Full-scale Intervention Research Articles

Preliminary feasibility assessment of a targeted, pharmacist-led intervention for older adults with polypharmacy: a mixed-methods study

BackgroundPolypharmacy is associated with the prescription of inappropriate medications and avoidable medication-related harm. A novel pharmacist-led intervention aims to identify and resolve inappropriate medication prescriptions in older adults with polypharmacy.AimTo conduct a preliminary feasibility assessment of the intervention in primary care, testing whether specific components of the intervention procedures and processes can be executed as intended.MethodThe mixed-methods study was approved by the New Zealand Health and Disability Ethics Committees and public health agency. Patients from a New Zealand general practice clinic were recruited over 4 weeks to receive the intervention. The preliminary feasibility assessment included measures of intervention delivery, patient-reported outcome measures, and perspectives from ten patients and six clinicians. Data were analysed quantitatively and qualitatively to determine if a full-scale intervention trial is warranted. The study's progression criteria were based on established research and guided the decision-making process.ResultsThe intervention met the study's progression criteria, including patient recruitment, retention, and adherence to the intervention procedures. However, several modifications were identified, including: (1) enhancing patient recruitment, (2) conducting a preliminary meeting between the patient and pharmacist, (3) supporting pharmacists in maintaining a patient-centred approach, (4) reviewing the choice of patient-reported outcome measure, (5) extending the 8-week follow-up period, (6) allocating more time for pharmacists to conduct the intervention.ConclusionThe study found the intervention feasible; however, additional development is required before progressing to a full-scale trial. This intervention has the potential to effectively reduce medication-related harm and improve outcomes for older adults with polypharmacy.Trial registration number ACTRN12621000268842 Date registered: 11/03/2021

The Ukrainian language in the business environment after the full-scale Russian invasion of Ukraine

The full-scale war of Russia against Ukraine that started on February 24, 2022, has caused changes in the cultural, religious, and language areas. Since then, more and more Ukrainian citizens decided to switch to Ukrainian recognizing Russian as the language of the enemy. The study aims to investigate how the full-scale intervention has determined the language attitude, language shift, and language behaviour of Ukrainian businesses and businesspersons. The research data used for analysis includes both written and video interviews with business owners and CEOs of the companies as well as their posts on social media, namely Telegram, Facebook, and Twitter. The stories of Oleh Horokhovs’kyi, Nataliia Jemchenko, Volodymyr Popereshniuk, Vjacheslav Klymov, Oleksii Vadaturskyi, Valeriia Guzema, etc. and their business as well as position of the Ukrainian banks and official institutions form the core of the study. This material has been chosen since it represents demonstrative samples of businesspersons’ language practices and their reflections on the language situation in Ukraine, the role of the language in national building, sovereignty, and national security. The business representatives clarify their language choices and explain how it has influenced identity construction, as well as developing their linguistic personality. Moreover, the change in the status of the Russian language and its role in Ukraine and the Ukrainian business environment has been investigated. The analysis reveals that the concepts of language behaviour, language choice, and language attitude describe the language situation studied during the full-scale Russian-Ukrainian war. Keywords: language situation, language behaviour, Ukrainian language, Russian language, language shift.

Henry Kissinger and US policy in the South of Africa

The article deals with the American policy towards the southern Africa in the era of Henry Kissinger. The main driving force behind that enterprise in this direction was the National Security Advisor and US Secretary of State during the Nixon-Ford administration. The author examines how US relations to the southern portion of this continent, Angola in particular, unfolds from virtually non-existent to almost full-scale intervention in 1970s - and makes findings of the Kissinger’s dealings with the issue.

Ethical-Legal Models of the Society Interactions with the Artificial Intelligence Technology

Objective: to explore the modern condition of the artificial intelligence technology in forming prognostic ethical-legal models of the society interactions with the end-to-end technology under study.Methods: the key research method is modeling. Besides, comparative, abstract-logic and historical methods of scientific cognition were applied.Results: four ethical-legal models of the society interactions with the artificial intelligence technology were formulated: the tool (based on using an artificial intelligence system by a human), the xenophobia (based on competition between a human and an artificial intelligence system), the empathy (based on empathy and co-adaptation of a human and an artificial intelligence system), and the tolerance (based on mutual exploitation and cooperation between a human and artificial intelligence systems) models. Historical and technical prerequisites for such models formation are presented. Scenarios of the legislator reaction on using this technology are described, such as the need for selective regulation, rejection of regulation, or a full-scale intervention into the technological economy sector. The models are compared by the criteria of implementation conditions, advantages, disadvantages, character of “human – artificial intelligence system” relations, probable legal effects and the need for regulation or rejection of regulation in the sector.Scientific novelty: the work provides assessment of the existing opinions and approaches, published in the scientific literature and mass media, analyzes the technical solutions and problems occurring in the recent past and present. Theoretical conclusions are confirmed by references to applied situations of public or legal significance. The work uses interdisciplinary approach, combining legal, ethical and technical constituents, which, in the author’s opinion, are criteria for any modern socio-humanitarian researches of the artificial intelligence technologies.Practical significance: the artificial intelligence phenomenon is associated with the fourth industrial revolution; hence, this digital technology must be researched in a multi-aspectual and interdisciplinary way. The approaches elaborated in the article can be used for further technical developments of intellectual systems, improvements of branch legislation (for example, civil and labor), and for forming and modifying ethical codes in the sphere of development, introduction and use of artificial intelligence systems in various situations.

ПРОДОВОЛЬЧЕ ЗАБЕЗПЕЧЕННЯ ДОМОГОСПОДАРСТВ УКРАЇНИ: РЕАЛІЇ СЬОГОДЕННЯ

Today, Ukraine's food security is an important component of national security. The almost two-year war with the Russian Federation disrupted the sustainable production of basic food products and their availability to the population. Overcoming the complex challenges that Ukraine faces today requires transformational actions that embrace the principles of sustainability and the elimination of the consequences of martial law, which, since the beginning of the full-scale intervention of the aggressor country, caused a break in the food chain between rural areas, with rational use of nature and subjects of food provision in the regions of the country. The purpose of the article is to study the theoretical and methodological aspects of the formation of household food supply in wartime conditions. It has been established that the key criterion of food security is not ensured in Ukraine today - the economic availability of food of the necessary volume and quality for all social groups of the population. The obstacle to this is the system of distribution of national income, which is discriminatory towards the majority of the country's population. Therefore, to ensure economic access to food for the entire population of our country, changes in the current model of Ukraine's economy are necessary. It was determined that for the period of 2023-2026, provided that the production of meat and meat products by the rural OTG of Ukraine increases by 10%, the total amount of resources of the agricultural sector of the economy will increase by 14.4%, the increase in the consumption fund will be 15.5%, which will lead to an increase in the general needs of the population for this type of agricultural products up to 7.1%. Accordingly, this will allow to increase the food self-sufficiency index of the agricultural sector from 0.65 to 0.70, respectively. Thus, in Ukraine, even in the conditions of a crisis military conflict, it is necessary to increase the aggregate income of households on the basis of a balanced socio-economic policy of the state.Summary. Today, Ukraine's food security is an important component of national security. The almost two-year war with the Russian Federation disrupted the sustainable production of basic food products and their availability to the population. Overcoming the complex challenges that Ukraine faces today requires transformational actions that embrace the principles of sustainability and the elimination of the consequences of martial law, which, since the beginning of the full-scale intervention of the aggressor country, caused a break in the food chain between rural areas, with rational use of nature and subjects of food provision in the regions of the country. The purpose of the article is to study the theoretical and methodological aspects of the formation of household food supply in wartime conditions. It has been established that the key criterion of food security is not ensured in Ukraine today - the economic availability of food of the necessary volume and quality for all social groups of the population. The obstacle to this is the system of distribution of national income, which is discriminatory towards the majority of the country's population. Therefore, to ensure economic access to food for the entire population of our country, changes in the current model of Ukraine's economy are necessary. It was determined that for the period of 2023-2026, provided that the production of meat and meat products by the rural OTG of Ukraine increases by 10%, the total amount of resources of the agricultural sector of the economy will increase by 14.4%, the increase in the consumption fund will be 15.5%, which will lead to an increase in the general needs of the population for this type of agricultural products up to 7.1%. Accordingly, this will allow to increase the food self-sufficiency index of the agricultural sector from 0.65 to 0.70, respectively. Thus, in Ukraine, even in the conditions of a crisis military conflict, it is necessary to increase the aggregate income of households on the basis of a balanced socio-economic policy of the state.

Clinical Characteristics and Cause of Death Among Hospitalized Decedents With Cancer and COVID-19

There is scant information on the clinical progression, end-of-life decisions, and cause of death of patients with cancer diagnosed with COVID-19. Therefore, we conducted a case series of patients admitted to a comprehensive cancer center who did not survive their hospitalization. To determine the cause of death, 3 board-certified intensivists reviewed the electronic medical records. Concordance regarding cause of death was calculated. Discrepancies were resolved through a joint case-by-case review and discussion among the 3 reviewers. During the study period, 551 patients with cancer and COVID-19 were admitted to a dedicated specialty unit; among them, 61 (11.6%) were nonsurvivors. Among nonsurvivors, 31 (51%) patients had hematologic cancers, and 29 (48%) had undergone cancer-directed chemotherapy within 3 months before admission. The median time to death was 15 days (95% confidence interval [CI], 11.8 to 18.2). There were no differences in time to death by cancer category or cancer treatment intent. The majority of decedents (84%) had full code status at admission; however, 53 (87%) had do-not-resuscitate orders at the time of death. Most deaths were deemed to be COVID-19 related (88.5%). The concordance between the reviewers for the cause of death was 78.7%. In contrast to the belief that COVID-19 decedents die because of their comorbidities, in our study only 1 of every 10 patients died of cancer-related causes. Full-scale interventions were offered to all patients irrespective of oncologic treatment intent. However, most decedents in this population preferred care with nonresuscitative measures rather than full support at the end of life.

FOOD PROBLEM OF THE EASTERN REGION OF UKRAINE CAUSED BY THE WAR

The article deals with the scientifically substantiated analyses of the food problem of the eastern region of Ukraine based on its essential importance for the world problem of avoiding hunger. Taking into account the fact that the potential of external production exceeds the needs of the domestic market it is necessary to conduct a research of solving food problems when planning the development of the agricultural sector of the Ukrainian economy..
 This article considers such analytical issues estimating that Ukraine has been among the top five exporters of grain and legume resources for many years. Ukraine is one of the main countries that contributes to the agricultural sector of the world economy. The activities of future specialists, when dealing with the food problem, depend on the content and nature of the knowledge that not only the coronavirus pandemic, but also armed conflicts in most of the specified countries and climate change, several years of drought contributed to problems with agricultural production in the region.
 The general provisions on analysis of various options for solving this problem are given and it is estimated that the analytical approach is the most optimal, since it allows you to build a diagram for comparing percentage of the most popular agricultural crops in the sown areas. It is advisable to consider the process of selecting most of the data that have been collected before the invasion. This research paper reveals the fact that much of the concern is related to shortages in the supply of staple crops such as wheat, corn and oilseeds, which could rise up prices. The invasion also led to higher prices for fuel and related fertilizers, leading to further food shortages and higher prices. The rise in wheat prices resulting from the conflict has become a problem for the countries, heavily dependent on Russian and Ukrainian wheat exports, and raised fears of social protest.
 The article analyzes economists’ views on the process of solving the food problems.It should be noted that these main issues will affect further world market prices and inflation will rise. Due to invasion, the US Department of Agriculture published a forecast for the export of grain products from Ukraine. Food and Agriculture Organization of the United Nations published information on the growth of the grain price index. Practical recommendations are provided for solving the problems.
 The research has been developed to estimate that Ukraine is a leading country in the agricultural sector of the economy, which supplies food to the EU, Africa and India. Due to Russia's invasion into Ukrainian lands, many states may suffer from hunger and if the full-scale intervention into Ukraine is not stopped, then the world will face a food crisis.

Transport and transport infrastructure of Ukraine in the pre-war period (2010-2021)

The article researches the development state of transport and transport infrastructure in Ukraine over last years. The research findings specify the topicality of the issue solution concerning the enhancement of transport and transport infrastructure in the conditions of structural, energy and financial crises, as well as considering a destructive influence of COVID-19 pandemic, occupation of Crimea, an anti-terrorist operation in East of Ukraine and a full-scale intervention of the Russian Federation started on February 24, 2022. Such methods of improving transport and transport infrastructure development in Ukraine have been offered under the research findings: the increase of public administration level with regard to all aspects of transport infrastructure; the use of proactive management; activation of searches and implementation of investment projects; introduction of an institute of public- private partnership on transport; partial and temporary decrease of tax burden; the development of complex solutions for transport services consumers under the infrastructure areas; optimization of transport pricing, etc.

Feasibility of the Remote Physical Activity Follow-Up Intervention after the Face-to-Face Program for Healthy Middle-Aged Adults: A Randomized Trial Using ICT and Mobile Technology.

Although the effectiveness of face-to-face and remote intervention for increasing and maintaining physical activity (PA) have been compared, the effect of combining the two forms of intervention is unknown. The purpose of this study was to examine the feasibility of the remote PA follow-up intervention after the face-to-face PA program on changing PA behaviors and some health outcomes in healthy middle-aged adults. As a secondary analysis, we also attempted a preliminary analysis of the difference in the number of behavior change interviews in the remote PA follow-up intervention. After the face-to-face intervention, 30 healthy subjects were randomly divided into four behavior change coaching interviews (BCI4 group) or three BCI (BCI3 group). The results of this study showed that body weight, body fat mass, and waist circumference were significantly reduced after face-to-face intervention, and were further reduced after remote PA follow-up intervention. However, the difference in the number of BCI affected only body fat mass. The remote PA follow-up intervention may have potential to maintain the effects of face-to-face intervention. In the future, it is necessary to refine the research design and conduct a full-scale intervention study.

Microbial Involvement in the Bioremediation of Total Petroleum Hydrocarbon Polluted Soils: Challenges and Perspectives

Nowadays, soil contamination by total petroleum hydrocarbons is still one of the most widespread forms of contamination. Intervention technologies are consolidated; however, full-scale interventions turn out to be not sustainable. Sustainability is essential not only in terms of costs, but also in terms of restoration of the soil resilience. Bioremediation has the possibility to fill the gap of sustainability with proper knowledge. Bioremediation should be optimized by the exploitation of the recent “omic” approaches to the study of hydrocarburoclastic microbiomes. To reach the goal, an extensive and deep knowledge in the study of bacterial and fungal degradative pathways, their interactions within microbiomes and of microbiomes with the soil matrix has to be gained. “Omic” approaches permits to study both the culturable and the unculturable soil microbial communities active in degradation processes, offering the instruments to identify the key organisms responsible for soil contaminant depletion and restoration of soil resilience. Tools for the investigation of both microbial communities, their degradation pathways and their interaction, will be discussed, describing the dedicated genomic and metagenomic approaches, as well as the interpretative tools of the deriving data, that are exploitable for both optimizing bio-based approaches for the treatment of total petroleum hydrocarbon contaminated soils and for the correct scaling up of the technologies at the industrial scale.

Między niestarannością a związkiem przyczynowym. Uwagi na tle orzeczenia Okręgowego Sądu Lekarskiego w Warszawie (OSL - 45/12)

The article is a case study rather than a traditional commentary (glossa). Its subject is a disciplinary case, that was heard by a first instance medical court in Warsaw, attached to the Mazowiecka Okręgowa Izba Lekarska (Mazovian Regional Chamber of Physicians). The medical courts are not „real” courts as provided by Chapter VIII of the Polish constitution of 1997. Notwithstanding they are established by statutory law (Ustawa o izbach lekarskich) and they use both substantive and procedural rules that are provided by law and are clearly analogous to criminal responsibility. The starting point for the case was an medical intervention, undertaken (in 2009) for purely cosmetic purposes – „skin rejuvenation” or, more precisely, a fractional photothermolysis, by use of a specially designed laser device (fractional laser). It resulted in severe complications and, finally, in grave and irremovable scarring on the patient's cleavage. Facts of the case are thorougly presented, as well as scientific and practical background of the use of high-energy lasers in cosmetic surgery, including history of such practices since the late eighties of the 20th century. Then, three important legal questions are discussed: (1.) What is generally the status of purely cosmetic medical interventions under today's Polish law? – the answer appears vague, as this class of interventions is under some conditions perceived permissible both by the legal doctrine and the courts, but such a conclusion doesn't come from any actual statutory provisions (and Polish legal system is, as a rule, statutory). (2.) The article fully refers the court's detailed reasoning on the causal relationship between initial medical intervention and final harm, suffered by the patient. Within the scope of causation the case can be recognized as paradigmatic. The events arranged a clear „causal chain”, the chain's links were well identifiable and relatively easy to be proven, without referring to presumptions, suppositions, statistical typicality and similar instruments of arguing. The court didn't appeal as well to „but-for” (conditio sine qua non) reasoning and using of the „but-for” causation test (in this case it would be obviously useless, redundant and idle). The article contains also some considerations on the of so-called obiektywne przypisanie skutku (objective attribution of an effect, i.e. an equivalent of German objektive Zurechnung doctrine) and on use of such a test in the discussed case (this part is only hypothetical). (3.) Finally, the opposition „careful”/„careless” as a premise of responsibility is discussed. A human action is usually interpreted as careless if it is in discordance with some technical safety rules. In the case discussed the surgeon carried out the full scale intervention using arbitrary settings of the laser and omitted the test irradiation of a small area of the patient's skin. It could be put into doubt if the tests were really an obligatory rule, but the medical court decided it positively: however such a rule was not explicitly declared by medical manuals, it can be deduced from the the actual practice based on scientific evidence.

Транскордонне співробітництво з Україною в умовах війни

The article studies the systemic support provided to the border regions in expanding cooperation in the economic, educational, cultural, environmental and other fields. It is noted that European experience is being transferred to the border regions of Ukraine. During the full-scale intervention of Russia into Ukraine, the cross-border policy has changed the emphasis and focused regional projects on humanitarian support and military issues. A number of European countries was analysed in the course of the study, namely, Romania, Poland, Slovakia, Hungary and Moldova, which border Ukraine and provide various support to it. The partnership as well as the geo-strategic significance of Ukraine and the bordering countries facilitate the formation of a tandem of regional leaders in Central Europe that are able to confront the challenges and threats of the changing international order. Poland and Romania actively support the implementation of the Intermarium alliance, which will be a powerful step for Ukraine in strengthening its European potential. Also, it is noted that Poland is actively supporting Ukraine in the energy sector, military-anddefence, cross-border and customs cooperation, environmental policy, rebuilding of Ukraine as well as in the issues of national memory. Cross-border cooperation was studied through the prism of Ukrainian refugees. The article analyses the number of Ukrainian citizens abroad as of March 7, 2022 and August 3, 2022. It determines the number of Ukrainian citizens that have received the status of a refugee and have asked for shelter. The data on crossing the border of partner countries has been processed. The article provides up-to-date information on the situation in the border regions and indicates the number of people that have returned to Ukraine.

Сутнісні характеристики відновлення країн світу після збройних конфліктів

The purpose of the article is to analyze the international experience of countries in the period of post-war recovery, to determine the main factors that influenced the development of the economy, and to form a plan for the reconstruction and development of our country on the basis of the data obtained. Ukraine during 2014–2021 suffered from aggression in the east of the country implemented by gangs funded by the Russian Federation, all this had a significant impact on all sectors of the country’s economy, but in early 2022 Russia resorted to a full-scale intervention, which led to enormous human casualties, destruction of social infrastructure, the industrial complex and the economy as a whole. Now it is not individual regions that suffer from armed aggression, but the territory of the entire country, a significant part of which is occupied, while strikes from various types of weapons occur in most regions on daily basis. Although the fighting is not over yet, and the scale of the consequences and losses is already difficult to calculate, but after the end of the war there will come a period of recovery, so it would be advisable to analyze in advance the historical events of the past and study the experience of the countries of the world, which suffered destruction during wartime and hostilities. The article considers the practice of reconstruction and economic development of the country in the post-war period. The main factors for ensuring economic growth of countries such as West Germany, Japan, Italy, South Korea and Israel have been identified. The authors analyzed the means, having implemented which, it will be possible to develop an action plan for the reconstruction of the economy and realize the potential of Ukraine’s development. The draft State Budget of Ukraine for 2023 and plans to raise funds to finance the country’s economy by international organizations and foreign governments are considered. Examples of post-war recovery of Ukraine, which have been introduced by the government and are already being implemented, are presented in order to stabilize the country’s economy now and restore the destroyed country in the future.

Громада як основний елемент місцевого самоврядування

The article determines key characteristics of a “hromada” as a key element of local self-government. It describes main concepts and categories that are mentioned in the course of decentralization reform implementation and introduction of changes to the structure of local self-government. The article describes the legislation that regulates the operation of hromadas (communities) and establishment of territorial hromadas (communities) in the context of decentralization. While analyzing the legislation, special attention was paid to differentiation such terms as “hromada” and “territorial hromada”. The study analyzes historical preconditions as it has been so historically formed in Ukraine that a hromada (community) was the basic territorial unit, which, having its own governing bodies, has performed a number of important functions. It has been determined that there are many different opinions as to the types of communities and their functions. While analyzing the rights and obligations of hromadas (communities) of a territorial hromada (community), the following spheres were selected: social, economic, culturalspiritual, political, judicial and defense. It has been proven that a territorial hromada, as a subject regulating the socio-economic development of a territory, is vested with function, which generally coincide with the power and functions of local self-government. The authors states that in the course of the decentralization reform, it was impossible to establish territorial hromadas (communities) on the occupied territories of the Donetsk and Luhansk oblasts (since 2014), thus military-civil administrations were established on these territories. In addition, it has also been analyzed that since the beginning of a fullscale intervention on the russian federation on February 24, 2022, part of territorial hromadas (communities) in Ukraine are defined as territories that are temporarily occupied; territoriesthat are surrounded (blocked); territories where active hostilities are ongoing.

Coagulation and precipitation of cyanobacterial blooms

Eutrophication is the prime water quality issue in inland waters. Eutrophication and its key symptom, harmful cyanobacterial blooms, is expected to further increase in the future, which highlights the importance of managing the issue. The reduction of external nutrient load is crucial but might not bring fast relief to eutrophic waters due to ongoing diffuse pollution and legacy nutrients in the sediment. In this context, in-lake measures are needed to speed-up recovery. In this review, we discuss different in-lake measures based on coagulation and precipitation of cyanobacteria and/or phosphate for different lake categories (e.g., shallow or deep, mainly external or internal nutrient load, occurrence of perennial or summer blooms). In deep lakes with an external nutrient load higher than the internal load, a “Floc and Sink” method could be used in which a coagulant (e.g. aluminium salts, Al-salts; chitosan) combined with a ballast (e.g. soil, clay) removes a cyanobacterial bloom out of the water column. In case the deep lake suffers from high internal load, a phosphate (P)-fixative (e.g. lanthanum modified bentonite or Al-salts) can be used to “Lock” the legacy P, possibly combined with a coagulant – a “Floc and Lock” technique. The latter approach will target both the particulate P in a bloom and the internal P load. A shallow lake that suffers from summer blooms and in which the internal load is higher than the external load, a “Lock” strategy of winter application of a P-fixative is proposed to prevent bloom development. In shallow lakes with perennial blooms, an agent to damage the cells (such as H2O2) is required together with a coagulant and a ballast to avoid recolonization of the water column due to resuspension – a “Kill, Floc and Sink/Lock” method. The selection of the most promising in-lake measures and materials should be based on a proper system diagnosis and tests prior to a full-scale intervention. These methods can be effective, but evidently reduction of external nutrient loads, both from point- and non-pointed sources, is an absolute necessity to restore aquatic ecosystems in a holistic sense.

BWHealthy Weight Pilot Study: A randomized controlled trial to improve weight-loss maintenance using deposit contracts in the workplace.

ObjectiveDeposit contracts, where participants “bet” on achieving a goal and get their money back only if successful, have been shown to be effective for short-term weight-loss. This pilot study examined their effect on weight-loss maintenance.MethodsFrom 2016 to 2018, we conducted a pilot, 50-week randomized controlled trial among 42 hospital employees (19 intervention and 23 control), in Boston, Massachusetts, who lost ≥10 lb (4.5 kg) in the two years prior to enrollment. Participants were recruited primarily in-person. Both control and intervention participants were asked to attend a weigh in weekly and received weekly email communication. Intervention participants also entered into a deposit contract to maintain baseline weight within ≤2 lb (0.9 kg). We examined weight change from baseline to 50 weeks (primary outcome) and maintenance of baseline weight at 50 weeks (secondary outcome; binary – yes v. no). Participants completed baseline and follow-up surveys and received incentives for completion.ResultsAt baseline, mean (SD) weight was 83.2 (15.5 kg) among intervention and 80.7 (14.5 kg) among control participants. After 50 weeks, intervention participants had slightly less but non-significant weight gain (adjusted β −1.12 kg; 95% CI −5.28, 3.05) than control participants; 73.7% of intervention v. 39.1% of control participants met their weight-loss maintenance goal by study end (adjusted OR 4.78; 95% CI 1.01, 22.71).ConclusionsA deposit contract was not associated with differences in weight but led to more participants meeting their weight-loss maintenance goals; a deposit contract for weight-loss maintenance should be tested in a full-scale intervention. Most intervention participants viewed the deposit contract as acceptable.

An Integrated Approach Supporting Remediation of an Aquifer Contaminated with Chlorinated Solvents by a Combination of Adsorption and Biodegradation

Hydrogeological uniqueness and chemical-physical peculiarities guide the contamination dynamics and decontamination mechanisms in the environmental arena. A single composite geodatabase, which integrates geological/hydrological, geophysical, and chemical data, acts as a “cockpit” in the definition of a conceptual model, design of a remediation strategy, implementation, near-real-time monitoring, and validation/revision of a pilot test, and monitoring full-scale interventions. The selected remediation strategy involves the creation of "reactive" zones capable of reducing the concentration of chlorinated solvents in groundwater through the combined action of adsorption on micrometric activated carbon, which is injected into the aquifer, and degradation of organic contaminants, stimulating the dechlorinating biological activity by the addition of an electron donor. The technology is verified through a pilot test, to evaluate the possibility of scaling up the process. The results of post-treatment monitoring reveal abatement of the concentration of chlorinated solvents and intense biological dechlorination activity. Achieving the remediation objectives and project closure is based on the integration of multidisciplinary data using a multiscale approach. This research represents the first completed example in European territory of remediation of an aquifer contaminated with chlorinated solvents by a combination of adsorption and biodegradation.

A Smart Home System for Information Sharing, Health Assessments, and Medication Self-Management for Older People: Protocol for a Mixed-Methods Study.

BackgroundOlder adults often want to stay in a familiar place, such as their home, as they get older. This so-called aging in place, which may involve support from relatives or care professionals, can promote older people’s independence and well-being. The combination of aging and disease, however, can lead to complex medication regimes and difficulties for care providers in correctly assessing the older person's health. In addition, the organization of health care is fragmented, which makes it difficult for health professionals to encourage older people to participate in their own care. It is also a challenge to perform adequate health assessments and to engage in appropriate communication between health care professionals.ObjectiveThe purpose of this paper is to describe the design for an integrated home-based system that can acquire and compile health-related evidence for guidance and information-sharing among care providers and care receivers in order to support and promote medication self-management among older people.MethodsThe authors used a participatory design approach for this mixed-methods project, which was divided into four phases. Phase I, Conceptualization, consists of the conceptualization of a system to support medication self-management, objective health assessments, and communication between health care professionals. Phase II, Development of a System, consists of building and bringing together the conceptualized systems from Phase I. Phase III, Pilot Study, and Phase IV, Full-Scale Intervention, are described briefly.ResultsParticipants in Phase I were people who were involved in some way in the care of older adults and included older adults themselves, relatives of older adults, care professionals, and industrial partners. With input from Phase I participants, we identified two relevant concepts for promoting medication self-management, both of which related to systems that participants believed could provide guidance for the older adults themselves, relatives of older adults, and care professionals. The systems will also encourage information-sharing between care providers and care receivers. The first is the concept of the Intelligent Age-Friendly Home (IAFH), defined as an integrated residential system that evolves to sense, reason, and act in response to individuals’ needs, preferences, and behaviors as these change over time. The second concept is the Medication safety, Objective assessments of health-related behaviors, and Personalized medication reminders (MedOP) system, a system that would be supported by the IAFH, and which consists of three related components: one that assesses health behaviors, another that communicates health data, and a third that promotes medication self-management.ConclusionsThe participants in this project were older adults, relatives of older adults, care professionals, and our industrial partners. With input from the participants, we identified two main concepts that could comprise a system for health assessment, communication, and medication self-management: the IAFH and the MedOP system. These concepts will be tested in this study to determine whether they can facilitate and promote medication self-management among older people.International Registered Report Identifier (IRRID)DERR1-10.2196/12447

CONFLICT IN EASTERN UKRAINE AND ITS PSYCHOLOGICAL PECULIARITIES

The conflict that has been flaming up since 2014 in the East of Ukraine is a real multi-faceted war between Russia and Ukraine. It is also called the Anti-terrorist operation (ATO), Joint forces operation or “hybrid” war, as in Ukraine at the legislative level it has not been acknowledged as a war. When a war is defined as “hybrid” it is suggested that it is not a full-scale intervention of the Russian Federation and thus it is easier for many politician to justify their inactivity; just crossing the Ukrainian border, Russian forces take off chevrons and other identification marks. The West take advantage of this, pretending to be doubtful and, herewith, its reaction is reasonably less determined; and it vivifies “conspiracy theories” as to Putin’s probable allies. Legislative ambiguity generates not only enhancement of military threat, but also different psychological insinuation, which affect the conscious state of the Ukrainian society.

Evaluation of a sound environment intervention in an ICU: A feasibility study

BackgroundCurrently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes. Objectives(1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms. MethodsA quasi-randomized clinical trial design was chosen. The intervention consisted of a refurbished two-bed ICU patient room (experimental) with a new suspended wall-to-wall ceiling and a low frequency absorber. An identical two-bed room (control) remained unchanged. Inclusion criteria: Patients >18 years old with ICU lengths of stay (LoS) >48h. The final study group consisted of 31 patients: six from the rebuilt experimental room and 25 from the control room. Methodological problems and possible solutions were continuously identified and documented. ResultsUndertaking a full-scale intervention study with continuous measurements of acoustic data in an ICU is possible. However, this feasibility study demonstrated some aspects to consider before start. The randomization process and the sound measurement procedure must be developed. Furthermore, proper education and training are needed for determining ICU delirium. ConclusionThis study raises a number of points that may be helpful for future complex interventions in an ICU. For a full-scale study to be completed a continuously updated cost calculation is necessary. Furthermore, representatives from the clinic need to be involved in all stages during the project.