Clinical Facilities Research Articles

A comparison of artificial intelligence-enhanced electrocardiography approaches for prediction of time-to-mortality using electrocardiogram images

Abstract Background Most artificial intelligence-enhanced ECG (AI-ECG) models used to predict adverse events including death require that the ECGs be stored digitally. However, the majority of clinical facilities worldwide store ECGs as images. Methods 1,163,401 ECGs (189,539 patients) from a secondary care dataset were available as both natively digital traces and PDF images. A digitisation pipeline extracted signals from PDFs. Separate 1D convolutional neural network (CNN) models were trained on natively digital or digitised ECGs, with a discrete-time survival loss function to predict time-to-mortality. A 2D CNN model was trained on 310x868 pixel ECG images. External validation was performed in 958,954 ECGs (645,373 patients) from a Brazilian primary care cohort and 1022 ECGs (1022 patients) from a Chagas disease cohort. Results The image 2D CNN model and digitised 1D CNN model performed comparably to natively digital 1D CNN model in internal (C-index 0.780 (0.779-0.781), 0.772 (0.771-0.774) and 0.775 (0.774-0.776 respectively) and external validation. Models trained on natively digital 1D ECGs had comparable performance when applied to digitised 1D ECGs (C-index 0.773 (0.771-0.774). Conclusion Both the image 2D CNN and digitised 1D CNN enable mortality prediction from ECG images, with comparable performance to natively digital 1D CNN. Models trained on natively digital 1D ECGs can also be applied to digitised 1D ECGs, without any significant loss in performance. This works allows AI-ECG mortality prediction to be applied in diverse global settings lacking digital ECG infrastructure.

Exploring interprofessional collaboration in the intensive care unit

Background: Critical care units require an interprofessional management approach to optimise patients’ health. Clinical education and training delivered in remote healthcare settings are vital for fostering interprofessional collaboration (IPC) among health science students for future team functioning.Objectives: Our study explored the IPC among clinicians in the intensive care unit (ICU) setting at two South African decentralised clinical training facilities to understand the existing collaborative practices that students are exposed to during their clinical training.Method: A qualitative study design, utilising semi-structured interviews, was used to gather information on the experiences of 40 purposively selected participants working in the ICU settings at the two clinical sites. Data collected from the interviews were transcribed verbatim and thematically analysed.Results: Four major themes were identified from the data, namely, scope-of-practice dispute, teamwork disruption, organisational obstacles and future aspirations.Conclusion: Participants believed that a lack of professional regard by medical doctors and an inadequate understanding of the role of other professionals impeded appropriate referral practice and collaborative team functioning. Under-exposure to interprofessional education (IPE) at an undergraduate level and the pervasive medical hierarchy were perceived as a primary attributable cause of this phenomenon. Moreover, the coronavirus disease 2019 (COVID-19) pandemic and persistent staff shortages purportedly obstructed potential opportunities to collaborate in multidisciplinary meetings. Participants believed that improving undergraduate IPE and compulsory multidisciplinary meetings to promote communication would improve team functioning in these clinical settings.Clinical Implications: Undergraduate IPE is a feasible approach to improve collaborative care in ICUs to achieve better patient outcomes.

Diagnostic performance of Typhidot RDT in diagnosis of typhoid fever and antibiotic resistance characterisation in a cross-sectional study in Southern Ghana

BackgroundTyphoid fever remains a significant public health problem contributing to significant misapplication of antibiotics in Ghana. However, there is little data on the accuracy of the commonly used serology based rapid diagnostic Typhidot test kit (Typhidot RDT) for confirming typhoid fever.MethodsWe conducted a study to assess the diagnostic accuracy of Typhidot RDT in seven clinical facilities across five regions in Southern Ghana. A total of 258 participants, clinically diagnosed with typhoid fever, were enrolled in this study. Blood and stool samples were obtained for culture, Typhidot and PCR assays. Disc diffusion antibiotic sensitivity was performed to determine the resistance pattern of Salmonella enterica isolates from positive blood and stool cultures.ResultsRecovery of S. enterica isolates was higher from stool samples (14.7%) in comparison to blood samples (1.6%). The sensitivity and specificity of Typhidot compared to blood and stool cultures was 35% (19.94%—52.65%) and 45% (38.67%—51.45%), respectively. Compared to PCR, the Typhidot had a sensitivity and a specificity of 61% and 53%, respectively. Resistance phenotyping of isolates showed broad sensitivity to the front-line antibiotics used. Resistance to ampicillin (10%), cotrimoxazole (7%), azithromycin and ciprofloxacin (< 5%) was found in some isolates.ConclusionsThese findings suggest sub-optimal performance of the Typhidot RDT for diagnosis of typhoid in Ghana with a higher chance for misdiagnosis and misapplication of antibiotics. The high proportion of isolates recovered from stool culture is consistent with the pathophysiology of bacterial shedding during the acute phase of infection, which provides a window of opportunity to control typhoid transmission.

Анкетирование как один из методов оценки качества образовательной деятельности в медицинском учреждении.

The article deals with the issues of training highly qualified specialists (residents) at the Federal State Budgetary Scientific Institution “Central TB Research Institute” (FSBI CTRI). Major changes in the society and development of information technologies require improvement of methods used for education and training of highly qualified specialists and set up new requirements for managing the training process, namely: the use of digital technologies, including distance learning, development of new interactive teaching methods and practicing individualized approach to training. FSBI CTRI trains specialists in the field of phthisiology, pulmonology and surgery using its clinical and laboratory facilities. Through its self-assessment procedure that is part of the accreditation monitoring of educational activities, FSBI CTRI engages the main players of the educational process into the survey aimed at improving training of highly qualified specialists. The authors of the article analyze the results of the questionnaire survey from the CTRI teachers. The data obtained during the survey helped assess the degree of satisfaction with the CTRI system of education among the survey participants, identify the main challenges of educational activities and find solutions.

Development and Initial Implementation of a Clinical Monitoring Strategy in a Non-regulated Trial: a research note from the ReStOre II Trial

Background Data and Safety Monitoring is integral to quality assurance of clinical trials. Although monitoring is a core legal component of regulated clinical trials, non-regulated trials are not mandated to incorporate monitoring. Consequently, the monitoring process has been underutilised and underreported in this setting. This research report outlines the development and plans for implementing a bespoke Clinical Monitoring Strategy within the ‘Rehabilitation Strategies Following Oesophagogastric and Hepatopancreaticobiliary Cancer (ReStOre II) Trial’, a non-regulated trial comparing a 12-week multidisciplinary programme of rehabilitation to standard care in a cohort of 120 cancer survivors. Methods This research note provides a detailed overview of the ReStOre II Clinical Monitoring Strategy and describes the development of the strategy pre and post awarding of the grant. The strategy consists of the establishment and implementation of a comprehensive trial governance structure, inclusive of a Trial Management Group, Trial Steering Committee Meeting, and Independent Data Monitoring Committee. In addition, external trial monitoring by the Clinical Research Facility at St James’s Hospital. Three monitoring visits will be conducted during the trial; i) site initiation visit, ii) interim monitoring visit, and iii) close our visit. Results The Clinical Monitoring Strategy has been finalised and is currently being implemented within the ReStOre II Trial. Two site initiation visits and one interim monitoring visit have been completed to date. Conclusion This research note provides a template for implementation of a Clinical Monitoring Strategy in a non-regulated clinical trial. Registration ReStOre II Trial: https://clinicaltrials.gov/ct2/show/NCT03958019

Public–Private Partnership Model in Delivering Quality Health Care and Medical Education - An Enduring Success Story for the Past Seven Decades

Public–private partnerships (PPPs) are integral to the National Health Mission (NHM). Kasturba Medical College (KMC), Mangalore, was the first private institution in India to embrace the PPP model way back in 1953. The then Government of Madras permitted KMC Mangalore to partner with the 2 district hospitals – the Government Wenlock and the Lady Goschen Hospitals. For almost seven decades, KMC Mangalore has been using the clinical facilities at District Wenlock and Lady Goschen hospitals to provide quality health care and also train the Undergraduate and Postgraduate students of KMC. The Manipal experiment is a shining example of public–private collaboration to provide quality accessible health care to everyone, which is in line with the Sustainable Development Goal (SDG) 3 and its targets.

Stress and Coping Behavior Exhibited by Family Members Toward Long-Term Care Facility Residents While Hospitalized.

With the increase in the elderly population, institution-based care has become another option for elderly people. In Changhua, Taiwan, the number of long-term institutions has doubled in the past decade, and more families are choosing to send their elders to institutions for care. However, there is stress induced by having to care for these elders when they come back to their family members when hospitalized. Therefore, this study aimed to understand the stress and coping behaviors of family members in regard to hospitalized long-term care facility residents and identify relevant factors that affect and predict the stress and coping behaviors exhibited by these family members. In this study, a quantitative and cross-sectional survey was conducted using the convenience-sampling method; family members of long-term care facility residents hospitalized in a regional hospital in central Taiwan were selected as the research participants and a total of 162 family members were admitted. The data were collected in the form of questionnaires including basic information and data on the stress and coping behaviors of the family members. The data were collected and coded by using SPSS 22.0 to perform descriptive and inferential statistical analysis. The standard average score of total stress for family members was 57.03 points, which corresponds to a moderate level. The four perceptions of stress by family members were, in order, physiological, life, psychological, and economic. Furthermore, family income, work status, and the relationship between residents of the family members and physiological, psychological, and economic factors had predictive power for their problem-oriented coping behaviors, with an explanatory power of 59.6%. Life aspects, gender, marital status, and the number of hospitalizations in half a year had significant predictive power for the family members' emotion-oriented coping behaviors, with an explanatory power of 19.0%. The family members had high levels of stress, especially physical stress, and the total scores of stress perception were higher for those who were younger than 39 years old and had no rotating family members. Additionally, the coping behavior of the main caregiver was mainly problem-oriented. The results of this study may serve as a reference that can help nursing staff in clinical or long-term care facilities to provide or develop effective and individualized services for family members of facility residents.

A-041 Metoclopramide Stimulation Test can Rule Out Prolactinoma in Patients with Moderate Hyperprolactinemia

Abstract Background Prolactinoma is the main cause of hyperprolactinemia once physiological and pharmacological causes are excluded. Prolactin (PRL) and thyrotropin (TSH) response to dopaminergic antagonists has been previously used in prolactinoma diagnosis. Current guidelines only recommend baseline PRL concentration in diagnosis, considering values exceeding 250 ng/mL highly suggestive of prolactinoma. However, subtler hyperprolactinemia is much more frequent, and magnetic resonance imaging (MRI) studies are necessary to detect potential prolactinomas. Our aim was to examine the utility of a metoclopramide (MCP) stimulation test as a screening tool to evaluate the need for pituitary MRI studies in patients with moderate hyperprolactinemia. Methods We retrospectively selected 67 moderate hyperprolactinemia patients (&amp;lt;250 ng/mL), with a MCP test and a pituitary MRI within the same assistance. We excluded patients with pharmacological treatments affecting dopaminergic axis. According MRI results we classified them in patients with microadenoma (&amp;lt;10 mm; n=23), with macroadenoma (≥10 mm; n=5) or without adenoma (n=39). Maximum relative increases over baseline concentrations were calculated for PRL (ΔPRLMax) and TSH (ΔTSHMax). The Research Ethic Committee approved the study. Results ΔPRLMax exceeds baseline PRL capability to identify patients with an adenoma (AUC=0.8718 vs 0.7756). ΔPRLMax below 220% identifies 100% of these patients with 71% of specificity (Table 1). Screening with MCP test would have avoided 42% of MRI, resulting in 34% costs saving. Analysis of TSH response only slightly increased the specificity when considered as a secondary criterion. Test length can be reduced from 60 to 30 minutes without losing screening capability. Conclusions A shortened MCP test is a useful and cost-effective screening tool to avoid unnecessary MRI. Its simplicity allows its performance in almost any clinical facility, allowing to easily rule out prolactinoma in an important percentage of patients, something of upmost importance specially in regions were MRI facilities are scarce.

B-203 Advancing Equity, Inclusion, and Diversity in Genetic Testing: Disparities in Detection Rates and Access to Carrier Screening Among 8,000 Patients Nationwide

Abstract Background Professional medical societies recommend that carrier screening for 113 different genetic disorders be offered during pregnancy or preconception to all individuals, regardless of ancestry, in order to provide more equitable opportunities for patients to ascertain their reproductive risks. In our clinical laboratory experience, however, the vast majority of healthcare providers continue to order carrier screening for only cystic fibrosis (CF), which is disproportionately common in white individuals of Northern European descent. Our highest volume CF screening test is performed on &amp;gt;10,500 diverse patients per year and utilizes a targeted genotyping array that detects &amp;gt;500 variants in CFTR and &amp;gt;1200 variants in &amp;gt;150 other pertinent genes. Here we report the inequities in diagnostic yield among our first 8,000 patients for whom only limited testing was ordered and examine the barriers to widespread adoption of more inclusive carrier screening. Methods Three carrier screening options (CF, CF+spinal muscular atrophy [SMA], CF+SMA+fragile X syndrome [FXS]+hemoglobinopathies) were ordered clinically and performed on DNA extracted from 8,000 whole blood samples from unique individuals utilizing a custom SNP array (Thermo Fisher GeneTitanTM platform) designed to detect &amp;gt;1700 pathogenic variants in 218 different genes. Data was retrospectively reviewed to determine overall detection rates for carriers of all recommended conditions vs. only the condition(s) included in the originally ordered service. Finally, reproductive health providers at nine different ordering sites across the U.S. were interviewed regarding their current carrier screening practices. Results Patients were referred for testing by 119 different clinical facilities. 98.1% (7847/8000) had CF-only testing ordered, 1.2% (99/8000) had CF+SMA testing ordered, and 0.68% (54/8000) had testing for CF+SMA+FXS+hemoglobinopathies ordered. 7.1% (568/8000) of patients had reportable variants in CFTR. Had CF+SMA testing been ordered on all 8,000 patients, however, the diagnostic yield would have been 8.9%. Of the patients who had CF-only or CF+SMA testing ordered, 11.9% (943/7946) were found to be carriers of hemoglobinopathies. Finally, had all 8000 patients had testing for all currently recommended targets on the panel, the diagnostic yield would have increased to 55% (4396/8000). Ordering providers at 9/50 different contacted sites agreed to interview requests. 100% (9/9) of respondents indicated that their patients experience significant disparities in access to carrier screening, and that the primary cause of these inequities was insufficient insurance reimbursement. 67% (6/9) of respondents indicated that &amp;gt;50% of their patient population identified as non-white and would have “very strongly” benefitted from “testing for other disorders beyond CF.” Conclusions Despite clinical practice guidelines urging for more population-neutral carrier screening, major gaps exist between what is recommended versus ultimately ordered. This significantly limits the clinical utility of testing, especially in patients from underrepresented backgrounds. Improved insurance coverage for more inclusive carrier screening is needed to help reduce such disparities.

Clinical outcomes in chronic conditions: An observational case series at a US complementary medicine student clinical facility employing the MYMOP outcome measure

Objective/purposeThis study reports on a case series of clients using individualized homeopathy on a wide variety of health complaints seen in cases from a supervised teaching clinical setting between 2017 and 2020 at the Academy of Homeopathy Education. This teaching clinic sees self-selecting clients of all ages, and cases were taken by faculty or advanced students and subsequently managed by advanced students under supervision. MethodsThe cohort study evaluated n = 85 cases using the patient-generated outcome measure, the Measure Yourself Medical Outcome Profile (MYMOP). Average MYMOP values for initial and final consultations were analyzed for degree of change across the intervention period. Principle ResultsScores from initial consultation to last follow up showed a positive change in 80.23 % of cases. Clinically significant improvements were seen in all profile areas. The average profile score at last reported follow up of all cases showed a reduction in symptom severity of.56, and the greatest change between first and last average MYMOP scores showed a reduction of 1.2 after the homeopathic intervention. The greatest positive change was seen in Skin (1.88) followed by Respiratory (1.83) and Digestive-related (1.71) complaints. ConclusionsClinically significant improvement in physical and psychological health is found across a diverse population of people with a wide variety of long-term conditions. These results suggest that individualized homeopathic care in a teaching clinic setting proved to be valuable for complex chronic health problems, and that further similar, confirmatory research is warranted.

Emulating the Delivery of Sawtooth Proton Arc Therapy Plans on a Cyclotron-Based Proton Beam Therapy System

Purpose: To evaluate and compare the deliverability of ‘sawtooth’ proton arc therapy (PAT) plans relative to static intensity modulated proton therapy (IMPT) at a cyclotron-based clinical facility. Methods: The delivery of single and dual arc Sawtooth PAT plans for an abdominal CT phantom and multiple clinical cases of brain, head and neck (H&amp;N) and base of skull (BoS) targets was emulated under the step-and-shoot and continuous PAT delivery regimes and compared to that of a corresponding static IMPT plan. Results: Continuous PAT delivery increased the time associated with beam delivery and gantry movement in single/dual PAT plans by 4.86/7.34 min (brain), 7.51/12.40 min (BoS) and 6.59/10.57 min (H&amp;N) on average relative to static IMPT. Step-and-shoot PAT increased this delivery time further by 4.79 min on average as the delivery was limited by gantry motion. Conclusions: The emulator can approximately model clinical sawtooth PAT delivery but requires experimental validation. No clear benefit was observed regarding beam-on time for sawtooth PAT relative to static IMPT.

Cancer radiotherapy with mini neutron/gamma-ray generators

Recent advancements in negative hydrogen (H-) or negative deuterium (D-) ion source technology as well as the commercial availability of high-frequency AC high-voltage power supplies have enabled the development of mini neutron/gamma-ray generators using low-energy nuclear reactions. These generators can provide a useful flux of high-energy neutrons or gamma photons in either pulsed or continuous operations. With the new mini generator, intraoperative radiotherapy as well as treatment of tumors in the brain, skin, breast, salivary gland, pancreas, liver, and kidney can be performed using external or internal neutron/gamma-ray beams. The new radiotherapy system is very compact and requires very low power for operation, enabling its location inside an operation room of a hospital or clinical facility.

How can the failure mode and effect analysis improve the working processes in the ART center?

Objective(s)Assisted reproductive technology (ART) Centers and laboratories perform complex tasks with patients and their gametes/embryos daily. The degree of problems/non-conformances in such surroundings must be minimized at zero point. This study aimed to establish the proper risk management system with well-defined process steps to prevent and eliminate problems/non-conformances. Study designFailure mode and effect analysis (FMEA) was introduced in the ART Center and the IVF laboratory. ART Center working processes were grouped into the categories of Clinical procedures, Forms, Identification, Personnel, Patients, and Facility. Working processes in the IVF laboratory were grouped into the categories of Consumables, Media, Equipment, Personnel, Working space, and Procedures. The traceability and safety of the working processes were evaluated before and after corrective measures regarding risk priority number (RPN). The severity (S), occurrence (O), and detection (D) index of problems/non-conformance were scaled from 1 to 5. The RPN was calculated by multiplying the SOD index, and the cut-off value for RPN was ≥12. ResultsThe increased RPN was found in the following working processes of the ART Center: Embryo transfer and pregnancy (RPN = 18) in the category of Clinical procedures; Informed consents and agreements (RPN = 16) in the category Forms; Continuous education of the knowledge and skills (RPN = 12) in Personnel category; Space conditions (RPN = 24) and Equipment (RPN = 12) in the category Facility.In the IVF laboratory, increased RPN was found in the following working processes: Production of the plasticware (RPN = 12), Transport (RPN = 12) and Storage (RPN = 12) in the category Consumables; Media production (RPN = 16) in category Media; Alarm notification system for the critical equipment (RPN = 12) in category Equipment; Personnel number and qualifications (RPN = 12), Standard operative procedures (SOP) (RPN = 12) and Continuous education of the knowledge and skills (RPN = 12) in category Personnel; Working conditions (RPN = 18) and Security (RPN = 20) in Working space; Patient identification (RPN = 20), Biological samples identification (RPN = 20), Records (RPN = 12), ART procedure (RPN = 30), Embryo transfer (RPN = 30) and Cryopreservation and thawing of biological samples (RPN = 30) in category Procedures.According to the RPN score, corrective measures were implemented. Most RPN scores were reduced after the implementation of the electronic witnessing system in patient/sample tracing steps. Phases Patient identification and Biological sample identification showed a double reduction of RPN scores, from 20 to 10. Also, for critical steps in ART procedures, Embryo transfer, Cryopreservation, and thawing of biological samples, the RPN score was reduced from 30 to 10. Proper education of personnel was another corrective measure that significantly contributed to a reduction of RPN scores in most of the categories. Conclusion(s)The FMEA analysis is useful in recognizing the critical steps of an ART Center. The RPN scores for patient traceability were successfully reduced using the electronic witnessing system. Nonetheless, the study has certain limitations, as FMEA is highly dependent on the specific healthcare organization, adherence to national guidelines, and the subjective nature of SOD and RPN evaluations.

Opioid prescription status around surgery, bone metastasis, or death events among patients with breast cancer in Japan: an analysis of the Japanese public health insurance comprehensive claims database (the National Database).

To investigate the opioid prescription status around clinical events among patients with breast cancer in Japan using a comprehensive claims database. This was a retrospective cohort study using the National Database (April 2009-March 2020). The target patients had a first breast cancer diagnosis in April 2010 or later. The percentages of patients prescribed opioids before and after surgery, before and after bone metastasis, and before death with a breast cancer diagnosis in the same month were analyzed by month and by clinical facility characteristics and location. We identified 1 085 388 target patients, including 216 503, 72 645, and 70 832 patients with data for the events of surgery, bone metastasis, and death, respectively. The percentage of patients prescribed opioids in the month of surgery was the highest of the entire study period at ≥70%. The percentage of patients prescribed opioids increased before bone metastasis, peaked 1 month later, and decreased thereafter while remaining higher than that before the event. The percentage of patients who were prescribed opioids before death increased over time, peaking at 33.4% 1 month before death. Prescriptions differed by facility characteristics and facility location around surgery; no differences by facility characteristics, including location, were noted around the other events. The percentage of patients prescribed opioids was consistently lower than that reported in other countries for all events. We showed the opioid prescription status around clinical events, including some distinct patterns depending on facility characteristics for the period around surgery, among patients with breast cancer in Japan.

Midwives’ descriptions of policies on access to maternity health services in North West Province, South Africa

The study sought to explore and describe the various policies regarding access to Maternity health care services in the North West Province, South Africa, through the lens of midwives. Legal and ethical frameworks guide maternity healthcare services to ensure such a service's quality, safety, and standardization. A qualitative, descriptive, explorative research design was followed. Nine purposefully sampled midwives participated in a one-on-one in-depth interview. Data were analyzed using Collaizi's descriptive method based on the emerging themes and categories. One overarching theme with six categories emerged from the data. From the overarching perspective, it was evident that midwives were dissatisfied with the ambiguity of various policies guiding patients' access to Maternity healthcare services. To a certain extent, the admission policy was inconsistent with the patient's rights and constitution of the land on access to health. The ambiguity of admission position led to uncontrolled movements of self-referred patients to clinical facilities. The ambiguity of the transfer policy contributed to challenges during interfacility transfers of referred patients from lower levels of care facilities and vice versa. In addition, the policy on escorts of patients was unspecific about the healthcare personnel required to escort complicated patients in transit, which caused care interruptions. The study findings highlight the Midwives' concerns regarding various policies of access to maternity health services, and the marked ineffectiveness of controlling patients' movement into facilities could be the reason for overcrowding, inadvertently causing a decline in the quality of maternity healthcare services. The study findings may alert policymakers to be cautious and ensure that policies are succinct and consistent with other related laws.

Real-time multivariate statistical monitoring of biopharmaceutical processes with no prior product-specific history

Biologics drug substance manufacturing normally comprises several processing steps including cell culture, purification, etc. Real-time Multivariate Statistical Process Monitoring (RT-MSPM) is an integral need in order to achieve early fault detection and prevention to guarantee robust and efficient process performance. As a part of RT-MSPM framework, Batch Evolution Models (BEMs), which take into account the transient phase of a batch prior to reaching full maturity (steady state), are the standard methods for real-time early fault detection in batch processes. Prior product-specific knowledge and training dataset are critical in order to model time (batch maturity) dependencies. Unlike traditional settings, modern biopharmaceutical manufacturing and clinical facilities use modular designs to enable simultaneous production of multiple medicines and quickly pivot from producing one medicine to another where no prior product-specific historical data might be available. In this article, first, a framework is proposed to detect the steady state operation of a manufacturing scale cell culture bioreactor. This is critical to achieve the ultimate goal to demonstrate feasibility of developing a continuous statistical process monitoring framework to monitor the steady state operation of a batch with no prior product specific history. Steady state time series data from previous step are processed following a systematic approach. The requirements for statistical properties of the processed time series in order to leverage data from different products to monitor a new product are outlined. The new framework establishes a guideline to develop models using datasets from other products with different recipes to monitor new products with no prior product-specific history. A novel software product is developed to test the framework. The framework is successfully applied for real-time monitoring of fast-rate sensors of a manufacturing cell culture bioreactor.

Effect of Psychotherapy on Intolerance of Uncertainty: A Systematic Review and Meta-Analysis.

Intolerance of uncertainty (IU) is the tendency to react negatively on affective, cognitive and behavioural levels to uncertain situations and to harbour negative beliefs about the implications of uncertainty. IU has been linked to psychopathology and shown to impact treatment outcomes. This study systematically reviewed the literature and performed a meta-analysis of the effects of psychotherapy on IU. A total of 22 studies (1491 participants) were identified in online searches and included in the meta-analyses. Analyses were performed on studies with passive and active control conditions. The pooled effect on IU from studies with passive control was large (g = -0.94 [95% CI -1.25 to -0.62]) but with significant heterogeneity. Pooled effects on IU from studies with active controls were not significant. Moderator analysis showed that among studies with a passive control condition, studies that recruited participants from clinical care facilities produced smaller effect sizes. Among studies with an active control condition, study quality significantly moderated the results, with higher quality leading to a larger effect size. These results indicate that changes in IU may be difficult to reliably achieve in psychotherapy and leave many questions about the effect of psychotherapy on IU unanswered, such as what active components produced the observed changes in studies with passive control.

The Analysis of Utilization of Voluntary Counseling and Testing (VCT) Clinics by Men Who Have Sex with Men Living with HIV/AIDS

Men Who Have Sex with Men (MSM) are a high-risk group for HIV/AIDS transmission due to their tendency to have multiple partners and engage in anal sex. This study aims to determine the factors influencing the utilization of VCT clinics by MSM living with HIV/AIDS in the VCT clinic at Kendari City General Hospital. This research method is quantitative with an analytical cross-sectional design, conducted in March 2024 at the VCT Clinic of Kendari City General Hospital with a population of 428 MSM who visited the VCT clinic until March. Sampling was done using simple random sampling. The data obtained were processed using SPSS software by conducting chi-square tests, then presented in tabular form accompanied by narration. The research results showed that 74.4% utilized the VCT Clinic well, while 25.6% underutilized the VCT clinic. Based on bivariate analysis, it was found that there is an influence between knowledge (p = 0.000), peer support (p = 0.004) on the utilization of VCT clinics. The researchers suggest that local authorities conduct socialization and disseminate information about HIV/AIDS and VCT clinics through mass media, print, electronic media, optimize mobile VCT, and develop comfortable VCT clinic facilities Keywords: Knowledge, Attitude, Behavior, Family Support, Peer Support, VCT, Men Who Have Sex with Men

Paediatric ankle rehabilitation system based on twisted and coiled polymer actuators

Rehabilitation is crucial for children with physical disabilities arising from various conditions. Traditional exoskeletons, reliant on electric motors and rigid components, making them cumbersome, heavy, and unsuitable for use outside clinical facilities. To overcome these, researchers are turning to soft wearable rehabilitation robots (SWRRs) with artificial muscles based on smart materials like twisted and coiled polymer actuators (TCPs). TCPs offer enhanced compliance, adaptability, comfort, safety, and reduced weight—critical for paediatric use. Despite facing challenges like low operating frequencies and high temperatures, TCPs are explored as potential artificial muscles for SWRRs, due to their advantages on the force they can generate, the strain and a linear behaviour. This study details a proof of concept for a paediatric rehabilitation system for ankles based on TCPs, including the actuator characterization, mechanical design, control strategy, and human-computer-interface (HCI). The resulting device achieved a 1.4 Nm torque, a 10° range of motion in dorsiflexion within 5 s, and integrated electromyographic HCI. This research marks a promising step towards innovative, soft wearable rehabilitation solutions for children with physical disabilities.

Nurses, non-nurse healthcare providers, and clients’ perspectives, encounters, and choices of nursing gender in Tanzania: a qualitative descriptive study

BackgroundA growing share of male nurses in the nursing profession in Tanzania has changed the trend of diversity of nursing gender. This might have created a divergent perspective within the communities. Therefore, the current study aimed to explore the perspective, encounters, and choices of nursing gender among licensed nurses, non-nurse healthcare providers, and clients in Tanzania.MethodsThe study employed a qualitative descriptive design. The data were collected between August 2022 to January 2023 by the principal investigator and one research assistant. Twelve Focus Group Discussions (FGDs) were carried out in four different hospitals in Dar es Salaam comprised of total participants (n = 59). The participants were nurses, clients, and non-nurse healthcare providers. The data was collected through an interview guide developed by the principal investigator and validated by nurse experts. The data was analyzed using qualitative content analysis to generate themes and subthemes.ResultsEight themes and twenty-seven subthemes emerged from the study. The following are themes; ① Variations of male and female nurses in communication ② Differences of male and female nurses in carrying out leadership roles ③ Divergent clinical qualities and outcomes across nursing gender ④ Positive value of male nurses in clinical facilities from colleagues and patients ⑤ Different cooperation of male and female nurses at the clinical settings ⑥ Mixed perspective towards clinical competencies across nursing gender ⑦ Perspective towards gender diversity in nursing ⑧ Preferences of nurse’s gender, reasons, and opinion towards gender preferences.ConclusionMale nurses and female nurses differ in how they communicate, execute leadership roles, and clinical qualities. However, their variations don’t mean one gender is underrated than the other, but every gender has unique communication styles, leadership styles, and clinical qualities that both lead to effective outcomes. Diversity in nursing gender is very important and should be strategized. Since preferences of nursing gender seems to enhance somebody’s freedom and creates an environment where a person can discuss sensitive issues, nursing bodies and healthcare stakeholders might initiate a discussion about approaches to promote the implementation of nursing preference and perform the feasibility studies.