Future Delivery Research Articles

You Can Lead an Adolescent to Mindfulness, but You Can’t Make Them Mindful

Meta-analyses of mindfulness-based interventions (MBIs) in schools consistently show small, positive effects, but the field remains dominated by studies with low methodological rigour. Recent large randomised controlled trials in adolescents demonstrate poor traction in this age group together with some adverse effects, creating a crossroads for their future. In their recent commentary on the null effects of the MYRIAD trial (Kuyken et al., 2022), Strohmaier and Bailey (2023) postulated that making mindfulness practice available within the school day may increase the dosage and benefits of MBIs for adolescents, and called for funders to direct efforts at developing and testing this approach. We agree that identifying ways to increase dose beyond weekly classroom lessons is important, but explore whether this suggestion is practical or developmentally appropriate for secondary school settings. Our commentary broadens to group together other large and moderately large RCTs that have also shown disappointing results in adolescents, and presents seven barriers that together may be compounding the lack of effect in this age group. We offer alternative suggestions for future school-based research and delivery of MBIs.

The effect of different care delivery models in a hospital setting on patient- and nurse-related outcomes: A systematic review with narrative synthesis.

To synthesize and assess the effectiveness of different care delivery models in a hospital setting, taking into account patient- and nurse-related outcomes. A systematic review with narrative synthesis in which a comparison was made between different care delivery models. The search string consisted of four clusters: 'nursing', 'care delivery models', 'hospital setting' and 'quantitative research designs'. Four electronic databases were searched from the inception of the databases to January 2023: Medline, Embase, CINAHL and Web of Science. In total, 19 studies were included in the systematic review. The most commonly compared care delivery models were functional nursing to primary nursing (n = 6), patient allocation to team nursing (n = 4), team nursing to primary nursing (n = 3) and functional nursing to modular nursing (n = 3). Only one randomized crossover trial was found, other included studies were pretest-posttest designs or quasi-experimental designs. The implementation of a nursing care delivery model was the study intervention. The following aspects of the intervention were not reported or inadequately described by the majority of the authors; tailoring of an intervention, modifications to an intervention and the adherence or fidelity to the intervention. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. Due to a high heterogeneity in outcome measures between the studies, a meta-analysis of the included studies was not possible. All included studies had a high risk of overall bias. This systematic review found mixed evidence, inconsistent reporting of certain elements of the interventions, high heterogeneity in outcome measures and low methodological quality. Although this systematic review could not answer which nursing care delivery model is the most effective or most promising, other important findings from this review may inform future research. There are differences in care delivery model descriptions and a lack of agreement on the strengths and weaknesses of the care delivery models. No clear-cut answer can be given about the effect of different care delivery models in a hospital setting on patient- and nurse-related outcomes. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. This review can support the development of future care delivery redesign strategies. The systematic review was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). No patient or public contribution.

Nephrology nurse practitioner model of care for chronic kidney disease: Lessons learned and informing future healthcare delivery

Background: Chronic kidney disease (CKD) affects more than 10% of the Australian adult population. It is a progressive disease that involves multiple physiological systems and is associated with several comorbid conditions, making it particularly burdensome on patients and the healthcare system. Alternative models of healthcare delivery are required to slow the progression to kidney failure. Aim: To describe the characteristics, patient profiles, and health outcomes of patients with CKD attending a nephrology nurse practitioner-led clinic. Design: Longitudinal health-service exploratory design. Methods: Following ethics approval, data were extracted from a chronic kidney disease registry for all consenting patients who attended a nephrology nurse practitioner-led clinic. Data were analysed descriptively. Results: Over the study period, 253 patients (122 male and 131 female) attended the clinic. The mean age was 70.27 ± 10.48 years, and at baseline most had either chronic kidney disease grade 3A (32.8%) or 3B (41.5%). For the majority of those who remained in the clinic, kidney function remained stable or slightly improved. A large proportion were within recommended target ranges for systolic (85.6%) and diastolic (98%) blood pressure although many had high BMI (mean 31.99 ± 6.47) and HbA1c (57.1%). Conclusion: The nephrology nurse practitioner-led clinic demonstrated effectiveness in addressing CKD targets for patients and provides an opportunity to transform traditional primary and specialist healthcare delivery. What is already known about the topic? Early intervention in chronic kidney disease (CKD) can slow or halt the progression of the disease, reducing long-term burden and healthcare costs. An integrated model of care including primary and specialist providers is considered optimal for the early detection and treatment of CKD. An integrated nephrology nurse practitioner model is an emerging model of care for CKD patients. However, studies investigating the cost-effectiveness, efficacy, and characteristics of this model compared to specialist or primary care in Australia are lacking. What this paper adds: This paper describes the characteristics and outcomes of a nephrology nurse practitioner-led outpatient clinic embedded within a multidisciplinary model of care. The majority of patients who remained in nephrology nurse practitioner care maintained recommended CKD targets. The findings provide evidence that nephrology nurse practitioners are able to manage patients with less advanced CKD grades who have comorbid conditions and other health risk-factors.

The importance of group factors in the delivery of group-based parenting programmes: a process evaluation of Mellow Babies

IntroductionThe role of the group has been largely overlooked within evaluations of group-based parenting programmes. Group contextual factors, including size and level of homogeneity, may impact on essential group processes, such as group identification and cohesion, that are necessary to activate interpersonal change mechanisms and attain programme outcomes. This process evaluation of Mellow Babies, a 14-week attachment-based group parenting programme for mothers of infants aged under 18 months, explores how group context affected mother and practitioner experiences of the programme.MethodsIn-depth interviews were conducted with fourteen mothers and three practitioners from three different Mellow Babies groups. Framework Analysis was employed to analyse data, using groups as cases within the framework matrix while preserving individual participants within each case. This allowed comparisons to be made within and between groups.ResultsFour group contextual factors impacted on the quality of programme delivery: (1) group size; (2) level of group homogeneity; (3) pre-existing relationships; and (4) personalities within the group. These contextual factors affected the hypothesised intervention mechanisms: (1) fluid progression through the stages of group development; (2) a safe, non-judgemental, contained space; (3) social identification with group; (4) group cohesion; and (5) a culture of openness, support and empowerment.DiscussionFindings have implications for future delivery and implementation of group-based parenting programmes, for example, the importance of considering group composition during programme recruitment. Practitioners may also benefit from a stronger focus on group processes and enabling group dynamics within training, supervision, and the programme manual.

Practitioner experiences of pulmonary rehabilitation service delivery during COVID-19 and impact on future service delivery

Introduction During COVID-19, pulmonary rehabilitation as we know it ceased to exist. The service needed to adapt rapidly to the requirements of the patient group, while complying with government isolation guidelines. Most groups moved online, but with little time to evaluate the service. What can we learn from this roll out to ensure practitioners continue to deliver a safe and effective pulmonary rehabilitation service. Aim To explore the opinions of physiotherapist and respiratory nursing specialists’ on how pulmonary rehabilitation has changed due to COVID-19 and the impact on future service delivery. Methods A qualitative design was used to gain in-depth understanding of lived experiences. Forty nine participants completed the online survey of 14 open ended questions, and a four-stage thematic analysis used to identify emergent themes. Findings Three main themes were identified- a need for best practice, a need for patient centred care, and acknowledging the emotional stressors of COVID-19 on vulnerable patients. Conclusion Patients should be offered both online and face-to-face options for pulmonary rehabilitation, to promote patient centred care; providing options to participate in effective rehabilitation without physical or emotional restriction; and to increase staff training to enable practitioners to provide the increasingly complex and holistic service required.

Equine-Assisted Therapy Pilot Program: A Post-Participation Study of Client Satisfaction

Equine-assisted therapy (EAT) is an emerging practice area that has been shown to decrease negative symptoms in individuals experiencing post-traumatic stress disorder (PTSD). While the research for equine-assisted therapy demonstrates effectiveness in decreasing PTSD symptoms, there is a lack of evidence to verify client satisfaction. The purpose of this mixed-methods study was to evaluate participant satisfaction using the eight-question “Client Satisfaction Survey” and compose recommendations based on participant feedback from a focus group after completing an Equine-Assisted Therapy Post-traumatic stress disorder (EAT-PTSD) program. Two participants attended an EAT-PTSD program that utilized the protocol developed by the Man O’ War project. Both participants attended all sessions and completed pre- and post-measures including the Post-Traumatic Stress Disorder Checklist Criterion Assessment, the 16-item Quick Inventory of Depressive Symptomatology Self-Report, informal numerical anxiety ratings, and a focus group for evaluation of program satisfaction and future recommendations. The results show that completion of an EAT-PTSD program decreases negative PTSD symptoms. Additionally, participants had an overall high satisfaction rate after completion of an EAT-PTSD program. Recommendations from program participants for future program delivery include increasing program length, using additional resources like talk and group therapy, and recruiting more participants to take part in the program.

Holistic preconception care: Providing real-time guidance via a mobile app to optimise maternal and child health.

Preconception is a critical period to optimise gamete function and early placental development, essential for successful conception and long-term maternal-child health. However, there is a lack of preconception services and consequently, global fertility rates continue to fall and mothers embark on their pregnancy journey in poor health. There is an urgent need to implement a holistic community-level preconception care programme to optimise risk factors for poor fecundability and improve long-term maternal-child health. We reviewed current evidence on fecundability lifestyle risk factors, the efficacy of existing preconception interventions and the use of digital platforms for health optimisation, to create a new digital-based preconception intervention model that will be implemented via an app. We present the theory, content and mode of delivery of this holistic model targeting couples planning for pregnancy. We propose a new model featuring a user-friendly mobile app, which enables couples to self-assess fecundability risks through a personalised risk score that drives a tailored management plan. This tiered management provides anticipatory guidance supported by evidence-based recommen-dations, and promotes ongoing engagement for behavioural optimisation and specialist referrals as required. Based on the health belief model, this new model delivered with a mobile app seeks to shift couples' perceptions about their susceptibility and severity of subfertility, benefits of making a change and barriers to change. Our proposed digital-based intervention model via a mobile app stands to enhance preconcep-tion care by providing personalised risk assessments, real-time feedback and tiered management to optimise preconception reproductive health of couples. This model forms a reference content framework for future preconception care intervention delivery.

Evaluation of the responsiveness pattern to caffeine through a smart data-driven ECG non-linear multi-band analysis

This study aimed to explore more efficient ways of administering caffeine to the body by investigating the impact of caffeine on the modulation of the nervous system's activity through the analysis of electrocardiographic signals (ECG). An ECG non-linear multi-band analysis using Discrete Wavelet Transform (DWT) was employed to extract various features from healthy individuals exposed to different caffeine consumption methods: expresso coffee (EC), decaffeinated coffee (ED), Caffeine Oral Films (OF_caffeine), and placebo OF (OF_placebo). Non-linear feature distributions representing every ECG minute time series have been selected by PCA with different variance percentages to serve as inputs for 23 machine learning models in a leave-one-out cross-validation process for analyzing the behavior differences between ED/EC and OF_placebo/OF_caffeine groups, respectively, over time. The study generated 50-point accuracy curves per model, representing the discrimination power between groups throughout the 50 min. The best model accuracies for ED/EC varied between 30 and 70 %, (using the decision tree classifier) and OF_placebo/OF_caffeine ranged from 62 to 84 % (using Fine Gaussian). Notably, caffeine delivery through OFs demonstrated effective capacity compared to its placebo counterpart, as evidenced by significant differences in accuracy curves between OF_placebo/OF_caffeine. Caffeine delivery via OFs also exhibited rapid dissolution efficiency and controlled release rate over time, distinguishing it from EC. The study supports the potential of caffeine delivery through Caffeine OFs as a superior technology compared to traditional methods by means of ECG analysis. It highlights the efficiency of OFs in controlling the release of caffeine and underscores their promise for future caffeine delivery systems.

#796 Obstetric nephrology in Europe: a survey of nephrologists’ self-reported experience and training

Abstract Background and Aims Chronic kidney disease (CKD) is estimated to affect 3% of pregnant women in high-income countries. The prevalence of CKD in pregnancy is predicted to rise due to advancing maternal age, obesity, and co-morbidities. There is a paucity of evidence regarding nephrologists’ experience in and exposure to women's health in Europe. North American literature reports two thirds of nephrologists self-reported a lack of confidence in women's health issues. This survey aimed to assess the confidence in and exposure to women's health among nephrologists in Europe. Method An anonymized online survey was conducted using the survey monkey platform from March to April 2023. A validated survey was utilised to ensure internal and external validity with minimal modifications made (Hendren, 2019). It was disseminated via email to Irish Nephrology Society membership, via link sharing on social media and messaging applications. Results were analysed using GraphPad prism. Results Demographics: A total of 75 participants responded, of those 52 identified as practising in Europe (22 Ireland and 30 other European countries). The results of respondents from Europe are detailed below. 63.46% (33) of respondents identified as female. 9.61% (5) were under 30 years of age, 42.3% (22) were aged from 30-40 years, 23.07% (12) were aged from 40-50 years, 23.07% (12) were aged from 50-60 years, and 1.92% (1) respondent over 60 years of age. Service provision: Women with kidney disease who are planning pregnancy are seen by the following Physicians: General or Transplant Nephrologist 63.46% (33), Nephrologist who specializes in pregnancy 42.31% (22), High Risk Obstetrician or Maternal Foetal Medicine Specialist 38.42% (20), Specialized interdisciplinary kidney disease in pregnancy clinic (Obstetrician and Nephrologist) 26.92% (14),Primary care doctor/family doctor 15.38% (8), Obstetrical Internal Medicine specialist 7.69% (4). Women with kidney disease who are pregnant are seen by the following Physicians: Nephrologist who specializes in pregnancy 40.38% (21), Specialized interdisciplinary kidney disease in pregnancy clinic (Obstetrician and Nephrologist) 34.62% (18),High Risk Obstetrician or Maternal Foetal Medicine Specialist 50% (26), General or Transplant Nephrologist 50% (26), Primary care doctor/family doctor 11.54% (6), Obstetrical Internal Medicine specialist 7.69% (4). 17.42% (9) of respondents had cared for <1 pregnant woman in the last year. Education: 73.07% (38) of respondents noted receiving dedicated education in women's health while in specialty training. Resources that were identified as potentially be helpful for counselling and management of women of childbearing age with CKD included: Interdisciplinary guidelines established by Obstetrics and Nephrology 80.77% (42), continuing education seminars or case based materials 78.85% (41), referral to a nephrologist with special interest and/or training in women's health 53.85% (28), patient education pamphlets or videos with shared decision making tools 44.23% (23), and access to e-consultation in 21.15% (11). Pregnancy counselling: 57.69% (30) of Nephrologists were confident/very confident in counselling on pregnancy outcomes by CKD stage. 48.08% (25) of Nephrologists were confident/very confident in counselling on foetal outcomes by CKD stage. 63.46% (33) of respondents offer pre-conception counselling to less than one women per month. Conclusion Nephrologists practising in Europe have varied exposure to and confidence in caring for women with kidney disease who are planning pregnancy or are pregnant. There is potential for improvement in training and expansion of combined obstetric and nephrology pre-conceptual counselling and pregnancy care. Further consultation with patient advocacy groups is required to plan future care delivery.

The delivery of creative socially prescribed activities for people with serious mental health needs during lockdown: Learning about remote, digital and hybrid delivery.

Social prescribing interventions connect mental health service users to community resources, to support physical and mental wellbeing and promote recovery. COVID-19 restrictions impacted the delivery of socially prescribed activities, preventing face to face contact for long periods. The aim of this study was to understand how Voluntary Community and Social Enterprise (VCSE) organisations working with a local NHS mental health Trust responded to the challenges of social distancing during the COVID-19 pandemic. This understanding will be used to make recommendations for future practice, post-lockdown. Using a convergent mixed methods design, we surveyed VCSE providers of socially prescribed activities intended to be accessible and appropriate for people with severe mental health needs. Follow-up interviews explored further how they adapted during the first year of the pandemic, the challenges they faced, and how they sought to overcome them. The survey and interview data were analysed separately and then compared to identify convergent and divergent findings. Twenty VCSE representatives completed the survey which provided a snapshot of changes in levels of connection and numbers reached during lockdown. Of 20 survey respondents, 11 participated in follow-up interviews. Interviews revealed that lockdown necessitated rapid change and responsive adaptation; activities were limited by resource, funding, safeguarding and government restrictions; no single format suited all group members; connection was key; and impact was difficult to gauge. VCSE organisations commissioned to deliver creative socially prescribed activities during the pandemic rapidly adapted their offer to comply with government restrictions. Responsive changes were made, and new knowledge and skills were gained. Drawing on experiences during lockdown, VCSE organisations should develop bespoke knowledge, skills and practices to engage service users in future hybrid delivery of arts, sports, cultural and creative community activities, and to ensure that digital activities offer an equivalent degree of connection to face-to-face ones. Additionally, more effective methods of gaining feedback about patient experience of hybrid delivery is needed.

Digital Adoption by an Organization Supporting Informal Caregivers During COVID-19 Pandemic Showing Impact on Service Use, Organizational Performance, and Carers' Well-Being: Retrospective Population-Based Database Study With Embedded User Survey.

The COVID-19 pandemic has catalyzed a move from face-to-face to digital delivery of services by hospitals and primary care. However, little is known about the impact of digital transformation on organizations supporting unpaid caregivers. Since the start of the COVID-19 pandemic, the value of care provided by such informal caregivers is estimated to be £111 billion (US$ 152.7 billion) in England. This study aims to analyze service uptake patterns (including digital service options) over the pandemic period in an English caregivers' support organization covering a population of 0.98 million; measure changes in organizational performance, service efficiency, and quality; and identify the views of caregivers on service provision and future digital delivery. This was a retrospective analysis of the use of digital versus nondigital support services (January 2019 to June 2021) by caregivers in city and rural geographic areas. We compared organizational performance and service quality indicators for 2 financial years (2019-2020 and 2020-2021). A survey was conducted to identify barriers and facilitators to digital service uptake, the computer proficiency of caregivers (the Computer Proficiency Questionnaire, 12-item version), and preferences for future digital service provision. Quantitative data were analyzed using Stata 13 (StataCorp LLC). Thematic analysis was used for open-text survey responses. The number of caregivers registered with the organization rose from 14,817 in 2019 to 20,237 in 2021. Monthly contacts rose from 1929 to 6741, with remote contacts increasing from 48.89% (943/1929) to 86.68% (5843/6741); distinctive patterns were observed for city versus rural caregivers. There was an increase in one-to-one contacts (88.8%) and caregiver assessments (20.9%), with no expansion in staffing. Service quality indicators showed an improvement in 5 of 8 variables (all P<.05). The 152 carers completing the survey had similar demographics to all registered caregivers. The Computer Proficiency Questionnaire, 12-item version, mean score of 25.61 (SD 4.40) indicated relatively high computer proficiency. The analysis of open-text responses identified a preference for the organization to continue to offer face-to-face services as well as web-based options. The digital services that were the most highly rated were carers' well-being assessments, support needs checks, and peer support groups. Our findings show that staff in the caregiver support organization were agile in adapting their services to digital delivery while dealing with increased numbers of registered clients and higher monthly contacts, all without obvious detriment to service quality. Caregivers indicated a preference for blended services, even while recording high computer proficiency. Considering the economic importance of unpaid caregivers, more attention should be given to organizations funded to provide support for them and to the potential for technology to enhance caregivers' access to, and engagement with, such services.

“We might not have been in hospital, but we were frontline workers in the community”: a qualitative study exploring unmet need and local community-based responses for marginalised groups in Greater Manchester during the COVID-19 pandemic

BackgroundThe response to the COVID-19 pandemic saw a significant increase in demand for the voluntary, community, faith and social enterprise (VCFSE) sector to provide support to local communities. In Greater Manchester (GM), the VCFSE sector and informal networks provided health and wellbeing support in multiple ways, culminating in its crucial supportive role in the provision of the COVID-19 vaccination rollout across the GM city region. However, the support provided by the VCFSE sector during the pandemic remains under-recognised. The aims of the study were to: understand the views and experiences of marginalised communities in GM during the COVID-19 pandemic; explore how community engagement initiatives played a role during the pandemic and vaccine rollout; assess what can be learnt from the work of key stakeholders (community members, VCFSEs, health-system stakeholders) for future health research and service delivery.MethodsThe co-designed study utilised a participatory approach throughout and was co-produced with a Community Research Advisory Group (CRAG). Focus groups and semi-structured interviews were conducted remotely between September-November 2021, with 35 participants from local marginalised communities, health and care system stakeholders and VCFSE representatives. Thematic framework analysis was used to analyse the data.ResultsLocal communities in GM were not supported sufficiently by mainstream services during the course of the COVID-19 pandemic, resulting in increased pressure onto the VCFSE sector to respond to local communities’ need. Community-based approaches were deemed crucial to the success of the vaccination drive and in providing support to local communities more generally during the pandemic, whereby such approaches were in a unique position to reach members of diverse communities to boost uptake of the vaccine. Despite this, the support delivered by the VCFSE sector remains under-recognised and under-valued by the health system and decision-makers.ConclusionsA number of challenges associated with collaborative working were experienced by the VSCE sector and health system in delivering the vaccination programme in partnership with the VCFSE sector. There is a need to create a broader, more inclusive health system which allows and promotes inter-sectoral working. Flexibility and adaptability in ongoing and future service delivery should be championed for greater cross-sector working.

Integration of primary care and palliative care services to improve equality and equity at the end-of-life: Findings from realist stakeholder workshops

Background: Inequalities in access to palliative and end of life care are longstanding. Integration of primary and palliative care has the potential to improve equity in the community. Evidence to inform integration is scarce as research that considers integration of primary care and palliative care services is rare. Aim: To address the questions: ‘how can inequalities in access to community palliative and end of life care be improved through the integration of primary and palliative care, and what are the benefits?’ Design: A theory-driven realist inquiry with two stakeholder workshops to explore how, when and why inequalities can be improved through integration. Realist analysis leading to explanatory context(c)-mechanism(m)-outcome(o) configurations(c) (CMOCs). Findings: A total of 27 participants attended online workshops (July and September 2022): patient and public members (n = 6), commissioners (n = 2), primary care (n = 5) and specialist palliative care professionals (n = 14). Most were White British (n = 22), other ethnicities were Asian (n = 3), Black African (n = 1) and British mixed race (n = 1). Power imbalances and racism hinder people from ethnic minority backgrounds accessing current services. Shared commitment to addressing these across palliative care and primary care is required in integrated partnerships. Partnership functioning depends on trusted relationships and effective communication, enabled by co-location and record sharing. Positive patient experiences provide affirmation for the multi-disciplinary team, grow confidence and drive improvements. Conclusions: Integration to address inequalities needs recognition of current barriers. Integration grounded in trust, faith and confidence can lead to a cycle of positive patient, carer and professional experience. Prioritising inequalities as whole system concern is required for future service delivery and research.

Nursing/midwifery students' perceptions of caring pedagogy and online learning during the COVID-19 pandemic.

This study aimed to gain a better understanding of nursing/midwifery students' perspectives on a pedagogy of caring and online learning during the COVID-19 pandemic. In addition, it aimed to determine if the COVID-19 pandemic impacted students' perceptions and experience of online learning and students' desire to enter the nursing/midwifery workforce. Mixed methods. A multi-centre cross-sectional survey of Australian nursing and midwifery students was undertaken to explore students' experience of learning during the COVID-19 pandemic. There are several key findings from this study that may be relevant for the future delivery of undergraduate health education, students transitioning to practice and healthcare workforce retention. The study found that although students were somewhat satisfied with online learning during COVID-19, students reported significant issues with knowledge/skill acquisition and barriers to the learning process. The students reported feeling less prepared for practice and identified how clinical staff were unable to provide additional guidance and support due to increased workloads and stress. The textual responses of participants highlighted that connection/disconnection, empathy and engagement/disengagement had an impact on learning during COVID-19. Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. In addition, graduates entering the workforce felt less prepared for entry into practice due to changes in education delivery during COVID-19 that they perceived impacted their level of clinical skills, confidence and ability to practice as new graduate nurses/midwives. Not applicable. Attention must be given to the transition of new graduate nurses and midwives whose education was impacted by pandemic restrictions, to support their professional career development and to ensure retention of future healthcare workforce. Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. Educators should consider how connection and engagement can be actively embedded in the online learning environment.

Assessment of an online tooth morphology course and 3D examination tool during the COVID-19 pandemic.

The COVID-19 pandemic brought major disruptions to dental teaching and has impacted the delivery of tooth morphology courses where students are introduced to the three-dimensional features of the dentition. The aim of this study was to assess the implementation of newly developed online teaching modalities for tooth morphology, evaluate their usefulness and identify elements that are beneficial for learners. Following the delivery of an online course that included online 3D models, 2D cue cards, live discussion sessions and Socrative™ quizzes, the participants were asked to rate the usability and usefulness of each tool. The participants' knowledge of tooth morphology was assessed through an online examination using 3D-digitised tooth models. The participants identified lecture handouts and online 3D models as their preferred learning tools, while lecture video recordings and 2D cue cards were viewed as less useful. Data analysis from Socrative™ quizzes demonstrated improvement in tooth identification skills throughout the course delivery. Finally, results from the final assessment are in line with previous in-person deliveries of this course. The study provides valuable information on the usefulness of teaching modalities that were implemented in response to the COVID-19 pandemic and their merit to be retained in future deliveries of the course. The 3D models have been identified as particularly useful in this context, but the participants still value the opportunity to learn with extracted teeth. Furthermore, it remains to be confirmed whether tooth identification skills acquired using 3D models can be transferred to the clinical setting.

A prediction method of interaction based on Bilinear Attention Networks for designing polyphenol-protein complexes delivery systems

Polyphenol-protein complexes delivery systems are gaining attention for their potential health benefits and food industry development. However, creating an ideal delivery system requires extensive wet-lab experimentation. To address this, we collected 525 ligand-protein interaction data pairs and established an interaction prediction model using Bilinear Attention Networks. We utilized 10-fold cross validation to address potential overfitting issues in the model, resulting in showed higher average AUROC (0.8443), AUPRC (0.7872), and F1 (0.8164). The optimal threshold (0.3739) was selected for the model to be used for subsequent analysis. Based on the model prediction results and optimal threshold, by verifying experimental analysis, the interaction of paeonol with the following proteins was obtained, including bovine serum albumin (lgKa = 6.2759), bovine β-lactoglobulin (lgKa = 6.7479), egg ovalbumin (lgKa = 5.1806), zein (lgKa = 6.0122), bovine α-lactalbumin (lgKa = 3.9170), bovine lactoferrin (lgKa = 4.5380), the first four proteins are consistent with the predicted results of the model, with lgKa >5. The established model can accurately and rapidly predict the interaction of polyphenol-protein complexes. This study is the first to combine open ligand-protein interaction experiments with Deep Learning algorithms in the food industry, greatly improving research efficiency and providing a novel perspective for future complex delivery system construction.

"WOOP is my safe haven": A qualitative feasibility and acceptability study of the Wish Outcome Obstacle Plan (WOOP) intervention for spouses of people living with early-stage dementia.

As symptoms emerge and worsen in people living with dementia, their spouses can benefit from behavioral interventions to support their adjustment as a care partner. The Wish Outcome Obstacle Plan (WOOP) intervention improves the well-being of spouses of people living with dementia early in the disease course, but intervention mechanisms and opportunities for improvement are unclear. The present study gave voice to spouses who participated in a trial of WOOP, describing how WOOP was incorporated into their lives and how it could be improved for future implementation. For this qualitative study, we conducted longitudinal semi-structured interviews among 21 spouses of people living with dementia (three interviews over three months; 63 interviews total). Codebook thematic analysis was performed. Three meta-themes were derived: (1) assessing baseline strengths and limitations of WOOP, (2) learning from experience, and (3) fine-tuning and sustaining WOOP. Participants described how WOOP addressed their interpersonal and emotional stressors, their responses to behaviors of the person living with dementia, and their relationship quality. Considerations for future intervention delivery (e.g., solo vs. in group settings) and instructions (e.g., encouraging writing vs. thinking through the four steps of WOOP) were identified as areas of improvement. WOOP was described as a practical, feasible, and desirable intervention for spouses at the early stages of their partner's dementia. Participants made WOOP easier to incorporate in their everyday lives by adapting the design into a mental exercise that they used as needed. Suggestions from participants specified how to make the everyday use of WOOP more feasible, sustainable, and applicable in a variety of contexts. ClinicalTrials.gov HIC 2000021852.

Autistic Women's Experience of Motherhood: A Qualitative Analysis of Reddit.

Autistic mothers remain under-represented in parental and autism research despite the associated physical and psychosocial challenges that accompany the transition to motherhood. Extant literature suggests autistic mothers experience sensory difficulties, communication challenges, stigma, and comorbidities as difficulties, but these studies have focused on autistic women in the perinatal period. The aim of this study was to examine reflections on motherhood from a Reddit community for autistic parents. Identified themes were Autistic Mothering is Different, Autistic Mothers Need Autistic Mothers, Autistic Mothers Experience Stigma, and Learnings from Lockdown. Findings extend existing research by offering insight into the ways autism impacts mothers beyond the perinatal period and have important implications for the future design and delivery of support services for autistic mothers.

Thin silk fibroin coating on electrospun fibers for sustained release of active compounds

This study describes a method for producing a silk fibroin (SF) layer on fibrous structures formed by an amorphous polymer matrix for sustained drug diffusion. The presented model system is electrospun nanofibers of polycaprolactone (PCL) with ciprofloxacin (CIP). The nanofibers were covered with SF by immersion in its 0.2 wt% aqueous solution, which allows the forming on the nanofiber surface of a 50 nm layer. SF layer was crystallized by ethanol vapor and made SF insoluble in water for over 2 weeks due to an increase of β-sheet content in the protein secondary structure. SF does not affect the high surface-area-to-volume ratio of the fibers and makes them hydrophilic.The nanofibers reveal antibacterial properties against Gram-positive Staphylococcus aureus and -negative Klebsiella pneumoniae bacteria. The inhibition zone of bacteria growth after 24 h incubation is bigger for non-coated fibers indicating inhibition of the drug release by SF coating. Both kinds of fibers reveal the Fickian diffusion model of drug release, characterized by burst release for fibers non-covered with SF and sustained release for those covered with SF layer. The presented SF layer preparation method can facilitate the construction of future drug delivery systems and design materials with sustained release profiles.

Koolangka Infant Life Saving: Culturally responsive infant CPR education for Aboriginal Australian parents

Objectives: Among Aboriginal children, the year between birth and 1 year of age has the highest mortality rate compared with any other age. Prompt administration of cardiopulmonary resuscitation (CPR) leads to better outcomes and a lower likelihood of ongoing sequalae. Current education on infant CPR is not provided to parents except in certain circumstances in a neonatal intensive care unit. Currently, there are no identified CPR education courses specifically available for Aboriginal or Torres Strait Islander people, meaning that current infant CPR education courses are not culturally responsive. Design: Partnering with an Aboriginal community from the Bindjareb region of the Western Australian Noongar nation, the researchers used a co-design approach and an Aboriginal Participatory Action Research (APAR) design to explore how to deliver culturally safe and responsive infant CPR community education. This resulted in the development of the Koolangka Infant Life Saving Education Framework (KILSEF), which can be used to guide future planning and delivery of culturally safe and responsive community level infant CPR education. Results: The study findings identified that members of the Aboriginal community were very interested in receiving infant CPR education, but the barriers identified from mainstream CPR course delivery need to be removed for the community to benefit from culturally responsive ways of learning. Culturally responsive community CPR education should be provided in culturally safe places and the focus of learning should be on the practical applications of CPR and less on the academic pre-reading and written requirements. Explanations should be provided in lay terms and patience is required to communicate ideas in ways that facilitate understanding, and the course may need to be delivered over several days to accommodate community participant availability. Conclusion: Addressing Aboriginal community concerns and barriers allowed for the implementation of culturally responsive infant resuscitation education which was highly valued by community members and led to increased community confidence and participation in CPR education.