Strategies for de-implementation of low-value care-a scoping review

Background

The use of low-value care (LVC) is a persistent problem that calls for knowledge about strategies for de-implementation. However, studies are dispersed across many clinical fields, and there is no overview of strategies that can be used to support the de-implementation of LVC. The extent to which strategies used for implementation are also used in de-implementing LVC is unknown. The aim of this scoping review is to (1) identify strategies for the de-implementation of LVC described in the scientific literature and (2) compare de-implementation strategies to implementation strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and strategies added by Perry et al.

Method

A scoping review was conducted according to recommendations outlined by Arksey and O’Malley. Four scientific databases were searched, relevant articles were snowball searched, and the journal Implementation Science was searched manually for peer-reviewed journal articles in English. Articles were included if they were empirical studies of strategies designed to reduce the use of LVC. Two reviewers conducted all abstract and full-text reviews, and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data-charting form. The strategies were first coded inductively and then mapped onto the ERIC compilation of implementation strategies.

Results

The scoping review identified a total of 71 unique de-implementation strategies described in the literature. Of these, 62 strategies could be mapped onto ERIC strategies, and four strategies onto one added category. Half (50%) of the 73 ERIC implementation strategies were used for de-implementation purposes. Five identified de-implementation strategies could not be mapped onto any of the existing strategies in ERIC.

Conclusions

Similar strategies are used for de-implementation and implementation. However, only a half of the implementation strategies included in the ERIC compilation were represented in the de-implementation studies, which may imply that some strategies are being underused or that they are not applicable for de-implementation purposes. The strategies assess and redesign workflow (a strategy previously suggested to be added to ERIC), accountability tool, and communication tool (unique new strategies for de-implementation) could complement the existing ERIC compilation when used for de-implementation purposes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-022-01247-y.

Modern biotechnological strategies for vaccine development in aquaculture - Prospects and challenges

Advances in genomics and the gradual reduction of cost for technologies like whole-genome sequencing have provided exciting opportunities for developing modern biotechnological-based vaccines in aquaculture. This systemic review describes the prospects and challenges of implementing these high-tech vaccines in fish species. The majority of the commercial vaccines in aquaculture utilize conventional procedures for which cost of administration, protective immunity and safety issues are the major challenges. In recent years, more efficient vaccines are being developed by adopting the advances in vaccine technology. Vaccines based on surface antigens, protein/peptide/polysaccharide subunits, recombinant DNA/mRNA/plasmids, novel antigen expression and delivery systems (bacteriophage particles, virus like particles/VLPs, recombinant yeast, mucosal vaccines), novel molecular adjuvants (IL-8, IL-12, HSPs), and encapsulation polymers and polysaccharides like chitosan nanoparticles and PLGA microcapsule were successfully developed. These biotechnology-based vaccines have proved to be very efficient in field trials, but are always in the research pipeline or as patents. Only very few of them are licensed for use, that too, in high-valued fishes like salmonids. Currently, commercial aquaculture vaccines are available for Aeromonas salmonicida, Vibrio salmonicida, Yersinia ruckeri, Vibrio anguillarum, Edwardsiella ictalurid, and for certain Betanodaviruses. Nevertheless, no registered vaccines are available for other major infectious diseases/pathogens such as viral hemorrhagic septicemia virus (VHSV), viral nervous necrosis virus (VNN) and certain other betanodaviruses, channel catfish virus (CCV), gill disease bacteria, mycobacteria, flavobacterium, Edwardsiella tarda, and certain streptococci. Despite the important economic losses that the pathogens cause to aquaculture worldwide, the commercialization of vaccines remains limited due to immunological pitfalls in aquatic species, large-scale vaccination issues, unregulated use of antibiotics and chemicals, gene-based vaccine regulations and commercial viability. If attempts are to be made to develop novel delivery methods, cost-effective procedures, and relaxations in DNA vaccine regulations, biotechnology-based vaccination could circumvent the emerging disease challenges in aquaculture.

Facilitators, barriers and strategies for health-system guidance implementation: a critical interpretive synthesis protocol

Background

As systematically developed statements regarding possible courses of action, health system guidance (HSG) can assist with making decisions about addressing problems or achieving goals in health systems. However, there are conceptual and methodological challenges in HSG implementation due to the complexity of health-system policy-making, the diversity of available evidence and vast differences in contexts. To address these gaps, we aim to develop a theoretical framework for supporting HSG implementation as part of a broader effort to promote evidence-informed policy-making in health systems.

Methods

To develop a theoretical framework about facilitators, barriers and strategies for HSG implementation, we will apply a critical interpretive synthesis (CIS) approach to synthesize the findings from a range of relevant literature. We will search 11 electronic databases and seven organizational websites to identify relevant published and grey literature. We will check the references of included studies and contact experts to identify additional eligible papers. Finally, we will conduct purposively sampling of the literature to fill any identified conceptual gaps. We will use relevance and five quality criteria to assess included papers. A standardized form will be developed for extracting information. We will use an interpretive analytic approach to synthesize the findings, including a constant comparative method throughout the analysis. Two independent reviewers will conduct the literature screening and relevance assessment, and disagreements will be resolved through discussion. The principal investigator will conduct data extraction and synthesis, and a second reviewer will check the sample of extracted data for consistency and accuracy.

Discussion

A new theoretical framework about facilitators, barriers and strategies for HSG implementation will be developed using a CIS approach. The HSG implementation framework could be widely used for supporting the implementation of HSG covering varied topics and in different contexts (including low-, middle- and high-income countries). In later work, we will develop a tool for supporting HSG implementation based on the theoretical framework.

Registration PROSPERO CRD42020214072. Date of Registration: 14 December 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00908-0.

A systematic review of the international evolution of online mental health strategies and recommendations during the COVID-19 pandemic

INTRODUCTION

The global health crisis caused by the COVID-19 pandemic has had a negative impact on mental health (MH). As a response to the pandemic, international agencies and governmental institutions provided an initial response to the population's needs. As the pandemic evolved, the population circumstances changed, and some of these international agencies updated their strategies, recommendations, and guidelines for the populations. However, there is currently a lack of information on the attention given to response strategies by the different countries throughout the beginning of the pandemic.

OBJECTIVES

1) To evaluate the evolution of online MH strategies and recommendations of selected countries to cope with the MH impact of COVID-19 from the early stages of the pandemic (15 April 2020) to the vaccination period (9 June 2021) and 2) to review and analyse the current structures of these online MH strategies and recommendations.

METHODOLOGY

An adaptation of the PRISMA guidelines to review online documents was developed with a questionnaire for MH strategies and recommendations assessment. The search was conducted on Google, including documents from April 2020 to June 2021. Basic statistics and Student's t test were used to assess the evolution of the documents, while a two-step cluster analysis was performed to assess the organisation and characteristics of the most recent documents.

RESULTS

Statistically significant differences were found both in the number of symptoms and mental disorders and MH strategies and recommendations included in the initial documents and the updated versions generated after vaccines became available. The most recent versions are more complete in all cases. Regarding the forty-six total documents included in the review, the cluster analysis showed a broad distribution from wide-spectrum documents to documents focusing on a specific topic.

CONCLUSIONS

Selected governments and related institutions have worked actively on updating their MH online documents, highlighting actions related to bereavement, telehealth and domestic violence. The study supports the use of the adaptation, including the tailor-made questionnaire, of the PRISMA protocol as a potential standard to conduct longitudinal assessments of online documents used to support MH strategies and recommendations.

Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa

Background

Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of ‘asthma’ defined by symptoms is high compared to ‘doctor diagnosed asthma’. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges?

Methods

The Arksey and O’Malley’s framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The ‘Preview, Question, Read, Summarise’ system was used and a narrative report was used to summarise the findings.

Results

A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening.

Conclusion

This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-022-02170-y.

Change Management: From Theory to Practice

This article presents a set of change management strategies found across several models and frameworks and identifies how frequently change management practitioners implement these strategies in practice. We searched the literature to identify 15 common strategies found in 16 different change management models and frameworks. We also created a questionnaire based on the literature and distributed it to change management practitioners. Findings suggest that strategies related to communication, stakeholder involvement, encouragement, organizational culture, vision, and mission should be used when implementing organizational change.

Comparative efficacy and safety of different catheter ablation strategies for persistent atrial fibrillation: a network meta-analysis of randomized clinical trials

AIMS

Whereas pulmonary vein isolation (PVI) is the universally agreed target in catheter ablation of paroxysmal atrial fibrillation (AF), an ideal ablation set in persistent AF remains questioned. Aim of this study is to conduct a network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing different ablation strategies in persistent AF patients.

METHODS AND RESULTS

Network meta-analysis was performed in a frequentist framework with the different ablation strategies constituting the competitive arms of interest. Primary efficacy endpoint was recurrences of atrial tachyarrhythmia (AF, atrial flutter, and/or organized atrial tachycardia). Secondary endpoints included major peri-procedural complications, procedure, and fluoroscopy duration. PubMED/MEDLINE and EMBASE databases were searched through June 2020. 2548 records were screened and 57 full-text articles assessed. Eventually 24 RCTs were included, encompassing 3245 patients (median follow-up 15 months, IQR 12-18). Compared to PVI alone, PVI plus linear lesions in the left atrium and elimination of extra-PV sources was the only strategy associated with a reduced risk of arrhythmia recurrence (RR 0.49, 95%CI 0.27-0.88). Most treatment arms were associated with longer procedural time compared with PVI; however, major peri-procedural complications and fluoroscopy time did not differ.

CONCLUSION

A comprehensive strategy including PVI, linear lesions in the left atrium, and elimination of extra-PV sources (constrained by a heterogeneous definition across studies) was associated with reduced risk of recurrent atrial tachyarrhythmias compared to PVI alone. All investigated treatment arms yielded similar safety profiles. Further research should rely on enhanced substrate-based approach definitions to solve one of the most evident knowledge gaps in interventional electrophysiology.

Personal motivation, self-regulation barriers and strategies for weight loss in people with overweight and obesity: a thematic framework analysis

OBJECTIVE

To explore motivations, self-regulation barriers and strategies in a multi-ethnic Southeast Asian population with overweight and obesity.

DESIGN

Qualitative design using semi-structured face-to-face and videoconferencing interviews. Data were analysed using thematic framework analysis and constant comparison method.

SETTING

Specialist weight management clinic.

PARTICIPANTS

Twenty-two participants were purposively sampled from 13 April to 30 April 2021. Median age and BMI of the participants were 37·5 (interquartile range (IQR) = 13·3) and 39·2 kg/m² (IQR = 6·1), respectively. And 31·8 % were men, majority had a high intention to adopt healthy eating behaviours (median = 6·5; IQR = 4·8-6·3) and 59 % of the participants had a medium level of self-regulation.

RESULTS

Six themes and fifteen subthemes were derived. Participants were motivated to lose weight by the sense of responsibility as the family's pillar of support and to feel 'normal' again. We coupled self-regulation barriers with corresponding strategies to come up with four broad themes: habitual overconsumption - mindful self-discipline; proximity and convenience of food available - mental tenacity; momentary lack of motivation and sense of control - motivational boosters; and overeating triggers - removing triggers. We highlighted six unique overeating triggers namely: trigger activities (e.g. using social media); eating with family, friends and colleagues; provision of food by someone; emotions (e.g. feeling bored at home, sad and stressed); physiological condition (e.g. premenstrual syndrome); and the time of the day.

CONCLUSIONS

Future weight management interventions should consider encompassing participant-led weight loss planning, motivation boosters and self-regulation skills to cope with momentary overeating triggers.

A systematic review of COVID-19 transport policies and mitigation strategies around the globe

This paper reports a Scopus-based systematic literature review of a wide variety of transportation policies and mitigation strategies that have been conducted around the world to minimize COVID-19 contagion risk in transportation systems. The review offers a representative coverage of countries across all continents of the planet, as well as among representative climate regions - as weather is an important factor to consider. The readership interested in policies and mitigation strategies is expected to involve a wide range of actors, each involving a particular application context; hence, the literature is also characterized by key attributes such as: transportation mode; actor (users, operators, government, industry); jurisdiction (national, provincial, city, neighborhood); and area of application (planning, regulation, operations, research, incentives). An in-depth analysis of the surveyed literature is then reported, focusing first on condensing the literature into 151 distinct policies and strategies, which are subsequently categorized into 25 broad categories that are discussed at length. The compendium and discussion of strategies and policies reported not only provide comprehensive guidelines to inform various courses of action for decision-makers, planners, and social communicators, but also emphasize on future work and the potential of some of these strategies to be the precursors of meaningful, more sustainable behavioral changes in future mobility patterns.

A survey of Circular Economy initiatives in Portuguese central public sector organisations: National outlook for implementation

The Circular Economy (CE) is generally understood as an opportunity to transform the current unsustainable linear economic system by redesigning the way organisations provide goods and services rethinking how society consumes and uses those resources. In this context, the public sector is mainly recognised as an actor enabling the implementation of a sustainable CE through governmental interventions and policy initiatives. However, there is a lack of studies considering the public sector at an organisational level. CE in organisations includes a wide range of different practices that are important to examine in order to analyse the CE implementation process. Consequently, this study aims to characterise the current state of implementing circular practices and supporting strategies in central public sector organisations. To fulfil this aim, a questionnaire survey was sent to the organisations pertaining to the Portuguese Central Public Administration, as surveys are valuable tools to systematically collect information on various topics. The results demonstrate a relatively low level of implementation. Circular practices such as purchasing remanufactured or used items, using sharing platforms, increasing the efficiency of buildings, adopting green human resources and collaborative initiatives for circularity, and assessing and communicating about CE activities have presented low levels of adoption. At the same time, waste collection for recycling and dematerialisation practices showed good implementation levels. There is, thus, immense potential for further implementation of circularity in central public sector organisations in Portugal. This research contributes to deepening the understanding of the extent to which circular practices are embedded in public sector organisations and identifying the main implementation strengths and weaknesses. This research has the potential to help practitioners and researchers in the transition towards circularity in identifying circular opportunities in their organisations and in building a vision to further implement circularity in public sector organisations.

Capacity and strategies of energy production from renewable sources in Arab countries until 2030: a review from renewable energy potentials to environmental issues

Slowing and reversing climate change and keeping energy prices at affordable levels are the main important achievements of the use of renewable energy. About 210% increase in energy consumption from 1990 to 2018, reduction in fossil fuel reserves, and high capacity of renewable energy in Arab countries encourage them to increase the use of renewable and sustainable energy sources as a key way to supply the energy in future and have a sustainable economy. There is no a comprehensive review study to focus on the capacity and strategies of renewable energy in Arab countries at the transnational level until 2030. To fill this gap, this article investigates the current and future capacities and strategies of renewable energy production by 22 Arab countries, which are the center of fossil energy production in the world, until 2030. Indeed, it provides a roadmap for advancement towards energy production from renewable sources in these countries. It is observed that Egypt and Morocco with an installed capacity of 5980 and 3447 MW, respectively, had the highest installed renewable energy capacity among the Arab countries in 2020. The results also showed that most ambitious goal is related to Djibouti, where it is targeted to supply 100% of energy from renewable resource by 2035. Finally, it should be mentioned that most Arab countries focus on solar and wind energy, and very little attention is paid to geothermal, biomass, and hydroelectric energy.

Implementations and strategies of telehealth during COVID-19 outbreak: a systematic review

Background

Telehealth is an effective option to fight the outbreak of COVID-19. This review aims to systematically characterize the utilization and applications of telehealth during the COVID-19 pandemic focusing mainly on technology implementations.

Methods

This study was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The literature search was conducted in Science Direct, IEEE XPLORE, Scopus, and Web of Science databases from January 2020 until July 2021, with an English language restriction. A quality assessment was based on the Critical Appraisal Skills Programs checklist.

Results

The included studies focused on the implementation of technology for telehealth, multidisciplinary approach, service satisfaction, guidelines, and medical training. They provided illustrative insight into the strategy of telehealth in different medical specialties, such as pediatric gastroenterology, oncology, ophthalmology, and laryngology. Nonsurgical specialties had the greatest number of telehealth visits. Clinicians showed positive attitudes toward the implementation of video telehealth visits; patients report high levels of satisfaction with this care and strong interest in continuing this modality as a significant portion of clinical practice.

Conclusions

This systematic review provided an illustrative insight into the strategy of telehealth for different purposes. According to our findings, telehealth may be used in different medical area with a clear strategy of intervention according to patients’ and doctors’ needs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08235-4.

Managing community engagement in research in Uganda: insights from practices in HIV/AIDS research

Background

Community engagement (CE) in research is valuable for instrumental and intrinsic reasons. Despite existing guidance on how to ensure meaningful CE, much of what it takes to achieve this goal differs across settings. Considering the emerging trend towards mandating CE in many research studies, this study aimed at documenting how CE is conceptualized and implemented, and then providing context-specific guidance on how researchers and research regulators in Uganda could think about and manage CE in research.

Methods

We conducted qualitative interviews and focus group discussions involving forty-one respondents who were experienced in HIV/AIDS biomedical research involving CE. Thirty-eight of these were directly or indirectly associated with Uganda’s leading research institution in the field of HIV/AIDS. They included Principal Investigators, Community Liaisons Officers, Research Ethics Committee members and Community Advisory Board Members. Three respondents were from Uganda National Council for Science and Technology. Data were collected between August 2019 and August 2020, using audio-taped focus group discussions and key informant interviews, transcribed and analyzed manually to generate themes and subthemes.

Results

Three major themes emerged: goals or value of CE; the means of CE, and, the evaluation of CE. Goals or value of CE generated four subthemes representing the overarching goals of CE: (1) Promote communities’ agency; (2) Generate and sustain trust; (3) Protect and promote communities’ rights and interests; and, (4) Help studies optimize participation in the form of enrolment and retention of participants. What usually comes under the nomenclatures of methods, strategies, and approaches of CE, such as town-hall meetings, sports events, drama, and the like, should simply be understood as the means of CE, and it is not desirable to hold pre-conceived and fixed ideas about the best means to conduct CE in research since a lot depend on the context. Finally, the study found that despite CE’s critical importance, which suggests the need to track and evaluate it, CE is currently intermittently evaluated, and for inadequate motivations.

Conclusions

Existing guidance on how to conduct robust CE in research is no substitute for creativity, flexibility, and reflexivity on the part of both researchers and research regulators.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-022-00797-6.

Mapping evidence on the use of health promotion and disease prevention interventions as a strategy to sustaining pro-poor health insurance schemes: a scoping review protocol

BACKGROUND

Removing financial barriers and making healthcare accessible to all who need it remains an essential component of the United Nations' sustainable development goals. Pro-poor healthcare financing schemes are policies that enable patients to concentrate on obtaining absolute medical care when needed rather than worrying about the cost of care. The demand for health services in healthcare facilities has increased tremendously due to the increasing burden of communicable and non-communicable diseases. This potentially threatens the sustainability of pro-poor health financing schemes. This study seeks to synthesize literature and map evidence on the use of health promotion and disease prevention interventions as a strategy to sustaining pro-poor health financing schemes globally.

METHODS

We will conduct a systematic scoping review utilizing the Arksey and O'Malley framework, Levac et al. recommendations, and the Joanna Briggs Institute guidelines. A comprehensive keyword search for relevant published articles will be conducted in MEDLINE through PubMed, Web of Science, Google Scholar, SCOPUS, CINAHL, and Science Direct from 1 January 2000 to the last search date in 2021. Limiters such as date and language (English) will be applied, but study design limitations will be removed during the search. Boolean term AND/OR Medical Subject Heading terms will also be included. The reference list of all included articles will also be searched for potentially eligible articles. Two investigators will independently screen the articles in parallel at the abstract and full-text stages using the eligibility criteria designed in a Google form. Charting of data will also be conducted independently by two investigators using a piloted data abstraction form and thematic analysis conducted. The emerging themes will be collated, summarized, and the results reported.

DISCUSSION

We hope to provide evidence of diverse health promotion and disease prevention policies/strategies used by countries to sustain their pro-poor health financing schemes for possible adoption by other countries. We also anticipate finding research gaps for further studies to help find innovative contextualized health prevention and promotion strategies to sustain pro-poor health financing schemes especially those in LMICs. The findings will be comprehensively discussed and disseminated at conferences and publication in a peer-reviewed journal.

Family matters in Canada: understanding and addressing family homelessness in Ontario

Background

Homelessness is becoming an international public health issue in most developed countries, including Canada. Homelessness is regarded as both political and socioeconomic problems warranting broad and consistent result-oriented approaches.

Methods

This paper represents the qualitative findings of a project that explored risk factors associated with family homelessness and strategies that could mitigate and prevent homelessness among families using a focused ethnographic study guided by the principles of participatory action research (PAR). The sample includes 36 family members residing at a family shelter who participated in focus groups over two years (between April 2016 and December 2017). Most of the participants were single-parent women.

Results

The analysis yielded five major themes including, life challenges, lack of understanding of the system, existing power differentials, escaping from hardship, and a theme of proposed solutions for reducing family homelessness in the community.

Conclusion

The findings illustrated the complex nature of family homelessness in Ontario; that the interaction of multiple systems can put families at risk of homelessness. Findings from this study underscore the need for urgent housing protocols aimed at educating homeless families on how to navigate and understand the system, enhance their conflict resolution skills, and develop strategies beyond relocation to help them to cope with difficulties with housing.

A qualitative exploration of attitudes to walking in the retirement life change

Background

Walking is a simple activity that could help to reduce the prevalence of chronic diseases in all populations. Furthermore, an inverse dose–response relationship exists between steps taken and risk of premature death and cardiovascular events in middle-aged and older adults. There is a lack of information on how to effectively engage older adults around retirement age in walking. This qualitative study explored attitudes towards walking in older people with regard to habits, intensity, preferences and strategies for increasing walking behaviour.

Methods

In-depth qualitative interviews were conducted with 26 older adults who were either close to retirement or recently retired. An inductive thematic analysis was conducted.

Results

Three themes were identified from the data; 1) Engagement and perceived value of walking; was focused on the meaning of walking for the participant and the attributes they associate with their walking practice. 2) Integration and connectivity of walking; was focused on how participants integrate walking in their daily lives and whether walking can be practiced as a viable means of connectivity. 3) Strategies to increase walking; was focused on what factors motivate participants in their walking practice and what strategies they perceived to be beneficial to increase walking distance and intensity at an individual level.

Discussion

The views of walking in people of retirement age were represented within 3 key themes. The factors contained in these themes that may influence future walking practice are discussed with regard to future strategies to promote walking in the retirement life change.

Conclusion

It may be beneficial to promote qualitative aspects of walking practice and strive for regularity rather than intensity of walking to accrue the social, psychological and intellectual benefits reported by individuals in the retirement life change.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12853-2.

Safety and health management response to COVID-19 in the construction industry: A perspective of fieldworkers

The COVID-19 outbreak has significantly impacted the construction industry. The pandemic can exacerbate an already dire safety and health situation in the industry and negatively impact construction employees and employers. The present study investigates the safety and health measures implemented by construction firms in the United States (US), their effectiveness and usefulness, and workers' satisfaction with these COVID-19 measures. A questionnaire survey was developed and distributed to construction fieldworkers in the US to collect their perspectives on the implemented COVID-19 measures in the construction industry. A total of 187 valid responses were received and analyzed to achieve the aim of the study. Results revealed that strategies implemented to increase social distance and minimize group gathering to 10 persons in certain workstations were perceived to be substantially more effective than job-site screening strategies. Furthermore, smaller contractors implemented fewer safety measures and perceived them to be significantly less effective than those used by medium- and large-sized contractors. Fieldworkers were favorably disposed toward using technologies, such as video-conferencing apps and wearable sensing devices, to slow the spread of COVID-19 on construction job sites. The present study contributes to the body of knowledge by identifying safety and health measures to mitigate the spread of COVID-19 in construction. Practically, the study findings provide valuable insights to inform the successful implementation of safety strategies in the construction industry during a pandemic. The results are crucial for industry practitioners responsible for developing and revising pre- and post-pandemic safety and health plans.

Communication strategies to facilitate the implementation of new clinical practices: a qualitative study of community mental health therapists

Although communication is widely observed to be central to the implementation process, the field of implementation science has largely overlooked the details of how communication may best be utilized to facilitate implementation. This paper draws on relevant insights from Rogers' Diffusion of Innovations Theory, which laid the foundation for explicitly attending to the role of communication as a mechanism for implementation strategies to exert their effects. To offer empirically-derived and theory-informed recommendations regarding communication processes to support the effective introduction of new clinical practices. This investigation leverages data from 61 therapists poised to undergo implementation of measurement-based care (MBC) for depressed adults receiving psychotherapy in community mental health settings. Data were collected via focus groups across 12 sites. Themes emergent in the data analysis suggest five practices to facilitate effective communication in the introduction of new clinical practices like MBC: the communication of a clear rationale for the new practice; the provision of necessary procedural knowledge; communication about the change via multiple methods; sufficient lead time to prepare for the change; and the opportunity for bidirectional engagement. In addition to indicating several best practices to improve communication prior to implementation, our results suggest that the current conceptualization of implementation strategies may not yet be complete. Components and/or methods of effective communication about new practices should be included among the growing set of implementation strategies. Existing implementation strategies might also benefit from more temporal specificity, with more attention to the exploration and preparation phases. (Trial Registration: Clinicaltrials.gov NCT02266134. Registered 12 October 2014.).

Fostering the implementation of transitional care innovations for older persons: prioritizing the influencing key factors using a modified Delphi technique

Background

Transitions in care for older persons requiring long-term care are common and often problematic. Therefore, the implementation of transitional care innovations (TCIs) aims to improve necessary or avert avoidable care transitions. Various factors were recognized as influencers to the implementation of TCIs. This study aims to gain consensus on the relative importance level and the feasibility of addressing these factors with implementation strategies from the perspectives of experts. This work is within TRANS-SENIOR, an innovative research network focusing on care transitions.

Methods

A modified Delphi study was conducted with international scientific and practice-based experts, recruited using purposive and snowballing methods, from multiple disciplinary backgrounds, including implementation science, transitional care, long-term care, and healthcare innovations. This study was built on the findings of a previously conducted scoping review, whereby 25 factors (barriers, facilitators) influencing the implementation of TCIs were selected for the first Delphi round. Two sequential rounds of anonymous online surveys using an a priori consensus level of > 70% and a final expert consultation session were performed to determine the implementation factors’: i) direction of influence, ii) importance, and iii) feasibility to address with implementation strategies. The survey design was guided by the Consolidated Framework for Implementation Research (CFIR). Data were collected using Qualtrics software and analyzed with descriptive statistics and thematic analysis.

Results

Twenty-nine experts from 10 countries participated in the study. Eleven factors were ranked as of the highest importance among those that reached consensus. Notably, organizational and process-related factors, including engagement of leadership and key stakeholders, availability of resources, sense of urgency, and relative priority, showed to be imperative for the implementation of TCIs. Nineteen factors reached consensus for feasibility of addressing them with implementation strategies; however, the majority were rated as difficult to address. Experts indicated that it was hard to rate the direction of influence for all factors.

Conclusions

Priority factors influencing the implementation of TCIs were mostly at the organizational and process levels. The feasibility to address these factors remains difficult. Alternative strategies considering the interaction between the organizational context and the outer setting holds a potential for enhancing the implementation of TCIs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02672-2.

Assays to Estimate the Binding Affinity of Aptamers

Aptamers have become coming-of-age molecular recognition elements in both diagnostic and therapeutic applications. Generated by SELEX, the 'quality control' of aptamers, which involves the validation of their binding affinity against their respective targets is pivotal to ascertain their potency prior to use in any downstream assays or applications. Several aptamers have been isolated thus far, however, the usage of inappropriate validation assays renders some of these aptamers dubitable in terms of their binding capabilities. Driven by this need, we provide an up-to-date critical review of the various strategies used to determine the aptamer-target binding affinity with the aim of providing researchers a better comprehension of the different analytical approaches in respect to the molecular properties of aptamers and their intended targets. The techniques reported have been classified as label-based techniques such as fluorescence intensity, fluorescence anisotropy, filter-binding assays, gel shift assays, ELISA; and label-free techniques such as UV-Vis spectroscopy, circular dichroism, isothermal titration calorimetry, native electrospray ionization-mass spectrometry, quartz crystal microbalance, surface plasmon resonance, NECEEM, backscattering interferometry, capillary electrophoresis, HPLC, and nanoparticle aggregation assays. Hybrid strategies combining the characteristics of both categories such as microscale thermophoresis have been also additionally emphasized. The fundamental principles, complexity, benefits, and challenges under each technique are elaborated in detail.

The COVID-19 pandemic: a new epoch and fresh challenges for cancer patients and caregivers-a descriptive cross-sectional study

PURPOSE

Cancer patients and their caregivers are overwhelmed with features of uncertainty, fear, shock, worry, anxiety, sadness, and grief. To add on to their misery, the COVID-19 pandemic has severely afflicted the cancer care delivery. The study was conducted to observe the challenges faced by cancer patients and their caregivers and to formulate strategies for oncological setups to overcome those challenges.

METHODS

After obtaining institutional ethical clearance, a descriptive cross-sectional study was conducted to observe the challenges faced by patients and their caregivers at the level of various domains (physical, logistic, psychological, socioeconomic, and spiritual) who visited the outpatient and inpatient department of cancer pain and palliative care unit. The results were expressed in absolute numbers.

RESULTS

Major challenges encountered were suffering from physical symptoms like pain, nausea, vomiting, dyspnea (90%), postponement of cancer treatment (80%), fear of contracting COVID infection due to hospital visit (93.5%), lack of accommodation (70%), and lack of spiritual clarity and hope (50%).

CONCLUSIONS

Major challenges faced by patients were in physical and psychological domains, and those by caregivers were in socioeconomic domains and handling physical symptoms of their patients. It is imperative to recognize and be cognizant of the challenges faced by cancer patients and their caregivers. Health care setups should formulate strategies to alleviate these challenges and provide holistic care to cancer patients. These strategies will hold in good stead for future pandemics also.

Use of population health data and qualitative analysis to guide local planning and implementation of Supplemental Nutrition Assistance Program Education

PURPOSE

To describe how local quantitative and qualitative data were used to assess the progress of the Supplemental Nutrition Assistance Program Education (SNAP-Ed) interventions in Los Angeles County, California.

APPROACH

Data from the California Health Interview Survey informed the geographical concentration of program resources during the planning phase. At the end of the program, semi-structured interviews with stakeholders were conducted to assess factors that facilitated SNAP-Ed implementation.

SETTING

Los Angeles County, California.

PARTICIPANTS

Twenty-four project coordinators were interviewed.

INTERVENTION

From 2016-2020, 24 organizations across Los Angeles County delivered nutrition education, reaching an estimated 2 million people. Two-hundred policy, systems, and environmental change interventions reached an estimated 1.2 million people.

METHOD

Semi-structured interview data were analyzed using a form of both inductive and deductive content analysis. A codebook was developed based on themes identified in these interviews. Each interview was coded by two team members; discrepancies (if they arose) were resolved by a 5-member group.

RESULTS

Two facilitators - support for capacity building from a local health department and presence of community partnerships - were identified as critical factors that contributed to the success of SNAP-Ed implementation.

CONCLUSIONS

A local health department can increase SNAP-Ed intervention reach and uptake by assisting funded partners with further capacity building, helping them to develop feasible work plans, foster evaluation skills, and engage in sustainability planning.

Comprando Rico y Sano: Increasing Latino nutrition knowledge, healthful diets, and food access through a national community-based intervention

PURPOSE

Evaluation findings from "X" a culturally relevant, community-based intervention addressing nutrition knowledge and food access are presented.

DESIGN

No-control quasi-experimental intervention with pre, post, and follow-up assessments.

SETTING

"X" was promotores-led through "X" community-based partners.

SAMPLE

Low-income Latino adults (N=966) receiving services at 25 partner sites.

INTERVENTION

"X" was a six-hour intervention focused on nutrition knowledge and consumption of fruits, vegetables, and home-prepared meals. It also provided guidance for health-conscious grocery shopping, Supplemental Nutrition Assistance Program (SNAP) information, and enrollment assistance.

MEASURES

Self-report surveys assessed nutrition knowledge; intention to change; and frequency of fruit, vegetable, and home-prepared meal consumption. Sites reported monthly SNAP enrollment data.

ANALYSIS

Paired-samples t-tests and repeated-measures ANOVAs assessed changes in knowledge, intentions, and behavior from pre-to-post (n=960) and pre-to-follow-up (n=115).

RESULTS

Pre-to-follow-up increases in nutrition knowledge (p<.001) were observed. Intention to consume more vegetables (p=.027) and home-prepared meals (p<.001) also improved between pre and follow-up. Increases from pre-to-follow-up were observed for frequency of consuming fruits (p=.007), vegetables (p=.001), and home-prepared meals (p<.001). Across 16 months, 24,359 Latinos enrolled for SNAP.

CONCLUSION

Large-scale community collaborations to deliver culturally relevant nutrition education and SNAP enrollment assistance can increase food access, health literacy, and promote healthful diets for Latinos.

Evaluating "The REST of your Life," a workplace health program to improve employee sleep, health, energy, and productivity

Purpose Sleep is critical for employee health, well-being, and productivity. Our purpose is to evaluate a sleep-focused interactive workplace health promotion program. Design We evaluate sleep and mental health before and after exposure to the program using a pre/post quasi-experimental pilot study design with surveys administered at baseline and 1-, 6-, and 12-months post-exposure (Phase 1). We design program evaluation surveys for dissemination when the program is offered broadly to hospital employees (Phase 2). Setting The study was conducted at a large teaching hospital in the Southeast U.S. in 2016. Subjects Subjects were full-time hospital employees. Intervention The program was presented to subjects in one four-hour interactive session. Measures In Phase 1 (n=55), surveys included the validated Apnea Risk Evaluation System (ARES), Dysfunctional Beliefs About Sleep (DBAS), Generalized Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire (PHQ-9). Phase 2 (n=3,935) utilized program evaluation surveys. Analysis We compare survey responses between pre- and post-program using ANOVA with post-hoc tests. Results Statistically significant improvement in all sleep and mental health domains was demonstrated. In Phase 2, 81.9% reported "strongly agree" to willingness to recommend the program to co-workers. Conclusion We demonstrate improvement in employee sleep and mental health after exposure to a novel workplace health promotion program to improve sleep.

Sleep Moderates Improvements in Mental Health Outcomes in Youth: Building Resilience for Healthy Kids

PURPOSE

To examine the role of sleep in a school-based resiliency intervention.

DESIGN

Single group feasibility study.

SETTING

Urban middle school Subjects: Sixth grade students Intervention: A total of 285, 11-12-year-old students (70% White, 18% Hispanic, 55% female) participated in the six-week 1:1 Healthy Kids intervention. Youth (n=248) completed electronic surveys at pre-post the 6-week study assessing mental health parameters and self-reported bed and wake time.

MEASURES

Students were categorized as having insufficient sleep opportunity if they reported time in bed of <9 hours per night.

ANALYSIS

General linear models examined differences between groups for each mental health parameters pre-post study.

RESULTS

A third of participants (28%) were classified as having insufficient sleep opportunity. Youth with insufficient sleep were more often Hispanic (27% vs 16%; p<0.001) and were more often classified with both mild to severe depression and anxiety symptoms (55% vs 35%; p=0.004). The health coaching intervention was found to have a significant improvement on overall resilience and self-efficacy only among students who reported sufficient sleep, while no significant intervention effect was found for those students who reported insufficient sleep.

CONCLUSIONS

Our findings suggest that youth with poor sleep health may not benefit from school-based resiliency interventions.

"Everyone in our community should be informed about the HPV vaccine": Latinx mothers' suggested strategies to promote the human papillomavirus vaccine

PURPOSE

Parents play a critical decision-making role in vaccinating their children against HPV, and mothers, in particular, are key stakeholders as they are often the parent taking their children to healthcare visits. Given the importance of the HPV vaccination as a cancer prevention strategy, this study was designed to explore Latinx mothers' suggested strategies to promote vaccine uptake among Latinx parents.

SETTING AND PARTICIPANTS

Community-based in Massachusetts, United States, and Latinx mothers.

DESIGN AND METHODS

Descriptive qualitative research employing individual semi-structured interviews. Data were analyzed using a hybrid method of thematic analysis incorporating deductive and inductive approaches.

RESULTS

Twenty-two, majority foreign-born (91%) Latinx mothers of adolescent girls (∼60%) and boys (∼40%) aged 11-19 years participated. Mothers suggested several strategies to promote uptake of the HPV vaccine among Latinx families including healthcare providers' increased communication and anticipatory guidance addressing factors influencing parents' HPV vaccination hesitancy, and improved community-wide dissemination of culturally and linguistically relevant information targeting not only parents of age-eligible participants but the broader community. Finally, mothers suggested the use of social media using personal narratives and an enhanced active role of schools in providing accurate information to raise awareness and educate adolescents and parents about the importance of HPV vaccination.

CONCLUSION

Findings are relevant to the development of tailored interventions to meet the needs of Latinx populations, and ultimately increase Latinx children's HPV vaccination rates.

Unique Barriers to Workplace Health Promotion Programs (WHP) by Wage Category: A Qualitative Assessment of Secondary Data

PURPOSE

To understand barriers around accessing or using workplace health promotion (WHP) programs among workers in different wage categories.

APPROACH

We conducted qualitative analysis of responses to three open-ended questions about WHP program participation, collected as part of an existing WHP program evaluation.

SETTING

A large mid-western university.

PARTICIPANTS

Of the 20,000 employees emailed an online survey, 3,212 responded (16.1%). The sample was mostly female (75%), white (79%), and comprised of staff members (84%). The average age was 44 years and 67% had annual incomes <$75,001.

METHOD

We used NVivo-12 Plus and two coders to apply Grounded Theory on the open-ended questions and identify emergent themes.

RESULTS

Although most respondents were happy with the program, differences across wage categories emerged around time, financial incentives, commute, workload, and organizational policies/support. Employees at all wage levels were enthusiastic about creating a culture of health but needed different supports to do so. For instance, higher-wage workers needed to overcome self-made time constraints, while lower-wage workers needed supervisor support to overcome coverage constraints that prevented participation.

CONCLUSION

The unique participation challenges experienced by employees in different wage categories provide justification for WHP programs that can better accommodate the participation barriers of all employees. While some programs may simply require more flexible offerings, others may need to train supervisors to support and foster healthy environments.

Increasing the electron selectivity of nanoscale zero-valent iron in environmental remediation: A review

Nanoscale zero-valent iron nanoparticles (nZVI) have been used for groundwater remediation and wastewater treatment due to their high reactivity, high adsorption capacity and nontoxicity. However, side reactions generally occur in tandem with the target contaminants removal process, resulting in poor electron selectivity (ES) of nZVI, and subsequently restricting its commercial application. Major efforts to increase ES of nZVI have been made in recent years. This review's objective is to provide a progress report on the significant developments in nZVI's ES during the past decade. Firstly, the definition of ES and its quantification approaches were documented, and the intrinsic (i.e. particle size, crystallinity, and surface area) and extrinsic factors (i.e. solutions pH, target contaminant concentration, and presence of co-contaminants) affecting the ES of nZVI were reported. The latest techniques for increasing ES were summarized in detail, with reference made to sulfidation, magnetization, carbon loading and other features. Then the mechanisms of those strategies for ES enhancement were described. Finally, some constructive suggestions on future research directions concerning nZVI's ES in the future were proposed.

Iowa Implementation for Sustainability Framework

Background

An application-oriented implementation framework designed for clinicians and based on the Diffusion of Innovations theory included 81 implementation strategies with suggested timing for use within four implementation phases. The purpose of this research was to evaluate and strengthen the framework for clinician use and propose its usefulness in implementation research.

Methods

A multi-step, iterative approach guided framework revisions. Individuals requesting the use of the framework over the previous 7 years were sent an electronic questionnaire. Evaluation captured framework usability, generalizability, accuracy, and implementation phases for each strategy. Next, nurse leaders who use the framework pile sorted strategies for cultural domain analysis. Last, a panel of five EBP/implementation experts used these data and built consensus to strengthen the framework.

Results

Participants (n = 127/1578; 8% response) were predominately nurses (94%), highly educated (94% Master’s or higher), and from across healthcare (52% hospital/system, 31% academia, and 7% community) in the USA (84%). Most (96%) reported at least some experience using the framework and 88% would use the framework again. A 4-point scale (1 = not/disagree to 4 = very/agree) was used. The framework was deemed useful (92%, rating 3–4), easy to use (72%), intuitive (67%), generalizable (100%), flexible and adaptive (100%), with accurate phases (96%), and accurate targets (100%). Participants (n = 51) identified implementation strategy timing within four phases (Cochran’s Q); 54 of 81 strategies (66.7%, p < 0.05) were significantly linked to a specific phase; of these, 30 (55.6%) matched the original framework. Next, nurse leaders (n = 23) completed a pile sorting activity. Anthropac software was used to analyze the data and visualize it as a domain map and hierarchical clusters with 10 domains. Lastly, experts used these data and implementation science to refine and specify each of the 75 strategies, identifying phase, domain, actors, and function. Strategy usability, timing, and groupings were used to refine the framework.

Conclusion

The Iowa Implementation for Sustainability Framework offers a typology to guide implementation for evidence-based healthcare. This study specifies 75 implementation strategies within four phases and 10 domains and begins to validate the framework. Standard use of strategy names is foundational to compare and understand when implementation strategies are effective, in what dose, for which topics, by whom, and in what context.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13012-021-01157-5.

Automatization through Practice: The Opportunistic-Stopping Phenomenon Called into Question

As a theory of skill acquisition, the instance theory of automatization posits that, after a period of training, algorithm‐based performance is replaced by retrieval‐based performance. This theory has been tested using alphabet‐arithmetic verification tasks (e.g., is A + 4  = E?), in which the equations are necessarily solved by counting at the beginning of practice but can be solved by memory retrieval after practice. A way to infer individuals’ strategies in this task was supposedly provided by the opportunistic‐stopping phenomenon, according to which, if individuals use counting, they can take the opportunity to stop counting when a false equation associated with a letter preceding the true answer has to be verified (e.g., A + 4  = D). In this case, such within‐count equations would be rejected faster than false equations associated with letters following the true answers (e.g., A + 4  = F, i.e., outside‐of‐count equations). Conversely, the absence of opportunistic stopping would be the sign of retrieval. However, through a training experiment involving 19 adults, we show that opportunistic stopping is not a phenomenon that can be observed in the context of an alphabet‐arithmetic verification task. Moreover, we provide an explanation of how and why it was wrongly inferred in the past. These results and conclusions have important implications for learning theories because they demonstrate that a shift from counting to retrieval over training cannot be deduced from verification time differences between outside and within‐count equations in an alphabet‐arithmetic task.

Floristic biodiversity, biogeographical significance, and importance of Morocco's Arganeraie Biosphere Reserve

The coastal and subcoastal areas of west-central Morocco (Safi to Draa River, the Souss Valley, and the southern part of the western High Atlas and northern and southern slopes of the western Anti-Atlas) are characterized by typical Infra-Mediterranean vegetation ranking them amongst the important of the remarkable borderlands of North Africa. The flora is determined by complex historical and environmental factors occurring since the Tertiary period. The originality of this sector is due to the presence of the argan tree (Argania spinosa (L.) Skeels), Moroccan gum (Acacia gummifera Willd), olive trees (Olea europaea L. subsp. maroccana (Greuter & Burdet) P. Vargas & al.), a thermophilic flora adapted to an arid climate with several endemic species. This flora constitutes the final barrier against the desert and is of environmental and socioeconomical interest. Leaves and fruits provide forage material, while wood is used for fuel. Argan fruits are collected for their oily constitutes and for nutritional, cosmetic, and medicinal properties. Additionally, many species of Argan ecosystems are used in medicine and cosmetics. Recognizing its ecological value and local economic importance, the Argan region was declared a UNESCO Biosphere Reserve in 1998. Despite their biogeographical, historical, and socioeconomic value, vegetation structures in west-central Morocco are vulnerable and threatened by human activities. They exhibit high levels of degradation due to increasing clearance, overgrazing, and overexploitation. The area requires high conservation priority and sustainable management strategies for key species and genetic diversity.

Strategies and experiences for sand and dust storm adaptation: A qualitative study in Iran

BACKGROUND AND PURPOSE

Sand and Dust storms (SDS) are meteorological hazards that are increasing due to climate change. Mitigation and adaptation are two main strategies that help to deal with this global concern. In the recent decades, Iran has been prone to SDS. Therefore, this study was conducted in 2018 in order to explore the SDS adaptation experiences and strategies in the Iranian community.

METHODS

Using content analysis approach and purposive sampling, three groups (including 14 experts, 8 authorities, and 23 individuals) were selected. Data were collected through semi-structured interviews. Data analysis was performed using Graneheim and Lundman's method. Finally, Gaba and Lincoln's scientific criteria were used for data validity.

RESULTS

Two major categories emerged from the analysis. The first category was related to the adaptation experiences and included two subcategories: "citizens' experiences" and "experts'/ authorities' experiences". The second was related to SDS adaptation strategies and included five subcategories: "educational development", "public participation", "inter-sectorial coordination", "institutional development", and "environment preservation".

CONCLUSIONS

Identifying the experiences and strategies that are implemented by a community to adapt to SDS is the core stone for developing a comprehensive local and national adaptation plan. This study suggests strategies and action plans for SDS adaptation that can be used in policy making.

Photosynthesis research under climate change

Increasing global population and climate change uncertainties have compelled increased photosynthetic efficiency and yields to ensure food security over the coming decades. Potentially, genetic manipulation and minimization of carbon or energy losses can be ideal to boost photosynthetic efficiency or crop productivity. Despite significant efforts, limited success has been achieved. There is a need for thorough improvement in key photosynthetic limiting factors, such as stomatal conductance, mesophyll conductance, biochemical capacity combined with Rubisco, the Calvin-Benson cycle, thylakoid membrane electron transport, nonphotochemical quenching, and carbon metabolism or fixation pathways. In addition, the mechanistic basis for the enhancement in photosynthetic adaptation to environmental variables such as light intensity, temperature and elevated CO₂ requires further investigation. This review sheds light on strategies to improve plant photosynthesis by targeting these intrinsic photosynthetic limitations and external environmental factors.

Connecting teachers' classroom instructions with children's metacognition and learning in elementary school

Many children have difficulties with accurate self-monitoring and effective regulation of study, and this may cause them to miss learning opportunities. In the classroom, teachers play a key role in supporting children with metacognition and learning. The present study aimed to acquire insights into how teachers' cognitive and metacognitive strategy instruction, as well as teacher-directed and child-centered instructional practices are related to children's self-monitoring accuracy, regulation of study, and learning performance. Twenty-one teachers and 308 children (2nd and 4th grade elementary school) participated. Teachers instructed a secret code task, children had to learn the match between letters of the alphabet and corresponding symbols. Teachers were observed and audio-recordings were made of their instructions. Then, children were asked to (a) make restudy selections, (b) complete a test, and (c) self-monitor test performance. Although teachers both addressed cognitive and metacognitive strategies, they more often instructed children about cognitive strategies. Further, teaching practices were more often teacher-directed than child-centered. Although there were no relations between teachers' instructions for metacognitive strategies and children's outcome measures, teaching cognitive strategies was positively associated with children's performance and self-monitoring accuracy. However, teaching cognitive strategies did not predict effective restudy selections. Rather, child-centered instructions (i.e., giving children autonomy to regulate their own learning) positively predicted children's restudy, and further, children's self-monitoring was more accurate in classrooms where teachers more often used child-centered instructional practices. This seems to imply that not only the content of the instructions itself, but particularly the way these are given, affects children's metacognition.

Mechanisms of cytokine release syndrome and neurotoxicity of CAR T-cell therapy and associated prevention and management strategies

Chimeric antigen receptor (CAR) T-cell therapy has yielded impressive outcomes and transformed treatment algorithms for hematological malignancies. To date, five CAR T-cell products have been approved by the US Food and Drug Administration (FDA). Nevertheless, some significant toxicities pose great challenges to the development of CAR T-cell therapy, most notably cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Understanding the mechanisms underlying these toxicities and establishing prevention and treatment strategies are important. In this review, we summarize the mechanisms underlying CRS and ICANS and provide potential treatment and prevention strategies.

Undertaking general practice quality improvement to improve cancer screening - a thematic analysis of provider experiences

Background

Cancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives.

Methods

We used a qualitative approach and interviewed 18 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives.

Results

In a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities.

Conclusions

The tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01581-y.

A case analysis of a mass treatment approach to control GI and water-related conditions in Sudan

Background

The efficiency of mass chlorination in controlling diarrheal diseases during acute emergencies has been extensively reported in literature. However, long-term crises received unparallel attention. Researchers have previously carried out a trial that investigated the impact of using chemical means to treat water reservoirs of Um-Baddah Nevachah, a refugee camp located in the western outskirts of Khartoum, Sudan.

A double-blind community experimental trial was carried out by randomly adding either chlorine or a placebo to the major water tanks in the area. Data were collected using a mixed-methods study design. The primary input was the quantitative data derived from total coliforms lab tests and records of the local primary healthcare center, while the embedded (nested) portion generated most of the qualitative data from direct face-to-face interviews.

As a case analysis, this study aims to critically appraise the original trial. In the Background the authors discussed the context of the trial, approach used, and outcomes. Discussion section included three issues related to the trial: scientific importance, challenges and strategies.

Discussion

Importance: There are two factors that contribute to the importance of this study: First, the integrated and systematic approach followed to resolve associated challenges. The study swiftly moved from investigating potential water contamination, to test whether it is related to an endogenous focus that auto-taints drinking water, and finally it explored the impact of tanks chlorination on public health. Second, the longstanding humanitarian context which remains largely underreported in literature. Challenges: funding limitations were among the first obstacles faced. During the fieldwork preparation phase, a lot of work was required to resolve logistical and security challenges. Keeping volunteers motivated was the biggest concern during the last phase of data collection. Strategies: The “Matrix Solutions Strategy” was developed and used to optimize scarce resources to simultaneously target multiple problems through a single intervention.

Conclusion

Key lessons learned from the whole experience were: persistence is paramount for the success of studies in precarious situations; lateral thinking generates alternative solutions that are novel, feasibility and practical in resources-limited settings; and finally respecting local culture and regulations is essential for building trust with both authorities and vulnerable societies.

Advanced strategies in Metal-Organic Frameworks for CO2 Capture and Separation

The continuous carbon dioxide (CO₂ ) gas emissions associated with fossil fuel production, valorization, and utilization are serious challenges to the global environment. Therefore, several developments of CO₂ capture, separation, transportation, storage, and valorization have been explored. Consequently, we documented a comprehensive review of the most advanced strategies adopted in metal-organic frameworks (MOFs) for CO₂ capture and separation. The enhancements in CO₂ capture and separation are generally achieved due to the chemistry of MOFs by controlling pore window, pore size, open-metal sites, acidity, chemical doping, post or pre-synthetic modifications. The chemistry of defects engineering, breathing in MOFs, functionalization in MOFs, hydrophobicity, and topology are the salient advanced strategies, recently reported in MOFs for CO₂ capture and separation. Therefore, this review summarizes MOF materials' advancement explaining different strategies and their role in the CO₂ mitigations. The study also provided useful insights into key areas for further investigations.

Interventions to boost enrollment in nursing doctor of philosophy (PhD) programs

BACKGROUND

Nursing Doctor of Philosophy (PhD) enrollments are languishing, and little is known about PhD enrollment strategies that may lessen nursing's PhD shortage.

PURPOSE

This study examined strategies for bolstering PhD enrollments or enrollment intentions among college students and graduates.

METHODS

An integrative review was undertaken using Whittemore and Knafl's methodology and Garrard's Matrix Method. Nine databases were searched, and a hand search was conducted.

FINDINGS

Strategies were predominantly situated in science, technology, engineering, and mathematics (STEM) disciplines. Features of successful strategies contained core components of faculty mentoring, hands-on research, funding and compensation, undergraduate participation, summer timeframe, informational sessions, and social support.

DISCUSSION

Less rigorous study designs and mostly STEM samples inhibit the transferability of these strategies to nursing. Qualitative research is needed to better understand nursing students' perspectives about the PhD. Additionally, current PhD enrollment strategies within nursing schools need to be systematically evaluated and the findings disseminated.

Developing the first pan-Canadian survey on patient engagement in patient safety

BACKGROUND

Patient safety is a worldwide problem, and the patient contribution to mitigate the risk of patient harm is now recognized as a cornerstone to its solution. In order to understand the nature of integrating patients into patient safety and healthcare organizations and to monitor their integration, a Canadian survey tool has been co-constructed by patients, researchers and the Canadian Patient Safety Institute (CPSI). This questionnaire has been adapted from the French version of the patient engagement (PE) in patient safety (PS) questionnaire created for the province of Quebec, Canada.

METHODOLOGY

The pan-Canadian PE in PS survey tool was developed in a five-step process: (1) a literature review and revision of the initial tool developed in the province of Quebec; (2) translation of the French questionnaire into an English version tool; (3) creation of a Canadian expert advisory group; (4) adaptation of the English version tool based on feedback from the expert advisory group (assessment and development of the construct's dimensions, wording assessment and adaptation for pan-Canadian use, technical testing of the online platform for the survey); and (5) pilot testing and pre-validation of the tool before pan-Canadian use.

RESULTS AND CONCLUSION

Eight pan-Canadian PE in PS surveys were completed from five Canadian provinces by the expert advisory group and six surveys were completed during the pilot project by participants from different provinces in Canada. This survey tool comprises 5 sections: (1) demographic identification of the participants (Q1 to Q5); (2) general questions (Q6 to Q17); (3) the patient engagement process (experience level of participants and organizational incentives for PE in general) (Q18 to Q33); (4) PE in PS processes, such as current activities, strategies, structures, resources and factors (Q34 to Q67); and (5) the context and impact of PE in PS initiatives in Canadian healthcare organizations (CHOs) (Q68 to Q75), including outcome identification, improvement mechanisms and strategies, evaluation mechanisms, and indicators.

Obesity in Latin America, a scoping review of public health prevention strategies and an overview of their impact on obesity prevention

OBJECTIVE

To describe the strategies implemented in seventeen Latin American countries for obesity prevention and to provide an overview of their impact.

DESIGN

A thorough search of strategies and their impact was done through an Internet search, governmental webpages, reports and research articles in English, Spanish and Portuguese.

SETTING

Latin America (not including the Caribbean countries).

PARTICIPANTS

Any.

RESULTS

The Ministry of Health is the main oversight for obesity prevention, with six countries having a specific structure for this. Regular obesity monitoring occurs in a few countries, and thirteen countries have a national obesity prevention plan. The main regulations being implemented/designed are front-of-package labelling (sixteen countries), school environment (fifteen countries), school nutrition education (nine countries), promotion of physical activity level (nine countries) and sugar-sweetened beverage tax (eight countries). All countries have dietary guidelines. The main community-based programmes being implemented are school meals (seventeen countries), complementary nutrition (eleven countries), nutrition education (fourteen countries), promotion of physical activity (nine countries) and healthy environments (nine countries). Most of these strategies have not been evaluated. The few with positive results have used a coordinated, multi-disciplinary and multi-sector approach, with legislation and executive-level support.

CONCLUSIONS

Important obesity prevention strategies are being implemented in the seventeen Latin American countries included in the present review. However, few have been evaluated to assess their impact on preventing obesity. This information can help assess that actions can be generalised to other countries within the region and can help inform how to prevent obesity in different settings.

Prioritizing vaccination by age and social activity to advance societal health benefits in Norway: a modelling study

Background

Vaccination has the proven effectiveness in reducing disease burden. As the emergency program is moving towards completion in many countries, there is a new urgency to appropriately assess the societal health benefits in both the near and longer term.

Methods

Using an age-structured mathematical infection model, we evaluate the gains achievable by adopting the ongoing and the possible alternative vaccination strategies to reduce COVID-19 infections in the current pandemic as well as during the future successive waves in Norway. We explicitly consider three allocation strategies, with single focus group on either (i) the older age groups at high risk of dying or (ii) the core-sociable groups at high risk of exposure and onwards transmission, versus strategies focusing on both groups by (iii) switching among the high-risk to the core-sociable.

Findings

Following the Norwegian Institute of Public Health (FHI) schedule, we estimate that allocating vaccines in an age-descending order may reduce around one-third of the infections; while strategy considering age-specific sociability may contribute to an additional ∼10% fewer infections.

Interpretation

A key insight of our study is that prioritizing the high-risk and core-sociable groups may maximize the benefit due to both direct and indirect protections, and thus achieving the larger societal health benefits. Our analyses provides a quantitative tool to planning of future campaigns for Scandinavian and other countries with comparable infection-fatality ratios, demographies and public health infrastructure.

Funding

Research Council of Norway and the Penn State University.

How do elderly outpatients manage polypharmacy including DOAC - A qualitative analysis highlighting a need for counselling

BACKGROUND

Patients with polypharmacy are challenged with the management of their daily medication. Medication management strategies for direct oral anticoagulants (DOAC) are especially important to guarantee medication adherence and to prevent thromboembolic events. Patients are often left alone with finding an appropriate strategy.

OBJECTIVE(S)

To explore medication management strategies, to measure adherence to DOAC with the aim of deducing recommendations for practice.

METHODS

Face-to-face semi-structured interviews were conducted at the home of outpatients who were taking ≥4 medications daily including a DOAC, and self-managing their medication. A small electronic device (Time4Med™) was given to record medication intake during the four following weeks. During a second home visit, participants saw a graph of their medication intake as dot chart, and obtained a feedback. Interviews were transcribed verbatim and thematically analysed. Medication adherence was calculated with electronic data.

RESULTS

Eighteen individuals (61.1% female; median age 77.5 years) were interviewed and reported 30 different medication management strategies, together with triggers, advantages and limitations. They combined at least five strategies, composed of internal (memory-based) and external (packaging-based or intake-based) strategies. The number of strategies was neither associated with the number of medications nor with medication adherence. Taking adherence was <100% for eight patients (44.4%). The inability of any medication management strategy to adapt to ageing and cognitive decline emerged as its most dramatic limitation, especially because individuals would fail to notice when their strategy became unsuited.

CONCLUSIONS

Elderly patients develop manifold medication management strategies, which can inspire future medication users. Limitations are present such as forgetting medication intake in spite of a management strategy. The moment to adapt the strategy to ageing or cognitive decline is crucial and often goes unnoticed. It is therefore decisive that healthcare professionals regularly re-evaluate the appropriateness of the medication management strategies during counselling or ideally during home visits.

Decision-Making Deficits in Adolescent Boys with and without Attention-Deficit/Hyperactivity Disorder (ADHD): an Experimental Assessment of Associated Mechanisms

Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrate increased levels of real-life risk-taking behavior like substance abuse and reckless behavior in traffic, which potentially originates in decision-making deficits. Using experimental gambling tasks, the current study investigated three potential underlying mechanisms: (1) risky vs. suboptimal decision making, (2) the complexity of decision-making strategies and (3) the influence of feedback. Participants were 181 male adolescents (81 ADHD, 100 Typically Developing (TD); M_age = 15.1 years). First, we addressed a common confound in many gambling tasks by disentangling risk seeking from suboptimal decision making, and found that ADHD-related decision-making deficits do not originate in increased risk seeking but in suboptimal decision making. Second, we assessed decision-making strategies with a Bayesian latent mixture analysis and found that ADHD-related decision-making deficits are characterized by the use of less complex strategies. That is, adolescent boys with ADHD, relative to TD adolescent boys, less often adopted strategies in which all characteristics relevant to make an optimal decision were integrated. Third, we administered two gambling task conditions with feedback in which adolescents experience the outcomes of their decisions and found that adolescents with ADHD performed worse relative to TD adolescents on both conditions. Altogether, this set of studies demonstrated consistent decision-making deficits in adolescent boys with ADHD: The use of less complex decision-making strategies may cause suboptimal decision making, both in situations with and without direct feedback on performance.

Addressing barriers to the conduct and application of research in complementary and alternative medicine: a scoping review

BACKGROUND

Over the past few decades, the popularity of complementary and alternative medicine (CAM) has grown considerably and along with it, scrutiny regarding its evidence base. While this is to be expected, and is in line with other health disciplines, research in CAM is confronted by numerous obstacles. This scoping review aims to identify and report the strategies implemented to address barriers to the conduct and application of research in CAM.

METHODS

The scoping review was undertaken using the Arksey and O'Malley framework. The search was conducted using MEDLINE, EMBASE, EMCARE, ERIC, Scopus, Web of Science, The Cochrane Library, JBI and the grey literature. Two reviewers independently screened the records, following which data extraction was completed for the included studies. Descriptive synthesis was used to summarise the data.

RESULTS

Of the 7945 records identified, 15 studies met the inclusion criteria. Using the oBSTACLES instrument as a framework, the included studies reported diverse strategies to address barriers to the conduct and application of research in CAM. All included studies reported the use of educational strategies and collaborative initiatives with CAM stakeholders, including targeted funding, to address a range of barriers.

CONCLUSIONS

While the importance of addressing barriers to the conduct and application of research in CAM has been recognised, to date, much of the focus has been limited to initiatives originating from a handful of jurisdictions, for a small group of CAM disciplines, and addressing few barriers. Myriad barriers continue to persist, which will require concerted effort and collaboration across a range of CAM stakeholders and across multiple sectors. Further research can contribute to the evidence base on how best to address these barriers to promote the conduct and application of research in CAM.

Most significant barriers and proposed solutions for medical schools to facilitate simulation-based undergraduate curriculum in OBGYN

Despite having a good understanding of medicine, doctors lack clinical skills, problem-solving abilities, and the ability to apply knowledge to patient care, particularly in unanticipated circumstances. To overcome this, medical education has evolved into a system-oriented core curriculum with cognitive, psychomotor, and affective learning goals. With an emphasis on problem-based learning, the educator's aim is to establish a long-term, predetermined improvement in the learner's behavior, acquired skills, and attitudes (Datta R, Upadhyay KK, Jaideep CN. Simulation and its role in medical education. Med J Armed Forces India. 2012;68(2):167-172. https://doi.org/10.1016/S0377-1237(12)60040-9 ). However, teaching these disciplines to real patients is almost impossible; this is where simulation comes in. This opinion paper will discuss the relevance and necessity of a simulation-based undergraduate curriculum in obstetrics and gynecology. What are the biggest obstacles that medical schools face in making the most of simulation-based learning, and how can they be overcome?

Increasing dietary calcium intake of children and their parents: a randomised controlled trial

OBJECTIVE

Approximately 25 % of Canadian children aged 4-8 years fail to meet the recommended dietary allowance (RDA) of calcium (Ca). Young children's food choices are primarily determined by their parents. No interventions have directly targeted parents as a medium through which to increase children's Ca consumption. This study compared the effectiveness of a Ca-specific intervention targeted towards parents, with generic dietary advice on the Ca consumption of children aged 4-10 years.

DESIGN

A parallel two-arm randomised controlled trial was conducted.

SETTING

The study was conducted across Canada. Both conditions received information on the RDA of Ca and an index of intake requirements. Material sent to the intervention condition included behavioural strategies to increase dietary Ca consumption, information on the benefits of dietary Ca intake and messages addressing perceived barriers to the consumption of Ca-rich foods.

PARTICIPANTS

A total of 239 parents (93 % mothers) of children aged 4-10 years who consumed less than the RDA of Ca were randomly assigned in a 1:1 allocation ratio.

RESULTS

There was a significant increase in total Ca intake and Ca from dairy for children at weeks 8, 34 and 52 (P ≤ 0·001) in both conditions. Parental Ca intake and amount spent on dairy products did not significantly increase following the intervention.

CONCLUSIONS

Provision of daily Ca requirements with regular reminders could impact parents' delivery of Ca-rich foods to their children. This finding is important for public health messaging as it suggests that parents are a potent medium through which to promote Ca intake in children.

A data-driven approach to strengthening policies to prevent freeway tunnel strikes by motor vehicles

Freeway tunnel strikes by motor vehicles inflict serious damages to the infrastructure, cause personal injuries, and create traffic congestions. Freeway tunnel hits are a constant threat in South Korea due to its mostly mountainous terrain. Despite efforts by public agencies to include disaster remedial or preventative facilities in the development of freeway tunnels, these facilities are designed mainly to reduce the number of collisions instead of also mitigate the consequences of a crash. Hence, the Korea Ministry of Land, Infrastructure and Transport (KMOLIT) recently presented a plan to modify the list of risk factors affecting tunnel traffic safety, and it recommended several strategies for tunnel traffic safety management. The study presented here took a data-driven approach to quantitatively confirming the strategies recommended by KMOLIT through the random forest-based binomial regression. The following factors were found to be significantly associated with serious injury crashes involving freeway tunnel strikes: adverse weather, fatigued and distracted drivers, collision type (i.e., head-on/angle/rear-end), tunnel exit, tunnel width, curve radius (radius less than 1800 m), and heavy vehicle. This study compares specifications of each government strategy with the effects of the identified risk factors on injuries involved in tunnel crashes to quantitatively support recommendations to modify the government strategies.