Planning Delivery Research Articles

Assessment of automated non-coplanar stereotactic radiosurgery planning in single isocenteric linac-based treatment for brain metastases with respect to planner's experience.

One of the reasons for planning heterogeneity is lack of enough experience and recommendations on the quality of Linac-based stereotactic radiosurgery (SRS). In this study, our goal is to investigate the impact of planner's experience on the quality of Linac-based SRS plans for brain metastases (BMs) with varying levels of complexity. Specifically, to assess the impact of experience on the outcome of an automated noncoplanar treatment planning. A cohort of 120 patients with intracranial SRS plans, with a total of 633 BMs, was examined using VMAT delivery calculated with an available automated plan delivery system. Four planners with different levels of experience, ranging from under 1 year to over 5 years (Expert planner) of SRS planning, generated treatment plans. Dosimetric parameters and plan quality metrics were evaluated including: conformality index, homogeneity index, modulation factor, R50%, total volume of brain receiving 12Gy, 6Gy, and 3Gy (V12Gy, V6Gy, V3Gy) were assessed for each plan and compared with plan which was created by an expert planner with the highest planning experience. Experienced planners consistently produced acceptable plans, while less experienced one required revisions. Single BM cases showed minimal deviations in dosimetric parameters (under 10%) irrespective of planner experience. However, as the number and complexity of BMs increased, differences in plan quality became more pronounced. Moreover, expert planner's plans consistently outperformed others in terms of organs at risk sparing. This difference was particularly pronounced for cases involving the volume of healthy brain tissue. Our study underscores the critical role of planner's experience in the quality of Linac-based SRS plans using an automated planning. By standardizing and enhancing the planning process, the study aims to improve the quality of care for patients with multiple BMs, contributing to more efficient and effective treatments in the field of SRS.

Feasibility of HIV self-test implementation among Mizo youths: a field investigation from Northeast India bordering Myanmar

IntroductionThis study investigated the potential of HIV self-test (HIVST) to reach individuals who otherwise might not access testing or antiretroviral therapy (ART). The study had two main objectives: (a) to develop an HIV self-test implementation plan based on the findings from qualitative inquiries with local stakeholders and (b) to examine HIVST uptake among youths in the urban setting of Aizawl district in Mizoram.MethodologyIn the first phase, qualitative in-depth interviews (IDI) were conducted with HIV program officials, religious leaders, community influencers, youths, and key population groups. These inquiries guided the planning of strategic communication, community engagement, HIVST delivery, and linkages with HIV confirmatory testing services in phase two. Factors associated with the non-uptake of HIV confirmatory tests by youths following HIVST were analyzed quantitatively. Additionally, secondary data collected from attendees of the “Integrated Counselling and Testing Centre” (ICTC) were also analyzed.ResultsThe in-depth interviews underscored the need to introduce HIVST among Mizo youths. The respondents emphasized the importance of diverse outreach approaches and communication strategies, including the use of social media platforms, as critical components for successful HIVST implementation. They also provided valuable insights on the optimal locations and methods for making HIVST kits accessible. Among the youths who used HIVST, the majority were first-time testers (1,772/2,101; 84.3%). Those diagnosed with an undiagnosed HIV infection were started on ART. The preference for the blood-based HIVST format (1,162/2101; 55%) was noted to be slightly higher than the saliva-based format. Confirmatory test uptake was significantly higher among those with sero-reactive HIVST results (χ2 23.89; p < 0.001). Factors independently associated with (adjusted odds ratio; AOR with 95% CI) “no-show for HIV confirmatory tests,” which hold significant programmatic implications, included “age > 20 years (1.47; 1.18–1.82),” “gender (men)” (1.25; 1.01–1.55), “education below 10th standard” (5.16; 2.66–10.01), “no prior HIV testing experience” (2.12; 1.61–2.81), and “unwillingness to undergo HIV confirmatory testing” (2.85; 2.05–3.96). Individuals who opted for the blood-based HIVST were 23% less likely (AOR 0.77; 95% CI; 0.62–0.96) to drop out of the HIV confirmatory testing process. Additionally, only 1% of respondents perceived HIVST as having self-harm potential.ConclusionSustained community engagement, effective networking with HIV program officials, and strategic communication were three critical pillars supporting the successful implementation of HIVST. There was a significant increase in HIVST uptake among young first-time testers.

Standardized Note Template Expedites Completion of Consults for Surgical Fetal Anomalies.

We developed standardized electronic medical record templates (EMR-temp) for use in ambulatory prenatal surgical consultations for surgical fetal anomalies (SFAs). Our aim was to evaluate EMR-temp impact in provider documentation in prenatal care of SFA. Prenatal consultations for SFAs at a single institution were retrospectively reviewed (2019-2022). Disease-specific EMR-templates were developed. Note content and time to encounter closure (TEC) were collected. Descriptive statistics, chi-square, Fisher's Exact Test, and Wilcoxon rank sum tests were used. Seven hundred twenty-four prenatal consultations were analyzed, with 131 consultations (18%) using EMR-temp for 55 (42%) congenital diaphragmatic hernia, 50 (38%) congenital lung malformations, 9 (7%) neural tube defects, 8 (6%) gastroschisis, and 9 (7%) heterotaxy. Overall median TEC was 23.9hs [interquartile range (IQR) 1.3-128.6]. EMR-temp use decreases TEC from 28.4hs [IQR 1.6-159.4] to 2.07hs [IQR 0.85-76.2] (P<0.001). The impact of EMR-temp varies depending on pathology. In congenital diaphragmatic hernia, EMR-temp decreased TEC 61%, from 52.0 [IQR 2.6-171.1] to 20.3hs [IQR 1.5-55.5] (P=0.01). In neural tube defect, EMR-temp decreased TEC 98% from 48.6 [IQR 2.6-157.1] to 1.02hs [IQR 0.5-1.5] (P<0.001). There were no differences in TEC with EMR-temp use in congenital lung malformation, gastroschisis and heterotaxy (P>0.05). Across all diseases, EMR-temp had more comprehensive documentation of the following content: pathophysiology (92%), pregnancy planning (92%), delivery planning (84%), postnatal planning (95%), and long-term follow-up (90%) compared to nontemplates (P<0.01). EMR templates in SFA consultations improves encounter closure with comprehensive documentation of disease-specific pathophysiology and plans. However, impact varies across pathology, suggesting other factors are also important.

Multi-site blinded validation of a deep learning approach for clinical-grade MSI/dMMR detection in colorectal cancer from H&amp;E-stained pathology images.

44 Background: Testing for microsatellite instability (MSI) or mismatch repair deficiency (dMMR) is part of the diagnosis and clinical management of patients with colorectal cancer (CRC). Healthcare services recommend MSI or dMMR testing for all CRC patients to guide therapeutic choices and assist in identifying Lynch Syndrome. However, in clinical practice, high costs and the demand for timely test results, combined with the rising prevalence of CRC and a shrinking pathology workforce, present a barrier to universal adoption. This highlights the need for rapid and affordable alternatives. PANProfiler CRC (PPC) is a deep learning-based solution for detecting MSI/dMMR in CRC tumors that only requires whole slide images (WSIs) of haematoxylin and eosin (H&amp;E)-stained tissue to provide test results. Using only WSIs, PPC offers an efficient alternative to standard testing. This study evaluates PPC's performance in a multi-site blinded setting. Methods: Blinded validation was performed using 3246 WSIs of H&amp;E-stained CRC specimens. PPC provided outputs as "Stable", "Unstable", or "Indeterminate", with "Unstable" indicating dMMR or MSI-High, and "Stable" indicating proficient mismatch repair or non-MSI-High. "Indeterminate" was returned when PPC did not have a definitive result. PPC was evaluated by comparison to standard MSI/dMMR tests. Validation data spanned three cohorts from two sites (Table). St James’s University Hospital (SJUH), Leeds, UK, supplied Cohorts 1 and 2; Cohort 3 was sourced from Wales Cancer Biobank (WCB), UK. Blinded analysis was performed at SJUH. Results: Results are given (Table). PPC demonstrated an overall percent agreement of 93.91%, a positive percent agreement of 92.17%, and a negative percent agreement of 94.15%, returning a definitive result for 88.05% of WSIs. Conclusions: This real-world, multi-site, blinded validation study demonstrates PPC’s remarkable performance, comparable to standard tests for detecting MSI/dMMR in CRC, with high test replacement rates. In the clinical setting, PPC could significantly accelerate testing and enable timely delivery of stratified treatment plans. This accurate and cost-effective diagnostic solution promises to revolutionize MSI/dMMR testing in CRC. Blinded validation results of PPC with confidence intervals (CI) at 95%. Site Cohort Sample Size (Unstable; Stable) Overall Percent Agreement % (CI) Positive Percent Agreement % (CI) Negative Percent Agreement %(CI) Test Replacement Rate % SJUH 1 488 (78; 410) 92.79 (89.86-95.08) 90.16 (79.81-96.30) 93.24(90.11-95.62) 85.25 SJUH 2 2704 (318; 2386) 94.31(93.31-95.21) 92.31(88.48-95.18) 94.57(93.52-95.50) 88.42 WCB 3 54 (11; 43) 84.31 (71.41-92.98) 100.00(71.51-100.00) 80.00(64.35-90.95) 94.44 All 3246 (407; 2839) 93.91 (92.97-94.76) 92.17(88.82-94.78) 94.15(93.16-95.04) 88.05

Public Service Provisions for Land Resource Planning

This study explored the intricate nexus between public service provision and land use planning, specifically focusing on the conservation of local plant species in Tambon Khao Phanom, Amphoe Khao Phanom, Krabi Province. The research aimed to explore, understand, and analyze Thailand's land use resources, planning, and implementation. This study employed a multi-method research approach to gather an exhaustive set of data and insights. The researcher collected data from documentation research and secondary data sources in this research study. Based on the grounded theory, this research adopts the triangulation method. The data analysis was done using the 5P model and strengths, weaknesses, threats, and opportunities. This multidisciplinary approach integrates the one-map method with the Sustainable Development Goals (SDGs). The findings depict the lack of adequate implementation of government policies and awareness among the landholders, which are required for sustainable community development. This study underscores the critical synergy between public service delivery and land use planning, highlighting their collective potential to advance community well-being and sustainable development. Doi: 10.28991/ESJ-2025-09-01-021 Full Text: PDF

First dosimetric evaluation of clinical raster-scanned proton, helium and carbon ion treatment plan delivery during simultaneous real-time magnetic resonance imaging

First dosimetric evaluation of clinical raster-scanned proton, helium and carbon ion treatment plan delivery during simultaneous real-time magnetic resonance imaging

The Relationship Between Teachers' Planning and Content Delivery Using the Five‐Stage Lesson Plan Structure: An Analysis of Age, Gender, Experience and Academic Qualifications in Kenya

ABSTRACTEffective instruction is vital for quality education in Kenya, with learners' success mainly dependent on structured methods like the five‐stage lesson plan (5‐SLP). Nonetheless, the effectiveness of instruction may differ depending on the demographic and professional attributes of the teachers. Although the value of planning for content delivery is well acknowledged, there is limited information on how teachers' characteristics (age, gender, experience and academic qualification) influence their planning and content delivery. Thus, this study examined the relationship between teachers' planning and content delivery through the 5SLP, focusing on their characteristics. A sample of 226 CRE teachers was analysed using an observation checklist and a semi‐structured questionnaire. The impact of gender, age, experience and academic qualification on teachers' planning and content delivery was investigated in the study using multivariate analysis of variance (MANOVA) and tests of between‐subjects effects. Results indicated that age significantly affects both planning and content delivery (p = 0.003, p = 0.002, p = 0.000), while gender, experience and educational qualifications did not show a substantial impact. Nevertheless, significant combined effects were observed between age and gender (p = 0.010), gender and experience (p = 0.045), age and experience (p = 0.004) and age and academic qualification (p = 0.016). Furthermore, tests of between‐subjects effects indicated significant interactions among age, academic qualifications and experience (p = 0.039, p = 0.016, p = 0.004) affecting content delivery. The study findings recommended a policy on the need for customised training programmes that consider these complex interactions to enhance instructional effectiveness. Generally, the study contributes to understanding how demographics influence educational practices, offering valuable insights for improving teacher preparation and professional development.

Neobladder saving caesarean section in a pregnant woman with congenital bladder exstrophy.

To propose an obstetric management model for patients with congenital bladder exstrophy (BE) and multiple previous surgeries, recognizing the unique anatomical variations of each patient and emphasizing the importance of personalized treatment approaches. We present the obstetric management and delivery of a 32-year-old pregnant woman with congenital BE, focusing on antenatal anatomical assessment, accurate delivery planning and key surgical steps during an elective caesarean section. Additionally, we conduct a comprehensive review of the current literature to enhance understanding of the reproductive implications associated with this exceptionally rare condition. Following urological magnetic resonance imaging and intraoperative ultrasound, a successful neobladder-saving caesarean section was performed at 37weeks, resulting in the delivery of a healthy infant with no maternal complications. Obstetric management in women with congenital BE presents unique challenges due to its significant impact on urinary and reproductive functions. Careful delivery planning and antenatal anatomical assessment are crucial for optimizing both maternal and fetal outcomes. A personalized, multidisciplinary approach can help minimize potential complications.

Standards-Based Teaching and Learning in a Catholic School: Benchmarking from the Standards of Quality in Basic Education

Amidst the crises faced by the Philippine educational system, several reform movements promote standards-based teaching and learning. This descriptive-comparative study determined if differences exist in the extent of implementation of standards-based teaching and learning in a senior high school program of a private university. The study utilized 46 teachers and a stratified random sample of 227 students who completed a modified research questionnaire. Mean, standard deviation, and one-way analysis of variance were employed in data analyses. The findings revealed excellent implementation as assessed by teachers and very good implementation as assessed by students. Further, significant differences were found in the extent of implementation when students were grouped according to strand, but no significant difference when teachers were grouped according to teaching experiences and educational qualifications. The findings of the study will be the basis for the formulation of the Content, Delivery, and Assessment (CDA) Plan.

Artificial Intelligence in Fetal Growth Restriction Management: A Narrative Review.

This narrative review examines the integration of Artificial Intelligence (AI) in prenatal care, particularly in managing pregnancies complicated by Fetal Growth Restriction (FGR). AI provides a transformative approach to diagnosing and monitoring FGR by leveraging advanced machine-learning algorithms and extensive data analysis. Automated fetal biometry using AI has demonstrated significant precision in identifying fetal structures, while predictive models analyzing Doppler indices and maternal characteristics improve the reliability of adverse outcome predictions. AI has enabled early detection and stratification of FGR risk, facilitating targeted monitoring strategies and individualized delivery plans, potentially improving neonatal outcomes. For instance, studies have shown enhancements in detecting placental insufficiency-related abnormalities when AI tools are integrated with traditional ultrasound techniques. This review also explores challenges such as algorithm bias, ethical considerations, and data standardization, underscoring the importance of global accessibility and regulatory frameworks to ensure equitable implementation. The potential of AI to revolutionize prenatal care highlights the urgent need for further clinical validation and interdisciplinary collaboration.

Addressing System Challenges in Mental Health Services Research for Youth in the Child Welfare System: Insights From the Foster Care Family Navigator Trial

ABSTRACTChild welfare‐involved (CWI) youth have high rates of unaddressed mental health needs, and system‐level barriers (e.g., inadequate coordination between child welfare agencies and other systems designed to serve CWI youth) are one major reason why disparities in mental health services' access continue to persist for CWI youth. This Research Note aims to inform the mental health services field about system‐level challenges to conducting real‐world, health services research with CWI youth and their families. We present challenges experienced in conducting our NIMH‐funded Foster Care Family Navigator (FCFN) trial focused on development and preliminary testing of a clinic‐embedded navigation intervention designed to improve detection of foster care youth services need, linkage to and engagement in community‐based mental health services. Systems‐level challenges that impacted proposed research trial design and data collection included: (1) Limited system staff time and compensation processes; (2) Staff training and knowledge; and (3) System disruptions. Health services research geared toward increasing access to mental health services to CWI youth must incorporate multiple complex design considerations prior to intervention development and delivery including longer (than 12 months) intervention development phases, detailed contingency plans for intervention delivery and integrated tailored, ongoing support and training for staff with existing clinic workflows. In this way, structural challenges to access to care that researchers are trying to ameliorate for CWI and other underserved, minoritized populations are not being inadvertently perpetuated through research study designs.

Validity of one-time phantomless patient-specific quality assurance in proton therapy with regard to the reproducibility of beam delivery.

Patient-specific quality assurance (PSQA) is a crucial yet resource-intensive task in proton therapy, requiring special equipment, expertise and additional beam time. Machine delivery log files contain information about energy, position and monitor units (MU) of all delivered spots, allowing a reconstruction of the applied dose. This raises the prospect of phantomless, log file-based QA (LFQA) as an automated replacement of current phantom-based solutions, provided that such an approach guarantees a comparable level of safety. To retrieve a reliable LFQA conclusion from a one-time plan delivery before treatment initiation, deviations between planned and logged parameters must either be persistent over all following treatment fractions or, in case of random fluctuations, must not have a relevant impact on the reconstructed dose distribution. We therefore investigated the reproducibility of log file parameters over multiple patient treatment fractions and compared the reconstructed dose distributions. Log file variability was examined at both spot parameter and integral dose levels. The log files of 14 patient treatment plans were analyzed retrospectively for a total of 339 delivered fractions. From the recorded x/y position and MU parameters per spot, the respective mean difference to the planned value (accuracy) and the standard deviation (reproducibility) were calculated for 108,610 planned spots. The dose distributions reconstructed from the log files of each fraction were evaluated against the planned fraction dose using 3D gamma index analysis. The dose-based gamma pass rate was correlated with a new spot-based log file pass rate . Beam timing information from the log files was used to quantify the total plan/field delivery time stability after excluding machine interlocks. The mean spot-wise accuracy with respect to distance from planned positions and MUs was (0.6±0.3)mm and (0.0001±0.0023) MU, respectively. The mean reproducibility of the observed single spot deviations was (0.2±0.1) mm and (0.0004±0.0004) MU (mean±standard deviation). These variations resulted in minimal changes in the reconstructed fraction dose with (2mm/2%)>99% for all studied fractions. Results for more sensitive criteria (1mm/1%) were plan-specific, but on average>92.6% per plan and correlated with (1mm) pass rates (0.51≤rPearson≤0.99). Field delivery times were reproducible within±4 s (2σ) and no treatment interruptions were observed in 92.8% of cases. The log file records of plan-relevant spot parameters are well-reproducible over multiple fractions and deviations have no dosimetrically relevant impact on the reconstructed fraction doses. Results of a one-time pre-treatment LFQA are considered as valid for the entire treatment course and there is no concern in this regard to replace state-of-the-art phantom measurements in the current PSQA workflow.

An Exploration of Continuous Quality Improvement Approaches within the Texas Quality Rating and Improvement System

ABSTRACT This study explored the use of continuous quality improvement (CQI) approaches in the Texas quality rating and improvement system (QRIS), Texas Rising Star. CQI approaches can assist child programs with engaging in quality improvement support and lift the quality of early learning programs to serve young children. We applied an implementation science-based fidelity monitoring framework as we analyzed secondary data from 1,789 child care programs using an online platform, survey data from mentors (n = 97), directors (n = 562), and teachers (n = 211), focus group transcripts (12 focus groups with 48 participants), and data from CQI plans (n = 173). Research Findings: Key findings from the study showed variability in how CQI was implemented across early learning programs, but generally showed (1) opportunities to differentiate delivery of CQI plans with lower star rated programs, (2) promising levels of engagement and participation within the CQI approach, and (3) positive director and teacher perceptions of the CQI approach. Practice or Policy: Study findings suggest that CQI approaches within QRIS may be a useful way to provide differentiated quality improvement support to early learning programs.

Developing an automatic treatment record review system for quality assurance of patient treatment delivery in radiation therapy

Background and purposeTreatment record contains most of information related to treatment plan delivery in radiation therapy. Reviewing treatment record is an important quality assurance (QA) task for safety and quality of patient treatments. This task is usually performed by senior medical physicists. However, it is time-consuming, tedious, and error-prone. To assist this process, a treatment record review system (TRRS) is developed to automatically review items related to treatment delivery record.MethodsThe treatment record is firstly extracted from oncology information system (OIS). Based on the daily patient treatment information, the original plan from the treatment planning system is identified. Then the original plan and the delivered plan are correlated. Eight review categories (parameter consistency, treatment completeness, treatment progression, image guidance, override, treatment couch, documentation, and treatment mode) are created. Tailored rules are designed for various review items to automate the review process. As a result, for each daily treatment record, a reviewed flag (pass, failure, warning, and N/A) is assigned by the TRRS. Finally, this system is evaluated by 6 months patient treatment records collected in our institute and compared to the manual process on the same data.ResultsTRRS processed a total of 76,651 treatment fractions from 4230 patients with an average of 574 treatments per day. The percentage of the detected anomalies among the total records was 0.76%. The average processing time was 3.9 s and 282 s per treatment record for the automatic and manual processes, respectively. Comparing with the manual process, the time efficiency of TRRS is improved by a factor of 72. The average numbers of anomalies detected by the automatic and manual processes are 21 and 13 per day, respectively. TRRS detects 61.5% more anomalies than those of the manual process.ConclusionTRRS is not only efficient in processing a large amount of treatment records on a daily basis but also effective in finding more anomalies than those of physics weekly check. The application of the TRRS could significantly reduce the workload of the review physicists and let them focus on more important works related to patient safety.

The Effect of Provider-Related Factors on Healthcare Utilization in the Upper East Region of Ghana: The Mediating Role of Marketing Strategies

This study investigates the mediating role of marketing strategies on the relationships between healthcare provider-related factors and patients' healthcare utilization. Adopting a descriptive cross-sectional quantitative design, the study utilizes a survey method to collect responses from 322 sampled healthcare professionals, using simple random sampling from a population of 1980 who work in public clinics and Community Health Planning Services (CHPS). The theory underpinning this study is the Andersen Behavioural Model of Health Service Utilization. Structural Equation Modelling technique was adopted to analyze and test the hypotheses. The study revealed that provider-related factors significantly and positively influenced healthcare utilization (β = 0.355, t = 3.406, p &lt; 0.001). Furthermore, provider-related factors also had a direct and positive relationship with marketing strategies (β = 0.534, t = 7.283, p = 0.000). Marketing strategies also significantly and positively influenced healthcare utilization (β = 0.432, t = 5.366, p = 0.000). Conversely, the moderating influence of provider-related factors on the relationship between marketing strategies and healthcare utilization was significant (β = 0.456, t = 4.892, p = 0.000). The study concludes that marketing strategies mediate the relationship between provider-related factors and healthcare utilization. Thus, it is recommended that integrating marketing strategies into health planning and healthcare delivery by managers of health institutions can strengthen and facilitate health promotion and education.

The implementation of safer drug consumption facilities in Scotland: a mixed methods needs assessment and feasibility study for the city of Edinburgh

BackgroundScotland currently has amongst the highest rates of drug-related deaths in Europe, leading to increased advocacy for safer drug consumption facilities (SDCFs) to be piloted in the country. In response to concerns about drug-related harms in Edinburgh, elected officials have considered introducing SDCFs in the city. This paper presents key findings from a feasibility study commissioned by City of Edinburgh Council to support these deliberations.MethodsUsing a multi-method needs assessment approach, we carried out a spatial and temporal analysis of drug-related data in Edinburgh including health, mortality, consumption, crime and service provision indicators; and 48 interviews including 22 people with lived/living experience (PWLE) of drug use in the city, five family members affected by drug-related harms, and 21 professional stakeholders likely to be involved in commissioning or delivering SDCFs. Data were collected using a convergent parallel design. We carried out a descriptive analysis of quantitative date and a thematic analysis of qualitative data. Quantitative data provides an overview of the local context in terms of recorded harms, service provision and consumption patterns as reported in prior surveys. Qualitative PWLE and families data captures the lived experiences of people who use drugs, and affected loved ones, within that local context, including perceived consumption trends, views on the practicality of SDCF provision, and hopes and anxieties regarding potential service provision. Professional stakeholders data provides insights into how people responsible for strategic planning and service delivery view the potential role of SDCF provision within the context described in the quantitative data.ResultsIn Edinburgh, drug-related harms and consumption patterns are dispersed across multiple locations, with some areas of higher concentration. Reported levels of opioid use, illicit benzodiazepine use and cocaine injecting are high. Qualitative interviews revealed strong support for the provision of SDCFs, and a preference for services that include peer delivery. However, PWLE also expressed concerns regarding safety and security, and professional stakeholders remained uncertain as to the prioritisation of facilities and possible opportunity costs in the face of restricted budgets.ConclusionThere is a strong case for the provision of SDCFs in Edinburgh. However, service design needs to reflect spatial distributions of consumption and harm, patterns of consumption by drug type, and expressed preferences for both informality and security among potential service users. Models of SDCF provision used elsewhere in Scotland would therefore need to be adapted to reflect such considerations. These findings may apply more broadly to potential SDCF provision in the UK and internationally, given changing patterns of use and harm.

Maternal and Fetal Complications in Pregnant Women with Neurofibromatosis Type 1: Literature Review and Two Case Reports.

Neurofibromatosis is a genetic disorder arising de novo or with an autosomal dominant transmission that typically presents either at birth or in early childhood, manifesting through distinctive clinical features such as multiple café-au-lait spots, benign tumors in the skin, bone enlargement, and deformities. This literature review aims to resume the spectrum of maternal and fetal complications encountered in pregnant women with neurofibromatosis type 1 (NF1). Thorough research was conducted on databases such as Web of Science, PubMed, Science Direct, Google Scholar, and Wiley Online Library. This review includes 48 case reports, original studies, and reviews on NF1 in pregnancy. The research on the interlink between NF1 and fertility and its influence on human-assisted reproduction techniques is limited. Preimplantation testing (by in vitro fertilization) and prenatal diagnosis (by chorionic villus sampling or amniocentesis) are available to detect affected fetuses. However, genotype-phenotype correlation is difficult to predict. Preconceptional planning and targeted investigations are crucial in understanding the extent of maternal disease. Although in some cases lesions can evolve rapidly during pregnancy, most pregnancies and births in NF1 go well with careful planning. There is a higher incidence of pheochromocytomas and pre-eclampsia, vascular rupture, and cardio-respiratory issues. Anesthesia at birth is a challenge in most cases, and before offering spinal anesthesia, imaging tests should be performed to characterize spinal lesions. General anesthesia may also be challenging when the disease affects the face, neck, upper spine, or airways. Birth-related difficulties may arise because of large neurofibromas located at the level of skin incision or birth canal; uterine atony may be expected if there are uterine lesions. Some complications can develop in postpartum, and affected women should be carefully followed even after pregnancy. Fetal risks include preterm birth (spontaneous or iatrogenic), growth restriction and developmental issues, birth complications, cardiovascular risk, and fetal/neonatal demise. Pregnancies in women with NF1 should be regarded as high-risk and followed in a multidisciplinary fashion. Careful assessment of lesions is of utmost importance before and during pregnancy for anticipating potential maternal risks and before birth to plan anesthesia and delivery.

Distribution and determinants of the utilization of senior residential care homes in Saudi Arabia: a cross-sectional study.

With the accelerated increase in the population of seniors aged 60 years or older in Saudi Arabia, understanding the utilization of senior residential care homes is crucial for improving service delivery and policy planning to meet the care transformation objectives of Vision 2030. To assess the distribution and determinants of senior residential care home utilization across Saudi Arabia's 13 administrative regions, focusing on predictors of functional dependency among different socio-demographic groups. This study analyzed data from 283 Saudi individuals aged ≥65 admitted to social residential care homes in 2021. Variables included age, sex, education level, marital status, region, and reasons for service use. Statistical analyses comprised descriptive statistics, chi-square tests, independent t-tests, and multivariable logistic regression. The Makkah region had the highest number of senior residential care home users (56.8%; p < 0.0001). Most participants were men (67.8%), while women constituted 32.2%. The mean age was 78.9 years (SD = 10.6), with women being significantly older than men (p = 0.014). Illiteracy was prevalent (73.5%), particularly among women (82.4% vs. 69.3% for men; p = 0.006). Most participants were divorced (68.2%), with higher rates among men (84.9% vs. 33% for women; p < 0.0001). The primary reasons for utilizing residential care home services were old age and functional dependency (88.5% of men and 83.4% of women). Multivariable logistic regression indicated that being in the age group 75-84 years (odds ratio [OR] = 1.62, 95% confidence interval [CI] = 1.02-1.81, p < 0.001), 85 years and above (OR = 2.63, 95% CI = 1.28-3.11, p < 0.001), and being single (OR = 2.43, 95% CI = 1.14-5.13, p = 0.019) were significant predictors of old age and functional dependency. The study highlights regional and socio-demographic variations in senior residential care home service utilization in Saudi Arabia, emphasizing the need for targeted interventions and policies aligned with Saudi Arabia's Vision 2030 to enhance service accessibility and effectiveness for the aging population.

Uncovering the Life Experiences Being Fathers of Children With Cerebral Palsy.

This research aims to uncover the life experiences of fathers of children with Cerebral Palsy (CP) in Indonesia. This study utilized a descriptive phenomenological approach. Nine fathers of young children and adolescents with CP were purposively recruited and were interviewed in-depth between June and August 2023. Data were analysed by using Giorgi's descriptive phenomenological approach. Our study identified three main themes: uncovering the meaning of being a father, expectations and hope for children's growing up, and the challenges of being a father. These themes were further divided into 10 sub-themes. Our research suggests that fathers consider having a disabled child as a gift and a test from God, and they hold specific meanings about being a father that gives them strength. Fathers are responsible for taking care of their children and not neglecting them. They have expectations and hopes for their children to become independent and successful, with the skills needed to make a living. Fathers face many challenges, such as dividing their time between work and family and figuring out how to stimulate their children's motor skills. The research indicates that involving fathers in caring for children, particularly those with CP, has significant implications for program planning and service delivery. Therefore, professionals should integrate fathers' role in planning and delivering services for childcare.

Cardiac magnetic resonance impacts pregnancy delivery plans: A case series

Cardiac magnetic resonance impacts pregnancy delivery plans: A case series