. These findings offer a comprehensive perspective on how online assessment practices, course design, and support systems contribute to the quality of higher education in Malaysia amidst evolving educational practices.

 
Effects of Outdoor Education on Elementary School Students’ Perception of Scientific Literacy and Learning Motivation
Authors: Fan Ming-Ren , Tran Ngoc-Huy , Nguyen Lam-Huu-Phuoc , Huang Chin-Fei
Published: April 2024

This study aims to explore the impact of outdoor education on senior elementary school students' perceptions of scientific literacy and learning motivation. 42 senior elementary school students (25 males, 17 females; average age = 11.6) were enrolled and divided into experimental (N = 21) and control (N = 21) groups. Participants were taught the same content about science for four weeks. The control group adopted traditional indoor teaching, whereas the experimental group adopted outdoor education. Before and after the course, each student completed the 23 items of scientific literacy and the 6 items of learning motivation scale. The results show that the experimental group had significantly higher perceptions of scientific literacy and learning motivation. The outdoor education teaching method has positive effects on the higher levels of awareness and creative development of students. These findings imply that outdoor education has a positive effect on improving students' perceptions of scientific literacy and learning motivation.

 