Feasibility Of Implementation Research Articles

Feasibility and potential effectiveness of nurse-led video-coaching interventions for childhood, adolescent, and young adult cancer survivors: the REVIVER study

BackgroundChildhood, adolescent, and young adult (CAYA) cancer survivors, at risk for late effects, including cancer-related fatigue, cardiovascular issues, and psychosocial challenges, may benefit from interventions stimulating behaviour adjustments. Three nurse-led eHealth interventions (REVIVER) delivered via video calls and elaborating on person-centred care, cognitive behaviour therapy and/or motivational interviewing were developed. These interventions target: 1) fatigue management, 2) healthier lifestyle behaviours, and 3) self-efficacy and self-management. This study aimed to assess the feasibility and potential effectiveness of the REVIVER interventions for CAYA cancer survivors and healthcare professionals.MethodsIn a single-group mixed methods design, CAYA cancer survivors aged 16–54, more than five years post-treatment, were enrolled. Feasibility, assessed via Bowen's outcomes for feasibility studies, included acceptability, practicality, integration and implementation, demand and adherence. Qualitative data from semi-structured interviews and a focus group interview with survivors and healthcare professionals supplemented the evaluation. Paired sample t-tests assessed changes in self-reported quality of life, fatigue, lifestyle, self-management, and self-efficacy at baseline (T0), post-intervention (T1), and 6-month follow-up (T2).ResultsThe interventions and video consults were generally acceptable, practical, and successfully integrated and implemented. Success factors included the nurse consultant (i.e., communication, approach, and attitude) and the personalised approach. Barriers included sustainability concerns, technical issues, and short intervention duration. Regarding demand, 71.4%, 65.4%, and 100% of eligible CAYA cancer survivors engaged in the fatigue (N = 15), lifestyle (N = 17) and empowerment (N = 3) intervention, respectively, with 5, 5 and 2 participants interviewed, correspondingly. Low interest (demand) in the empowerment intervention (N = 3) and dropout rates of one-third for both fatigue and empowerment interventions were noted (adherence). Improvements in quality of life, fatigue (fatigue intervention), lifestyle (lifestyle intervention), self-efficacy, and self-management were evident among survivors who completed the fatigue and lifestyle interventions, with medium and large effect sizes observed immediately after the intervention and six months post-intervention.ConclusionsOur study demonstrates the feasibility of nurse-led video coaching (REVIVER interventions) despite lower demand for the empowerment intervention and lower adherence to the fatigue and empowerment interventions. The medium and high effect sizes found for those who completed the interventions hold potential clinical significance for future studies investigating the effectiveness of the REVIVER interventions.

Comprehensive sexuality education as a strategy to prevent teenage pregnancy in predominantly Indigenous communities of Chiapas, Mexico: context, scope and implementation feasibility

ABSTRACT Comprehensive sexuality education (CSE) aims to prepare adolescents for safe, healthy, and fulfilling lives. The aim of this study was to assess the perspective of key informants regarding CSE content to prevent teenage pregnancy, as well as to identify implementation barriers in predominantly indigenous communities in Chiapas, Mexico. We conducted a descriptive qualitative study using semi-structured interviews to explore three different groups’ perceptions, opinions and experiences. Adhering to grounded theory principles, we performed an inductive analysis and identified categories of interest. A total of 45 key informants (16 school staff members, 15 health personnel and 14 community leaders) were interviewed. School staff members are primarily responsible for CSE. Among all the participants, we identified a lack of training and the presence of prejudices. The information provided to adolescents by the informants was diverse and at times, incomplete. There was limited parental involvement and even opposition to sharing CSE content. Deeply rooted customs and traditions within a patriarchal context posed a significant obstacle to the implementation of CSE in the studied communities. Gaining a deeper understanding of rural and Indigenous contexts can facilitate the identification of barriers and promote the design of targeted strategies to reduce obstacles to pregnancy prevention in vulnerable populations.

Dynamic traffic signal control for heterogeneous traffic conditions using Max Pressure and Reinforcement Learning

Optimization of green signal timing for each phase at a signalized intersection in an urban area is critical for efficacious traffic management and congestion mitigation. Many algorithms are developed, yet very few are for cities in developing nations where traffic is characterized by its heterogeneous nature. While some of the recent studies have explored different variants of Max Pressure (MP) and Reinforcement Learning (RL) for optimizing phase timing, the focus is limited to homogeneous traffic conditions. In developing nations, such as India, control systems, like fixed and actuated, are still predominantly used in practice. Composite Signal Control Strategy (CoSiCoSt) is also employed at a few intersections. However, there is a notable absence of advanced models addressing heterogeneous traffic behavior, which have a great potential to reduce delays and queue lengths. The present study proposes a hybrid algorithm for an adaptive traffic control system for real-world heterogeneous traffic conditions. The proposed algorithm integrates Max Pressure with Reinforcement Learning. The former dynamically determines phase order by performing pressure calculations for each phase. The latter optimizes the phase timings for each phase to minimize delays and queue lengths using the proximal policy optimization algorithm. In contrast to the past RL models, in which the phase timing is determined for all phases at once, in the proposed algorithm, the phase timings are determined after the execution of every phase. To assess the impact, classified traffic volume is extracted from surveillance videos of an intersection in Ludhiana, Punjab and simulated using Simulation of Urban Mobility (SUMO). Traffic volume data is collected over three distinct time periods of the day. The results of the proposed algorithm are compared with benchmark algorithms, such as Actuated, CoSiCoSt, and acyclic & cyclic Max Pressure, Reinforcement Learning-based algorithms. To assess the performance, queue length, delay, and queue dissipation time are considered as key performance indicators. Of actuated and CoSiCoSt, the latter performs better, and thus, the performance of the proposed hybrid algorithm is compared with CoSiCoSt. The proposed algorithm effectively reduces total delay and queue dissipation time in the range of 77.07%–87.66% and 53.95%–62.07%, respectively. Similarly, with respect to the best-performing RL model, the drop in delay and queue dissipation time range from 55.63 to 77.12% and 22.13 to 43.7%, respectively, which is significant at 99% confidence level. The proposed algorithm is deployed on a wireless hardware architecture to confirm the feasibility of real-world implementation. The findings highlight the algorithm’s potential as an efficient solution for queues and delays at signalized intersections, where mixed traffic conditions prevail.

Enhancing patient-clinician collaboration during treatment decision-making: study protocol for a community-engaged, mixed method hybrid type 1 trial of collaborative decision skills training (CDST) for veterans with psychosis

BackgroundPatient participation in treatment decision making is a pillar of recovery-oriented care and is associated with improvements in empowerment and well-being. Although demand for increased involvement in treatment decision-making is high among veterans with serious mental illness, rates of involvement are low. Collaborative decision skills training (CDST) is a recovery-oriented, skills-based intervention designed to support meaningful patient participation in treatment decision making. An open trial among veterans with psychosis supported CDST’s feasibility and demonstrated preliminary indications of effectiveness. A randomized control trial (RCT) is needed to test CDST’s effectiveness in comparison with an active control and further evaluate implementation feasibility.MethodsThe planned RCT is a hybrid type 1 trial, which will use mixed methods to systematically evaluate the effectiveness and implementation feasibility of CDST among veterans participating in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California. The first aim is to assess the effectiveness of CDST in comparison with the active control via the primary outcome, collaborative decision-making behavior during usual care appointments between veterans and their VA mental health clinicians, and secondary outcomes (i.e., treatment engagement, satisfaction, and outcome). The second aim is to characterize the implementation feasibility of CDST within the VA PRRC using the Practical Robust Implementation and Sustainability Model framework, including barriers and facilitators within the PRRC context to support future implementation.DiscussionIf CDST is found to be effective and feasible, implementation determinants gathered throughout the study can be used to ensure sustained and successful implementation at this PRRC and other PRRCs and similar settings nationally.Trial registrationClinicalTrials.gov NCT04324944. Registered on March 27, 2020. Trial registration data can be found in Appendix 1.

Exploring implementation strategies for healthy longevity among the elderly population in China based on the delphi method

Objective: To explore the implementation strategies for promoting healthy longevity among the elderly population in China based on the Delphi method. Methods: Through literature review and expert discussion, a framework for implementation strategies to achieve healthy longevity among the elderly was determined, and a preliminary checklist of implementation strategies was developed. The Delphi method was employed from August to December 2022, inviting 25 experts from various disciplines such as clinical medicine, public health, basic research, and the elderly care services industry. Experts were sent consultation questionnaires via email to assess the importance, feasibility, judgment basis and familiarity of each implementation strategy. Active coefficient, authority coefficient, and harmony coefficient were analyzed to ultimately determine the important and feasible implementation strategies for healthy longevity that were suitable for the Chinese elderly population. Results: The expert active coefficients of the two rounds were 96.00% (24/25) and 79.17% (19/24). The authority coefficients were (0.76±0.19) and (0.77±0.17). The average scores of importance were (4.32±0.84) and (4.36±0.82), and the corresponding scores of feasibility were (3.72±1.04) and (3.80±0.92). The harmony coefficients for the importance score were 0.269 (χ2=594.084, P<0.001) and 0.159 (χ2=193.624, P<0.001). The harmony coefficients for feasibility scores were 0.205 (χ2=452.008, P<0.001) and 0.167 (χ2=202.878, P<0.001). The final eight implementation strategies were identified after two rounds of consultation. Conclusion: Through two rounds of Delphi consultations, eight important and feasible implementation strategies for promoting healthy longevity that are suitable for the Chinese context have been proposed.

MyBack - effectiveness and implementation of a behavior change informed exercise programme to prevent low back pain recurrences: a hybrid effectiveness-implementation randomized controlled study protocol

BackgroundLow back pain (LBP) is a common health condition and the leading cause of years lived with disability worldwide. Most LBP episodes have a favourable prognosis, but recurrences within a year are common. Despite the individual and societal impact related to LBP recurrences, there is limited evidence on effective strategies for secondary prevention of LBP and successful implementation of intervention programmes in a real-world context. The aim of this study is to analyse the effectiveness of a tailored exercise and behavioural change programme (MyBack programme) in the secondary prevention of LBP; and evaluate acceptability, feasibility and determinants of implementation by the different stakeholders, as well as the implementation strategy of the MyBack programme in real context.MethodsThis protocol describes a hybrid type I, randomized controlled trial to evaluate the effectiveness and implementation of MyBack programme in the context of primary health care. The Behaviour Change Wheel framework and FITT-VP principles will inform the development of the behaviour change and exercise component of MyBack programme, respectively. Patients who have recently recovered from an episode of non-specific LBP will be randomly assigned to MyBack and usual care group or usual care group. The primary outcome will be the risk of LBP recurrence. The secondary outcomes will include disability, pain intensity, musculoskeletal health, and health-related quality of life. Participants will be followed monthly for 1 year. Costs data related to health care use and the MyBack programme will be also collected. Implementation outcomes will be assessed in parallel with the effectiveness study using qualitative methods (focus groups with participants and health providers) and quantitative data (study enrolment and participation data; participants adherence).DiscussionTo our knowledge, this is the first study assessing the effectiveness and implementation of a tailored exercise and behaviour change programme for prevention of LBP recurrences. Despite challenges related to hybrid design, it is expected that data on the effectiveness, cost-effectiveness, and implementation of the MyBack programme may contribute to improve health care in patients at risk of LBP recurrences, contributing to direct and indirect costs reduction for patients and the health system.Trial registration numberNCT05841732.

Bayesian Networks for the Diagnosis and Prognosis of Diseases: A Scoping Review

Bayesian networks (BNs) are probabilistic graphical models that leverage Bayes’ theorem to portray dependencies and cause-and-effect relationships between variables. These networks have gained prominence in the field of health sciences, particularly in diagnostic processes, by allowing the integration of medical knowledge into models and addressing uncertainty in a probabilistic manner. Objectives: This review aims to provide an exhaustive overview of the current state of Bayesian networks in disease diagnosis and prognosis. Additionally, it seeks to introduce readers to the fundamental methodology of BNs, emphasising their versatility and applicability across varied medical domains. Employing a meticulous search strategy with MeSH descriptors in diverse scientific databases, we identified 190 relevant references. These were subjected to a rigorous analysis, resulting in the retention of 60 papers for in-depth review. The robustness of our approach minimised the risk of selection bias. Results: The selected studies encompass a wide range of medical areas, providing insights into the statistical methodology, implementation feasibility, and predictive accuracy of BNs, as evidenced by an average area under the curve (AUC) exceeding 75%. The comprehensive analysis underscores the adaptability and efficacy of Bayesian networks in diverse clinical scenarios. The majority of the examined studies demonstrate the potential of BNs as reliable adjuncts to clinical decision-making. The findings of this review affirm the role of Bayesian networks as accessible and versatile artificial intelligence tools in healthcare. They offer a viable solution to address complex medical challenges, facilitating timely and informed decision-making under conditions of uncertainty. The extensive exploration of Bayesian networks presented in this review highlights their significance and growing impact in the realm of disease diagnosis and prognosis. It underscores the need for further research and development to optimise their capabilities and broaden their applicability in addressing diverse and intricate healthcare challenges.

Novel Integrated Zeta Inverter for Standalone Applications

In recent years, distributed generation systems based on renewable energy sources have gained increasing prominence. Thus, the DC/AC converters based on power electronics devices have become increasingly important. In this context, this article presents an integrated Zeta inverter for low-power conditions, which operates in continuous conduction mode (CCM), achieving efficiency greater than 95%. The proposed topology is composed of four power switches, two operating at high frequency and two operating at low frequency, i.e., at the output frequency. Compared with the topologies in the literature, these configurations make it a competitive solution from the point of view of efficiency, number of elements, and, consequently, implementation cost. The proposed converter operates as a sinusoidal voltage source for local loads and is supplied by a DC source, such as batteries or a photovoltaic array. A multi-resonant voltage controller was used to guarantee the sinusoidal voltage provided to the non-linear load while dealing with the complex dynamics of the Zeta converter in the CCM. Experimental results from a 324 W prototype show the converter’s implementation feasibility and the high efficiency of the DC/AC conversion.

Cervical cancer screening in 48000 females over two decades: Feasibility and success of community-based screening in Kerala, India.

10550 Background: Cervical Cancer is still significant cause of mortality and morbidity among females in India. Various methods of cancer screening are currently practiced for cervical cancer prevention including human papilloma virus (HPV) screening, pap smear, visual inspection with Lugol’s iodine (VILI), visual inspection with acetic acid (VIA) etc. The success of any cancer screening method is based on the feasibility of large-scale implementation at community level and the scientific validity of the screening test. VIA/VILI has been proven to prevent mortality in cervical cancer. This study is based on analysis of prospectively maintained database of community based cervical cancer screening using VIA/VILI in northern Kerala from 2002 to 2020. Methods: Retrospective analysis of prospective database of cervical cancer screening from 2002 to 2020 done by Malabar Cancer Care Society in Kerala, a non-governmental organization with support from governmental bodies like ISRO. Data was collected into excel sheets and were rechecked. The data on demography, type of screening, detection of precancerous and cancerous lesions was analyzed. Descriptive statistics were used to analyze the data using SPSS Version 20.0. Results: A total of 48008 individuals were screened over 18 years. 55% were premenopausal. 33% were fully asymptomatic and remaining 66% had white discharge per vaginum (25%), bleeding per vaginum (14%) or combination of symptoms (25%). 18% had abnormal per speculum findings (bleeds on touch, discharge etc.) 86% had unhealthy cervix.26% (12650) had VIA/VILI and 74% (35658) had pap smear. The pap smear findings were normal (41%), atrophic (17%), inflammatory (40%) and 2% had pre-cancerous/ cancerous changes. Of these lesions, 46% were HSIL, 36% were LSIL, 5% ASUS and 13% were squamous cell carcinoma (52 cases). Screen positive rate was 325 (0.005%) out of 48008. Treatment of precancerous lesions was by Cryotherapy (54%), LEEP (10%) and Surgery (36%). Treatment of invasive carcinoma was by surgery (91%) and radiation (85%). Referral to regional cancer center was done in 26% patients. The screen positive rate shows decreasing trend over the last two decades. Conclusions: Cervical Cancer screening in large scale in low resource setting is feasible in India by both pap smear and VIA/VILI with community based interventions led by NGO with support from governmental bodies. This model can be considered ideal for India and other low middle income countries with logistic difficulties for large scale HPV based screening.

Health equity in multi-cancer early detection (MCEDs): A literature review and content analysis.

10549 Background: Multi-cancer early detection tests (MCEDs) are an emerging screening technology to identify biomarkers of up to 50 different types of cancer using a single blood sample. While there is potential for MCEDs to advance health equity in cancer screening, considerations for how to do so are not established. We sought to identify emerging health equity themes related to MCEDs, and to explore where along the MCED evaluation process they have been considered. Methods: We conducted a targeted review of white and grey literature to identify references discussing health equity and MCEDs. We searched PubMed and Google Scholar from 2015-2024, using key search terms including “MCEDs,” “health equity,” and “diversity, equity and inclusion.” We used thematic analysis to identify health-equity related themes raised across included records. We then used content analysis to describe where these themes arose along the phases of cancer screening evaluation described by the CanTest Framework (product design, test performance, clinical feasibility, clinical effectiveness, and screening implementation). Results: We identified 22 records for inclusion, which varied in their content and depth when exploring health equity considerations for MCEDs. Thematic analysis of the records revealed five overarching health equity themes: access, acceptability, affordability, bias, and disparities. Acceptability, which included topics such as patient preference and measuring benefit/harms, and disparities, such as racial/ethnic differences in cancer deaths, were the most discussed themes (55% of records; Table). Bias, including provider discrimination, was the least discussed theme (32% of records). Content analysis revealed that health equity themes mostly arose across cancer screening evaluation phases of clinical feasibility, effectiveness, and implementation (82%, 73%, 64% of records respectively). No records explored health equity themes of acceptability, access, or bias in the product design phase (0%). Conclusions: Current literature considering health equity for MCEDs consistently address equity aspects related to clinical feasibility, clinical effectiveness, and implementation, but generally fails to consider health equity in early phase evaluation. Increasing consideration of health equity across all phases of the screening lifecycle is crucial if MCEDs are to advance health equity.[Table: see text]

The Impact of Mind-Body Medicine on Patient-Reported Outcomes in the Management of Chronic Pelvic Pain.

Background Recent research has suggested a role for mindfulness-based therapy for patients with chronic medical conditions, but there is limited data on pelvic pain. We aim to determine if mindfulness improves patient-reported outcomes in pelvic pain and to determine the feasibility of implementation of this program. Methodology This is a pilot feasibility trial consisting of women with chronic pelvic pain at a single academic tertiary referral clinic.A convenience sample of 15 subjects was enrolled. Subjects were scheduled for three 60-minute virtual mind-body sessions with a certified counselor. Baseline scores were obtained using the Patient-Reported Outcomes Measurement Information System-Computer Adaptive Testing (PROMIS-CAT) platform. They were repeated three months and six months after enrollment. Descriptive statistics were performed. Results A total of 15 patients were enrolled in the study. Among the 13 patients who completed the three-month PROMIS-CAT scores, seven had a clinically significant 5-point improvement in sleep disturbance T-score.At least a 5-point improvement in fatigue, pain interference, and ability to participate in social roles and activities T-scores were observed in six patients each. There was a 40% dropout rate. Conclusions A formal mind-body counseling program can support patients with chronic pelvic pain. Our trial demonstrated the feasibility of establishing a program and modest improvement in patient-reported quality of life.

Enablers and obstacles for designing and implementing intersectoral health policies: Lessons from Mexico

AbstractBackgroundThis study analyzes how national intersectoral public policy experiences have been adopted and implemented using a Health in All Policies (HiAP) approach in the past two decades. It seeks to provide evidence on enabling factors that triggered three effective intersectoral public policies to improve population health in Mexico by improving nutritional, educational, and healthcare access conditions, reducing road traffic injuries, and addressing obesogenic feeding practices.MethodsWe followed a qualitative approach to analyze the three intersectoral public policies selected as case studies. First, we designed an analytical framework to assess how intersectoral public policies are adopted, implemented, and sustained. The proposed framework is based on peer‐reviewed articles and gray public policy literature. Second, we used information from eleven semi‐structured interviews with key stakeholders conducted in previous research to identify more specific enablers and barriers of the three intersectoral policies selected according to predefined analytical categories used in the questionnaire.ResultsThe analysis showed three overall key findings. First, sound empirical evidence is essential for adopting a HiAP approach. Second, effective intersectoral mechanisms enhance implementation feasibility. Third, results‐based monitoring and evaluation contribute to the continuity of the analyzed intersectoral public policies. Finally, political support is needed throughout the policy process to maintain governance capacity and deliver results.ConclusionWe drew five global policy lessons that may be applicable in similar public policy settings in other countries. First, both technical and political enablers help set the intersectoral agenda. Second, effective communication is instrumental in convincing all stakeholders to address public health‐related policy issues. Third, political support at the highest level possible and the federal government's capacity are essential to implement sound policies. Fourth, several enablers exist for enhancing collaboration between ministries during implementation. Finally, monitoring and evaluation results are necessary for sustaining intersectoral policies beyond administrations.

Status-neutral community-based multilevel intervention to address intersectional stigma and discrimination, and increase HIV testing, PrEP, and ART uptake among YGBMSM in Ghanaian Slums: A clustered randomized control trial protocol.

While GBMSM constitute less than 2% of Ghana's population, their HIV prevalence surpasses the national average by more than eightfold, emphasizing the critical need for targeted interventions to improve detection, care linkage, and reduce community transmission. This study seeks to increase HIV testing, Pre-Exposure Prophylaxis (PrEP), and Antiretroviral Therapy (ART) uptake (HPART) among YGBMSM through the adaptation of an evidence-based intervention (LAFIYA). We will employ the ADAPTT-IT framework to adapt LAFIYA and evaluate its feasibility and effectiveness in addressing intersectional stigma and increasing HPART uptake among YGBMSM residing in Ghanaian slums. In aim 1, we will hold focus groups (n=5) and interviews (n=20) among YGBMSM and two FGDs among GBMSM-led organizations. At the HCF level, we will hold 6 FGDs and interviews (n=20) among nurses. In AIM 2, we will randomly assign 6 healthcare facilities (HCFs) to receive the LAFIYA (n=3) or wait-list control (n=3). Friend groups (cluster) of YGBMSM (N=240) will be assigned to receive LAFIYA (n=120) or a wait-list control (n=120). We will collect 3-, 6-, and 9-months post-intervention data among YGBMSM(n=240) and HCWs(n=300) to measure HPART adherence (primary outcomes), ISD reduction, HIV and status-neutral knowledge (secondary outcomes), and intervention acceptability, appropriateness, and feasibility (implementation outcomes). The intervention group will observe increased HPART adherence, reduced ISD, and enhanced HPART knowledge and efficacy relative to the wait-list control group. The findings will inform ISD reduction and HIV status-neutral implementation strategies - and place-based interventions that address access to HIV prevention and care among YGBMSM, slum and in different settings. This study was registered on clinicalTrail.gov, with identifier number NCT06312514 on 03/14/2023. https://classic.clinicaltrials.gov/ct2/show/NCT06312514.

A novel combinatorial approach usingsulforaphane- and withaferin A-rich extracts for prevention of estrogen receptor-negative breast cancer through epigenetic and gut microbial mechanisms.

Estrogen receptor-negative [ER(-)] mammary cancer is the most aggressive type of breast cancer (BC) with higher rate of metastasis and recurrence. In recent years, dietary prevention of BC with epigenetically active phytochemicals has received increased attention due to its feasibility, effectiveness, and ease of implementation. In this regard, combinatorial phytochemical intervention enables more efficacious BC inhibition by simultaneously targeting multiple tumorigenic pathways. We, therefore, focused on investigation of the effect of sulforaphane (SFN)-rich broccoli sprouts (BSp) and withaferin A (WA)-rich Ashwagandha (Ash) combination on BC prevention in estrogen receptor-negative [ER(-)] mammary cancer using transgenic mice. Our results indicated that combinatorial BSp + Ash treatment significantly reduced tumor incidence and tumor growth (~ 75%) as well as delayed (~ 21%) tumor latency when compared to the control treatment and combinatorial BSp + Ash treatment was statistically more effective in suppressing BC compared to single BSp or Ash intervention. At the molecular level, the BSp and Ash combination upregulated tumor suppressors (p53, p57) along with apoptosis associated proteins (BAX, PUMA) and BAX:BCL-2 ratio. Furthermore, our result indicated an expressional decline of epigenetic machinery HDAC1 and DNMT3A in mammary tumor tissue because of combinatorial treatment. Interestingly, we have reported multiple synergistic interactions between BSp and Ash that have impacted both tumor phenotype and molecular expression due to combinatorial BSp and Ash treatment. Our RNA-seq analysis results also demonstrated a transcriptome-wide expressional reshuffling of genes associated with multiple cell-signaling pathways, transcription factor activity and epigenetic regulations due to combined BSp and Ash administration. In addition, we discovered an alteration of gut microbial composition change because of combinatorial treatment. Overall, combinatorial BSp and Ash supplementation can prevent ER(-) BC through enhanced tumor suppression, apoptosis induction and transcriptome-wide reshuffling of gene expression possibly influencing multiple cell signaling pathways, epigenetic regulation and reshaping gut microbiota.

Implementing regular physical activity for older individuals in the family strategy program using the RE-AIM framework to ensure feasibility and sustainability: EISI study protocol

The EISI study protocol aims to address the low participation rate in physical exercise programs among older individuals, emphasizing its significance as a non-pharmacological therapeutic approach for overall health and increased physical activity. The objectives include implementing physical activity (PA) and educational health programs in Jequié, Bahia, Brazil, targeting the Family Health Strategy population to enhance local physical activity levels among older individuals. The study also seeks to evaluate the program's feasibility, safety, and sustainability for large-scale implementation, along with assessing its impact on immune and inflammatory response biomarkers to the SARS-CoV virus, as well as physical-functional and brain health. Participants, aged 60 or above, will be divided into two groups: multicomponent exercise (MCE) and behavioral change interventions (BCI). The study employs a mixed-method approach, utilizing a non-randomized controlled short-term pathway model for a 4–8 weeks of pilot study and 16-week intervention impact assessment. Data collection encompasses various aspects such as sociodemographic information, mental health, physical fitness, fall risk, functional capacity, anthropometric measurements, hemodynamic assessment, habitual physical activity, and health-related quality of life. Blood and saliva samples are collected for cytokine and antibody biomarker analysis related to SARS-CoV immunity. Pre- and post-intervention evaluations for both groups will be conducted, with the hypothesis that MCE will yield more favorable responses compared to BCI. The study's holistic approach, including the assessment of feasibility, safety, and sustainability, aims to contribute to achieving Sustainable Development Goals (SDG) 3 and SDG 9 b y promoting accessible and sustainable healthcare initiatives for older individuals. This research aligns with global efforts to enhance health and well-being, emphasizing the importance of regular exercise in the aging population.

Evaluating the use of the AMBIANCE-Brief measure in clinical settings: Assessing acceptability, feasibility, and utility of the AMBIANCE-Brief.

Community agencies and practitioners around the globe seek opportunities to learn various assessment tools and interventions rooted in attachment theory. However, information regarding the feasibility of implementation and sustainability of these tools once participants have been trained to use them, is limited. This study investigated the perceived acceptability, feasibility, utility, relevance, fidelity, and sustainability of the Atypical Maternal Behavior Instrument for Assessment and Classification-Brief (AMBIANCE-Brief) among practitioners who had taken a training. Practitioners (N=59) who attended a virtual AMBIANCE-Brief training originating from Canada between June 2020 and November 2021 completed an online follow-up survey. Practitioners reported that they primarily used the AMBIANCE-Brief for case conceptualization (68%). Additionally, 95% agreed that the AMBIANCE-Brief was relevant to their clinical practice, 98% agreed it was useful for their clinical work, 76% agreed that it was feasible to implement into their clinical work, and 59% found it easy to incorporate into their treatment planning with clients. Findings suggest that the AMBIANCE-Brief may be acceptable, feasible, and useful for practitioners. Avenues for continuing to evaluate the AMBIANCE-Brief include cross-cultural validity, coder drift, and booster sessions. Additional work clarifying how practitioners integrate the measure into practice would be valuable.

Optimization of alert notifications in electronic patient-reported outcome (ePRO) remote symptom monitoring systems (AFT-39).

Clinical benefits result from electronic patient-reported outcome (ePRO) systems that enable remote symptom monitoring. Although clinically useful, real-time alert notifications for severe or worsening symptoms can overburden nurses. Thus, we aimed to algorithmically identify likely non-urgent alerts that could be suppressed. We evaluated alerts from the PRO-TECT trial (Alliance AFT-39) in which oncology practices implemented remote symptom monitoring. Patients completed weekly at-home ePRO symptom surveys, and nurses received real-time alert notifications for severe or worsening symptoms. During parts of the trial, patients and nurses each indicated whether alerts were urgent or could wait until the next visit. We developed an algorithm for suppressing alerts based on patient assessment of urgency and model-based predictions of nurse assessment of urgency. 593 patients participated (median age = 64years, 61% female, 80% white, 10% reported never using computers/tablets/smartphones). Patients completed 91% of expected weekly surveys. 34% of surveys generated an alert, and 59% of alerts prompted immediate nurse actions. Patients considered 10% of alerts urgent. Of the remaining cases, nurses considered alerts urgent more often when patients reported any worsening symptom compared to the prior week (33% of alerts with versus 26% without any worsening symptom, p = 0.009). The algorithm identified 38% of alerts as likely non-urgent that could be suppressed with acceptable discrimination (sensitivity = 80%, 95% CI [76%, 84%]; specificity = 52%, 95% CI [49%, 55%]). An algorithm can identify remote symptom monitoring alerts likely to be considered non-urgent by nurses, and may assist in fostering nurse acceptance and implementation feasibility of ePRO systems.

Selecting and Tailoring Implementation Strategies to Improve Human Papillomavirus Vaccine Uptake in Zambia: A Nominal Group Technique Approach.

The human papillomavirus (HPV) vaccine is effective in cervical cancer prevention. However, many barriers to uptake exist and strategies to overcome them are needed. Therefore, this study aimed to select and tailor implementation strategies to barriers identified by multiple stakeholders in Zambia. The study was conducted in Lusaka district between January and February 2023. Participants were purposively sampled from three stakeholder groups namely, adolescent girls, parents, and teachers and healthcare workers. With each of the stakeholders' groups (10-13 participants per group), we used the nominal group technique to gain consensus to tailor feasible and acceptable implementation strategies for mitigating the identified contextual barriers. The identified barriers included low levels of knowledge and awareness about the HPV vaccine, being out of school, poor community sensitisation, lack of parental consent to vaccinate daughters, and myths and misinformation about the HPV vaccine. The lack of knowledge and awareness of the HPV vaccine was a common barrier across the three groups. Tailored strategies included conducting educational meetings and consensus-building meetings, using mass media, changing service sites, re-examining implementation, and involving patients/consumers and their relatives. Our study contributes to the available evidence on the process of selecting and tailoring implementation strategies to overcome contextual barriers. Policymakers should consider these tailored strategies to mitigate barriers and improve HPV vaccine uptake.

Towards Comprehensive Newborn Hearing and Genetic Screening in Russia: Perspectives of Implementation

The universal newborn hearing screening (NHS) program was implemented in Russia in 2008 to replace the high-risk newborn hearing screening. More than 95% coverage and significant improvement in early detection and intervention is achieved. Meanwhile, it was shown that current OAE-based hearing screening missed 13% of newborns with genetically ascertained hereditary sensorineural hearing loss (SNHL). The aim of the study is to assess the results of genetic investigation and NHS in a large cohort of Russian children with bilateral SNHL and to study the feasibility of implementation of combined hearing and genetic screening in Russia. Genetic, audiological and NHS data of 1292 pediatric patients with bilateral SNHL born in 2008–2021 were analyzed. GJB2 sequencing was performed for all subjects, 644 patients had pathological GJB2 genotype, 406 of them were homozygous for c.35delG variant. The group of 155 GJB2-negative patients were searched for other SNHL genes, The pathological genotypes were identified at 87 patients. The most frequent genes were STRC (21.8%), USH2A (16.1%), OTOF (8%) and SLC26A4 (6.9%). Children with confirmed genetic etiology passed NHS in 21% of cases. The perspectives of implementation of national comprehensive newborn hearing and genetic screening including whole exome sequencing technologies are discussed.

Stabilization of polytopic discrete-time varying systems with rate and magnitude saturating actuators and bounded disturbances

This study tackles the critical challenge of designing parameter-dependent controllers for the wide class of discrete-time polytopic systems under rate and magnitude saturating actuators. Such a class finds widespread use in diverse applications spanning from medicine to industrial engineering. Our central contribution lies in developing novel convex parameter-dependent state feedback controller synthesis conditions that ensure regional and input-to-state stability, effectively mitigating the adverse effects of rate and magnitude-saturating actuators. Our approach considers the ℓ2/ℓ∞ gain between disturbance input and controlled output, offering performance specifications and retaining validity for specific initial conditions and amplitude-limited input disturbances. Moreover, our methodology is highly adaptable and suitable for a broad spectrum of systems, including LPV/quasi-LPV and T–S fuzzy systems. We leverage the position-type feedback model with speed limitation (PMSL) and the generalized sector condition to derive our controller synthesis method, resulting in a parallel-distributed-compensation strategy under standard assumptions, ensuring practicality and applicability to diverse system requirements. To highlight the effectiveness of our approach, we present numerical examples for comparative evaluation concerning the existing literature. Furthermore, we validate our methodology through real-time experiments conducted on a nonlinear coupled tank system, providing concrete evidence of its efficacy and feasibility for real-world implementation.