Actual Intervention Research Articles

Climate resilience action to policy: embodied community-based climate risk resilience (CBCRR) in drought prone community in Thailand’s economic corridor

ABSTRACT Climate change exacerbates drought and water scarcity in Thailand, particularly in the Eastern Economic Corridor (EEC), a key geoeconomic strategy corridor. Climate risk, coupled with industrialization and urbanization, has accelerated water shortages in this area. Despite adaptation efforts such as shifting to drought-tolerant crops, rural communities face an increasing threat of water scarcity. Thailand's 2018 National Adaptation Plan (NAP) aims to increase adaptive capacity and enhance resilience. However, while national and provincial plans are underway, district, subdistrict, municipal, and community-level plans are still under development. This participatory action research applied the Community-Based Climate Risk Resilience (CBCRR) approach to communities at risk of drought in the EEC of Thailand. The demonstrated CBCRR approach and empirical evidence for the actual process, practice, and intervention were observed and documented. Both qualitative and quantitative methods were utilized, including questionnaire surveys, interviews, gaming simulations, mapping workshops, field surveys, and brainstorming meetings. The key findings of this research are as follows: (1) Community-household-level climate action: This case study identified empirical climate resilience actions that can be generalized to other vulnerable local communities. These actions highlight the importance of addressing climate change at the community and household levels, alongside national/provincial plans and policies. (2) Three-tier resilience strategies: This research identifies three levels of resilience strategies that can be applied to local practices and policies in other communities. (3) CBCRR is an alternative approach: the concept of the CBCRR and its four key elements can be utilized to build climate resilience. Key policy insights Promote Climate Resilience at All Levels: Climate risk resilience practices should be prioritized at all levels of governance, from national to local. Investing in Local Capacity Building: Investing in capacity building at the local level is crucial for achieving tangible results that reinforce broader national climate initiatives. Integrate Resilience into Local Planning: A resilience approach should be embedded in local plans, policies, budget allocations, and evaluation systems. Institutionalize CBCRR: Community-Based Climate Risk Resilience (CBCRR) should be institutionalized, especially in high-risk and vulnerable communities. Data-Driven Decision Making: Prioritize the collection and utilization of risk and vulnerability data at the community and household levels.

The Gerber bridges in Italy: retracing history to safeguarding existing infrastructures

The static scheme of the Gerber beam was formalized in 1886 when the Bavarian engineer Heinrich Gerber (1832-1912) filed the patent “Balkentrager mit freigenden Stuntzpunkten,” introducing the concept of internal hinges within the continuous girder static model. By the 1890s, large metal viaducts constructed applying the Gerber scheme became widely adopted. Subsequently, from around 1930 onwards, the Gerber scheme was extended to reinforced concrete bridges. In Italy, the Gerber scheme was widely applied to reinforced concrete bridges from the 1930s to the 1970s. In this context, the Gerber scheme evolved with the technological advancements in reinforced concrete construction, adapting to the gradual integration of prefabrication techniques, prestressing methods, and the industrialization of castings. The present paper retraces the evolution of the reinforced concrete Gerber bridge in Italy, proving the knowledge base framework for the actual assessment and maintenance intervention on existing bridges.

Effect of artificial insemination, ruminal incubation, and esophageal tubing on cortisol concentration in blood of lactating dairy cows

Cortisol is a hormone associated with pain, fear, distress, or discomfort. We hypothesized that human interventions increase cortisol concentrations in plasma. Therefore, the objective of this study was to determine the concentration of cortisol in plasma before and after animals were subjected to routine on-farm and research procedures including artificial insemination, ruminal incubation, or esophageal tubing. Forty lactating Holstein cows were used in this study. Experimental treatments consisted of 4 interventions. Before any intervention, a first blood sample was collected from all cows. Following this bleeding, all cows were assigned to 1 of 4 treatments. A negative control treatment consisted of bleeding for a second time without any human intervention at least 30 min after the previous bleeding. Artificial insemination was performed by the herd managers from the Virginia Tech Dairy Complex. A rumen incubation treatment consisted of bleeding for a second time 30 min after opening the rumen cannula, inserting the operator's arm, and pulling ruminal contents out of the rumen for 2 min mimicking a ruminal in situ incubation, and placing back the cannula plug. An esophageal tubing treatment consisted of bleeding for a second time 30 min after inserting an esophageal tube into the esophagus and maintaining it inserted for 2 min mimicking a ruminal drenching procedure. Blood samples were collected from the coccygeal vessels. Cortisol concentration in plasma was measured by an independent laboratory using a chemiluminescence assay. The experiment was designed as a completely randomized design with repeated measures, where cow was the subject and the pre- and post-intervention bleeding were the repeated observations. The statistical model included the fixed effect of treatment, the random effect of cow, the fixed effect of time, the fixed effect of the treatment by time interaction, and the random residual error. According to Akaike's criterion, compound symmetry was utilized as the covariance structure for the repeated measures. Cortisol concentrations in plasma after the interventions did not differ from the cortisol concentrations in plasma before the interventions. Cows subjected to artificial insemination had greater cortisol concentrations than cow subjected to the other treatments. No interaction existed between treatment and time. Most cows subjected to insemination in a palpation rail had elevated cortisol concentrations before the intervention. Therefore, animal restraint seems to affect cortisol concentrations in plasma more than the actual human intervention. In conclusion, human interventions like artificial insemination, ruminal incubation, and esophageal tubing did not elevate the cortisol concentrations in the plasma of lactating dairy cattle under the conditions of this study.

The impact of tobacco retailers density reduction on smoking status of Belgian adults

Abstract Background Smoking being one of most impactful risk factors for causing non-communicable diseases (NCD) and consequently attributable death, represents an enormous public health issue. New policy interventions aimed at reducing smoking prevalence are planned in the Belgian Tobacco Free Generation plan. Within the plan, it is aimed to reduce the number of outlets that sell tobacco products, as a higher tobacco retail density (TRD) is believed to be linked to higher smoking prevalence. Using health impact assessment (HIA), this study aims to evaluate the policy before it is set in place. Methods For this intervention a 17% reduction in density was estimated according to the scoping review would be associated with an 0.39 percentage point reduction in prevalence. The Potential Impact Fraction (PIF) was calculated to assess the change in proportion of current smokers. Time series and projections of the Belgium Health Interview Survey provided data on the smoking status from 1997 untill 2040. The relative risk were retrived from the Global Burden of Disease 2021 study. Using data from the Belgian Burden of Disease Study, the avoidable burden was estimated. Results The policy is expected to reduce the density by 17 % by 2025, which results in a PIF for lung cancer of 0.92%, decreasing to 0.82% in 2040. The smoking prevalence would decrease from 12.62% to 12.23%. We estimated that this intervention would avoid the burden of more than 300 lung cancer cases and around 100 deaths in 2040. Conclusions The HIA in this study suggests that reducing TRD has a potential to contribute to achieving the objectives in Tobacco Free Generation plan. However, it should be noted that the impact is rather small, lower than 1% for most diseases. In addition, the actual impact may vary depending on the specific implementation of the policy and future smoking trends. Further research is needed to refine the effect size estimate based on the actual policy intervention details. Key messages • Reducing tobacco retail density can reduce the burden of smoking. • Modeling limitations need further research to refine HIA results.

«Values Evaluation Method» to assist in the decision-making process for intervention on architectural heritage

A method of analysis of heritage values (VEM - Values Evaluation Method) as criteria for intervention in existing buildings is presented. It is based on the authenticity of the values and on the integrity and functionality of the building. A matrix of values has been prepared that allows their parameterization and weighting, as well as the proposal of possible interventions for their recovery. Here we carry out the application of the method to a series of interventions already made to verify the effectiveness of the method. Eleven cases of buildings in two countries (Algeria and Spain) have been selected, on which there are previous studies and total or partial interventions. The buildings are briefly presented and the application of the methodto these buildings is compared with the actual interventions. The great similarity between them allows us to confirm the effectiveness of the VEM as a tool for decision-making prior to the intervention.

Analyzing Riders’ Behavioral Adaptation to Driving Patterns of Advanced Autonomous Vehicles: A Virtual Reality Simulation Study

The necessity of human supervision and intervention during autonomous driving has long been a topic of controversial discussion. From a developer’s perspective, it is expected that users will readily adapt to well-calibrated autonomous driving systems (ADS) due to their superior performance in dynamic driving tasks (DDT) compared to conventional human-driven vehicles. However, when passengers experience an autonomous vehicle (AV), there may be an adjustment period during which they modify their behavior to accommodate the driving patterns of the ADS. Additionally, some passengers might not adapt to autonomous driving at all, highlighting potential limitations in the current ADS development strategy. This work studies the dynamics of human-automation interaction and introduces an “objective method”, which employs a Virtual Reality (VR)-enabled simulation approach for in-depth behavioral analysis concerning riders’ behavioral adaptation to autonomous driving. Specifically, we examined how participants interacted with and intervened in Level 4 ADS operating under conservative, moderate, and aggressive driving patterns in a fully autonomous environment. A realistic urban road network was recreated in VR, integrated with traffic microsimulation to generate various driving scenarios. Twenty-seven participants completed driving tasks across different AV modes, with their intervention behaviors analyzed in relation to traffic conditions and AV aggressiveness. Key findings include: (1) Participants showed higher intention to intervene but lower actual intervention rates under aggressive AV modes compared to moderate and conservative modes, suggesting quicker adaptation to more challenging driving scenarios. (2) Interventions generally proved unnecessary and sometimes detrimental to overall traffic performance in a full-AV environment. (3) Aggressive AV modes significantly improved traffic efficiency, with a 40% increase in average travel speed and a 53% reduction in waiting time. However, human interventions posed the greatest challenge to achieving optimal traffic conditions. This research provides insights into the complex dynamics of human-AV interaction and adaptation, offering valuable implications for AV interface design, implementation strategies, and public acceptance of autonomous driving technologies.

Health gains from achieving optimal body mass index in Australia: a simulation study

We estimated the health gains and health inequality impacts for the Australian population alive in 2021 (n=25.0 million) in the next 20 years and over their remaining lifespan, from shifting everyone above a BMI of 25kg/m2 to 25kg/m2 compared to the BMI distribution in 2021 persisting into the future. National Health Survey 2017-2018 was used to estimate BMI distributions by sex, age and, socio-economic status (Socio-Economic Indexes for Areas; SEIFA). A proportional multistate life table linking BMI to 19 associated diseases and allowing for time lags and competing morbidity and mortality, was used to estimate the future stream of health adjusted life years (HALYs) gained from eradicating high BMI. Undiscounted health gains in the first 20 years and lifetime of the population were, respectively, 2.00 million (95% uncertainty interval 1.70-2.32) and 20.4 million (17.0-24.2) (at a 3% annual discount rate, HALY gains were 1.37 and 5.77 million, respectively). Reductions in the incidence of cardio metabolic diseases contributed 61% (95% UI: 54%-68%) of the undiscounted health gains in the first 20 years, musculoskeletal diseases contributed 26% (20%-32%) and cancer 5% (3%-8%). HALY gains in the first 20 years and lifetime, per person alive in 2021, were 2.5 (2.4-2.5) and 1.9 (1.9-2.0) times higher for the most compared to the least deprived SEIFA quintile. The total theoretical envelope of health gains, and health inequality reductions, through eradication of BMI is substantial. Our modeling infrastructure can be used to estimate the health impacts and cost effectiveness of many actual interventions. No funding was received for the study.

The Impact of Pain Education Interventions for Cancer Survivors and Caregivers: A Systematic Review with Meta-Analysis.

Cancer-related pain is a global health-related problem associated with functional impairment, anxiety, depression, and reduced quality of life. The use of educational interventions for patients and their caregivers has been proposed as a promising tool for overcoming pain in cancer. The aim of this study was to summarize by means of a standardized methodological systematic revision the actual pain education intervention used in cancer patients and their caregivers and to analyze its effects on pain. A search was conducted through PubMed, Web of Science, Scopus and Cinhal from their inception to September 2022. Randomized controlled trials which included pain education interventions were identified. Two reviewers performed independent data extraction and methodologic quality assessments of these studies. A total of seven studies was included in the study. The meta-analysis showed that pain education interventions have a significant effect on the worst pain; however, there was no effect on average pain. Pain education interventions addressed to patients and their caregivers could have positive effects on cancer-related pain. It is recommended that a minimum of three sessions of about one hour's duration be held once a week. Further research needs to be carried out and analyzed on the effects over the long term. Pain education interventions show positive results in improving pain in cancer patients regardless of etiology or extent of the cancer. Studies with better methodological quality should be carried out to address specific components related to education interventions.

Understanding Practical, Robust Implementation and Sustainability of Home-based Comprehensive Sexual Health Care: A Realist Review

This review identifies which elements of home-based comprehensive sexual health care (home-based CSH) impacted which key populations, under which circumstances. A realist review of studies focused on home-based CSH with at least self-sampling or self-testing HIV and additional sexual health care (e.g., treatment, counseling). Peer-reviewed quantitative and qualitative literature from PubMed, Embase, Cochrane Register of Controlled Trials, and PsycINFO published between February 2012 and February 2023 was examined. The PRISM framework was used to systematically assess the reach of key populations, effectiveness of the intervention, and effects on the adoption, implementation, and maintenance within routine sexual health care. Of 730 uniquely identified records, 93 were selected for extraction. Of these studies, 60% reported actual interventions and 40% described the acceptability and feasibility. Studies were mainly based in Europe or North America and were mostly targeted to MSM (59%; 55/93) (R). Overall, self-sampling or self-testing was highly acceptable across key populations. The effectiveness of most studies was (expected) increased HIV testing. Adoption of the home-based CSH was acceptable for care providers if linkage to care was available, even though a minority of studies reported adoption by care providers and implementation fidelity of the intervention. Most studies suggested maintenance of home-based CSH complementary to clinic-based care. Context and mechanisms were identified which may enhance implementation and maintenance of home-based CSH. When providing the individual with a choice of testing, clear instructions, and tailored dissemination successful uptake of STI and HIV testing may increase. For implementers perceived care and treatment benefits for clients may increase their willingness to implement home-based CSH. Therefore, home-based CSH may determine more accessible sexual health care and increased uptake of STI and HIV testing among key populations.

Survey on Findings and Utilization of Preoperative Chest Radiography in Ophthalmic Surgery.

Objective: The objective of this paper is to reconsider the significance of preoperative chest radiography (CXR) before ophthalmic surgery through investigation of imaging findings and usage status. Methods: This retrospective observational clinical study involved 1616 patients who underwent ophthalmic surgery at Saga University Hospital from 1 January 2019 to 31 December 2020. The patients' radiology reports were obtained from the electronic medical records, and their CXR findings, therapeutic interventions, and progress were investigated. Results: Among all patients, 539 (33.4%) had abnormal preoperative CXR findings. Of these patients, 74 (4.6%) had newly identified abnormal findings. In both patient groups, approximately 70% of patients with abnormal findings were aged ≥70 years, and interstitial shadows were the most common finding. Among all patients with abnormal findings, three (0.19%) received preoperative therapeutic interventions, and all surgeries were performed safely. Forty-three patients with abnormal findings were referred to our hospital or other hospitals for further investigation and treatment postoperatively. Among those patients, eight (0.5%) had primary lung cancer, seven underwent surgery, and one received chemoradiation. The other patients were also followed up and received appropriate therapeutic interventions. Conclusions: Before ophthalmic surgery, few patients required actual therapeutic interventions based on their CXR results. However, many abnormal findings were revealed in elderly patients, including some serious diseases. Furthermore, research has suggested that appropriate therapeutic intervention after ophthalmologic surgery may reduce the risk of a poor life prognosis. This study clearly shows that preoperative CXR is not only useful for perioperative systemic management but also ultimately benefits patients. It is also considered particularly meaningful for patients aged ≥70 years.

Impact of Covid-19 Pandemic on the Access to Congenital Heart Disease Health Services A Single Center Study

Abstract Background The SARS-COV2 virus has been extensively researched on a microbiological basis with overview on its various symptoms, complications, modes of transmission and how to possibly treat or even prevent it. But in our research, we are pre-determined to look on how much damage the pandemic has cost our health care system indirectly causes many people to suffer and have their services delayed or postponed. Aim and objectives To quantify the impact that COVID-19 had on access to congenital heart disease heath care, comparing data at different time intervals, during March 2020, September-October 2020 and November 2021. In the congenital and structural heart disease unit in Ain Shams university hospitals. Patients and Methods This is a Cross-sectional observational study of a 260-patient presented to Ain Shams University Hospitals Structural heart disease in the congenital heart disease cath lab. Patients or their guardians were asked via survey over the Telephone to assess their demographic data, their medical condition, delay in health care services and the respondent own perception to the delay in effect. The answers were compared according to the different time frames and their relation to COVID-19 pandemic. Results We have revealed a difference in number of cases between March 2020 (peak pandemic), September-October 2020 and 1 year after in November 2021; number of respondents 31,80 and 149 respectively. There was a statistically significant relation between the delay time (time interval from decision taken to actual intervention done) and (date of the actual procedure); patients who underwent their procedure in the group of March 2020; patients experienced less delay, with 42% of the patients had their procedure done in less than one month. While the group Sep-Oct 2020; Patients experienced the most delay with 50% of the patients had their procedure done in more than 6 months. In group of Nov 2021; 43% of the population had less than one month delay. Over the course of the population studied, almost 21% of respondents believed that there had been a delay in their case due to non -COVID-19 related reasons (hard paperwork and/or long waiting lines). In the group who had their procedure done in March 2020, 60% of respondents believed that their cases were delayed because of non-Covid-19 related reasons (hard paperwork and/or long waiting lines). In the group who had their procedure done in Sep-Oct 2020; 58.9% of respondents thought that their cases were delayed mainly because of COVID-19 related reasons. In the group who had their procedure done in Nov 2021; 39% of respondents believed that their delay was because of COVID-19 related reasons (fear of infection and/or Turing of hospitals into isolation centers/cancelling elective procedures). Conclusion We concluded that COVID-19 pandemic has affected the provided the health care services provided. Most of the delayed population, had their procedures delayed because of COVID-19 related reasons. Risk stratification of ACHD according to complexity of illness or severity of symptoms is a must to allow intervention and follow up during drastic times according to a pre-set list of patients’ priorities.

Clear amniotic fluid aspiration syndrome: A novel description of an old entity.

Clear amniotic fluid aspiration syndrome (CAF-AS) is a very rare event occurring in 0.25% of our term clear amniotic fluids deliveries. The study's aims were: 1. to characterize the risk factors and outcomes associated with Clear Amniotic Fluid Aspiration Syndrome and 2. to compare the outcomes of Clear Amniotic Fluid Aspiration to Meconium Aspiration. This was an observational study over a 22-year period in a single level-3 medical center. Compared were parturient/labor characteristics and neonatal outcomes in cases with suspected Clear Amniotic Fluid Aspiration to cases suspected for Meconium Aspiration. Out of 79,620 term deliveries there were 66,705 (83.8%) clear amniotic fluids and 12,915 (16.2%) meconium stained amniotic fluid (MSAF). Of neonates born with clear amniotic fluid, 166 (0.25%) were diagnosed with Clear Amniotic Fluid Aspiration Syndrome (CAF-AS), while 202 (15.7%) of those born with MSAF, were diagnosed with aspiration syndrome (MSAF-AS). Both conditions had comparable rates of mild manifestation (67.5% vs 69.2%, p = 0.63). Persistent pulmonary hypertension (PPH) occurred 5 times less in CAF-AS than MSAF-AS (4% vs 20%, OR 0.17, P< 0.0001) Both conditions presented similar rates of surfactant without PPH (11.1% vs 13.4%, p = 0.87). There was 1 postnatal death in CAF-AS vs 10 in MSAF. CAF-AS were quantitatively quite similar in terms of need of actual active intervention of the neonatologists in the delivery room (166 vs 202, i.e. in terms of numbers of cases and not prevalence) to MSAF-AS.We identified in these cases two major specific causes: hyperkinetic explosive deliveries in multiparas and long-lasting episodes of maternal hypotension due to epidural/spinal anaesthesia during labor. Out of 140 million births per year in the world, it should be of concern that 3 million cases are neglected nowadays. Future studies should evaluate if this CAF-AS should benefit from a more active intervention such as immediate endotracheal suction at birth, this clear fluid being very easy to suction.

Oral curcumin ameliorates acute murine campylobacteriosis

IntroductionHuman infections with the food-borne enteropathogen Campylobacter jejuni are responsible for increasing incidences of acute campylobacteriosis cases worldwide. Since antibiotic treatment is usually not indicated and the severity of the enteritis directly correlates with the risk of developing serious autoimmune disease later-on, novel antibiotics-independent intervention strategies with non-toxic compounds to ameliorate and even prevent campylobacteriosis are utmost wanted. Given its known pleiotropic health-promoting properties, curcumin constitutes such a promising candidate molecule. In our actual preclinical placebo-controlled intervention trial, we tested the anti-microbial and anti-inflammatory effects of oral curcumin pretreatment during acute experimental campylobacteriosis.MethodsTherefore, secondary abiotic IL-10-/- mice were challenged with synthetic curcumin via the drinking water starting a week prior oral C. jejuni infection. To assess anti-pathogenic, clinical, immune-modulatory, and functional effects of curcumin prophylaxis, gastrointestinal C. jejuni bacteria were cultured, clinical signs and colonic histopathological changes quantitated, pro-inflammatory immune cell responses determined by in situ immunohistochemistry and intestinal, extra-intestinal and systemic pro-inflammatory mediator measurements, and finally, intestinal epithelial barrier function tested by electrophysiological resistance analysis of colonic ex vivo biopsies in the Ussing chamber.Results and discussionWhereas placebo counterparts were suffering from severe enterocolitis characterized by wasting symptoms and bloody diarrhea on day 6 post-infection, curcumin pretreated mice, however, were clinically far less compromised and displayed less severe microscopic inflammatory sequelae such as histopathological changes and epithelial cell apoptosis in the colon. In addition, curcumin pretreatment could mitigate pro-inflammatory innate and adaptive immune responses in the intestinal tract and importantly, rescue colonic epithelial barrier integrity upon C. jejuni infection. Remarkably, the disease-mitigating effects of exogenous curcumin was also observed in organs beyond the infected intestines and strikingly, even systemically given basal hepatic, renal, and serum concentrations of pro-inflammatory mediators measured in curcumin pretreated mice on day 6 post-infection. In conclusion, the anti-Campylobacter and disease-mitigating including anti-inflammatory effects upon oral curcumin application observed here highlight the polyphenolic compound as a promising antibiotics-independent option for the prevention from severe acute campylobacteriosis and its potential post-infectious complications.

Use of Machine Learning for Early Detection of Maternal Cardiovascular Conditions: Retrospective Study Using Electronic Health Record Data.

Cardiovascular conditions (eg, cardiac and coronary conditions, hypertensive disorders of pregnancy, and cardiomyopathies) were the leading cause of maternal mortality between 2017 and 2019. The United States has the highest maternal mortality rate of any high-income nation, disproportionately impacting those who identify as non-Hispanic Black or Hispanic. Novel clinical approaches to the detection and diagnosis of cardiovascular conditions are therefore imperative. Emerging research is demonstrating that machine learning (ML) is a promising tool for detecting patients at increased risk for hypertensive disorders during pregnancy. However, additional studies are required to determine how integrating ML and big data, such as electronic health records (EHRs), can improve the identification of obstetric patients at higher risk of cardiovascular conditions. This study aimed to evaluate the capability and timing of a proprietary ML algorithm, Healthy Outcomes for all Pregnancy Experiences-Cardiovascular-Risk Assessment Technology (HOPE-CAT), to detect maternal-related cardiovascular conditions and outcomes. Retrospective data from the EHRs of a large health care system were investigated by HOPE-CAT in a virtual server environment. Deidentification of EHR data and standardization enabled HOPE-CAT to analyze data without pre-existing biases. The ML algorithm assessed risk factors selected by clinical experts in cardio-obstetrics, and the algorithm was iteratively trained using relevant literature and current standards of risk identification. After refinement of the algorithm's learned risk factors, risk profiles were generated for every patient including a designation of standard versus high risk. The profiles were individually paired with clinical outcomes pertaining to cardiovascular pregnancy conditions and complications, wherein a delta was calculated between the date of the risk profile and the actual diagnosis or intervention in the EHR. In total, 604 pregnancies resulting in birth had records or diagnoses that could be compared against the risk profile; the majority of patients identified as Black (n=482, 79.8%) and aged between 21 and 34 years (n=509, 84.4%). Preeclampsia (n=547, 90.6%) was the most common condition, followed by thromboembolism (n=16, 2.7%) and acute kidney disease or failure (n=13, 2.2%). The average delta was 56.8 (SD 69.7) days between the identification of risk factors by HOPE-CAT and the first date of diagnosis or intervention of a related condition reported in the EHR. HOPE-CAT showed the strongest performance in early risk detection of myocardial infarction at a delta of 65.7 (SD 81.4) days. This study provides additional evidence to support ML in obstetrical patients to enhance the early detection of cardiovascular conditions during pregnancy. ML can synthesize multiday patient presentations to enhance provider decision-making and potentially reduce maternal health disparities.

Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach.

Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. This study aims to evaluate the implementation of a digitalized discharge management system, the project "Optimizing instersectoral discharge management" (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: "optimization potential," "barriers," and "enablers." On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital's social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system.

Timeo danaos et dona ferentes, або як Кремль дружив з незалежною Литвою проти другої Речі Посполитої (1918–1940): історична та історико-правова розвідка

Soviet foreign policy in the interwar (1918–1939) period was carried out on the basis of the strategy and tactics of the "world revolution", which, in turn, provided for the rallying of all "anti-imperialist forces", including the so-called oppressed peoples. While supporting the struggle of the Hindus against the British colonialists or the Chinese Kuomintang against imperial Japan, the Kremlin manipulators did not let the European continent out of their sight. One of the powerful knots of contradictions at that time became the Polish-Lithuanian relations, caused by the forceful annexation of the Vilnius region by the Poles, even contrary to the decision of the Versailles Conference. From the very beginning of the conflict, the Union of the SSR sided with Kaunas under the Pharisaic slogan of the right of nations to self-determination. Explanations for this lay on the surface. First, the interwar Second Commonwealth in its then borders was a project of the Council of Ambassadors of the Versailles Conference (primarily of France), concerned about the Soviet threat. Secondly, Moscow did not have a territorial conflict with Lithuania, but it did with Poland. Thirdly, actual (non)intervention in the conflict, its intensification or, on the contrary, its weakening could be used as a bargaining chip in relations with third states (such as Germany). Kaunas also had its interest, which lay on the surface (Vilnius region). The Soviet invasion of Poland, carried out under the pretext of taking under the protection of the population, which the "unreasonable policy of the Polish authorities" allegedly put in an extremely dangerous situation, was accompanied by a "generous" act of restoration of historical justice for the Lithuanians offended by the Polish invaders. However, in less than a year, the Soviet Janus showed his true face to the until recently friendly Lithuania.

A RCT to explore the effectiveness of supporting adherence to nebuliser medication in adults with cystic fibrosis: fidelity assessment of study interventions

BackgroundA multi-component self-management intervention ‘CFHealthHub’ was developed to reduce pulmonary exacerbations in adults with Cystic Fibrosis (CF) by supporting adherence to nebuliser medication. It was evaluated in a randomized controlled trial (RCT) involving 19 CF centres, with 32 interventionists, 305 participants in the intervention group, and 303 participants in the standard care arm. Ensuring treatment fidelity of intervention delivery was crucial to ensure that the intervention produced the expected outcomes.MethodsFidelity of the CFHealthHub intervention and standard care was assessed using different methods for each of the five fidelity domains defined by the Borrelli framework: study design, training, treatment delivery, receipt, and enactment. Study design ensured that the groups received the intended intervention or standard care. Interventionists underwent training and competency assessments to be deemed certified to deliver the intervention. Audio-recorded intervention sessions were assessed for fidelity drift. Receipt was assessed by identifying whether participants set Action and Coping Plans, while enactment was assessed using click analytics on the CFHealthHub digital platform.ResultsDesign: There was reasonable agreement (74%, 226/305) between the expected versus actual intervention dose received by participants in the CFHealthHub intervention group. The standard care group did not include focused adherence support for most centres and participants. Training: All interventionists were trained. Treatment delivery: The trial demonstrated good fidelity (overall fidelity by centre ranged from 79 to 97%), with only one centre falling below the mean threshold (> 80%) on fidelity drift assessments. Receipt: Among participants who completed the 12-month intervention, 77% (205/265) completed at least one action plan, and 60% (160/265) completed at least one coping plan. Enactment: 88% (268/305) of participants used web/app click analytics outside the intervention sessions. The mean (SD) number of web/app click analytics per participant was 31.2 (58.9). Additionally, 64% (195/305) of participants agreed to receive notifications via the mobile application, with an average of 53.6 (14.9) notifications per participant.ConclusionsThe study demonstrates high fidelity throughout the RCT, and the CFHealthHub intervention was delivered as intended. This provides confidence that the results of the RCT are a valid reflection of the effectiveness of the CFHealthHub intervention compared to standard care.Trial registrationISRCTN registry: ISRCTN55504164 (date of registration: 12/10/2017).

The role of the armed forces in the April 2002 coup attempt in Venezuela

The article deals with the problem of the influence of representatives of the National Armed Forces of Venezuela on the course and results of the coup in April 2002. The relevance of the topic is determined by the fact that the failed coup became a key point in the first stage of the government of Hugo Chavez and largely determined the president's policy towards further establishing personal control over all institutions of power, as well as definitively outlined the harsh anti-American vector of the Bolivarian policy. The emphasis on the actions of military officials in the coup makes it possible to determine their real significant role in the April events. In this regard, attention is paid to the influence of the institution of the army in general and individual officers in particular on political processes in Venezuela. The methodological basis in the article is provided by general scientific (descriptive, analysis and synthesis), as well as historical (chronological) and political science (institutional) research methods. In Russian historiography, the episode with the coup, as a rule, was considered within the framework of global studies on H. Chavez and Chavismo in general. Therefore, within the framework of the work, more emphasis is placed on foreign historiography. These facts determine the novelty of the work, which consists both in attracting previously unused materials to the study, and in specifying the topic of the coup and the role of the Venezuelan Armed Forces in it. Based on the analyzed data, the conclusions of the work indicate that the actual intervention of senior officers in the political crisis in the country initially brought the presidency to the putschists, and then deprived them of almost seized power, ensuring the return of Hugo Chavez to the Miroflores Palace. In addition, independence in the actions of the military is emphasized in the conditions of chaos and a vacuum of power that came on April 11, 2002. In this regard, it is also indicated that specifically the senior officers acted spontaneously and were not actively involved in the real-life conspiratorial circles that were preparing a coup d'etat. Therefore, when the military most important for the coup saw that the measures taken by the putschists did not meet their vision, they deprived the right of their support and did not actually oppose the fact that another group of military officers returned the legitimately elected president to office.

Unsuspected Limitations of 3D Printed Model in Planning of Complex Aortic Aneurysm Endovascular Treatment.

Static 3-dimensional (3D) printing became attractive for operative planning in cases that involve difficult anatomy. An interactive (low cost, fast) 3D print allowing deliberate surgical practice can be used to improve interventional simulation and planning. Endovascular treatment of complex aortic aneurysms is technically challenging, especially in case of narrow aortic lumen or significant aortic angulation (hostile anatomy). The risk of complications such as graft kinking and target vessel occlusion is difficult to assess based solely on traditional software measuring methods and remain highly dependent on surgeon skills and expertise. A patient with juxtarenal AAA with hostile anatomy had a 3-dimensional printed model constructed preoperatively according to computed tomography images. Endovascular graft implantation in the 3D printed aorta with a standard T-Branch Cook (Cook® Medical, Bloomington, IN, USA) was performed preoperatively in the simulation laboratory enabling optimized feasibility, surgical planning and intraoperative decision making. The 3D printed aortic model proved to be radio-opaque and allowed simulation of branched endovascular aortic repair (BREVAR). The assessment of intervention feasibility, as well as optimal branch position and orientation was found to be useful for surgeon confidence and the actual intervention in the patient. There was a remarkable agreement between the 3D printed model and both CT and X-ray angiographic images. Although the technical success was achieved as planned, a previously deployed renal stent caused unexpected difficulty in advancing the renal stent, which was not observed in the 3D model simulation. The 3D printed aortic models can be useful for determining feasibility, optimizing planning and intraoperative decision making in hostile anatomy improving the outcome. Despite already offering satisfying accuracy at present, further advancements could enhance the 3D model capability to replicate minor anatomical deformities and variations in tissue density.

How does the central bank stabilize the stock market under macro uncertainty: Evidence from China stock market

This paper establishes mathematical models and PVAR models to verify the micro transmission path and the validity of central bank communication and actual interest rate intervention on China stock market. Through heterogeneity analysis, we further test whether the level of macroeconomic uncertainty affects their effect. We confirmthat both central bank communication and actual interest rate intervention have a significant effect. However, central bank communication is ineffective in the high macroeconomic uncertainty sample while the interest rate intervention can have a greater effect. Overall, the results suggest that central bank communication is a more effective monetary policy tool on stock market in low macroeconomic uncertainty period, while interest rate intervention is a better choice in high macroeconomic uncertainty period.