Palliative care for patients with hematologic malignancies in Germany: a nationwide survey on everyday practice and influencing factors from the perspective of treating physicians

Integrating palliative care into the treatment of patients with advanced hematological malignancies (HM) remains challenging. To explore treating physicians' perspectives on current palliative care practice and to evaluate factors influencing integration, we conducted a nationwide online survey. Based on literature and expert review, the survey addressed the importance of palliative care, communication about life-threatening conditions, challenges in establishing goals of care, and factors influencing the integration of palliative care. 207 physicians treating patients with HM in Germany participated. We used standard descriptive statistics to analyze quantitative data and a content structuring approach. Most physicians considered palliative care in HM to be very important (60.6%) and discussed life-threatening conditions with more than half of their patients (52%), especially when goals of care were changed (87.0%) or when patients raised the topic (84.0%). Disease-related factors, different professional perspectives on prognosis, and patient hopes were the main barriers to changing goals of care, but collaboration with colleagues and multidisciplinary teams provided important support. Time constraints were identified as the main barrier to integrating palliative care. The majority worked well with palliative care teams. Referral processes and conditions were perceived as minor barriers. The study highlights the need to address barriers to integrating palliative care into the management of patients with advanced HM. Future research should aim at optimizing palliative care for patients with HM.

Trends and predictors of unmet need for family planning among women living with HIV in Zambia: implications for elimination of vertical transmission of HIV

BACKGROUND

Prevention of vertical (mother to child) transmission of HIV is one of the key strategies towards HIV epidemic control. Despite considerable progress over the past decade in Zambia, the country is yet to reach global and national target for elimination of vertical transmission of HIV. Avoidance of unintended pregnancy among women living with HIV is one of the cost-effective interventions in a comprehensive approach to prevent vertical transmission of HIV. Therefore, this study aimed at ascertaining trends in and predictors of unmet need for family planning among women living with HIV in Zambia.

METHODS

The study employed a repeated cross sectional (RCS) study design, using data from the three (3) most recent consecutive rounds of the Zambia Demographic and Health Survey (ZDHS) conducted in 2007, 2013/2014 and 2018. The study used data from a total of 27,153 women aged 15-49 years over the three survey periods among whom 4,113 had an HIV positive result following a rigorous HIV testing algorithm of the demographic and health surveys, and these constituted our sample size of women living with HIV. We used descriptive statistics and logistic regression analyses to respectively ascertain trends in and predictors of unmet need for family planning among women living with HIV.

RESULTS

Over the three survey points, unmet need for family planning among women living with HIV has largely remained unchanged from 20.8% in 2007 to 20.5% in 2013/14 and 21.1% in 2018 DHS. Residence, age of women, household wealth, woman's parity, employment, and age of spouse emerged as significant predictors of unmet need for family planning among women living with HIV in Zambia.

CONCLUSION

Preventing HIV infection in a child preserves life, contributes to improving quality of life from its early stages and averts lifetime costs of HIV treatment and associated healthcare costs. There is need to consider optimization of interventions to prevent vertical transmission of HIV including shaping programming regarding preventing unintended pregnancies among women living with HIV. Among other aspects, policy and practice need to strengthen SRH/HIV integration and better target rural residents, younger women, those with high parity and consider positive male engagement to reduce unmet need for family planning among women living with HIV.

An Artificial Intelligence-Supported Medicinal Chemistry Project: An Example for Incorporating Artificial Intelligence Within the Pharmacy Curriculum

OBJECTIVE

This study aims to integrate and use AI to teach core concepts in a medicinal chemistry course and to increase the familiarity of pharmacy students with AI in pharmacy practice and drug development. Artificial intelligence (AI) is a multidisciplinary science that aims to build software tools that mimic human intelligence. AI is revolutionizing pharmaceutical research and patient care. Hence, it is important to include AI in pharmacy education to prepare a competent workforce of pharmacists with skills in this area.

METHODS

AI principles were introduced in a required medicinal chemistry course for first-year pharmacy students. An AI software, KNIME, was used to examine structure-activity relationships for 5 drugs. Students completed a data sheet that required comprehension of molecular structures and drug-protein interactions. These data were then used to make predictions for molecules with novel substituents using AI. The familiarity of students with AI was surveyed before and after this activity.

RESULTS

There was an increase in the number of students indicating familiarity with use of AI in pharmacy (before vs after: 25.3% vs 74.5%). The introduction of AI stimulated interest in the course content (> 60% of students indicated increased interest in medicinal chemistry) without compromising the learning outcomes. Almost 70% of students agreed that more AI should be taught in the PharmD curriculum.

CONCLUSION

This is a successful and transferable example of integrating AI in pharmacy education without changing the main learning objectives of a course. This approach is likely to stimulate student interest in AI applications in pharmacy.

A Call to Action for Integrating Introductory Pharmacy Practice Experiences With Purpose

Introductory pharmacy practice experiences (IPPEs) are essential to exposing students to contemporary pharmacy practice and promoting advanced pharmacy practice experience readiness. An IPPE curriculum should be sequenced and progressive, with IPPE experiences built upon each other and coordinated with the didactic curriculum. Pharmacy programs are faced with several internal and external challenges that can influence the design and implementation of their IPPE curriculum. Periodic IPPE curricular review is imperative as new challenges arise and existing challenges abate. Pharmacy programs should use a systematic and holistic process to evaluate and revise their IPPE programs. It is an opportune time to begin this process, with new standards being released in 2024. This commentary describes common challenges associated with integrating a high-quality IPPE program into a Doctor of Pharmacy curriculum along with potential solutions, with the intention for individual programs to use this as a tool to guide IPPE evaluation and revision.

Factors to Improve Reverse Integration: A Mixed Method Embedded Design Study

Individuals with serious mental illness face inequity in receiving primary care services. The Substance Abuse and Mental Health Services Administration (SAMHSA) granted funds to Certified Community Behavioral Health Clinics (CCBHC) to integrate primary care and behavioral health specialties to increase access to care. This mixed method study aimed to measure the SAMHSA-defined levels of reverse integration at a CCBHC at one point in time. Providers and patients provided feedback through semi-structured interviews. Qualitative data was investigated for themes, while the quantitative data was run through inferential analysis with the Kruskal Wallis H test. Clinically meaningful results showed people using primary care at the integrated clinic were more satisfied and were more apt to continue seeing their current providers than those receiving non-integrated care. The CCBHC achieved level 4 integration; factors investigated confirmed proximity alone does not necessitate integration without effective communication and implementation of practice changes.

A health promotion perspective on One Health

The One Health concept has acquired increasing attention due to the COVID-19 pandemic. We argue for a health promotion perspective that frames One Health in terms of positive health for people, animals, and ecosystems and includes a spiritual-cosmological dimension. This would enhance policy, research, and practice across disciplines and sectors for a more resilient and harmonious planet.

On the role of memory in misinformation corrections: Repeated exposure, correction durability, and source credibility

Misinformation can negatively affect cognition, beliefs, and behavior, and thus contribute to societal disruption. Correcting misinformation can counteract these effects by updating memory and beliefs. In this selective review, we highlight recent perspectives on and evidence for the role of memory in the efficacy of correction methods. Two theoretical accounts propose that repeating misinformation can impair or improve correction efficacy to the extent that familiarity or integrative encoding prevails. We summarize evidence that recollection of corrections can counteract potential interference from misinformation repetitions on memory and belief updating. The efficacy of such updating also declines over time, especially when misinformation sources are not remembered. We call for more research on the role of memory in everyday misinformation corrections to better understand interactions among these processes.

Leveling Up PrEP: Implementation Strategies at System and Structural Levels to Expand PrEP Use in the United States

PURPOSE OF REVIEW

Despite highly effective biomedical HIV pre-exposure prophylaxis (PrEP) options, suboptimal PrEP uptake impedes progress towards ending the epidemic in the United States of America (USA). Implementation science bridges what we know works in controlled clinical trial settings to the context and environment in which efficacious tools are intended to be deployed. In this review, we focus on strategies that target PrEP use barriers at the system or structural level, exploring the implications and opportunities in the context of the fragmented USA healthcare system.

RECENT FINDINGS

Task shifting could increase PrEP prescribers, but effectiveness evidence is scarce in the USA, and generally focused in urban settings. Integration of PrEP within existing healthcare infrastructure concentrates related resources, but demonstration projects rarely present the resource implications of redirecting staff. Changing the site of service via expanded telehealth could improve access to more rural populations, though internet connectivity, technology access, and challenges associated with determining biomedical eligibility remain logistical barriers for some of the highest burden communities in the USA. Finally, a tailored care navigation and coordination approach has emerged as a highly effective component of PrEP service provision, attempting to directly modify the system-level determinants of PrEP use experienced by the individual. We highlight recent advances and evidence surrounding task shifting, integration, service delivery, and tailoring. With the exception of tailored care navigation, evidence is mixed, and the downstream impact and sustainability of task shifting and care integration require further attention. To maximize PrEP outcomes, research will need to continue to examine the interplay between individuals, clinics, and the healthcare system and associated policies within which they operate.

Intensification of integrated immunization services to recover routine vaccination coverage and bring COVID-19 vaccine to the population of Iraq in 2022

INTRODUCTION

COVID-19 seriously impacted routine immunization (RI) in Iraq. Coverage declined to a 6-year low in 2021, and COVID-19 vaccination uptake was slow. In response, government implemented intensification of integrated immunization services (3IS), a nationwide approach comprising regular outreach sessions of COVID-19 vaccination and RI for children who had either missed doses or never commenced scheduled vaccination (zero-dose children). We describe the 3IS and its impact on vaccination coverage in Iraq.

METHODS

3IS comprised new outreach sessions for urban and rural communities where administrative data suggested there were gaps in coverage. Groups of six personnel from each of 1,321 primary healthcare centres implemented six outreach sessions per month during February-November 2022. Community engagement was an integral component. We compared RI administrative data (2019-2022) and data reported during 3IS activities to assess its impact.

RESULTS

In total 4,189,859 vaccine doses were administered during 72,495 3IS outreach sessions, over one-fifth of 19,106,849 vaccine doses administered in Iraq over these 10 months. Among them, 957,874 (22.9 %) were COVID-19 vaccines, adding slightly to national coverage, and 3,231,985 (77.1 %) were RI vaccines, dramatically reducing zero-dose children, adding 18 %, 25 %, 21 %, and 31 % to 2022 penta1, penta3, measles first-dose and MMR1 vaccine coverage, and contributing to national coverage of 102.2 %, 94.5 %, 91.8 % and 96.3 % for these vaccines during February-November, respectively. Moreover, 3IS sessions delivered 133,528 doses of tetanus toxoid, 16,353 doses of adult HepB vaccine, and 315,032 vitamin A doses to eligible individuals.

CONCLUSION

In the context of global encouragement to integrate vaccination services, Iraq's 3IS approach enabled dramatic improvements in RI coverage, virtual elimination of zero-dose status among children born during the pandemic, and small improvements in COVID-19 and adult vaccination. Our findings provide lessons for future integrated primary care towards universal health coverage in Iraq, and for other countries yet to undertake integration.

Integration of scRNA-seq data by disentangled representation learning with condition domain adaptation

BACKGROUND

The integration of single-cell RNA sequencing data from multiple experimental batches and diverse biological conditions holds significant importance in the study of cellular heterogeneity.

RESULTS

To expedite the exploration of systematic disparities under various biological contexts, we propose a scRNA-seq integration method called scDisco, which involves a domain-adaptive decoupling representation learning strategy for the integration of dissimilar single-cell RNA data. It constructs a condition-specific domain-adaptive network founded on variational autoencoders. scDisco not only effectively reduces batch effects but also successfully disentangles biological effects and condition-specific effects, and further augmenting condition-specific representations through the utilization of condition-specific Domain-Specific Batch Normalization layers. This enhancement enables the identification of genes specific to particular conditions. The effectiveness and robustness of scDisco as an integration method were analyzed using both simulated and real datasets, and the results demonstrate that scDisco can yield high-quality visualizations and quantitative outcomes. Furthermore, scDisco has been validated using real datasets, affirming its proficiency in cell clustering quality, retaining batch-specific cell types and identifying condition-specific genes.

CONCLUSION

scDisco is an effective integration method based on variational autoencoders, which improves analytical tasks of reducing batch effects, cell clustering, retaining batch-specific cell types and identifying condition-specific genes.

Linking shape conspicuous asymmetry with shape covariation patterns and performance in the insect head and mandibles

Bilateral symmetry is widespread across animals, yet, among bilaterians, many cases of conspicuous asymmetries evolved. This means that bilaterally homologous structures on the left and right side display divergent phenotypes. Evolution of such divergent phenotypes between otherwise similarly shaped structures can be thought to be favoured by modularity, but this has rarely been studied in the context of left-right differences. Here, we provide an empirical example, using geometric morphometrics, to assess patterns of asymmetry and covariation between landmark partitions in a grasshopper with conspicuously asymmetric mandibles. Our morphometric data confirms the presence of strictly directional conspicuous asymmetry in the mandibles, and surrounding structures. Covariance patterns and tests hint at a strong integration between mandibles despite their divergent morphologies, and variational modularity with the head capsule. While mandibles have been selected to achieve a key-and-lock morphology by having interlocking shapes, the developmental modularity required to achieve this seems to be overwritten by developmental and/or functional integration, allowing the precise matching required for feeding. The consequent conflicting covariation patterns are reminiscent of the palimpsest model. Finally, the degree of directional asymmetry appears to be under selection, although we find no relationship between bite force and mandible shape or asymmetry.

Structural and relational factors for successful cross-sector collaboration in home visiting: a multiple case study

BACKGROUND

Aligning delivery and financing systems across sectors to create broader systems of care can improve the health and well-being of families experiencing adversities. We aimed to identify structural and relational factors for best practices to achieve successful cross-sector collaboration among home visiting programs in the United States.

MATERIALS AND METHODS

We used a multiple case study approach to identify best practices for successful cross-sector collaboration between home visitors and other community service providers. We selected five diverse exemplary cases with cross-sector collaboration with variation in implementing agency type and geographic location. Cases were selected using a positive deviance approach based on strong coordination and integration with different community service provider types identified from previous survey data. We conducted in-depth qualitative interviews with home visiting staff, community providers, and clients with a total of 76 interviews conducted from 2021 to 2022. We wrote memos to synthesize themes within each case through data triangulation using interview data, documents, and site visit observations. We compared themes across the five cases to create a cross-case synthesis of best practices for successful cross-sector collaboration.

RESULTS

Across the five cases, relational factors including leadership from all levels, champions across sectors, and shared goals between community providers were key factors for successful collaboration. Interpersonal relationships, coupled with the desire and capacity to engage, facilitated effective coordination to address families' needs. At the structural level, shared data systems, written agreements, and co-location enabled care coordination activities. Community Advisory Boards provided a venue for developing partnerships, relationship-building, resource-sharing, and increasing awareness of home visiting.

CONCLUSIONS

We identified key elements of successful cross-sector collaboration across five case studies where home visitors coordinate care frequently and/or are structurally integrated with a range of providers. These learnings will inform future interventions to improve home visiting collaboration with other community providers to create a system of care to enhance family well-being.

A comprehensive review and perspective research in technology integration for the treatment of gaseous volatile organic compounds

Volatile organic compounds (VOCs) are harmful pollutants emitted from industrial processes. They pose a risk to human health and ecosystems, even at low concentrations. Controlling VOCs is crucial for good air quality. This review aims to provide a comprehensive understanding of the various methods used for controlling VOC abatement. The advancement of mono-functional treatment techniques, including recovery such as absorption, adsorption, condensation, and membrane separation, and destruction-based methods such as natural degradation methods, advanced oxidation processes, and reduction methods were discussed. Among these methods, advanced oxidation processes are considered the most effective for removing toxic VOCs, despite some drawbacks such as costly chemicals, rigorous reaction conditions, and the formation of secondary chemicals. Standalone technologies are generally not sufficient and do not perform satisfactorily for the removal of hazardous air pollutants due to the generation of innocuous end products. However, every integration technique complements superiority and overcomes the challenges of standalone technologies. For instance, by using catalytic oxidation, catalytic ozonation, non-thermal plasma, and photocatalysis pretreatments, the amount of bioaerosols released from the bioreactor can be significantly reduced, leading to effective conversion rates for non-polar compounds, and opening new perspectives towards promising techniques with countless benefits. Interestingly, the three-stage processes have shown efficient decomposition performance for polar VOCs, excellent recoverability for nonpolar VOCs, and promising potential applications in atmospheric purification. Furthermore, the review also reports on the evolution of mathematical and artificial neural network modeling for VOC removal performance. The article critically analyzes the synergistic effects and advantages of integration. The authors hope that this article will be helpful in deciding on the appropriate strategy for controlling interested VOCs.

Optimizing integration of community-based management of possible serious bacterial infection (PSBI) in young infants into primary healthcare systems in Ethiopia and Kenya: successes and challenges

BACKGROUND

Ethiopia and Kenya have adopted the community-based integrated community case management (iCCM) of common childhood illnesses and newborn care strategy to improve access to treatment of infections in newborns and young infants since 2012 and 2018, respectively. However, the iCCM strategy implementation has not been fully integrated into the health system in both countries. This paper describes the extent of integration of iCCM program at the district/county health system level, related barriers to optimal integration and implementation of strategies.

METHODS

From November 2020 to August 2021, Ethiopia and Kenya implemented the community-based treatment of possible serious bacterial infection (PSBI) when referral to a higher facility is not possible using embedded implementation research (eIR) to mitigate the impact of COVID-19 on the delivery of this life-saving intervention. Both projects conducted mixed methods research from April-May 2021 to identify barriers and facilitators and inform strategies and summative evaluations from June-July 2022 to monitor the effectiveness of implementation outcomes including integration of strategies.

RESULTS

Strategies identified as needed for successful implementation and sustainability of the management of PSBI integrated at the primary care level included continued coaching and support systems for frontline health workers, technical oversight from the district/county health system, and ensuring adequate supply of commodities. As a result, support and technical oversight capacity and collaborative learning were strengthened between primary care facilities and community health workers, resulting in improved bidirectional linkages. Improvement of PSBI treatment was seen with over 85% and 81% of estimated sick young infants identified and treated in Ethiopia and Kenya, respectively. However, perceived low quality of service, lack of community trust, and shortage of supplies remained barriers impeding optimal PSBI services access and delivery.

CONCLUSION

Pragmatic eIR identified shared and unique contextual challenges between and across the two countries which informed the design and implementation of strategies to optimize the integration of PSBI management into the health system during the COVID-19 pandemic. The eIR participatory design also strengthened ownership to operationalize the implementation of identified strategies needed to improve the health system's capacity for PSBI treatment.

Characteristics of patients who return unplanned to the ED, and factors that contribute to their decision to return: Integrated results from an explanatory sequential mixed methods inquiry

AIM

To identify common characteristics of patients who return to the ED unplanned and factors that may contribute to their decision to return.

BACKGROUND

Return visits to the Emergency Department (ED) have been associated with adverse events and deficits in initial care provided. There is increasing evidence to suggest that many return visits may be preventable.

METHODS

The results of primary quantitative measures (QUAN) followed by qualitative measures (qual) were integrated to build on and explain the quantitative data found in the initial phase of the research.

RESULTS

Integration of results produced three new findings. 1) Most return visits occurred beyond 48 hrs because patients intentionally delayed going back to the ED despite their persisting symptoms; 2) Clinical urgency and deterioration were rarely evident in patients who made return visits in patients and 3) Ineffective communication between the clinician and the patient at discharge may have contributed to patients making the decision to return to the ED.

CONCLUSION

The decision to return unplanned to the ED is not an immediate response for most patients, and several potentially avoidable factors may influence their decision-making process. Future research should focus on strategies which contribute to the avoidance of unplanned return visits.

Assessing the commensurability of theories of consciousness: On the usefulness of common denominators in differentiating, integrating and testing hypotheses

How deep is the current diversity in the panoply of theories to define consciousness, and to what extent do these theories share common denominators? Here we first examine to what extent different theories are commensurable (or comparable) along particular dimensions. We posit logical (and, when applicable, empirical) commensurability as a necessary condition for identifying common denominators among different theories. By consequence, dimensions for inclusion in a set of logically and empirically commensurable theories of consciousness can be proposed. Next, we compare a limited subset of neuroscience-based theories in terms of commensurability. This analysis does not yield a denominator that might serve to define a minimally unifying model of consciousness. Theories that seem to be akin by one denominator can be remote by another. We suggest a methodology of comparing different theories via multiple probing questions, allowing to discern overall (dis)similarities between theories. Despite very different background definitions of consciousness, we conclude that, if attention is paid to the search for a common methological approach to brain-consciousness relationships, it should be possible in principle to overcome the current Babylonian confusion of tongues and eventually integrate and merge different theories.

Implementation and impact of integrated health and social care services: an umbrella review

Governments in many European countries have been working towards integrating health and social care services to eliminate the fragmentation that leads to poor care coordination for patients. We conducted a systematic review to identify and synthesize knowledge about the integration of health and social care services in Europe. We identified 490 records, in 14 systematic reviews that reported on 1148 primary studies and assessed outcomes of integration of health care and social care. We categorized records according to three purposes: health outcomes, service quality and integration procedures outcomes. Health outcomes include improved clinical outcomes, enhanced quality of life, and positive effects on quality of care. Service quality improvements encompass better access to services, reduced waiting times, and increased patient satisfaction. Integration procedure outcomes involve cost reduction, enhanced collaboration, and improved staff perceptions; however, some findings rely on limited evidence. This umbrella review provides a quality-appraised overview of existing systematic reviews.

Unraveling plant-microbe interactions: can integrated omics approaches offer concrete answers?

Advances in high throughput omics techniques provide avenues to decipher plant microbiomes. However, there is limited information on how integrated informatics can help provide deeper insights into plant-microbe interactions in a concerted way. Integrating multi-omics datasets can transform our understanding of the plant microbiome from unspecified genetic influences on interacting species to specific gene-by-gene interactions. Here, we highlight recent progress and emerging strategies in crop microbiome omics research and review key aspects of how the integration of host and microbial omics-based datasets can be used to provide a comprehensive outline of complex crop-microbe interactions. We describe how these technological advances have helped unravel crucial plant and microbial genes and pathways that control beneficial, pathogenic, and commensal plant-microbe interactions. We identify crucial knowledge gaps and synthesize current limitations in our understanding of crop microbiome omics approaches. We highlight recent studies in which multi-omics-based approaches have led to improved models of crop microbial community structure and function. Finally, we recommend holistic approaches in integrating host and microbial omics datasets to achieve precision and efficiency in data analysis, which is crucial for biotic and abiotic stress control and in understanding the contribution of the microbiota in shaping plant fitness.

Integration of rehabilitation services in primary, secondary, and tertiary levels of health care systems in low- and middle-income countries: a scoping review

PURPOSE

Integration is a concept that seeks to strengthen the delivery of services to ensure people receive a continuum of care across the health system. We conducted a scoping review to explore how rehabilitation services have been integrated into health systems in low- and middle- income countries (LMICs).

MATERIALS AND METHODS

We conducted a scoping review using Valentijn's Rainbow Model of Integrated Care (RMIC) as an organising framework. The key enablers of integration of rehabilitation were extracted, charted and summarised according to the RMIC framework.

RESULTS

Of 4667 articles identified, 44 met inclusion criteria. Most studies focused on rehabilitation within secondary and tertiary level facilities, and described service models incorporating clinical, professional and functional integration characteristics. The geographical and clinical scope of rehabilitation models that demonstrate elements of integration from LMICs is limited.

CONCLUSION

The key enablers identified highlight the important role of responsive multidisciplinary care plans, and interdisciplinary guidelines, protocols and interprofessional education to support an integrated rehabilitation service model in LMICs.

The salamander limb: a perfect model to understand imperfect integration during skeletal regeneration

Limb regeneration in salamanders is achieved by a complex coordination of various biological processes and requires the proper integration of new tissue with old. Among the tissues found inside the limb, the skeleton is the most prominent component, which serves as a scaffold and provides support for locomotion in the animal. Throughout the years, researchers have studied the regeneration of the appendicular skeleton in salamanders both after limb amputation and as a result of fracture healing. The final outcome has been widely seen as a faithful re-establishment of the skeletal elements, characterised by a seamless integration into the mature tissue. The process of skeletal integration, however, is not well understood, and several works have recently provided evidence of commonly occurring flawed regenerates. In this Review, we take the reader on a journey through the course of bone formation and regeneration in salamanders, laying down a foundation for critically examining the mechanisms behind skeletal integration. Integration is a phenomenon that could be influenced at various steps of regeneration, and hence, we assess the current knowledge in the field and discuss how early events, such as tissue histolysis and patterning, influence the faithful regeneration of the appendicular skeleton.

Association of collaborative care intervention features with depression and metabolic outcomes in the INDEPENDENT study: A mixed methods study

AIMS

The INtegrating DEPrEssioN and Diabetes treatmENT (INDEPENDENT) trial tested a collaborative care model including electronic clinical decision support (CDS) for treating diabetes and depression in India. We aimed to assess which features of this clinically and cost-effective intervention were associated with improvements in diabetes and depression measures.

METHODS

Post-hoc analysis of the INDEPENDENT trial data (189 intervention participants) was conducted to determine each intervention feature's effect: 1. Collaborative case reviews between expert psychiatrists and the care team; 2. Patient care-coordinator contacts; and 3. Clinicians' CDS prompt modifications. Primary outcome was baseline-to-12-months improvements in diabetes control, blood pressure, cholesterol, and depression. Implementer interviews revealed barriers and facilitators of intervention success. Joint displays integrated mixed methods' results.

RESULTS

High baseline HbA1c≥ 74.9 mmol/mol (9%) was associated with 5.72 fewer care-coordinator contacts than those with better baseline HbA1c (76.8 mmol/mol, 9.18%, p < 0.001). Prompt modification proportions varied from 38.3% (diabetes) to 1.3% (LDL). Interviews found that providers' and participants' visit frequencies were preference dependent. Qualitative data elucidated patient-level factors that influenced number of clinical contacts and prompt modifications explaining their lack of association with clinical outcomes.

CONCLUSION

Our mixed methods approach underlines the importance of the complementarity of different intervention features. Qualitative findings further illuminate reasons for variations in fidelity from the core model.

Demanded interdisciplinary subjects for integration in medical education program from the point of view of graduated medical physicians and senior medical students: a nationwide mixed qualitative-quantitative study from Iran

INTRODUCTION

This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran.

METHODS

A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts' opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians' social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics.

RESULTS

By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants.

CONCLUSION

This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

Integrating magnetic tweezers and single-molecule FRET: A comprehensive approach to studying local and global conformational changes simultaneously

This chapter presents the integration of magnetic tweezers with single-molecule FRET technology, a significant advancement in the study of nucleic acids and other biological systems. We detail the technical aspects, challenges, and current status of this hybrid technique, which combines the global manipulation and observation capabilities of magnetic tweezers with the local conformational detection of smFRET. This innovative approach enhances our ability to analyze and understand the molecular mechanics of biological systems. The chapter serves as our first formal documentation of this method, offering insights and methodologies developed in our laboratory over the past decade.

The immediate-early protein 1 of human herpesvirus 6B interacts with NBS1 and inhibits ATM signaling

Viral infection often trigger an ATM serine/threonine kinase (ATM)-dependent DNA damage response in host cells that suppresses viral replication. Viruses evolved different strategies to counteract this antiviral surveillance system. Here, we report that human herpesvirus 6B (HHV-6B) infection causes genomic instability by suppressing ATM signaling in host cells. Expression of immediate-early protein 1 (IE1) phenocopies this phenotype and blocks homology-directed double-strand break repair. Mechanistically, IE1 interacts with NBS1, and inhibits ATM signaling through two distinct domains. HHV-6B seems to efficiently inhibit ATM signaling as further depletion of either NBS1 or ATM do not significantly boost viral replication in infected cells. Interestingly, viral integration of HHV-6B into the host's telomeres is not strictly dependent on NBS1, challenging current models where integration occurs through homology-directed repair. Given that spontaneous IE1 expression has been detected in cells of subjects with inherited chromosomally-integrated form of HHV-6B (iciHHV-6B), a condition associated with several health conditions, our results raise the possibility of a link between genomic instability and the development of iciHHV-6-associated diseases.

Sexual and reproductive health (SRH) of women with mental illness (WMI) - An integrative mixed-method study

Background

Women with mental illness (WMI) are more likely to experience unreported sexual and reproductive health (SRH) problems. Mixed-method research studies with the strengths of quantitative and qualitative approaches provide deeper insight into SRH issues of WMI.

Methods

A sequential explanatory mixed-method design was used to understand better the SRH problems of WMI attending tertiary care psychiatry hospital. In phase 1, a survey was conducted to identify if they have SRH problems. Women who were identified to have SRH problems were part of Phase II. In this phase, in-depth interview was conducted to explore their lived-in experiences. Integration at the method level was adopted by connection through sampling. Using a narrative approach, integration was accomplished at the level of interpretation and reporting.

Results

Among the users, 261 (64.6%) female sterilization, 244 (93%) was the most common, and the other methods like coitus interruptus, male condoms, and intrauterine devices were reported less. Of the non-users, 137 (33.9%) WMI 100 (73%) were unaware of the best family planning approach. Most of them, 377 (93.3%), were ignorant about sexually transmitted infection (STI) symptoms. WMI reported 62 (15.3%) unusual foul-smelling vaginal discharge and 58 (14.4%) genital ulcers, with poor treatment-seeking behavior. Sexual dysfunction in desire, arousal, lubrication, orgasm, satisfaction, and pain were also reported. The findings were described in a single report based on the quantitative data followed by themes obtained from qualitative interviews using weaving techniques under the headings of contraceptive use and its awareness, prevalence of STI symptoms and its treatment, and sexual health experiences.

Conclusion

Data integration demonstrated that one-fourth of WMI had inadequate awareness of contraceptive use, were ignorant of STI symptoms, and experienced sexual dysfunction.

Impaired segregation of the attention deficit hyperactivity disorder related pattern in children

BACKGROUND

Inattention is a key characteristic of attention deficit hyperactivity disorder (ADHD). Specific brain abnormalities associated with this symptom form a discernible pattern related with ADHD in children (i.e., ADHD related pattern) in our earlier research. The developmental processes of segregation and integration may be crucial to ADHD. However, how brains reconfigure these processes of the ADHD related pattern in different subtypes of ADHD and across sexes remain unclear.

METHODS

Nested-spectral partition method was applied to identify effects of subtype and sex on segregation and integration of the ADHD related pattern, using 145 ADHD patients and 135 typically developing controls (TDC) aged 7-14. Relationships between the measures and inattention symptoms were also investigated.

RESULTS

Children with ADHD exhibited lower segregation of the ADHD related pattern (p = 1.17 × 10-8) than TDCs. Only the main effect of subtype was significant (p = 1.14 × 10-5). Both ADHD-C (p = 2.16 × 10-6) and ADHD-I (p = 2.87 × 10-6) patients had lower segregation components relative to the TDC. Moreover, segregation components were negatively correlated with inattention scores.

CONCLUSIONS

This study identified impaired segregation in the ADHD related pattern of children with ADHD and found shared neural bases among different subtypes and sexes.

Genomic data integration tutorial, a plant case study

BACKGROUND

The ongoing evolution of the Next Generation Sequencing (NGS) technologies has led to the production of genomic data on a massive scale. While tools for genomic data integration and analysis are becoming increasingly available, the conceptual and analytical complexities still represent a great challenge in many biological contexts.

RESULTS

To address this issue, we describe a six-steps tutorial for the best practices in genomic data integration, consisting of (1) designing a data matrix; (2) formulating a specific biological question toward data description, selection and prediction; (3) selecting a tool adapted to the targeted questions; (4) preprocessing of the data; (5) conducting preliminary analysis, and finally (6) executing genomic data integration.

CONCLUSION

The tutorial has been tested and demonstrated on publicly available genomic data generated from poplar (Populus L.), a woody plant model. We also developed a new graphical output for the unsupervised multi-block analysis, cimDiablo_v2, available at https://forgemia.inra.fr/umr-gdec/omics-integration-on-poplar , and allowing the selection of master drivers in genomic data variation and interplay.

Integrating basic sciences into clerkship rotation utilizing Kern's six-step model of instructional design: lessons learned

BACKGROUND

It is generally agreed that basic and clinical sciences should be integrated throughout the undergraduate medical education, however, there is still need for continued formal integration of basic sciences into clinical clerkship in many medical schools across the globe.

METHODS

Utilizing Kern's Six-Step Model of Instructional Design, we aimed to develop an intervention that would facilitate cognitive integration of basic and clinical sciences. After problem identification and targeted needs assessment through focused group discussion with the students and faculty, objectives were devised with an implementation plan of using flipped class approach to develop a content-focused and learner-centered teaching strategy. This intervention was piloted in the 2-week cardiology clerkship in Year 5. Evaluation of the content, integration, student and faculty experiences were recorded through in-depth interviews, FGDs and a formative MCQ test.

RESULTS

Flipped classroom based integrated sessions were successfully developed. The implementation phase was met with challenges that primarily stemmed from the diverse teaching styles among faculty members, hesitance to deviate from conventional practices, variations in clinic timings, and demanding schedules. Noteworthy observations were in terms of ownership of the project, the need for faculty development in modern student-centered teaching pedagogies, opportunities for content improvement, scheduling of sessions, and suggestion of revisiting fundamental concepts in basic sciences through a brief boot camp-style session at the onset of the clerkship. The role of flipped case model and clinical cases in integrating basic sciences into clinical sciences were appreciated by the students. Standardization in teaching practices was identified as the major challenge by the faculty.

CONCLUSIONS

A functional, learner-centered framework of cognitive integration of basic sciences in clinical sciences curriculum of cardiology rotation was developed with a potential to be implemented in other clerkship rotations.

Accuracy of Radiomics in Predicting IDH Mutation Status in Diffuse Gliomas: A Bivariate Meta-Analysis

Purpose To perform a systematic review and meta-analysis assessing the predictive accuracy of radiomics in the noninvasive determination of isocitrate dehydrogenase (IDH) status in grade 4 and lower-grade diffuse gliomas. Materials and Methods A systematic search was performed in the PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases for relevant articles published between January 1, 2010, and July 7, 2021. Pooled sensitivity and specificity across studies were estimated. Risk of bias was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2, and methods were evaluated using the radiomics quality score (RQS). Additional subgroup analyses were performed according to tumor grade, RQS, and number of sequences used (PROSPERO ID: CRD42021268958). Results Twenty-six studies that included 3280 patients were included for analysis. The pooled sensitivity and specificity of radiomics for the detection of IDH mutation were 79% (95% CI: 76, 83) and 80% (95% CI: 76, 83), respectively. Low RQS scores were found overall for the included works. Subgroup analyses showed lower false-positive rates in very low RQS studies (RQS < 6) (meta-regression, z = -1.9; P = .02) compared with adequate RQS studies. No substantial differences were found in pooled sensitivity and specificity for the pure grade 4 gliomas group compared with the all-grade gliomas group (81% and 86% vs 79% and 79%, respectively) and for studies using single versus multiple sequences (80% and 77% vs 79% and 82%, respectively). Conclusion The pooled data showed that radiomics achieved good accuracy performance in distinguishing IDH mutation status in patients with grade 4 and lower-grade diffuse gliomas. The overall methodologic quality (RQS) was low and introduced potential bias. Keywords: Neuro-Oncology, Radiomics, Integration, Application Domain, Glioblastoma, IDH Mutation, Radiomics Quality Scoring Supplemental material is available for this article. Published under a CC BY 4.0 license.

Return to sender: Unraveling the role of structural and social network ties in patient sharing networks

Healthcare is increasingly delivered through networks of organizations. Well-structured patient sharing networks are known to have positive associations with the quality of delivered services. However, the drivers of patient sharing relations are rarely studied explicitly. In line with recent developments in network and integration theorizing, we hypothesize that structural and social network ties between organizations are uniquely associated with a higher number of shared patients. We test these hypotheses using a Bayesian zero-dispersed Poisson regression model within the Additive and Multiplicative Effects Framework based on administrative claims data from 732,122 dermatological patients from the Netherlands in 2017. Our results indicate that 2.6% of all dermatological patients are shared and that the amount of shared patients is significantly associated with structural (i.e. emergency contracts) and social (i.e. shared physicians) ties between organizations, confirming our hypotheses. We also find some evidence that patients are shared with more capable organizations. Our findings highlight the role of relational ties in the way health services are delivered. At the same time, they also raise some potential anti-trust concerns.

Evaluation of Stem-Cell Embryo Models by Integration with a Human Embryo Single-Cell Transcriptome Atlas

Single-cell RNA sequencing (scRNA-seq) revolutionized our understanding of the molecular processes of early development and provided us with the means to capture biological heterogeneity and assess the cellular composition in early embryos. Comparative analysis of the transcriptional landscapes of embryos with single-cell resolution allows us to better understand and improve stem-cell-based embryo models. However, proper comparison between different single-cell datasets acquired by different laboratories and through different technologies is imperative for adequate analysis and findings. In this chapter, we focus on the analysis of human blastoids, which model the blastocyst, and their integrative analysis with human embryo datasets and a 2D in vitro early development model system dataset, which models epiblast, extraembryonic mesoderm, and trophoblast cells.

Multiple stations in an integrated design of cardiovascular system morphology for medical undergraduate

The morphology knowledge is essential for clinical, diagnostic and surgical practice in medicine. However, it is a great challenge teaching this science in an integrated curriculum, since it has the need of active methods associated with technology, in a total impaired workload. Therefore, this work described an educational design of multiple practice stations in order to teach morphology of the cardiovascular system in the undergraduate medical education. This activity was conducted in the Multicampi School of Medical Sciences of Federal University of Rio Grande do Norte (UFRN) in Caicó/Brazil. Four anatomy stations and four embryology and histology stations of heart and blood vessels were drawn up. Anatomy stations approached cardiac cycle and cardiac valves (1 A); mediastinum and pericardium (2 A); internal morphology and heart conduction system (3 A) and external morphology of heart (4 A). Whereas embryology and histology stations approached embryogenesis of the heart (1B); cardiac microanatomy and fetal circulation (2B); and vascular microanatomy (3B;4B). All the stations emphasized cognitive and psychomotor fields associated with clinical correlations to active application of morphology knowledge. The multiple stations were considered as an organized, productive, enlightening and riveting alternative to medical students and teaching staff. This innovative experience integrated and energized the three areas of morphological sciences, resignifying the teaching and learning of cardiovascular system morphology.

Mental Health Services Integration in Primary Health Care in Iran: A Policy Analysis

Objective: The National Mental Health Services (N-MHSs) in Iran was integrated with Primary Health Care (PHC) in 1988. This study aimeds to analyze the policy of integrating N-MHSs in PHC, focusing on the analysis of the current situation, pathology, and the existing challenge. Method : This qualitative research was conducted in 2020 using a case study approach. This study used the policy triangle model to analyze the policy. The required data were collected via interviews, literature review, and document analysis. The interviews were conducted with 23 experts, stakeholders across the country who were selected through purposive sampling, and the data were analyzed using the content-analysis method. Results: The main goals of this policy were to raise mental health literacy among the people and eliminate its stigma in the society, while implementing the referral system for N-MHSs. Twenty weaknesses were extracted in eight areas, including negative views of mental health, weaknesses in human resource training, compensation for the service of psychologists, unfavorable working conditions of the workforce, inappropriate service delivery facilities, lack of meaningful communication between different levels of service delivery, poor inter-sectorial communication, and the challenging nature of mental health care. De-stigmatizing psychological disorders in the society and identifying hidden patients are some of the most significant achievements of this policy. Conclusion: Despite the successful implementation and significant achievements in integrating N-MHSs in PHC, the results of the present study indicate that there are many challenges in this field that require serious planning and attention from relevant authorities.

How early should be "Early Integrated Palliative Care"?

Palliative care, with its focus on comprehensive patient assessment encompassing physical, social, emotional, and spiritual pain, plays a crucial role in modern medicine. Despite its significance, integration with oncology and other healthcare specialties often occurs late in the disease trajectory. Strategies to bridge this gap include considering a "rebranding" of palliative care to "supportive care." Early initiation of palliative care, although challenging to define precisely, aims to improve the quality of life for patients and their families. Studies show some benefits, but the evidence remains limited. An embedded model that encourages interdisciplinary collaboration between oncologists and palliative care practitioners has shown promise. However, it raises questions about training and availability of palliative care specialists. A broader approach involves integrating palliative care principles into medical and nursing education to ensure early recognition of patient needs and empathetic communication. Regular monitoring of patients' physical and non-physical needs, along with appropriate interventions, can alleviate suffering and improve patient outcomes. Ultimately, the integration of palliative care into oncology and other disciplines focuses on addressing the individual's needs and understanding their unique experience of suffering.

Swiss digital pathology recommendations: results from a Delphi process conducted by the Swiss Digital Pathology Consortium of the Swiss Society of Pathology

Integration of digital pathology (DP) into clinical diagnostic workflows is increasingly receiving attention as new hardware and software become available. To facilitate the adoption of DP, the Swiss Digital Pathology Consortium (SDiPath) organized a Delphi process to produce a series of recommendations for DP integration within Swiss clinical environments. This process saw the creation of 4 working groups, focusing on the various components of a DP system (1) scanners, quality assurance and validation of scans, (2) integration of Whole Slide Image (WSI)-scanners and DP systems into the Pathology Laboratory Information System, (3) digital workflow-compliance with general quality guidelines, and (4) image analysis (IA)/artificial intelligence (AI), with topic experts for each recruited for discussion and statement generation. The work product of the Delphi process is 83 consensus statements presented here, forming the basis for "SDiPath Recommendations for Digital Pathology". They represent an up-to-date resource for national and international hospitals, researchers, device manufacturers, algorithm developers, and all supporting fields, with the intent of providing expectations and best practices to help ensure safe and efficient DP usage.

scInterpreter: a knowledge-regularized generative model for interpretably integrating scRNA-seq data

BACKGROUND

The rapid emergence of single-cell RNA-seq (scRNA-seq) data presents remarkable opportunities for broad investigations through integration analyses. However, most integration models are black boxes that lack interpretability or are hard to train.

RESULTS

To address the above issues, we propose scInterpreter, a deep learning-based interpretable model. scInterpreter substantially outperforms other state-of-the-art (SOTA) models in multiple benchmark datasets. In addition, scInterpreter is extensible and can integrate and annotate atlas scRNA-seq data. We evaluated the robustness of scInterpreter in a variety of situations. Through comparison experiments, we found that with a knowledge prior, the training process can be significantly accelerated. Finally, we conducted interpretability analysis for each dimension (pathway) of cell representation in the embedding space.

CONCLUSIONS

The results showed that the cell representations obtained by scInterpreter are full of biological significance. Through weight sorting, we found several new genes related to pathways in PBMC dataset. In general, scInterpreter is an effective and interpretable integration tool. It is expected that scInterpreter will bring great convenience to the study of single-cell transcriptomics.

Integration of life cycle assessment and system dynamics modeling for environmental scenario analysis: A systematic review

System dynamics (SD) is widely recognized as a tool for simulating spatial and temporal dynamics in life cycle assessment (LCA) studies of the product system. However, there is no agreement on how SD and LCA could be applied effectively together in a consistent way. To address this gap, this research conducted a systematic literature review, analyzing 54 scientific articles published worldwide between 2010 and 2023, to explore the joint application of LCA with SD. The study aimed to answer three research questions: (1) What can be considered an integration of LCA and SD? (2) How can SD and LCA be effectively integrated? and (3)What are the advantages and constraints of this integration? The results highlighted the popularity of LCA and SD as impact assessment tools for sustainable design, each with its own strengths and limitations. Two primary integration types were identified when LCA was jointly applied with SD: (1) inclusion of the life cycle inventory and characterization factors in an SD model, and (2) inclusion of SD model results in an LCA. In the second type of integration, SD models the components of the technical system, and its outcomes served as input for scenario analysis, providing temporal and potentially spatial inventory data for the LCA model. The integrated approach offers a comprehensive understanding of product sustainability, aids decision-making, and enhances stakeholder engagement. The study also identifies knowledge gaps in the joint application of SD and LCA for environmental scenario analysis, suggesting the incorporation of optimization tools and strategy guidance for policy makers.

Development and application of a systematic and quantitative weighting framework to evaluate the quality and relevance of relative potency estimates for dioxin-like compounds (DLCs) for human health risk assessment

The toxic equivalency factors (TEFs) approach for dioxin-like chemicals (DLCs) is currently based on a qualitative assessment of a heterogeneous data set of relative estimates of potency (REPs) spanning several orders of magnitude with highly variable study quality and relevance. An effort was undertaken to develop a weighting framework to systematically evaluate and quantitatively integrate the quality and relevance for development of more robust TEFs. Six main-study characteristics were identified as most important in characterizing the quality and relevance of an individual REP for human health risk assessment: study type, study model, pharmacokinetics, REP derivation method, REP derivation quality, and endpoint. Subsequently, a computational approach for quantitatively integrating the weighting framework parameters was developed and applied to the REP2004 database. This was accomplished using a machine learning approach which infers a weighted TEF distribution for each congener. The resulting database, weighted for quality and relevance, provides REP distributions from >600 data sets (including in vivo and in vitro studies, a range of endpoints, etc.). This weighted database provides a flexible platform for systematically and objectively characterizing TEFs for use in risk assessment, as well as providing information to characterize uncertainty and variability. Collectively, this information provides risk managers with information for decision making.

Multi-modal characterization of the left atrium by a fully automated integration of pre-procedural cardiac imaging and electro-anatomical mapping

Background

The combination of information obtained from pre-procedural cardiac imaging and electro-anatomical mapping (EAM) can potentially help to locate new ablation targets. In this study we developed and evaluated a fully automated technique to align left atrial (LA) anatomies obtained from CT- and MRI-scans with LA anatomies obtained from EAM.

Methods

Twenty-one patients scheduled for a pulmonary vein (PV) isolation with a pre-procedural MRI were enrolled. Additionally, a recent computed tomography (CT) scan was available in 12 patients. LA anatomies were segmented from MRI-scans using ADAS-AF (Galgo Medical, Barcelona) and from the CT-scans using Slicer3D. MRI and CT anatomies were aligned with the EAM anatomy using an iterative closest plane-to-plane algorithm. Initially, the algorithm included the PVs, LA appendage and mitral valve anulus as they are the most distinctive landmarks. Subsequently, the algorithm was applied again, excluding these structures, with only three iterative steps to refine the alignment of the true LA surface. The result of the alignments was quantified by the Euclidian distance between the aligned anatomies after excluding PVs, LA appendage and mitral anulus.

Results

Our algorithm successfully aligned 20/21 MRI anatomies and 11/12 CT anatomies with the corresponding EAM anatomies. The average median residual distances were 1.9 ± 0.6 mm and 2.5 ± 0.8 mm for MRI and CT anatomies respectively. The average LA surface with a residual distance less than 5.00 mm was 89 ± 9% and 89 ± 10% for MRI and CT anatomies respectively.

Conclusion

An iterative closest plane-to-plane algorithm is a reliable method to automatically align pre-procedural cardiac images with anatomies acquired during ablation procedures.

Metabolomic responses based on transcriptome of the hepatopancreas in Exopalaemon carinicauda under carbonate alkalinity stress

High carbonate alkalinity is one of the major stress factors for survival of aquatic animals in saline-alkaline water. Exopalaemon carinicauda is a good model for studying the saline-alkaline adaption mechanism in crustacean because of its great adaptive capacity to alkalinity stress. In this study, non-targeted liquid chromatography-mass spectrometry (LC-MS) metabolomics analyses based on high-throughput RNA sequencing (RNA-Seq) were used to study the metabolomic responses of hepatopancreas in E. carinicauda at 12 h and 36 h after acute carbonate alkalinity stress. The results revealed that most of the significantly differential metabolites were related to the lipid metabolism. In particular, the sphingolipid metabolism was observed at 12 h, the glycerophospholipid metabolism was detected at 36 h, and the linoleic acid metabolic pathway was significantly enriched at both 12 h and 36 h. The combined transcriptome and metabolome analysis showed that energy consumption increased at 12 h, resulting in significant enrichment of AMPK signaling pathways, which contributed to maintain energy homeostasis. Subsequently, the hepatopancreas provided sufficient energy supply through cAMP signaling pathway and glycerophosphate metabolism to maintain normal metabolic function at 36 h. These findings might help to understand the molecular mechanisms of the E. carinicauda under carbonate alkalinity stress, thereby promote the research and development of saline-alkaline resistant shrimp.

[Integration of natural sciences and basic medical subjects in the integrated dentistry program (iMED DENT) at the University of Hamburg]

In October 2019, an integrated dentistry program (iMED DENT) was implemented at the University of Hamburg and was the first of its kind in Germany. This model curriculum builds on didactic concepts that have been applied successfully for many years in curricula for human medicine, including interdisciplinary teaching, early clinical experience, and scientific education. The first year focuses on the healthy situation ("normal function") and aims to integrate the natural sciences (biology, chemistry, physics) and the basic medical subjects (anatomy, biochemistry, physiology, medical terminology) in the context of dental health. Further, basic practical and clinical tasks are assigned to the students during the first year.From the experience of the first four cohorts, initial conclusions can be drawn about this stage of study. Generally, its modular structure results in a condensation of learning content, which students judge as demanding. However, its interdisciplinary approach is well accepted. For instance, presenting the basics of the natural sciences in the context of their dental relevance is much better evaluated in the new compared to the previous curriculum, in which this content was taught without specific references to dental health. Teaching the basics of medicine within clinical context and the inclusion of early clinical practice are similarly appreciated. Presently, the interdisciplinary approach is limited by the focus on practical competencies of the dentistry curriculum, as some practical courses offer only few opportunities for other disciplines to interconnect their teaching. The continuous evaluation of the curriculum and exchange of experiences between the disciplines will further improve the integrative concept of the curriculum.

Why do Integrated Maternal HIV and Infant Healthcare Services work? A Secondary Analysis of a Randomised Controlled Trial in South Africa

In a randomised trial, we found that integrated maternal HIV and infant health services through the end of breastfeeding were significantly associated with the primary outcome of engagement in HIV care and viral suppression at 12 months postpartum, compared to the standard of care. Here, we quantitatively explore potential psychosocial modifiers and mediators of this association. Our findings suggest that the intervention was significantly more effective among women experiencing an unintended pregnancy but did not improve outcomes among women reporting risky alcohol use. Although not statistically significant, our results suggest that the intervention may also be more effective among women experiencing higher levels of poverty and HIV-related stigma. We observed no definitive mediator of the intervention effect, but women allocated to integrated services reported better relationships with their healthcare providers through 12 months postpartum. These findings point to high-risk groups that may benefit the most from integrated care, as well as groups for whom these benefits are hampered and that warrant further attention in intervention development and evaluation.

[Study section "From Symptom to Disease"-steps towards an integrated dentistry program]

Based on the integrated medicine program (iMED) at the University Medical Center Hamburg-Eppendorf, the dental education concept was fundamentally revised and an integrated dentistry program (iMED DENT) was developed. During this process, reform goals such as interdisciplinarity between dentistry and medicine, early patient contact, and psychosocial and communicative competencies as well as a scientific orientation were defined. The second study section "From Symptom to Disease" during the second and third years of study form a link between "Normal Function" in the first year and the final training section "Therapy". The modular structure of the integrated dentistry program allows topics to be taken up repetitively and deepened as well as strengthen dental skills during the preclinical practical training in preparation for patient treatment. Here, the implementation of dental prophylaxis, assisting in the clinic, and the assessment of patients' findings create an early link to the practice. Newly integrated are the science and communication tracks, which are also modular and closely interlinked with dentistry. So far, the results of the first three cohorts indicate a successful implementation of the new concept, but it should be continuously developed and improved.

HIV assisted partner services (aPS) to support integrated HIV and hypertension screening in Kenya: a pre-post intervention study

BACKGROUND

People living with HIV (PLWH) have a higher risk of developing hypertension compared to HIV uninfected individuals. HIV assisted partner services (aPS), where PLWH are assisted by a healthcare provider to disclose their status to sexual and / or drug injecting partner(s), offers an opportunity for integrated HIV and hypertension screening. We evaluated the feasibility of the aPS model in supporting integrated HIV and hypertension screening at the Kenyatta National Hospital, Kenya.

METHODS

Between August 2019 and December 2020, we conducted a pre-post intervention study. We enrolled women receiving HIV testing services (HTS) with confirmed hypertension (female index clients) and traced their male relatives for HIV and hypertension screening and reviewed management at 3-months. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, and/or use of antihypertensive medication.

RESULTS

One hundred female index clients (median age: 55 years; interquartile range (IQR): 47-65) mentioned 165 male relatives (median: 49 years; IQR: 40-59) of whom 35% (n = 58/165) were enrolled. Of the male relatives, 29% had hypertension (n = 17/58), 34% had pre-hypertension (n = 20/58), and none were HIV-positive (n = 0/58). Among the female index clients, there was a statistically significant decline in SBP (pre: 156 mmHg, post: 133 mmHg, p-value: < 0.0001) and DBP (pre: 97 mmHg, post: 80 mmHg, p-value: < 0.0001), and increase in antihypertensive medication uptake (pre: 91%, n = 84/92; post: 98%, n = 90/92; X2: 4.3931, p-value: 0.036) relative to baseline. Among the male relatives, there was a statistically significant increase in antihypertensive medication uptake among those with hypertension (pre: 13%, n = 6/46; post: 17%, n = 8/46; X2: 32.7750, p-value: < 0.0001) relative to baseline.

CONCLUSION

HIV aPS holds promise for integrated HIV and hypertension screening among at-risk clients and their families. Twenty-nine percent of the male relatives had hypertension, higher than the national prevalence (24%), while one-third had pre-hypertension. We observed relatively high participant retention, reductions in blood pressure, and increase in antihypertensive medication uptake among those with confirmed hypertension. Future research expanding the aPS model to other non-communicable diseases through larger studies with longer follow-ups is required to better assess causal relationships and optimize integrated service delivery.

Family planning integration in Ethiopia's primary health care system: a qualitative study on opportunities, challenges and best practices

BACKGROUND

Family planning (FP) service integration into primary health care (PHC) is an effective approach to realize reproductive autonomy, increase the use of contraceptives, and improve maternal and child health outcomes. The Ethiopian government promotes integration of FP services into primary health care (PHC). However, there is paucity of evidence on the status of FP service integration. The aim of this study is to explore the state of FP integration into PHC services and identify facilitators and barriers to integration.

METHODS

A qualitative study nested with a larger national study was conducted from July to October 2022. A total of 60 interviews were conducted with FP stakeholders including, government organizations, non-governmental organizations, donors, service providers, and clients. Interviews were audio recorded, transcribed, and coded using OpenCode 4.03. The coded data were analyzed using framework analysis approach, using the Primary Health Care Performance Initiative (PHCPI) framework. Direct quotes and results from the coding and categorization were used to develop the report.

RESULTS

Family planning is largely provided in designated units by dedicated staff within PHC facilities. The provision of integrated FP service within each service unit is in its early stage. Successful examples of integration include integration of FP with postnatal care, abortion care, and youth-friendly service centers. Facilitators of integration include commitment of the government and partners, the presence of policies and guidelines, and positive attitude of service providers and clients. However, integration of FP also faces challenges that are largely related to challenges of the FP program even before integration. These include resource shortage, health workers shortage, health workers' capacity/skill gaps, misconceptions about FP, religious and socio-cultural norms, and lack of awareness.

CONCLUSIONS

Integration of FP with PHC services in the Ethiopian public health facilities is viable. Pre-existing challenges of the FP program continued to be barriers to integration. Expanding the experiences of good practices in the integration of FP with post abortion care, post-natal care, and youth-friendly service centers to other components of PHC warrants attention. Addressing both supply- and demand-side challenges of the FP program is needed to facilitate the integration of FP with other PHC services.

Evaluating the internalisation of the intrinsic role of health advocacy of student pharmacists in a new integrated Bachelor of Pharmacy curriculum: a mixed-methods study

To keep up with the contemporary health landscape, there is an imperative need for healthcare professionals to practise health advocacy through health promotion on the individual, population, and systems levels. In the Academic Year of 2020/2021, the National University of Singapore (NUS) Department of Pharmacy implemented a new spiral curriculum integrating basic, clinical, and systems sciences with one of its aims to deepen students' health advocacy internalisation and prepare them as future health advocates. A mixed-methods approach was adopted. Questionnaires were disseminated across three time-points to elicit students' levels of internalisation of health advocacy, which were then categorised into levels, and a Mann-Whitney U test was conducted. In comparison with prematriculation, no significant difference was found after students underwent the first year of the curriculum, while a significant difference was found after students underwent two years of the curriculum. Semi-structured interviews were also conducted after each Academic Year to gain deeper insights into the questionnaire results. Thematic analysis of the interviews revealed that curricular integration in the first year was perceived to be lacking. However, with learnt knowledge constantly reinforced and more experiential learning opportunities incorporated throughout the second year, students found the integrated curriculum beneficial in instilling confidence to practise health advocacy. This study offers insights into the prospects of a spiral integrated curriculum in imparting health advocacy, and may even suggest its potential to be applied to other educational settings. Future follow-up studies can also be conducted on the same study population to evaluate long-term impacts and areas for improvement of the curriculum.

Sustainability of integrated hypertension and diabetes with HIV care for people living with HIV at primary health care in South Ethiopia: implication for integration

BACKGROUND

People living with human immunodeficiency virus (PLWH) have an increased risk of developing noncommunicable diseases (NCDs) compared with people without HIV. The multimorbidity of NCDs and HIV increases the need for integrated care. However, there is a paucity of evidence on the implementation of integrated sustained hypertension and diabetes with HIV care to address the multiple chronic care needs of PLWH in Ethiopia.

OBJECTIVE

This study aimed to determine the sustainability of integrated hypertension and diabetes within HIV care for PLWH in primary healthcare (PHC) in southern Ethiopia.

METHODS

The National Health Service Institute for Innovation and Improvement Sustainability Model (NHS- SM) self-assessment tool was used to assess sustainability. HIV care and NCD team members from five PHC facilities in South Ethiopia were included. Participants completed the self-administered NHS-SM assessment tool independently.

RESULT

The overall mean sustainability was 43.74 (95% CI: 42.15-45.33). All facilities had an overall sustainability score of less than 55. The perceived benefit beyond helping the patient, the likelihood of adaptability, and perceived alignment with the organizational goal were identified as potential factors promoting sustainability. The perceived lack of an effective system to monitor progress, staff behavior, inadequate staff involvement and training, inadequate senior leadership support and clinical leadership engagement, and infrastructure limitations could negatively affect sustainability.

CONCLUSIONS

Integrating hypertension and diabetes with HIV care sustainably at PHC requires staff involvement and training, staff behavior change communication, ensuring PHC management and clinical leadership (doctors and senior clinicians) engagement, and addressing infrastructure limitations.

The impact of integrating bioscience and nursing subjects in a first-year nursing curriculum: A retrospective study

AIM

The aim of this study is to explore the effects of integrating bioscience and nursing units on academic achievement and perception in the first-year nursing curriculum.

BACKGROUND

Nursing students have historically found biosciences difficult and struggle to relate it to nursing practice. In response, nursing and non-nursing academics have employed different teaching modes and integration strategies to enhance learning. Despite these efforts, substantial gaps still persist concerning the integration of biosciences within nursing curriculum and the effect of integration on student academic achievement and student perception.

DESIGN

Retrospective descriptive. The setting was a large University in Victoria Australia with two undergraduate nursing campuses (metropolitan and non-metropolitan).

METHOD

Student academic records and online evaluation surveys that were completed from 2014 to 2019 were examined. Students self-reported their experiences of the unit using a five-point Likert scale and two open-ended questions. Descriptive and inferential statistics were used to analyse the data. Content analysis was used to analyse the two open-response survey items.

RESULTS

First-year student records from 2014 to 2016 (pre-integration) and 2017-2019 (post-integration) were examined. Student mean age was 24.5 years (SD 7.2) and 20.9 years (SD 4.8) pre-integration and post-integration respectively. There was a statistically significant decrease in student attrition from pre-integration (n=536, 29.9%) to post-integration (n=358, 20.2%) (p <0.001), and a significant improvement in students' mean academic scores post-integration in the first semester 61.9 (SD 15.9) and 67.0 (SD 14.9) respectively, confidence interval 3.9-6.2 (p <0.001). Student satisfaction with the units improved post-integration, from 77.8% to 85.8% (χ2 = 10.1076) (p=0.001). However, there was no significant difference in students' perception of feeling overwhelmed, and their self-reported ability to link theory to practice.

CONCLUSION

Integrating bioscience and clinical nursing practice units in the first-year curriculum can help decrease student attrition rates, improve student academic results and increase student satisfaction which may lead to an overall improvement in student learning experiences.

The Integration of Foot and Ankle Instruments to Enhance Orthopedic Hand Surgery: Technical Note

Introduction

The scaphoid fracture is the most common type of carpal fracture, and disruption of the proximal row of carpal bones alters wrist mechanics altering the stabilization that permits the wrist to work efficiently. When the displacement is at least 2 mm, the majority of surgeons would preferentially operatively intervene in this fracture. Non-union of the fracture will occur when left untreated. The gold standard for treatment is open reduction and internal fixation using autologous bone graft. This case report is the first to describe the integration of the Hintermann™ Distractor, used as an integral part of the surgery in scaphoid waist fracture fixation to improve fracture stabilization, preparation, and compression.

Case Report

A 20-year-old male presented with a volar flexed scaphoid non-union, 4 months after the initial injury. Open reduction internal fixation, with the use of the Hintermann™ Distractor, facilitated ease of reduction and placement of Russe graft.

Conclusion

Scaphoid waist non-unions with volar angulation and an associated DISI deformity can lead to a significant decrease in function. This case study is the first to describe the use of a foot and ankle instrument to assist with fracture preparation and distraction to place a corticocancellous strut graft in the scaphoid fracture efficiently. This case study demonstrates the efficiency of the technique.

A political economy analysis of strengthening health information system in Tanzania

BACKGROUND

Many countries' health systems are implementing reforms to improve the functioning and performance of the Health Management Information System (HMIS) to facilitate evidence-based decisions for delivery of accessible and quality health services. However, in some countries such efforts and initiatives have led to a complex HMIS ecosystem characterized by multiple and fragmented sub-systems. We undertook an in-depth analysis of the HMIS ecosystem in Tanzania to inform the ongoing initiatives, by understanding the relationship and power differences among stakeholders, as well as drivers and barriers to HMIS investment and strengthening.

METHODOLOGY

This was a qualitative research method incorporating data collection through document review and key informant interviews guided by political economy analytical framework. A total of 17 key informant interviews were conducted between April and May 2022. A thematic content analysis was used during data analysis.

RESULTS

Good relationship between the government and stakeholders dealing/supporting HMIS ecosystem was noted as there are technical working groups which brings stakeholders together to discuss and harmonize HMIS activities. The 'need for the data' has been the driving force toward investment in the HMIS ecosystem. The analysis showed that the government is the main stakeholder within the HMIS ecosystem and responsible for identifying the needs for improvement and has the power to approve or reject systems which are not in line with the government priority as stipulated with the HMIS investment roadmap/strategy. Moreover, partners with long relationship are powerful in influencing HMIS investment decision-making compared to those who are recently coming to support. It was further noted shortage of staff with technical competence, inadequate financial resources, and the development of fact that some of the existing systems have not been developed to their full capacity and have hindered the whole systems' integration and interoperability exercise of ensuring integration and interoperability of the systems.

CONCLUSION

A need-based assessment of staff capacity at the sub-national level is equally important to identify available capabilities and the knowledge gap to strengthen the HMIS ecosystem. Strong coordination of the ideas and resources intended to strengthen the HMIS ecosystem would help to reduce fragmentation. In addition, there is a need to mobilize resources within and outside the country to facilitate the integration and interoperability process smoothly.