Inconsistent Availability Research Articles

Peluang Investasi dan Pengembangan Energi Biomassa: Perspektif Pemanfaatan dan Daya Saing Pengembangannya

The current achievement range for renewable energy is around 12%, making it the greatest hurdle. Investment in biomass renewable energy has positive environmental and social impacts despite its lucrative financial potential. However, there are a number of dangers associated with this investment. Therefore, investment might be successful in the development of sustainable and sustainable biomass energy if a thorough investigation and careful planning are carried out. Biomass energy has a lot of potential, but it has yet to reach its full potential because of challenges like high production costs, inconsistent biomass availability, and a lack of supporting infrastructure. Policy and regulatory support, research and innovation, management of the biomass supply chain, increased production scale, diversified biomass sources, increased awareness and education, public-private partnerships, increased efficiency, consolidation of support finance, and environmental impact management are all crucial steps toward a solution. Improvements in conversion technology, sustainable management of biomass resources, increased government assistance, and investments in supporting infrastructure are all necessary steps toward making Indonesia's biomass energy more competitive on the global stage.

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Feasibility and acceptability of a novel intervention to improve hand hygiene behavior in rural Liberian health facilities

Abstract Hand hygiene is central to the prevention of healthcare-associated infection. In low-income settings, barriers to health worker hand hygiene may include inconsistent availability of hand hygiene supplies at the point of care. However, there is a lack of knowledge of interventions to improve and sustain health worker hand hygiene in these settings. This pilot study evaluates acceptability and feasibility of a personally-worn hand hygiene holster device for improving point-of-care access to alcohol-based handrub (ABHR). Holsters were distributed to clinical staff at a hospital in Liberia in July–September 2021. Data collection included 2,066 structured observations of hand hygiene behavior, six spot checks of supply availability, and focus group discussions with 13 clinical staff. The Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH) provided a framework for study design and qualitative analysis. Acceptability of the intervention was high, with users reporting that holsters were comfortable, easy to use, and aligned with their professional identities. Feasibility depended on consistent ABHR availability, which may diminish sustainability of this intervention. The hand hygiene holster is a promising tool for improving health worker hand hygiene behavior, but solutions to ABHR supply chain and distribution constraints are necessary to support sustainability of this intervention.

Non-adherence to growth monitoring and promotion sessions amongst caregivers of children under 5 years in Polokwane Municipality, Limpopo province.

Child growth is crucial for nutritional and health status; poor growth may result in stunting. South Africa experiences a high prevalence of stunting, micronutrient deficiencies and late identification of growth faltering. Non-adherence to growth monitoring and promotion (GMP) sessions remains a challenge and caregivers contribute to non-adherence. Therefore, this study explores factors affecting the non-adherence of GMP services. Qualitative approach and phenomenological exploratory study design were used. One-on-one interviews were conducted with 23 participants conveniently sampled. Sampling size was dependent on data saturation. Voice recorders were used to capture data. Tesch's eight steps, inductive, descriptive and open coding techniques were used to analyse data. Measures of trustworthiness were ensured through credibility, transferability, dependability and confirmability. Participants indicated non-adherence to GMP sessions because of a lack of knowledge of the importance of adherence and poor service by healthcare workers, which includes long waiting hours. Inconsistent availability of GMP services at healthcare facilities and growth of the firstborn children with non-adherence to GMP sessions are factors influencing participants' adherence. A lack of transportation and lunch money also contributed to non-adherence to sessions. A lack of knowledge of the importance of adherence to GMP sessions, long waiting hours and inconsistent availability of GMP services at facilities contributed enormously to non-adherence. Therefore, the Department of Health must ensure consistent availability of GMP services to demonstrate the importance and enable adherence. Healthcare facilities should reduce waiting hours to minimise the need for lunch money, and service delivery audits should be conducted to identify other factors contributing to non-adherence to address these.Contribution:Primary health care providers should conduct service delivery audits and internal surveys to identify factors that contribute to non-adherence in order to introduce measures to address them.

Considerable gaps and differences in rehabilitation after major lower extremity amputations across regions and municipalities in Denmark - A national survey.

Equal access to healthcare is a fundamental principle in the fully tax-financed Danish healthcare system. This study reveals whether this system lives up to the principle of equal access when it comes to the rehabilitation of patients who have major lower extremity amputations. With the aim of exploring possible inequality in rehabilitation for patients having major lower extremity amputation in Denmark, a nationwide electronic survey was conducted in the autumn of 2020, which included all hospitals and municipalities in Denmark. Eighty six percent of hospitals (n=19) and 97% (n=95) of municipalities responded. Of the 32% (n=6) of hospitals and 78% (n=74) of municipalities that provided prosthesis rehabilitation, the majority (hospitals 50% /municipalities 91%) provided prostheses for <10 patients in 2019, and 36% reported having competencies at only a general level among physiotherapists performing prosthetic training. Psychosocial rehabilitation modalities were lacking overall. This national study documents pronounced geographic inequality in access to qualified rehabilitation services for the relatively few patients undergoing lower extremity amputations in Denmark. The decentralised organisation of amputation rehabilitation makes it difficult to build and maintain specialist competencies among healthcare professionals. Inconsistent availability of psychosocial rehabilitation modalities of all kinds found in this study points to a need for action particularly among patients not in prosthetic rehabilitation where palliative needs should also be considered.

Kidney Transplant Practice in Pandemic Times: Lessons Learned for the Future.

Kidney Transplant Practice in Pandemic Times: Lessons Learned for the Future.

Comparative Study of Hybrid Solar Photovoltaic - Diesel Power Supply System

In an environment with unstable power supply, incessant load shedding and inconsistent energy availability remains a major challenge. Hence, there is a need for an urgent alternative source of energy to mitigate this challenge. Over the years, fossil fuel-based energy sources have been considered as an effective solution, however the greenhouse gases emissions from these sources contribute largely to the rise in the depletion of the ozone layer which eventually leads to pollution and global warming. This work contributes to efforts in curbing this menace by reducing the use of diesel generators and focus more on a hybrid renewable energy system. This study, used selected residential buildings as a case study. A photovoltaic system and a diesel generator were incorporated as hybrid energy system, and the data gathered was processed using the HOMER software. The output of the simulation provided two optimal systems (PV-Diesel Generator, Battery coupled with the complete Hybrid system) and (PV- Diesel generator). The optimal and cost-effective system from the analysis is the PV-diesel hybrid system. This consists of a 10kW solar PV, 45kW Diesel generator, a 10kW converter and six 6FM200D batteries. This study provides a synergy of individual subsystems as analyzed in the result to enhanced the reliability of the system.

National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke: A Scoping Review in the Context of Hypertension Prevention and Control in India.

A scoping review was carried out to identify gaps in the performance of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) towards the preparedness of the public health system especially at primary level in dealing with hypertension (HTN). The World Health Organization Innovative Care for Chronic Conditions (WHO ICCC) framework was adapted for the current review under three levels namely micro, meso, and macro. PubMed Central was accessed to retrieve eligible articles published since 2010. Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews checklist was followed for reporting. A final selection of 27 articles that fulfilled the eligibility criteria of the current review was drawn from a long list of 542 articles. Cross-sectional studies contributed to 51.8% of the included studies. We observed that NPCDCS had gaps across all levels of health care, especially at the primary level. At the micro-level noncommunicable diseases (NCDs), awareness among patients was suboptimal and treatment adherence was poor. At the meso-level, there was a vacancy in all cadres of workers and lack of regular training of workforce, laboratory services, and inconsistent availability of essential drugs, equipment, and related supplies to be ensured. At the macro-level, public spending on NCD care needs to be increased along with strategies to reduce out-of-pocket expenditure and improve universal health coverage. In conclusion, there is a need to improve components related to all three levels of the WHO ICCC framework to amplify the impact of HTN care through NPCDCS, particularly at the primary level.

Attitudes of Caregivers of Children under Five Years Regarding Growth Monitoring and Promotion in Polokwane, Limpopo Province.

Growth monitoring and promotion (GMP) is critical in tracking child growth to address widespread malnutrition and health status. Attitudes influence behaviour change, including attendance of GMP, and negative attitudes are linked to non-attendance. Moreover, negative attitudes correlate with low socioeconomic position. South Africa is characterized by inequality, which may lead to negative attitudes towards GMP among caregivers with a poor socioeconomic status. Hence, this study seeks to explore the attitudes of caregivers of children under five towards GMP. A qualitative exploratory study design was used. Caregivers of children under five were purposively sampled. Twenty-three participants were interviewed one-on-one, and the data were recorded using voice recorders and field notes. Tesch's eight steps and inductive, descriptive, and open coding techniques were used to analyse the data. Participants understood the significance of GMP and were confident their children would benefit from it; hence, they attended sessions out of love for their children. The inconsistent availability of GMP services and the behaviour of health workers affected participants' attitude. Despite these challenges, participants felt good about GMP. Caregivers' love for their children/grandchildren helped them overcome challenges experienced at the health facilities. Good feelings about GMP boosted caregivers' attitudes and aided in adherence. An intervention to address element impacting attitudes of caregivers is recommended.

The effects of antiretroviral stockout on primary health care nurses in the Ethekwini and Ilembe districts, KwaZulu-Natal

Background: Nurses face challenges of antiretroviral therapy (ART) stock out when rolling out, leading to drug resistance, poor compliance and decreased viral suppression. Poor viral suppression leads to higher morbidity and mortality rates, hence a need to strengthen supply chain principles in order to achieve equal distribution of resources amongst clinics. Nurses also need to have relevant guidelines available to prevent treatment failure. The study aimed to describe the effects of ART stockouts on primary health nurses rolling out ART in clinics in KwaZulu Natal. Methods: The study followed a qualitative approach, using a descriptive design. Two primary healthcare clinics in Ilembe and Ethekwini districts were selected for the study. The population comprised of 8 purposively selected participants. In-depth interviews and focus groups were conducted to describe the experiences of primary health care nurses rolling out antiretroviral therapy regarding stockout and how it was managed. Data collection and analysis followed Yates, Partridge and Bruce steps. Ethics and trustworthiness were maintained. Results: The singular theme of inconsistent availability of treatment emerged, as well as sub-themes of means used to manage treatment stockout and supply change management issues. Conclusions: An adequate supply of ART through an efficient supply chain management strategy, ongoing training in primary health care and nurse-initiated management of antiretroviral therapy and the availability of treatment guidelines should be enforced.

AGING AGENCIES’ AND PROVIDERS’ REASONS FOR HOSTING OR NOT HOSTING GERONTOLOGY INTERNS

Abstract Hands-on experience is essential to gerontological education and associated with numerous student benefits. Much less is known about the community agency perspective, including why they do/don’t host gerontology interns. In this national study (n=281), non-profit, for-profit, and government aging-service providers (e.g., Social Services, Health Care, Housing) were surveyed regarding their perceptions of internship benefits, challenges, and areas to improve. Unique to this study is the inclusion of both hosting (n=129) and non-hosting (n=142) agencies. Hosts’ reasons for accepting interns included: share experience/knowledge (n=81, 87%); future university relationships (n=71, 76%); intergenerational interaction for students (n=69, 74%) and clients (n=60, 65%); attract future employees (n=68, 73%); and fills unmet need at agency (n=47, 50%). Non-host reasons for abstaining included: lack of applicants (n=58, 41%); never considered it (n=40, 28%); insufficient staffing (n= 37, 26%); unsure where to start (n=34, 24%) or find/attract interns (n=34, 24%), and too time-consuming (n=25,18%). Additional reasons for nonparticipation included: lack of space; insufficient intern-suitable work; risk/liability; and agency policy. Both hosting and non-hosting agencies anticipated/realized student-related challenges (e.g., limited motivation, inconsistent availability, inadequate preparation) and agency-based factors (e.g., insufficient time, staffing). Given the ongoing need for suitable gerontology internship sites and the finding that almost half of the non-hosting agencies indicated possible future interest in accepting gerontology interns (n=80, 49%), attention to agency recommendations (e.g., increased faculty communication/feedback, stronger student commitment/preparation, recognition of agency contributions) is warranted. Strategies for addressing identified challenges and implementing requested changes to enhance the community agency experience with gerontology interns are discussed.

Current Status of Immunology Education in U.S. Medical Schools

Immunology is an integral component of undergraduate medical education because of its critical role in many disease processes. Due to the complexity of the subject, the best practice of immunology education in the undergraduate medical curriculum has not been extensively discussed. This study intended to determine the current status of immunology education in U.S. medical schools with the hope of providing insight into curriculum design pertaining to this subject. Immunology curriculum information was collected from the curriculum Web pages of 199 U.S. medical schools, including multiple campuses. Data pertaining to the setting of immunology education such as subjects that are co-taught with immunology, timing of courses, credit hours, and integration level were recorded in Microsoft Excel for analysis. Of 199 U.S. medical schools studied, 174 posted curriculum information related to immunology online. For course settings, 59 (33.9%) offer immunology with microbiology, 42 (24.1%) offer immunology as part of a foundational sciences course, and 18 (10.3%) offer immunology as a stand-alone course. Ten programs (5.7%) have immunology fully integrated in system-based curriculum. Of 119 medical schools that provide information regarding timing, 94 (71.9%) provide immunology education in year 1 of the curriculum, 16 (9.2%) in year 2, and 9 (5.2%) in both years 1 and 2. Differences exist in allopathic versus osteopathic programs in the immunology curriculum setting. Credit hour data were not complete due to inconsistent availability. Our data suggest that immunology education in U.S. medical schools lacks consensus. Continued discussion on best practices of immunology education across U.S. medical schools is recommended.

Characterizing surface water concentrations of hundreds of organic chemicals in United States for environmental risk prioritization.

Thousands of chemicals are observed in freshwater, typically at trace levels. Measurements are collected for different purposes, so sample characteristics vary. Due to inconsistent data availability for exposure and hazard, it is complex to prioritize which chemicals may pose risks. We evaluated the influence of data curation and statistical practices aggregating surface water measurements of organic chemicals into exposure distributions intended for prioritizing based on nation-scale potential risk. The Water Quality Portal includes millions of observations describing over 1700 chemicals in 93% of hydrologic subbasins across the United States. After filtering to maintain quality and applicability while including all possible samples, we compared concentrations across sample types. We evaluated statistical methods to estimate per-chemical distributions for chosen samples. Overlaps between resulting exposure ranges and distributions representing no-effect concentrations for multiple freshwater species were used to rank estimated chemical risks for further assessment. When we apply explicit data quality and statistical assumptions, we find that there are 186 organic chemicals for which we can make screening-level estimates of surface water chemical concentration. Of the original 1700 observed chemicals, this number decreased primarily due to a predominance of censored values (that is, observations indicating concentrations too low to be measured). We further identify 423 chemicals where all measurements were censored but, through consideration of detection limits, risk might still be prioritized based on the detection limits themselves. In the final set of 1.5 million samples, the median environmental concentration of one chemical (acetic acid) exceeded the 5th percentile of no-effect concentrations for the most delicate freshwater species (the highest priority risk condition identified here), and a further 29 chemicals were identified for possible further evaluation based on a small margin between occurrence and toxicity values. This method shows the broad range of chemical concentrations seen for organic chemicals across the country and identifies methods of determining their central tendency, allowing for researchers to characterize higher-than-normal or lower-than-normal surface water conditions as well as providing an overall indication of the presence of organic chemicals in the United States. The highest chemical concentrations did not always indicate the highest-risk conditions. Even when accounting for the high level of uncertainty in these data due to differences in data collection and reporting across the set, some chemicals may still be categorized as higher environmental risk than others using this method, providing value to chemical safety decision makers and researchers by suggesting avenues for more focused investigation.

320 IDENTIFYING OUTCOMES FOR PATIENTS LEAVING REHABILITATION WITHOUT THE MULTI-DISCIPLINARY TEAM (MDT) RECOMMENDED HOME CARE PACKAGE (HCP) HOURS IN PLACE

Abstract Background Home-Care Packages (HCPs) aim to support older people to remain in their homes. The community care system in Ireland has a small range of services with inconsistent availability. This study aims to identify outcomes for patients leaving rehabilitation without the MDT recommended HCP. Methods Demographics of patients discharged from rehab January 2021 to December 2021 were collected. Patients were classified into those with and without recommended HCP at time of discharge. Telephone consultations were held and data collected including; number of falls since discharge and EQ-ED-5L quality of life questionnaires were completed. Results Of 30 patients included (aged 66-94), 9 did not have full HCP hours on discharge. The range of Length of Stay (LoS) was 2-120 days in the correct HCP group and 7-59 in the incorrect HCP group. There was 7 readmissions to hospital, 5 from full HCP group. Three patients had a fall since discharge. In the correct HCP group, 42% had a mobility score of 3 or greater and 38% had a self-care score of 3 or greater. This was 11% and 33% respectfully in the incorrect HCP group. Conclusion Those who were discharged with full HCP had larger range of LoS. All patients who suffered falls were in the full HCP group. Incorrect HCP group had better scores in mobility and self-care. There were low rates of readmission to hospital in this group of patients discharged following a period of rehabilitation.

Changes in the Symptomatic Burden of High Koos Grade Vestibular Schwannomas Following Definitive and Adjuvant Stereotactic Radiosurgery

<h3>Purpose/Objective(s)</h3> Emerging literature suggests definitive SRS is an option for large vestibular schwannomas with brainstem compression. We investigate our institutional experience of SRS on the Gamma Knife platform (GKRS) in both the definitive and post-operative settings and report control and morbidity outcomes. <h3>Materials/Methods</h3> An IRB-approved institutional database compiled clinical, radiographic, and treatment planning data for Koos grade 3-4 vestibular schwannomas treated by GKRS in our institution from March 2014 to January 2021 with minimum of 6-month follow-up, stratified by definitive (GKRS-D cohort) vs. adjuvant (GKRS-A cohort) treatment approaches. Baseline symptoms per CTCAE definitions were recorded for all patients prior to SRS (pre-SRS) and after SRS (post-SRS). For the adjuvant cohort, pre-operative symptoms were also recorded (pre-op). Hearing function was excluded due to inconsistent availability of audiometric records. Outcomes of tumor control, treatment toxicity, and changes in individual and aggregate symptomatic burdens as sums of relevant CTCAE grades (aggregate impairment; AI) were analyzed. AI was tested for association with definitive vs. adjuvant treatment parameters on presentation and post treatment. <h3>Results</h3> 34 patients were identified, of whom 19 were GKRS-D and 15 GKRS-A. Tumor control rates were 100% with median follow-up 34.2 months for GKRS-D (range: 6-74) and 48.6 months for GKRS-A (range: 6-84). Rates of brainstem necrosis or prolonged steroid use were 0%. No patients required shunt placement or developed clinical hydrocephalus post-GKRS. GKRS-A had greater symptom burden both at pre-op presentation and pre-GKRS than GKRS-D (AI 3.73 vs 2.11, p=0.017; AI 3.40 vs. 2.11, p=0.093). Symptom burden improved following treatment in both groups (mean AI Δ = -1.13 and -0.47 for GKRS-A and GKRS-D, p=0.243). In the GKRS-A cohort, symptom burden improved both with surgical intervention (mean Δ = -0.33), and following GKRS (mean Δ = -0.80.) Following definitive GKRS, 6 subjects had improvement in AI (mean Δ = -2.00), 3 subjects had worsening in AI (mean Δ = +1.00), and 10 subjects had no change. 1 subject had improvement in CNVII weakness (Δ = -2.00) and the remainder had no change. Following subtotal resection and adjuvant GKRS, 11 subjects had improvement in AI (mean Δ = -2.09) and 4 had worsening in AI (mean Δ = +1.50). 1 subject had improvement in CNVII weakness (Δ = -1.00), 6 had worsening (mean Δ = -1.33), and 8 had no change. <h3>Conclusion</h3> In well-selected patients with Koos grade 3 or 4 vestibular schwannomas, definitive SRS without surgical decompression has demonstrated excellent local control and minimal toxicity, with significant numbers of patients demonstrating an improvement in their baseline symptoms post-treatment. We increasingly select surgical intervention based on pre-treatment clinical symptoms rather than tumor volume or Koos grade alone. Larger prospective data are needed to confirm our experience.

Exploring lessons from five years of biochar-producing cookstoves in the Kagera region, Tanzania

Biochar-producing cookstoves can supply fuel-efficient heat for cooking in developing countries. The produced biochar can be used as a soil amendment, providing a range of environmental and agronomic benefits and serve to remove carbon dioxide from the atmosphere. Despite these advantages, many stove initiatives have not been sustained in the long term, but very little attention has been devoted to understanding the reasons behind this. The present study contributes to filling this knowledge gap, by identifying key factors affecting the level of stove adoption and use, as well as biochar utilization. Based on a follow-up survey of 50 households in northwestern Tanzania that received microgasifier stoves in 2015, only 12 still made use of their stove 5 years later. One of the main reasons for this relates to the inadequate quality of stove material. Declining or inconsistent availability of feedstocks was also identified as a major challenge. Furthermore, the households generally did not embrace the idea of amending soils with biochar, due to a combination of local practices and perceptions, and a lack of education and awareness programs. We conclude that, under the conditions of the studied project, three factors are required to scale dissemination: improvement of the stove design, provision of training programs on biochar management and subsidies or microloans that would make more durable stoves affordable. Sustained stove deployment can only be achievable by institutionalizing financing structures that are independent from short-term grant-based initiatives.

A Pattern Language for Inclusive Design: A Set of Patterns for Designing Reusable Accessible Solutions.

A common cause for inconsistent accessibility in the design of ICT applications is that designers work to develop optimal and satisfactory interfaces but they do not take care to comply with all users' needs and possibilities to access. The study presented in this paper stems from a lack of published evidence able to support designs in developing accessible interfaces for websites, mobile apps or conversational Interfaces (chatbot or voicebot). This work aims at investigating accessible design patterns that can be used by designers to implement applications accessible by multiple devices. To solve this problem, we propose a design pattern language able to provide WCAG compliant design out-of-the-box solutions. The navigation through the design patterns allows designers to gather existing solutions based on solid evidence and examples to develop inclusive applications accessible by web, mobile devices or conversational agents.

Historical mapping of rice fields in Japan using phenology and temporally aggregated Landsat images in Google Earth Engine

Mapping the expansion or reduction of rice fields is fundamental for food and water security, greenhouse gas emission accounting, and environmental management. The historical mapping of rice fields with satellite images is challenging because of the limited availability of remote sensing and training data from past decades. The use of phenology-based algorithms has been proposed for mapping rice fields because they can take advantage of rice fields’ characteristic spectral signature during the transplanting phase and do not need training data. However, in order to employ phenology-based algorithms effectively for the historical rice mapping of large areas, we need to incorporate automatized methods able to deal with non-usable data (e.g., cloud cover) and with spatial inconsistencies in the number of available images for each pixel. Here we propose the combination of a pixel-based, phenological algorithm with the temporal aggregation of all available Landsat images to produce national level historical maps of rice fields in Japan from the 1980s onwards. We used temporally aggregated metrics (median, percentiles, etc.), derived from spectral indices of a large number of images within the Google Earth Engine, to minimize the issue of inconsistent image availability and reduce the effects of outliers in phenology-based algorithms. We produced seven rice field maps, for the periods 1985–89, 1990–94, 1995–99, 2000–04, 2005–09, 2010–14, and 2015–19. The overall map accuracies ranged from 83% to 95% when validated with visually interpreted aerial photography. We detected a 23% decrease in the area of rice fields at a country level, although the changes varied greatly among prefectures. Here we present the first freely available historical rice field maps of Japan from the 1980s onwards, together with the source code, and a web application that enables the exploration of the maps and data relating to the derived rice field area changes. The application of temporal aggregation is promising for dealing with the gap-filling of large amounts of satellite data, reducing the issue of data outliers and providing an effective use of the historical Landsat archive for phenology-based crop detection algorithms. Our maps could greatly help researchers, conservationists and policymakers studying the drivers and consequences of rice field changes, and our methods could be extrapolated to map rice fields at large scales in other regions of the world.

Pharmacoeconomic research of surgical treatment of juvenile nasopharyngeal angiofibroma: preoperative endovascularly occlusion classes

Introduction. Intraoperative control of bleeding during surgical treatment of juvenile nasopharyngeal angiofibroma (JAN) remains controversial. There is no consensus as to the routine use of preoperative embolization, given its high cost and inconsistent availability of the procedure in care centers. There were no publications devoted to the comprehensive pharmacoeconomic analysis of preoperative vascular embolization (PVE) occlusion classes on the surgical treatment of JAN by the time of publication Aim. To evaluate pharmacoeconomic value of preoperative vascular embolization (PVE) occlusion classes (non-embolized, incomplete and complete) on the surgical treatment of JAN.Materials and methods. A total of 139 patients who underwent JNA surgical resection in 2013-2021 time period were identified. All of these patients were treated in National Medical Research Center for Children's Hematology, Oncology and Immunology named after Dmitry Rogachev. We evaluated JNA surgical resection outcomes, length of stay (LOS) with prognostic factors using a multiple linear regression (MLR), cost-per-day (CPD), cost-minimization analysis (CMA), cost-utility ratio (CUR), willingness to pay (WTP) with purchasing power parity (PWP).Results and discusion. Surgical transnasal endoscopic treatment of JAN in the quaternary healthcare center, regardless of the degree of embolization and the presence/absence of intraoperative blood transfusion, is at the willingness-to-pay threshold for the healthcare system of the Russian Federation. The most cost-utility method of treatment remains the absence of embolization (within clips placed in the larger diameter vessels). and the absence of blood transfusion, the least cost-utility method is the incomplete embolization, regardless of the presence/absence of blood transfusion.Conclusion. The results of the pharmacoeconomic study emphasize the high significance of the rejection of routine preoperative vascular embolization of JAN and implementation of standard risk-adapted treatment algorithm for indications of preoperative vascular embolization. Which is particularly important for resource allocations and health policy decision making to increase the efficacy and safety of the JNA treatment.

Development of Best Practice Guidance on Online Peer Support for People With Young Onset Dementia: Protocol for a Mixed Methods Study.

BackgroundMany people with young onset dementia (YOD) may feel isolated. Peer support has the potential to improve social health, but the inconsistent availability of age-appropriate, in-person (peer) support services for people with YOD suggests that many people with YOD miss out on the potential benefits. Online peer support could be useful, as it overcomes geographical barriers, offers a variety of options, and adjusts to various needs and preferences.ObjectiveOur study aims to develop evidence-based best practice guidance on online peer support for people with YOD and group facilitators to improve online peer support for people with YOD.MethodsOur mixed methods study consists of 4 phases and follows the guidelines of the Medical Research Council on complex interventions. Each phase consists of multiple substudies. The study focuses on the development stage of the Medical Research Council framework and additionally develops a plan for the feasibility/piloting, evaluation, and implementation stages. The participants are people living with YOD and peer support facilitators. The qualitative research methods include interviews, focus groups, and open questions in a web-based survey. The quantitative methods include a web-based survey consisting of existing outcome measures.ResultsThe study is funded by the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie Actions – Innovative Training Networks (H2020-MSCA-ITN-2018; grant agreement number: 813196), and it received ethical approval from the London Bromley Research Ethics Committee (reference number: 21/LO/0248) in April 2021. Recruitment started in May 2021. Data collection and analysis are expected to be finished by September 2022.ConclusionsThe best practice guidance can provide people with YOD with tailored and evidence-based information about online peer support, and it will be disseminated locally (in the United Kingdom) and internationally through dementia organizations, research networks, and academic institutions.International Registered Report Identifier (IRRID)DERR1-10.2196/38379