Effectiveness Of Different Interventions Research Articles

Fabrication of deformable patient-specific AAA models by material casting techniques.

Abdominal Aortic Aneurysm (AAA) is a balloon-like dilatation that can be life-threatening if not treated. Fabricating patient-specific AAA models can be beneficial for in-vitro investigations of hemodynamics, as well as for pre-surgical planning and training, testing the effectiveness of different interventions, or developing new surgical procedures. The current direct additive manufacturing techniques cannot simultaneously ensure the flexibility and transparency of models required by some applications. Therefore, casting techniques are presented to overcome these limitations and make the manufactured models suitable for in-vitro hemodynamic investigations, such as particle image velocimetry (PIV) measurements or medical imaging. Two complex patient-specific AAA geometries were considered, and the related 3D models were fabricated through material casting. In particular, two casting approaches, i.e. lost molds and lost core casting, were investigated and tested to manufacture the deformable AAA models. The manufactured models were acquired by magnetic resonance, computed tomography (CT), ultrasound imaging, and PIV. In particular, CT scans were segmented to generate a volumetric reconstruction for each manufactured model that was compared to a reference model to assess the accuracy of the manufacturing process. Both lost molds and lost core casting techniques were successful in the manufacturing of the models. The lost molds casting allowed a high-level surface finish in the final 3D model. In this first case, the average signed distance between the manufactured model and the reference was () mm. However, this approach was more expensive and time-consuming. On the other hand, the lost core casting was more affordable and allowed the reuse of the external molds to fabricate multiple copies of the same AAA model. In this second case, the average signed distance between the manufactured model and the reference was () mm. However, the final model's surface finish quality was poorer compared to the model obtained by lost molds casting as the sealing of the outer molds was not as firm as the other casting technique. Both lost molds and lost core casting techniques can be used for manufacturing patient-specific deformable AAA models suitable for hemodynamic investigations, including medical imaging and PIV.

Efficacy of multidisciplinary interventions in preventing metabolic syndrome and improving body composition in prostate cancer patients treated with androgen deprivation therapy: A systematic review and meta-analysis

Exercise is known to reduce adverse side effects of androgen-deprivation therapy (ADT) on quality of life, bone health and fatigue for prostate cancer (PCa) patients. We conducted a systematic review with meta-analysis to evaluate the effect of multidisciplinary interventions on body composition and metabolic syndrome (MetS) in ADT-treated PCa patients. A systematic review and meta-analysis were conducted based on searches of EMBASE, MEDLINE, CENTRAL and Scopus databases from inception to March 2023. Participants included ADT-treated PCa patients who received multidisciplinary interventions including exercise, diet, nutrition, pharmacotherapy, bariatric surgery, or psychological/behavioural therapy. Primary outcomes were changes in body composition and MetS, with prostate-specific antigen (PSA) as a secondary outcome. After meta-analysis, results were reported in mean difference, 95% confidence interval and p-value, with forest plots. Additionally, we conducted subgroup analyses to compare the effect of different interventions. Thirty-three articles met the eligibility criteria out of 1443 articles and 28 studies were included in meta-analysis. Of 33 studies, 17 included exercise-only interventions and 10 included exercise+diet/nutrition interventions, but no studies included diet/nutrition-only interventions. All studies employed multidisciplinary approaches in developing or delivering the interventions. Most studies (85%) had low-moderate risk of bias, thus providing good evidence to this review. Overall, interventions had a positive effect on body composition measures; lean mass (LM):0.82kg (95% CI:0.47,1.17;p<0.00001), body fat mass (BFM):-0.68kg (95% CI:-1.12,-0.24;p=0.002), fat-free mass:0.75kg (95% CI:0.14,1.37;p=0.02) and body fat percentage (BFP):-0.99% (95% CI:-1.29,-0.68;p<0.00001), as well as on MetS; waist circumference:-1.95cm (95% CI:-3.10,-0.79;p=0.0009), systolic blood pressure:-3.43mmHg (95% CI:-6.36,-0.50;p=0.02) and diastolic blood pressure:-2.48mmHg (95% CI:-4.19,-0.76;p=0.005). Subgroup-analyses showed that a combined approach including exercise+diet/nutrition was most effective in improving BFP, WC, SBP and DBP whereas exercise was more effective in improving LM and BFM. In ADT-treated PCa patients, multidisciplinary interventions, especially those combining exercise and diet/nutrition, can improve body composition and metabolic health.

A systematic review of interventions to improve medication adherence in family medicine patients

Background: Medication non-adherence poses a significant challenge in healthcare, leading to suboptimal treatment outcomes. This systematic review aims to evaluate the effectiveness of different interventions in improving medication adherence. Methodology: A comprehensive search was conducted to identify relevant studies. Inclusion criteria encompassed interventions targeting medication adherence and reporting quantitative measures of adherence outcomes. The selected studies were assessed for quality, and data were extracted for analysis. Results: The review included a total of 14 studies. Interventions involving tailored phone calls or educational materials did not yield significant improvements in medication adherence. Conversely, interventions such as face-to-face counseling sessions and self-management programs showed promise in improving adherence. Nurse-led interventions and pharmacist-led consultations did not demonstrate significant improvements. Similarly, interventions involving stroke physician specialist assessments, behavioral feedback, medication reviews, and motivational interviewing did not yield significant improvements. A pooled analysis of various interventions across different healthcare settings showed a moderate but not statistically significant difference in medication adherence. Conclusion: The findings from this systematic review suggest that interventions tailored to individual patient characteristics and involving personalized support and education show promise in improving medication adherence. However, interventions relying solely on tailored phone calls, educational materials, nurse-led care, pharmacist-led consultations, stroke physician specialist assessments, behavioral feedback, medication reviews, or motivational interviewing may not consistently improve adherence. Keywords: Medication Adherence, Patient Compliance, Family Medicine, Education, Behavioral Modification.

Penile rehabilitation effectiveness after prostate cancer treatment: A systematic review of randomized controlled trials.

Prostate cancer treatment can significantly impact erectile function, and penile rehabilitation has been proposed to improve the impacts. However, the effectiveness of penile rehabilitations after treatment of prostate cancer is scarce. The aim of this systematic review was to evaluate the effectiveness of different interventions of penile rehabilitation program after prostate cancer treatment. We conducted a comprehensive search of electronic databases, PubMed and Google Scholar, to identify randomized controlled trials that evaluated interventions for penile rehabilitation after prostate cancer treatment. Studies that met our inclusion criteria were systematically reviewed, and data were synthesized and analyzed. We identified 11 randomized controlled trials that evaluated different interventions for penile rehabilitation after prostate cancer treatment. The interventions included the use of phosphodiesterase type 5 inhibitors, intracavernous injections, vacuum erection devices, and penile rehabilitation programs. The data suggest that these phosphodiesterase inhibitors, intracavernous injections, vacuum erection devices, and penile rehabilitation programs are promising in improving erectile function after prostate cancer treatment. However, the optimal timing and duration of these interventions remain unclear, and there is a need for further research to determine their long-term effectiveness and safety. Healthcare providers should consider individualized approaches to penile rehabilitation, taking into account patient characteristics and preferences.

Efficacy and safety of antidepressants for smoking cessation: A systematic review and network meta-analysis.

To evaluate the effectiveness, safety and tolerability of antidepressants in helping smokers quit tobacco dependence, five databases were searched for randomized controlled trials (RCTS ) on different antidepressant interventions involving smoking cessation in populations (September 2022). The STATA 15.1 software was used to perform network meta-analysis. The Cochrane bias risk tool was used to assess the risk of bias, and CINeMA was used to evaluate the evidence credibility for the effect of different interventions on smoking cessation. In all, 107 RCTs involving 42 744 patients were included. Seven studies were rated as having a low risk of bias. All trials reported 18 interventions and 153 pairwise comparisons were generated. The network meta-analysis showed that compared with placebo, varenicline + bupropion (OR = 3.53, 95% CI [2.34, 5.34]), selegiline + nicotine replacement therapy (NRT) (OR = 3.78, 95% CI [1.20, 11.92]), nortriptyline + NRT (OR = 2.33, 95% CI [1.21, 4.47), nortriptyline (OR = 1.58, 95% CI [1.11,2.26]), naltrexone + bupropion (OR = 3.84, 95% CI [1.39, 10.61]), bupropion + NRT (OR = 2.29, 95% CI [1.87, 2.81]) and bupropion (OR = 1.70, 95% CI [1.53, 1.89]) showed benefits with respect to smoking cessation. In addition, bupropion + NRT showed better effects than bupropion (OR = 1.35, 95% CI [1.12, 1.64]) and NRT (OR = 1.38, 95% CI [1.13, 1.69]) alone. The final cumulative ranking curve showed that varenicline + bupropion was the most likely to be the best intervention. There was moderate- to very-low-certainty evidence that most interventions showed benefits for smoking cessation compared with placebo, including monotherapy and combination therapies. Varenicline + bupropion had a higher probability of being the best intervention for smoking cessation.

Comparative Different Interventions to Improve Medication Adherence in Patients with Hypertension: A Network Meta-analysis.

Hypertension has become a major public problem. One of every 4 adults has hypertension. Medications are critical in controlling blood pressure, but patient medication adherence is low. Therefore, it is very crucial to promote medication adherence. However, the complexity and variety of interventions cause clinical decision-making difficulties for health managers and patients. The aim of this study was to compare the effectiveness of different interventions to improve medication adherence in patients with hypertension. We searched PubMed, Cochrane Library, Web of Science, EMBASE, Wan Fang, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc databases for eligible studies. Medication adherence rate and medication adherence difference were assessed as outcomes. Sensitivity analysis and inconsistency detection were performed to evaluate whether the exclusion of high-risk studies affected the validity. The risk of bias was assessed using the risk of bias table in Review Manager 5.4. The surface under the cumulative ranking curve was used to estimate the rankings among different interventions. Twenty-seven randomized controlled trials were included, and the interventions involved were categorized into 8 different categories. The network meta-analysis showed that the health intervention was the best to promote medication compliance in patients with hypertension. Health intervention is recommended to improve medication adherence in patients with hypertension. Health managers are recommended to provide health intervention to patients with hypertension to improve their medication adherence. This approach reduces morbidity, mortality, and healthcare costs for patients with cardiovascular disease.

Balance and gait in progressive supranuclear palsy: a narrative review of objective metrics and exercise interventions.

The use of objective gait and balance metrics is rapidly expanding for evaluation of atypical parkinsonism, and these measures add to clinical observations. Evidence for rehabilitation interventions to improve objective measures of balance and gait in atypical parkinsonism is needed. Our aim is to review, with a narrative approach, current evidence on objective metrics for gait and balance and exercise interventions in progressive supranuclear palsy (PSP). Literature searches were conducted in four computerized databases from the earliest record up to April 2023: PubMed, ISI's Web of Knowledge, Cochrane's Library, and Embase. Data were extracted for study type (cross-sectional, longitudinal, and rehabilitation interventions), study design (e.g., experimental design and case series), sample characteristics, and gait and balance measurements. Eighteen gait and balance (16 cross-sectional and 4 longitudinal) and 14 rehabilitation intervention studies were included. Cross-sectional studies showed that people with PSP have impairments in gait initiation and steady-state gait using wearable sensors, and in static and dynamic balance assessed by posturography when compared to Parkinson's disease (PD) and healthy controls. Two longitudinal studies observed that wearable sensors can serve as objective measures of PSP progression, using relevant variables of change in turn velocity, stride length variability, toe off angle, cadence, and cycle duration. Rehabilitation studies investigated the effect of different interventions (e.g., balance training, body-weight supported treadmill gait, sensorimotor training, and cerebellar transcranial magnetic stimulation) on gait, clinical balance, and static and dynamic balance assessed by posturography measurements. No rehabilitation study in PSP used wearable sensors to evaluate gait and balance impairments. Although clinical balance was assessed in 6 rehabilitation studies, 3 of these studies used a quasi-experimental design, 2 used a case series, only 1 study used an experimental design, and sample sizes were relatively small. Wearable sensors to quantify balance and gait impairments are emerging as a means of documenting progression of PSP. Robust evidence for improving balance and gait in PSP was not found for rehabilitation studies. Future powered, prospective and robust clinical trials are needed to investigate the effects of rehabilitation interventions on objective gait and balance outcomes in people with PSP.

Analyzing the number of articles with network meta-analyses using chord diagrams and temporal heatmaps over the past 10 years: Bibliometric analysis.

Network meta-analyses (NMAs) are statistical techniques used to synthesize data from multiple studies and compare the effectiveness of different interventions for a particular disease or condition. They have gained popularity in recent years as a tool for evidence-based decision making in healthcare. Whether publications in NMAs have an increasing trend is still unclear. This study aimed to investigate the trends in the number of NMA articles over the past 10 years when compared to non-NMA articles. The study utilized data from the Web of Science database, specifically searching for articles containing the term "meta-analysis" published between 2013 and 2022. The analysis examined the annual number of articles, as well as the countries, institutions, departments, and authors associated with the articles and the journals in which they were published. Ten different visualization techniques, including line charts, choropleth maps, chord diagrams, circle packing charts, forest plots, temporal heatmaps, impact beam plots, pyramid plots, 4-quadrant radar plots, and scatter plots, were employed to support the hypothesis that the number of NMA-related articles has increased (or declined) over the past decade when compared to non-NMA articles. Our findings indicate that there was no difference in mean citations or publication trends between NMA and non-NMA; the United States, McMaster University (Canada), medical schools, Dan Jackson from the United Kingdom, and the Journal of Medicine (Baltimore) were among the leading entities; NMA ranked highest on the coword analysis, followed by heterogeneity, quality, and protocol, with weighted centrality degrees of 32.51, 30.84, 29.43, and 24.26, respectively; and the number of NMA-related articles had increased prior to 2020 but experienced a decline in the past 3 years, potentially due to being overshadowed by the intense academic focus on COVID-19. It is evident that the number of NMA articles increased rapidly between 2013 and 2019 before leveling off in the years following. For researchers, policymakers, and healthcare professionals who are interested in evidence-based decision making, the visualizations used in this study may be useful.

Differential effects of bariatric surgery and caloric restriction on hepatic one-carbon and fatty acid metabolism

Weight loss interventions, including dietary changes, pharmacotherapy, or bariatric surgery, prevent many of the adverse consequences of obesity, and may also confer intervention-specific benefits beyond those seen with decreased weight alone. We compared the molecular effects of different interventions on liver metabolism to understand the mechanisms underlying these benefits. Male rats on a high-fat, high-sucrose diet underwent sleeve gastrectomy (SG) or intermittent fasting with caloric restriction (IF-CR), achieving equivalent weight loss. The interventions were compared to ad-libitum (AL)-fed controls. Analysis of liver and blood metabolome and transcriptome revealed distinct and sometimes contrasting metabolic effects between the two interventions. SG primarily influenced one-carbon metabolic pathways, whereas IF-CR increased de novo lipogenesis and glycogen storage. These findings suggest that the unique metabolic pathways affected by SG and IF-CR contribute to their distinct clinical benefits, with bariatric surgery potentially influencing long-lasting changes through its effect on one-carbon metabolism.

Exploring the effects of different interventions of the problem-oriented teaching model on students’ creativity in STEM education

ABSTRACT Background Creativity is one of the key competencies for the talent of the 21st century to meet future challenges in a complex world. It is also an innovative basis for students to discover and pose questions. Purpose This study aimed to explore which two interventions of the problem-oriented teaching model, teacher-guided problem finding (TGPF) and teacher-directed question posing (TDQP), was more effective in terms of improving students’ creativity in STEM education. Sample A total of 60 seventh-grade students participated in this study. Design and methods The TGPF group included 30 students who adopted the problem-finding method in which the teacher guided them to find problems, while another 30 students in the TDQP group adopted the method in which the teacher directly posed the questions. The Williams Creativity Aptitude Test (WCAT) was used to test the pre- and post-creativity of the two groups. Paired samples t tests were used to verify whether the two interventions of the problem-oriented teaching model could enhance students’ creativity, and independent samples t tests were used to verify the differences between the two interventions of the problem-oriented teaching model in the enhancement of creativity. Results The results indicated that both TGPF and TDQP can improve students’ creativity. Compared with the TDQP group, the TGPF group’s students could better improve their creativity, especially in the dimensions of adventure, imagination, and challenge. Conclusion This study provides references for teachers to use different problem-oriented teaching interventions in STEM education. Teachers should break from the previous approach of direct problem posing to the creation of situations and other methods to guide students to actively think of and discover problems, so as to better improve students’ creativity.

Planning for fear of crime reduction: Assessing the impact of public space regeneration on safety perceptions in deprived neighborhoods

Fear of crime significantly reduces people’s time–space access to and use of public space, notably in high-crime neighborhoods where concerns around personal safety are more acute. One widely used strategy to reduce fear of crime is the regeneration of the built environment. However, tension remains on whether this strategy is effective, and if it is, then where, which and for whom public space interventions work. This research, incorporating a gender perspective, assesses whether neighborhood-level regeneration of public space significantly enhances or reduces residents’ perceptions of safety in deprived urban areas with a gender perspective. To test these impacts, we run a randomized control trial with 100 residents in a high-crime neighborhood in Santiago de Chile. A series of geotagged photographs of the area and ten treatment photo simulations of proposed interventions were rated by residents according to their perceived safety related to crime. The results suggest that: highly unsafe perceptions cluster in specific neighborhood locations and are particularly acute for women; the regeneration of public spaces significantly increases perceived safety for both men and women; and the effectiveness of different interventions is gender-specific. The results suggest, while an effective technique, public space regeneration in deprived neighborhoods can be further optimized through urban design and planning policy that are space- and gender-specific. The technique presented could support researchers and practitioners to understand the spatial distribution of perceptions of safety, to select effective interventions to make deprived neighborhoods feel safer, and to assess the impact of regeneration strategies.

(032) Development of a Core Outcome Set for Provoked Vestibulodynia

Abstract Introduction The literature on vulvodynia treatment is heterogeneous in terms of intervention type, study quality, and outcome measures. A systematic review (SR) of vulvodynia treatments was recently published focusing on randomized controlled trials (RCTs) and non-RCTs for provoked vestibulodynia (PVD, a vulvodynia subtype). The authors of the SR concluded that most studies had very low certainty of evidence, which limited the ability to draw conclusions about intervention efficacy. In addition, the authors noted a large degree of heterogeneity in outcome measures, which limited the ability to conduct a meta-analysis, and they recommended that future studies incorporate a core outcome set (COS, an agreed-upon standardized set of outcomes that should be assessed and reported, as a minimum, in all clinical trials in specific areas of health or healthcare) so that results from future clinical trials of PVD can be combined and evaluated. Objective To establish a COS for PVD. Methods The Project Management Team of the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) consists of vulvodynia researchers/clinicians, a patient partner, and health technology methodologists. Since March 2022, the team has conducted a literature review and extracted all outcomes from the PVD treatment literature (as of 1990 for published studies, and no date limit for the clinical trials database). Sixty-six outcomes (e.g., pain during intercourse, sexual function) have been identified. To conduct a two round Delphi survey with multiple stakeholders, registration for participation in the study (ongoing) has been open to a variety of stakeholders: people with current or past lived experience of PVD, relatives of those with lived experience of PVD, healthcare practitioners, researchers, and others (e.g., leaders of patient or funding organizations). Participants who register will provide background information to ensure representativeness of stakeholder identification and sociodemographic status (e.g., country of residence, gender), after which they will be asked to participate in the first survey. The first survey asks participants to rate each of the outcomes on a 9-point scale (from outcome is not important to outcome is critical to include and should always be measured in treatment studies) and to list any outcomes that should be included but were missed. In the second survey, the outcomes with the highest ranks from the first survey and all new outcomes will be presented to the participants, and they will be asked to rate them. Then, a virtual consensus meeting will be held with some members from all stakeholder groups to discuss the highest ranked outcomes and to decide which ones to include in the core outcome set. Results We will report on interim progress of the COS for PVD. Conclusions The results of this study will contribute critical information to standardize outcome reporting across PVD treatment studies so that stakeholders can directly compare the effectiveness of different interventions, identify clinically relevant outcomes, and reduce the risk of reporting bias. In addition, they will allow for the generation of consistent data for meta-analyses. Disclosure No

Use of System Dynamics Modelling for Evidence-Based Decision Making in Public Health Practice

In public health, the routine use of linear forecasting, which restricts our ability to understand the combined effects of different interventions, demographic changes and wider health determinants, and the lack of reliable estimates for intervention impacts have limited our ability to effectively model population needs. Hence, we adopted system dynamics modelling to forecast health and care needs, assuming no change in population behaviour or determinants, then generated a “Better Health” scenario to simulate the combined impact of thirteen interventions across cohorts defined by age groups and diagnosable conditions, including “no conditions”. Risk factors for the incidence of single conditions, progression toward complex needs and levels of morbidity including frailty were used to create the dynamics of the model. Incidence, prevalence and mortality for each cohort were projected over 25 years with “do nothing” and “Better Health” scenarios. The size of the “no conditions” cohort increased, and the other cohorts decreased in size. The impact of the interventions on life expectancy at birth and healthy life expectancy is significant, adding 5.1 and 5.0 years, respectively. We demonstrate the feasibility, applicability and utility of using system dynamics modelling to develop a robust case for change to invest in prevention that is acceptable to wider partners.

Investigating Anxiety in Speaking among EFL Students: A Qualitative Study

This study investigates the causes of anxiety in speaking among EFL students and provides solutions to overcome them. A total of 33 students from the sixth semester of the English Education Department at Universitas Ahmad Dahlan participated in this descriptive qualitative research by completing questionnaires and interviews. The results revealed that nervousness, trembling, and shyness are causing anxiety among students in speaking English, and preparation, confidence, peer-seeking, and effort can help overcome speaking anxiety. The implication of the study suggests that language educators should be aware of the causes of anxiety in EFL students and provide appropriate solutions to help them overcome their speaking anxiety. Limitations of the study may include the relatively small sample size and the fact that the study only focused on sixth-semester students in one particular department at a single university. Therefore, the findings may not be generalizable to other populations or contexts. For future research, it would be useful to include a more extensive and diverse sample of participants from different levels of language proficiency and different educational backgrounds. Additionally, incorporating other data collection methods, such as observation or focus groups, could provide a more comprehensive understanding of the factors contributing to speaking anxiety among EFL students. Finally, exploring the effectiveness of different interventions or strategies to reduce speaking anxiety could be an interesting avenue for future research.

Comparative efficacy and acceptability of interventions for insomnia in breast cancer patients: A protocol for systematic review and network meta-analysis.

Symptoms of insomnia are highly prevalent in patients with breast cancer. There are a large number of pharmacological and non-pharmacological interventions that can be used for the management of insomnia in breast cancer patients; however, their comparative effectiveness and acceptability remain uncertain. This review aims to evaluate the efficacy and acceptability of different interventions for insomnia in breast cancer patients using a Bayesian network meta-analysis (NMA). We will perform a comprehensive literature search in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and PsycINFO from inception to November 2022. We will include randomized controlled trials (RCTs) that compared the effects of different interventions on the management of insomnia in breast cancer patients. We will assess the risk of bias assessment using a modified Cochrane instrument. We will conduct a Bayesian random-effects framework NMA to estimate relative effects of interventional procedures. We will use Grading of Recommendations Assessment, Development and Evaluation to rate the certainty of evidence. To our knowledge, this will be the first systematic review and network meta-analysis to compare the effectiveness and acceptability of all currently available interventions for insomnia in patients with breast cancer. The results of our review will help provide more evidence for the treatment of insomnia in breast cancer patients. PROSPERO registration number CRD42021282211.

PKCθ Regulates Pituitary Adenoma Bone Invasion by Activating Osteoclast in NF-κB/IL-1β-Dependent Manner

Pituitary adenoma (PA) bone invasion results in adverse outcomes, such as reduced rates of complete surgical resection and biochemical remission as well as increased recurrence rates, though few studies have been conducted. We collected clinical specimens of PAs for staining and statistical analysis. Evaluation of the ability of PA cells to induce monocyte-osteoclast differentiation by coculturing PA cells with RAW264.7 in vitro. An in vivo model of bone invasion was used to simulate the process of bone erosion and evaluate the effect of different interventions in alleviating bone invasion. We found an overactivation of osteoclasts in bone-invasive PAs and concomitant aggregation of inflammatory factors. Furthermore, activation of PKCθ in PAs was established as a central signaling promoting PA bone invasion through the PKCθ/NF-κB/IL-1β pathway. By inhibiting PKCθ and blocking IL1β, we were able to significantly reverse bone invasion in an in vivo study. Meanwhile, we also found that celastrol, as a natural product, can obviously reduce the secretion of IL-1β as well as alleviate the progression of bone invasion. By activating the PKCθ/NF-κB/IL-1β pathway, pituitary tumors are able to induce monocyte-osteoclast differentiation in a paracrine manner and promote bone invasion, which can be alleviated by celastrol.

Different interventions for the treatment of patent ductus arteriosus in children: a protocol for a network meta-analysis

IntroductionPatent ductus arteriosus (PDA) is one of the most common congenital heart diseases. Once the PDA is diagnosed, it needs to be dealt with in time. At present, main methods include pharmacological treatment, surgical closure, and interventional closure for treatment of PDA. However, the effect of different interventions in PDA management is still controversial. Thus, our study aims to assess the effectiveness of different interventions together and estimate the sequence of these therapies for PDA children. Meanwhile, it is necessary to conduct a Bayesian network meta-analysis to compare the safety of different interventions comprehensively.Methods and analysisTo the best of our knowledge, this is the first Bayesian network meta-analysis comparing the efficacy and safety of different interventions for the treatment of PDA. PubMed, Embase, Cochrane Library, Web of Science, gray literature, and trial registry databases were searched from inception to December 2022. We will extract and report data according to methodological guidelines for Bayesian network meta-analysis by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Primary PDA closure, overall PDA closure, technical success, surgical success rate, mortality during hospital stay, operation time, intensive care unit stay, intraoperative radiation dose, radiation exposure time, total postoperative complication rate, and postoperative major complication rate will be defined as the outcomes. The quality of all random studies will be assessed using ROB, and quality of evidence for all outcomes will be judged by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).Ethics and disseminationThe results will be disseminated through peer-reviewed publication. Since no private and confidential patient data will be contained in the reporting, there are no ethical considerations associated with this protocol.Systematic review registrationINPLASY2020110067.

Setting-up place-based and transdisciplinary research to foster agrifood system transformation: Insights from the Aliment'Actions project in western France

Many agrifood systems around the world can be characterized as unsustainable. Research is increasingly required to inform the necessary radical transformations of the ways we produce, process, transport, and consume food. This article presents the research approach and methods of an ongoing project carried out at a long-term social–ecological research site, the Zone Atelier Plaine and Val de Sèvre (western France). The research project presented here, Aliment'Actions, started in 2018 and within 10 years of its implementation seeks to study and trigger transformation to enhance the sustainability and resilience of the regional agrifood system. Its research agenda contains four types of actions: (a) backdrop actions that enhance communication and trust between researchers and local stakeholders, (b) targeted actions that are conducted in specific villages with a wide range of stakeholders to elaborate and implement various transformation levers, (c) assessment actions evaluating the effects of different interventions, and (d) communication and result from dissemination actions. Overall, these actions aim to co-produce knowledge, raise awareness regarding challenges in the food system, envision new interactions between stakeholders, collectively generate innovative ideas, and catalyze actions oriented toward agrifood system transformation. The project implementation is adaptive and iterative, from theory to practice. This Methods paper puts this ongoing project into the perspective of other place-based research initiatives and provides insights on how to foster the engagement of non-academic actors in transdisciplinary research supporting agrifood system transformation.

Stratification of spine patients based on self-reported clinical symptom classes: Evaluation of long-term outcomes and subsequent interventions

BackgroundPrior work by our group developed a stratification tool based on four PROMIS domains for patients with low back pain (LBP). Our study aimed to evaluate the ability of our previously developed symptom classes to predict long-term outcomes, and determine whether there were differential treatment effects by intervention. MethodsThis was a retrospective cohort study of adult patients with LBP seen in spine clinics in a large health system between November 14, 2018 and May 14, 2019 who completed patient-reported outcomes as part of routine care at baseline and again at 12-months follow-up. Latent class analysis identified symptom classes based on PROMIS domain scores (physical function, pain interference, social role satisfaction, and fatigue) that were ≥1 standard deviation worse (meaningfully worse) than the general population. The ability of the profiles to predict long-term outcomes at 12-months was evaluated through multivariable models. Differences in outcomes by subsequent treatments (physical therapy, specialist visits, injections, and surgery) were investigated. ResultsThere were 3,236 adult patients (average age 61.1 ± 14.2, 55.4% female) included in the study with three distinct classes identified: mild symptoms (n = 986, 30.5%), mixed (n = 798, 24.7%) with poor scores on physical function and pain interference but better scores on other domains, and significant symptoms (n = 1,452, 44.9%). The classes were significantly associated with long-term outcomes, with patients with significant symptoms improving the most across all domains. Utilization differed across classes, with the mixed symptom class receiving more PT and injections and significant symptom class receiving more surgeries and specialist visits. ConclusionsPatients with LBP have distinct clinical symptom classes which could be utilized to stratify patients into groups based on risk of future disability. These symptom classes can also be used to provide estimates of the effectiveness of different interventions, further increasing the clinical utility of these classes in standard care.

Assessing intervention effectiveness at promoting voluntary conservation practice adoption in agrienvironments.

Although implementing conservation practices on private farms and forests can produce substantial environmental benefits, these practices are not being adopted widely enough to result in measurable improvements at regional scales. Researchers have investigated the production and program factors influencing producer choices to voluntarily adopt these practices. However, the findings of reviews are inconsistent, raising questions about review methods, including the omission of relevant variables. Further, applying lessons from past work to promote adoption is difficult because many reviews investigated dispositional or demographic variables that practitioners and policy makers cannot directly observe or influence. We conducted a new review of 146 empirical studies that tested the effects of different interventions (e.g., financial incentives, outreach events, and nudges) on increasing the likelihood of producers adopting conservation practices. We conducted a metaregression of quantitative studies from diverse disciplines that filtered studies by quality (i.e., use of randomization and clear analysis reporting). We synthesized these results with a thematic analysis of qualitative studies on producer perspectives about conservation practices. Financial incentives had the strongest evidence of increasing producers' likelihood of adopting conservation practices (odds ratio 1.86, p < 0.05). However, this effect was only apparent after filtering by study quality, which also improved model fit and identified significant regional differences (odds ratio -1.69, p < 0.01). The thematic review of qualitative studies revealed that peer groups may be successful in reinforcing adoption behaviors due to homophily effects and that financial incentives not only offset implementation costs but also mitigated perceived risks of adoption. Given the problems we encountered in testing hypotheses about the magnitude of variability explained by intervention types and practice characteristics, we recommend additional experimental and longitudinal work that accounts for financial incentives and pairs qualitative and quantitative data to clarify relationships between program design and practice adoption rates.