Ongoing Intervention Research Articles

N-of-1 Trials of Antimicrobial Stewardship Interventions to Optimize Antibiotic Prescribing for Upper Respiratory Tract Infection in Emergency Departments: Protocol for a Quasi-Experimental Study.

Antimicrobial stewardship programs attempting to optimize antibiotic therapy and clinical outcomes mainly focus on inpatient and outpatient settings. The lack of antimicrobial stewardship program studies in the emergency department (ED) represents a gap in tackling the problem of antimicrobial resistance as EDs treat a substantial number of upper respiratory tract infection cases throughout the year. We intend to implement two evidence-based interventions: (1) patient education and (2) providing physician feedback on their prescribing rates. We will incorporate evidence from a literature review and contextualizing the interventions based on findings from a local qualitative study. Our study uses a quasi-experimental design to evaluate the effects of interventions over time in the EDs of 4 public hospitals in Singapore. We will include an initial control period of 18 months. In the next 6 months, we will randomize 2 EDs to receive 1 intervention (ie, patient education) and the other 2 EDs to receive the alternative intervention (ie, physician feedback). All EDs will receive the second intervention in the subsequent 6 months on top of the ongoing intervention. Data will be collected for another 6 months to assess the persistence of the intervention effects. The information leaflets will be handed to patients at the EDs before they consult with the physician, while feedback to individual physicians by senior doctors is in the form of electronic text messages. The feedback will contain the physicians' antibiotic prescribing rate compared with the departments' overall antibiotic prescribing rate and a bite-size message on good antibiotic prescribing practices. We will analyze the data using segmented regression with difference-in-difference estimation to account for concurrent cluster comparisons. Our proposed study assesses the effectiveness of evidence-based, context-specific interventions to optimize antibiotic prescribing in EDs. These interventions are aligned with Singapore's national effort to tackle antimicrobial resistance and can be scaled up if successful. ClinicalTrials.gov NCT05451863; https://clinicaltrials.gov/study/NCT05451836. DERR1-10.2196/50417.

Trajectories of mental health outcomes following COVID-19 infection: a prospective longitudinal study

BackgroundThe COVID-19 pandemic has triggered a global mental health crisis. Yet, we know little about the lasting effects of COVID-19 infection on mental health. This prospective longitudinal study aimed to investigate the trajectories of mental health changes in individuals infected with COVID-19 and to identify potential predictors that may influence these changes.MethodsA web-survey that targeted individuals that had been infected with COVID-19 was used at three time-points: T0 (baseline), T1 (six months), and T2 (twelve months). The survey included demographics, questions related to COVID-19 status, previous psychiatric diagnosis, post-COVID impairments, fatigue, and standardized measures of depression, anxiety, insomnia. Linear mixed models were used to examine changes in depression, anxiety, and insomnia over time and identify factors that impacted trajectories of mental health outcomes.ResultsA total of 236 individuals completed assessments and was included in the longitudinal sample. The participants’ age ranged between 19 and 81 years old (M = 48.71, SD = 10.74). The results revealed notable changes in mental health outcomes over time. The trajectory of depression showed significant improvement over time while the trends in anxiety and insomnia did not exhibit significant changes over time. Younger participants and individuals who experienced severe COVID-19 infection in the acute phase were identified as high-risk groups with worst mental ill-health. The main predictors of the changes in the mental health outcomes were fatigue and post-COVID impairments.ConclusionsThe findings of our study suggest that mental health outcomes following COVID-19 infection exhibit a dynamic pattern over time. The study provides valuable insights into the mental health trajectory following COVID-19 infection, emphasizing the need for ongoing assessment, support, and interventions tailored to the evolving mental health needs of this population.

Treating Target Behaviors of Autistic Individuals With Applied Behavior Analysis: An Ongoing Replication Study.

Background Ongoing outcome data replication on target behaviors with autistic individuals using applied behavior analysis (ABA) confirms its effectiveness and remains an essential evidenced-based standard of care. This replication study aims tofurther confirm the impact of discrete trial training and mass trials on general target behaviors within a naturalistic environment. Methods Data was gathered from 92 children and four adult autistic individuals over one month from 7/7/23to 8/8/23using a repeated measures design. This study used a retrospective chart review with general target behaviors to determine the effectiveness of ABA treatments using discrete trial training and mass trials across time and age categories in a naturalistic environment. Results A mixed analysis of variance (ANOVA) indicated statistical significance (sphericity assumed), F(2,168) = 31.663, p < 0.001 (time). Multiple comparisons using bootstrapped paired t-tests indicated p < 0.001 on the three comparisons. There was a significant interaction effect (sphericity assumed) with timex age category, F(8,168) = 2.918, p = 0.004. Interaction contrasts indicated statistically significant differences over time within the 1-4 years, 5-8 years, and a portion of 9-12 years, and not within the 13-16 years and 17-73 years age groups. Conclusions Autistic individuals receiving ABA demonstrated statistically significant improvement in target behaviors over one month. There was a significant interaction between timeand ageon target behaviors, suggesting a significant association between time and age categories.The reporting of ongoing intervention outcomes provides further justification for continued treatmentsrelative to target behavior mastery with autistic individuals.

Factors Associated with Intention to Use Telerehabilitation for Children with Special Needs: A Cross-Sectional Study.

Background: Children with special health care needs (CSHCN) require long-term and ongoing rehabilitation interventions supporting their development. Telerehabilitation can provide continuous rehabilitation services for CSHCN. However, few studies have explored the intention of CSHCN and their caregivers to use telerehabilitation and its impact on them. Objective: The objective of this study was to identify factors that influence the intention to use telerehabilitation among CSHCN and their caregivers. Methods: This study was a cross-sectional study. Based on the unified theory of acceptance and use of technology, extended with additional predictors (trust and perceived risk [PR]), this study developed a research model and proposed 10 hypotheses. A structured questionnaire was distributed to 176 caregivers. Data were analyzed and research hypotheses were tested using partial least squares structural equation modeling to better understand the factors influencing the use of telerehabilitation. Results: A total of 164 valid questionnaires were collected. CSHCN and their caregivers were overall satisfied with this telerehabilitation medical service. The results of the structural model analysis indicated that social influence (SI), facilitating conditions (FC), and trust had significant effects on behavioral intention (BI) to use telerehabilitation, while the paths between performance expectancy (PE), effort expectancy (EE), and PR and BI were not significant. PE, EE, and SI had a significant effect on trust. Moreover, EE and SI had indirect effects on BI, with trust as the mediator. Conclusions: The results indicated that SI, FC, and trust are significant factors influencing CSHCN and their caregivers' use of telerehabilitation. Trust is also an important mediator for the intention and highly influenced by PE, EE, and SI.

Priming constraint-induced movement therapy with intermittent theta burst stimulation to enhance upper extremity recovery in patients with stroke: protocol for a randomized controlled study.

The treatments based on motor control and motor learning principles have gained popularity in the last 20 years, as well as non-invasive brain stimulations that enhance neuroplastic changes after stroke. However, the effect of intermittent theta burst stimulation (iTBS) in addition to evidence-based, intensive neurorehabilitation approaches such as modified constraint-induced movement therapy (mCIMT) is yet to be investigated. We aim to establish a protocol for a randomized controlled study investigating the efficiency of mCIMT primed with iTBS after stroke. In this randomized controlled, single-blind study, patients with stroke (N = 17) will be divided into 3 groups: (a) mCIMT + real iTBS, (b) mCIMT + sham iTBS, and (c) mCIMT alone. 600-pulse iTBS will be delivered to the primary motor cortex on the ipsilesional hemisphere, and then, patients will receive mCIMT for 1h/session, 3 sessions/week for 5weeks. Upper extremity recovery will be assessed with Fugl-Meyer Test-Upper Extremity and Wolf Motor Function Test. Electrophysiological assessments, such as Motor-Evoked Potentials, Resting Motor Threshold, Short-Intracortical Inhibition, and Intracortical Facilitation, will also be included. In this study, a protocol of an ongoing intervention study investigating the effectiveness of iTBS on ipsilesional M1 prior to the mCIMT in patients with stroke is proposed. This will be the first study to research priming mCIMT with iTBS and it may have the potential to reveal the true effect of the iTBS when it is added to the high-quality neurorehabilitation approaches. Trial registration number: NCT05308667.

CAREGIVERS’ ROLES IN ENHANCING SOCIO-COMMUNICATION SKILLS IN CHILDREN WITH AUTISM SPECTRUM DISORDER IN A SELECTED NON-GOVERNMENTAL ORGANIZATION FOR PARENTS OF CHILDREN WITH AUTISM SPECTRUM DISORDER, NAIROBI COUNTY, KENYA

Caregivers (parents and guardians) of children with ASD play an integral role in early intervention for children with autism spectrum disorder (ASD) since they spend more time interacting and providing formal care for their children; they are supposed to provide early diagnosis and ongoing intervention to mitigate socio-communication challenges for their children. Some caregivers, however, lack knowledge and expertise on their roles in this resulting in miscommunication, unmet needs, and frustration. The purpose of this study was to establish caregivers’ extent of involvement in Speech and Language Pathology Services (SLP) in enhancing the socio-communication skills of children with ASD. The study was guided by Structural Functional Theory (SFT) by Comte. The study adopted a descriptive survey design with a mixed-method research approach. It targeted a population of 38 respondents comprising of thirty-six caregivers, one occupational therapist from a nongovernmental organization of parents with ASD, and one Speech and Language Pathologist (SLP) outside a nongovernmental organization. The study employed a purposive sampling technique, and the pilot study was undertaken among caregivers of children with ASD b with the same characteristics as the target population. The key research instruments were questionnaires and face-to-face interviews. Quantitative data from closed-ended items were examined and coded. This was followed by analysis with the aid of SPSS version 26. The data was reported usinge descriptive statistics. Qualitative data we read repeatedly to establish patterns and then themes. It was reported narratively. Conclusions were drawn and necessary recommendations were made based on research findings. The research found that caregivers’ involvement was critical in enhancing the acquisition of socio-communication skills. The study recommends government and non-governmental organizations of parents with ASD children promote more caregiver participation by creating more awareness of SLP services, recruiting more SLPs locally, offering comprehensive training, and coaching caregivers on SLP strategies.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0759/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Filling in the gaps: early middle English, nationalist philology, and reparative codicology

ABSTRACT Ongoing interventions by antiracist scholars and activists demonstrate the lasting impact that the racist, nationalist, and colonialist foundation of the field has had on modern perceptions of the pre-Conquest English past and those who study it. This article identifies the impact of the same ideologies on the study of early Middle English literatures and its place in canonical accounts. The deployment of medieval English literatures in a teleological effort to establish histories of whiteness and legitimize white colonial superiority. However, close interrogation of the linguistic and literary developments of the period threatened the very structures they were invoked to sustain. Effectively, early Middle English was placed in a medial position that invoked its presence only to deny its importance. This article offers an alternative. Eve Sedgwick's conception of ‘reparative reading’ has resonances with both the material forms in which early Middle English is preserved, and the human experiences that underlie that preservation. Fragmentary lyrics, like the couplet from Poema Morale, provide an example. These snippets point to the presence of a widely circulating ‘cultural repository’ that could negotiate the structures of institutional (primarily Latinate) literacy and opened those frameworks to dynamic participation by a wide range of readers and users.

From Conception to Delivery: A Comprehensive Review of Thyroid Disorders and Their Far-Reaching Impact on Feto-Maternal Health.

This comprehensive review delves into the multifaceted landscape of thyroid disorders during pregnancy, exploring their impact from conception to postpartum considerations. Key findings highlight the intricate interplay between maternal thyroid health and fetal development, emphasizing the critical importance of timely screening and targeted interventions. The evolving landscape of research and technology suggests a paradigm shift towardpersonalized approaches in clinical practice, emphasizing integrated care models and the integration of telehealth platforms. Postpartum considerations, including postpartum thyroiditis, underscore the necessity for ongoing monitoring and intervention for maternal well-being. Implications for clinical practice encompass healthcare provider education, public awareness campaigns, and policy advocacy for standardized screening guidelines. The call to action resonates for increased research funding to advance understanding and improve outcomes. By fostering awareness, education, and collaborative efforts, this review aims to navigate the complexities of thyroid disorders during pregnancy, ensuring a healthier start for both mothers and their infants.

Abstract TP53: Above Par on the Back Nine: Improving Triage of Posterior Circulation Stroke

Background and Purpose: Notoriously difficult to recognize, posterior circulation strokes (PCS) can be some of the most devastating. It is incumbent on the triage nurse to recognize these signs and symptoms. This project was developed to educate frontline ED staff on early identification of posterior strokes, decrease time to recognition, and improve outcomes. Methods: The community Primary Stroke Center (PSC) identified the need to improve recognition of PCS after a series of treatment-eligible patients were missed. A team was created including the directors of the PSC and associated Comprehensive Stroke Center (CSC), emergency room physicians, and nurses. A triage algorithm was created to capture as many strokes as possible without a glut of false positives. This included focal and non-focal signs of stroke. ANY sign of stroke should initiate the code stroke (CS) process provided that the presentation was within 24 hours of last known well, the presentation was sudden, and the symptoms were disabling to the patient. Once approved, the algorithm and education were provided to all patient-facing ED staff. Updates were added to huddle notes and a copy of the algorithm was made available at all triage areas. Data was collected retroactively for a total of 16 months, 8 months prior to the intervention and 8 months after. Results: - For all PCS the median time from arrival to initiation of CS improved from 9 minutes to 1 minute - For all PCS the median time from arrival to confirmation of stroke improved from 597 minutes to 249 minutes - Prior to intervention, only 60% of CS-eligible patients had a CS initiated, compared to 92% after - Ninety-day Rankin was from 0-2 in 86% of PCS patients prior to intervention compared to 100% after Conclusions: A clear triage process can maximize identification of PCS, increase capture of treatment-eligible patients, and decrease disability. A PSC with tele-stroke coverage and ongoing education improved identification of posterior circulation strokes and outcomes. Key takeaways for success include clear and concise code stroke algorithm, support from providers, and ongoing educational interventions. While this data is preliminary, we will continue to track and trend. Next steps should include education directed to EMS personnel in the field.

The Museum as a Laboratory: An Approach to the Experience of Public Museums in Chile

The present article analyzes the recent debates regarding the redefinition of the museum, exploring resonances in reflective practices and processes in public museums in Chile. While these have caused controversy and discord, they appear to converge in the need to rethink the relationship between museums and society, seeking to make them more inclusive, democratic and diverse. The present discussion is based on the preliminary results of “LAB_Museums: Contemporary Museums and Museologies”, an ongoing interdisciplinary research intervention model promoting processes of co-production of knowledge regarding museums and museography. This paper is the publication of the results of the project. To this end, a collaborative ecosystem of knowledge has been developed between the university, museums and public sector, based on the implementation of laboratories, initially, in five public museums of the Metropolitan Region of Santiago, Chile: the National Museum of Fine Arts, the National Historical Museum, the Museum of Contemporary Art, the Popular Art Museum and the National Center of Contemporary Art. The theoretical/methodological framework used was that of Institutional Analysis (IA), based on which interviews and discussion groups with museum professionals promote dialogues on the present reality and contemporary challenges of museums.

Exploring a Gaming-Based Intervention for Unemployed Young Adults: Thematic Analysis.

Promoting positive psychologies that promote resilience such as a growth mindset could be beneficial for young, unemployed adults, as many lack the self-esteem and self-efficacy to cope with job search adversity. These young people may be reached at scale through the web-based delivery of self-administered positive psychology interventions. However, past studies report unsatisfying user experiences and a lack of user engagement. A gaming-based experience could be an approach to overcoming these challenges. Our research objective was to explore how young, unemployed adults experience a positive psychology intervention designed as a game to extract learning and principles for future intervention research and development. To respond to the research question, a team of researchers at the University of Stavanger worked with designers and developers to conceptualize and build a gaming-based intervention. Feedback from the users was collected through formative usability testing with 18 young adults in the target group. Retrospectively, recordings and notes were transcribed and subjected to thematic analysis to extract learnings for the purposes of this paper. A total of 3 themes were identified that pinpoint what we consider to be key priorities for future gaming interventions for unemployed young adults: adaptation to user preferences (eg, need for responding to user preferences), empathic player interaction (eg, need for responsiveness to user inputs and a diverse set of interaction modes), and sensemaking of experience and context (eg, need for explicit presentation of game objectives and need for management of user expectations related to genre). Feedback from end users in usability-testing sessions was vital to understanding user preferences and needs, as well as to inform ongoing intervention design and development. Our study also shows that game design could make interventions more entertaining and engaging but may distort the intervention if the game narrative is not properly aligned with the intervention intent and objectives. By contrast, a lack of adaptation to user needs may cause a less motivating user experience. Thus, we propose a structured approach to promote alignment between user preferences and needs, intervention objectives, and gameplay.

The School of No Fun and No Play: Learning How to Create Supportive Environments from Children with Osteogenesis Imperfecta

Abstract Children with medically complex dis/abilities hold sophisticated views on effective school leadership, adapted built environments, inspiring peer solidarity, catalyzing transformational solutions and a possible school-hospital liaison model to support student well-being. Using child-centric collaborative techniques, this ethnodramatic study engaged children with osteogenesis imperfecta (oi), a rare genetic disease, to create a children’s book describing their moral experiences to be disseminated to other children and families. Children living with oi experience ongoing medical interventions and dis/ability that broadly jeopardized the quality of their academic experience relative to their peers. As such, children living with oi offered trenchant insight into what supports and thwarts operationalization of their values and highlights the programs, leadership, services and paradigm shifts they feel that they need to flourish in the academic context.

Assessing groundwater quality, health risks, and policy implications: A case study of West Medinipur District, West Bengal, India

AbstractGroundwater is a vital freshwater resource for various uses, including drinking, irrigation, and industry needs. The increasing dependence of India on groundwater due to dwindling surface water sources and climate extremes has led to concerns about its availability and quality. This study focuses on the groundwater quality and associated human health risks in the West Medinipur district of West Bengal, India. The region, situated between the Kangsabati and Subarnarekha rivers, faces challenges from anthropogenic activities such as agricultural practices and industrial pollution. A comprehensive analysis of physicochemical parameters was conducted on well water samples collected during the monsoon and post‐monsoon periods. The study examined the suitability of groundwater for drinking and irrigation purposes. Water quality indices were calculated to assess its fitness for human consumption. Despite several parameters meeting the water quality standards, elevated iron (Fe) and ammonia (NH4+) levels were observed, potentially impacting groundwater use for drinking. Similarly, groundwater's suitability for irrigation was evaluated based on parameters like sodium adsorption ratio (SAR) and sodium percentage (Na%). The groundwater types dominated by magnesium bicarbonate and the quality could affect soil structure and crop productivity in certain areas. The elevated levels of Fe and NH4+ showed potential human health risks, indicating the need to mitigate adverse effects on human well‐being through appropriate policy and other interventions. The study highlights the complexity of groundwater quality in the study area. It underscores the necessity for comprehensive water policy and management strategies to safeguard water resources and human health in rural India. The findings emphasize the importance of ongoing monitoring and intervention measures to ensure the sustainability and safety of groundwater for present and future generations.

Vocal fingerprinting reveals a substantially smaller global population of the Critically Endangered cao vit gibbon (Nomascus nasutus) than previously thought

The cao vit gibbon (Nomascus nasutus) is one of the rarest primates on Earth and now only survives in a single forest patch of less than 5000 ha on the Vietnam–China border. Accurate monitoring of the last remaining population is critical to inform ongoing conservation interventions and track conservation success over time. However, traditional methods for monitoring gibbons, involving triangulation of groups from their songs, are inherently subjective and likely subject to considerable measurement errors. To overcome this, we aimed to use ‘vocal fingerprinting’ to distinguish the different singing males in the population. During the 2021 population survey, we complemented the traditional observations made by survey teams with a concurrent passive acoustic monitoring array. Counts of gibbon group sizes were also assisted with a UAV-mounted thermal camera. After identifying eight family groups in the acoustic data and incorporating long-term data, we estimate that the population was comprised of 74 individuals in 11 family groups, which is 38% smaller than previously thought. We have no evidence that the population has declined—indeed it appears to be growing, with new groups having formed in recent years—and the difference is instead due to double-counting of groups in previous surveys employing the triangulation method. Indeed, using spatially explicit capture-recapture modelling, we uncovered substantial measurement error in the bearings and distances from field teams. We also applied semi- and fully-automatic approaches to clustering the male calls into groups, finding no evidence that we had missed any males with the manual approach. Given the very small size of the population, conservation actions are now even more urgent, in particular habitat restoration to allow the population to expand. Our new population estimate now serves as a more robust basis for informing management actions and tracking conservation success over time.

The ATLAS Alarm Helper

The Detector Safety System is the last line of defence to protect the ATLAS detector against abnormal and potentially even unforeseen situations. It is designed to return the detector to a safe state based on predefined actions triggered by alarms which are triggered on their part by specific sets of conditions. Every alarm whether it results in an action taken or not is followed up by the operations team that assesses the criticality, takes countermeasures and identifies the point of failure. From experience abnormal situations can result either from faults or from side effects of planned interventions which were either not properly identified despite the mandatory planning and review or where a mistake during execution occurred. In many cases there are multiple interventions ongoing simultaneously in order to profit from shutdown periods. The rapid analysis of alarms while the incident is ongoing is often complicated due to the complexity of the ATLAS detector and its infrastructure and the large number of responsible groups and experts. A new Alarm Helper tool was designed to assist the operation team, particularly the operator in the control room responsible for infrastructure and safety (SLIMOS – Shift Leader in Matters of Safety), by providing real-time information about ongoing interventions and the possible related causes of failure. The new tool will combine historical events, documentation, and limited knowledge about ongoing interventions. It extends the Expert System which visualizes and simulates infrastructure inter-dependencies and allows to trace faults or alarms to a list of potential points of failure. The new tool also proposes which experts should be contacted in the particular circumstances.

Self-management practice and associated factors among asthmatic patients on follow-up care at public tertiary hospitals, south west, Ethiopia, 2022.

Bronchial asthma is a major public health issue that affects patients, families, and communities worldwide. Despite the growing importance of self-management and its clear link to better health outcomes, the uptake and use of self-management among asthmatic patients is not well understood. Thus, the study aimed to determine the level of self-management practice and associated factors among asthmatic patients on follow-up care at public tertiary hospitals found in south-west Ethiopia. An institutional-based cross-sectional study design was employed from August 1 to September 30, 2022. The study included all asthmatic patients on follow-up care at public tertiary hospitals found in south west Ethiopia, among whom 274 were interviewed. All asthmatic patients who were registered at the chronic follow-up unit of each hospital and fulfilled inclusion criteria were included and interviewed consecutively. The data were collected using a structured interviewer-administered questionnaire adapted from previous studies, entered into EpiData version 4.6, and exported to SPSS version 25 for analysis. Descriptive statistics were used to summarize the participant's characteristics. Linear regression was used to identify variables associated with asthma self-management practice, and variables with a p-value of 0.05 were considered statistically significant. Finally, tables, graphs, and text were used to present the data. Out of 274 interviewed asthmatic patients, 45.26% 95% CI (39, 51) had good asthma self-management practices. Advancing in age (ß = -0.009, P = 0.043), being a smoker (ß = -0.346, 95%, P = 0.03, being alcohol drinker (ß = -0.217, P = 0.001), having depression (ß = -0.038, P = 0.005), having anxiety (ß = -0.029, P = 0.02) and having social support (ß = 0.022, P<0.001) were identified as factors affecting asthma self-management practice. The finding revealed that four of every nine asthmatic patients had good asthma self-management practices. Age, alcohol consumption, smoking, anxiety, depression, and social support were significantly associated with asthma self-management practice. Ongoing self-management support and collaborative target interventions aimed at improving asthma self-management practices and identified factors are very crucial.

Nurses' experiences and perspectives regarding evidence-based practice implementation in healthcare context: A qualitative study.

To explore nurses' experiences and perspectives about evidence-based practice (EBP) implementation in the healthcare context. A qualitative descriptive study design using focus group discussions (FGDs). Sixty-four nurses who purposefully selected and worked at various healthcare organizations in Bisha Governorate, Saudi Arabia, were included. Eight FGDs were used to obtain data using open-ended questions. The collected data underwent inductive qualitative content analysis. Two main categories were extracted: experiences and perspectives towards EBP. The experiences category emerged into four sub-categories: familiarity with concepts and benefits, steps, dissemination sources of EBP and sources of EBP knowledge, while perspectives towards the EBP category included four sub-categories: application of EBP in clinical practice, barriers, facilitators and EBP application methods. The participants experienced being in a non-supportive and non-encouraging atmosphere which results from a lack of organizational commitment to EBP implementation and illuminates the complexities involved in the integration process. The nurses' experience with EBP indicated that there was limited support for the implementation of this approach. Furthermore, they experienced varying barriers to EBP implementation. They viewed EBP as a complex technique as they lacked knowledge and skills related to the formulation of research questions, and retrieving, applying and disseminating of EBP in clinical practice decision-making. That is due to barriers pertinent to the individual, organizational and patient factors. The key to successfully implementing an EBP in nursing practice is to promote professional development, comprehensive and continuous training, a culture of change, organizational support and motivation. Through the construction and provision of ongoing educational interventions and mentoring programmes about EBP, healthcare organizations and nursing leadership may develop a comprehensive strategy to encourage staff nurses' participation in the EBP process. This is to enhance nurses' experiences and perspectives towards the EBP approach and overcome the barriers to effective implementation. Patients or the general public were not involved in the design, analysis or interpretation of the data in this study.

Unveiling Coronasomnia: Pandemic Stress and Sleep Problems During the COVID-19 Outbreak.

The COVID-19 pandemic posed an unprecedented challenge to public well-being, necessitating an examination of its health impact. This review discusses the relationship between pandemic-induced stressors and individual sleep patterns and quality. The pandemic stressors include lockdown or physical distancing measures, direct virus exposure, and the dissemination of misinformation and disinformation. The pandemic led to delayed sleep-wake cycles, except for healthcare professionals, and worsened sleep quality. The prevalence of insomnia was higher for women due to pre-existing conditions and susceptibility stressors such as lockdown stress and family responsibilities. Healthcare professionals, who experienced worsened work conditions during the pandemic, reported higher rates of insomnia and sleep difficulties due to infection anxiety and post-traumatic stress from direct virus exposure. For the general population, stress stemmed from social isolation under lockdown and overwhelming false information available online, resulting in sleep problems. Taken together, the findings highlight the importance of promoting social interactions, providing psychological support services, and caution in navigating health information. In summary, this review underscores the need for individual- and group-centered approaches in ongoing research and interventions to address pandemic-related stress and sleep issues during COVID-19.

Evaluating site selection at design in food systems interventions: A formative geospatial approach

Within international development, formative evaluation is becoming increasingly important to make rapid assessments of project design and support adaptive learning in early implementation of ongoing interventions. Such evaluation is critical for institutions with short funding cycles, which need early evidence to assess the utility of new initiatives to inform donors’ decision-making for upcoming funding cycles. However, obtaining quantitative evidence is difficult in formative evaluation as results are not yet available or visible early in the project cycle. Geospatial multi-criteria suitability analysis provides one method for evaluating the relevance of program and project design through creating a quantitative spatial index, combining data on several spatial indicators to evaluate project site selection and help inform future priority geographies. This study demonstrates the use of such a geospatial analysis in the formative evaluation of the Global Environment Facility’s food systems integrated programs.

INVESTIGATING THE NEURAL CORRELATES OF SOCIAL AND INDIVIDUAL SINGING IN PERSONS WITH DEMENTIA

Abstract Music interventions for persons with Alzheimer’s Disease and related dementias (PwADRD) have documented psychological benefits; however, the neurological correlates underlying these advantages remain less certain. Using functional near infrared spectroscopy (fNIRS), the present study i) investigated within-person patterns of cortical oxygenation during choral vs. individual singing; ii) explored how singing context (choral vs. individual) modulated patterns of functional connectivity (FC) within and across frontal and parietal cortices; and iii) leveraged these functional activations as predictors of cognitive status (degree of impairment) in a series of discriminant function analyses (DFA). Participants were 13 PwADRD who volunteered from a larger, ongoing social-cognitive choir intervention. fNIRS data were collected using a TechEn Cw6 system during both choral and individual singing conditions. Paired sample t-tests evaluated differences in activation patterns between singing conditions, with DFA used to determine whether these activations and neuropsychological function were predictive of between-person differences in cognitive impairment. Significant differences in cerebral oxygenation were identified in the right anterior PFC, with individual singing associated with significantly greater cortical oxygenation relative to group singing. Although not significant, individual singing was also associated with bilateral increases in cortical oxygenation across the majority of fNIRS channels, as well as increased FC, relative to group singing. The DFA analyses were not significant. This novel study is the first to examine differences in music-cognition correlates across environmental contexts for PwADRD. Patterns of functional activation suggest that choral singing in particular may represent an optimal lifestyle activity, placing comparatively fewer demands on cognitive function.