Changes In Practice Research Articles

Are research articles becoming more syntactically complex? Corpus-based evidence from research articles in applied linguistics and biology (1965–2015)

Research on the diachronic changes of syntactic complexity in research articles (RAs) in recent decades has been scant. As one of the first studies addressing this gap, the present study investigated the diachronic changes of eight indices of syntactic complexity in the RAs of applied linguistics and biology from 1965 to 2015 based on a corpus of 720 RAs (totalling 4.14 million tokens) from prestigious journals. The study revealed several common patterns of diachronic changes in syntactic complexity in two disciplines. First, RA writers in both disciplines tended to produce longer production units and employed more coordinate phrases and complex nominals over time, reflecting increased levels of syntactic complexity in two disciplines in recent five decades. In addition, both disciplines displayed an overall decline in the reliance on clausal elaboration (e.g. clausal coordination and clausal subordination), but an increase in phrasal complexity (e.g. phrasal coordination and complex nominals), which demonstrated an increased level of information compression in RA writing over time. The study also discussed changes in publication norms and practices in the two academic fields in recent decades that may be related to the diachronic changes of syntactic complexity features.

Perspectives on how evidence-based practice changes over time: A qualitative exploration of occupational therapy and physical therapy graduates.

The integration of evidence-based practice (EBP) into rehabilitation education programs has been widespread, but little is known about how graduates' EBP competencies evolve over time. To explore how and why the use of EBP by occupational therapists (OTs) and physical therapists (PTs) evolves during the first 3 years of clinical practice. We used an interpretive description methodology. We conducted semi-structured interviews with OTs and PTs who participated in a minimum of three out of four time points in a previous longitudinal pan-Canadian mixed methods study. Data analysis was guided by Braun and Clarke's approach to thematic analysis. Seventeen clinicians (13 OTs and 4 PTs) participated in the study. Our analysis identified six overarching themes: (1) evolution of "what EBP is and what it means"; (2) over time, evidence takes a back seat; (3) patients and colleagues have a vital and perennial role in clinical decision making; (4) continuing professional development plays a vital role in EBP; (5) personal attitudes and attributes influence EBP; and (6) organizational factors influence EBP. Our study highlights the dynamic nature of EBP use among OTs and PTs in the first 3 years of clinical practice, emphasizing the need for contextualized approaches and ongoing support to promote evidence-informed healthcare in rehabilitation.

Evaluating access during change: A qualitative exploration of access impacts to Canadian primary care rehabilitation providers during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic required substantial changes in delivery of team-based primary care, impacting both how and which patients accessed the more comprehensive services teams provide. We sought to explore changes in access to primary care rehabilitation services during the first year of the COVID-19 pandemic to identify potential new problems and improvements. MethodsIn this longitudinal study, sixteen rehabilitation professionals working on primary care teams in Manitoba and Ontario recorded audio-diaries and later participated in interviews throughout the first year of the pandemic. Qualitative analysis included data immersion, coding to identify the practice changes and associated access impacts, then applying Levesque and colleagues’ Patient-Centred Access to Healthcare framework to interpret findings. FindingsParticipants described service changes that both enhanced and reduced access, including redeployment, outreach, virtual care, discontinuation of some services and start of new ones, and new risk management strategies. Some implied equity-specific impacts. Virtual care and outreach activities created access for patient populations who previously may have been underserved, while virtual care, redeployment, and new risk management activities created new access barriers and inequities, leaving some patients completely unable to reach care. Changes to team collaboration activities could help or hinder access. ConclusionContinuing outreach activities, strengthening team collaboration, and thoughtfully integrating virtual care can improve access to comprehensive primary care. As the primary care sector works to recover from pandemic impacts and address population health needs, applying a patient-centred access framework during practice redesign offers a meaningful way to strengthen services.

Evaluating the effects of mental health e-learning on the knowledge, attitudes and practices of allied and healthcare professionals in Senegal

BackgroundDespite the widespread prevalence and substantial burden of mental disorders, they remain significantly underdiagnosed and undertreated. In low- and middle-income countries like Senegal, integrating mental health services into primary care represents the most feasible strategy to bridge the treatment gap. This study aimed to assess the effects of a mental health e-learning program on the knowledge, attitudes, and practices of allied and healthcare professionals in Senegal. MethodsAn e-learning platform including 12 interactive modules was used to train 322 allied and healthcare professionals. We evaluated changes in knowledge, attitudes, and practices, as well as in satisfaction with knowledge and in self-assessed ability to diagnose and manage patients, by comparing data collected before and after the e-learning modules. Qualitative feedback on the satisfaction with the various components of the program was also collected via a post-training survey. OutcomesKnowledge, attitudes and practices scores increased significantly for all modules. Additionally, scores related to satisfaction with knowledge and ability to diagnose and manage patients showed significant improvements (+77.0 % and +75.0 %, respectively), surpassing the gains observed in knowledge, attitudes, and practices scores (+19.2 %, +11.1 % and +15.0 %, respectively). Mean scores regarding participants' satisfaction with the various elements of the program ranged from 8.1 to 9.1, out of a maximum of 10. ConclusionAlthough only a limited number of participants completed all 12 modules, the mental health e-learning program showed positive results on the knowledge, attitudes, and practices of participants. It also increased their confidence and was perceived as a very positive experience by learners.

Diversity of Late Yangshao Agricultural Practices at Xishanping, NW China

ABSTRACT Previous work at the Xishanping site, located in the upper Wei River basin in eastern Gansu Province, NW China, has identified the earliest archaeological evidence for agricultural diversification for the period 5200–4300 cal. yr BP. This study presents the first integrated archaeobotanical and isotopic research on charred crop remains at Xishanping site. Our essay suggests that late Yangshao populations at Xishanping not only implemented a wider mixed-crop millet-based agricultural regime, but to some extent intensified cultivation from around 5200–4800 cal. yr BP. This study enriches current understandings of the spatial and temporal changes in agricultural practices in the late Neolithic Wei River Basin at the dawn of complex society in northern China.

Impact of a PD-L1 Learning Collaborative: outcomes from a mixed-methods evaluation

Abstract Introduction/Objective PD-L1 Immunohistochemistry testing is often required to determine eligibility for immune checkpoint inhibitor therapy. An ASCP PD-L1 Learning Collaborative (LC) was formed aiming to: 1) identify ways to streamline PD-L1 testing; 2) encourage members to locally implement changes; and 3) develop a resource guide for the community. Methods/Case Report The PD-L1 LC (n=38 pathologists and laboratory professionals) participated in 3 activities: 1) 4 meetings in which LC members discussed current literature and practice; 2) 3 30-minute on-demand, credit-bearing panel videos, in which selected LC members summarized the LC outputs and shared their experiences; and 3) a guide summarizing resources relevant to streamlining PD-L1 testing. The mixed-methods evaluation included: 1) five- minute surveys before (n=24), immediately after (n=11) and 7-months post-LC (n=17); 2) polling questions (2-4 per meeting); 3) semi-structured interviews (n=5). Quantitative data was analysed using descriptive and inferential analysis, qualitative data using a thematic analysis / inductive reasoning approach. Results (if a Case Study enter NA) Baseline data confirmed delays in testing caused by unstandardized PD-L1 testing processes and suboptimal confidence in PD-L1 validation and methodologies. Post-LC, members self-reported perceived increased knowledge and higher confidence levels regarding discussion of PD-L1 scientific evidence and best practices. At the 7-month follow-up, 59% of respondents reported at least one PD-L1-related practice change, with 29% of participants selecting:1) Improving protocols for specimen acquisition, handling, or processing; 2) Improving communication with multidisciplinary care team; 3) Optimizing biomarker testing workflows. Remaining suboptimal knowledge post-LC suggests need for further educational efforts. Participants identified “Tumor-specific considerations” as the main resource missing for PD-L1 testing. Conclusion A learning collaborative has shown impact in improving PD-L1 testing processes and related practices among a group of pathology professionals. The group successfully made available three panel videos and a resource guide, and PD-L1-related practice changes were reported. Future initiatives should address remaining gaps and develop tumor-specific PD-L1 testing considerations.

Fall prevention among psychiatric patients in an Iranian hospital: a best practice implementation project.

Falls are the main cause of disability among psychiatric patients, as well as being the most common adverse event in hospitals. The aim of this evidence implementation project was to improve fall prevention and management among psychiatric patients in a neurology ward in an Iranian tertiary psychiatric hospital. This project used the JBI Evidence Implementation Framework, which recommends an audit, feedback, and re-audit strategy. A baseline audit was conducted to evaluate current fall prevention practices among 50 psychiatric patients and 20 health care professionals. The baseline audit was used to identify gaps in compliance. After the implementation of improvement strategies, a follow-up audit was conducted to measure any changes in practice. The baseline and follow-up audits revealed that compliance with best practices improved in ward transfer fall risk assessment (Criterion 2: 87% to 90%), patient participation in fall risk assessment (Criterion 3: 95% to 96%), revising patient fall risk status (Criterion 9: 50% to 86%), and person-centered education of health care providers (Criterion 11: 78% to 96%). Other audit criteria remained unchanged. However, for Criterion 6 on patient engagement in goal-setting and treatment planning, compliance dropped from 100% at baseline to 94% at follow-up. This project successfully increased evidence-based practices regarding fall prevention and management, as well as providing mechanisms for sustaining the practice changes. Future audits are required to further improve outcomes. http://links.lww.com/IJEBH/A267.

PATTERNS OF RADIOTHERAPY PRACTICE FOR FUNCTIONING PITUITARY TUMOURS - A SURVEY OF UK CENTRES

Abstract AIMS Pituitary adenomas are benign tumours that are classified as functioning or non-functioning based on the production of excess pituitary hormones. Functioning adenomas (FA) typically present as hypersecretory syndromes including acromegaly and Cushing’s disease. In FA, radiotherapy is used when surgery fails to achieve hormone normalisation and/or when medical treatment does not control hormone excess. In the absence of prospective studies that clearly define the optimal radiotherapy technique in FA, it is expected that there will be variability in practice. A survey of UK neuro-oncology centres was undertaken, aiming to establish the extent of this variability in FA. METHOD A survey was distributed electronically to 20 neuro-oncology departments across the UK. Data were collected on patient numbers, radiotherapy indications, techniques, dosing, and target volume delineation. RESULTS Responses were received from eight centres (40% response rate), treating a total of approximately 32 FA per annum. There was variability in techniques employed to treat FA. While four centres treated most FA with IMRT, two treat most with stereotactic radiosurgery (SRS), and two with fractionated stereotactic radiotherapy (fSRT). The most common dose used for IMRT treatment was 45Gy in 25 fractions (n=7), with 50.4Gy in 28 fractions, 50Gy in 30 fractions and 54Gy in 30 fractions also reported. Use of margins around residual disease (n=5) and inclusion of involved cavernous sinuses and surgical tract (n=3) within clinical target volumes also varied. Most centres (n=7) would agree to a change in target volume delineation practices for the purpose of a clinical trial in FA. CONCLUSION This survey found that there is variability in radiotherapy dosing, technique, and target volume delineation practices for radiotherapy to FA across the UK. All centres but one would accept changes in their practice within the context of a prospective clinical trial of radiotherapy for FA.

Proceedings of a membrane update symposium: advancements, scientific insights, and future trends for dialysis membranes for enhanced clinical outcomes in end stage kidney disease patients.

From September 6 - 8 2022, the Life/2022 Membrane Symposium was held in Frankfurt, Germany, and transmitted live to a worldwide internet audience. The event was part of the Life/Nephrology Campus initiative, a continuous educational platform for the nephrology community to expand knowledge and share expertise on contemporary topics in chronic kidney disease. We describe recent questions and advances in the field, and we underline challenges in the care of dialysis patients and opportunities for integration of new findings into clinical practice to improve patient outcomes in end stage kidney disease patients. Most patients with kidney failure are on maintenance hemodialysis (MHD). The scientific program of the symposium was developed around topics about the role, functional determinants, technical aspects, limitations, and clinical implications of membranes presently in use. International experts with clinical or technical expertise as well as scientific recognition within the nephrology community were asked to prepare their presentations based on their own experiences, perceptions, opinions, and sources of information. The symposium devoted a major portion to discussing novel approaches for improving membranes and treatment quality, including updates on innovative concepts that may could potentially transform the landscape of kidney replacement therapy for chronic kidney disease patients in the future. The intent was to provide insights into current attention points for healthcare professionals new to the field of MHD, and to test a unique forum for continuing medical education integrating physician and patient experiences to promote changes in clinical practice. Furthermore, the symposium premiered a specifically developed mixed reality holographic 3D model to demonstrate recent dialyzer innovation diminishing protein fouling on membrane surfaces. As a continuous online educational platform for scientific exchange, this Life/2022 event provided online learning opportunities with on-demand content, with all symposium lectures freely available on nephrologycampus.com.

Changes in platelet transfusion thresholds utilized in the NICU since PlaNeT-2

Abstract Background Use of prophylactic platelet transfusions in the neonatal setting is a common practice due to concerns about bleeding despite evidence of a developmental mismatch with transfusion of adult platelets. The Platelets for Neonatal Transfusion-Study 2 (PlaNeT-2) published in January 2019 showed that using higher platelet thresholds (50 x 109/L) was associated with more adverse outcomes and no improvement in bleeding events compared to lower platelet thresholds (25 x 109/L). Following this trial, implementation of a lower threshold was provider dependent as there were no changes made to the neonatal intensive care unit (NICU) institutional policies. Our goal was to determine if there were any overall changes in individual clinical practice with thresholds used for platelet transfusions in our NICU and number of transfusions per patient. Methods Our center has a 52 bed level IV NICU that specializes in care for critical and/or preterm infants. We performed a retrospective review from 2017 to 2023 of patients admitted in the NICU who received platelet transfusion and had an available platelet count in the 12 hours prior to the transfusion. Results There were 272 platelet transfusions given to 107 unique NICU patients who had platelet counts available. There were 66 transfusions given to 32 patients pre-PlaNeT-2 (2017-2018) and 206 transfusions given to 75 patients post-PlaNeT-2 (2019-2023). The average platelet count pre-PLaNeT-2(2017 to 2018) was 43 x 109/L (SD±24 x 109/L) and post-PLaNeT-2 (2019 to 2023) was 36 x 109/L (SD±21 x 109/L, p=0.03). Prior to PLaNeT-2, 26% of platelet transfusions were for platelet counts ≤ 25 x 109/L and 35% were for platelet counts between 51 to 100x9/L. Post PLaNeT-2 the percentages changed to 35% and 21% respectively. The percentage of transfusions occurring for platelet counts between 26 to ≤50 x 109/L was 38% and 44%, respectively. The number of platelet transfusions per year did not decrease significantly after the PLaNeT-2 trial (average of 33/year versus 41/year, p=0.5). The number of transfusions per patient before and after PLaNeT-2 did not change (2.1 transfusions per patient versus 2.6 transfusions per patient, p=0.3). Conclusion Platelet thresholds utilized in our center decreased after the PLaNeT-2 trial with less transfusions occurring for platelet counts greater than 50 x 109/L. Although thresholds decreased, the number of transfusions per year and the number of transfusions per patient did not significantly change. Further studies are needed to understand changes in patient outcomes and platelet utilization in the NICU.

The effectiveness of stage-matched interventions in changing waste source separation behaviour: Evidence from a consecutive quasi-experiment.

In many developing countries, inefficient waste source separation poses a significant challenge to sustainable waste management systems, hindering progress towards a circular economy. Previous research has shown mixed results regarding the effectiveness of informational interventions and has not thoroughly evaluated regulatory measures. This study innovatively employs a quasi-experimental design, enhanced by successive surveys, to assess the impact of targeted interventions on behavioural changes in waste separation practices. Utilizing the Health Action Process Approach, we introduced three interventions - posters, educational lectures and a supervision policy - over 8 weeks among university students. Our results indicate stepwise improvements in waste separation accuracy: posters modestly increased awareness without significantly altering behaviours; educational lectures led to a 40% increase in the food waste separation rate and supervision achieved over 90% separation purity, but with an increase in 'fly-dumping'. The interventions incurred costs of 36, 60 and 365 RMB per capita annually. This research underlines the importance of customized informational interventions and the costs and challenges of initial regulatory measures in waste management, offering crucial empirical evidence and insights for creating impactful environmental behaviour change interventions.

WHOLE BRAIN RADIOTHERAPY FOR INTRACRANIAL METASTATIC DISEASE IN NON-SMALL CELL LUNG CANCER: THE WESSEX EXPERIENCE

Abstract AIMS The QUARTZ trial (2016) reported that corticosteroid therapy was non-inferior to whole brain radiotherapy(WBRT) for non-small cell lung cancer (NSCLC) with regards overall survival(OS). This is a single centre experience of WBRT for NSCLC in the post-QUARTZ era and in the context of the changes in clinical practice over the past 8 years. METHOD Single centre retrospective observational study. Patients included with NSCLC treated with WBRT for radiologically confirmed intracranial (IC) metastatic disease January 2018 to December 2022. OS, baseline tumour/patient characteristics and lines of treatment were recorded from medical records. Data compiled using Excel and statistical analysis using the R language for statistical programming. RESULTS 62 patients were included, median age 64 (37 -82). 29(46.8%) were Performance status 0-1. 50(80.6%) received 20Gy in 5 fractions, 12(19.4%) received 30Gy in 10 fractions. PDL1 >50% in 14(22.6%), EGFR mutation positive in 10(16.1%), 0(0%) ALK/ROS mutations. 9(14.5%) had received prior radiotherapy(RT) for IC disease (SRS:8, partial brain VMAT:1). 20(32.3%) had IC disease at presentation. Median OS 68 days (95%CI:58-111;range12-777) in keeping with QUARTZ results (median OS 65 days, 95%CI:50- 78). Univariate analyses demonstrated: subsequent systemic therapy (p=0.0022), receiving immunotherapy (p=0.002) and baseline performance status (p=0.0017) associated with improved OS. PDL1 >50%, EGFR mutation positive, RT dose, prior systemic therapy, histological subtype, presence of a targetable mutation, first or subsequent IC treatment did not predict survival. The chi-squared test was used to compare differences in the groups with OS>100days(n=22) and OS<100days(n=40). Systemic therapy after WBRT(p=0.0011) and immunotherapy treatment(p=0.0092) were significant differences between the cohorts and associated with improved survival. CONCLUSION This data supports conclusions of QUARTZ study and it remains difficult to define a role for WBRT in the management of IC disease in NSCLC. There is a cohort who have better OS, though we believe this may be related to systemic therapy (particularly immunotherapy) exposure.

GLIOBLASTOMA IN THE UK POST WHO CNS 5: INITIAL fiNDINGS FROM THE HISTO-MOL GBM COLLABORATIVE

Abstract AIMS The 2021 World Health Organisation Classification (WHO CNS5) incorporated molecular diagnostic features for glioblastoma for the first time. The Histo-Mol GBM collaborative is conducting a retrospective cohort study evaluating the outcomes of patients prospectively diagnosed with WHO CNS5 IDH wild type glioblastoma. METHOD Biopsy confirmed glioblastoma patients diagnosed between 01/01-31/12/2021 were identified. Demographic, tumour, treatment, and survival data were collected. Descriptive statistics and Kaplan-Meier method were used to describe the cohort and for survival analysis respectively, assessed from surgery date. RESULTS So far, 363 glioblastoma patients were included from 13 centres (range: 11-61 patients/centre). Median age was 63.0, 65.8% were male, 77.4% had an ECOG performance status of 0-1 at diagnosis, and 28/333 had a molecular glioblastoma (8.4%). Biopsy was performed in 106/363 patients (29.2%), and gross total resection in 50/363 (13.8%). Adjuvant radiotherapy was performed in 290/363 (79.9%), and 71/290 (24.5%) had an additional pre-radiotherapy MRI with rapid early progression identified in 30/71 patients (42.3%). 128/269 (47.6%) patients received 2nd line treatment; most commonly systemic therapy (91/128, 71.1%) followed by re-resection (27/128, 21.1%). Second line systemic therapy was primarily lomustine (48/81, 52.7%). Median progression free survival was 7.7 months and median overall survival (OS) was 11.6 months. Median OS was 16.9 months with conventional fractionation chemoradiotherapy (n=169/363, 46.6%), 10.4 months with hypofractionated chemoradiotherapy (n=64/363, 17.6%), and 2.3 months with no oncological treatment (n=57/363, 15.7%). On univariate analysis age, gender, performance status, multifocality, MGMT promoter methylation, surgery extent, radiotherapy type (none, palliative, hypofractionated, conventional fractionation), larger planning target volume (PTV), receiving concurrent temozolomide, and receiving adjuvant temozolomide were statistically significant. On multivariate analysis age, and receiving concurrent temozolomide remained significant. CONCLUSION We describe the initial findings from a large real-world cohort of glioblastoma patients prospectively diagnosed according to WHO CNS5. Survival compares favourably with the practice changing phase 3 clinical trial outcomes.

The "Green Doctor" Initiative: Ethical Healthcare in the Age of Medical Commercialization

The "Green Doctor" initiative represents a groundbreaking shift in global healthcare systems, aiming to prioritize ethical, compassionate, and patient-centered care in an era of increasing commercialization. Proposed by Professor Reza Ghalamghash, the "Green Doctor" concept focuses on the moral obligations of healthcare professionals to provide care that transcends financial considerations and commercial pressures. This innovative model emphasizes the humanistic aspects of medicine, where physicians are encouraged to focus on patients' holistic well-being, mental and emotional health, and equitable access to care. In the face of rising healthcare costs, systemic inequities, and ethical dilemmas posed by profit-driven models, the "Green Doctor" approach is particularly timely. This article explores the philosophical foundation of the "Green Doctor" concept, its implications for healthcare systems around the globe, and its potential to drive meaningful change in public health policy and medical practices. Through a detailed exploration of real-world case studies, the article delves into how this model is being adopted in different healthcare settings, examining its efficacy in enhancing patient outcomes, promoting healthcare equity, and reshaping the relationship between doctors and their patients. Additionally, the article discusses the structural challenges faced by healthcare providers in implementing this approach, including financial constraints, regulatory hurdles, and the need for institutional support. It also highlights the role of technology in facilitating the "Green Doctor" model, particularly through the use of telemedicine, digital health platforms, and AI-driven diagnostics, which allow doctors to extend care to underserved populations while maintaining a patient-centered focus. Finally, the article assesses the future of the "Green Doctor" initiative in the context of evolving global healthcare challenges, offering insights into how it could serve as a sustainable model for ethical healthcare in the 21st century.

PERENCANAAN PEMBELAJARAN PAI BERBASIS HIGHER ORDER THINKING SKILLS (HOTS) DI ERA SOCIETY 5.0: STRATEGI DAN IMPLEMENTASI

The Society 5.0 era, which is characterized by the integration of smart technology in everyday life, demands significant changes in educational practices, including Islamic Religious Education (PAI). To answer this challenge, PAI needs to integrate Higher Order Thinking Skills (HOTS) into its curriculum, with the aim of producing students who not only understand religious teachings but also have critical, creative and solution thinking skills. Strategies such as a contextual learning approach that links Islamic teachings with social issues and the use of digital technology can be used to strengthen the learning process.Research shows that implementing HOTS has a positive impact on students' critical thinking and problem solving abilities. However, challenges remain, including limited teacher knowledge about the HOTS method and inadequate technological facilities. Therefore, continuous teacher training and support from technological facilities are needed to ensure that technology-based learning can run effectively

Barriers to Adoption of a Child-Abuse Clinical Decision Support System in Emergency Departments.

Child abuse is a leading cause of morbidity and mortality in children. The rate of missed child abuse in general emergency departments (ED), where 85% of children are evaluated, is higher than in pediatric EDs. We sought to evaluate the impact of an electronic health record (EHR)-embedded child-abuse clinical decision support system (CA-CDSS) in the identification and evaluation of child maltreatment in a network of EDs three years after implementation. We anonymously surveyed all 196 ED attending physicians and advanced practice practitioners (APP) in the University of Pittsburgh Medical Center network. The survey evaluated practitioner awareness of, attitudes toward, and changes in clinical practice prompted by the CA-CDSS. We also assessed practitioner recognition and evaluation of sentinel injuries. Of the 71 practitioners (36%) who responded to the survey, 75% felt the tool raised child abuse awareness, and 72% had a face-to-face discussion with the child's nurse after receiving a CA-CDSS alert. Among APPs, 72% consulted with the attending physician after receiving an alert. Many practitioners were unaware of at least one function of the CA-CDSS; 38% did not know who completed the child abuse screen (CAS); 54% were unaware that they could view the results of the CAS in the EHR, and 69% did not recognize the clinical decision support dashboard icon. Slightly over 20% of respondents felt that the CA-CDSS limited autonomy; and 4.5% disagreed with the recommendations in the physical abuse order set, which reflects American Academy of Pediatrics (AAP) guidelines. Greater than 90% of respondents correctly identified an intraoral injury and torso bruise in an infant as sentinel injuries requiring an evaluation for abuse. A child-abuse clinical decision support system embedded in the electronic health record was associated with communication among practitioners and was overall perceived as improving child abuse awareness in our system. Practitioners correctly recognized injuries concerning for abuse. Barriers to improving identification and evaluation of abuse include gaps in knowledge about the CA-CDSS and the presence of practitioners who disagree with the AAP recommendations for physical abuse evaluation and/or felt that clinical decision support in general limited their clinical autonomy.

The New Era of Total Neoadjuvant FLOT Therapy for Locally Advanced, Resectable Gastric Cancer: A Propensity-Matched Comparison With Standard Perioperative Therapy.

The FLOT 4-AIO trial established the docetaxel-based regimen's superiority over epirubicin-based triplet therapy in terms of survival rates and acceptable toxicity for locally advanced resectable gastric (LARGC). Yet, fewer than half of the patients achieved completion of eight prescribed FLOT cycles. We proposed that administering all FLOT cycles in the form of total neoadjuvant therapy may improve completion rates and downstaging. This study contrasted total neoadjuvant therapy (FLOT x8) with standard neoadjuvant therapy (FLOT 4+4) for patients LARGC adenocarcinoma who underwent curative resection with routine D2 lymphadenectomy, focusing on histopathological outcomes, toxicity, and survival outcomes. We reviewed patients with histologically confirmed advanced clinical stage cT2 or higher, nodal positive stage (cN+), or both, with resectable gastric tumors and no distant metastases (January 2017 to July 2023). We divided patients into two groups, FLOT 4+4 and FLOT x8; FLOT 4+4 patients underwent four preoperative and four postoperative bi-weekly cycles of docetaxel, oxaliplatin, leucovorin, and fluorouracil, while FLOT x8 patients received all eight cycles preoperatively after a gradual practice change starting from January 2020. Propensity score matching adjusted for age, clinical stage, tumor location, and histology. Of the 77 patients in the FLOT x8 group, 37 were propensity-matched to an equal number in the FLOT 4+4 group. Demographics, duration of surgery, and hospital stay showed no significant differences between the groups. The FLOT x8 group exhibited a significantly higher all-cycle completion rate at 89.1% compared to FLOT 4+4's 67.6% (p < 0.01). Both groups demonstrated comparable hematological and non-hematological toxicity rates, Clavien-Dindo ≥ 3 complications, and CAP tumor regression grades. The mean number of harvested lymph nodes was 42.5 and 41.2 in the FLOT 4+4 and FLOT x8 groups, respectively. Similar rates of disease-free survival and overall survival were noted in both groups, despite a trend toward a higher pathological complete response rate, albeit not statistically significant (8.1% vs. 18.9%, p = 0.29), in the FLOT x8 group at a median follow-up of 36 months. Total neoadjuvant therapy with the FLOT x8 protocol corresponds to higher treatment completion rates, a safety profile similar to standard perioperative therapy, and a twofold increase in complete pathological response. Further research on long-term oncological outcomes is needed to confirm the effectiveness of total neoadjuvant therapy.

The influence of disruptive events on energy-related household practices: Results of a longitudinal study in the Netherlands

Household energy use relates to our socio-cultural identity, our socio-economic status and the socio-cultural and material contexts in which we live. Around the world, households experienced dramatic changes in light of the COVID-19 pandemic and the drastic increase of energy prices following the Russian invasion of Ukraine. Habits and routines were disrupted, reinterpreted, reorganized and renegotiated, albeit under constraints and in most cases involuntarily. This paper analyses how the practice of ‘keeping warm’ responds to disruptive events ranging from a small-scale and short-lived experiment to much more drastic and far-reaching geopolitical events. Following an initial study challenging households to reduce temperatures inside their homes during October/November 2018, the same households were revisited for follow-up questioning two and a half years after the start of the COVID-19 pandemic in Europe and six months after the attack of Russian armed forces on Ukraine. Quantitative and qualitative data were collected before, during, and three months as well as three years after the original ‘heating challenge’. The final follow-up survey took place in August 2022 and turned the initial short-lived Living Lab-based experiment into a longitudinal study.The experimental exploration of possibilities to reduce household energy use through the disruption of routinized practices in Living Labs enables an analysis of the effects of disruptive events, including the role of values, social norms, habits and routines (Sahakian et al., 2021). But what happens, when experiments get serious and large-scale upheaval affecting many challenges and changes meanings, thus contributing to changes in social norms and practices? This research explores lasting-changes in energy-related household practices following voluntary disruptive experimentation and subsequent involuntary disruptions. Compared to the macro-systemic disruptions experienced during the COVID-19 pandemic and the more recent energy crisis, the disruptions induced through the initial ‘heating challenge’ are of a much smaller magnitude. Our findings show that reductions in energy use are possible when routinized practices are disrupted through voluntary experimentation. In addition, our results indicate that the meanings tied up with indoor comfort had changed due to the initial experiment and that participants who initially experimented in an interactive community setting had learned more about how to connect, share experiences and reflections to adapt to other, also large-scale disruptions collaboratively.

Newly adopted dromedary husbandry systems and breeding practices in the Algerian northern Sahara

Background: Traditional nomadic livestock farmers have adopted new lifestyles, management methods and husbandry practices to improve their livestock income and enhance the value of camel products, whose benefits are increasingly being recognized worldwide. Driven by a rising demand for camel products among urban consumers, these changes include a strong tendency for nomadic communities to settle near urban centers, the temporary stationing of part of the camel herd in urban and peri-urban areas, and the intensification of production in these areas. Aims: This paper aims to present the newly adopted dromedary husbandry practices, and discuss the products and services provided by dromedaries. Methods: Between September 2020 and March 2021, formal and informal interviews were carried out in three locations in the Algerian northern Sahara with 11 camel breeders, whoheld a total of 537 dromedaries (average 48.8 ± 4.36). Results: The study identified three types of dromedary farming systems: 70% of the farms were peri-urban,semi-intensive dairy farms established to meet the rising demand for camel milk, 23% were settled, intensive, peri-urban feedlot farms producing all categories of fattened dromedaries, especially young males, and 7% were settled, urban, and peri-urban dromedary racing farms dedicated to breeding dromedaries for racing and riding during local festivals, activities anchored in the traditions of the native population. The surveyed farms primarily generated income from the sale of milk and live animals, with manure and wool also contributing to their earnings. The food resources used for dromedaries were natural pastures, crop residues and harvest residues. Conclusion: The intensification of dromedary breeding appears essential to ensure the sustainability of this animal resource as it can improve reproductive potential, milk production, and the availability of young calves for fattening farms. The changes in practices identified in this study are enabling breeders, who are managing their livestock in guarded and semi guarded camel production systems, to increase their income.

Engaging commercial dairy demonstration farmers in farmland biodiversity management communication

ABSTRACT Purpose: This paper presents the process, experiences and outcomes of piloting various communi­cation activities relating to farmland biodiversity management with 11 Irish dairy demonstration farmers. Design/Method/Approach: A 17-month cycle of action research, which included a 12-month communication activity pilot, researcher diary entries, and baseline and endline semi-structured interviews with participating demonstration farmers. Findings: The integration of farmland biodiversity management into an on-farm group meeting was identified by the demonstration farmers as most influential on their decisions to make changes to biodiversity management on their farms, while the integration of farmland biodiversity management into online group meetings was ranked lowest. Positive attitude and practice changes were identified over the communication activity pilot. Practical Implications: Awareness of communication activities that effectively engage demonstration dairy farmers on farmland biodiversity management, with foundation and guidance for the implementation of such activities with a wider cohort of farmers. Theoretical Implications: Identification of the potential to positively influence on-farm biodiversity management change through co-creative, participatory communication activities. Originality/Value: Addresses communication on farmland biodiversity management with demonstration dairy farmers in Ireland.