Parallel Design Research Articles

Stress management training program to address caregiver burden and perceived stress among family caregivers of patients undergoing hemodialysis: a randomized controlled trial study

BackgroundThe objective of the current study was to assess the effectiveness of stress management training, grounded in Lazarus and Folkman’s stress management model, on reducing caregiving burden and perceived stress among family caregivers of patients on hemodialysis.MethodsThis two-group clinical trial study was conducted in parallel design among 60 family caregivers of patients on hemodialysis in 2023. The participants were divided into two groups of training and control using a random quadruple block allocation method. The intervention took place over two months, in six online group sessions of 35–45 min. Zarit Burden Inventory (ZBI) and Cohen’s Perceived Stress Scale (PSS-14) were used to collect information before and two weeks after the intervention. The study data were analyzed using and analysis of covariance (ANCOVA), pair, and independent t-tests at a significance level of 0.05.ResultsAt baseline, the two groups exhibited homogeneity in terms of mean scores for caregiving burden (Training group = 50.8 ± 4.9; Control group = 49.1 ± 6.0; P = 0.264) and perceived stress (Training group = 32.8 ± 4.7; Control group = 31.5 ± 2.4; P = 0.192). Nevertheless, following the intervention, there was a significant decrease in caregiving burden (Training group = 45.9 ± 4.1; Control group = 49.0 ± 5.8; P = 0.017) and perceived stress (Training group = 28.0 ± 4.4; Control group = 30.7 ± 3.5; P = 0.01) scores within the training group compared to the control group.ConclusionBased on the findings of the current study, given that family caregivers of patients on hemodialysis encounter psychological distress and contend with the negative aspects of care, it is advisable to implement psycho-educational interventions, such as stress management training. Incorporating these interventions into the care plan for hemodialysis could help mitigate these adverse consequences and provide valuable support for family caregivers.Trial registrationIranian Registry of Clinical Trials (IRCT), IRCT20180728040617N6. Registered on 17/04/2023.

Livelihood Resilience Strategies to Climate Variability among Pastoralists in Longido District, Tanzania

This paper assessed the level of livelihood strategies practiced by Maasai pastoralists in Longido district, Tanzania. It focused on their resilience to climate variability. The main question that this sought to address was: How resilient are livelihood strategies to climate change and variability among the Maasai pastoralists in response to climate variability? This study employed the resilient theory by Holling and the DFID Livelihood Framework. The study used a mixed-method design, also known as a convergent parallel design. A multistage sampling technique was used to purposefully select wards, then villages, and then a simple random selection of the 373 households for the survey. This study purposively selected 21 key informants from traditional leaders, ward and village leaders, NGO officials, and livestock officers. While data gathered through interviews, observation and focus group discussions was analysed qualitatively. Data obtained through questionnaires was analysed quantitatively using IBM SPSS (version 20). The chi-square was used to test the association of the variables. Findings revealed that key strategies such as mobility, communal pooling, causal labour, livestock management, and others. Also, the role of education and sources of income were crucial in shaping resilience strategies. Household with more education were more likely to have reliable resilience strategies. The main challenge faced by Maasai pastoralists in building climate resilience strategies is increased variability in climate, in the form of frequent drought and unreliable rainfall. This paper recommends more efforts to understand and support these communities by blending their traditional strategies with technical ones for sustainable livelihoods

Refining and expanding accountability policy for English learners to support Lau implementation: A critical policy analysis

ABSTRACT Title I accountability requirements under the Every Student Succeeds Act (ESSA) represent the present-day instantiation of Lau, which requires schools to provide a program for English learners (ELs) that supports their meaningful engagement and to provide transparent information about EL program quality. This study uses critical policy analysis to explore whether ESSA accomplishes what it intends. Employing a parallel mixed methods design, we first analyze longitudinal data from two states to examine whether their approaches to assessing EL students’ academic performance and progress support valid claims about EL achievement. Then, we analyze focus group and interview data from educators, advocates, and families in states to understand how they assess the quality of a school’s EL program. Taken together, our findings highlight the need for the incorporation of multiple perspectives into the design of state accountability systems and for the development of robust data systems that facilitate the sharing of accurate and nuanced information related to EL student outcomes and opportunities.

Postoperative analgesic effectiveness of ultrasound-guided bilateral erector spinae plane block vs. rectus sheath block for midline abdominal surgery in a low- and middle-income country: a randomised controlled trial.

The use of erector spinae plane block and rectus sheath block for postoperative analgesia in midline abdominal procedures is becoming more common. However, the most effective and appropriate method remains unclear. We aimed to compare the postoperative analgesic effecacy of ultrasound-guided bilateral erector spinae plane blocks with rectus sheath blocks for midline abdominal surgery in a low- and middle-income country. We allocated randomly 72 patients aged 18-65 y undergoing midline abdominal surgery to an erector spinae plane block (n = 36) or a rectus sheath block (n = 36) utilising a prospective, parallel study design. Patients, care providers and outcome assessors were blinded to the interventions. The primary outcome measures were total postoperative analgesia consumption, postoperative pain severity and time to first rescue analgesic administration. Secondary outcomes included the incidence of postoperative complications and adverse events. Of 78 patients assessed for eligibility, six were excluded, leaving 72 for analysis. Patients allocated to erector spinae plane block had a lower mean (SD) postoperative opioid consumption compared with those allocated to rectus sheath block (3.5 (8.7) morphine milligram equivalents vs. 8.2 (2.8) morphine milligram equivalents, respectively; p = 0.003). Time to first analgesic request was greater in patients allocated to erector spinae plane block compared with those allocated to rectus sheath block (mean (95%CI) 16 (13-17) h vs. 12 (11-13) h, respectively; p < 0.001). There were no block-related complications in either group. Erector spinae plane blocks are more effective than rectus sheath blocks for the management of postoperative pain following midline abdominal surgery. Integration of erector spinae plane blocks into multimodal opioid-sparing analgesic strategies after midline abdominal surgeries may promote enhanced patient recovery in low-and middle-income countries.

Oxytocin moderates fMRI connectivity and response to implicit threat processing in cocaine use disorder

Stressful social experiences play an important role in increasing vulnerability to substance use, including cocaine. Oxytocin (OXT), known for its anxiolytic properties and involvement in social functioning, has been suggested as a potential therapeutic for cocaine use disorder (CUD). However, limited research has explored OXT’s influence on social stress in CUD, and no study has examined its effects on neural response to subconscious (implicit) social threat cues in this population. To address this gap, the present study administered intranasal OXT (24 IU) or placebo (PBO) to participants with CUD (CUD+, N = 76) or without CUD (CUD-, N = 61) in a randomized parallel design. Participants then completed a functional magnetic resonance imaging (fMRI) task involving briefly presented facial fear and anger (i.e., threat) cues, followed by neutral face stimuli. Whole-brain activation and amygdala functional connectivity (using psychophysiological interaction modeling) were examined in response to the facial threat cues. OXT reduced activation in the thalamus and pontine reticular formation in response to fear cues, and in the supplementary motor area for both fear and anger cues, regardless of CUD status. Additionally, under PBO, amygdala-medial prefrontal cortex connectivity to fear stimuli was negative for the CUD+ group, but under OXT, this coupling was positive, similar to the positive coupling observed for the CUD- group under both PBO and OXT administration. The finding of OXT-mediated reversal of amygdala-prefrontal coupling was specific to CUD+ and suggests that OXT alters circuitry related to threat surveillance and implicit emotion regulation in CUD. However, additional research is needed to determine whether these alterations due to OXT have clinical significance in CUD.

MixUNETR: A U-shaped network based on W-MSA and depth-wise convolution with channel and spatial interactions for zonal prostate segmentation in MRI

Magnetic resonance imaging (MRI) plays a pivotal role in diagnosing and staging prostate cancer. Precise delineation of the peripheral zone (PZ) and transition zone (TZ) within prostate MRI is essential for accurate diagnosis and subsequent artificial intelligence-driven analysis. However, existing segmentation methods are limited by ambiguous boundaries, shape variations and texture complexities between PZ and TZ. Moreover, they suffer from inadequate modeling capabilities and limited receptive fields. To address these challenges, we propose a Enhanced MixFormer, which integrates window-based multi-head self-attention (W-MSA) and depth-wise convolution with parallel design and cross-branch bidirectional interaction. We further introduce MixUNETR, which use multiple Enhanced MixFormers as encoder to extract features from both PZ and TZ in prostate MRI. This augmentation effectively enlarges the receptive field and enhances the modeling capability of W-MSA, ultimately improving the extraction of both global and local feature information from PZ and TZ, thereby addressing mis-segmentation and challenges in delineating boundaries between them. Extensive experiments were conducted, comparing MixUNETR with several state-of-the-art methods on the Prostate158, ProstateX public datasets and private dataset. The results consistently demonstrate the accuracy and robustness of MixUNETR in MRI prostate segmentation. Our code of methods is available at https://github.com/skyous779/MixUNETR.git.

Improving student engagement with a flipped classroom instruction model in Ethiopian higher education institutions: The case of Mattu University.

Currently, the flipped classroom instruction model has received greater attention for its multifaceted advantages in improving student learning by boosting learning environments. To this end, a flipped classroom model was employed in the current study with the purpose of increasing student engagement across all three dimensions-behavioral, emotional, and cognitive. To look at the improvement observed as a result of this model, this study used a mixed-methods design, mainly a convergent parallel design. In the present study, fifty-five students from two distinct academic departments participated. In addition, the instructors of the courses that were chosen to be taught using a flipped classroom model were also participants in this study. The study employed focus groups, interviews, self-report surveys, and classroom observation strategies to gather the necessary data. The quantitative data were analyzed using descriptive aggregate means and paired sampling t-tests, while the qualitative data were analyzed using a thematic data analysis approach. The findings revealed that a flipped classroom greatly improved each of the three dimensions of student engagement. Moreover, the findings showed that the instruction model improved student engagement by creating learning environments where students could participate actively in class activities, interact more effectively with teachers and other students as well as with learning resources, and acquire the necessary knowledge from the courses. Future research may employ a large sample size with a sufficient time frame to make the findings more applicable to different educational institutions.

Cervical Spine Vibration Modifies Oculomotor Function in Young Adults with Traumatic Brain Injury

ObjectiveThe purpose of this study was to investigate if vibrational interference of spinal proprioception affects oculomotor function, visual attention and processing, and selective attention in individuals with mild traumatic brain injury (mTBI) compared to healthy age-matched controls. MethodsThis study was a parallel design, single-session intervention with 20 young adults with mTBI and 20 age-matched controls. Each completed a battery of computerized eye-tracking assessments (CEAs), including egocentric localization, fixational stability, smooth pursuit, saccades, Stroop, and the vestibulo-ocular reflex (VOR), and then had their cervical spine function (flexion-relaxation ratio) recorded at baseline. Spinal vibration (100 Hz) was applied to the cervical spine and the CEA battery was repeated. CEA outcomes were compared to baseline and between mTBI and control groups. ResultsFollowing cervical vibration, significant pre to post-differences were seen in both the mTBI and control group for egocentric localization, fixation stability, pursuit, saccades, Stroop, and VOR. At baseline, there was a significant difference between the mTBI and control groups across many CEA measures, with the mTBI group performing more poorly in egocentric localization, pursuit, saccades, Stroop, and VOR. The mTBI group also had a poorer flexion-relaxation ratio than the control group. ConclusionCervical spine vibration improved cognitive and oculomotor performance in the mTBI group for VOR, Stroop, and pursuit, but had mixed effects on the control group. These findings suggest that some optometric mTBI symptoms may result from spinal or proprioceptive dysfunction, as altering proprioceptive input appears to positively impact visual outcomes.

Population Pharmacokinetic Modeling and Simulation for Dose Optimization of GB-5001, a Long-Acting Intramuscular Injection of Donepezil, in Healthy Participants.

GB-5001 is an intramuscular (IM) formulation of donepezil under development for the treatment of Alzheimer's disease. The objective of this study was to develop a population pharmacokinetic (PK) model for donepezil in both IM and oral formulations, and to optimize the IM dosage of GB-5001 using bioequivalence (BE) simulation. A population PK model of donepezil was developed using NONMEM. It was based on plasma concentration data from a Phase 1 dose escalation study, which involved a single administration of donepezil IM formulation at doses of 70, 140, and 280mg, and the oral formulation at 10mg. The model was evaluated based on goodness-of-fit plots, conditional weighted residuals, visual predictive checks, and bootstrapping. BE simulations were conducted using a parallel design between various doses of the IM formulation and the 10-mg dose of oral formulation. The PKs of donepezil were best described by a two-compartment model, which incorporated distinct absorption compartments for the IM (dual first-order absorption and simultaneous zero-order absorption with lag time) and oral (first-order absorption with lag time) formulations. Based on the simulation results, an IM dosage range of 210-215 mg in a sample size of over 92 was estimated to achieve a success rate of approximately 80% for BE. The population PK model well explained the PKs of donepezil following administration of both the IM and oral formulations. This model could be applied for the design and dose selection of future BE trials. ClinicalTrials.gov identifier, NCT05525780.

The effects of AG1® supplementation on the gut microbiome of healthy adults: a randomized, double-blind, placebo-controlled clinical trial.

This study aimed to examine the effect of a commercially available multi-ingredient powder (AG1Ⓡ) on the gut microbiome and assess the impact of AG1Ⓡ on GI tolerability and other clinical safety markers in healthy men and women. Using a double-blind, randomized, two-arm, placebo-controlled, parallel design, we examined a 4-week daily supplementation regimen of AG1Ⓡ vs. placebo (PL). Fifteen men and 15 women provided stool samples for microbiome analysis, questionnaires for digestive quality of life (DQLQ), and completed visual analog scales (VAS) and Bristol stool charts to assess stool consistency and bowel frequency before and after the 4-week intervention. Participant's blood work (CBC, CMP, and lipid panel) was also assessed before and after the 4-week intervention. Alpha diversity was determined by Shannon and Chao1 index scores and evaluated by a two-way ANOVA, beta diversity in taxonomic abundances and functional pathways was visualized using partial least squares-discriminant analyses and statistically evaluated by PERMANOVA. To identify key biomarkers, specific feature differences in taxonomic relative abundance and normalized functional pathway counts were analyzed by linear discriminant analysis (LDA) effect size (LEfSe). Questionnaires, clinical safety markers, and hemodynamics were evaluated by mixed factorial ANOVAs with repeated measures. This study was registered on clinicaltrials.gov (NCT06181214). AG1Ⓡ supplementation enriched two probiotic taxa (Lactobacillus acidophilus and Bifidobacterium bifidum) that likely stem from the probiotics species that exist in the product, as well as L. lactis CH_LC01 and Acetatifactor sp900066565 ASM1486575v1 while reducing Clostridium sp000435835. Regarding community function, AG1Ⓡ showed an enrichment of two functional pathways while diminishing none. Alternatively, the PL enriched six, but diminished five functional pathways. Neither treatment negatively impacted the digestive quality of life via DQLQ, bowel frequency via VAS, or stool consistency via VAS and Bristol. However, there may have been a greater improvement in the DQLQ score (+62.5%, p = 0.058, d = 0.73) after four weeks of AG1Ⓡ supplementation compared to a reduction (-50%) in PL. Furthermore, AG1Ⓡ did not significantly alter clinical safety markers following supplementation providing evidence for its safety profile. AG1Ⓡ can be consumed safely by healthy adults over four weeks with a potential beneficial impact in their digestive symptom quality of life.

Effect of physical activity on social communication impairments in children with autism spectrum disorder: A meta-analysis

This meta-analysis aims to systematically evaluate if different physical activities (PA) improve the social communication impairments (SCI) seen in children with autism spectrum disorder (ASD). For this meta-analysis, five databases (Web of Science, PubMed and Cochrane Library database in English, and CNKI and Wanfang Data Knowledge Service Platform in Chinese) were searched from database inception to September 11, 2024. The eligibility criteria included (1) study population comprised children with ASD, with no gender restriction; (2) experimental group consisted of a PA intervention; (3) control group consisted of nonPA interventions or routine activities; (4) outcomes were assessed using validated SCI scales (e.g., social cognition, social motivation, and/or social awareness); and (5) study design involved a randomized parallel group design. The quality of the evidence for each study was assessed using the Cochrane Risk of Bias tool. From a pool of 2714 potentially relevant articles, 17 were eligible for inclusion in this review. The results of overall response of PA intervention to SCI illustrated a Medium degree of statistical heterogeneity between studies (I2 = 53.3 %, p < 0.01); the effect size of PA intervention on SCI (expressed as standardized mean difference) was −0.34 (95 % CI: −0.57, −0.11), which was statistically significant. SCI of autistic children could be potentially improved by PA interventions, though further research is needed to clarify if benefits achieve clinical significance in addition to statistical significance. Proper design of PA interventions (45–90 min per session, more than 3 times per week and for 8–12 weeks) may enhance their effectiveness in treating SCI in children with ASD.

Helping Others Facilitates Well-Being for Indigenous Peoples Living With HIV/AIDS in Canada.

Research has found that helping others facilitates well-being for Indigenous peoples living with HIV and AIDS, but limited research exists that investigates the mechanism(s) underlying this relationship. Indigenous perspectives posit that helping others facilitates well-being through the development of an individual's spiritual, physical, emotional, and mental aspects (four aspects). Similarly, self-determination theory posits that helping others facilitates well-being by satisfying basic psychological needs. In the present study, we examined if helping others facilitates well-being through the fulfillment of the spiritual, physical, emotional, and mental aspects among Indigenous peoples living with HIV and AIDS. We used a convergent parallel mixed methods design, coupled with a community-engaged approach grounded in the United Nations Greater Involvement of People Living with HIV and AIDS principles and Indigenous and decolonizing research methodologies. Survey (n = 117) and interview data (n = 9) collected by an Indigenous-led HIV/AIDS organization in Canada were employed to examine the relationship between helping, the four aspects, and well-being. Participants were primarily First Nations leaders and mentors who live with HIV/AIDS, with some Métis and Inuit. A parallel multiple mediation model and reflexive thematic analysis were used to analyze the relationship between helping, the four aspects, and well-being. Mixed-methods findings support the idea that helping others promotes well-being by fulfilling the emotional and mental aspects. Qualitative findings demonstrated this relationship for all four aspects. This research may facilitate the development of programs to support Indigenous peoples living with HIV/AIDS well-being and contribute to the literature on integrating Indigenous perspectives and methodologies within psychological research.

Fostering TBL Success at Alfaisal University: A Complex Adaptive Systems Approach.

This study explores the implementation of Team-Based Learning (TBL) at Alfaisal University's College of Medicine through the lens of Complex Adaptive Systems (CAS) theory. The research question investigates how the application of CAS principles can enhance the implementation and effectiveness of TBL in medical education. The study employed a convergent parallel mixed methods longitudinal design, integrating quantitative performance metrics and qualitative themes. Quantitative analysis revealed modest improvements in individual and team-based learning scores, with a promising trend of students moving from the lower to the higher quartiles over time. Qualitative insights aligned with CAS principles, highlighting the adaptive implementation, emergent outcomes, self-organization, positive feedback loops, and depth of learning facilitated by TBL. The findings demonstrate the value of a CAS-informed approach in navigating the complexities of educational change and fostering a more resilient and adaptive educational model. The study contributes to the understanding of how CAS theory can guide the successful implementation of innovative pedagogies like TBL in medical education.

Differential effects of mindfulness treatment and mobile neurofeedback on event-related potentials in early posterior negativity in cancer patients: a clinical-experimental parallel group design.

Cancer frequently leads to psychological challenges, among them emotion regulation problems. These can be alleviated with the help of mindfulness therapies or neurofeedback (NF) interventions. Possible intervention effects on emotion procession can be detected in clinical EEG studies by exploring event-related potentials, e.g., early posterior negativity (EPN), which recently has been established to investigate emotional processing and represents very early attention to affective stimuli. Therefore, this clinical-experimental study investigated the efficacy of mindfulness and NF (10 sessions each) on the EPN in oncology patients. The study enrolled 42 cancer patients (age: 31-73 years; gender: 28 female, 14 male). The study design was an RCT with a parallel group [NF (n = 21) versus mindfulness (n = 21)] waitlist paradigm. EEG recordings in an oddball task with neutral, rare positive and negative valence and high and low arousal stimuli were performed at three measurement time points (T0 = before waitlist, T1 = before intervention, T2 = after intervention). Following preprocessing, data from electrodes O1, Oz and O2 were analyzed for EPN amplitudes. Response time did not differ across groups and conditions. Comparing EPN at T1 and T2, there was a significant interaction of time, valence, and intervention (p = 0.042). Descriptive statistics showed increased EPN for negative stimuli after the NF intervention (T1 to T2), while EPN for positive stimuli only slightly increased. For mindfulness, positive stimuli evoked stronger amplitudes after the intervention, while EPN for negative stimuli increased from T1 to T2. Distinct effects were observed for the EPN for pictures with negative valence. Here, it is presumed that mindfulness treatment led to a refocusing of attention with a focus on positive valence, whereas NF seems to entail a different processing of images with negative valence and is therefore to be seen more in the sense of a confrontational approach. Our results suggest that both interventions are suitable for modulating EPN. However, it is not clear to what extent the effects are due to the interventions alone and how other factors might have affected the amplitudes, which highlights the need for further research in this area.

A Preliminary Sentiment Analysis on Digital Barriers among Senior Citizens During Covid-19 Pandemic

Nowadays, digital technology has been an important element in assisting the community in their daily routine. During the COVID-19 era, The Special Committee for Ensuring Access to COVID-19 Vaccine Supply (JKJAV) has been initiated to assist the health and well-being of Malaysian citizens in recovering from the COVID-19 pandemic. MySejahtera, a healthcare application technology, has been used by Malaysian citizens for seeking vaccination information as well as updating their health status. While there are benefits to using the application, there is still a challenge in using the technology among senior citizens. This study aims to investigate digital barriers to using a healthcare application, known as MySejahtera, among senior citizens in Kelantan. This study also reveals lessons learned regarding the use of technology among senior citizens during the Covid-19 era. Convergent parallel mixed method research design is initiated to produce a sentiment analysis for identifying digital barriers issues and challenges among senior citizens in Kelantan. 5 respondents aged from 60 to 80 years old were interviewed to obtain their sentiments on using digital technology for vaccination information and Covid-19 news. This study highlights issues namely awareness of knowledge, misconception about digital technology, information quality and technology usage among the senior citizens in Kelantan. This study summarizes that there is a need to reduce digital barriers among senior citizens to ensure digital inclusion for their benefit in health and well-being.

Parallel Implementation of the CCSDS Turbo Decoder on GPU

This paper presents a software turbo decoder on graphics processing units (GPU). Unlike previous works, the proposed decoding architecture for turbo codes mainly focuses on the Consultative Committee for Space Data Systems (CCSDS) standard. However, the information frame lengths of the CCSDS turbo codes are not suitable for flexible sub-frame parallelism design. To mitigate this issue, we propose a padding method that inserts several bits before the information frame header. To obtain low-latency performance and high resource utilization, two-level intra-frame parallelisms and an efficient data structure are considered. The presented Max-Log-Map decoder can be adopted to decode the Long Term Evolution (LTE) turbo codes with only small modifications. The proposed CCSDS turbo decoder at 10 iterations on NVIDIA RTX3070 achieves about 150 Mbps and 50 Mbps throughputs for the code rates 1/6 and 1/2, respectively.

Effect of a simulation game on nursing students’ reflective thinking skills: a mixed methods study

BackgroundThis study aimed to investigate the effect of a simulation game called “The Ward” on reflective thinking skills of senior nursing students.MethodsA convergent mixed methods parallel research design was conducted between February-April 2018. The sample for this study was a convenience sample (n = 23) of senior nursing students. Student Information Form, Reflective Thinking Scale and a structured interview form were used as data collection tools. During study, simulation game was played once a week for seven weeks. Descriptive statistics (frequency, percentage, mean) were used for analyzing data, t test for dependent groups tests were applied to determine differences within group and qualitative data was analyzed with content analysis.ResultsAfter playing the simulation game, nursing students’ reflective thinking scores (pre-test = 39.70 ± 5.15; post-test = 67.39 ± 8.13) increased significantly (p < 0.05). It was found students noticed their shortcomings and mislearnings by comparing their existing knowledge in setting of teamwork and cooperation created by the game, and consequently students’ motivation increased or decreased. The teamwork and collaboration created with in the simulation game caused students to gain self-confidence, to expand their perspectives, to develop effective decision-making skills, to increase their motivation, to discover their own incomplete knowledge, skills or mislearnings.ConclusionsThese results support that the simulation games can be used to improve reflective thinking level of students. This finding shows that nursing education curriculum needs to be restructured using new methods such as simulation games aimed at improving students’ reflective thinking skills. In this direction nurse educators should be involved with policy making and policy makers to develop strategies to ensure that graduated nursing students should gain reflective thinking skills. In addition nurse executives should encourage using simulation and simulation games in service training to improve nurses’ reflective thinking skills and life long learning.

Remote monitoring to improve low adherence in non-invasive ventilation: a protocol for a randomised controlled clinical trial (READ-NIV trial).

Obstructive sleep apnoea (OSA) is the most common sleep-related breathing disorder. Non-invasive ventilation (NIV) is essential for managing hypercapnic respiratory failure in patients with obesity hypoventilation syndrome (OHS) and those with co-existing OSA, where continuous positive airway pressure (CPAP) alone is insufficient. However, adherence to NIV can be challenging, with substantial non-compliance occurring due to factors such as discomfort and phobia. The objective of this protocol is to assess the improvement of adherence to NIV remotely monitored, as well as to record symptom control and long-term clinical outcomes, and to optimise healthcare resource usage. This is a prospective, randomised, and controlled (usual care) trial with a two-arm parallel group design, testing remote monitoring of home NIV (T4P device, SRETT, Paris, France) for 3 months in patients with OSA/OHS who have previously had low NIV adherence (<4 hours/night). This project has been approved by the research ethics committee/Health Research Authority (HRA) [Integrated Research Application System (IRAS) ID: 270108], as well as by Guy's & St Thomas' NHS Foundation Trust R&D Department. Outcomes will be compared between the intervention and the control group (NIV with vs. without remote monitoring). The trial will also assess suitability of the outcome parameters, and test whether the data collection, symptom questionnaires, and used healthcare resources are suitable to describe the impact on patient-related outcomes. This study is registered at ClinicalTrials.gov (NCT04884165).

Interprofessional Collaboration and Patient/Family Engagement on Rounds in a Comprehensive Stroke Center: A Mixed-Methods Study

Background and Objectives: Daily rounds provide an opportunity for interprofessional collaboration and patient/family engagement, which are critical to stroke care. As part of a quality improvement program, we conducted a baseline assessment to examine interprofessional collaboration and patient/family engagement during the current rounding process in a 12-bed comprehensive stroke center. Findings from the baseline assessment will be used to inform the development, implementation, and evaluation of a new rounding model. Methods: The baseline assessment used a mixed-methods approach with a convergent parallel design. Although observations of the current rounding process were conducted to quantitatively assess interprofessional collaboration and patient/family engagement on rounds, qualitative interviews were conducted with different stakeholders to identify strengths and weaknesses of the current rounding process, as well as suggestions for facilitating interprofessional collaboration and patient/family engagement. Results: We observed 103 table rounds and 99 bedside rounds and conducted 30 interviews with patients, families, and clinicians. Although the current process was perceived to facilitate interprofessional collaboration, the participation of nurses and other health care professionals on rounds was inconsistent due to competing clinical duties. Good practices for engaging patients and families during bedside rounds were also performed inconsistently. Conclusions: These findings lead to recommendations for revising the rounding process with poststroke patients, utilizing a more interprofessional collaborative approach with focus on patient/family engagement.

Parallelization of Curved Inertial Microfluidic Channels to Increase the Throughput of Simultaneous Microparticle Separation and Washing

The rising global need for clean water highlights the importance of efficient sample preparation methods to separate and wash various contaminants such as microparticles. Microfluidic methods for these purposes have emerged but they mostly deliver either separation or washing, with very low throughputs. Here, we investigate parallelization of a curved-channel particle separation and washing device in order to increase its throughput for sample preparation. A curved microchannel applies inertial forces to focus larger 10 µm microparticles at the inner wall of the channel and separate them from smaller 5 µm microparticles at the outer wall. At the same time, Dean flow recirculation is used to exchange the carrier solution of the large microparticles to a clean buffer (washing). We increased the number of curved channels in a stepwise manner from two to four to eight channels in two different arraying designs, i.e., rectangular and polar arrays. We examined efficient separation of target 10 µm particles from 5 µm particles, while transferring the larger microparticles into a clean buffer. Dean flow recirculation studies demonstrated that the rectangular arrayed device performs better, providing solution exchange efficiencies of more than 96% on average as compared to 89% for the polar array device. Our 8-curve rectangular array device provided a particle separation efficiency of 98.93 ± 0.91%, while maintaining a sample purity of 92.83 ± 1.47% at a high working flow rate of 12.8 mL/min. Moreover, the target particles were transferred into a clean buffer with a solution exchange efficiency of 96.81 ± 0.54% in our 8-curve device. Compared to the literature, our in-plane parallelization design of curved microchannels resulted in a 13-fold increase in the working flow rate of the setup while maintaining a very high performance in particle separation and washing. Our microfluidic device offers the potential to enhance the throughput and the separation and washing efficiencies in applications for biological and environmental samples.