High Quality Research Articles

CONTRIBUTION OF PLASTIC ROAD CONSTRUCTION IN MANAGING NON-BIODEGRADABLE PLASTIC WASTE

Waste affects every part of society and is not only environmentally damaging but also expensive. Businesses, local authorities, government and members of the public plays a part in the creation, management and disposal of waste and it is vital that they all recognize the benefits of reducing waste and the roles they must play in doing this. Whilst much attention has been paid to re-use, recycling and waste management, in this research we focus on plastic waste reduction and there is now a need for government and the media to promote the importance of this message solely focusing on use of these plastic generated waste, understanding its composition and properties to be used for road construction. Roads must reliably carry heavy loads, often under challenging environmental and geotechnical condition. It follows that the roads are routinely designed to contain high quality, newly produced materials. This research reviews the use of plastic wate materials in road construction and will give an understanding of plastic waste reduction and reusing it into a durable development. Keywords- Plastic waste, bitumen mixed plastic, reducing environmental impacts

Geoinformatics-Based Mapping of Environmental Sensitive Areas for Desertification over Satara and Sangli Districts of Maharashtra, India

Desertification processes in arid, semi-arid, and dry sub-humid conditions have been enhanced in recent decades. The geospatial database and associated satellite data can be effectively employed for regional planning to address desertification and land degradation. In this study, the Mediterranean Desertification and Land Use (MEDALUS) model has been used to map environmentally sensitive areas due to desertification in the Satara and Sangli districts of Maharashtra, India. This was achieved by combining Landsat-8 multispectral data, Census data, soil data, and climatic variables like temperature, rainfall, and evapotranspiration. The algorithm of MEDALUS is the geometric mean of four indicators, namely soil quality index (SQI), climate quality index (CQI), vegetation quality index (VQI), and socio-economic quality index (SEQI). The findings indicated that the majority of the study area comes under the potential category of desertification (60.32%) followed by fragile (27.87%) and critical (11.81%). Areas with a high propensity for desertification were found over the low to very low climatic quality and moderate to high soil quality including lower socio-economic quality. The lower socio-economic quality is mainly due to high to very high population density (>100 people/km2), low to moderate illiteracy rate (<16%), and low to moderate work participation rate (<50%) that incentivize unsustainable land use practices. The study provides a valuable tool for understanding and managing natural resources. It offers a detailed analysis of the environmental sensitivity of the study area, taking into account various factors like land use, vegetation cover, slope, and soil erosion potential. The developed comprehensive map of the area helps in identifying the most sensitive regions and developing appropriate conservation strategies. The information obtained from the study can be utilized to develop and implement successful measures to prevent or alleviate desertification, which is crucial for sustaining the health of ecosystems and the welfare of local residents.

Organisational Enablers of Artificial Intelligence Adoption in Public Institutions: A Systematic Literature Review

Purpose: The purpose of the presented study was to develop a set of recommendations for decision-makers (policymakers and public managers) and public employees to enhance the effectiveness and efficiency of organisational elements in the adoption of artificial intelligence (AI) in public institutions. Design/methodology/approach: Utilising a systematic literature review following the PRISMA protocol, the study examines the organisational enablers of AI adoption in public institutions. Comprehensive search queries in the Scopus database identified relevant literature focusing on the intersection of AI technologies and various organisational elements. The analysis was facilitated by NVivo 12, enabling a structured examination of key organisational facets for people, culture, structure, processes, and technology within public institutions. Findings: Previous studies on AI adoption in public institutions identified numerous enablers of AI adoption associated with organisational elements like people/employees, structure, culture, technology, and processes. Several surveys and case studies stress the importance of concentrating on the introduction or transformation of these organisational elements prior to or concurrently with the adoption of AI. Academic contribution to the field: By applying a systematic literature review protocol, the study represents the first holistic and systematic review of specific organisational elements that can serve as enablers of AI adoption in public institutions. Research limitations/implications: This systematic literature review was subject to several limitations. Firstly, the division of AI literature between natural and social sciences, with the former focusing on technical aspects and the latter on broader organisational themes, may have resulted in an incomplete depiction of the intersection of AI and organisational change. Secondly, despite the broad search queries, inherent limitations of keyword-based searches may have excluded some relevant studies. Thirdly, considering the rapid evolution of AI technology, our review may not fully encapsulate the very latest developments in the field as it covers literature published until May 2023. Finally, the interpretation and coding of literature, despite the use of NVivo 12, involved subjective elements that could affect the study’s outcomes. Practical implications: Drawing from experiences in the private sector, public institutions are increasingly adopting AI technologies across various subsectors such as public finance (taxation), research, healthcare, law enforcement, defence, education. This requires a transformation in both hard (structure, processes etc.) and soft aspects (people, organisational culture etc.). Therefore, the enablers identified in the study can serve as guidelines for decision-makers and implementers of AI at all levels of public institutions. Social implications: If adopted effectively and efficiently and used professionally and ethically, the use of AI in public institutions can bring many benefits to society, such as transparency, justice, cost and time efficiency, high quality services, and improved collaboration between different stakeholders in society. Originality/significance/value: Our study makes a distinct contribution by shifting the focus from technological barriers to organisational enablers of AI adoption in public institutions. It bridges a critical gap in the literature by integrating both technical and social science perspectives, providing valuable insights for theory and practice in the fields of organisation and management.

Enhanced Photon-Pair Generation Based on Thin-Film Lithium Niobate Doubly Resonant Photonic Crystal Cavity

In this work, a doubly resonant photonic crystal (PhC) cavity is proposed to enhance second harmonic generation (SHG) efficiency and photon pair generation rate (PGR). Through the exploration of geometry parameters, a band-edge mode within the light cone is identified as the first harmonic (FH) mode, and a band-edge mode outside the light cone is designated as the second harmonic (SH). Subsequently, by increasing the layers of the core region, a heterostructure PhC cavity is designed. The results showcase a doubly resonant PhC cavity achieving a 133/W SHG efficiency and a photon pair generation rate of 3.7 × 108/s. The exceptional conversion efficiency is attributed to the high quality factors Q observed in the FH and SH modes with values of approximately 280,000 and 2100, respectively. The remarkably high Q factors compensate for nonlinear efficiency degradation caused by detuning, simultaneously making the manufacturing process easier and more feasible. This work is anticipated to provide valuable insights into efficient nonlinear conversion and photon pair generation rates.

Evaluation of DNA yield from various tissue and sampling sources for use in single nucleotide polymorphism panels

Genetics studies are used by wildlife managers and researchers to gain inference into a population of a species of interest. To gain these insights, microsatellites have been the primary method; however, there currently is a shift from microsatellites to single nucleotide polymorphisms (SNPs). With the different DNA requirements between microsatellites and SNPs, an investigation into which samples can provide adequate DNA yield is warranted. Using samples that were collected from previous genetic projects from regions in the USA from 2014 to 2021, we investigated the DNA yield of eight sample categories to gain insights into which provided adequate DNA to be used in ddRADseq or already developed high- or medium-density SNP panels. We found seven sample categories that met the DNA requirements for use in all three panels, and one sample category that did not meet any of the three panels requirements; however, DNA integrity was highly variable and not all sample categories that met panel DNA requirements could be considered high quality DNA. Additionally, we used linear random-effects models to determine which covariates would have the greatest influence on DNA yield. We determined that all covariates (tissue type, storage method, preservative, DNA quality, time until DNA extraction and time after DNA extraction) could influence DNA yield.

Moiré superlattices arising from growth induced by screw dislocations in layered materials

Abstract Moiré superlattices (MSLs) are modulated structures produced from homogeneous or heterogeneous two-dimensional layers stacked with a twist angle and/or lattice mismatch. Enriching the methods for fabricating MSL and realizing the unique emergent properties are key challenges on its investigation. Here we recommend that the spiral dislocation driven growth is another optional method for the preparation of high quality MSL samples. The spiral structure stabilizes the constant out-of-plane lattice distance, causing the variations in electronic and optical properties. Taking SnS2 MSL as an example, we find prominent properties including large band gap reduction (~0.4 eV) and enhanced optical activity. First-principles calculations reveal that these unusual properties can be ascribed to the locally enhanced interlayer interaction associated with the Moiré potential modulation. We believe that the spiral dislocation driven growth would be a powerful method to expand the MSL family and broaden their scope of application.

Alternative methodology of special coffee roasting in the electric popcorn maker

The aim was to develop and evaluate an alternative method for roasting coffee, using a domestic electric popcorn machine, estimating an ideal roasting time to obtain a drink of high quality. The experiment was conducted under laboratory conditions, with 10 treatments, with roasting times ranging from 3 to 8 minutes. Grain mass reduction and roasting color classification, according to the ABG Agtron scale, were evaluated. Roasting was carried out in a domestic electric popcorn maker, from Mondial brand, model PP-04, with a power of 1200W. Time intervals of five to six minutes showed better coffee characteristics, medium roasting point, ideal for specialty coffees. The use of the popcorn machine as a coffee roaster showed a satisfactory result, since in a short period of time, it provided a uniform roast, which attributes superior quality, compared to conventional coffee found on the market.

Primary mental healthcare for adults with mild intellectual disabilities: Patients’ perspectives

Background People with mild intellectual disabilities (MID) experience more mental health (MH) problems than the general population but often do not receive appropriate primary MH care. Primary MH care is essential in integrative MH care and, therefore, demands high quality. To improve primary MH care for this patient group, account must be taken of the experiences of people with MID. So far, their perspectives have been largely absent from primary MH care research. Objectives To explore patients’ experiences, needs, and suggestions for improvement regarding primary MH care for people with MID. Methods Qualitative study among adults with MID who visited their GP with MH problems in the previous 12 months. Semi-structured interviews were conducted using a guide based on Person-Centred Primary Care Measures. Transcripts were analysed thematically. Results The 11 interviews that we conducted revealed four themes. The first theme, cumulative vulnerability, describes the vulnerability – instigated by the MID and reinforced by MH problems – experienced on a GP visit. The other themes (needs regarding the GP, needs regarding the network, self-determination) arise from this vulnerability. Conclusion People with both MID and MH problems are extra vulnerable in primary care but desire self-determination regarding their MH care trajectory. This requires investment in a good GP-patient relationship and the organisation of additional support to meet these patients’ needs, for which collaborative care with the patient, the patient’s network, and other (care) professionals is of utmost importance.

Mediterranean Diet and Mental Health in Children and Adolescents: A Systematic Review.

Childhood and adolescence are periods of critical importance in the development of mental health disorders. The Mediterranean diet (MD) has been linked to multiple positive health outcomes, including reduced incidence of mental health disorders and fewer psychiatric symptoms. This study aimed to investigate the association between adherence to an MD and mental health outcomes in children and adolescents. A systematic literature review was conducted of original research that explored the relationship between psychiatric symptoms or disorders and adherence to an MD. The literature search was conducted on PubMed, Scopus, Web of Science, MEDES, Dialnet, and Latindex from inception to November 2022, and the Newcastle-Ottawa Scale was used to evaluate the quality of studies. A total of 13 studies (6 cross-sectional, 4 case-control, 2 randomized clinical trials, and 1 longitudinal cohort) out of 450 met the inclusion criteria. A total of 3058 children or adolescents with a mean age range from 8.6 to 16.2 years were included. Among the reviewed studies, 5 (71.42%) of those looking at attention-deficit/hyperactivity disorder, 4 (80%) examining depression, and 2 (50%) assessing anxiety found a significant protective association. Seven articles (53.84%) were found to be of high quality and 6 (46.15%) of moderate quality. Adherence to an MD could be a protective factor for mental health in child and adolescent populations. This suggests that promoting an MD could help prevent the onset of clinical psychiatric symptoms, reduce symptom severity, and improve prognosis in young patients. PROSPERO registration no. CRD42021276316.

Modeling of Deuteron-Induced Reactions on Molybdenum at Low Energies

The activities of the EUROfusion consortium on the development of high quality nuclear data for fusion applications include evaluations of deuteron induced reactions and related data libraries for needs of the DEMO fusion power plant and IFMIF-DONES neutron-source nuclear analyses. Molybdenum is one of the major constituents of the reference stainless steels used in critical components of these projects. While the TENDL deuteron data library was the current reference used by EUROfusion, need of its further improvement has already been pointed out. The weak binding energy of the deuteron is responsible for the high complexity of its interaction with nuclei, involving also a variety of reactions initiated by the nucleons following the deuteron breakup. Their analysis completed that of the deuteron interactions with Mo and its stable isotopes, from elastic scattering to pre-equilibrium and compound–nucleus reactions, up to 50 MeV. A particular attention has been paid to the breakup, stripping, and pick-up direct interactions which amount to around half of the deuteron total–reaction cross section. The due account of most experimental data has validated the present approach, highlighted some prevalent features, and emphasized weak points and consequently the need for modeling/evaluation upgrade.

Issues and Challenges Concerning Mental Health in India: Time to Brood Over

Good mental health is obligatory for a high quality of life. One’s wellness is tested by the daily life-challenging situations relating to family, work and environment. Everyone experiences stress and strain throughout their life. Mental health issues continue to be a sombre issue that affects individuals of all age groups and communities throughout the orb. The fundamental cause of mental health issues is societal and cultural norms and practices that affect the individual as well as their relatives. This article highlights the factors contributing to mental illness and socio-economic, cultural, religious and legal challenges in dealing with mental health. The article also discusses all the significant provisions along with their real spirits with which they have been made under the Mental Healthcare Act, 2017. The Act not only makes the provisions in the light of nationwide scenario but also takes into account the global perspective concerning mental health. Also, this article provides some suggestions that will help deal with the issues of mental illness.

Preparation of biomolecular anthocyanin-immobilized plasma-cured nonwoven fibers from pomegranate (Punica granatum L.) and recycled cotton waste for detection of ammonia

Cotton fibers have been one of the major resources for various modern textile and non-textile industries. They are breathable, soft, and high absorbent natural fibers with a low production cost. Cotton fibers have found uses in a wide range of fields, such as medical field, automobile industry, and furniture design. However, there have been increasing demands to find out other resources for cotton production at high quality and low cost for high technological applications, such as colorimetric sensors. In this work, we provide a novel technique for plasma-induced coloring of nonwoven recycled cotton waste with an anthocyanin natural probe obtained from pomegranate (Punica granatum L.) peel. High-performance liquid chromatography (HPLC) was used to study the anthocyanin extract. Mordant was employed to bind anthocyanin to nonwoven fibers, creating an anthocyanin-mordant coordinative complex. The diameters of the anthocyanin-mordant complex particles were between 5 and 15 nm. A small coating layer of anthocyanin probe was applied to plasma-activated nonwoven cotton. Coloration parameters, absorbance spectra, and colorimetric strength (K/S) data showed that anthocyanin-finished nonwoven cotton had a detection limit of 1–250 ppb of aqueous ammonia, with a corresponding colorimetric change from purple (549 nm) to white (393 nm) due to intramolecular charge transfer. The results demonstrated satisfactory colorfastness of the anthocyanin-dyed nonwoven cotton fibers, UV blocking, and antibacterial efficacy. Promising portable colorimetric technology of anthocyanin-dyed nonwoven cotton fibers was developed for onsite detection of ammonia that can cause severely harmful effects on human organs or even death. Signs of a high surface area in the sensor material include anthocyanin-mordant complex nanoparticles and cotton microfibers.

Talent Cultivation Quality of Software Engineering Majors Based on Deep Learning

Online learning, to cultivate talents it is inevitable to encounter some pictures or videos with poor visual quality. Deep-learning algorithms are both data-hungry and expensive to compute. These algorithms work better after being trained on a broad and extensive collection of samples. The current moment deep learning methods must urgently make use of human intellect to address the issue in a way that reduces the most expensive effort computationally. This paper analyzes the current situation of software engineering talent cultivation quality of software engineering to enhance the quality of the education is improved by Hierarchically Gated Recurrent Neural Network (HGRNN). The aim of the work is to foster the development of world-class software engineering talents. Initially, the input data’s are gathered from public dataset train 400 with 400 grey pictures. HGRNN is image de-noising module, as for the smart teaching platform to assist instructors in obtaining teaching photography with high quality and improve teaching quality. The proposed model is implemented in MATLAB/ Simulink platform and the accuracy is compared to various existing approaches such Back Propagation Network (BPN), Artificial Neural Network (ANN) and Decision Tree Algorithm (DTA) our proposed method obtains 98% of accuracy.

Healthcare providers' attitudes and associated factors on palliative care referral: A qualitative systematic review and meta-aggregation.

Early referral to palliative care has been viewed as providing opportunity for accomplishing end-of-life care goals of life closure, comfortable dying and effective grieving. However, previous studies have shown that palliative care referrals are being made too late. Healthcare providers play important role in helping terminally ill patients to early access and being referred to palliative care. It is necessary to understand healthcare providers' attitudes on palliative care referral and associated factors regarding referrals. This review aimed to identify and synthesise healthcare providers' attitudes and associated factors on palliative care referrals systematically. A systematic review of qualitative evidence and meta-aggregation was conducted and guided according to PRISMA guideline. PubMed, CINAHL, PsycINFO, EMBASE, Web of Science and Cochrane databases from inception to 24 October 2022. Database searches yielded 5856 references. Twenty-two studies met eligibility criteria and of moderate to high methodological quality were included. Studies occurred in USA, UK, Australia and France with 716 healthcare providers participants were included. A total of 378 codings were finally extracted and integrated into 41 categories, forming three synthesised findings: (1) Healthcare providers' attitudes towards palliative care referrals, (2) the influence of subjective norms on palliative care referral behaviour and (3) perceived behavioural control on palliative care referral behaviour. This review demonstrates a series of factors that affect the palliative care referrals, including the attitudes of healthcare providers, the participation of patients and families, the support of colleagues and supervisors, inter-professional collaboration, the availability of hospice resource, disease trajectory and socio-economic factors. Further research that addresses these factors and design relevant trainings on improving healthcare providers' attitudes, enhancing patient and family engagement, strengthening support networks and optimising resource allocation may aid to meet increasing demands of patients. This review not only guides healthcare providers in making better decisions about patient referrals by identifying and addressing barriers but also aids in the development of effective interventions that facilitate the early initiation of referrals. No patient or public contribution.

Impedance-Based Method for Predictive Stability Assessment

Impedance-based analysis methods enable a more specific and earlier foundation for assessing harmonic stability in decentralized converter-based power plants compared to the conventional compliance testing in the grid connection process. Essentially, they can be implemented as black-box model approaches without the necessity to disclose internal control models. Initially, only knowledge of the input impedances of the planned grid connection point and the planned PV system is required for application. For this purpose, the method of impedance spectroscopy for inverters has already been developed as a means to determine the effective impedance profile and the internal harmonic sources of inverters, allowing for the description of the frequency-dependent behavior of individual units. The time- and frequency-dependent grid impedance at the grid connection point (GCP) has also been successfully measured in several campaigns on medium and low-voltage grids. Through the coordinated application of both measurement methods, a predictive harmonic assessment is intended in the future, ensuring high planning reliability and grid quality even in grids with a high penetration of power electronics-coupled systems. This paper provides an overview of the current state of research on impedance-based stability criteria and presents measurement methods for practical implementation. Furthermore, it outlines remaining open questions until application in the field.

A fully haplotype-resolved and nearly gap-free genome assembly of wheat stripe rust fungus

Stripe rust fungus Puccinia striiformis f. sp. tritici (Pst) is a destructive pathogen of wheat worldwide. Pst has a macrocyclic-heteroecious lifecycle, in which one-celled urediniospores are dikaryotic, each nucleus containing one haploid genome. We successfully generated the first fully haplotype-resolved and nearly gap-free chromosome-scale genome assembly of Pst by combining PacBio HiFi sequencing and trio-binning strategy. The genome size of the two haploid assemblies was 75.59 Mb and 75.91 Mb with contig N50 of 4.17 Mb and 4.60 Mb, and both had 18 pseudochromosomes. The high consensus quality values of 55.57 and 59.02 for both haplotypes confirmed the correctness of the assembly. Of the total 18 chromosomes, 15 and 16 were gapless while there were only five and two gaps for the remaining chromosomes of the two haplotypes, respectively. In total, 15,046 and 15,050 protein-coding genes were predicted for the two haplotypes, and the complete BUSCO scores achieved 97.7% and 97.9%, respectively. The genome will lay the foundation for further research on genetic variations and the evolution of rust fungi.

The general theoretic aspects of the optimization of democracy in the context of the guaranteeing of the order and welfare

The article is devoted to the problems and perspectives of democracy as the form of organization of the social and political existence in general, as well as to the some aspects of the optimization of democracy in the context of the guaranteeing of the social welfare in particular. The real aim of the existence of the democracy was revealed. It was noted that stability is the most important elements of the value of the state. The author pays attention to the advantages of the presidential republic, of the constitutional monarchy, of the «Polybius scheme» of the ideal «mixed» state, of the two-party system, of the indirect elections, of the temporal fixation of the elections and of the absence of the snap elections in the context of the guarantee of the political stability. The optimal model of government, the rational limits of the democracy and its acceptable forms were proposed. The author says that democracy is more or less acceptable only if the laws of the state guarantee the impossibility of the election of the unworthy candidate. The system of the electoral qualifications for the members of the Electoral College as well as for the candidates to the elected positions was recommended. Also, the similar system of the qualifications for the officials of the executive power was recommended. The author says that the republican state should be built «from the below». It was noticed that citizens may make the conscious choice only inside their common during the local elections or during the elections of the members of the Electoral College, when they really know the candidates and their personal qualities. The author recommends the political model, when people elect the members of the Electoral College, and the last one form the local representative organs during the local elections, and after that the local representative organs delegate some their members to the regional representative organs, and the last one delegate some their members and form the parliament of the state. Also, the political model, when the executive power is built «from the below», was recommended. The author says that each official of the executive power should start his service from the primary position in local executive bodies, and that the filling of the vacant positions should be done exclusively on the basis of professionalism, experience, length of service and seniority of the officials, but not on the grounds of the arbitrariness of the highest officials or randomnicity. The main principles of replacing of the post of the head of the state in the parliamentary republic as well as in the presidential republic were outlined. It was noted that the professionalism, experience and the high moral qualities of the officials, and especially of the senior state officials, are the fundament of the effective governance and welfare of society, etc.

Treatment of complex limb fractures with 3D printing technology combined with personalized plates: a retrospective study of case series and literature review

BackgroundIn recent years, 3D printing technology has made significant strides in the medical field. With the advancement of orthopedics, there is an increasing pursuit of high surgical quality and optimal functional recovery. 3D printing enables the creation of precise physical models of fractures, and customized personalized steel plates can better realign and more comprehensively and securely fix fractures. These technologies improve preoperative diagnosis, simulation, and planning for complex limb fractures, providing patients with better treatment options.Patients and methodsFive typical cases were selected from a pool of numerous patients treated with 3D printing technology combined with personalized custom steel plates at our hospital. These cases were chosen to demonstrate the entire process of printing 3D models and customizing individualized steel plates, including details of the patients' surgeries and treatment procedures. Literature reviews were conducted, with a focus on highlighting the application of 3D printing technology combined with personalized custom steel plates in the treatment of complex limb fractures.Results3D printing technology can produce accurate physical models of fractures, and personalized custom plates can achieve better fracture realignment and more comprehensive and robust fixation. These technologies provide patients with better treatment options.ConclusionThe use of 3D printing models and personalized custom steel plates can improve preoperative diagnosis, simulation, and planning for complex limb fractures, realizing personalized medicine. This approach helps reduce surgical time, minimize trauma, enhance treatment outcomes, and improve patient functional recovery.

The final part of the CRESS trilogy- how to evaluate the quality of stability studies.

High quality laboratory results are critical for patient management. However, poor sample quality can impact these results and patient safety. To ensure reliable and accurate results laboratories must be aware of each analyte's stability under various storage conditions and matrices to guarantee correct and dependable outcomes. This knowledge allows laboratories to define the allowable delay between sample collection and centrifugation/analysis for all analytes to guarantee appropriate results quality and interpretation. The EFLM WG-PRE therefore established a 4-step plan to tackle this issue, aiming to standardize and harmonize stability studies for improved comparison andmeta-analysis. The plan included the development of checklists and how-to guides for performing and reporting stability studies as well as a central resource of stability data. This manuscript deals with the issue of evaluating publications and incorporating them into a central resource. To evaluate stability studies, the CRESS checklist was used to structure 20 sections used to judge the quality of studies. Each section has 4 levels of quality, with scores converted to numerical values and weighted based on expert opinion. Based on this, a final score ranging from A to D was determined. The procedure was then tested on six manuscripts and checked for agreement between expert judgements. The results demonstrated that the proposed evaluation process is a useful tool to distinguish between best in class manuscripts and those of lower quality. The EFLM WG-PRE strongly believes that the provided recommendations and checklists will help improving stability studies both in quality and standardisation.

Pulsed Radiofrequency Neuromodulation of the Greater Occipital Nerve for the Treatment of Headache Disorders in Adults: A Systematic Review

ABSTRACT Background Pulsed radiofrequency neuromodulation (PRFN) of greater occipital nerve (GON) is considered in patients with headaches failing to achieve sustained analgesic benefit from nerve blocks with local anesthetic and steroids. However, the evidence supporting this practice is unclear. Aims This narrative systematic review aims to explore the effectiveness and safety of GON PRFN on headaches. Methods Databases were searched for studies, published up to February 1, 2024, investigating PRFN of GON for adults with headaches. s and posters were excluded. Primary outcome was change in headache intensity. Secondary outcomes included effect on monthly headache frequency(MHF), mental and physical health, mood, sleep, analgesic consumption, side-effects. Two reviewers screened and extracted data. Results Twenty-two papers (2 randomized controlled trials (RCT), 11 cohort, and 9 case reports/series) including 608 patients were identified. Considerable heterogeneity in terms of study design, headache diagnosis, PRF target and settings, and image-guidance was noted. PRFN settings varied (38-42oC, 40-60V, and 150-400 Ohms). Studies demonstrated PRFN to provide significant analgesia and reduction of MHF in chronic migraine (CM) from 3 to 6 months; and significant pain relief for ON from six to ten months. Mild adverse effects were reported in 3.1% of cohort. A minority of studies reported on secondary outcomes. The quality of the evidence was low. Conclusions Low quality evidence indicates an analgesic benefit from PRFN of GON for ON and CM, but its role for other headache types needs more investigation. Optimal PRFN target and settings remain unclear. High quality RCTs are required to further explore the role of this intervention. PROSPERO ID CRD42022363234.