Small-scale Pilot Study Research Articles

A development and implementation of a preconception counseling program for black women and men in the southeastern United States: a pilot protocol.

Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States. This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities. Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

“Being a Parent in Finland” - psycho-educative intervention: development and acceptability of a group programme aimed at increasing trust among migrant parents

ABSTRACT The existing literature highlights distrust among migrant parents in Nordic countries towards child welfare and other services. However, interventions to enhance parental trust are few in number, and descriptions of their development and feasibility testing in a Nordic context are lacking. This paper describes the development of ‘Being a Parent in Finland’, a psycho-educative group intervention designed for migrant parents to foster institutional trust. The intervention’s content and structure are outlined using the Six Steps for Quality Intervention Development framework (6SQuID). Additionally, the paper presents findings from a small-scale pilot study involving thematic interviews with 16 parents and a pre-post survey with 14 parents to assess programme acceptability. The pilot study indicated high acceptability and perceived benefits among parents, although no changes in institutional trust emerged in the quantitative survey. Implications for future development, practice, and research are discussed.

Virtual reality education on myalgic encephalomyelitis for medical students and healthcare professionals: a pilot study

IntroductionMyalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) is a chronic condition which may be characterised by debilitating fatigue, post-exertional malaise, unrefreshing sleep, and cognitive difficulties. ME/CFS has significant negative impact on quality of life for those living with the condition. This may be exacerbated by a lack of knowledge within healthcare regarding the condition. Previous research has found that immersive virtual reality (VR) educational experiences within healthcare education can increase knowledge and empathy.MethodsThe present study employed a quasi-experimental pre-test-post-test design to investigate the impact of a short immersive VR educational experience on knowledge of ME/CFS and empathy for those living with the condition. The VR experience placed participants into a virtual scene which told real life stories of the experience of people living with ME/CFS and their families. 43 participants completed in this pilot study: 28 medical students and 15 primary care health professionals. Participants completed measures of knowledge of ME/CFS and empathy before and after engagement with the experience.ResultsA statistically significant increase was found for levels of knowledge (p < .001, d = 0.74) and empathy (p < .001, d = 1.56) from pre-VR experience levels to post-VR experience levels with a medium and large effect size, respectively. Further analysis revealed no statistically significant difference between baseline levels of knowledge of ME/CFS between healthcare professionals and medical students.DiscussionThe present study is the first to explore the use of this short immersive VR experience as an education tool within healthcare to increase knowledge of ME/CFS, and empathy for those living with the condition. Findings allude to the previously established lack of knowledge of ME/CFS within healthcare although promisingly the increases in knowledge and empathy found suggest that this immersive VR experience has potential to address this. Such changes found in this small-scale pilot study suggest that future research into the use of VR as an educational tool within this setting may be beneficial. Use of a control group, and larger sample size as well as investigation of retention of these changes may also enhance future research.

What is known about the challenges people with Parkinson's disease experience with their medicines and what solutions have been explored to overcome them? A scoping review.

The symptomatic management of Parkinson's disease (PD) relies heavily on medications, which increase in complexity as the disease progresses. To describe (i) the extent, range, and nature of research describing the experience and challenges people with PD and their carers have with their medicines for symptomatic treatment, and (ii) any interventions that have been reported in a community setting that address medicine-related challenges experienced by people with PD. The scoping review searched electronic databases (EMBASE, PubMed, and CINAHL). The studies included were full-text articles in English only, including conference abstracts that focussed on patients with PD or their carers and discussed medicines in the primary care setting, even where this was not the primary focus. Thirty-nine papers were taken forward for data extraction. Twenty described patient experience and challenges. Although none were explicitly focussed on medications, they did highlight challenges including the work of taking multiple medications and a desire for non-oral formulations. Nineteen described or tested interventions to support people with PD with their medication including community pharmacist-led reviews, medication compliance aids, and the use of text message reminders. These were all small-scale feasibility and pilot studies, and none were grounded in a methodological framework. Positive outcomes were reported against various scales, but no evidence of scaling up any of the interventions was found. There is very little published research surrounding the challenges people with PD have with their medicines. The published research that does exist alludes to challenges with medicines taking in people with PD but identifies a gap in the detail and understanding. Further work is required to improve our understanding and allow the development of sustainable interventions that support people with PD and their carers.

Feasibility and acceptability of chaplain decision coaching on Periviable resuscitation decision quality: A pilot study

ObjectiveTo pilot test and assess the feasibility and acceptability of chaplain-led decision coaching alongside the GOALS (Getting Optimal Alignment around Life Support) decision support tool to enhance decision-making in threatened periviable delivery. MethodsPregnant people admitted for threatened periviable delivery and their ‘important other’ (IO) were enrolled. Decisional conflict, acceptability, and knowledge were measured before and after the intervention. Chaplains journaled their impressions of training and coaching encounters. Descriptive analysis and conventional content analysis were completed. ResultsEight pregnant people and two IOs participated. Decisional conflict decreased by a mean of 6.7 (SD = 9.4) and knowledge increased by a mean of 1.4 (SD = 1.8). All rated their experience as “good” or “excellent,” and the amount of information was “just right.” Participants found it “helpful to have someone to talk to” and noted chaplains helped them reach a decision. Chaplains found the intervention a valuable use of their time and skillset. ConclusionThis is the first small-scale pilot study to utilize chaplains as decision coaches. Our results suggest that chaplain coaching with a decision support tool is feasible and well-accepted by parents and chaplains. InnovationsOur findings recognize chaplains as an underutilized, yet practical resource in value-laden clinical decision-making.

‘I learned this in the gardening group’: the impact of a community garden on children and their families’ eating habits

ABSTRACT Increased scholarly and practitioner attention has been paid to community gardens and their potential impact on community building and sustainability, as well as a tool to combat the decline in physical and mental well-being connected to childhood obesity. Specifically, community gardens may play a role in on families’ eating habits, and there is a need to investigate parents’ perspectives of their children’s involvement in a rural community garden and to explore the impact this has on children’s and their families’ healthy eating habits. This is a small-scale pilot study of children’s involvement in a community garden. Using a qualitative design method, semi-structured interviews were conducted to explore parents’ viewpoints of their children’s eating habits prior to and after the children’s involvement. The data gathered was coded and organised into emerging themes for interpretation. The study found indications that children’s involvement in a community garden has a positive impact on children’s social development, confidence and food awareness, along with a noticeable influence on the family’s general healthy food consumption. While the findings suggest that involvement in a community garden has positive impact on children’s eating habits, further research is needed with a higher number of participants for more accurate data.

Renal Denervation in End-Stage Renal Disease: Current Evidence and Perspectives.

In patients with end-stage renal disease (ESRD) undergoing haemodialysis, hypertension is of common detection and frequently inadequately controlled. Multiple pathophysiological mechanisms are involved in the development and progression of the ESRD-related high blood pressure state, which has been implicated in the increased cardiovascular risk reported in this hypertensive clinical phenotype. Renal sympathetic efferent and afferent nerves play a relevant role in the development and progression of elevated blood pressure values in patients with ESRD, often leading to resistant hypertension. Catheter-based bilateral renal nerves ablation has been shown to exert blood pressure lowering effects in resistant hypertensive patients with normal kidney function. Promising data on the procedure in ESRD patients with resistant hypertension have been reported in small scale pilot studies. Denervation of the native non-functioning kidney's neural excitatory influences on central sympathetic drive could reduce the elevated cardiovascular morbidity and mortality seen in ESRD patients. The present review article will focus on the promising results obtained with renal denervation in patients with ESRD, its mechanisms of action and future perspectives in these high risk patients.

Managing Non-Cancer Chronic Pain in Frail Older Adults: A Pilot Study Based on a Multidisciplinary Approach.

Considering the multidimensionality of chronic pain, it is crucial to develop comprehensive strategies for its effective management. However, establishing well-defined, evidence-based guidelines for such approaches remains challenging. To overcome this, we present the finding from a 4-month intervention to enhance the management of non-cancer chronic pain in older adults with pre-frailty and frailty. The intervention's core elements comprised a multidisciplinary individualized plan, a case manager, and patient education. This pilot study involved 22 participants (≥65 years). It assessed changes in pain frequency and intensity (pain scale), frailty (Fried frailty phenotype criteria), and medication adherence (Brief Adherence Rating Scale) before and after the 4-month intervention. The results were encouraging: pain frequency and intensity and frailty score tended to decrease, and medication adherence showed significant improvement. This preliminary small-scale pilot study provides a foundation for further research and for exploring the potential scalability of this multidisciplinary patient-centred intervention.

The Multicomponent Medicinal Product Hepar Compositum Reduces Hepatic Inflammation and Fibrosis in a Streptozotocin- and High-Fat Diet-Induced Model of Metabolic Dysfunction-Associated Steatotic Liver Disease/Metabolic Dysfunction-Associated Steatohepatitis.

Metabolic dysfunction-associated steatotic liver disease (MASLD)-formerly known as non-alcoholic fatty liver disease (NAFLD)-is the most common chronic liver disease worldwide. Since there is currently no approved pharmacotherapy for MASLD, there is an urgent unmet need for efficacious therapeutics for this disease. Hepar compositum (HC-24) is a multicomponent medicinal product that consists of 24 natural ingredients. It has been shown to have anti-inflammatory properties in an obesity-associated MASLD mouse model, but its potential to reduce MASLD-associated fibrosis had not been explored before this study. Here, we investigated the hepatic anti-inflammatory and anti-fibrotic potential of HC-24 in a streptozotocin (STZ)- and high-fat diet (HFD)-induced model of MASLD. Mice received a single injection of low-dose STZ at 2 days of age, followed by HFD feeding from 4 to 9 weeks of age. Mice were treated every second day with HC-24 or daily with the positive control telmisartan from 6 to 9 weeks of age. A non-diseased control group was included as a healthy reference. An explorative small-scale pilot study demonstrated that HC-24 improved liver histology, resulting in a lower NAFLD activity score and reduced liver fibrosis. A subsequent full study confirmed these effects and showed that HC-24 reduced hepatic inflammation, specifically reducing T helper cell and neutrophil influx, and decreased hepatic fibrosis (with qualitatively reduced collagen type I and type III immunopositivity) in the absence of an effect on body and liver weight, blood glucose or liver steatosis. These results show that HC-24 has hepatoprotective, anti-inflammatory, and anti-fibrotic properties in an STZ- and HFD-induced model of MASLD/MASH, suggesting that this multicomponent medicine has therapeutic potential for MASLD patients.

Elevated concentrations of Neu5Ac and Neu5,9Ac2 in human plasma: potential biomarkers of cardiovascular disease

Cardiovascular disease (CVD) is a group of health conditions affecting the heart and vascular system with very high prevalence and mortality rates. The presence of CVD is characterised by high levels of inflammation which have previously been associated with increased plasma concentrations of N-acetyl neuraminic acid (Neu5Ac). While Neu5Ac has been studied in the context of CVD, Neu5,9Ac2 has not, despite being the second most abundant sialic acid in human plasma. A small-scale pilot study of thirty plasma samples from patients with diagnosed CVD, and thirty age and sex-matched healthy controls, was designed to gain insight into sialic acids as biomarkers for CVD and potential future areas of study. Each sample was assayed for Neu5Ac and Neu5,9Ac2 concentrations. Mean Neu5Ac and Neu5,9Ac2 concentrations were significantly elevated in patients with CVD compared to healthy controls (Neu5Ac: P < 0.001; Neu5,9Ac2: P < 0.04). Receiver operator curve (ROC) analysis indicated that both Neu5Ac and Neu5,9Ac2 have reasonable predictive power for the presence of CVD (Neu5Ac AUC: 0.86; Neu5,9Ac2 AUC: 0.71). However, while Neu5Ac had both good sensitivity (0.82) and specificity (0.81), Neu5,9Ac2 had equivalent specificity (0.81) but very poor sensitivity (0.44). A combination marker of Neu5Ac + Neu5,9Ac2 showed improvement over Neu5Ac alone in terms of predictive power (AUC: 0.93), sensitivity (0.87), and specificity (0.90). Comparison to a known inflammatory marker, high sensitivity c-reactive protein (hs-CRP: P-value: NS, ROC:0.50) was carried out, showing that both Neu5Ac and Neu5,9Ac2 outperformed this marker. Further to this, hs-CRP values were combined with the three different sialic acid markers to determine any effect on the AUC values. A slight improvement in AUC was noted for each of the combinations, with Neu5Ac + Neu5,9Ac2 + hs-CRP giving the best AUC of 0.97 overall. Thus, Neu5Ac would appear to offer good potential as a predictive marker for the presence of CVD, which the addition of Neu5,9Ac2 predictive power improves, with further improvement seen by the addition of hs-CRP.

Service Uptake Challenges Experienced by Pasifika Communities during COVID-19 Lockdowns in New Zealand

Background: New Zealand was one of the first countries to adopt an elimination strategy based on a four-tier Alert Level system that included strict lockdowns at levels three and four. The lockdowns meant shutting out external social networks and being confining to individual household ‘bubbles’ only. This presented challenges for minority Pasifika communities in New Zealand as their cultural values are based on social bonding, interconnectedness, community engagement and caring for each other. The aim of this research was to conduct a small-scale pilot study to test and refine the study design and identify the major challenges faced by Pasifika communities in relation to accessing health, social and mental services while in lockdown. Methods: This exploratory study was designed using an online anonymous questionnaire survey targeting people who identified as Pasifika. A total of eighty-seven respondents were included in our analyses following the questionnaire survey. Results: Five main barriers to accessing health, social and mental health services during lockdowns were identified; (1) unavailability of or limited services; (2) fear of contracting the virus; (3) perception of high costs associated with seeking medical assistance; (4) transportation difficulties; and (5) lack of time. Almost a quarter of the respondents reported losing their jobs, 80% indicated a decline in their household income and more than half experienced some form of psychosocial distress while in lockdown. Conclusions: The findings of this research highlight existing challenges faced by Pasifika communities in adequately accessing essential services. Future research can focus on the key barriers to access identified in this research to gain a deeper understanding of services and its interaction with Pasifika communities during lockdowns.

Stratification of neurogenic bladder risk in spina bifida using the urinary peptidome.

Neurogenic bladder poses a major morbidity in children with spina bifida (SB), and videourodynamic studies (VUDS) are used to stratify this risk. This small-scale pilot study utilized current mass-spectrometry-based proteomic approaches to identify peptides or proteins in urine that may differentiate children at high risk of developing renal complications from a neurogenic bladder. Twenty-two urine samples of which nine had high bladder pressure storage that put the upper urinary tract at risk, while 13 with a lower risk for renal compromise were analyzed. More than 1,900 peptides across all 22 samples were quantified, and 115 peptides differed significantly (P < 0.05) between the two groups. Using machine learning approaches five peptides that showed the greatest differences between these two clinical categories were used to build a classifier. We tested this classifier by blind analysis of an additional six urine samples and showed that it correctly assigned the unknown samples in their proper risk category. These promising results indicate that a urinary screening test based on peptides could be performed on a regular basis to stratify the neurogenic bladder into low or high-risk categories. Expanding this work to larger cohorts as well as across a broad spectrum of urodynamics outcomes may provide a useful diagnostic test for neurogenic bladder.NEW & NOTEWORTHY This approach could help risk stratify the neurogenic bladder in patients with spina bifida and could allow us to safely defer on up to 1/3 of urodynamic studies. These pilot data justify a larger trial before this approach becomes a clinical tool.

A framework for making citizen science inclusive with storytelling methods

Citizen science is challenged by a participation inequality that is not compatible with a democratic approach to science. To include the voices of underrepresented groups, this article presents “STORCIT”, a framework for making citizen science inclusive with storytelling methods. This framework was trialed in the project “Climate Stories” with two small-scale pilot studies in Hasselt and Brussels (Belgium). This project involved around 50 young people with a diverse background, since they are often overlooked as agents of change in the climate debate. During the project, they recorded their experiences related to the changing climate through citizen science and storytelling methods. The STORCIT-framework was designed through five consecutive phases: i) setting the scene, ii) generating knowledge and learning, iii) sharing personal narratives iv) developing stories, and v) exhibiting to the public. The results reflect on the implementation of this approach, together with the experienced challenges, limitations, and gains. Overall, the approach is highly participatory, multi-faceted and supports the democratization of knowledge generation. The gathered knowledge helps participants to reflect on their story, raise their voice and catalyze actions for social change. In the context of citizen science research, practitioners are encouraged to explore and further adapt this framework to other (justice) domains and involve other vulnerable target groups. In particular, it can be deployed by those who aim to include diverse audiences and stimulate inclusive dialogue between science, society and policy with actions for social change.

An Outbred Calf Model for Determining Innate Immune Sensing and Evolutionary Trajectories of a Cell Culture-Adapted Bovine Foamy Virus Variant.

Bovine foamy virus (BFVbta) displays a very high degree of cell-associated replication which is unprecedented even among the other known foamy viruses. Interestingly, recent studies have shown that it can in fact adapt in vitro to high-titer (HT) cell-free transmission due to genetic changes acquired during repeated rounds of cell-free BFVbta passages in immortalized bovine MDBK cells. Molecular clones obtained from the HT BFVbta Riems cell-free variant (HT BFVbta Riems) have been thoroughly characterized in MDBK cell cultures However, during recent years, it has become increasingly clear that the source of the host cells used for virus growth and functional studies of virus replication and virus-cell interactions plays a paramount role. Established cell lines, mostly derived from tumors, but occasionally experimentally immortalized and transformed, frequently display aberrant features relating, for example. to growth, metabolism, and genetics. Even state-of-the-art organoid cultures of primary cells cannot replicate the conditions in an authentic host, especially those concerning cell diversity and the role of innate and adaptive immunity. Therefore, to determine the overall replication characteristics of the cloned wt and HT BFVbta Riems variant, we conducted a small-scale animal pilot study. The replication of the original wt BFVbta Riems isolate, as well as that of its HT variant, were analyzed. Both BFVbta variants established infection in calves, with proviruses in peripheral blood mononuclear cells and induced Gag-specific antibodies. In addition, a related pattern in the host innate immune reaction was detected in the peripheral blood leukocytes of the BFV-infected calves. Surprisingly, an analysis of the Gag sequence two weeks post-inoculation revealed that the HT BFVbta variant showed a very high level of genetic reversion to the wild type (parental BFVbta genotype).

Exploring the experience of Year 10 South Korean students’ English language learning in immersive virtual reality.

A prescribed English language textbook often directs classroom teaching practices in secondary school classes in EFL contexts, such as in South Korea. The textbook is often accompanied by multimedia resources which are delivered to students as input at a regulated pace with limited opportunities for communicative interaction or spoken output. Such opportunities are further limited in the community outside of the English classroom. Immersive virtual reality (i-VR) has the potential to situate learners in a real-world context for authentic application of textbook language learning. English teachers in the formal classroom focus on linguistic competence development within time constraints by teaching new vocabulary and grammatical items in decontextualised forms. By comparison, i-VR environments focus on learning to construct meaning in communicative events in contextualised, real-world settings based on students’ existing linguistic knowledge and ability. In a small-scale pilot study, two teachers of Year 10 English classes in Seoul implemented four i-VR language learning modules in their classes: one as a self-directed learning experience that extended beyond formal classroom learning, and the other as a teacher-facilitated learning experience within the formal classroom. Both teachers were interviewed after the two-week implementation to seek their views on their perceptions of the value of such i-VR learning for their students. Beyond the motivational and entertainment value, the teachers viewed the i-VR experience as capable of incorporating pedagogical structures using the embedded multimodal resources that is not possible in other immersive forms of language learning. Moreover, the teachers believed that incorporation of authentic conversations and interactional opportunities could further enhance the learning potential.

Determinant of Optimal and Inhibited Mobile Language Learning Activity

Learner analytic driven research concerned with mobile app learner survivability. An app was developed to indicate productiveness of quiz app usage for global mobile assisted language learning (MALL). The research focused on inhibiting and optimizing effects of level length on total questions answered. How many questions per level leads to the highest total unique questions being answered? The research focused on nine-day cohort timeframes and included three phases: a small-scale pilot study to establish parameters, an exploratory stage undertaken within the parameters and finally the use of a quadratic regression predictive model. The null hypothesis (H0) was rejected. A one-way analysis of variance found a statistically significant difference in the mean productivity of the lengths. Results of a Tukey post hoc test (p &lt; .05) suggests question sets with less than eight questions, or more than 15 questions, appear to inhibit MALL autonomous learning. Optimal level question sets appear to be between lengths 8-14. The results visually encapsulated by a quadratic regression model broadly support H1 and H2. Set 12 is the statistically most significant optimal load. Gains of up to 107% are reported for switching from suboptimal to optimal approaches.

Evaluating an app for digital medical history taking in urgent care practices: study protocol of the cluster-randomized interventional trial ‘DASI’

BackgroundIn out-of-hours urgent care practices in Germany, physicians of different specialties care for a large number of patients, most of all unknown to them, resulting in a high workload and challenging diagnostic decision-making. As there is no common patient file, physicians have no information about patients’ previous conditions or received treatments. In this setting, a digital tool for medical history taking could improve the quality of medical care. This study aims to implement and evaluate a software application (app) that takes a structured symptom-oriented medical history from patients in urgent care settings.MethodsWe conduct a time-cluster-randomized trial in two out-of-hours urgent care practices in Germany for 12 consecutive months. Each week during the study defines a cluster. We will compare participants with (intervention group) and without app use (control group) prior to consultation and provision of the self-reported information for the physician. We expect the app to improve diagnostic accuracy (primary outcome), reduce physicians’ perceived diagnostic uncertainty, and increase patients’ satisfaction and the satisfaction with communication of both physician and patient (secondary outcomes).DiscussionWhile similar tools have only been subject to small-scale pilot studies surveying feasibility and usability, the present study uses a rigorous study design to measure outcomes that are directly associated with the quality of delivered care.Trial registrationThe study was registered at the German Clinical Trials Register (No. DRKS00026659 registered Nov 03 2021. World Health Organization Trial Registration Data Set, https://trialsearch.who.int/Trial2.aspx? TrialID = DRKS00026659.

A qualitative process evaluation of universal free school meal provision in two London secondary schools

BackgroundIn the UK, one in five households with children experienced food insecurity in 2022, defined as a household-level economic and social condition of limited or uncertain access to adequate food. Free school meals are a public health intervention aimed at reducing food insecurity amongst children. The provision of universal free school meals (UFSM) to secondary school-aged children is a novel and untested intervention in the UK. This study is a process evaluation of a pilot of UFSM in two secondary schools in England. The aim was to understand the feasibility, acceptability, cost implications and lessons for the implementation of UFSM.Methods20 parents, 28 students and 8 school staff from two intervention schools participated in online qualitative interviews, as well as 4 staff from non-intervention schools. The Framework Method of thematic analysis was applied. These data were supplemented with student-led observations of school meal times, and school lunch uptake-data and cost information provided by the local authority delivering the pilot.ResultsUFSM in secondary schools is a feasible and acceptable intervention, with coherent goals of increased access to a healthy meal, reduced food insecurity and better nutrition. All participants perceived these goals were met. Acceptability was further enhanced by the perception that UFSM were supporting a greater proportion of low-income families than the national, targeted Free School Meal scheme, as well as being easier to implement. Potential barriers to implementation include limited school kitchen and dining infrastructure, meal quality and choice, and increased queuing times. Participants’ concerns that UFSM may benefit middle- and high- income families not in need were not as prevalent as the perception that UFSM was an effective way to support all families with secondary-aged children experiencing food insecurity.ConclusionThis small-scale pilot study suggests that UFSM in secondary schools is feasible and acceptable, but more evidence is required from larger studies on the impact on long-term health, psychosocial and educational outcomes. Future, larger studies should also include detailed economic evaluations so this approach can be compared with other possible interventions.

Precise and accurate behavioural monitoring of captive Chukar (Alectoris chukar) by using the advanced digital ethogram: a small scale pilot study.

Precise and accurate behavioural monitoring of captive Chukar (Alectoris chukar) by using the advanced digital ethogram: a small scale pilot study.

Centrally supported clinical pharmacist intervention to reduce clinical inertia in hypertension.

To assess the impact of a one-time hypertension (HTN)-focused clinical pharmacist intervention on the occurrence of clinical inertia and change in blood pressure (BP). This retrospective study included patients 18 to 89 years of age with a current diagnosis of HTN and average systolic BP of ≥150 mm Hg. Centralized outreach coordinators performed telephone outreach to patients to schedule an HTN-focused visit with their primary care provider (PCP) and forwarded outreach notes for half of these patients to clinical pharmacists embedded in an internal medicine clinic. The clinical pharmacists performed a one-time focused medication review and provided evidence-based recommendations to a patient's PCP prior to the scheduled appointment. The primary outcome was therapy intensification (medication adjustment or adherence discussion) as a measure of overcoming clinical inertia. Secondary outcomes were the mean changes in systolic and diastolic BP from preintervention values to 6-month follow-up in the intervention group versus the control group. A total of 91 patients were included, and 34 of 47 intervention patients (72%) had therapy intensification at the HTN-focused PCP appointment, compared to 20 of 44 control patients (46%) (P =0.017). The mean (SD) systolic BP reductions from baseline were 12.26 (29.04) mm Hg and 6.97 (27.05) mm Hg for the intervention and control groups, respectively (P =0.427), with diastolic BP reductions of 3.83 (13.14) mm Hg and 1.35 (10.60) mm Hg, respectively (P =0.380). A collaborative model involving centralized outreach coordinators and embedded clinical pharmacists led to a significant reduction in clinical inertia. This was a small-scale pilot study, and further research is needed to determine the effect of this intervention on BP reduction.