Evidence-based Strategies Research Articles

A structured approach to modifying an implementation package while scaling up a complex evidence-based practice.

To describe a structured, iterative, data-driven approach for modifying implementation strategies for a complex evidence-based practice during a nationwide scale-up initiative. We scaled-up implementation of Critical Time Intervention (CTI)-an evidence-based case management model-across 32 diverse community-based Veterans Affairs (VA) "Grant and Per Diem" case management (GPD-CM) agencies that serve homeless-experienced Veterans transitioning to independent living. Primary data were collected using qualitative methods. We embarked on a scale-up initiative while conducting a pragmatic randomized evaluation using a roll-out design, comparing two versions of a CTI implementation package tailored to VA's GPD-CM program. We iteratively assessed contextual factors and implementation outcomes (e.g., acceptability); findings informed package modifications that were characterized using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies. We conducted semi-structured interviews with Veterans, GPD-CM staff, and liaising VA clinicians; periodic reflections with liaising VA clinicians and implementation team members; and drew upon detailed meeting notes. We used rapid qualitative methods and content analysis to integrate data and characterize modifications. After each scale-up wave-in response to variations in agency-level characteristics- we made iterative modifications to the implementation package to increase CTI adoption and fidelity across the diverse contexts of our scale-up sites. Modifications included adding, deleting, integrating, and altering the package; core package components were preserved. Implementation packages for complex evidence-based practices undergoing scale-up in diverse contexts may benefit from iterative modifications to optimize practice adoption with fidelity. We offer a structured, pragmatic approach for iteratively identifying data-driven, midstream implementation package adjustments, for use in both VA and non-VA scale-up initiatives. Our project demonstrates the importance of assessing for and making modifications in a scale-up initiative, as well as the trade-offs of projects having simultaneous formative and summative evaluation aims.

Clinical and electroencephalographic correlates of carbamazepine-associated hiccups in epileptic patients.

Carbamazepine, a commonly prescribed antiepileptic drug, is known to induce hiccups in a subset of epileptic patients. Although relatively uncommon, can have significant clinical implications. This comprehensive review delves into the clinical and electroencephalographic correlates of carbamazepine-associated hiccups, aiming to enhance understanding and management of this neurological side effect. The authors' review synthesizes qualitative epidemiological data, revealing that carbamazepine-induced hiccups occur in a subset of patients receiving the medication, with reported incidence rates ranging from 2.5 to 40%. Despite its relatively low prevalence, hiccups pose substantial challenges for patients and healthcare providers. Complications associated with carbamazepine-induced hiccups include disruption of sleep, impaired social functioning, and decreased quality of life, underscoring the clinical significance of this side effect. Effective management strategies can be implemented through a multidisciplinary approach, including collaboration among neurologists, pharmacists, and other healthcare professionals. These may include dose adjustments, medication discontinuation, and adjunctive therapies such as diaphragmatic breathing exercises or acupuncture. Additionally, close monitoring for adverse effects and timely intervention are essential to mitigate the impact of hiccups on patient well-being. Essentially, carbamazepine-induced hiccups represent a clinically relevant phenomenon that warrants attention in the management of epilepsy. By recognizing the clinical manifestations, understanding the underlying pathophysiology, and implementing evidence-based management strategies, healthcare providers can optimize patient care and improve outcomes in this patient population.

Ziabetus (Prediabetes): A Harbinger of Critical Stage in the Continuum of Glucose Metabolism Disorder: A Review

Background: Prediabetes is a metabolic condition characterized by blood glucose levels higher than normal but below the threshold for diabetes mellitus. It represents a critical stage in the progression towards type 2 diabetes mellitus (T2DM) and is associated with an increased risk of cardiovascular disease and other complications. The two major pathophysiologic defects responsible for losing glucose tolerance are insulin resistance and β-cell glucose insensitivity, both appearing in subjects of Intermediate Hyperglycaemia. In classical literature, Unani physicians have described the initial symptoms and factors leading to the pathology, the risk factors are described in terms of ‘Su-e-mizaj’ as per the concept of Tibb. So, it is considered in the context of Ziabetus which is described as a disease that develops due to Sue-mizaj haar (abnormal hot temperament). The symptoms mentioned in Unani medicine are increased frequency of micturition (ants and flies are attracted to urine), increased thirst, nocturia, dryness of mouth and whole body, fatigue, loss of weight, malaise, and cramps in lower extremities. The modern drug-based approach for the management of Intermediate Hyperglycaemia is associated with inherent drawbacks, including toxicity, tolerability, cost, and efficacy. Objective: The purpose of this review is to provide an in-depth understanding of prediabetes concerning the classical literature of Greek medicine based on the analysis of certain parameters like etiopathophysiology, current diagnostic criteria, risk factors, and evidence-based management strategies. By synthesizing findings from epidemiological studies, and clinical trials, this paper aims to enhance understanding of prediabetes and facilitate effective preventive measures and interventions. Keywords: Prediabetes, Intermediate hyperglycaemia, Impaired Glucose Tolerance, Impaired Fasting Glucose, Insulin Resistance.

Exploring Nursing Students' Expectations on Preceptoring and Preceptorship Program: A Mixed Method Study.

This study addresses the imperative in contemporary nursing education to prepare students for diverse healthcare settings by exploring nursing students' expectations and perceptions of preceptorship programs, emphasizing the role of evidence-based educational strategies. The research aims to bridge the existing literature gap and contribute valuable insights into strategically designing preceptorship programs aligned with nursing students' needs, preferences, and aspirations, ultimately enhancing precepting practices and relationships within nursing education. Employing a sequential explanatory mixed method, 140 nursing students, from various colleges in the United Arab Emirates (UAE) participated in the study. A structured questionnaire, encompassing demographic information, a need assessment survey, and a survey on expectations on preceptors was administered. A focus group discussion was conducted to identify perceived barriers to the utilization of preceptorship practices in nursing colleges. Data analysis involved descriptive statistics, the chi-square test, exploratory factor analysis, and content analysis of the focus group discussion. The majority of participants expressed a high need for a preceptorship program, providing empirical evidence to support the development of a nurse educator preceptorship program in colleges and institutes. Preceptorship was identified as a significant contributor to career growth and achievement for nursing students, serving as a valuable tool to establish professional competency throughout their careers. There is a complex demand and high expectations for the core role of nurse educators as preceptors in the field of nursing education. This pioneering study sheds light on the need and perception of nursing students for a preceptorship program in the nursing curriculum.

Prostate cancer screening-current overview

The harm-to-benefit ratio of prostate cancer (PCa) screening remains controversial mainly due to the unfavorable test characteristics of prostate-specific antigen (PSA) as ascreening test. In this nonsystematic review, we present acurrent overview of the body of evidence on prostate cancer screening with afocus on the role of magnetic resonance imaging (MRI) of the prostate. Evidence generated in large randomized controlled trials showed that PSA-based screening significantly decreases cancer-specific mortality. The main obstacle in developing and implementing PCa screening strategies is the resulting overdiagnosis and as aconsequence overtreatment of indolent cancers. Opportunistic screening is characterized by an adverse benefit-to-harm ratio and should, therefore, not be recommended. The German Statutory Early Detection Program for prostate cancer, which consists of adigital rectal examination (DRE) as astand-alone screening test, is not evidence-based, neither specific nor sensitive enough and results in unnecessary diagnostics. The European Commission recently urged member states to develop population-based and organized risk-adapted PSA-based screening programs, which are currently tested in the ongoing German PROBASE trial. Finetuning of the diagnostic pathway following PSA-testing seems key to improve its positive and negative predictive value and thereby making PCa screening more accurate. Incorporation of prostatic MRI into screening strategies leads to more accurate diagnosis of clinically significant prostate cancer, while diagnosis of indolent cancers is reduced. In the future, molecular liquid-based biomarkers have the potential to complement or even replace PSA in PCa screening and further personalize screening strategies. Active surveillance as an alternative to immediate radical therapy of demographically increasing PCa diagnoses can potentially further improve the benefit-to-harm ratio of organized screening. Early detection of PCa should be organized on apopulation level into personalized and evidence-based screening strategies. Multiparametric MRI of the prostate may play akey role in this setting.

Intensification of a Reading Comprehension Intervention Using Student Data: A Pilot Study

Many students in the upper elementary grades and beyond uniquely struggle with reading comprehension, necessitating explicit instruction and remediation in this area. This study used data-based decision-making (DBDM), a research-based systematic approach to student data collection and analysis, to intensify the evidence-based Strategies for Reading Information and Vocabulary Effectively (STRIVE) reading comprehension intervention. Results indicate that students who received DBDM to intensify STRIVE and students who received STRIVE alone outperformed students in a business-as-usual comparison condition on a researcher-designed vocabulary mastery measurement. Other findings, future directions, and implications for research and teaching are also discussed.

Knowledge, attitude, and practice toward allergic rhinitis among parents in Ningbo, China

BackgroundThis study examined the knowledge, attitude, and practice (KAP) toward allergic rhinitis (AR) among parents.MethodsThis cross-sectional study enrolled parents of children with AR at Ningbo Hangzhou Bay Hospital between December 2022 and March 2023. A self-administered questionnaire was developed to collect the demographic characteristics, knowledge, attitudes, and practices toward AR.ResultsThis study included 480 questionnaires, and 78.33% were mothers. The mean knowledge, attitude, and practice scores were 13.49 ± 6.62 (possible range: 0–24), 33.99 ± 3.40 (possible range: 8–40), and 21.52 ± 3.36 (possible range: 5–26), indicating poor knowledge, positive attitudes, and proactive practice. Multivariable logistic regression analysis showed living in urban areas in Ningbo outside Hangzhou Bay New Zone (OR = 4.33, 95%CI: 1.52–12.34, P = 0.006), living in rural areas in Ningbo (OR = 2.15, 95%CI: 1.00-4.59, P = 0.049), being self-employed (OR = 1.99, 95%CI: 1.00-3.95, P = 0.049), monthly income per capita ≥ 20,000 CNY (OR = 1.89, 95%CI: 1.02–3.47, P = 0.042), child with one biological sibling (OR = 0.48, 95%CI: 0.30–0.78, P = 0.003), and ≥ 6 times hospital visits for AR (OR = 2.32, 95%CI: 1.40–3.86, P = 0.001) were independently associated with adequate knowledge. The knowledge (OR = 1.09, 95%CI: 1.05–1.13, P < 0.001) and ≥ 6 times hospital visits for AR (OR = 1.84, 95%CI: 1.06–3.22, P = 0.032) were independently associated with a positive attitude. The knowledge (OR = 1.08, 95%CI: 1.04–1.13, P = 0.001), attitude (OR = 1.41, 95%CI: 1.28–1.55, P < 0.001), monthly income per capita ≥ 20,000 CNY (OR = 3.59, 95%CI: 1.49–8.65, P = 0.004), no previous hospital visit for AR (OR = 0.35, 95%CI: 0.16–0.78, P = 0.003), and ≥ 6 times hospital visits for AR (OR = 0.40, 95%CI: 0.20–0.81, P = 0.011) were independently associated with the practice scores.ConclusionsThe parents of children with AR had poor knowledge but positive attitudes and proactive practice toward AR. This study has identified a need for specific and reliable information initiatives to be introduced as a means of reducing parental concern and ensuring evidence-based strategies for managing children with AR.

Determinants of psychological distress during the COVID-19 pandemic among people who use drugs in Montreal, Canada.

Limited data exists on psychological impacts of the COVID-19 pandemic among people who use drugs (PWUD). This study aimed to determine the prevalence and correlates of severe psychological distress (PD) among PWUD in Montreal around the beginning of the pandemic. We conducted a rapid assessment study from May to December 2020 among PWUD recruited via a community-based cohort of people who inject drugs in Montreal (Hepatitis C cohort [HEPCO], N = 128) and community organisations (N = 98). We analysed self-reported data on changes in drug use behaviours and social determinants since the declaration of COVID-19 as a public health emergency, and assessed past-month PD using the Kessler K6 scale. Multivariable logistic regression was conducted to examine correlates of PD distress (score ≥13). Of 226 survey participants, a quarter (n = 56) were screened positive for severe PD. In multivariable analyses, age (1-year increment) (adjusted odds ratio = 0.94, 95% confidence interval [0.90, 0.98]) and a decrease in non-injection drug use versus no change (0.26 [0.07, 0.92]) were protective against severe PD, while positive associations were found for any alcohol use in the past 6 months (3.73 [1.42, 9.78]), increased food insecurity (2.88 [1.19, 6.93]) and both moving around between neighbourhoods more (8.71 [2.63, 28.88]) and less (3.03 [1.18, 7.74]) often compared to no change. This study documented a high prevalence of severe PD among PWUD during the COVID-19 pandemic compared with pre-COVID-19 data. Social determinants such as food insecurity and mobility issues, alongside demographic and substance use-related factors, were linked to distress. Evidence-based risk mitigation strategies for this population could reduce negative consequences in future pandemics or disruptions.

Role of Symbolism in Reader Understanding and Interpretation in Nigeria

Purpose: The aim of the study was to assess the role of symbolism in reader understanding and interpretation in Nigeria. Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: The role of symbolism in reader understanding and interpretation is profound, as symbols serve as powerful tools for conveying deeper meanings and themes within literary works. Through symbolism, authors imbue objects, characters, and events with additional layers of significance, allowing readers to engage with the text on multiple levels. Symbolism facilitates the exploration of complex ideas, emotions, and societal issues, often transcending language barriers and resonating with diverse audiences. Moreover, it encourages readers to actively participate in the interpretation process, fostering personal connections and insights that enrich their reading experiences. Consequently, the study of symbolism underscores its crucial role in shaping reader comprehension and interpretation, highlighting its capacity to evoke profound reflections on the human condition and the world around us. Implications to Theory, Practice and Policy: Reader-response theory, semiotic theory and cognitive theory of metaphor may be used to anchor future studies on assessing the role of symbolism in reader understanding and interpretation in Nigeria. Educators should implement evidence-based instructional strategies for teaching symbolism in educational settings, including guided discussion, close reading, and scaffolded instruction. Educational policymakers should consider integrating symbolism into curriculum standards and assessments to ensure that students develop symbolic literacy skills alongside other critical reading competencies.

“Behind bars: Understanding prisoner perception of penitentiary rehabilitation in Kazakhstan”

This study focuses on identifying factors that, from the perspective of prisoners, contribute to positive perceptions of rehabilitation (correction) in prison. A survey was conducted of 645 soon-to-be-released inmates (530 males and 115 females) in five institutions, with questions covering demographics, incarceration details, access to social services, and personal values. The research revealed that male inmates tended to hold more positive views on penitentiary rehabilitation than female inmates. However, it was observed that the rigidity of the prison regime and the existence of chronic illnesses among inmates negatively influenced these positive perceptions towards rehabilitation. Furthermore, the implementation of diverse rehabilitation-focused initiatives by non-governmental organisations (NGOs), coupled with an awareness of rights and responsibilities and the presence of strong family values, has been linked to fostering positive perceptions of rehabilitation. These findings highlight the critical need for enhanced cooperation between non-governmental organisations and prison facilities, as well as the introduction of social work practices within Kazakhstan's prison system. Policymakers should consider these factors when designing evidence-based rehabilitation strategies, emphasising the utilization of social work technologies.

Methodology for adapting a co-created early childhood development intervention and implementation strategies for use by frontline workers in India and Guatemala: a systematic application of the FRAME-IS framework

ABSTRACT There is little evidence on optimizing the effectiveness and implementation of evidence-based early childhood development (ECD) interventions when task-shifted to frontline workers. In this Methods Forum paper, we describe our adaptation of the International Guide for Monitoring Child Development (GMCD) for task-shifting to frontline workers in Guatemala and India. In 2021–2022, implementers, trainers, frontline workers, caregivers, and international GMCD experts collaborated to adapt the GMCD for a task shifted implementation by frontline workers. We used an eight-step co-creating process: assembling a multidisciplinary team, training on the existing package, working groups to begin modifications, revision of draft modifications, tailoring of visual materials and language, train-the-trainers activities, pilot frontline worker trainings, final review and feedback. Preliminary effectiveness of adaptations was evaluated through narrative notes and group-based qualitative feedback following pilot trainings with 16 frontline workers in India and 6 in Guatemala. Final adaptations included: refining training techniques to match skill levels and learning styles of frontline workers; tailoring all visual materials to local languages and contexts; design of job aids for providing developmental support messages; modification of referral and triage processes for children in need of enhanced support and speciality referral; and creation of post-training support procedures. Feedback from pilot trainings included: (1) group consensus that training improved ECD skills and knowledge across multiple domains; and (2) feedback on ongoing needed adjustments to pacing, use of video-based vs. role-playing materials, and time allocated to small group work. We use the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) framework to document our adaptations. The co-creating approach we use, as well as systematic documentation of adaptation decisions will be of use to other community-based early childhood interventions and implementation strategies.

Using an mHealth approach to collect patient-generated health data for predicting adverse health outcomes among adult survivors of childhood cancer.

Cancer therapies predispose childhood cancer survivors to various treatment-related late effects, which contribute to a higher symptom burden, chronic health conditions (CHCs), and premature mortality. Regular monitoring of symptoms between clinic visits is useful for timely medical consultation and interventions that can improve quality of life (QOL). The Health Share Study aims to utilize mHealth to collect patient-generated health data (PGHD; daily symptoms, momentary physical health status) and develop survivor-specific risk prediction scores for mitigating adverse health outcomes including poor QOL and emergency room admissions. These personalized risk scores will be integrated into the hospital-based electronic health record (EHR) system to facilitate clinician communications with survivors for timely management of late effects. This prospective study will recruit 600 adult survivors of childhood cancer from the St. Jude Lifetime Cohort study. Data collection include 20 daily symptoms via a smartphone, objective physical health data (physical activity intensity, sleep performance, and biometric data including resting heart rate, heart rate variability, oxygen saturation, and physical stress) via a wearable activity monitor, patient-reported outcomes (poor QOL, unplanned healthcare utilization) via a smartphone, and clinically ascertained outcomes (physical performance deficits, onset of/worsening CHCs) assessed in the survivorship clinic. Participants will complete health surveys and physical/functional assessments in the clinic at baseline, 2) report daily symptoms, wear an activity monitor, measure blood pressure at home over 4 months, and 3) complete health surveys and physical/functional assessments in the clinic 1 and 2 years from the baseline. Socio-demographic and clinical data abstracted from the EHR will be included in the analysis. We will invite 20 cancer survivors to investigate suitable formats to display predicted risk information on a dashboard and 10 clinicians to suggest evidence-based risk management strategies for adverse health outcomes. Machine and statistical learning will be used in prediction modeling. Both approaches can handle a large number of predictors, including longitudinal patterns of daily symptoms/other PGHD, along with cancer treatments and socio-demographics. The individualized risk prediction scores and added communications between providers and survivors have the potential to improve survivorship care and outcomes by identifying early clinical presentations of adverse events.

Nexus of knowledge oriented leadership and knowledge worker performance in Chinese higher education institutions: a post-pandemic behavioral analysis

PurposeIn the wake of the COVID-19 outbreak understanding the behavioral dynamics and role of knowledge-oriented leadership (KOL) in driving knowledge worker performance (KWP) is paramount for organizations striving to adapt and thrive in the post-pandemic era. Drawing on the path-goal theory, this study explores the impact of KOL on KWP. In addition, this study seeks to examine both the direct and indirect influences of KOL on KWP via digital orientation (DO) and digital citizenship practices (DCP), especially for higher education institutions (HEIs) located in China.Design/methodology/approachThe sample consisted of 319 academic staff from HEIs in China. The study used Smart-PLS 4.0 for analytical examination.FindingsThe results indicate that the impact of knowledge-oriented leadership on KWP is negligible. Furthermore, DCP and DO partially mediate the relationship between KOL and KWP. The findings of this research have practical implications for Chinese HEIs and organizations across industries, providing insights into how to navigate the complexities of the post-pandemic work environment and effectively harness digitalization to optimize the KWP.Research limitations/implicationsThe implications of this research extend beyond the HEIs, providing organizations in various industries with evidence-based strategies to promote effective leadership, foster digital skills, and cultivate a culture of digital citizenship in the post-pandemic work landscape.Originality/valueDespite the increasing significance of KOL in the higher education sector, there is a dearth of studies establishing a relationship between KOL and KWP in HEIs. The present study seeks to fill this gap by examining the association among KOL, KWP, DO, and DCP in HEIs during the post-pandemic. This research provides significant contributions to the existing literature on the topic by scientifically exploring the association between KOL and KWP by examining the intervention mechanism of both digital citizenship practices and digital orientation.

Building a sharable literature collection to advance the science and practice of implementation facilitation.

Implementation science seeks to produce generalizable knowledge on strategies that promote the adoption and sustained use of evidence-based innovations. Literature reviews on specific implementation strategies can help us understand how they are conceptualized and applied, synthesize findings, and identify knowledge gaps. Although rigorous literature reviews can advance scientific knowledge and facilitate theory development, they are time-consuming and costly to produce. Improving the efficiency of literature review processes and reducing redundancy of effort is especially important for this rapidly developing field. We sought to amass relevant literature on one increasingly used evidence-based strategy, implementation facilitation (IF), as a publicly available resource. We conducted a rigorous systematic search of PubMed, CINAHL, and Web of Science citation databases for peer-reviewed, English-language articles with "facilitation" and a combination of other terms published from January 1996 to December 2021. We searched bibliographies of articles published from 1996 to 2015 and identified articles during the full text review that reported on the same study. Two authors screened 3,168 abstracts. After establishing inter-rater reliability, they individually conducted full-text review of 786 relevant articles. A multidisciplinary team of investigators provided recommendations for preparing and disseminating the literature collection. The literature collection is comprised of 510 articles. It includes 277 empirical studies of IF and 77 other articles, including conceptual/theoretical articles, literature reviews, debate papers and descriptions of large-scale clinical initiatives. Over half of the articles were published between 2017 and 2021. The collection is publicly available as an Excel file and as an xml file that can be imported into reference management software. We created a publicly accessible collection of literature about the application of IF to implement evidence-based innovations in healthcare. The comprehensiveness of this collection has the potential to maximize efficiency and minimize redundancy in scientific inquiry about this strategy. Scientists and practitioners can use the collection to more rapidly identify developments in the application of IF and to investigate a wide range of compelling questions on its use within and across different healthcare disciplines/settings, countries, and payer systems. We offer several examples of how this collection has already been used.

Lowland Tropical Peatlands – A Brief Review of Their Important Role in the Global Carbon Cycle and Biodiversity Support

Tropical peatlands are crucial ecosystems, storing vast carbon reserves and supporting rich biodiversity. Despite covering a small land area, they play significant roles in global carbon cycling and climate regulation. However, these ecosystems face escalating threats from human activities, including agricultural expansion and peatland drainage. This paper provides a concise overview of tropical peatlands, focusing on their distribution, characteristics, and ecological importance in Southeast Asia, Africa, and South America. It highlights the diverse vegetation communities and notable animal species found in peat swamp forests, underscoring their conservation value. Peatland degradation leads to increased greenhouse gas emissions, land subsidence, and loss of traditional livelihoods for local communities. Addressing these challenges requires integrated approaches, including conservation efforts to protect and restore intact peat swamp forests, sustainable land-use practices, and policy interventions to regulate land management. Research collaboration between scientists, policymakers, and local communities is essential for developing evidence-based conservation strategies. By prioritizing the preservation of tropical peatlands, we can mitigate climate change impacts, conserve biodiversity, and safeguard the well-being of local communities.

Emerging Technology Integration - Artificial Intelligence (AI) and Machine Learning (ML) for Predictive Analysis for Safety and Toxicity Assessment in Environmental Toxicology

Environmental toxicology is facing unprecedented challenges due to the escalating complexity of environmental issues. Traditional methodologies for safety and toxicity assessment are struggling to keep pace with the rapid evolution of pollutants and their impacts on ecosystems and human health. In response to this pressing need, there has been a paradigm shift in the field towards the integration of Artificial Intelligence (AI) and Machine Learning (ML) techniques. This research article delves into the transformative potential of AI and ML in environmental toxicology, elucidating how these advanced computational tools offer promising solutions for predictive analysis. By leveraging vast datasets and sophisticated algorithms, AI and ML enable more efficient, accurate, and timely assessment of environmental risks. They empower researchers and policymakers to anticipate and mitigate potential hazards before they escalate into crises. This paper provides a comprehensive overview of the diverse applications of AI and ML in environmental toxicology, ranging from predictive modeling of chemical hazards to early detection of environmental threats. Furthermore, it highlights the potential of AI and ML to revolutionize decision-making processes in environmental management and policy formulation. By synthesizing vast amounts of data and identifying complex patterns and correlations, these technologies offer invaluable insights for crafting evidence-based policies and strategies to safeguard the environment and public health. This research article underscores the pivotal role of AI and ML in addressing the multifaceted challenges of environmental toxicology. Through their integration, we have the opportunity to enhance our understanding of environmental risks, optimize resource allocation, and ultimately, pave the way towards a more sustainable and resilient future.

Five Evidence-Based Strategies to Foster a Culture of Well-Being in Physician Assistant Education.

The objective of this study was to discuss evidence-based strategies to promote a culture of well-being with physician assistant (PA) education. Published literature on medical student, resident, and PA student well-being was reviewed with findings subsequently categorized according to well-being strategy. Five themes were found from existing well-being research within medical student and PA student education: faculty role modeling and support, dedicated curricular time, pass/fail grading schema and de-emphasizing grades, peer support and learning communities, and evaluation importance. Physician assistant educators may be able to foster a culture of well-being for their students by making even small adjustments to the existing educational curriculum.

National trends in utilisation of glucose lowering medicines by older people with diabetes in long-term care facilities

AimsTo examine national trends in glucose lowering medicine (GLM) use among older people with diabetes in long-term care facilities (LTCFs) during 2009–2019. MethodsA repeated cross-sectional study of individuals ≥65 years with diabetes in Australian LTCFs (n = 140,322) was conducted. Annual age-sex standardised prevalence of GLM use and number of defined daily doses (DDDs)/1000 resident-days were estimated. Multivariable Poisson or Negative binomial regression models were used to estimate adjusted rate ratios (aRRs) and 95 % confidence intervals (CIs). ResultsPrevalence of GLM use remained steady between 2009 (63.9%, 95 %CI 63.3–64.4) and 2019 (64.3%, 95 %CI 63.9–64.8) (aRR 1.00, 95 %CI 1.00–1.00). The percentage of residents receiving metformin increased from 36.0% (95 %CI 35.3–36.7) to 43.5% (95 %CI 42.9–44.1) (aRR 1.01, 95 %CI 1.01–1.01). Insulin use also increased from 21.5% (95 %CI 21.0–22.0) to 27.0% (95 %CI 26.5–27.5) (aRR 1.02, 95 %CI 1.02–1.02). Dipeptidyl peptidase-4 inhibitor use increased from 1.0% (95 %CI 0.9–1.1) to 21.1% (95 %CI 20.7–21.5) (aRR 1.24, 95 %CI 1.24–1.25), while sulfonylurea use decreased from 34.4% (95 %CI 33.8–35.1) to 19.3% (95 %CI 18.9–19.7) (aRR 0.93, 95 %CI 0.93–0.94). Similar trends were observed in DDDs/1000 resident days. ConclusionsThe increasing use of insulin and ongoing use of sulfonylureas suggests a need to implement evidence-based strategies to optimise diabetes care in LTCFs.

Recruitment and retention of adolescents for an ecological momentary assessment measurement burst mental health study: The MHIM engagement strategy.

Recruitment and long-term retention of adolescent participants in longitudinal research are challenging and may be especially so in studies involving remote measurement and biosampling components. The ability to effectively recruit and retain participants can be supported by the use of specific evidence-based engagement strategies that are built in from the earliest stages. Informed by a review of the evidence on effective engagement strategies and consultations with adolescents (via two Young Person Advisory Groups [YPAGs]; ages 11-13 and 14-17), the current protocol describes the planned participant engagement strategy for the Mental Health in the Moment Study: a multimodal measurement burst study of adolescent mental health across ages 11-19. The protocol incorporates engagement strategies in four key domains: consultations/co-design with the target population, incentives, relationship-building and burden/barrier reduction. In addition to describing general engagement strategies in longitudinal studies, we also discuss specific concerns regarding engagement in data collection methods such as biosampling and ecological momentary assessment where a paucity of evidence exists. Engagement strategies for adolescent mental health studies should be based on existing evidence and consultations with adolescents. We present our approach in developing the planned engagement strategies and also discuss limitations and future directions in engaging adolescents in longitudinal research. The study design for this project places a strong emphasis on the active engagement of adolescents throughout its development. Specifically, the feedback and suggestions provided by the YPAGs have been instrumental in refining our strategies for maximising the recruitment and retention of participants.

Comparing harm reduction and overdose response services between community-based and public health department syringe service programmes using a national cross-sectional survey

Syringe services programmes (SSPs) are an evidence-based strategy to reduce infectious diseases and deliver overdose prevention interventions for people who use drugs. They face regulatory, administrative, and funding barriers that limit their implementation in the US, though the federal government recently began providing funding to support these efforts. In this study we aim to understand whether the organisational characteristics of SSPs are associated with the provision of syringe and other overdose response strategies. We examine four outcomes using the National Survey of Syringe Services Programs (NSSSP) (N=472): syringe distribution, naloxone distribution, fentanyl test strip (FTS) availability, and buprenorphine implementation. These outcomes are assessed across three organizational categories of SSPs-those operated by public health departments (DPH), community-based organizations (CBOs) with government funding, and CBOs without government funding-while adjusting for community-level confounders. The proportion of SSPs by organizational category was 36% DPH, 42% CBOs with government funding, and 22% CBOs without government funding. Adjusting for community-level differences, we found that CBO SSPs with government funding had significantly higher provision of all four syringe and overdose response services as compared to DPH SSPs and across three of the four services as compared to CBO SSPs without government funding. CBO SSPs without government funding still had significantly higher provision of three of the four services as compared to programmes maintained by the DPH. CBO SSPs have strong potential to expand overdose response services nationally, particularly if provided with sustained and adequate funding. Communities should aim to provide funding that does not hinder SSP innovation so they can remain flexible in responding to local needs. This study was supported by Arnold Ventures (20-05172).