Use Of Alternative Approaches Research Articles

Co-designing restrictive practice elimination: A systems thinking approach with mental health service users and practitioners in rural/regional Australia.

Elimination of restrictive practices (physical/mechanical restraint and seclusion) from adult acute mental health care services has been demanded internationally for many decades. This study aimed to: (1) Identify priority issues in the elimination of and use of alternative approaches to restrictive practices (seclusion and physical/mechanical restraint) in rural/regional acute adult mental healthcare services, as told by mental healthcare service users and practitioners, (2) identify the community-based, system-level feedback loops that enhance or reduce the use of restrictive practices and viable alternatives and, (3) identify potential action areas to improve system structures to increase regional mental healthcare services' ability to eliminate restrictive practices and use alternative approaches. Group model building (GMB) workshops were held with a small group (n = 9) of mental healthcare practitioners and service users with lived experience of restrictive practice use. This participatory approach enables exploration and visual mapping of local structures causing behaviour patterns of practitioner and service user concern over time - in this case, the barriers, and enablers to alternative approaches to restrictive practices in adult acute mental healthcare services within the Geelong-Barwon region. This is the first study that specifically applies GMB in the discussion of the elimination of restrictive practices in mental health in the non-metropolitan regional/rural context. Participants identified four key priorities in relation to eliminating restrictive practices: (1) self-advocacy, (2) continuity of care, (3) early intervention, and (4) safety for all. The study findings were distilled into a novel preliminary set of mental healthcare practitioner and service user action ideas.

Market power and wages in Russian local labor markets

The paper investigates the relationship between market power of employers and level of employees’ wages in local labor markets in Russia. The study is based on the modern concept of local labor markets, which assumes that the latter have not only geographical (spatial), but also sectoral (professional) boundaries. Using data from the web portal of Rostrud “Rabota Rossii” (Jobs of Russia) about 13.2 million vacancies posted in the period 2018Q1—2022Q3, for the first time in Russian practice concentration indicators were calculated for 30 thousand local labor markets in Russia, determined by a pair of properties “settlement— profession”. It is shown that 20% of local labor markets of mass professions in Russia are characterized by at least a temporary state of monopsony. Using the methods of economic-mathematical (econometric) modeling, it is demonstrated that the growth of the market power of employers is statistically significantly associated with a decrease in the wages of workers in mass professions. According to the estimates obtained, when moving from the 25th to the 75th percentile of the distribution of market power, the level of nominal wages offered to employees in local labor markets, other things being equal, decreases by 6.3—8.4%. The result is robust to the use of alternative approaches to defining the boundaries of local labor markets in Russia.

Exploring alternative normalization approaches for life cycle assessment

PurposeThis work investigates the use of alternative approaches to normalization in life cycle assessment (LCA) and shows the relevance of the normalization step in the interpretation of the results of life cycle impact assessment (LCIA) by testing the use of five alternative normalization sets.MethodsFive normalization sets are applied and compared. The five sets are based on the following: (i) a production-based approach at global and (ii) at EU level; (iii) a consumption-based approach at EU level based on process-based LCA; (iv) a consumption-based approach at EU level based on environmental extended input/output; and (v) a planetary boundaries-based approach. The five normalization sets are applied to the environmental impacts of 144 products, and the resulting normalized impacts are aggregated into a single score by adopting two alternative weighting sets to investigate how the adoption of different normalization and weighting sets can affect the interpretation of LCIA results. The relative contribution of each impact category to the single score is derived and the ranking of impact categories is compared for each normalization and weighting option.Results and discussionThe relative contribution of the impact categories to the aggregated score of a product is significantly affected by the choice of the normalization set and to a lesser extent by the application of different weighting sets. The main benefits and limitations of each normalization approach presented are discussed together with their implications on the interpretation of the results deriving from the application of each set.ConclusionsThe dominating role of the normalization step on the interpretation of the results emphasizes the need to choose the most suitable normalization set according to the goal and scope of the study and to make sure that normalization references are based on comprehensive inventories of emissions and resources, well aligned with the impact assessment methods used in terms of coverage and classification, to avoid the risk of biased normalization. Future research needs for developing more robust and comprehensive normalization sets are identified.

Comparing internal versus external carotid artery branch delivery of intraarterial chemotherapy for the treatment of retinoblastoma.

The goal of this study was to compare the efficacy of intraarterial chemotherapy (IAC) for retinoblastoma delivered via the ophthalmic artery (OA) division of the internal carotid artery (ICA) versus alternative branches of the external carotid artery (ECA). We performed a retrospective chart review of patients receiving IAC for retinoblastoma at a single institution. Subjects were divided into three groups: those that received IAC solely through the OA branch of the ICA, those that initially received IAC through the OA branch of the ICA but were later switched to the ECA, and those that only received IAC through the ECA. The main outcomes compared included globe salvage rate and reduction in tumor thickness and size. A total of 30 eyes from 26 patients were included. A total of 91 (58%) sessions of IAC were performed through the OA division of the ICA and 65 (42%) were performed through branches of the ECA. Eleven eyes (37%) solely received IAC through the OA branch of the ICA, 16 eyes (53%) were converted to ECA treatment, and 3 eyes solely received IAC through branches of the ECA. Statistical analysis did not show any significant difference in globe salvage rate or reduction in tumor thickness and size. The use of alternative approaches for IAC when the OA branch of the ICA catheterization is not feasible allows for safe continued delivery of highly effective IAC, leading to similar outcomes in terms of globe salvage and reduction in tumor size.

Identifying the barriers to alternative approaches for behaviour management in schools

Each year, many children are excluded from school in England. Often, exclusion from school is the result of an escalating cycle of challenging behaviour and punitive responses. Despite this, there is still limited use of alternative approaches for behaviour management in schools, with a continued focus on systems of rewards and sanctions. The main aim of this study is to explore senior leaders’ perceptions of the barriers to implementing alternative approaches for behaviour management in schools. Semi-structured interviews were conducted with 14 senior school leaders and analysed using Interpretative Phenomenological Analysis. Key barriers identified included: time and resources; the perceptions of others; and risk aversion. These barriers contribute to the continued use of punitive responses to challenging behaviour in schools. This suggests that there is a need for support to enable schools to overcome these barriers and widen the options available as alternatives to exclusion from school.

Structural proteins of SARS-CoV-2

The review presents the basic information available in the literature on the structural proteins of SARS-CoV-2 (S;N;E;M). Issues affecting the importance of these proteins in the pathogenesis, adaptation and life cycle of the virus are discussed. Structural multifunctional proteins are biomarkers of increased contagiousness and pathogenicity of SARS-CoV-2, forming its pathogenetic and adaptive potential. The multifunctionality of the structural proteins of the new coronavirus allows it to respond quickly to fluctuations in the conditions of existence through the use of alternative approaches to implement the mechanisms underlying its pathogenetic potential. Currently, the structure, properties, functions and role of structural proteins of SARS-CoV-2 are being actively studied, which is an actual vector of research that allows us to decipher the mechanisms underlying its high contagiousness, pathogenicity, adaptation, and in the future to evaluate possible ways of forming its new variants and develop a strategy and tactics of emergency response when it appears new strains.The prospects of further study of the structure and properties of structural proteins for solving the priority tasks of the present time on the creation of modern domestic vaccines and effective methods of diagnosis, treatment and prevention of a new coronavirus are noted.The authors analyzed scientific publications from various databases of electronic libraries, such as PubMed, e-library, CyberLeninka, etc.

Current Technical Approaches to Study RNA–Protein Interactions in mRNAs and Long Non-Coding RNAs

It is commonly understood that RNA-binding proteins crucially determine the fate of their target RNAs. Vice versa, RNAs are becoming increasingly recognized for their functions in protein regulation and the dynamics of RNA-protein complexes. Long non-coding RNAs are emerging as potent regulators of proteins that exert unknown RNA-binding properties and moonlighting functions. A vast array of RNA- and protein-centric techniques have been developed for the identification of protein and RNA targets, respectively, including unbiased protein mass spectrometry and next-generation RNA sequencing as readout. Determining true physiological RNA and protein targets is challenging as RNA–protein interaction is highly dynamic, tissue- and cell-type-specific, and changes with the environment. Here I review current techniques for the analysis of RNA–protein interactions in living cells and in vitro. RNA-centric techniques are presented on the basis of cross-linking or the use of alternative approaches. Protein-centric approaches are discussed in combination with high-throughput sequencing. Finally, the impact of mutations in RNA–protein complexes on human disease is highlighted.

Implementing an online peer tutoring intervention to promote reading skills of elementary students: Effects on fluency and accuracy

The global COVID-19 pandemic disrupted face-to-face teaching, having a significant impact on the teaching-learning process. As a result, many students spent less time reading (and learning to read) than they did during face-to-face instruction, requiring the use of alternative approaches of instruction. A combined online and peer tutoring intervention was designed to improve reading skills such as fluency and accuracy. Following a quasi-experimental design, this study sought to evaluated the impact of implementing an online peer tutoring intervention on the development of reading fluency and accuracy in a sample of 91 2nd and 4th graders (49.6% female). Children were aged 6–10 years old (M = 7.81, SD = 1.10) and were enrolled in five classrooms (A, B, C, D, and E) from three schools in the Portuguese district of Porto, between January and May 2021. A set of 10 texts were chosen from official textbooks to assess reading fluency and accuracy. Classes were evaluated in three moments: initial (pre-intervention), intermediate (after 10 sessions) and final (post-test, after other 10 sessions). In order to examine the effects of the intervention, there was a 8-week lag between the start of the intervention in classes A, B, and C (experimental group) and classes D and E (control group). Moreover, classes D and E started intervention with a gap of 5 weeks between them. Students in the experimental group registered significant higher improvements in reading accuracy and fluency than in the control group. Interaction effects revealed that students with an initial lower performance (i.e., at the frustration level) showed higher increases in reading accuracy. Furthermore, 2nd graders showed higher increases throughout the intervention while the 4th graders stablished their progress after the first 10 sessions of intervention. Despite the study’s limitations, the findings support the positive impact that online peer tutoring can have on promoting students’ reading skills, adding to the ongoing discussion—which has gained a special emphasis with the COVID-19 pandemic—about the development of effective strategies to promote reading abilities in the first years of school.

¿Cuándo llega el desarrollo? Transformaciones e incertidumbre en una pequeña comunidad rural de Marruecos

Development has always been a controversial issue, with multiple views surrounding it. However, theoretical discussions have rarely been transferred to the empirical field and have been confronted with the life experience of populations. The objective of this article is to delve into the implications of the implementation of development from the case of a small community located in the central mountains of Morocco. Our basic hypothesis is that understanding development remains complex, while requiring the integration of the views of different actors and the use of alternative approaches. From the continuous contact over time with the community, both on the field and from distance, we show the transformations that have taken place in it and the dilemmas that it still faces after two decades of development.

Comparing Domain-Specific Self-Efficacy in Pediatric Physical Therapy Education Across Classroom-Based, Online, and Hybrid Curriculum Designs.

To describe the pediatric curriculum across 3 years when different instructional designs were used, quantify change in self-efficacy (SE) after completing the curriculum, and define relationships between pediatric experience, SE, and interest in future pediatric practice. Students (N = 137) were included over 3 consecutive years. Instructional design varied across cohorts: classroom-based (n = 48), online (n = 44), and hybrid (n = 45). Pediatric content hours were analyzed. Measures were the Pediatric Communication and Handling Self-Efficacy Scale, pediatric experience, and interest in future pediatric practice. Pediatric content hours met published recommendations. Significant growth in SE occurred for all cohorts, with no significant differences in SE scores based on instructional design. Experience and interest in pediatrics were significantly related to communication SE. The pediatric physical therapy curriculum delivered via classroom-based, online, or hybrid instruction can be effective in promoting pediatric-specific growth in student SE. Remote pediatric experiential learning is a feasible option for physical therapy programs with limited direct contact with children. What this adds to the evidence : When pediatric curricula meet recommended total hours of instruction, regardless of instructional method or amount of direct laboratory time with real children, pediatric-specific student SE increases. This supports the use of alternative approaches for experiential learning activities in programs with limited access and availability for direct in-person child interactions. Programs may expand integrated clinical experiences (ICE) opportunities to include telehealth when in-person ICE is limited due to distance or availability in nearby clinical settings. Online learning activities (asynchronous or synchronous) may be viable options for laboratory activities when live child volunteers are limited or unavailable. Use of multiple methods of instruction (classroom-based, online, or hybrid) can be beneficial in covering pediatric physical therapy content and improving SE. This evidence can help programs expand their options for exposing student physical therapists to pediatric practice.

Informed consent in pragmatic trials: results from a survey of trials published 2014–2019

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not...

Solutions for hematocrit bias in dried blood spot hormone analysis.

Over the last years, dried blood spot (DBS) sampling has gained significant interest due to development of analytical techniques combined with DBS, the simplicity and low cost of the method. Despite its wide use, DBS sampling can lead to inaccurate results due to the impact of the hematocrit (Hct) on the analysis. Some analytes have shown to be hardly impacted by Hct values. However, in other cases, a significant impact of Hct is observed, which requires the use of alternative approaches to circumvent this issue. This review describes the possible impact of Hct-related bias in DBS sampling in the context of hormone analysis and discusses the different methodologies that can be used to overcome this bias to ensure accurate results.

SUSTAINABLE DEVELOPMENT IN LOW CARBON, CLEANER AND GREENER ENERGIES AND THE ENVIRONMENT

The increased availability of reliable and efficient energy services stimulates new development alternatives. This article discusses the potential for such integrated systems in the stationary and portable power market in response to the critical need for cleaner energy technology. Several issues relating to renewable energies, environment, and sustainable development are examined from both current and future perspectives throughout the theme. It is concluded that green energies like wind, solar, ground source heat pumps, and biomass must be promoted, implemented, and demonstrated from the economic and/or environmental point of view. Biogas from biomass appears to have potential as an alternative energy source, potentially rich in biomass resources. The current literature is reviewed regarding the ecological, social, cultural and economic impacts of biogas technology. Finally, this article gives an overview of the present and future use of biomass as an industrial feedstock to produce fuels, chemicals and other materials. However, to be truly competitive in an open market situation, higher-value products are required. Results suggest that biogas technology must be encouraged, promoted, invested, implemented, and demonstrated, especially in remote rural areas. Anticipated future energy use patterns and consequent environmental impacts (acid precipitation, ozone depletion, greenhouse effect, or global warming) are discussed in this article. An approach is needed to integrate renewable energies in a way to meet high building performance. However, their ability to match demand is determined by adoption of one of the following two approaches: the utilisation of a capture area greater than that occupied by the community to be supplied, or the reduction of the community’s energy demands to a level commensurate with the locally available renewable resources. Adopting green or sustainable approaches to how society is run is seen as an important strategy in finding a solution to the energy problem. The key factors to reducing and controlling CO2, which is the major contributor to global warming, are the use of alternative approaches to energy generation and the exploration of how these alternatives are used today and may be used in the future as green energy sources.

The cost effectiveness of lenvatinib versus atezolizumab and bevacizumab or sorafenib in patients with unresectable hepatocellular carcinoma (uHCC) in Canada.

4098 Background: Hepatocellular carcinoma (HCC) represents 72% of liver cancers in Canada. In the phase III REFLECT trial, lenvatinib met the primary endpoint of non-inferiority in overall survival (OS) versus sorafenib and demonstrated superiority in secondary endpoints of progression free-survival (PFS), time to progression and objective response rate. Based on the REFLECT trial, lenvatinib has become the standard of care in the treatment of Canadian patients with unresectable HCC (uHCC). In the Phase III IMbrave150 trial, the use of the combination of atezolizumab and bevacizumab (atezo+bev) resulted in statistically significant improvement in OS and PFS versus sorafenib for patients with uHCC. The aim of this analysis was to estimate the cost-effectiveness of lenvatinib versus atezo+bev or sorafenib as first-line treatment for patients with uHCC from the perspective of Ministry of Health in Canada. Methods: A cost-utility analysis was conducted using a partitioned survival analysis. Health state membership for lenvatinib and sorafenib were estimated based on patient level data and clinical inputs from REFLECT and extrapolated using parametric survival models. Relative efficacy for atezo+bev was estimated from a de novo network meta-analysis. In the base-case analysis, estimates from REFLECT used in the NMA were adjusted for imbalances in baseline characteristics. Sensitivity analyses included the use of alternative approaches to determine relative efficacy. Health state utility values were determined with EQ-5D data collected in REFLECT. Drug acquisition costs were obtained from publicly available sources and medical resource utilization was based on a survey of Canadian clinicians. The time horizon was 10 years. Results of the incremental analysis were calculated sequentially. Results: In the base case lenvatinib was associated with cost savings of CAD$4,640 and CAD$120,095 and a QALY difference of 0.15 and -0.28 vs sorafenib and atezo+bev, respectively. The base case deterministic analysis resulted in lenvatinib being dominant over sorafenib and cost-effective vs. atezo+bev (sequential ICER for atezo+bev was CAD$425,754 per QALY). Results of the probabilistic sensitivity analysis (PSA) were consistent with the base case findings with lenvatinib being the optimal treatment strategy in >99% of iterations. Conclusions: Results of this analysis demonstrate that lenvatinib represents the optimal use of healthcare resources as a first-line treatment for uHCC in Canada.

The Time Is Now: A FASTER Approach to Generate Research Evidence for Technology-Based Interventions in the Field of Disability and Rehabilitation

Current approaches for generating high-quality research evidence for technology-based interventions in the field of disability and rehabilitation are inappropriate. Prevailing approaches often focus on randomized controlled trials as standard and apply clinical trial practices designed for pharmaceuticals; such approaches are unsuitable for technology-based interventions and are counterproductive to the goals of supporting people with disabilities and creating benefits for society. This communication is designed to: (1) advocate for the use of alternative approaches to generating evidence in the development and evaluation of technology-based interventions; (2) propose an alternative framework and guiding principles; and (3) stimulate action by multiple disciplines and sectors to discuss, adopt, and promote alternative approaches. Our Framework for Accelerated and Systematic Technology-based intervention development and Evaluation Research (FASTER) is informed by established innovation design processes, complex intervention development, evaluation, and implementation concepts as well as our collective experiences in technology-based interventions research and clinical rehabilitation practice. FASTER is intended to be meaningful, timely, and practical for researchers, technology developers, clinicians, and others who develop these interventions and seek evidence. We incorporate research methods and designs that better align with creating technology-based interventions and evidence for integration into practice. We propose future activities to improve the generation of research evidence, enable the selection of research methods and designs, and create standards for evidence evaluation to support rigor and applicability for technology-based interventions. With this communication we aim to improve and advance technology-based intervention integration from conception to use, thus responsibly accelerating innovation to have greater positive benefit for people and society.

Open-label placebo for chronic low back pain: a 5-year follow-up.

Long-term follow-up of patients treated with open-label placebo (OLP) are nonexistent. In this article, we report a 5-year follow-up of a 3-week OLP randomized controlled trial (RCT) in patients with chronic low back pain. We recontacted the participants of original RCT and reassessed their pain, disability, and use of pain medication. We obtained follow-up data from 55 participants (82% of those who took OLP during the parent RCT), with a mean elapsed time between the end of the 3 weeks placebo trial and the follow-up interview of 55 months (SD = 7.85). We found significant reductions in both pain and disability between the baseline assessment immediately before the 3 weeks trial with placebo pills and the original trial endpoint (P < 0.00001 for the 2 primary outcomes of pain and disability). At the 5-year follow-up, we found no significant differences in either outcome between original trial endpoint and follow-up. Improvements persisted after 5 years and were accompanied by substantial reductions compared with baseline in the use of pain medication (from 87% to 38%), comprising analgesics (from 80% to 31%), antidepressants (from 24% to 11%), and benzodiazepines (from 15% to 5%). By contrast, the use of alternative approaches to pain management increased (from 18% to 29%). Although the reduction in pain and medication is comparable with the improvements that occurred in the original study, a major limitation of this long-term follow-up is the absence of controls for spontaneous improvement and new cointerventions. Nonetheless, our data suggest that reductions in pain and disability after OLP may be long lasting.

Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia

Introduction: Formal dementia ascertainment with research criteria is resource-intensive, prompting the growing use of alternative approaches. Our objective was to illustrate the potential bias and implications for study conclusions introduced through the use of alternate dementia ascertainment approaches. Methods: We compared dementia prevalence and risk factor associations obtained using criterion-standard dementia diagnoses to those obtained using algorithmic or Medicare-based dementia ascertainment in participants of the baseline visit of the Aging, Demographics, and Memory Study (ADAMS), a Health and Retirement Study (HRS) sub-study. Results: Estimates of dementia prevalence derived using algorithmic or Medicare-based ascertainment differ substantially from those obtained using criterion-standard ascertainment. Use of algorithmic or Medicare-based dementia ascertainment can, but does not always, lead to risk factor associations that substantially differ from those obtained using criterion-standard ascertainment. Discussion/Conclusions: Absolute estimates of dementia prevalence should rely on samples with formal dementia ascertainment. The use of multiple algorithms is recommended for risk factor studies when formal dementia ascertainment is not available.

Psychiatric emergency care during Coronavirus 2019 (COVID 19) pandemic lockdown: results from a Department of Mental Health and Addiction of northern Italy

BackgroundThe current COVID-19 pandemic and the consequent containment measures are leading to increasing mental health issues both in psychiatric patients and general population. ObjectiveWe aimed to compare the number and characteristics of emergency psychiatric consultations during the phase 1 of lockdown with respect to the same period in 2019 in a Department of Mental Health and Addiction (DMHA) located in Lombardy region. MethodsWe conducted a cross-sectional study including subjects consecutively admitted to two psychiatric emergency rooms of DMHA in Monza, Lombardy, Italy. Sociodemographic data, clinical characteristics, referred symptoms, diagnosis and information on patients’ illness course following the emergency consultations were collected. No subjects were excluded for the purposes of the study. ResultsBetween February 21st and May 3rd 2020, there was a marked reduction in the number of psychiatric emergency consultations, if compared to the same period of 2019. Subjects who were living in psychiatric residential treatment facilities, had cannabis addiction and a diagnosis of obsessive-compulsive disorder were significantly more likely to present to emergency psychiatric consultations during lockdown. ConclusionsCOVID-19 epidemic may have a negative impact on more vulnerable individuals. Strategies to enhance relapse prevention and the use of alternative approaches as e-health technologies should be promoted.

A Wizard-of-Oz experimental approach to study the human factors of automated vehicles: Platform and methods evaluation

Objectives Driving simulation is an important platform for studying vehicle automation. There are different approaches to using this platform – with most using scripting or programmatic tools to simulate vehicle automation. A less frequently used approach, the Wizard-of-Oz method, has potential for increased flexibility and efficiency in designing and conducting experiments. This study designed and evaluated an experimental setup to examine the feasibility of this approach as an alternative for conducting automation studies. Methods Twenty-four participants experienced simulated vehicle automation in two platforms, one where the automation was controlled by algorithms, and the other where the automation was simulated by an external operator. Surveys were administered after each drive and the drivers’ takeover performance after the automation disengaged was measured. Results Results indicate that while the kinematic parameters of the driving differed significantly for the two platforms, there were no significant differences in the perceptions of participants and in their takeover performance between the two platforms. Conclusion These results provide evidence for the use of alternative approaches for the conduct of human factors studies on vehicle automation, potentially lowering barriers to undertaking such experiments while increasing flexibility in designing more complex studies.

Recent Insights into Aeromonas salmonicida and Its Bacteriophages in Aquaculture: A Comprehensive Review.

The emergence and spread of antimicrobial resistance in pathogenic bacteria of fish and shellfish have caused serious concerns in the aquaculture industry, owing to the potential health risks to humans and animals. Among these bacteria, Aeromonas salmonicida, which is one of the most important primary pathogens in salmonids, is responsible for significant economic losses in the global aquaculture industry, especially in salmonid farming because of its severe infectivity and acquisition of antimicrobial resistance. Therefore, interest in the use of alternative approaches to prevent and control A. salmonicida infections has increased in recent years, and several applications of bacteriophages (phages) have provided promising results. For several decades, A. salmonicida and phages infecting this fish pathogen have been thoroughly investigated in various research areas including aquaculture. The general overview of phage usage to control bacterial diseases in aquaculture, including the general advantages of this strategy, has been clearly described in previous reviews. Therefore, this review specifically focuses on providing insights into the phages infecting A. salmonicida, from basic research to biotechnological application in aquaculture, as well as recent advances in the study of A. salmonicida.