Primary Strategy Research Articles

Tobacco industry interference to undermine the development and implementation of graphic health warnings in Bangladesh

BackgroundIn Bangladesh, the 2013 Amendment of the Tobacco Control Act made graphic health warnings (GHWs) on the upper 50% of all tobacco packs obligatory. However, at the time of writing...

Enhancing wind power with permanent magnet synchronous generator control strategies

AbstractDue to the substantial rise in wind power generation, the direct-drive permanent magnet synchronous generator has emerged as a leading technology for efficient variable speed operation, meeting grid demands effectively. This paper presents a comparative analysis of control strategies for permanent magnet synchronous generator based wind turbine using real variable wind speed data from a 2 MW of Tetouan wind farm in Morocco. The proposed approach is based on evaluating two primary control strategies: the adaptive fuzzy-proportional-integral controller and the conventional proportional-integral controller aimed at enhancing the wind turbine's output power. The simulation performed on MATLAB-Simulink indicates that pitch control mechanisms play a crucial role in optimizing power generation, also demonstrating its ability to achieve satisfactory performance.

Long-term clinical outcomes of hypofractionated stereotactic radiotherapy using the CyberKnife robotic radiosurgery system for jugular foramen schwannomas.

Jugular foramen schwannomas (JFSs) are rarely seen, benign tumors with slow growth. Today, management options for JFSs include observation, surgery, and radiation. However, the optimal treatment strategy remains controversial. Stereotactic radiosurgery serves as a minimally invasive alternative or adjuvant therapeutic regimen of microsurgery. Gamma Knife radiosurgery is suitable for patients with JFS who have small- and medium-sized tumors and normal cranial nerve (CN) function. Hypofractionated stereotactic radiotherapy (HSRT) offers a potential radiobiological advantage and may result in better preservation of normal structures compared to single-fraction stereotactic radiosurgery. The aim of the article was to review the clinical and radiographic outcomes of patients with JFS who were treated using HSRT. The authors retrospectively analyzed 74 patients with JFS who received HSRT between January 2009 and January 2020 in the authors' center. Among them, 53 patients were newly diagnosed with JFS, 19 patients had a previous history of microsurgical resection, and the other 2 patients underwent CyberKnife because of tumor recurrence after Gamma Knife radiosurgery. A total of 73 patients had preexisting CN symptoms and signs. The median tumor volume was 14.8 cm3 (range 0.5-41.2 cm3), and most of them (70.3%) were ≥ 10 cm3. The radiation dose regimen was prescribed depending on the tumor size, and more fractions were used in larger tumors. The median margin doses prescribed were 18.2 Gy/2 fractions, 21.0 Gy/3 fractions, and 21.6 Gy/4 fractions. The median follow-up was 103 months (range 18-158 months). After treatment, 42 (56.8%) patients had tumor regression, 27 (36.5%) patients had stable tumors, and 5 (6.8%) experienced tumor progression. Among them, MRI revealed that 1 patient had a complete response. Three patients received surgery at a median of 25 months because of tumor progression. One patient underwent ventriculoperitoneal shunt insertion for hydrocephalus that developed after HSRT independent of tumor progression. The 5-year progression-free survival rate was 93.2%. Preexisting cranial neuropathies improved in 46 patients, remained stable in 14, and worsened in 14. HSRT proved to be a safe and effective primary or adjuvant treatment strategy for JFSs, although 14 patients (18.9%) experienced some degree of delayed symptomatic deterioration posttreatment. This therapeutic option was demonstrated to provide both excellent tumor control and improvement in CN function.

A Critical Analysis of Reading Comprehension Tactics: Theoretical and Educational Implications

The review paper addresses classroom and non-classroom reading comprehension strategies and their theoretical foundations. Reading techniques include critical analysis and reflection on text structure and content to expand vocabulary and help readers integrate new material with their past knowledge. Secondary sources were used to collect data such as books, journals, facts, reports, publications, and research papers. The study uses four primary reading strategies: core diversified tactics, cognitive techniques, socialist-affective tactics, and metacognitive ways to emphasise the learner instructional value. The study results focused on reading strategies that teachers and students’ value, which ones they ignore, and how educational directives and assessment influence these approaches to create collaborative and revolutionary teaching and learning. The findings of the research demonstrated that each of these techniques is provided owing to the fact that they all make use of orthographic identification and cognitive patterns to enhance memory and retention in order to connect new information with previously acquired knowledge in order to accomplish conceptual transformation.

The Impact of Deep Decarbonization Policy on the Level of Greenhouse Gas Emissions in the European Union

The Green Deal, a cornerstone of the European Union’s climate goals, sets out to achieve a substantial 55% reduction in greenhouse gas emissions by 2030 compared to 1990 levels. The EU’s decarbonization strategies revolve around three pivotal avenues. First, there is a focus on enhancing energy efficiency and decreasing the energy intensity of economies. Second, concerted efforts are made to diminish the reliance on fossil fuels, particularly within industrial sectors. Lastly, there is a deliberate push to augment the share of renewable energy sources in the final energy consumption mix. These measures collectively aim to propel the decarbonization of EU economies, establishing EU member countries as global leaders in implementing these transformative processes. This manuscript seeks to evaluate the efficacy of three primary decarbonization strategies adopted by EU economies, namely the enhancement in energy efficiency, the promotion of renewable energy consumption and the reduction in fossil fuel consumption. The objective is to discern which strategies wield a decisive influence in achieving decarbonization goals across EU countries. The analysis encompasses all 27 member states of the European Union, spanning from 1990 to 2022, with data sourced from reputable outlets, including Eurostat, Our World in Data and the Energy Institute. Research findings underscore that, in the realm of decarbonization policies, statistically significant impacts on carbon dioxide emission reduction are attributable to the strategies of improving energy efficiency and augmenting the share of renewables in energy consumption across almost all EU countries. Conversely, the strategy with the least impact, embraced by a minority of EU member states, revolves around diminishing the share of fossil fuels in primary energy consumption. This approach, while statistically less impactful, is intricately linked with transitioning the economies toward renewable energy sources, thus playing a contributory role in the broader decarbonization landscape. The uniqueness of this research lies not only in its discernment of overarching trends but also in its fervent advocacy for a comprehensive and adaptive approach to EU decarbonization policy. It underscores the enduring significance of prioritizing energy efficiency, endorsing the integration of renewable energy and acknowledging the distinctive dynamics inherent in diverse regions. The study accentuates the necessity for nuanced, region-specific strategies, challenging the conventional wisdom of a uniform approach to decarbonization. In doing so, it accentuates the critical importance of tailoring policies to the varied energy landscapes and transition strategies evident in different EU member states.

Plasma metabolites and risk of seven cancers: a two-sample Mendelian randomization study among European descendants

BackgroundWhile circulating metabolites have been increasingly linked to cancer risk, the causality underlying these associations remains largely uninterrogated.MethodsWe conducted a comprehensive 2-sample Mendelian randomization (MR) study to evaluate the potential causal relationship between 913 plasma metabolites and the risk of seven cancers among European-ancestry individuals. Data on variant-metabolite associations were obtained from a genome-wide association study (GWAS) of plasma metabolites among 14,296 subjects. Data on variant-cancer associations were gathered from large-scale GWAS consortia for breast (N = 266,081), colorectal (N = 185,616), lung (N = 85,716), ovarian (N = 63,347), prostate (N = 140,306), renal cell (N = 31,190), and testicular germ cell (N = 28,135) cancers. MR analyses were performed with the inverse variance-weighted (IVW) method as the primary strategy to identify significant associations at Bonferroni-corrected P < 0.05 for each cancer type separately. Significant associations were subjected to additional scrutiny via weighted median MR, Egger regression, MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO), and reverse MR analyses. Replication analyses were performed using an independent dataset from a plasma metabolite GWAS including 8,129 participants of European ancestry.ResultsWe identified 94 significant associations, suggesting putative causal associations between 66 distinct plasma metabolites and the risk of seven cancers. Remarkably, 68.2% (45) of these metabolites were each associated with the risk of a specific cancer. Among the 66 metabolites, O-methylcatechol sulfate and 4-vinylphenol sulfate demonstrated the most pronounced positive and negative associations with cancer risk, respectively. Genetically proxied plasma levels of these two metabolites were significantly associated with the risk of lung cancer and renal cell cancer, with an odds ratio and 95% confidence interval of 2.81 (2.33–3.37) and 0.49 (0.40–0.61), respectively. None of these 94 associations was biased by weak instruments, horizontal pleiotropy, or reverse causation. Further, 64 of these 94 were eligible for replication analyses, and 54 (84.4%) showed P < 0.05 with association patterns consistent with those shown in primary analyses.ConclusionsOur study unveils plausible causal relationships between 66 plasma metabolites and cancer risk, expanding our understanding of the role of circulating metabolites in cancer genetics and etiology. These findings hold promise for enhancing cancer risk assessment and prevention strategies, meriting further exploration.

Clinical practice guideline on bladder cancer (Part III)

AbstractBladder cancer (BC) has become a significantly prevalent disease in China, with an incidence rate of 5.80 per 100 000 in 2015, ranking it as the thirteenth most common type of cancer within the nation. This illness presents a serious public health concern, highlighting the imperative need to unify the standards for diagnosis and treatment to improve patient outcomes. The section of the clinical practice guideline in question is dedicated to addressing muscle‐invasive bladder cancer (MIBC) and metastatic BC. The primary treatment strategies for MIBC are well‐defined: preoperative (neoadjuvant) chemotherapy combined with radical cystectomy stands as the conventional treatment protocol. For patients with locally advanced MIBC, integrating systemic and local therapies is advocated to enhance treatment effectiveness. In cases of metastatic BC, the focus shifts to systemic treatment supplemented by supportive care measures. The guideline also succinctly presents the pros and cons of various urinary diversion surgeries, which are critical considerations following radical cystectomy. It provides an in‐depth exploration of the treatment modalities for metastatic urothelial carcinoma of the bladder. Additionally, this part delves into the integrated approach to treatment and the use of radiotherapy in bladder preservation for localized disease. Moreover, it offers a concise overview of the classification, diagnosis, and therapeutic approaches for nonurothelial carcinoma of the bladder. Lastly, this part emphasizes the importance of recommended posttreatment follow‐up for MIBC patients to ensure comprehensive and ongoing care management.

Energy Requirement of Wastewater Treatment Plants: Unleashing the Potential of Microalgae, Biogas and Solar Power for Sustainable Development

Sustainable energy legislation in the modern world is the primary strategy that has raised the benchmark for energy and environmental security globally. The rapid growth in the human population has led to rising energy needs, which are predicted to increase by at least 50% by 2030. Waste management and environmental pollution present the biggest challenge to developing countries. The improvement of energy efficiency while ensuring higher nutritional evacuation wastewater treatment plants (WWTPs) is a significant problem for many wastewater treatment plants. Some treatment techniques require high energy input, which makes them expensive to remediate water use. Pollutants like chemical pesticides, hydrocarbons, colorants (dyes), surfactants, and aromatic compounds are present in wastewater and are contributing to other problems. Israel consumes 10% of the global energy supply, significantly more than other countries. The lagoon and trickling filters are the most widely used technologies in South African WWTPs, where the electricity intensity ranges from 0.079 to 0.41 kWh.m-3 (Wang et al. 2016). Korea and India use almost the same energy (0.24 kWh.m-3). An estimated one-fifth of the energy used in a municipality’s WWTPs is used for overall public utilities, and this percentage is anticipated to rise by 20% over the next 15 years owing to expanding consumption of water and higher standards. In this review paper, we examined the potential for creating energy-self-sufficient WWTPs and discussed how much energy is currently consumed by WWTPs. The desirable qualities of microalgae, their production on a global level, technologies for treating wastewater with biogas and solar power, its developments, and issues for sustainable development are highlighted. The scientific elaboration of the mechanisms used for pollutant degradation using solar energy, as well as their viability, are the key issues that have been addressed.

Predictors of successful primary antegrade wiring in chronic total occlusion percutaneous coronary intervention.

Antegrade wiring is the most commonly used chronic total occlusion (CTO) crossing technique. Using data from the PROGRESS CTO registry (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention; Clinicaltrials.gov identifier: NCT02061436), we examined the clinical and angiographic characteristics and procedural outcomes of CTO percutaneous coronary interventions (PCIs) performed using a primary antegrade wiring strategy. Of the 13 563 CTO PCIs performed at 46 centers between 2012 and 2023, a primary antegrade wiring strategy was used in 11 332 (83.6%). Upon multivariable logistic regression analysis, proximal cap ambiguity (odds ratio [OR]: 0.52; 95% CI, 0.46-0.59), side branch at the proximal cap (OR: 0.85; 95% CI, 0.77-0.95), blunt/no stump (OR: 0.52; 95% CI: 0.47-0.59), increasing lesion length (OR [per 10 mm increase]: 0.79; 95% CI, 0.76-0.81), moderate to severe calcification (OR: 0.73; 95% CI, 0.66-0.81), moderate to severe proximal tortuosity (OR: 0.67; 95% CI, 0.59-0.75), bifurcation at the distal cap (OR: 0.66; 95% CI, 0.59-0.73), left anterior descending artery CTO (OR [vs right coronary artery]: 1.44; 95% CI, 1.28-1.62) and left circumflex CTO (OR [vs right coronary artery]: 1.22; 95% CI, 1.07-1.40), non-in-stent restenosis lesion (OR: 0.56; 95% CI, 0.49-0.65), and good distal landing zone (OR: 1.18; 95% CI, 1.06-1.32) were independently associated with primary antegrade wiring crossing success. The use of antegrade wiring as the initial strategy was high (83.6%) in our registry. We identified several parameters associated with primary antegrade wiring success.

Simultaneous Analysis of Nicarbazin, Diclazuril, Toltrazuril, and Its Two Metabolites in Chicken Muscle and Eggs by In-Syringe Dispersive Solid-Phase Filter Clean-Up Followed by Liquid Chromatography-Tandem Mass Spectrometry.

Nicarbazin (NICA) and triazine anticoccidial drugs (diclazuril (DIZ) and toltrazuril (TOZ)) are the primary strategy for preventing and treating coccidiosis. To prevent the development of drug resistance and mitigate the potential chronic toxicity to humans resulting from prolonged exposure, a liquid chromatography-tandem mass spectrometry method with high reliability and sensitivity was developed to determine NICA, DIZ, TOZ, and its two metabolites in chicken muscle and eggs. Upon establishing the extraction conditions involving 10 mL of acetonitrile and 10 min of sonication, in-syringe dispersive solid-phase extraction with silica was performed in combination with n-hexane clean-up. The selection of isotope peaks of precursor ions and low-mass range scanning allowed the two transitions for the quantification of all compounds. The limits of detection for DIZ and NICA were both 0.1 μg/kg, and for TOZ and metabolites, they were 0.3 μg/kg; the limits of quantitation were 0.3 and 1 μg/kg, respectively. The linear range was 0.25-50 ng/mL with a correlation coefficient r > 0.999. The average recoveries at three spiking levels in muscle and eggs were 90.1-105.2% and 94.0-103.7% with the relative standard deviations of 3.0-8.1% and 3.1-14.4%, respectively. The precision, accuracy, and stability were evaluated by three quality control samples.

Discussion on the Application of Technical and Tactical Skills in Mixed Martial Arts Competitions

This article mainly analyzes the application of technical and tactical skills in mixed martial arts competitions,including mixed martial arts and its competition characteristics, the main application significance of technical and tactical skills in mixed martial arts competitions, and its primary application strategies. It is hoped that this analysis can provide some guidelines for the appropriate application of mixed martial arts athletes’ technical and tactical skills to improve their winning rate in mixed martial arts competitions.

Improved energy efficiency using adaptive ant colony distributed intelligent based clustering in wireless sensor networks

Optimization algorithms have come a long way in the last several decades, with the goal of reducing energy consumption and minimizing interference with primary users during data transmission over shorter distances. The adaptive ant colony distributed intelligent based clustering algorithm (AACDIC) is a key component of the cognitive radio (CR) system because of its superior performance in spectrum sensing among a group of multi-users in terms of reduced sensing errors, power conservation, and faster convergence times. This study presents the AACDIC method, which improves energy efficiency by determining the ideal cluster count using connectedness and distributed cluster-based sensing. In this study, we take into account the reality of a system with an unpredictable number of both primary users and secondary users. As a result, the proposed AACDIC method outperforms pre-existing optimization algorithms by increasing the rate at which solutions converge via the utilisation of multi-user clustered communication. Experiments show that compared to other algorithms, the AACDIC method significantly reduces node power usage by 9.646 percent. The average power of Secondary Users nodes is reduced by 24.23 percent compared to earlier versions. The AACDIC algorithm is particularly strong at reducing the Signal-to-Noise Ratio to levels as low as 2 dB, which significantly increases the likelihood of detection. When comparing AACDIC to other primary detection optimization strategies, it is clear that it has the lowest false positive rate. The proposed AACDIC algorithm optimizes network capacity performance, as shown by the results of simulations, due to its ability to solve multimodal optimization challenges. Our analysis reveals that variations in SNR significantly affect the probability of successful detection, shedding light on the intricate interplay between signal strength, noise levels, and the overall reliability of sensor data. This insight contributes to a more comprehensive understanding of the proposed scheme's performance in realistic deployment scenarios, where environmental conditions may vary dynamically. The experimental results demonstrate the effectiveness of the proposed algorithm in mitigating the identified drawback and highlight the importance of SNR considerations in optimizing detection reliability in energy-constrained WSNs.

Managing secondary risks with optimal risk response strategy and risk-related resource scheduling

Secondary risks may arise as a result of implementing a risk response plan and may substantially impact the achievement of project objectives. Despite their importance, there is a scarcity of research on scheduling resources to effectively manage these risks. This study presents a pioneering mixed-integer optimization model and a tailored meta-heuristic solution algorithm, specifically designed to determine optimal primary and secondary risk response strategies. To validate our model, we introduce a synthetic data generation framework capable of generating appropriate scenarios based on specific metrics. We apply the model and algorithm to a full factorial numerical experiment constructed using the synthetic data generation algorithm. This allows us to derive managerial insights on secondary risks and the impact that secondary risk responses may have on project objectives. The outcomes of this study provide valuable insights for project managers to better manage both primary and secondary risks.

Density functional theory for doped TiO2: current research strategies and advancements.

Since the inception of the density functional theory (DFT) by Hohenberg and Kohn in 1964, it rapidly became an indispensable theoretical tool across various disciplines, such as chemistry, biology, and materials science, among others. This theory has ushered in a new era of computational research, paving the way for substantial advancements in fundamental understanding. Today, DFT is routinely employed for a diverse range of applications, such as probing new material properties and providing a profound understanding of the mechanisms underlying physical, chemical, and biological processes. Even after decades of active utilization, the improvement of DFT principles has never been slowed down, meaning that more accurate theoretical results are continuously generated with time. This work highlights the latest achievements acquired by DFT in the specific research field, namely the theoretical investigations of doped TiO2systems, which have not been comprehensively reviewed and summarized yet. Successful progress in this niche is currently hard to imagine without the support by DFT. It can accurately reveal new TiO2properties after introducing the desired dopant and help to find the optimal system design for a specific application prior to proceeding to more time-consuming and expensive experimental research. Hence, by evaluating a selection of the most recent research studies, we aim to highlight the pertinent aspects of DFT as they relate to the study of doped TiO2systems. We also aim to shed light on the strengths and weaknesses of DFT and present the primary strategies employed thus far to predict the properties of various doped TiO2systems reliably.

Cost-Effectiveness and Clinical Outcomes of Secondary Hyperparathyroidism Treatments in Patients with Chronic Kidney Disease.

The study addresses the challenge of treating secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients, focusing on the cost-effectiveness of surgical versus pharmacological interventions. Conducting a retrospective analysis on 152 CKD patients with SHPT at the Third People's Hospital of Chengdu, the study matched 80 patients into two groups: 40 undergoing parathyroidectomy with autotransplantation (PTX + AT) and 40 treated with calcimimetics. PTX + AT was more effective in alleviating symptoms, particularly bodily pain, and demonstrated greater cost-effectiveness over a long-term period compared to calcimimetics. This was especially significant in patients with PTH levels > 1800 pg/mL and hyperphosphatemia. Despite similar initial costs, PTX + AT led to a substantial decrease in expenses during the 2-5 years post-treatment period, PTX + AT results in an ICER of -RMB 26.71/QALY for the first post-treatment year and -RMB-111.9k/QALY for the 2-5 year period, indicating cost-effectiveness with reduced long-term costs. The study also found an increased economic burden in managing patients with hyperphosphatemia. Surgical intervention (PTX + AT) is advocated as the primary treatment strategy for severe SHPT in CKD patients, owing to its long-term economic and clinical advantages. The results underscore the need for a severity-based approach in treating SHPT.

Treatment of Mixed Chimerism After Hematopoietic Stem Cell Transplantation in Patients with Thalassemia Major

Background: Incomplete donor cell chimerism often occurs in thalassemia transplant due to host cells remain or reappear overtime, which is termed as mixed chimerism (MC). Objective: To compare the immunosuppression withdrawal (ISW) and donor lymphocyte infusion (DLI) in the correction of mixed chimerism (MC) after thalassemia transplantation. Methods: Eighty-seven patients with post-transplant MC admitted in our center from January 2010 to December 2019 were analyzed. Among them donor cells of 90%-95% and 75%-89% were classified as MC1 and MC2 respectively. MC3 donor cells &amp;lt;75%. The incidence and correction rate of MC, the occurrence rate of graft versus host disease (GVHD), timing of DLI were studied. Results: DLI was associated with higher correction rates and higher GVHD than ISW. In MC1 group, higher GVHD occurred in early and intermediate stage (&amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt; = 0.024/0.023) than ISW. In MC2 group, DLI in late stages had higher correction rates than ISW (&amp;lt;I&amp;gt;P&amp;lt;/I&amp;gt; = 0.001). Conclusion: ISW was the primary strategy for MC1 patients. DLI should be given to the late-stage MC2 patients quickly. The earlier the treatment is provided, regardless of ISW or DLI, the more likely that patients develop GVHD.

Main issues and countermeasures for the development of small and medium-sized enterprises in China

This research delves into the primary challenges and strategies faced by Chinese small and medium-sized enterprises (SMEs) across various market contexts. Drawing from a synthesis of both domestic and international literature, the study highlights the prevalent difficulties encountered by SMEs, including funding constraints, market entry, talent acquisition, and technological advancement. Notably, the paper compares and contrasts Shenzhen Huake Technology Co., Ltd., a company in a developed urban setting, with a traditional textile firm in a less developed western county, examining their distinct challenges. The findings suggest that while both types of enterprises grapple with financial and technological hurdles, urban enterprises tend towards innovation-driven growth, whereas those in underdeveloped areas are often hindered by inadequate infrastructure and market limitations. To address these issues, the study proposes several approaches, such as bolstering technological innovation, creating adaptable supply chains, building brand identity, and proactively meeting diverse consumer demands. The research also emphasizes the critical role of green and sustainable practices in the future trajectory of SMEs. SMEs are encouraged to leverage digital tools and global opportunities while remaining attuned to local market needs and peculiarities.

Detecting Similarity of Program Code Using an Aggregated Approach to the Problem of Plagiarism Detection

In this work, the primary strategies employed for code plagiarism were explored, alongside an analysis of prevalent methods for detecting copied content. Based on the results of the analysis of various approaches, as well as the analysis of the subject area itself and on the basis of the formulated requirements, a new System for automatically checking software similarity for plagiarism was successfully designed, implemented and tested. When developing the System, an aggregated approach was used, which made it possible to use several basic similarity detection algorithms. Namely, the Greedy Row Tiling algorithm and the Sifting algorithm. Since the System is designed for programmers, in particular, for teachers, and also with the possibility of local launch, it is proposed to perform user interaction with the System in the form of a command line interface. The System is implemented in Python, which ensures that the suggested System is platform independent. Regular expressions are used to implement preprocessing and exclusion functions, and the libclang library is used for С++ code parsing and tokenization functions. Promising applications for the developed System include education and programming competitions. So universities and colleges can use the System to check code written by students to detect plagiarism. And in competitive environments such as hackathons or programming competitions, the System can be used to ensure fairness and prevent plagiarism among participants.

Phenobarbital as a Sedation Strategy to Reduce Opioid and Benzodiazepine Burden in Neonatal Extracorporeal Membrane Oxygenation.

The study aims to describe our experience with the implementation of phenobarbital as a primary sedation strategy during neonatal extracorporeal membrane oxygenation (ECMO). Retrospective chart review in a level IV neonatal intensive care unit between 2011 and 2021 comparing neonatal ECMO patients before and after the implementation of a sedation-analgesia (SA) protocol using scheduled phenobarbital as the primary sedative. Groups were compared for neonatal and ECMO characteristics, cumulative SA doses, and in-hospital outcomes. Comparison between groups was performed using Mann-Whitney test on continuous variables and chi-square on nominal variables. Forty-two patients were included, 23 preprotocol and 19 postprotocol. Birth, pre-ECMO, and ECMO clinical characteristics were similar between groups except for a lower birth weight in the postprotocol group (p = 0.024). After standardization of phenobarbital SA protocol, there was a statistically significant reduction in median total morphine dose (31.38-17.65 mg/kg, p = 0.006) and median total midazolam dose (36.21-6.36 mg/kg, p < 0.001). There was also a reduction in median total days on morphine by 7.5 days (p = 0.026) and midazolam by 6.6 days (p = 0.003). There were no differences in ECMO duration or in-hospital outcomes between groups. In this cohort, short-term use of phenobarbital as primary sedation strategy during neonatal ECMO was associated with reduced opioid and midazolam burden. Such reduction, however, did not affect in-hospital outcomes. · Prolonged sedation on ECMO puts infants at risk for iatrogenic withdrawal.. · Phenobarbital is a feasible sedation strategy for ECMO.. · Phenobarbital sedation strategy may mitigate risk by decreasing opioid and midazolam burden..

Virtual facilitation best practices and research priorities: a scoping review

BackgroundFacilitation is an implementation strategy that supports the uptake of evidence-based practices. Recently, use of virtual facilitation (VF), or the application of facilitation using primarily video-based conferencing technologies, has become more common, especially since the COVID-19 pandemic. Thorough assessment of the literature on VF, however, is lacking. This scoping review aimed to identify and describe conceptual definitions of VF, evaluate the consistency of terminology, and recommend “best” practices for its use as an implementation strategy.MethodsWe conducted a scoping review to identify literature on VF following the PRISMA-ScR guidance. A search of PubMed, Embase, Web of Science, and CINAHL databases was conducted in June 2022 for English language articles published from January 2012 through May 2022 and repeated in May 2023 for articles published from January 2012 through April 2023. Identified articles, including studies and conference abstracts describing VF, were uploaded into Covidence and screened independently by two reviewers. Data extraction was done by two reviewers in Microsoft Excel; additionally, studies were evaluated based on the Proctor et al. (2013) reporting guidelines for specifying details of implementation strategies.ResultsThe search strategy identified 19 articles. After abstract and full-text screening, eight studies described by 10 articles/abstracts were included in analysis. Best practices summarized across studies included (1) stakeholder engagement, (2) understanding the recipient’s organization, (3) facilitator training, (4) piloting, (5) evaluating facilitation, (6) use of group facilitation to encourage learning, and (7) integrating novel tools for virtual interaction. Three papers reported all or nearly all components of the Proctor et al. reporting guidelines; justification for use of VF was the most frequently omitted.ConclusionsThis scoping review evaluated available literature on use of VF as a primary implementation strategy and identified significant variability on how VF is reported, including inconsistent terminology, lack of details about how and why it was conducted, and limited adherence to published reporting guidelines. These inconsistencies impact generalizability of these methods by preventing replicability and full understanding of this emerging methodology. More work is needed to develop and evaluate best practices for effective VF to promote uptake of evidence-based interventions.Trial registrationN/A.