Intensive Intervention Research Articles

Effectiveness of virtual reality in cancer patients undergoing chemotherapy. Systematic review.

Virtual reality is on the rise and is currently postulated as one of the most innovative and promising techniques in the management of pain and anxiety in cancer patients, in the face of painful processes or the stress involved in chemotherapy treatment. The objective has been to find out the effectiveness of virtual reality in patients undergoing chemotherapy. Several literature reviews were conducted between November 2023 and January 2024 in the Pubmed, Web of Science and PEDro databases. The keywords "virtual reality," "cancer," "oncology," "exercise" and "chemotherapy" were combined using the Boolean operator AND. 641 manuscripts were selected as potential manuscripts and after elimination of duplicates and application of the inclusion and exclusion criteria, six articles comprised the final review sample. Virtual reality has proven to be an effective technique in reducing the anxiety, pain, asthenia and stress suffered by patients diagnosed with cancer and chemotherapy treatment. The distraction generated by this therapeutic modality, with a wide range of scenarios, helps to reduce the painful perception and worry of these procedures. However, there are no standard application guidelines or application protocols that demonstrate the superiority of one technique over another. Virtual reality could be a valid complementary tool in the treatment of patients undergoing chemotherapy, showing positive results in pain reduction, anxiety, stress or asthenia. More studies are needed, with larger sample sizes and long-term follow-ups to establish treatment protocols in relation to the frequency, intensity, duration and periodicity of interventions with virtual reality.

Tertiary lymphoid structures potentially promote immune checkpoint inhibitor response in SMARCB1-deficient medullary renal cell carcinoma.

The WHO's classification of renal cell carcinoma (RCC) has identified loss of SMARCB1 as one of the driven mutations. Despite intensive postoperative interventions, the prognosis for SMARCB1-deficient medullary RCC remains poor, indicating insufficiency in current therapy. Herein, we reported the treatment outcomes of five patients with metastatic SMARCB1-deficient medullary RCC and molecular correlates. Four patients were treated with first-line immune checkpoint inhibitors (ICI) plus tyrosine kinase inhibitors (TKI) combination therapy with a median PFS (mPFS) of 12.3 months. Transcriptomic analysis revealed enrichment of immune-related pathways in SMARCB1-deficient medullary RCC compared to clear-cell and papillary RCC. Multiple immunofluorescence (mIF) revealed the association between the formation of mature tertiary lymphoid structures (TLSs) and the favorable response to ICI-based combination therapy. In conclusion, ICI-based combination therapy showed promising anti-tumor activity in SMARCB1-deficient medullary RCC patients. The presence of mature tertiary TLSs may partially elucidate the mechanism underlying treatment response.

Abstract 4144573: Cardiac biomarkers, intensive lifestyle intervention, and risk of heart failure subtypes in type 2 diabetes – a post-hoc analysis of the Look AHEAD trial

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) identify subclinical heart failure (HF) in type 2 diabetes (T2D). The contribution of changes in cardiac biomarkers to HF risk, particularly HF subtypes, is unclear. Whether HF risk associated with cardiac biomarkers is modifiable with an intensive lifestyle intervention (ILI) targeting weight loss is unknown. Methods: Adults with T2D and overweight/obesity in the Look Action for Health in Diabetes (AHEAD) trial without prevalent HF were included. NT-proBNP and hs-cTnT were measured at baseline, 1- and 4-years (Roche Diagnostics). Adjusted Cox models were created to evaluate the associations of baseline, 1- and 4-year change in NT-proBNP and hs-cTnT with risk of HF with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively). Interaction testing was performed to evaluate heterogeneous effects of the ILI vs diabetes support and education (DSE) across baseline cardiac biomarkers. Results: Of the 3,959 participants included, 212 had incident HF (108 HFpEF, 84 HFrEF) over 12 years. Higher baseline NT-proBNP and hs-cTnT were each significantly associated with higher risk of HFpEF and HFrEF ( Table) . Increases in NT-proBNP over 1- and 4-years were significantly associated with higher risk of HFpEF and HFrEF with a similar pattern of association for hs-cTnT and HF subtypes. After accounting for risk factor changes, the association of 1- and 4-year changes in NT-proBNP, but not hs-cTnT, with risk of HF subtypes remained significant. There was a significant interaction between NT-proBNP and ILI for risk of HFpEF but not HFrEF (p-int = 0.001). The ILI reduced HFpEF risk among participants with elevated (≥125 pg/mL) but not non-elevated NT-proBNP (<125 pg/mL) (ILI vs DSE HR [95% CI]: 0.48 [0.25-0.93] and 1.67 [0.94-2.94], respectively). No significant treatment group by hs-cTnT interactions were identified. Conclusions: In T2D, longitudinal changes in cardiac biomarkers, particularly NT-proBNP, are significantly associated with HF risk, independent of risk factor changes. In Look AHEAD, elevated NT-proBNP may identify individuals who are more likely to benefit from the ILI for HFpEF prevention.

Abstract 4141434: Real-World Improvement of Cardiometabolic Risk Factors by Treating Obesity at Scale

Intro: Obesity is a critical risk factor for cardiometabolic disease. A growing body of clinical trial data shows GLP-1 receptor agonist medications (GLP-1s) are not only effective in treating obesity but also demonstrate significant impact on the reduction of cardiovascular risk. Yet current models of care have not been able to reach the >200 million Americans who meet criteria for obesity treatment. To improve access to evidence-based treatment, we established a virtual metabolic health company to provide medically-supervised obesity treatment at scale. Research Question: This real-world evaluation examines the impact of a virtual health program on weight and related cardiometabolic markers. Methods: Data were analyzed for individuals who completed at least 12 months (mos) in the core program and for a subset who continued to 24 mos. Obesity treatment involved GLP-1s combined with a proprietary intensive lifestyle intervention delivered with virtual coaching. Weights were submitted via cellular connected scale. Waist circumference, metabolic labs, and patient-completed surveys were analyzed at baseline and 12 mos. Results: The cohort included 6,766 patients, a subset with structured lab data from a larger population of 16,098 patients who had completed 12 mos in the commercial program. Average weight loss at 12 mos was -16.5% (n=5,932) and -17.8% at 24 os (n=1,171). Improvement was observed for all collected metabolic markers: waist circumference, AST/ALT, lipids, HbA1c, insulin, hs-CRP. Specifically for cardiovascular labs, 12 mos results showed improvement in HDL in 56.3% (n= 3,090), in LDL for 64.8% (n=3,066), in hs-CRP for 82.9% (n=2,446). Of n=825 with abnormal A1c at baseline, 77.1% achieve A1c <5.7%. Average reduction in waist circumference was -5.9 inches (n=3,682). Positive changes were also seen for patient-reported outcomes (PROs). Discussion: In the context of significant obesity and cardiovascular results for GLP-1s in clinical trials, it is important to gather data on the efficacy of approaches to scale treatment in the real world since factors such as medication shortages, gaps in insurance coverage, and challenges with adherence occur with treatment outside of clinical trials. Results from 6,766 patients in a virtual metabolic health program available in 50 states and DC demonstrate clinically significant and sustained weight loss through 24 mos, with improvement in associated key cardiometabolic risk markers, health behaviors, and PROs.

NCOG-11. FACTORS PREDICTING SPEECH AND GAIT RECOVERY IN CHILDREN WITH POST-OPERATIVE POSTERIOR FOSSA SYNDROME (PFS)

Abstract Posterior fossa syndrome/cerebellar mutism syndrome is a surgical complication of posterior fossa tumor resection, especially midline tumors. Initially thought to involve complete mutism, PFS is now recognized as a complex syndrome involving loss of language (complete [PFS1] and incomplete [PFS2]). Additional symptoms include apraxia, movement disorder, motor and coordination deficits, and emotional lability. The aim of this study was to identify factors that influence delayed speech and independent gait recovery in children with PFS. We prospectively studied 73 children ≥3 years of age with medulloblastoma who developed PFS (SJMB12, NCT01878617). Enrolled children received standardized neurologic examinations and serial imaging before, during and up to five years after completion of therapy. Neurological examinations included scale for assessment and rating of ataxia (SARA), CTCAE grading of neurologic deficits, and severity of injury to the superior cerebellar peduncles (SCP) on post-operative MRI. Median time to speech recovery was 1.4 months (range 0.3-14.3); 81% had return of speech at 3 months and 97% at 12 months. On multivariable Cox regression analysis, complete mutism (HR 0.17, p<0.0001) and inability to sit (HR 0.40, p=0.001) were associated with delayed speech return. Independent ambulation was regained by 80.8% at a median of 2.3 (range 0.3-71.3) months. 70% had a return of ambulation at 12 months and 77% at 24 months. On multivariable Cox regression analysis, complete mutism (HR 0.32, p=0.016), inability to sit (HR 0.30, p=0.002), SARA score (HR 0.94, p=0.002), and right SCP injury (HR 0.47, p=0.014) were significantly associated with delayed return of ambulation. Presence of mutism, inability to sit unassisted, higher SARA score, and right SCP injury at the time of PFS diagnosis are associated with time to recovery of speech/language and ambulation. Our findings have prognostic implications for families and to help identify children in need of more intensive interventions.

Exploring the long-term impact of a nurse-midwife mentorship intervention in Neno district, Malawi: a secondary data analysis of maternal and neonatal complications

Abstract Background There is critical need to strengthen the global nursing and midwifery workforce. This is especially true in Malawi where they are the primary providers of obstetric and neonatal care. In Neno district, Malawi, in 2017, we implemented an intensive training and longitudinal bedside mentorship intervention for nurses and midwives. From inception, there was a pre-planned project target completion after 5 years, including a staged handover to local ownership after 3 years. The objective of this study was to assess differences in reported maternal and neonatal complications following project completion and handover to local leadership. Methods The project was a partnership between an academic institution and local nongovernmental organization. In October 2020, the intervention was handed over and maintained by the local organization with limited support from the academic institution. Data from January 2019 to May 2023 were extracted from the Malawi District Health Information Software 2. Bivariate analyses explored differences in the pre- and post-handover periods for all government-collected, birth-related variables. The “pre-handover” period encompassed January 2019 to September 2020 and “post-handover” from October 2020 to May 2023. Multivariate linear regression explored outcomes while controlling for health facility. Results Data were collected from 10 health facilities in the district and included a total of 23,259 births. Overall, there were few significant changes between periods. Exceptions were in reporting of antepartum hemorrhage (p < 0.01), maternal sepsis (p = 0.01), and manual removal of the placenta (p < 0.01), where we observed decreases in reporting. There was a significant decrease in the reporting of neonatal sepsis (p = 0.01) in the bivariate analysis, which remained only borderline significant in the multivariate model (p = 0.05). Where differences occurred, they were associated with improvements in reported identification of complications and provision of associated emergency care. Conclusions Few differences in reported maternal and neonatal complications between the periods suggest positive impact of the intervention was sustained following project handover and transition of activities to local leadership. These findings strengthen support for longitudinal mentorship as a pivotal component for skill retention after training. Transparent partnerships which include pre-determined end points and time for handover of activities to local ownership are crucial components for sustainability.

Vulnerability to Achievement Stressors: More Evidence That Students With Learning Disabilities Require Intensive Intervention.

In this article, we introduce the term vulnerability to achievement stressors, which refers to differentially low achievement when shifts in the educational environment "stress" or threaten the capacity of an individual or a group of individuals to make academic progress. We also introduce a methodological framework for assessing vulnerability to achievement stressors. Vulnerability to achievement stressors in students with learning disabilities (LD), relative to students without disabilities, is illustrated with two achievement stressors: (a) the shift in learning standards codified in Common Core State Standards, specifically the increase in complexity of the fourth-grade fractions curriculum, and (b) the COVID-19 pandemic, which decreased instructional structure by disrupting in-person teaching. Because these illustrations were embedded within randomized controlled trials, each with an inclusive instruction condition and an intensive intervention condition, they also provide the basis for concluding that intensive intervention is more effective than inclusive instruction for addressing students with LD's vulnerability to achievement stressors and for narrowing their persistently severe achievement gaps.

Respiratory Viral Co-infection in SARS-CoV-2-Infected Children During the Early and Late Pandemic Periods

Background: Knowledge regarding the impact of respiratory pathogen co-infection in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children seeking emergency department care is limited, specifically as it relates to the association between SARS-CoV-2 viral co-infection and disease severity and factors associated with co-infection. Methods: This secondary analysis included data from 2 prospective cohort studies conducted between March 2020 and February 2022 that included children <18 years of age tested for SARS-CoV-2 infection along with additional respiratory viruses in a participating emergency department. Outcomes included the detection rate of other respiratory viruses and the occurrence of severe outcomes (ie, intensive interventions, severe organ impairment and death). Results: We included 2520 participants, of whom 388 (15.4%) were SARS-CoV-2-positive. Detection of additional respiratory viruses occurred in 18.3% (71/388) of SARS-CoV-2-positive children, with rhinovirus/enterovirus being most frequently detected (42/388; 10.8%). In multivariable analyses (adjusted odds ratio and 95% confidence interval), among SARS-CoV-2-positive children, detection of another respiratory virus was not associated with severe outcomes [1.74 (0.80–3.79)], but detection of rhinovirus/enterovirus [vs. isolated SARS-CoV-2 detection 3.56 (1.49–8.51)] and having any preexisting chronic medical condition [2.15 (1.06–4.36)] were associated with severe outcomes. Among SARS-CoV-2-positive children, characteristics independently associated with an increased odds of any other viral co-infection included: age and delta variant infection. Conclusions: Approximately 1 in 5 children infected with SARS-CoV-2 had co-infection with another respiratory virus, and co-infection with rhinovirus/enterovirus was associated with severe outcomes. When public health restrictions were relaxed, co-infections increased.

Differential Game Analysis of Carbon Emission Reduction Effect and Price Strategy Considering Government Intervention and Manufacturer Competition

ABSTRACTGovernments and enterprises are paying more and more attention to carbon emissions. Considering the dynamic of carbon emissions reduction (CER) and the government intervention, this study discusses the optimal CER effort level, price, and government intervention intensity in a two‐echelon supply chain consisting of a government and two manufacturers. The two manufacturers have two competitive behaviors: Cournot and Stackelberg. Two differential game models are constructed for the two different behaviors, and the optimal decisions under the two models are obtained. The comparisons of these optimal solutions are analyzed, and the influence of some parameters on the optimal solution in the two models is investigated under two scenarios. Furthermore, the optimal government intervention intensity is obtained with the goal of maximizing government utility. The results show that the Stackelberg game allows manufacturers to achieve higher profits and CER but is disadvantageous to consumers, and the manufacturer as the leader has a first‐mover advantage. Fierce market competition leads to greater CER and profits, but higher prices reduce consumer surplus. Larger penalties can promote enterprises to reduce carbon emissions when carbon emissions are large. Compared with the Cournot behavior game, the Stackelberg allows manufacturers to obtain higher profits and CER, but the prices are higher that are detrimental for consumers. The fierce market competition is good for manufacturers, the environment, and the society, but it reduces the consumer surplus. The low CER efficiency causes high costs and reduces the manufacturer's motivation to CER, which harm the environment and reduce profits. The government intervention is negatively correlated with the intensity of market competition and the sensitivity of manufacturers to policies.

Comparative Efficacy of Family-Mediated Intervention Versus Early Intensive Behavioral Intervention on Developmental Domains in Children with Autism Spectrum Disorder: A Randomized Controlled Trial

Background: Autism spectrum disorder is a neurodevelopmental disorder of childhood in which there is a deficit in social and communicative skill, and the child shows restricted and repetitive behavior. For children diagnosed with autism spectrum disorder, family-mediated intervention and early intensive behavioral intervention are considered standard of care. The study aimed to compare their efficacy on social skills and other developmental domains in our cultural context. Methods: This study was a parallel-arm, open-label, randomized active-controlled clinical trial. Fifty children diagnosed with autism spectrum disorder were randomly assigned to either the family-mediated intervention or early intensive behavioral intervention groups. Communication DEALL Developmental Checklist was applied at 0, 12, and 24 weeks. Results: The difference in the mean value of Communication DEALL Developmental Checklist at the end of 24 weeks from the initial value was significantly better in the family-mediated intervention as compared to the early intensive behavioral intervention group in social (mean difference = −16.8, 95% CI = −27.18, −6.49, p = .002) as well as fine motor, cognitive, and overall development. In other developmental domains of Communication DEALL Developmental Checklist, the family-mediated intervention group performed better in comparison to the early intensive behavioral intervention group at different time periods although not statistically significant. Conclusion: The results of the study indicated that, throughout the course of 24 weeks of treatment, autism spectrum disorder children in family-mediated intervention showed a distinct improvement in major developmental domains. Family-mediated intervention can be advocated for autism spectrum disorder children in our cultural context in view of improved functioning in major developmental domains in the background of our study findings.

Considerations for Intensifying Word-Problem Interventions for Students With MD: A Qualitative Umbrella Review of Relevant Meta-Analyses.

Word problem-solving (WPS) poses a significant challenge for many students, particularly those with mathematics difficulties (MD), hindering their overall mathematical development. To improve WPS proficiency, providing individualized and intensive interventions is critical. This umbrella review examined 11 medium- to high-quality meta-analyses to identify intervention and participant characteristics, informed by the Taxonomy of Intervention Intensity (TII) framework, that consistently moderate WPS outcomes for students with MD. Our analysis identified four characteristics with consistent moderating effects: intervention model, number of treatment sessions, group size, and academic risk area. This result suggests that these variables are potential considerations when customizing and intensifying WPS interventions to maximize their effectiveness for students with MD. We discuss the implications of these findings for practice and research and acknowledge the limitations of our review.

Biophysical and socioeconomic characterization of Agewmariam experimental watershed in Northern Ethiopia: insights and management options.

Watershed characterization is essential for sustainable watershed management and effective resource utilization, particularly in assessing changes resulting from interventions. This study investigates the biophysical and socio-economic conditions of the Agewmariam watershed, aiming to develop land capability and suitability maps while identifying viable management options. Biophysical data, including land slope, soil properties, erosion severity, stoniness/rockiness cover, and vegetation cover, were collected through field surveys and analyzed using overlay analysis in ArcGIS. Socio-economic data, encompassing population demographics, income, and expenditure, were gathered via individual interviews, complete census, and focus group discussions and summarized using descriptive statistics. The study identified 259 households with an average family size of 4 and a demographic dependency ratio of 96.6%. The major sources of income are crop production and livestock rearing supplemented by casual labor and food aid. The average farmland holding size is 0.5ha, with sorghum, barley, teff, and wheat as the dominant crops. The watershed is characterized by six land capability classes (classes II, III, IV, VI, VII, and VIII). The suitability analysis indicated that the watershed is not currently suitable for wheat and teff crops unless physical, chemical, and biological management improvements are implemented. The study revealed that the major limiting factors for land capability and suitability were slope, erosion severity, stoniness, soil organic matter, and soil texture. The socio-economic characterization enhanced awareness about the local socio-economic condition, informing appropriate planning and management strategies. The study recommends intensive soil and water conservation intervention, afforestation on hillsides, changing the land use system, and the addition of organic matter and fertilizers to enhance land capability and suitability for sustainable agricultural practices.

The association of reproductive health factors with periodontitis in 45-80 years old US women from NHANES 2009-2014.

We investigated the association of female reproductive factors with periodontitis. This cross-sectional study analyzed data from the US National Health and Nutrition Examination Survey 2009-2014 on 2321 women aged 45-80 years who had full-mouth periodontal examination and reproductive questionnaire. The 2018 World Workshop Classification of Periodontal and Peri-implant Diseases was used to classify periodontitis stages. After adjustment, > 3 pregnancies or live births were associated with increased stage III/IV periodontitis but age at first birth (AFB) > 23 years and female hormone use were associated with decreased stage III/IV periodontitis, while there were no associations of oral contraceptive use or menopause status with stage III/IV periodontitis. Stage III/IV periodontitis was more common in women with > 3 pregnancies or live births and AFB ≤ 23 years or never using female hormones but less common in women with ≥ 3 pregnancies or > 3 live births and AFB > 23 years or using female hormones. >3 pregnancies or live births were related with increased stage III/IV periodontitis and increased AFB was related with lowered stage III/IV periodontitis in overweight and smoking subgroups but using female hormone was related with reduced stage III/IV periodontitis in nonsmoking, non-overweight and black subgroups. >3 pregnancies/live births were related with severe periodontitis but AFB > 23 years and female hormone use were related with ameliorating periodontitis. Women with > 3 pregnancies/live births should receive intensive periodontal interventions. Female hormone therapy or AFB > 23 years may be beneficial for periodontal health of > 3 pregnancies/live births women.

The effect of intensive praziquantel administration on vaccine-specific responses among schoolchildren in Ugandan schistosomiasis-endemic islands (POPVAC A): an open-label, randomised controlled trial

Vaccine responses differ between populations and are often impaired in rural and low-income settings. The reasons for this are not fully understood, but observational data suggest that the immunomodulating effects of parasitic helminths might contribute. We hypothesised that Schistosoma mansoni infection suppresses responses to unrelated vaccines, and that suppression could be reversed-at least in part-by intensive praziquantel administration. We conducted an open-label, randomised controlled trial of intensive versus standard intervention against S mansoni among schoolchildren aged 9-17 years from eight primary schools in Koome islands, Uganda. Children were randomly allocated to either an intensive group or a standard group with a computer-generated 1:1 randomisation using permuted blocks sizes 4, 6, 8, and 10. Participants in the intensive group received three praziquantel doses (approximately 40 mg/kg) 2 weeks apart before first vaccination at week 0, and every 3 months thereafter. Participants in the standard group were given one dose of approximately 40 mg/kg praziquantel after the week 8 primary endpoint. Participants in both groups received the BCG vaccine (Serum Institute of India, Pune, India) at week 0; the yellow fever (Sanofi Pasteur, Lyon, France), oral typhoid (PaxVax, London, UK), and first human papillomavirus (HPV) vaccination (Merck, Rahway, NJ, USA) at week 4; and the HPV booster and tetanus-diphtheria vaccine (Serum Institute of India) at week 28. The primary outcome was vaccine response at week 8 (except for tetanus and diphtheria, which was assessed at week 52). The primary analysis population was participants who were infected with S mansoni at baseline, determined retrospectively using either plasma circulating anodic antigen (CAA) or stool PCR. The safety population comprised all randomly allocated participants. The trial was registered at the ISRCTN Registry (ISRCTN60517191) and is complete. Between July 9 and Aug 14, 2019, we enrolled 478 participants, with 239 children per group. 276 (58%) participants were male and 202 (42%) participants were female. Among participants who were positive for S mansoni at baseline (171 [72%] in the intensive group and 164 [69%] in the standard group) intensive praziquantel administration significantly reduced pre-vaccination infection intensity (to median 30 CAA pg/mL [IQR 7-223] vs 1317 [243-8562], p<0·001) compared with standard treatment. Intensive praziquantel administration also reduced week 8 HPV-16-specific IgG response (geometric mean ratio 0·71 [95% CI 0·54-0·94], p=0·017), but had no effect on other primary outcomes. Among all participants (regardless of S mansoni status at baseline) intensive praziquantel administration significantly improved week 8 BCG-specific IFNγ ELISpot response (1·20 [1·01-1·43], p=0·038). Recognised adverse effects of praziquantel were reported more frequently in the intensive group. There were no recorded serious adverse events in either group. We show evidence suggesting that praziquantel administration improves the BCG-specific cellular response, but not humoral responses to other vaccines. Despite observational evidence that helminths impair vaccine response, these results show minimal immediate benefits of reducing helminth burden. The effect of longer-term helminth control should be investigated. UK Medical Research Council. For the Luganda translation of the abstract see Supplementary Materials section.

Reversal of Diabetic Nephropathy with Intensive Lifestyle Intervention: A Case Report

Background: Diabetic nephropathy is a leading cause of chronic kidney disease, and early intervention is very important to prevent the progression of the disease .Case Presentation: A 45-year-old male patient who is a known case of type 2 diabetes mellitus from 10 years and nephropathy from 1 year underwent intensive lifestyle modification, including caloric restriction, high-intensity interval training, and stress management, alongside medication. Results: After 6 months of following the advice , significant improvements were observed:HbA1c decreased from 10.5% to 6.5%, eGFR increased from 45 to 60 ml/min/1.73m, proteinuria reduced from 2.5 to 0.5 g/day, and blood pressure normalized. Conclusion: This case demonstrates the potential for intensive lifestyle intervention to reverse diabetic nephropathy, highlighting the importance of a multidisciplinary approach in managing diabetes and preventing renal complications.

Implementing a stabilizing intervention for traumatized refugees in temporary accommodations in South-West Germany - a randomized controlled pilot trial.

https://drks.de/search/de/trial/DRKS00022862 Deutsches Register Klinischer Studien identifier, DRKS00022862.

Speech sound errors in adolescents with congenital hearing loss

Children with hearing impairment (HI) often have vowel and consonant errors. Speech-language pathologists need this information to correct articulation errors. Despite the prevalence of research on speech sound error patterns in hearing aid users, there is a lack of literature in the adolescent group. The present study aimed to investigate the common speech sound errors in HI adolescents from the Malayalam-speaking community who have severe to profound hearing loss and are digital hearing aid users. A total of 15 monolingual Malayalam-speaking children between the ages of 9 and 16 years were recruited who had been diagnosed with speech sound disorders secondary to congenital hearing impairment. The minimum language age for inclusion in the study was over three years. Articulatory error analysis was performed for all consonants and vowels of the Malayalam language, and frequently produced vowel and consonant errors were included in the SODA and PMV analyses. The consonants frequently produced speech sound errors and no vowel errors were found. The most commonly produced consonant errors were fricatives, trills, laterals, velars, and alveolars. Substitution and omission errors were the most common type of error. Place and manner errors were more common than other types of errors. The results of this study may help parents and rehabilitation professionals to understand the common errors that persist even after intensive intervention. It may also be a useful guide for AAC therapists and speech-language pathologists in setting appropriate speech production goals for adolescents with HI.

Parents' and guardians' experiences of barriers and facilitators in accessing autism spectrum disorder diagnostic services for their children: a qualitative systematic review.

The objectives of this review were to comprehensively identify the best available qualitative evidence about parents' and guardians' experiences of barriers and facilitators in accessing autism spectrum disorder (ASD) diagnostic services for their children; and to develop recommendations based on the review for addressing barriers to timely diagnosis and early intervention. Early identification of ASD is a priority because the best chance for improving symptoms occurs through early and intensive intervention. A definitive ASD diagnosis is often a prerequisite for children to access publicly funded services, yet obtaining a diagnosis in itself can be stressful, frustrating, and time-consuming for many families. It is essential to understand the barriers and facilitators parents and guardians face in accessing ASD diagnostic services for their children. This qualitative systematic review considered studies conducted worldwide that included parents and guardians of children up to 18 years of age who had accessed or who were attempting to access ASD diagnostic services for their children. This review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. A literature search included CINAHL (EBSCOhost), CINAHL Plus (EBSCOhost), MEDLINE (EBSCOhost), APA PsycINFO (EBSCOhost), Social Services Abstracts (ProQuest), ERIC (EBSCOhost), and Embase. Gray literature sources included ProQuest Dissertations and Theses, Google Scholar, Google, OpenGrey, other online resources (government and organizational websites), and reference lists of retrieved records. No language, date, or country limits were applied to the searches. Retrieved records from the academic databases, gray literature, and reference lists of retrieved records were screened, with potentially relevant records examined in full against the inclusion criteria. Eligible studies were critically appraised for methodological quality and those included in this review were subjected to data extraction of descriptive details and study findings relevant to the review question. Study findings were synthesized and assigned confidence scores. All reviewers agreed upon the categories and finalized synthesized findings. The 36 included studies varied in qualitative research designs with high methodological quality. There were approximately 661 eligible participants, and 55 credible and unequivocal research findings. The research findings yielded 6 categories and 3 synthesized findings with moderate confidence scores. Parents' and guardians' ability to access ASD diagnostic services for their children is affected by i) encountering health care providers who actively listened to and addressed parents' and guardians' concerns instead of dismissing them, providing a sense of support and validation; ii) facing extended waiting times and associated financial burdens resulting in frustration and associated financial impact when delays occurred; and iii) encountering health care providers lacking specialized knowledge about ASD contributing to parents' and guardians' confusion due to inaccurate or conflicting diagnoses related to ASD comorbidities. Many parents described their journey in accessing ASD assessment and diagnostic services for their children as cumbersome. Parents' and guardians' experiences were affected by the level of perceived support by and knowledge of health care providers; confusion surrounding inaccurate/mixed diagnoses related to ASD; lengthy delays; and systemic and contextual barriers in navigating the pathway to ASD assessment and diagnosis that included socioeconomic and cultural disparities. PROSPERO CRD42018100127.

Issue uncertainty and selections of policy instruments in policy pilots: evidence from China’s long-term care insurance

ABSTRACT Policy pilots have been instrumental in governing China’s economic and social development. Prior research has primarily concentrated on examining the types of policy pilots and their promotion strategies through the lens of central-local dynamics, and analysing the organizational models of policy pilots within specific contexts. However, there’s a gap in understandinghow the central government employs policy instruments to foster organizational learning within pilots. In complex policy pilots, there is often uncertainty regarding objectives, pathways, and outcomes. Using China’s Long-Term Care Insurance (LTCI) pilot as a case study, this research reveals that policy pilots utilize distinct sets of policy instruments during the organizational learning process, contingent upon the context. The first set of instruments indicates a shift in the central government’s intervention intensity, ranging from weak to strong, employing autonomous, advocacy, and directive policy instruments in sequence. The second set of instruments shows an evolution in the depth of the central government’s engagement with the policy issues, progressing from shallow to deep, with the use of booster, framework, and calibrated policy instruments, respectively. This study highlights how policy pilots employ a diverse array of instruments to navigate the intricacies of policy implementation when confronting complex social policy challenges.

Iatrogenic botulism after intragastric botulinum neurotoxin injections – a major outbreak

BackgroundIntragastric botulinum neurotoxin injections (IBNI) are offered off-label in the private medical sector in a few European countries as a safe and effective weight-loss measure. In February and March 2023, an outbreak of iatrogenic botulism occurred in several European countries following IBNI treatment in Turkey. This case series describes the clinical features of severe iatrogenic botulism after IBNI.MethodsWe retrospectively summarize the clinical course and emergency department and intensive care unit interventions in ten cases of severe iatrogenic botulism that occurred after receiving IBNI in this sudden outbreak in Austria and Germany.ResultsSeven out of ten cases initially showed characteristic symptoms of botulism with diplopia, dysphagia, dysarthria, dysarthrophonia, and descending paralysis. All patients were hospitalized, six in an intensive care unit and partially requiring mechanical ventilation. All patients recovered and were discharged without relevant permanent deficits.ConclusionOur study highlights ten clinical cases in this iatrogenic botulism outbreak, representing the largest reported outbreak worldwide. Clinicians should be aware of the risks associated with medical procedures involving botulinum neurotoxins and ensure measures to minimize the risk of iatrogenic botulism.