Implementation Of Optimal Strategy Research Articles

The effect of functional exercise program on physical functioning in older adults aged 60 years or more: A systematic review and meta-analysis of randomized controlled trials

ObjectiveIn this systematic review and meta-analysis, we assessed the impact of functional exercise training on physical functioning parameters in older adults 60 years and older. MethodDatabases including PubMed, MEDLINE, CINAHL, SPORTDiscus, and Cochrane Library were systematically searched. ResultsSixteen articles were included. Meta-analysis demonstrated that functional training significantly improved Barthel index (p = 0.01), gait speed (p = 0.002), gait cadence (p = 0.0002), Berg Balance Scale (p = 0.0003), Timed Up and Go test (TUG; p = 0.02), step length (p < 0.0001), Five Chair Stand (p < 0.0001) and physical activity questionnaire for the older adults score (p < 0.00001). However, hand grip strength remained unchanged. DiscussionThese findings underscore the significance of incorporating functional exercises in interventions for healthy aging and maintaining independence among older individuals. Further investigation is needed to explore long-term effects and optimal implementation strategies for functional exercise regimens in this populations.

Analysis of an Accurate Iterative Technique with Attenuation Compensation in Planar Laser Induced Fluorescence

Abstract Iterative techniques in Planar Laser Induced Fluorescence (PLIF) evaluations are theoretically analysed. Correction for laser light attenuation is also incorporated in the analysis. Conditions for the convergence of the results and the scalings for the errors are derived. The results are validated against experiments. It is shown that the optimal strategy for implementation of iterative PLIF evaluation with attenuation correction is on the ensemble mean of the fluorescence field. Compared to the implementation with instantaneous fluorescence images, this approach is not only far more efficient computationally, but also is assured to converge monotonically and extremely rapidly, with minimal errors. This is suggested to be a viable and useful technique for PLIF in general, but especially for cases where a reference cell is unfeasible for explicit attenuation correction.

Effectiveness of a 12-week combining tai chi and yoga program on pulmonary function and functional fitness in COPD patients

BackgroundChronic obstructive pulmonary disease (COPD) poses significant challenges to both patients and healthcare providers due to its progressive nature and adverse impact on respiratory function and quality of life (QoL). While pulmonary rehabilitation remains a cornerstone of non-pharmacological COPD management, additional interventions are needed to address patients' diverse needs and preferences. AimThis study investigated the feasibility and potential benefits of a 12-week combining Tai Chi and Yoga (TY combining) program on cardiorespiratory and lung functions, functional fitness, and QoL in older males diagnosed with COPD. MethodsTwenty-four male COPD patients (age: 70 ± 6 years) with moderate to severe disease were recruited and randomized into the TY combining group (n = 12) or control group (n = 12). Assessments were conducted at baseline and at week 12, including pulmonary function tests, quality of life measures, dyspnea, and fatigue. Functional fitness tests were assessed at baseline, week 4, week 8, and week 12. ResultsThe TY combining program significantly improved pulmonary functions, functional fitness, quality of life, and fatigue over the 12-week intervention period. Notably, improvements in functional fitness parameters were observed after just four weeks of training, emphasizing the rapid benefits of the intervention. Moreover, the program exhibited high safety and feasibility, with no reported complications. ConclusionThe 12-week TY combining program represents a safe, feasible, and effective adjunctive therapy for COPD management in older male patients. By addressing multiple dimensions of health and functioning, including pulmonary and cardiovascular health, functional fitness, and quality of life, this holistic approach holds promise for optimizing outcomes in COPD patients. Further research is warranted to validate these findings and explore optimal implementation strategies in clinical practice.

Contextual factors associated with successful alcohol screening and brief intervention implementation and sustainment in adult primary care

IntroductionHazardous drinking is a public health problem affecting approximately 20 % of the U.S. primary care population. Clinical trials have documented the efficacy and effectiveness of Alcohol Screening and Brief Intervention (ASBI), yet widespread implementation remains elusive, and questions remain regarding optimal implementation and sustainment strategies. Kaiser Permanente Northern California (KPNC) implemented systematic ASBI in adult primary care in mid-2013. We used 8 years of electronic health record (EHR) data, combined with surveys which captured primary care provider perceptions organized into PRISM (Practical, Robust Implementation and Sustainability Model) implementation framework domains (Intervention, External Environment, Implementation Infrastructure, and Recipients), to characterize ASBI implementation and sustainment and test how various factors are associated with ASBI rates. MethodsUsing EHR data, we calculated yearly screening rates of adults with a primary care visit, and brief intervention (BI) rates among those with a positive hazardous drinking screen, (exceeding the age and sex-specific daily and weekly low-risk NIH guidelines (≤3 per day and ≤ 7 per week for women and older men; ≤4 per day and ≤ 14 per week for men 18–65)), across KPNC, from 2014 to 2021. We collected web-based survey data, informed by the PRISM domains, from primary care providers (n = 796; 35.5 % RR) to assess perceptions on ASBI implementation and sustainability. ResultsBetween 1/1/2014 and 12/31/21 there were 5,072,270 completed screenings and 624,167 BIs. After adjusting for patient panel characteristics, we found that facilities with higher Implementation Infrastructure domain scores, indicating more robust implementation capacity, had higher screening and BI rates; facilities with higher Intervention domain scores, indicating positive perceptions of SBIRT evidence, and facilities with higher Recipients domain scores, indicating perceived organizational robustness, clinician culture and management support; and greater perceived patient needs and their likely benefit from SBIRT, had higher BI rates. ConclusionsResults provide information on factors which may facilitate successful ASBI implementation and sustainability and could inform future ASBI implementation efforts in healthcare system settings. In particular, efforts toward bolstering an organization's implementation infrastructure capacity, prior to embarking on implementation of a systematic ASBI program, could potentially help pave the way for successful implementation.

Meningkatkan Hasil Belajar Peserta Didik Melalui Metode Problem Based Learning pada Peserta Didik Kelas 2 Fase A SD Mardi Waluya Cibinong

At Elementary School Mardi Waluya Cibinong, it was found that the critical thinking ability and learning achievement targets of Catholic Religious Education especially in grade 2 were not optimal. This could be due to the use of less varied learning methods and the less optimal implementation of strategies that encourage active student participation. This research aims to improve the character dimension of critical thinking and student achievement targets by applying the Problem-Based Learning method in phase A of especially in grade 2. This classroom action research was conducted in two cycles with materials on the safety of God’s work through Kain and Habel, with each cycle consisting of four stages: planning, implementation, evaluation, and reflection. The research subject is students from Elementary school Mardi Waluya Cibinong with a total of 34 peoples. The results of the research show that the use of the PBL learning model can increase the character dimension of critical thinking in the Pancasila student profile (P3) from 70% to 84%. There was also an increase in student achievement outcomes, with mastery increasing from 20% to 68%, proficiency from 50% to 32%, and a decrease in appropriateness from 18% to 0%, which then increased to 12%. This indicates a significant decrease in the critical thinking dimension of the Pancasila students profile, which overall improves the critical thinking process and students achievement in grade 2 phase A. Recommendation: Teachers can focus on one dimension of P3 in the character development process by applying problem-solving learning methods.

Effectiveness of Mirror Therapy, Electrical Stimulation, and CIMT in Restoring Upper Extremity Function after Stroke

Objective: This study aimed to compare the effectiveness of mirror therapy (MT), electrical stimulation (EMS) combined with MT, and Constraint-Induced Movement Therapy (CIMT) in improving upper extremity function among stroke survivors. Methodology: A randomized controlled trial was conducted involving n=45 stroke patients undergoing rehabilitation at Wah International Hospital. The inclusion criteria for the study required participants to be above 45 years of age, to have survived either an ischemic or haemorrhagic stroke, and to have at least 10° wrist extension. Participants were excluded if they had an implanted electrical device such as an artificial pacemaker, paresis instead of paralysis, hemiplegia due to causes other than ischemic or haemorrhagic stroke (such as trauma, tumor, or coordination problems), or impaired sensory integration. Participants were divided into three groups: EMS combined with MT, CIMT alone, and Mirror therapy alone. Treatment sessions were administered four times a week for three months. Outcome measures included the Fugl-Meyer Assessment Scale (FMA) and Motor Assessment Scale (MAS). Results: Analysis revealed significant improvements in upper extremity function across all groups. However, the CIMT group exhibited the most substantial enhancement, with a mean difference of -68.5 (p &lt; 0.05) on the FMA and -24.1 (p &lt; 0.05) on the MAS compared to the other groups. Conclusion: The findings highlight the superior efficacy of CIMT in improving upper extremity function among stroke survivors. Incorporating CIMT into rehabilitation protocols is crucial for optimizing outcomes in this patient population. Further research is warranted to explore the long-term benefits and optimal implementation strategies of CIMT in diverse rehabilitation settings

Using Duolingo in Teaching and Learning Vocabulary: A Systematic Review

This systematic review examines the extant literature on the efficacy of the Duolingo application for vocabulary development in instructed second language (L2) contexts. Drawing on several empirical studies, the review synthesises findings related to (a) the comparative effectiveness of Duolingo versus traditional pedagogies, (b) the impact of Duolingo on learner motivation and engagement, and (c) practical implications for classroom integration. While the majority of evidence attests to measurable gains in receptive vocabulary knowledge, the findings must be interpreted with caution due to methodological limitations, including small sample sizes, short intervention periods, and construct underrepresentation. The motivational appeal of Duolingo's gamified interface emerges as a prominent theme, corroborated by self-report data. However, the limited research employing psychometrically robust motivational measures precludes definitive conclusions about the temporal stability and transferability of this motivational effect. Theoretically, the provision of individualised feedback aligns with interactionist theories, yet the restricted opportunities for the negotiation of meaning raise doubts about the depth of lexical engagement. Pedagogically, the reviewed studies advocate the careful integration of Duolingo as a supplementary tool within formal instructional contexts. However, optimal implementation strategies remain unspecified, necessitating further classroom-based research employing mixed-methods designs. Significant gaps are identified, including the lack of investigations into the differential impacts of Duolingo's features, vocabulary transfer to authentic communication, and the development of self-regulated learning strategies.

Towards circular manufacturing systems implementation: An integrated analysis framework for circular supply chains

The transition to circular manufacturing systems (CMS) is crucial for achieving sustainable growth, addressing the environmental concerns and resource scarcity challenges. Shifting towards CMS requires a systemic approach that integrates value proposition models, product design, and supply chains (SCs). Circular supply chains (CSCs) emerge as a core pillar of CMS, incorporating value delivery, use, recovery, and reuse. CSCs are inherently more complex and dynamic than linear SCs requiring a holistic analysis approach to capture their complex and dynamic attributes. This research proposes an integrated analysis framework combining qualitative and quantitative approaches to explore the complexities and dynamics of CSCs and assess their economic, environmental, and technical performance. Through the lens of two different CMS implementation case studies, one in automotive parts remanufacturing and one in white goods manufacturing, this research illustrates the framework's applicability. In the automotive case, centralizing core management activities was found to improve economic performance by 50-54 %. However, the introduction of regional logistics hubs, while economically efficient, led to a 20 % increase in CO2-equivalent emissions. On the other hand, the white goods case study highlighted the trade-offs in centralizing end-of-life recovery facilities, where financial savings of up to 60 % were offset by increased transportation costs and increased CO2 emissions. The analysis of CSCs in these two distinct manufacturing sectors underscores the relevance and flexibility of the proposed framework, providing decision-makers with a tool to examine how different CSCs configurations and strategies impact overall performance. This guidance is crucial for developing optimal CSCs design and implementation strategies.

Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory

BackgroundIn low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Education (PACE), an adaptive learning program to enhance provider competency in Tanzania’s guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal implementation strategies in LMIC settings are unknown.Objectives(1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential.MethodsMixed-methods study involving healthcare providers at three facilities. Quantitative data was collected using the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs).ResultsEighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrating that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study’s focus on PACE’s initial implementation.ConclusionThis study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation. Furthermore, the study underscores the value of the NPT as a framework for guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.

Strategies for Implementing GlobalConsent to Prevent Sexual Violence in University Men (SCALE): Study Protocol for a National Implementation Trial.

Globally, women 15-24 years are at heightened risk of sexual violence victimization, a risk factor for adverse mental, physical, and behavioral health outcomes. Sexual violence is common at universities and most often perpetrated by men, yet few evidence-based prevention strategies targeting men have been tested in low- and middle-income countries. GlobalConsent is a six-module, web-based educational program adapted from an efficacious U.S.-based program. Nine months post-treatment in a randomized trial in Vietnam, GlobalConsent reduced men's sexually violent behavior (Odds Ratio [OR] = 0.71, 95%CI 0.50-1.00) and increased prosocial intervening behavior (OR = 1.51, 1.00-2.28) relative to an attention-control. Evidence regarding optimal implementation strategies for scale up is needed. We will randomize six medical universities in North, Central, and South Vietnam to deliver GlobalConsent using two different packages of implementation strategies that vary in intensity. Higher-intensity strategies will include greater 1) pre- and post-implementation engagement with university leaders and faculty, and 2) greater pre-implementation outreach, follow-up, and incentives for students to promote engagement and completion of GlobalConsent. Higher intensity universities will receive additional training and support for their added activities. We will compare implementation drivers and outcomes, intervention effectiveness, and cost-effectiveness across the two implementation bundles. Our mixed-methods comparative interrupted time-series design includes 1) qualitative interviews and quantitative surveys with university leaders and implementation teams to assess implementation barriers and facilitators; 2) repeated surveys with leaders and faculty, implementation teams, and male students to assess multilevel implementation drivers and outcomes, 3) repeated surveys with male students to assess behavioral outcomes (sexual violence and intervening behavior) and mediating variables (knowledge, attitudes, affect, and capacities), and 4) time diaries and cost tracking to assess cost effectiveness of the two implementation-strategies bundles. This project is the first to assess packages of implementation strategies to deliver an efficacious web-based sexual-violence-prevention program for undergraduate men across all regions of Vietnam and synergizes with a violence-prevention training initiative (D43TW012188). This approach will produce rigorous evidence about how to disseminate GlobalConsent nationally, which holds promise to reduce gender-based health inequities linked to sexual violence as GlobalConsent is brought to scale. NCT06443541. Retrospectively registered with clinicaltrials.gov.

Analysis of Interactive Educational Puzzle Media to Improve Elementary School Students' English Language Skills

This study aims to analyze the effectiveness of interactive edugame puzzle media in improving English language skills of primary school students. The method used is a literature study that reviews various literature and previous research results related to using interactive learning media, especially edugame puzzles, in learning English at the primary school level. The results of the analysis show that interactive edugame puzzle media has significant potential to improve students’ English language skills, especially in the aspects of vocabulary, grammar, and reading comprehension. Factors contributing to this media’s effectiveness include interactive elements, immediate feedback, and fun aspects that increase students’ learning motivation. However, effective implementation requires careful design and support from teachers. This study concludes that interactive edugame puzzle media can be a valuable tool in English language learning in primary schools, with recommendations for further research into optimal design and implementation strategies in different learning contexts.

Evaluating Case-Based Learning to Enhance Dental Student Performance in Cavity Preparation: A Pilot Study.

Background The transition from theoretical knowledge to clinical competency in operative dentistry is an ongoing challenge in dental education. Undergraduate students often face a significant gap between understanding theory and applying practical skills for diagnosing and preparing cavities, which leads to decreased confidence, increased stress, and potential errors in clinical practice. Case-based learning (CBL), an active learning strategy that emphasizes real-world scenarios, has shown promise for improving clinical skills and knowledge retention in other healthcare disciplines. This pilot study explored the potential of CBL to address the theory-practice gap and enhance confidence among undergraduate dental students in performing cavity preparations. Methods This pilot study utilized a pre and post-intervention design and involved 30 second-year dental students. Participants completed confidence surveys at three points: before CBL activity, immediately after CBL activity, and following their first clinical cavity preparation procedure. The CBL activity consisted of two components: interactive case discussions and hands-on laboratory exercises designed to simulate real-world dental procedures. The interactive discussions focused on diagnostic and treatment planningwhile laboratory exercises provided practical experience in cavity preparation. Data were analyzed using repeated-measures analysis of variance (ANOVA) to assess the changes in confidence levels across the three survey points. Results CBL significantly increased students' confidence across multiple dimensions (p < 0.05). Confidence in modifying cavity preparations increased from a mean of 2.91 (SD = 0.292) before CBL to 5.12 (SD = 0.331) post-CBL and further to 5.52 (SD = 0.556) after clinical practice. Similarly, confidence in understanding the basic concepts of caries removal improved from 4.82 (SD = 0.528) pre-CBL to 5.45 (SD = 0.564) post-CBL, and to 5.61 (SD = 0.556) post-clinic. However, confidence in performing cavity preparations without faculty guidance remained relatively low, increasing from a baseline mean of 2.67 (SD = 0.478) to 2.91 (SD = 0.384) post-CBL and 3.64 (SD = 0.603) post-clinic. Conclusion Incorporating CBL into the curriculum can significantly improve undergraduate students' confidence in performing cavity preparation. This approach may help bridge the theory-practice gap and better prepare students for the clinical environment. This pilot study provides promising initial data, and further research is needed to determine the long-term impact of CBL and the optimal implementation strategies.

S14 Physical activity promotion in healthcare settings: Designing and implementing physical activity referral schemes

Abstract Purpose This symposium will share findings, expertise and experiences from different countries on the design and implementation of physical activity referral schemes (PARS). Description Physical activity promotion by healthcare professionals is a key strategy to increase population physical activity levels. This strategy has been outlined in the World Health Organisation’s (WHO) ‘Global Action Plan on Physical Activity’ (GAPPA) and the ‘Physical activity strategy for the WHO European Region 2016-2025‘. PARS are a promising intervention that allow healthcare professionals to advocate for physical activity and integrate its promotion into routine clinical care. PARS are a heterogeneous group of interventions. Simpler PARS, for example, may consist only of a written description, while more complex PARS might include different healthcare professionals working together systematically, applying several behaviour change techniques in combination with physical activity practice, to connect patients to community resources. There is currently no consensus on the optimal PARS approach and implementation strategies. Implementers need specific knowledge, skills and methods; however, implementation is also influenced by structural and context-related factors in the healthcare system. Accordingly, a successful implementation of PARS needs co-productive capacity building within healthcare systems and proper support for healthcare professionals. The symposium includes four contributions (3 research-oriented and 1 practise-oriented) related to the design and implementation of PARS in different countries. 1) EUPAP Feasibility Study. Practice transfer of a HEPA prescription model to other nine EU countries. From theory to practice. Sebastià Mas-Alòs 2) The association of physical activity referral scheme’ components with physical activity level, scheme uptake and adherence rates: a systematic review, meta-analysis with meta-regression. Wolfgang Geidl 3) The adoption and implementation of a physical activity referral pathway integrated into a major U.S. health system. Mark Stoutenberg 4) Designing a physical activity pathway in healthcare model for Irish Health Services. Sarah O’Brien This symposium will provide guidance on the development of PARS and future successful implementation in other healthcare settings.

Strategies for Implementing GlobalConsent to Prevent Sexual Violence in University Men (SCALE): study protocol for a national implementation trial

BackgroundGlobally, women 15–24 years are at heightened risk of sexual violence victimization, a risk factor for adverse mental, physical, and behavioral health outcomes. Sexual violence is common at universities and most often perpetrated by men, yet few evidence-based prevention strategies targeting men have been tested in low- and middle-income countries. GlobalConsent is a six-module, web-based educational program adapted from an efficacious U.S.-based program. Nine months post-treatment in a randomized trial in Vietnam, GlobalConsent reduced men’s sexually violent behavior (odds ratio [OR] = 0.71, 95%CI 0.50–1.00) and increased prosocial intervening behavior (OR = 1.51, 1.00–2.28) relative to an attention-control. Evidence regarding optimal implementation strategies for scale up is needed.MethodsWe will randomize six medical universities in North, Central, and South Vietnam to deliver GlobalConsent using two different packages of implementation strategies that vary in intensity. Higher-intensity strategies will include greater (1) pre- and post-implementation engagement with university leaders and faculty and (2) greater pre-implementation outreach, follow-up, and incentives for students to promote engagement and completion of GlobalConsent. Higher intensity universities will receive additional training and support for their added activities. We will compare implementation drivers and outcomes, intervention effectiveness, and cost-effectiveness across the two implementation bundles. Our mixed-methods comparative interrupted time series design includes (1) qualitative interviews and quantitative surveys with university leaders and implementation teams to assess implementation barriers and facilitators; (2) repeated surveys with leaders and faculty, implementation teams, and male students to assess multilevel implementation drivers and outcomes; (3) repeated surveys with male students to assess behavioral outcomes (sexual violence and intervening behavior) and mediating variables (knowledge, attitudes, affect, and capacities); and (4) time diaries and cost tracking to assess cost-effectiveness of the two implementation-strategies bundles.DiscussionThis project is the first to assess packages of implementation strategies to deliver an efficacious web-based sexual violence prevention program for undergraduate men across all regions of Vietnam and synergizes with a violence-prevention training initiative (D43TW012188). This approach will produce rigorous evidence about how to disseminate GlobalConsent nationally, which holds promise to reduce gender-based health inequities linked to sexual violence as GlobalConsent is brought to scale.Trial registrationNCT06443541. Retrospectively registered with ClinicalTrials.gov. Registered on June 05, 2024.

Identification of implementation enhancement strategies for national comprehensive care standards using the CFIR-ERIC approach: a qualitative study

BackgroundComprehensive care is important for ensuring patients receive coordinated delivery of healthcare that aligns with their needs and preferences. While comprehensive care programs are recognised as beneficial, optimal implementation strategies in the real world remain unclear. This study utilises existing implementation theory to investigate barriers and enablers to implementing the Australian National Safety and Quality Health Service Standard 5 - Comprehensive Care Standard in acute care hospitals. The aim is to develop implementation enhancement strategies for work with comprehensive care standards in acute care.MethodsFree text data from 256 survey participants, who were care professionals working in acute care hospitals across Australia, were coded using the Consolidated Framework for Implementation Research (CFIR) using deductive content analysis. Codes were then converted to barrier and enabler statements and themes using inductive theme analysis approach. Subsequently, CFIR barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) using the CFIR-ERIC Matching Tool, facilitating the development of implementation enhancement strategies.ResultsTwelve (n = 12) CFIR barriers and 10 enablers were identified, with 14 barrier statements condensed into 12 themes and 11 enabler statements streamlined into 10 themes. Common themes of barriers include impact of COVID-19 pandemic; heavy workload; staff shortage, lack of skilled staff and high staff turnover; poorly integrated documentation system; staff lacking availability, capability, and motivation; lack of resources; lack of education and training; culture of nursing dependency; competing priorities; absence of tailored straties; insufficient planning and adjustment; and lack of multidisciplinary collaboration. Common themes of enablers include leadership from CCS committees and working groups; integrated documentation systems; established communication channels; access to education, training and information; available resources; culture of patient-centeredness; consumer representation on committees and working groups; engaging consumers in implementation and in care planning and delivery; implementing changes incrementally with a well-defined plan; and regularly collecting and discussing feedback. Following the mapping of CFIR enablers and barriers to the ERIC tool, 15 enhancement strategies were identified.ConclusionThis study identified barriers, enablers, and recommended strategies associated with implementing a national standard for comprehensive care in Australian acute care hospitals. Understanding and addressing these challenges and strategies is not only crucial for the Australian healthcare landscape but also holds significance for the broader international community that is striving to advance comprehensive care.

Unraveling Calcium Absorption and Distribution in Peach and Nectarine during Fruit Development through 44Ca Isotope Labeling.

Calcium foliar applications are known to effectively enhance peach quality; however, the optimal implementation strategy regarding fruit developmental stages and cultivars remains unclear. In this study, three different moments of fruit Ca applications in peach and nectarine are tested: Early season, Mid-season, and Late season. For this aim, the 44Ca isotope was used as a tracer, enabling the quantification and location of the Ca derived from the foliar fertilizer. Stone, flesh, and skin 44Ca enrichment was separately analyzed at harvest. The results indicate that Ca absorption in the fruits from external CaCl2 applications was influenced by the timing of the application during fruit development, with Late-season applications proving to be the most effective in increasing the Ca content in the fruit, corresponding with a higher fruit size at the application moment. Nevertheless, no differences in the absorption efficiency were found between the three timings of the application. Furthermore, the Ca from the foliar fertilizer in the fruit predominately remained in the flesh, followed by the skin. The Ca derived from the foliar fertilizer reached the stone in all of the experimental situations, but the Early- and Mid-season applications resulted in the highest amount of Ca derived from the fertilizer in this part of the fruit. Interestingly, the peach exhibited a higher Ca absorption efficiency compared to the nectarine, likely due to the presence of trichomes that retain the foliar fertilizer on the fruit surface. In conclusion, the Ca absorption and distribution in peaches depends on the cultivar and timing of the Ca application.

Cost-effectiveness of group medical visits and microfinance interventions versus usual care to manage hypertension in Kenya: a secondary modelling analysis of data from the Bridging Income Generation with Group Integrated Care (BIGPIC) trial

The Bridging Income Generation with Group Integrated Care (BIGPIC) trial in rural Kenya showed that integrating usual care with group medical visits or microfinance interventions reduced systolic blood pressure and cardiovascular risk in participants. We aimed to estimate the incremental cost-effectiveness of three BIGPIC interventions for a modelled cohort and by sex, as well as the cost of implementing these interventions. For this analysis, we used data collected during the BIGPIC trial, a four-group, cluster-randomised trial conducted in the western Kenyan catchment area of the Academic Model Providing Access to Healthcare. BIGPIC enrolled participants from 24 rural health facilities in rural western Kenya aged 35 years or older with either increased blood pressure or diabetes. Participants were assigned to receive either usual care, group medical visits, microfinance, or a combination of group medical visits and microfinance (GMV-MF). Our model estimated the incremental cost-effectiveness of the three BIGPIC interventions via seven health states (ie, a hypertensive state, five chronic cardiovascular-disease states, and a death state) by simulating transitions between health states for a hypothetical cohort of individuals with hypertension on the basis of QRISK3 scores. In every cycle, participants accrued costs and disability-adjusted life-years (DALYs) associated with their health state. Incremental cost-effectiveness ratios (ICERs) were calculated for the entire modelled cohort and by sex by dividing the incremental cost by the incremental effectiveness of the next most expensive intervention. The main outcome of this analysis was ICERs for each intervention evaluated. This analysis is registered at ClinicalTrials.gov (NCT02501746). Between Feb 6, 2017, and Dec 29, 2019, 2890 people were recruited to the BIGPIC trial. 2020 (69·9%) of 2890 participants were female and 870 (30·1%) were male. At baseline, mean QRISK3 score was 11·5 (95% CI 11·1-11·9) for the trial population, 11·9 (11·5-12·2) for male participants, and 11·3 (11·0-11·6) for female participants. For the population of Kenya, group medical visits were estimated to cost US$7 more per individual than usual care and result in 0·005 more DALYs averted (ICER $1455 per DALY averted). Microfinance was estimated to cost $19 more than group medical visits but was only estimated to avert 0·001 more DALYs. Relative to group medical visits, GMV-MF was estimated to cost $29 more and avert 0·009 more DALYs ($3235 per DALY averted). Relative to usual care, GMV-MF was estimated to cost $37 more and avert 0·014 more DALYs ($2601 per DALY averted). In the first year of the intervention, usual care was estimated to be the least expensive intervention to implement ($87 per participant; $10 238 per health-facility catchment area [HFCA]), then group medical visits ($99 per participant; $12 268 per HFCA), then microfinance ($120 per participant; $14 172 per HFCA), with GMV-MF estimated to be the most expensive intervention to implement ($139 per participant; $16 913 per HFCA). Group medical visits and GMV-MF were estimated to be cost-effective strategies to improve blood-pressure control in rural Kenya. However, which intervention to pursue depends on resource availability. Policy makers should consider these factors, in addition to sex differences in programme effectiveness, when selecting optimal implementation strategies. US National Institutes of Health.

A framework of workplace yoga for expectant mothers: Acomprehensive review of benefits, safety considerations, and future perspectives.

This review explores the benefits of yoga during pregnancy and considers its implications for working pregnant women, focusing on safety, future directions, and limitations. The physical and psychological changes experienced during pregnancy can lead to increased stress and discomfort, impacting both maternal and fetal health, which may be further augmented by work stress during pregnancy. To address these challenges, various interventions such as yoga, relaxation techniques, and meditation have been proposed. Although there is evidence to support the benefits of yoga at both physical and psychological levels, there is a lack of proper strategies and guidelines for the implications of these interventions among working pregnant women. Incorporating yoga as a safe and cost-effective intervention for managing work-related distress during pregnancy can have significant benefits for both maternal and fetal health. However, careful consideration of safety guidelines, further research on working pregnant women, and exploring optimal implementation strategies are essential to fully harness the potential of yoga in this context. This review aims to provide a comprehensive overview of the current evidence for the benefits and safety of yoga during pregnancy, with a specific focus on working pregnant women. To ensure the scientific rigor of this review, we conducted a systematic search of the PubMed database for high-quality research studies published in peer-reviewed journals.

Role of informal sector to combat unemployment in developing economy: A modeling study

In developing countries, informal sector is the primary job provider for a significant portion of the workforce. This study aims to analyze how jobs in the informal sector affect the unemployment dynamics of developing nations. To achieve this goal, we formulate a nonlinear mathematical model by categorizing the considered workforce into three distinct classes: unemployed, employed, and self-employed, and include a separate dynamic variable to represent vacancies within the informal sector. The proposed model is analyzed using the qualitative theory of dynamical systems. A threshold quantity known as the reproduction number is derived and using this, one can compute the job generation rate necessary to stabilize the system. It is observed that variations in the reproduction number lead to qualitative changes, such as transcritical (forward or backward) and saddle-node bifurcations in the formulated system. Moreover, we propose an optimal control problem to determine an optimal strategy for government policy implementation in enhancing the employment rate of unemployed individuals and promoting the self-employment of informal employees inside the informal sector. Further, the analytical findings are validated numerically. The obtained results suggest that promoting the self-employment of informal employees for job generation effectively reduces unemployment.

Nurse-led sequential multiple assignment randomized trial of nudging intervention for early antiretroviral therapy initiation among patients with HIV/AIDS: Implementation study protocol.

In China, more than 30% of patients have not initiated treatment within 30 days of HIV diagnosis. Delayed initiation has a detrimental influence on disease outcomes and increases HIV transmission. The study aims to evaluate the effectiveness of a nurse-led antiretroviral therapy initiation nudging intervention for people newly diagnosed with HIV in China to find the optimal intervention implementation strategy. A Hybrid Type II sequential multiple assignment randomized trial will be conducted at four Centers for Disease Control and Prevention in Hunan, China. This study will recruit 447 people newly diagnosed with HIV aged ≥18 years and randomly assign them into two intervention groups and one control group. On top of the regular counselling services and referrals, intervention groups will receive a 4-week, 2-phase intervention based on the dual-system theory and the nudge theory. The control group will follow the currently recommended referral procedures. The primary outcomes are whether treatment is initiated, as well as the length of time it takes. The study outcomes will be measured at the baseline, day 15, day 30, week 12, week 24 and week 48. Generalized estimating equations and survival analysis will be used to compare effectiveness and explore factors associated with antiretroviral therapy initiation. Both qualitative and quantitative information will be collected to assess implementation outcomes. Existing strategies mostly target institutional-level factors, with little consideration given to patients' decision-making. To close this gap, we aim to develop an effective theory-driven nudging strategy to improve early ART initiation. This nurse-led study will help to prevent delayed initiation by employing implementation science strategies for people newly diagnosed with HIV. This study contributes to the United Nations' objective of ending the AIDS pandemic by 2030. Chinese Clinical Trial Registry ChiCTR2300070140. The trial was prospectively registered before the first participant was recruited. The nudging intervention was finalized through the Nominal Group Technique where we invited five experts in the related field and five people living with HIV to participate.