Cost-effective Treatment Research Articles

OTs Should Be Using Video Modeling to Teach Self-Care to Children with NDDs

ABSTRACT An evidence-based project aimed at finding whether utilizing video modeling as an occupational therapy (OT) intervention increased basic self-care skills in school-aged children with neurodevelopmental disorders (NDDs). A total of 11 pediatric outpatient OT clients, 6–12 years old, with one or more NDDs, participated in this project. Pre- and post-intervention surveys completed by their parents garnered information regarding parental views on their children’s self-care skills, parental stress, and quality of life. Real-time data gathered during the intervention revealed the efficacy of video modeling, showing an overall increase in the completion of basic self-care skills from 16.1% at baseline to 96.4%. Meaningful gains were achieved in all eight self-care skills addressed and with all participants, elucidating a combined mean percentage of 79.3% improvement using video modeling. Post-intervention, qualitative data showed resultant perspectives of less parental stress, improved quality of life for the children and their parents, and improved independence with basic self-care skills. Considering the increasing diagnosis of NDDs, the call for evidence-based interventions from both payers and NDD-related organizations, and the future socioeconomic ramifications of not addressing basic self-care skills, this project reveals the efficacy of video modeling as a viable, accessible, cost-effective intervention which can be utilized across environments to address these concerns.

The hydraulic characteristics of a subsurface flow stone biofilter for treating polluted runoff from an informal settlement

Abstract Polluted runoff from informal settlements in developing countries poses a growing challenge due to the elevated and variable nature of contaminants, particularly nutrients and pathogens, introduced to the environment. Cost-effective and scalable treatment systems with the ability to reduce nutrient and other pollutant concentrations in contaminated runoff are desirable. Biofilters are passive water treatment systems that have the potential to achieve this. The Franschhoek Water Hub, a research site for nature-based solutions, features six large biofiltration cells designed to remediate runoff from an informal settlement. Due to their large size, understanding hydraulic behaviour and validating the design proves challenging. To address this, a scaled-down version of the Water Hub's biofilters was constructed to inform design criteria for purpose-built filters. The pilot-scale subsurface flow biofilter, filled with 8–11 mm aggregate stone, had an available volume of 225 L. Pulse tracer studies conducted at various flow rates demonstrated that the system approximated plug flow behaviour. Lower flow rates resulted in deeper tracer infiltration, which is crucial for maximising the distribution of nutrients within the filter bed. This research contributes to the effective design and operation of biofiltration systems, which hold promise for addressing surface water contamination issues in resource-constrained regions.

Cost Analysis of Short Messaging Service and Peer Navigator Interventions for Linking and Retaining Adults Recently Diagnosed With HIV in Care in South Africa.

Large proportions of people living with HIV (PLHIV) in sub-Saharan Africa are not linked to or retained in HIV care. There is a critical need for cost-effective interventions to improve engagement and retention in care and inform optimal allocation of resources. We estimated costs associated with a short message service (SMS) plus peer navigation (SMS+PN) intervention; an SMS-only intervention; and standard of care (SOC), within the I-Care cluster-randomized trial to improve HIV care engagement for recently diagnosed PLHIV. We employed a uniform cost data-collection protocol to quantify resources used and associated costs for each intervention. Compared with SOC, the SMS+PN intervention cost $1284 ($828-$2859) more per additional patient linked to care within 30 days and $1904 ($1158-$5343) more per additional patient retained in care at 12 months, while improving linkage by 24% (95% CI: 11 to 36) and retention by 16% (95% CI: 6 to 26). By contrast, the SMS-only intervention cost $198 ($93-dominated) more per additional patient linked to care and $697 ($171-dominated) more per additional patient retained in care but was not significantly associated with improvements in linkage (12%; 95% CI: -1 to 25) or retention (3%; 95% CI: -7 to 14) compared with SOC. The efficiency of the SMS+PN intervention could be improved by 46%, to $690 more per additional patient linked and $1023 more per additional patient retained in care, if implemented within the Department of Health using more efficient distribution of staff resources. Findings suggest that scale-up of the SMS+PN intervention could benefit patients, improving care and health outcomes while being cost-effective.

Is behavioural activation an effective treatment for depression in children and adolescents? An updated systematic review and meta-analysis.

Behavioural Activation (BA)-a brief therapy based on the scheduling of enjoyable, purposeful and rewarding activities-is an effective and cost-effective treatment for depression in adults that shows promise for children and adolescents. We provide an update on a previous systematic review of evidence on BA-delivered in-person, telephone, or online-for depression and comorbid anxiety in children and adolescents.We conducted systematic literature searches in 6 databases up to February 2024. We included all study designs evaluating BA with participants up to 18years old with diagnosable depression, as established by a validated screening tool or diagnostic manual. We used the Moncrieff Scale and the Cochrane Risk of Bias tool to assess study quality. We summarised the findings of all study types with a narrative synthesis and of randomised controlled trials (RCTs) with a meta-analysis.Overall, 24 studies (6 RCTs, 18 pre-post evaluations, n = 2,758) met our inclusion criteria. A meta-analysis of 4 RCTs (n = 156) showed that BA has a small effect of 0.24 (Hedge's adjusted g) in reducing depression symptoms compared to a waiting-list control, usual care and other therapies. Online and telephone-facilitated BA was shown to be feasible in 3 studies and effective in 1. Outcomes on comorbid anxiety were mixed. No economic evaluations met our inclusion criteria.BA shows sufficient promise as an intervention for reducing depression symptoms in children and adolescents to justify the need for further RCTs, providing that five conditions are met: studies are powered to detect a minimal clinically important difference; BA materials are fit-for-purpose to produce clinically meaningful change; follow-ups are longer than 6months; primary outcomes are child-reported; and intervention costs, resource use and adverse events are reported.

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

BackgroundPrevention of vertical (mother to child) transmission of HIV is one of the key strategies towards HIV epidemic control. Despite considerable progress over the past decade in Zambia, the country is yet to reach global and national target for elimination of vertical transmission of HIV. Avoidance of unintended pregnancy among women living with HIV is one of the cost-effective interventions in a comprehensive approach to prevent vertical transmission of HIV. Therefore, this study aimed at ascertaining trends in and predictors of unmet need for family planning among women living with HIV in Zambia.MethodsThe study employed a repeated cross sectional (RCS) study design, using data from the three (3) most recent consecutive rounds of the Zambia Demographic and Health Survey (ZDHS) conducted in 2007, 2013/2014 and 2018. The study used data from a total of 27,153 women aged 15–49 years over the three survey periods among whom 4,113 had an HIV positive result following a rigorous HIV testing algorithm of the demographic and health surveys, and these constituted our sample size of women living with HIV. We used descriptive statistics and logistic regression analyses to respectively ascertain trends in and predictors of unmet need for family planning among women living with HIV.ResultsOver the three survey points, unmet need for family planning among women living with HIV has largely remained unchanged from 20.8% in 2007 to 20.5% in 2013/14 and 21.1% in 2018 DHS. Residence, age of women, household wealth, woman’s parity, employment, and age of spouse emerged as significant predictors of unmet need for family planning among women living with HIV in Zambia.ConclusionPreventing HIV infection in a child preserves life, contributes to improving quality of life from its early stages and averts lifetime costs of HIV treatment and associated healthcare costs. There is need to consider optimization of interventions to prevent vertical transmission of HIV including shaping programming regarding preventing unintended pregnancies among women living with HIV. Among other aspects, policy and practice need to strengthen SRH/HIV integration and better target rural residents, younger women, those with high parity and consider positive male engagement to reduce unmet need for family planning among women living with HIV.

Comparison of current relative value unit-based prices and utility between common surgical procedures, including orthopedic surgeries, in South Korea

BackgroundThe medical pricing system strongly influences physicians’ job satisfaction and patient health outcomes. This study aimed to investigate the current relative value unit (RVU)-based pricing and utility of patients in commonly performed surgical procedures in South Korea.MethodsFifteen common surgical procedures were selected from OECD statistics, and three additional orthopedic procedures were examined. The current pricing of each surgical procedure was retrieved from the Korea National Health Insurance Service, and the corresponding utilities were obtained as quality-adjusted life year (QALY) gains from previous studies. The relationship between the current prices (RVUs) and the patients’ utility (incremental QALY gains/year) was analyzed. Subgroup analysis was performed between fatal and non-fatal procedures and between orthopedic and non-orthopedic procedures.ResultsA significant negative correlation (r = − 0.558, p < 0.001) was observed between RVU and incremental QALY among all 18 procedures. The fatal subgroup had a significantly higher RVU than the non-fatal subgroup (p < 0.05), while the former had a significantly lower incremental QALY than the latter (p < 0.001). Orthopedic procedures showed higher incremental QALY values than non-orthopedic procedures, but they did not show higher prices (RVU).ConclusionsThis paradoxical relationship between current prices and patient utility is attributed to the higher pricing of surgical procedures for fatal and urgent conditions. Orthopedic surgery has been found to be a cost-effective treatment strategy. These findings could contribute to a better understanding of the potential role of incremental QALY in pursuing value-based purchasing or reasonable modification of the current medical fee schedule.

Awareness About Child Immunization among Women in Rural Area of District Jalaun

Introduction; Universal Immunization Programme (UIP) is one of the largest public health programmes targeting close of 2.67 crore newborns and 2.9 crore pregnant women annually. It is one of the most cost-effective public health interventions and largely responsible for reduction of vaccine preventable under-5 mortality rate. Under UIP, immunization is providing free of cost against 12 vaccine preventable diseases. Mission Indra dhanush (MI) was launched in December 2014 and aims at increasing the full immunization coverage to children to 90 % (1). Mother play a very important role in child immunization, so awareness and correct knowledge about immunization is very essential in women, keeping this thing in mind, the present study was undertaken. Aims and objectives;1. To assess the awareness about child immunization among women in rural area.2. To know the correct knowledge of vaccine given in children among women .Material and methods;A cross sectional study was carried out in a rural area of district Jalaun. Aata block was selected randomly for study area. RHTC Aata was selected and women attending the OPD during month of August to October were included in study. Sample size were calculated and 140 mothers were interviewed by using predesigned and pretested questionnaire after taking verbal consent and data was collected and analyzed using appropriate statistical tool. Results; mostly women had heard about immunization in children (82.1%) and most of the women got information from health workers like ASHA/ANM followed by family and friends. vaccine given to child that shows knowledge about BCG/POLIO/MMR was found good but average about DPT and HEPATITIS. Very few women had knowledge about HIB, JE and ROTA vaccine. Conclusion; need to focus on education and awareness programme on women regarding child immunization in rural areas.

A Psychometric Study of the Arabic Version of the “Searching for Hardships and Obstacles to Shots (SHOT)” Instrument for Use in Saudi Arabia

Vaccines are considered one of the top 10 public health achievements of the 20th century and the most cost-effective public health intervention to overcome diseases and disease-associated mortality. This study translated the “Searching for Hardships and Obstacles to Shots” (SHOT) instrument from English to Arabic and conducted a psychometric evaluation of the Arabic version to measure parental barriers to childhood immunization. The cross-sectional study utilized multistage cluster random sampling to recruit parents visiting 70 primary health centers in Jizan. Scale translation and cultural adaptation were used to translate the SHOT survey into Arabic. The survey revealed that the best-factor model was a one-factor solution for “barriers to child immunization.” The first principal component explained the highest variance (56.22%), and subsequent components explained decreasing percentages of variance. The third principal component explained the decreased variance (4.61%), and subsequent components explained the decreasing percentages of variance. The overall reliability (determined by Cronbach’s alpha) was 0.96. The strong internal consistency of the Arabic version of the SHOT instrument (as indicated by the high Cronbach’s alpha coefficients) indicates that researchers and practitioners can confidently use this scale to measure parents’ attitudes toward and perceptions of vaccinations. Furthermore, the study results will help policymakers develop programs or interventional initiatives to overcome these barriers.

Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone App-Led Cognitive Behavioral Therapy for Depression Under Therapist Supervision: Open Trial.

Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this treatment gap by reducing the time and frequency of therapy sessions needed for effective treatment through the provision of flexible, automated support. This study aimed to examine the feasibility, acceptability, and preliminary clinical effect of Mindset for Depression, a deployment-ready 8-week smartphone-based cognitive behavioral therapy (CBT) supported by brief teletherapy appointments with a therapist. This 8-week, single-arm open trial tested the Mindset for Depression app when combined with 8 brief (16-25 minutes) video conferencing visits with a licensed doctoral-level CBT therapist (n=28 participants). The app offers flexible, accessible psychoeducation, CBT skills practice, and support to patients as well as clinician guidance to promote sustained engagement, monitor safety, and tailor treatment to individual patient needs. To increase accessibility and thus generalizability, all study procedures were conducted remotely. Feasibility and acceptability were assessed via attrition, patient expectations and feedback, and treatment utilization. The primary clinical outcome measure was the clinician-rated Hamilton Depression Rating Scale, administered at pretreatment, midpoint, and posttreatment. Secondary measures of functional impairment and quality of life as well as maintenance of gains (3-month follow-up) were also collected. Treatment credibility (week 4), expectancy (week 4), and satisfaction (week 8) were moderate to high, and attrition was low (n=2, 7%). Participants self-reported using the app or practicing (either on or off the app) the CBT skills taught in the app for a median of 50 (IQR 30-60; week 4) or 60 (IQR 30-90; week 8) minutes per week; participants accessed the app on an average 36.8 (SD 10.0) days and completed a median of 7 of 8 (IQR 6-8) steps by the week 8 assessment. The app was rated positively across domains of engagement, functionality, aesthetics, and information. Participants' depression severity scores decreased from an average Hamilton Depression Rating Scale score indicating moderate depression (mean 19.1, SD 5.0) at baseline to a week 8 mean score indicating mild depression (mean 10.8, SD 6.1; d=1.47; P<.001). Improvement was also observed for functional impairment and quality of life. Gains were maintained at 3-month follow-up. The results show that Mindset for Depression is a feasible and acceptable treatment option for individuals with major depressive disorder. This smartphone-led treatment holds promise to be an efficacious, scalable, and cost-effective treatment option. The next steps include testing Mindset for Depression in a fully powered randomized controlled trial and real-world clinical settings. ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329.

Machine learning-based detection of sleep-disordered breathing in hypertrophic cardiomyopathy

BackgroundHypertrophic cardiomyopathy (HCM) is often concomitant with sleep-disordered breathing (SDB), which can cause adverse cardiovascular events. Although an appropriate approach to SDB prevents cardiac remodelling, detection of concomitant SDB in...

Combining artificial neural networks and a marginal structural model to predict the progression from depression to Alzheimer's disease

IntroductionDecades of research in population health have established depression as a likely precursor to Alzheimer's disease. A combination of causal estimates and machine learning methods in artificial intelligence could identify internal and external mediating mechanisms that contribute to the likelihood of progression from depression to Alzheimer's disease.MethodsWe developed an integrated predictive model, combining the marginal structural model and an artificial intelligence predictive model, distinguishing between patients likely to progress from depressive states to Alzheimer's disease better than each model alone.ResultsThe integrated predictive model achieved substantial clinical relevance when using the area under the curve measure. It performed better than the traditional statistical method or a single artificial intelligence method alone.DiscussionThe integrated predictive model could form a part of a clinical screening tool that identifies patients who are likely to progress from depression to Alzheimer's disease for early behavioral health interventions. Given the high costs of treating Alzheimer's disease, our model could serve as a cost-effective intervention for the early detection of depression before it progresses to Alzheimer's disease.

Olaparib not cost-effective as maintenance therapy for platinum-sensitive, BRCA1/2 germline-mutated metastatic pancreatic cancer.

To assess the cost-effectiveness and budget impact of olaparib as a maintenance therapy in platinum-responsive, metastatic pancreatic cancer patients harboring a germline BRCA1/2 mutation, using the Swiss context as a model. Based on data from the POLO trial, published literature and local cost data, we developed a partitioned survival model of olaparib maintenance including full costs for BRCA1/2 germline testing compared to FOLFIRI maintenance chemotherapy and watch-and-wait. We calculated the incremental cost-effectiveness ratio (ICER) for the base case and several scenario analyses and estimated 5-year budget impact. Comparing olaparib with watch-and wait and maintenance chemotherapy resulted in incremental cost-effectiveness ratios of CHF 2,711,716 and CHF 2,217,083 per QALY gained, respectively. The 5-year costs for the olaparib strategy in Switzerland would be CHF 22.4 million, of which CHF 11.4 million would be accounted for by germline BRCA1/2 screening of the potentially eligible population. This would amount to a budget impact of CHF 15.4 million (USD 16.9 million) versus watch-and-wait. Olaparib is not a cost-effective maintenance treatment option. Companion diagnostics are an equally important cost driver as the drug itself.

Leading under pressure: a contextualised development approach

PurposeThe study’s aim was to design and test a leadership development approach using blended learning, to equip leaders for strengthening their own resilience and that of their teams.Design/methodology/approachA contextualised leadership development intervention was produced and evaluated following the principles of design-based research. Participants were from three organisations that work internationally to address the impact of economic disadvantage. Initial research used the behavioural event interview technique. Online assessment incorporated measures of situational judgement, emotion recognition and attributional style. Validity measures were multi-rater feedback (criterion), and NEO-PI 3 (construct). Individual feedback and a simulation-based peer workshop were followed by a four-to-six month period of experience-driven development and a final peer workshop for consolidating and evaluating learning outcomes.FindingsThe online assessment was a valid measure of leaders’ personal resilience resources and their resilience-building capability. Overall, the intervention improved participants’ understanding of, and engagement with, the processes of strengthening individual and collective (team) resilience.Research limitations/implicationsThe target sample size for the study was relatively small, to ensure it would be practical to replicate the approach when designing similar interventions for a senior leadership population in other contexts. Significant results provided robust evidence for the validity of the assessment approach. Findings for the workshops and experience-driven development phase were more tentative, but the value of the design iterations was clearly demonstrated.Practical implicationsThe leadership development approach is suitable for application in other organisations, if similar principles are followed to produce and evaluate materials relevant to each broad sector context. Roll-out is cost-effective, with relatively few hours of blended or virtual delivery supporting experience-driven learning.Social implicationsThe impact leaders have on the wellbeing of those who report to them is well established, but less has been done to develop and formally evaluate practical, cost-effective interventions to improve this impact. The approach validated in this study can be applied more widely to benefit employee wellbeing as well as performance.Originality/valueThe study developed and evaluated a new approach to preparing leaders for the challenge of building team resilience, an aspect of leadership capability that has been given relatively little attention to date.

Mass Testing and Treatment to Accelerate Malaria Elimination: A Systematic Review and Meta-Analysis.

In regions where malaria transmission persists, the implementation of approaches aimed at eliminating parasites from the population can effectively decrease both burden of disease and transmission of infection. Thus, mass strategies that target symptomatic and asymptomatic infections at the same time may help countries to reduce transmission. This systematic review assessed the potential benefits and harms of mass testing and treatment (MTaT) to reduce malaria transmission. Searches were conducted in March 2021 and updated in April 2022 and included cluster-randomized controlled trials (cRCTs) as well as nonrandomized studies (NRSs) using malaria infection incidence, clinical malaria incidence, or prevalence as outcomes. The risk of bias was assessed with Cochrane's risk of bias (RoB2) tool and Risk of Bias Tool in Nonrandomized Studies - of Interventions (ROBINS-I), and the certainty of evidence (CoE) was graded for each outcome. Of 4,462 citations identified, seven studies (four cRCTs and three NRSs) contributed outcome data. The analysis revealed that MTaT did not reduce the incidence (risk ratio [RR]: 0.95, 95% CI: 0.87-1.04; 1,181 participants; moderate CoE) or prevalence (RR: 0.83, 95% CI: 0.67-1.01; 7,522 participants; moderate CoE) of malaria infection but resulted in a small reduction in clinical malaria (RR: 0.82; 95% CI: 0.70-0.95; 334,944 participants; moderate CoE). Three studies contributing data on contextual factors concluded that MTaT is an acceptable, feasible, and cost-effective intervention. Mathematical modeling analyses (n = 10) suggested that MTaT effectiveness depends on the baseline transmission level, diagnostic test performance, number of rounds, and other co-interventions. Based on the limited evidence available, MTaT has little to no impact on reducing malaria transmission.

Inter-facility transfers for emergency obstetrical and neonatal care in rural Madagascar: a cost-effectiveness analysis

ContextThere is a substantial lack of inter-facility referral systems for emergency obstetrical and neonatal care in rural areas of sub-Saharan Africa. Data on the costs and cost-effectiveness of such systems...

Point-of-care testing in a patient with vaginal discharge

Point-of-care testing refers to tests conducted at or close to the site of patient care. Point-of-care testing has the potential to generate rapid results that enable the clinician to offer prompt and cost-effective treatment. Vaginal discharge is a common complaint in Dermatology and Venereology practice. Analysis of vaginal smear can give valuable information regarding the condition producing vaginal discharge such as vaginal candidiasis, trichomoniasis, bacterial vaginosis, and gonococcal and chlamydial infections. After getting written, informed consent from the patient, the discharge specimen is collected and pH of the same is assessed. Potassium hydroxide mount, wet mount, and Gram stain study of smears prepared from vaginal discharge help to differentiate between candidiasis, trichomoniasis, bacterial vaginosis, and gonococcal/non-gonococcal infections. Careful collection and preparation of specimen are essential for accurate results.

499 Physiological and Metabolomic Effects of a Community-Based Cardiorenal Protective Diet Intervention in African Americans with Chronic Kidney Disease and Hypertension

OBJECTIVES/GOALS: Chronic kidney disease (CKD) impacts 15% of US adults and African American (AA) persons are disproportionately affected with more than 3 times higher risk of kidney failure when compared to Caucasian persons. This study evaluated the physiological and metabolomic effects of increased fruits and vegetables (F&amp;V) on cardio-renal risk factors. METHODS/STUDY POPULATION: This pilot trial used a prospective, 2-group, randomized study design to evaluate a F&amp;V intervention (N=46), where participants received a prescribed amount of fresh, base-producing F&amp;V compared to a wait-list control (WL) condition (N=45). All participants were African American adults (≥18 years), had self-reported hypertension, and had CKD (Stage 1-3) on screening spot-urine microalbumin test. Participants were measured at baseline and 6 weeks post-intervention. Clinical data (i.e., systolic and diastolic blood pressure, lipid panel, hemoglobin A1C, BMI [body mass index], and albumin to creatinine ratio) were collected. Targeted metabolomic quantitative analysis was performed followed by LC-MS/MS and FIA-MS/MS. Linear mixed models evaluated analyte expression and clinical data. RESULTS/ANTICIPATED RESULTS: AA participants (N=91) were aged 58 ± 10.2 years, 66% female, and 54% had incomes ≤$50,000. T-tests compared change scores (baseline to 6-weeks) between groups. The F&amp;V group demonstrated a significant reduction in BMI of -4.7 ± 10.5 kg/m² compared to a 1.9 ± 8.3 kg/m² increase in the WL group, p&lt;.01. Further, the F&amp;V group demonstrated a reduction in total cholesterol of -15.4 ± 58.8 mg/dL compared to a 17.7 ± 68.8 mg/dL increase in the WL group, p&lt;.05. Non-significant reductions in hemoglobin A1c were found in the F&amp;V versus the WL group. Metabolomic analysis indicated significant variation with an increase of suggestive key biomarkers for worse CKD in the WL versus F&amp;V groups at 6-weeks. DISCUSSION/SIGNIFICANCE: Consumption of only 2 cups of F&amp;V via a community-based intervention reduced CVD risk factors in AA adults with CKD and HTN and resulted in molecular/biochemical changes which may improve long-term kidney health. Further investigation may lead to development of cost-effective dietary intervention models to improve CKD outcomes in AA persons.

The construction of a microalgal-bacterial biofilm reactor for enhanced swine wastewater treatment

Traditional biological wastewater treatment methods face challenges in treating swine wastewater with a low carbon-to‑nitrogen ratio. Microalgae show great potential in low-cost swine wastewater treatment for nutrient recovery. This study investigated the effects of altering the carbon/nitrogen/phosphorus (C:N:P) ratio in swine wastewater and immobilizing microalgae for enhancing treatment using Desmodesmus sp. A C:N:P proportion of 106:16:1 was determined to be optimal for treatment. The implementation of an inclined plate bioreactor facilitated microalgal adherence, forming a biofilm that improved treatment efficiency. The biofilm exhibited removal rates of 92 % for ammonia nitrogen (NH4+-N), 98 % for total phosphorus (TP), and 99 % for chemical oxygen demand (COD). The harvested biomass from the biofilm was 7.6 times higher than that from the suspended system with a high content (63 %) of fatty acids (C16:0, C18:0, C18:1n9c and C18:2n6c) suitable for biodiesel production. Proteobacteria were dominant in the biofilm, while Firmicutes and Bacteroidetes contributed to effective organic matter and nitrogen removal. These findings present a promising technology for cost-effective swine wastewater treatment and resource recovery.

The availability, access, challenges and advancements in neurosurgical care in Africa: a mini review.

The availability and accessibility of neurosurgical care across Africa remains limited despite recent advancements. Overall, Africa accounts for 15% of the global neurosurgical disease burden but has access to less than 1% of neurosurgeons globally. While the number of neurosurgeons has increased in recent decades, huge workforce shortages remain, with the region facing the second-largest neurosurgical deficit. Access to adequate facilities and equipment is also lacking. Barriers like poverty, conflicts, and distance from care centres negatively impact patients' ability to access services. However, training programs like the World Federation of Neurosurgical Societies Rabat Training Center have contributed to building local capacity. Use of technologies like neuro-endoscopy is expanding access to more cost-effective interventions for conditions such as hydrocephalus. Undergraduate medical education is also seeing a rise in African students interested in neurosurgery. Despite these advancements, workforce shortfalls, inadequate infrastructure, and challenges posed by geopolitical instability continue to hinder the provision of comprehensive neurosurgical care. Limited research and funding discourage experienced surgeons from practicing in their home countries. Increased international collaboration, support for education, and tackling of structural issues are needed to continue strengthening Africa's neurosurgical capacity and reducing the disease burden. This narrative review aims to provide an overview of the current state of neurosurgery on the continent, highlight achievements, and identify persisting challenges.

Healthcare practitioners’ experiences and perspectives of music in perinatal care in Ireland: An exploratory survey

IntroductionEvidence shows that music can promote the wellbeing of women and infants in the perinatal period. Ireland's National Maternity Strategy (2016-2026) suggests a holistic approach to woman's healthcare needs and music interventions are ideally placed as a non-pharmacological and cost-effective intervention to improve the quality of care offered to women and infants. This cross-sectional survey aimed to explore the healthcare practitioners’ personal and professional experiences of using music therapeutically and its impact and barriers in practice. The survey also investigated practitioners’ knowledge and attitudes towards the use of music as a therapeutic tool in perinatal care. MethodsA novel online survey was developed and distributed through healthcare practitioners’ electronic mailing lists, social media, Perinatal Mental Health staff App, and posters at the regional maternity hospital during 26th June and 26th October 2020. Survey items included demographics, personal and professional use of music, and perspectives on music intervention in perinatal care. ResultsForty-six healthcare practitioners from across 11 professions were recruited and 42 were included in this study. 98% of perinatal practitioners used music intentionally to support their wellbeing and 75% referred to using music in their work. While 90% found music beneficial in their practice, 15% reported some negative effect. Around two-thirds of the respondents were familiar with the evidence on music and perinatal wellbeing and 95% thought there was not enough guidance. 40% considered music therapy an evidence-based practice and 81% saw a role for music therapy in standard maternity service in Ireland. The qualitative feedback on how music was used personally and professionally, its’ reported benefits, negative effects, and barriers are discussed. DiscussionThis study offers insights into how healthcare practitioners viewed and applied music in perinatal practice. The findings indicate high interest and positive experiences in using music as a therapeutic tool in perinatal care which highlights the need for more evidence and guidance.