Treatment Centers Research Articles

ATMP clinical trials in the UK.

The UK advanced therapy medicinal product (ATMP) clinical trials database, produced annually by CGT Catapult, aims to assess the progress and state of the UK ATMP clinical development landscape. The aim of this article is to highlight key findings from the database and put them into context within the global landscape and various initiatives intended to attract ATMP developers to the UK. A targeted search of GlobalData's clinical trial database was performed, followed by refinement so that only trials investigating products meeting ATMP definitions were included, and that each trial was only counted once in the analysis. The 2023 data show that the number of ongoing ATMP clinical trials in the UK has remained approximately static, in contrast to a 10% reduction reported globally. Approximately 80% of these trials were commercially sponsored. Although most ATMP clinical trials are early phase, there is evidence indicating progression to later phase studies. The data indicate that the UK remains an attractive region for ATMP clinical trials. Factors including UK government investment in research, regulatory support offered by MHRA, and the Advanced Therapy Treatment Centre (ATTC) network of clinical sites, may contribute to the positive ecosystem available to developers of ATMPs.

End of life perspectives: asystematic survey of patients with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is adisease that still has to be primarily treated symptomatically or palliatively. It is therefore all the more important, in addition to initiating treatment, such as percutaneous endoscopic gastrostomy (PEG), noninvasive ventilation therapy (NIVT) and invasive ventilation therapy via tracheotomy (IVT), to discuss the possible termination of these measures early on. What is the importance of advance directives for those affected and where are possible deficits in therapy planning for the end of life? Between March 2017 and January 2019 patients with aclinically confirmed diagnosis of ALS at six treatment centers were asked to fill out aquestionnaire. Atotal of 328 people returned the completed forms. Of the participants 72% had already made an advance directive (AD), 25% planned to fill one out and only 3% refused to do so. In composing the AD most patients (90%) had support, although 56% lacked medical counselling and only 18% had drawn up the will together with the doctor and relatives, with the majority of the rest also wanting support from adoctor. Atotal of 37% of all patients wanted acontact person to talk about their illness but only 40% of them had such acontact person. Of the patients 22% stated that they had considered suicide and of these only 55% stated that they had no contact person for the psychological stress caused by the illness but 31% wished to have such aperson. Acoordinated care of ALS patients, which also takes the psychosocial aspects into account is urgently needed.

The influential factors of anxiety among caregivers of children with CL/P: a path analysis based on diathesis-stress theoretical model.

This study aims to validate a hypothesized model of the relationships between optimism, resilience, coping, parenting stress, perceived social support, and anxiety, as well as their influencing factors and consequences among caregivers of children diagnosed with cleft lip and/or palate (CL/P). A hypothesized model was proposed based on diathesis-stress theoretical model and existing literature. A convenience sample of two CL/P treatment centers in China was collected between April 2019 and July 2020. Various well-validated instruments were used to collect 248 valid data points. Descriptive statistics and correlations were computed to assess model fitness and path analysis was performed to investigate direct and indirect effects. The results revealed that the average level of anxiety among caregivers of children suffering from CL/P was 3.00 (0.00,6.00). The fitness of the modified path model was evaluated using various measures, including χ2/df = 1.806, GFI = 0.989, RFI = 0.916, IFI = 0.990, CFI = 0.989, TLI = 0.960, RMSEA = 0.0570. Parenting stress had the greatest direct associated with anxiety, followed by perceived social support. Moreover, indirect relations to anxiety were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress. In summary, this work suggests that both parenting stress and perceived social support in caregivers of children suffering from CL/P are associated with anxiety. Therefore, developing effective intervention approaches targeting key factors might potentially instrumental to alleviate anxiety.

The effect of cognitive control on addiction relapse

Background and Aims When entering substance abuse treatment centers, some individuals with substance use disorder relapse whilst others do not. Predicting who is likely to relapse or not would enable for more effective treatment by targeting those who are at increased risk. Previous research would indicate that aspects related to cognitive control including cognitive bias, inhibitory control, and working memory may all be strong indicators of relapse likelihood. Therefore, this paper explores whether aspects of cognitive control can predict relapse likelihood. Method Participants were patients in substance treatment centers who were abstaining. They were tested on measures of cognitive bias (REsT), inhibitory control (go/no-go), and working memory (nBack). A follow-up survey was then issued after a twelve-week period to ascertain whether participants had remained abstinent or if they had relapsed. Results Relative to abstainers, individuals who relapsed had shown significant impairments in working memory and inhibitory control at baseline. They had also demonstrated increased preoccupation with substance-related stimuli as indicated by the cognitive bias measure. Conclusions These findings demonstrate that deficits in cognitive control contribute to the maintenance of substance use disorder and substance usage. The results indicate that inhibitory and working memory deficits may contribute to initial engagement in substance abuse, followed by an increase in cognitive bias and further deficits in inhibitory control and WM contributing to an increased likelihood of relapse. This suggests that decreased cognitive control may increase relapse likelihood.

Health care workers hospitalized for COVID-19 in Liberia: who were they, and what were their outcomes?

Background Sustaining a ‘fit-for-purpose’ health workforce requires a better understanding of the health care worker cadres that are affected during pandemics and their outcomes. In hospitalized health care workers with confirmed COVID-19 between March 2020 and May 2023 in Liberia, we determined the hospitalization and case fatality rates, type of health care worker cadres affected, their demographic and clinical characteristics and hospital exit outcomes. Methods This was a cohort study using routine data extracted from hospitalization forms for health care workers in 24 designated COVID-19 treatment facilities. Results Of the 424 health care workers with COVID-19, hospitalization rates progressively declined between 2020 and 2023, (P<0.001) with the highest rates in 2020 (24/1,000 health care workers) and 2021 (14/1,000 health care workers). Case fatality was 2% in both 2020 and 2021 with no deaths thereafter. Among those hospitalized, the highest proportions were nursing cadres with 191(45%), physicians with 63 (15%) and laboratory technicians with 42 (10%). The most frequent reported site for COVID-19 infection was the health facility (326, 89%). COVID-19 vaccination coverage in health care workers was 20%. The majority (91%) of hospitalizations were for mild symptomatic infections. Even in referral centres (n-52), 18 (35%) were for mild infections. Of the 424 who were hospitalized, 412 (97%) recovered, 9 (2%) died and 3 (1%) either left against medical advice or absconded. Of the nine deaths, none were vaccinated, seven had moderate-to-severe disease but were not referred to specialized COVID-19 treatment centers. Conclusions The hospitalized health care workers for COVID-19 were predominantly clinical and laboratory personnel who were mostly unvaccinated, and health facilities were hot-spots for contracting infections. The triage and referral system was weak with unnecessary hospitalization of mild infections. This study provides useful insights for outbreak preparedness including priority vaccination and improving health care worker safety in Liberia.

Challenges associated with access to recently developed hemophilia treatments in routine care: perspectives of healthcare professionals.

The treatment landscape for haemophilia continues to rapidly develop, and expectations for future treatment success are high. There is limited information on the challenges to accessing new and innovative therapies. The aim of this study was to explore challenges with accessing haemophilia treatment from the perspective of healthcare professionals (HCPs). A crosssectional study design was used. A pilot-tested, online survey was distributed to haemophilia treatment centres in Australia, Canada, France, Italy, New Zealand, Republic of Ireland, Turkey, the United States, and the United Kingdom. The questionnaire covered questions on product access, economic considerations, health technology assessment requirements, and patient organization involvement. The results were analyzed descriptively using SPSS. A total of 154 HCPs completed the questionnaire. There was heterogeneity across countries, regions, and centres regarding HCPs' knowledge of access to novel recently developed treatments. Notable limitations to access were reported such as differences in access based on age of patient and type of product, economic considerations, and the growing influence of HTA bodies. Many countries have a hemophilia patient organization that does not have a vote at the decision-making table. There is a need to empower HCPs to better understand national healthcare structures and decisions that lead to access limitations. Requirements from HTA bodies must be understood to optimally design clinical studies and value generation of treatment options. This may strengthen the haemophilia treatment centre's voice to collectively mandate for exchange with key involved individuals, such as the payers and politicians for the provision of optimal therapy.

AHP SO07 - Dietetic Outpatient Service to Patients undergoing Oesophagogastric (OG) Surgery for Cancer

Abstract Background Nutrition is a modifiable risk factor impacting surgical outcomes in OG cancer. Its key role influencing health related quality of life is emerging with improved survivorship. Guidelines depicting optimal timing and type of dietetic intervention for this patient group are unclear. In order to best direct dietetic care, optimise timing of nutritional interventions and understand demand for service it is important to reflect on current provision. This audit aimed to describe the dietetic outpatient service to patients undergoing OG Surgery for cancer in a national centre for treatment of oesophageal cancer. Method A retrospective review of dietetic records and statistics. Patients who underwent oesophagectomy (O), gastrectomy (G) or subtotal gastrectomy (STG) for cancer between May 2022- May 2023 were included. Results 63 patients were included: 38 O, 17 TG, 8 STG. 11 were seen by the dietitian at first visit to OG Clinic (9 O, 1 TG, 1 STG) – 6 had an elective feeding tube (FT) inserted for neoadjuvant treatment (5 O, 1 STG). 83% attended a surgical pre-assessment dietetic appointment (36 O, 14 TG, 2 STG). 86% were reviewed within 1 month post O or TG, 75% post STG. 258 dietetic interventions occurred in the first year post-op (median 3.5, range 0-14). 64% in the first 3 months(m) post op, 16% at 3-6m, 10% at 6-9m, 10% at 9-12m. Conclusion In this high nutritional risk group only 18% are assessed by a dietitian at first visit to UGI MDT clinic. There is a successful pathway for immediate peri-operative dietetic care in patients post O and TG. The pathway for STG is less well established. Dietetic interventions are concentrated in the first 3 months after surgery. There is no established protocol to support longer term nutritional needs into survivorship. To inform practice a measure of patient experience and needs would be useful, to explore best delivery format and access routes to future services.

Evaluating attachment-based family therapy in residential treatment in the United States: does adolescents' increased attachment security to caregivers lead to decreases in depressive symptoms?

The inclusion of family therapy in residential treatment centers (RTCs) has increased over time. However, there is little data on whether empirically-supported family therapies (ESFTs) are being adopted and if they contribute to treatment effectiveness. This study aimed to test whether Attachment-Based Family Therapy (ABFT), an ESFT integrated into a large residential psychiatric system, would improve perceived attachment insecurity (anxiety and avoidance) and contribute to decreases in depression for adolescents. ABFT was integrated into the clinical program of a large, residential psychiatric system. All family therapists were trained to a level of certification. Improvement was measured by changes in adolescent's perceived attachment to caregivers and reduction in depressive symptoms. The sample included 4786 patients. Attachment insecurity and depressive symptoms were measured at intake, week 3, and week 5. A random-intercept, cross-lagged panel model was used to examine the relationships between attachment and depression over time. The results generally supported hypotheses. Attachment insecurity and depressive symptoms improved over the five weeks of treatment. Improvements in attachment avoidance preceded improvements in depressive symptoms within subjects, over time. Simultaneously, improvements in depressive symptoms preceded those in both dimensions of attachment. Thus, improvement in perceived attachment was associated with a reduction in depressive symptoms. RTCs that can generate improvements in attachment insecurity and depressive symptoms, via ABFT or other ESFTs, might improve treatment outcomes, and ideally, adolescents' successful transition back home to families. More research is needed to disentangle the contribution of ABFT and other treatment elements in a multimodal, residential treatment program. The study supports the call for increased incorporation of families into the RTC treatment process.

Incidence of new, non-physiologic maternal findings on fetal magnetic resonance imaging.

Fetal magnetic resonance imaging (MRI) is increasingly used for evaluation of fetal anomalies, and rates of incidental maternal findings are not well characterized. Our objective was to evaluate the rate of incidental maternal findings at the time of antenatal MRI performed for fetal indications. This was a retrospective cohort study that included all fetal MRIs performed between 2018-2023 at a single tertiary care institution with a multidisciplinary fetal diagnosis and treatment center. The electronic medical record was reviewed to identify all documented maternal findings and any new, non-physiologic maternal findings. The latter was defined as previously unknown abnormalities of maternal structures unrelated to normal physiology. Our study included 834 imaging events, performed at an average gestational age of 23 weeks. The most common indication for imaging was fetal anomaly (81.1%). The most common imaging type was fetal brain MRI (81.4%). Overall, 16.2% reported a maternal finding and 7% reported a new, non-physiologic finding. The most common new, non-physiologic findings were renal cysts (n=11), liver cysts (n=6), and gallstones or gallbladder sludge (n=5). Compared to imaging events that included a fetal brain MRI, imaging events that included a fetal body MRI had a significantly higher rate of any maternal findings (53.0% vs 10.4%, p< 0.001) and new, non-physiologic maternal findings (26.9% vs 3.7%, p< 0.001). Our results suggest that the risk of identifying new, non-physiologic maternal findings on fetal MRI is low. The rate of any maternal and new, non-physiologic maternal findings may differ by fetal MRI type due to differences in imaging depth and extent of radiology subspecialist review. These data should be incorporated into pre-test counseling for patients planning to have fetal MRI.

‘No ability to choose freedom’: a qualitative study on people who use drugs’ experiences of compulsory isolation treatment

Background Extensive criminological literature has paid attention to the exacerbation of disadvantage due to compulsory treatment of drug use within vulnerable communities. However, understanding how compulsivity shapes users’ narrative framework and meaning construction of lives is still limited. Methods Based on an ethnography conducted at a Compulsory Isolation Treatment Center (CITC) in Central China, we collect in-depth interview data about how trainees who were convicted as drug dependents experienced and interpreted compulsory treatment in the context of life history. Our coding and case analysis of data illustrate four representative narratives on rehabilitation and reveal different ways of meaning-giving between each other. Results Our finding shows that the experience of incarcerated detoxification did not relieve the social disadvantages of people who use drugs. Instead, it was perceived as a negative encounter that intensified discrimination, deeply ingrained in social identity and constantly resurfaced in everyday life. Specifically, harmful experiences are generated by the punitive management of CITC, which underlines obedience between instructors (police officers) and trainees and encourages mutual distrust among peers. The crippling of interpersonal relationships prevents participants from developing social connections or restoring social skills. We also find trainees’ diverse coping strategies to the punitive institutions, ranging from showing physical weakness for board shelter catering to the standard of conduct for an early release to deciphering the intricacies of power relations in CITC. However, these temporary strategies cannot balance their permanent estrangement from public life and thus make them descend into the invisible confines of societal imprisonment. Implications Our ethnographic descriptions reveal the deliberated production of punishment and isolation in the process of compulsory isolation treatment and explicate the potential proximity between political correctives and drug treatment. We, thus, promote abolishing the compulsory isolation model in China, which stems not only from the inefficiency of the treatment at the medical level but also from the political motivations behind the institution and the superficiality of its moral reshaping.

Identification of Post-Tuberculosis Lung Function Impairment Early during the Course of Treatment.

Tuberculosis (TB) is a leading cause of morbidity and mortality and an important contributory factor to chronic lung disease. TB-associated permanent lung damage manifests with varying levels of respiratory disability long after TB has been successfully treated, which is a condition known as post-TB lung disease (PTLD). This study assessed whether lung function impairment associated with PTLD occurs early during TB treatment. Using a cross-sectional design, we enrolled newly diagnosed adult TB patients aged ≥18 years who had received anti-TB medication for ≥2 months from a large treatment center in northern Nigeria. We used spirometry and the Global Lung Initiative 2012 reference equations for African Americans to assess and characterize lung function for enrolled participants (N = 94). The median age (range) of participants was 34 (18-72) years. Approximately 5.3% (n = 5) of participants exhibited features of abnormal lung function, 4.2% (n = 4) showed features of obstructive lung abnormality, and 1.1% (n = 1) showed restrictive lung abnormality. Compared with historical patients recruited ≥6 months after TB treatment in the same center, our participants had significantly lower forced expiratory volume in one second and forced vital capacity values. Our findings suggest an opportunity for early intervention for primary and secondary prevention of PTLD to reduce the impact of severe respiratory impairment.

A case study on COVID-19 infected patient&amp;rsquo;s experience - challenging journey at Colombo East Base Hospital- Mulleriyawa

This study investigates the patient experience within the COVID-19 treatment centre at Colombo East Base Hospital, Mulleriyawa, amidst the global pandemic. A cross-sectional descriptive study was conducted over one month, involving 30 participants recruited through convenience sampling. Participants completed self-administered questionnaires assessing various aspects of care, including staff interaction, cleanliness, health education, counselling, and attention to health-related matters. Results indicate high levels of satisfaction among participants across multiple care domains, with the majority expressing satisfaction with staff interaction, cleanliness, health education, counselling, and attention to health-related matters. These findings underscore the healthcare delivery system's effectiveness in meeting patients' diverse needs and expectations during the pandemic. The study highlights the importance of patient-centred care in promoting positive patient experiences and outcomes, particularly in the context of public health emergencies. Recommendations include sustaining and enhancing best practices in healthcare delivery, prioritizing infection prevention and control measures, and promoting effective communication and patient education. By prioritizing patient-centred care and continuous quality improvement initiatives, healthcare providers can ensure the safety, satisfaction, and well-being of patients amidst crises such as the COVID-19 pandemic.

HHS OIG finds Medicaid and physicians limit access to MOUD

A new report has found that even patients with insurance coverage, especially from Medicaid in certain states, are less likely to receive medications for opioid use disorder (MOUD) because providers are just unwilling to treat them. Young people are most likely particularly victims of this bias, which is understandable on the part of physicians who have not been trained in prescribing buprenorphine. (Methadone can only be prescribed for OUD in certain specific treatment centers called opioid treatment programs, which also dispense the medication.)

PECULIARITIES OF FATAL CASES IN HIV-INFECTED PATIENTS WITH CENTRAL NERVOUS SYSTEM LESIONS IN TUBERCULOSIS INPATIENT SETTINGS FOR 2014-2023

Aim of the work is to study the peculiarities of fatal cases of CNS lesions in patients with tuberculosis against the background of HIV infection.Materials and methods. A retrospective analysis of 68 medical histories of tuberculosis patients with HIV infection who died in the CNE "Zaporizhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center" for the years 2014-2023 was carried out. An analysis of the anamnesis, clinical and radiological data, laboratory indicators, final clinical and pathological diagnoses was carried out.Results. The mortality rate among HIV-infected people in TB hospitals has a steady downward trend. In 2014-2023, 1234 patients with HIV infection were treated at the CNE "Zaporizhia Regional Phthisiopulmonology Clinical Treatment and Diagnostic Center", 214 (17.3%) died. In 2014, 33 (24.6%) out of 134 HIV-positive patients died, and in 2023, 3 (6.8%) out of 44 HIV-positive patients died. Central nervous system (CNS) lesions among the dead were noted in 68 (31.8%) patients. The study of medical records found that among those who died with CNS lesions, men prevailed - 55 (80.9%), women - 13 (19.1%), young patients - 53 (77.9%), and 15 (22.1%) patients over 45 years of age. In the structure of central nervous system lesions in patients with active tuberculosis, tuberculous meningoencephalitis prevails in fatal cases - 35 (51.5%), a significant share of cryptococcal meningoencephalitis - 18 (26.5%) and progressive multifocal leukoencephalopathy - 9 (13.2%). The main reason that leads to fatal consequences is the late diagnosis of HIV infection - in 26 (38.2%) the number of CD4&lt;50 cl./μl, 36 (52.9%) patients did not receive antiretroviral therapy (ART), 18 (26 .5%) of patients had been taking ART for a year. Improvement of tuberculosis microbiological diagnosis due to the introduction of the Xpert MTB/RIF® (Ultra) test at all levels of the laboratory network, the introduction of a mandatory test for cryptococci, free CT, MRI examination for the diagnosis in HIV-infected patients, improvement of drug-resistant tuberculosis treatment regimens contributed to the reduction of mortality in case of HIV and tuberculosis combination, which was 24.6% in 2014, and 6.8% in 2023.Conclusions. Diagnosis and treatment of CNS diseases in patients with active tuberculosis against the background of HIV infection requires a comprehensive approach: early diagnosis of HIV infection, tuberculosis and lesions of the CNS, improvement of treatment.

Clinical profile, risk factors, disease severity, and outcome for COVID-19 disease in patients with tuberculosis on treatment under the National Tuberculosis Elimination Program: a cohort of 1400 patients.

COVID-19 affected millions of people worldwide, and tuberculosis (TB) continues to affect millions of people each year. The combined pandemic of COVID-19 and TB had a catastrophic effect on healthcare policies and healthcare setups around the globe. The clinical profile and factors affecting the outcome of COVID-19 disease in TB patients on treatment in field conditions have not been studied in detail. The present study attempted to study the occurrence of COVID-19 among patients on TB treatment in terms of severity of COVID-19 disease and outcome of both COVID-19 and TB in patients at National Tuberculosis Elimination Program treatment centers over a period of one year during peak COVID-19 times. Out of 1400 TB patients enrolled, 65 (5%) suffered from COVID-19 disease. Of the 65 TB patients with COVID-19 disease, 37 (57%) were male and under 45 years old, 33 (51%) had a TB diagnosis after first receiving a COVID-19 diagnosis, 29 (45%) had a TB diagnosis first, and received anti-TB treatment before receiving a COVID-19 diagnosis, and only 3 patients (5%) had a COVID-19 and TB diagnosis concurrently. The majority of 59 (91%) patients had mild COVID-19 disease. The outcome of TB treatment was available in 25 patients out of these 65 COVID-19-positive patients, with 21 (84%) patients having a favorable outcome. Out of the 65 COVID-19-positive patients, 4/25 (16%) had unfavorable outcomes, with one patient (4%) failing TB treatment and two patients (8%) dying. This is the first study from India that studied the occurrence and course of COVID-19 among a large number of TB patients taking anti-TB treatment under programmatic conditions. Due to the similarity in symptoms of TB and certain viral respiratory illnesses, a protocol should be established for health care to check patients for both illnesses.

Psychometric Evaluation of the Dutch version of the Substance Use Recovery Evaluator (SURE-NL).

Introduction Patient-Reported Outcome Measures (PROMs) are an important source of information that allow for a patient-centered assessment. Outcome measurement of substance use disorder (SUD) treatment traditionally focuses on drug use and deficits in functioning, overlooking other aspects of the personal and dynamic process of recovery. The Substance Use Recovery Evaluator (SURE) is a PROM developed with service user input to monitor the recovery journey and assess treatment outcomes in people with SUD. The objective of this study was to examine the validity and reliability of the Dutch translation of the SURE, the SURE-NL, for measuring indicators of recovery in Dutch-speaking patients with SUD. Methods The original SURE questionnaire was translated from English to Dutch using forward-backward translation. A total of N=171 participants were recruited as part of a naturalistic multicenter study in inpatient (N=149) and outpatient (N=22) SUD treatment centers. We examined the factorial structure, reliability, and concurrent and discriminant validity of the SURE-NL. Results The original 5-factor structure of the SURE showed acceptable fit for the SURE-NL, and internal consistencies of the subscales ranged from .61 to .76 and internal consistency of the total score was .83. Concurrent validity was confirmed through positive correlations of the SURE-NL total and subscale scores with the WHOQoL-BREF subscales, but correlations varied depending on subscale and treatment setting, with higher correlations for the outpatient compared to the inpatient subgroup. Discriminant validity was confirmed through low, mostly non-significant correlations between the SURE-NL and the DASS-21. Conclusions Although the SURE was originally designed for outpatient settings, our findings in a predominantly inpatient sample indicate that the SURE-NL is suitable for assessing personal recovery and recovery capital in Dutch-speaking Belgian patients with SUD. However, subscales should be used and interpreted with caution. Further research is needed with larger Dutch-speaking outpatient samples and the development of a tailored SURE for inpatient settings should be considered.

Identifying barriers and opportunities to facilitate the uptake of whole genome sequencing in paediatric haematology and oncology practice

BackgroundThe clinical utility of whole genome sequencing (WGS) in paediatric cancer has been demonstrated in recent years. WGS has been routinely available in the National Health Service (NHS) England for all children with cancer in England since 2021, but its uptake has been variable geographically. To explore the underlying barriers to routine use of WGS in this population across England and more widely in the United Kingdom (UK) and the Republic of Ireland (ROI), a one-day workshop was held in Cambridge, United Kingdom in October 2022.MethodsFollowing a series of talks, delegates participated in open, round-table discussions to outline local and broader challenges limiting routine WGS for diagnostic work-up for children with cancer in their Principal Treatment Centres (PTCs) and Genomic Laboratory Hubs (GLHs). Within smaller groups, delegates answered structured questions regarding clinical capability, education and training needs, and workforce competence and requirements. Data was recorded, centrally collated, and analysed following the event using thematic analysis.ResultsSixty participants attended the workshop with broad representation from the 20 PTCs across the UK and ROI and the seven GLHs in England. All healthcare professionals involved in the WGS pathway were represented, including paediatric oncologists, clinical geneticists, clinical scientists, and histopathologists. The main themes highlighted by the group in ensuring equitable access to WGS identified were: lack of knowledge equity between NHS trusts, with a perception of WGS being for research only; and perception of lack of financial support for the clinical process surrounding WGS, including lack of time to take informed consent from patients. The latter also included limited trained staff available for data interpretation, affecting the turnaround time for reporting. Finally, the need for an integrated digital pathway to order, track, and return data to clinicians was highlighted.ConclusionAt the workshop, the general motivation for including WGS in the diagnostic work up for children with cancer was high throughout the UK, however a perceived lack of resources and education opportunities limit the widespread use of this commissioned assay. This workshop has led to some recommendations to increase access to WGS in this population in England and more widely in the devolved national of the UK and the ROI.

A randomized controlled trial on the effect of cranial electrotherapy stimulation on depression, anxiety, and craving in addicted male patients undergoing methadone maintenance treatment.

Addicted patients undergoing methadone maintenance treatment are prone to several complications and the risk of relapse. The present study aims to investigate the effect of cranial electrotherapy stimulation on depression, anxiety, and craving in addicted male people undergoing methadone maintenance treatment. This randomized controlled trial study was conducted on 60 male patients referred to Persia addiction treatment center between 2021 and 2022. Patients were randomly divided into two equal treatment and placebo groups. The treatment group received cranial electrotherapy stimulation intervention for 48 sessions of 30min. Depression and anxiety were evaluated using the Hamilton questionnaire before and after the intervention, and the level of craving was also evaluated with the Federdi 2008 questionnaire. Comparing the level of depression and anxiety before and after the intervention in both treatment and placebo groups did not show any significant difference (p < 0.05). Craving after the intervention was significantly different in both groups and was lower in the treatment group compared to the placebo group (33.43 versus 42.17, p = 0.004). In the placebo group, the level of anxiety and depression, and in the treatment group, the level of depression, anxiety and craving for consumption decreased significantly after the intervention compared to before the intervention (p < 0.05). Cranial electrotherapy stimulation did not have a significant effect on reducing the level of depression and anxiety of patients, but it is effective in the reduction of craving in addicted people undergoing methadone maintenance treatment. This randomized clinical trial was registered on 2022/5/13 with clinical trial code of IRCT20210523051367N1.

An Optimization Framework for Waste Treatment Center Site Selection Considering Nighttime Light Remote Sensing Data and Waste Production Fluctuations

As urbanization accelerates, the management of urban solid waste poses increasingly intricate challenges. Traditional urban metrics, such as GDP and per capita consumption rates, have become inadequate for accurately reflecting the realities of waste generation; moreover, the linear correlation between these metrics and waste production is progressively diminishing. Consequently, this study introduces a novel methodology leveraging nighttime light remote sensing data to enhance the precision of urban solid waste production forecasts. By processing remote sensing data to mitigate noise and integrating it with conventional urban datasets, an innovative index system and predictive model were developed. Using Beijing as a case study, the gradient boosting regression algorithm yielded a prediction accuracy of 92%. Furthermore, in light of the substantial costs associated with waste recovery route planning and site selection for treatment facilities, this research further devised a location and distribution framework for waste treatment centers based on high-precision predictions of waste production while employing multi-objective evolutionary algorithms (MOEAs) alongside the non-dominated sorting genetic algorithm II (NSGA-II) for optimization. Distinct from prior studies, this study suggests that service point waste quantities are not fixed values but rather adhere to a normal distribution within specified ranges and thus provides a more realistic simulation of fluctuations in waste production while enhancing both the robustness and predictive accuracy of the model. In conclusion, by incorporating nighttime light remote sensing data along with advanced machine learning techniques, this study markedly improves forecasting accuracy for waste production while offering effective optimization strategies for site selection and recovery route planning—thereby establishing a robust data foundation aimed at refining urban solid waste management systems.

Lived experience and lessons learned from the support of two secondary eye care units to improve cataract surgery and refractive services in two regions of Ethiopia: health system-strengthening support.

Blindness and poor eyesight are significant public health issues globally and specifically in Ethiopia. In Ethiopia, there is limited access to cataract surgery and refractive error treatment centers. Therefore, this study aimed to evaluate the role of health system support in improving access to eye care services, particularly cataract surgery and refractive error treatment services in two secondary eye care units (SECUs). A parallel mixed-lived experience study was conducted in two SECUs. A desk review of relevant project documents and health facility activity reports was performed for quantitative data. The study was conducted from 12 December 2022 to 30 January 2023. A total of 21 in-depth interview participants were included. Overall, 14 106 cataract surgeries were performed during the pilot project implementation period. Assela Teaching and Referral Hospital Eye Care Unit performed cataract surgery 20-30 times per week. Similarly, Debre Tabor Comprehensive Hospital performed cataract surgery 18-24 times per week. The refractive service of the two SECUs was planned to range from 15-30 to 60 per week, and the refractive services were increased from 50-60 per week in both eye care units. This project has significantly helped the existing health system achieve the 2030 global target and has improved access to eye care services in selected SECUs. The use of cataract surgery and refractive error performance markedly increased from 0 to 100%.