Wider Implementation Research Articles

Insulin Pump Therapy in Libya: A Comparative Study on Glycemic Control and Patient Outcomes in Type 1 Diabetes

This study evaluated the clinical effectiveness of continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) in managing type 1 diabetes mellitus (T1DM) among Libyan patients. Conducted in June 2022, the comparative cross-sectional study compared 32 CSII users (≥6 months of therapy) with 30 MDI controls through structured questionnaires. The CSII group demonstrated significantly better outcomes, including superior glycemic control (mean HbA1c 6.97±0.61 vs 9.8±1.99), reduced acute complications (hypoglycemia: 31.3% vs 50%; DKA: 3.1% vs 20%), and higher treatment adherence (81.3% vs 43.3%). Glycemic improvement correlated strongly with pump duration, showing progressive HbA1c reduction from 7.2±0.2 at 6-12 months to 6.89±0.16 after >2 years of use. The CSII cohort also exhibited more favorable BMI distributions (78.1% healthy weight vs 33.3%) and reported enhanced quality of life. Despite these benefits, challenges in maintenance supply availability were reported. These findings provide compelling evidence for CSII's clinical superiority in Libya's context and support its wider implementation through national programs that address current supply chain limitations while ensuring proper patient training and follow-up support. The results highlight CSII as a valuable therapeutic advancement for T1DM management in resource-constrained settings

Barriers and facilitators to implementation of home phototherapy for neonatal hyperbilirubinaemia: Perspectives from healthcare professionals and parents.

Phototherapy for hyperbilirubinaemia in neonates is one of the most frequent causes of hospitalisation in the first week of life, accounting for up to 35 % of hospital (re)admissions. Studies suggest that phototherapy can be applied safely and effectively at home. However, in-hospital phototherapy is still the standard care in most settings. We aimed to explore determinants of implementing home phototherapy from the perspectives of healthcare professionals and parents to inform its wider implementation. We conducted focus group interviews with healthcare professionals involved in home phototherapy for neonatal hyperbilirubinaemia. In addition, individual interviews were performed with parents of neonates treated with home phototherapy. We used the Consolidated Framework for Implementation Research (CFIR) for identifying determinants to guide data collection and analysis. Five focus group interviews with 21 healthcare professionals and 10 semi-structured interviews with parents (10 mothers, eight fathers) were conducted. Barriers concerned the lack of reimbursement options and the challenge to reach all the different healthcare professionals for education. Main facilitators concerned multiple relative advantages of home phototherapy experienced by healthcare professionals and parents such as keeping the family together, the low complexity of home phototherapy, the motivation of parents to perform home phototherapy, the attitude and self-efficacy among healthcare professionals, and the involvement of all key stakeholders from the beginning of the implementation process. This study identified key barriers and facilitators regarding implementation of home phototherapy for neonatal hyperbilirubinaemia. Based on these findings, tailored implementation strategies can be developed.

Clinical evaluation of a novel disposable neurostimulator used to accelerate regeneration of injured peripheral nerves in the hand

BackgroundPreclinical and early clinical evidence demonstrates that electrical stimulation (ES) applied for one hour following surgical nerve intervention enhances axonal regeneration and functional outcomes. Wide clinical implementation however, has been hindered by a lack of suitably designed stimulators. The aim of this pilot study was to investigate sensory recovery, safety, tolerability, and RCT feasibility for the use of a novel single-use stimulator to deliver ES therapy in an acute nerve transection cohort.MethodsPatients with complete transection of a proper digital nerve were included in the trial. An investigational version of PeriPulseTM was used with intraoperative electrode implantation and 1-hour ES therapy delivered postoperatively. Patient tolerance was assessed during stimulation and visual-analogue pain scores were collected at the first post-operative visit. At 3- and 6-months post-op, sensory recovery and quality of life were assessed using 2-point discrimination, monofilament tests, and the Disability of Arm, Shoulder, and Hand (DASH) questionnaire, respectively.ResultsA total of 10 patients were enrolled. Intraoperative electrode placement did not impact operating room time, taking less than 5 minutes to implement. There were no related adverse events. Participants reported tolerable stimulation during ES therapy with no reports of pain. At the first post-operative visit patients had a mean visual-analogue pain score of 0.6 (range 0 - 1.9). Pressure threshold detection significantly improved between baseline, 3 months and 6 months. A greater proportion of ES treated patients (87.5%) had improved hand pressure thresholds (diminished light touch or diminished protective sensation) at 6 months compared to a historical comparator group. DASH scores improved over the timeline. Participants treated with ES therapy experienced minimal postoperative functional disability.ConclusionsThe use of the PeriPulseTM prototype for the delivery of perioperative ES therapy was safe, well-tolerated, and usable. Sensory recovery was demonstrated and a larger RCT is feasible.Trial Registration NCT04732936; 2021 - 01 - 29

Selective Hopping and Stable Path Integration to Boost AODV's Message Delivery Assurance

In addition to carrying communications, Vehicular Ad-hoc Networks can be utilized to transfer vital information across nodes in the network, potentially averting disastrous losses. By following the established standards, this vital information is transmitted by moving cars on the road in conjunction with parked cars. In this case, the communication is forwarded via a mediator known as a "roadside unit." The Ad-hoc On-Demand Distance Vector (AODV) routing protocol is one of the finest for such a wireless environment because it can tolerate variations in vehicle density and speed. Though it performs better than other comparable protocols, the AODV routing protocol does not show much promise when it comes to unreachable nodes, unstable forwarding paths, broadcasting storms, and short connection lifetimes. In order to improve efficiency, this research paper suggests adding multiple Road Side Units, modifying the conventional AODV routing protocol by adding selective hopping and the Delay Minimization Problem. To confirm the usefulness of the suggested model in terms of propagation delay, transmission loss, network lifetime, etc., it is also simulated. The findings gained support the superiority of the suggested strategy, laying the groundwork for its wider implementation.

Polymer anti-stick lining plates

The conducted research and analysis of foreign experience showed that the most effective method of combating the adhesion of rocks to working surfaces is their lining with anti-adhesive and easily replaceable polymer plates. Thus, at the pelletizing plant of pelletizing factory of JSC Mikhailovsky GOK, as a result of the conducted research, the classification of polymer anti-stick lining plates (PASLP) was adopted, namely: PASLP HP (high pressure) SD (standard design); PASLP LP (low pressure) SD (standard design); PPFP IWR (increased wear resistance and impact resistance); PPFP HWR (high wear resistance and impact resistance). In the last 35 years, the following sheet materials have been recommended on the Russian market for various purposes: LDPE, HDPE, PP, PPFP-ASTIKI, PPL-EI, PPL-UI(CBM), Supralen1000, Tivar1000, VMPE 500, SVMPE1000, SVMPE9000, PE500, PE1000, PE9000, lnkulen 100, 500, 1000, 9000. For the correct selection of such materials for specific mining and geological and mining-technical conditions of operation of various process equipment, methods tested in the open press are recommended, allowing the selection of PASLP (sheets) depending on the strength of rocks according to the scale of prof. M.M. Protodyakonov and determining the optimal sheet thickness for various operating conditions of the equipment. Positive experience in combating the adhesion of finely ground iron ore concentrate and raw materials to the working surfaces of the process equipment of the pelletizing plant of JSC Mikhailovsky GOK named after A.V. Varichev is recommended for wide implementation at related enterprises of the Kursk Magnitka Anomaly, as well as at similar enterprises in other sectors of the mining and processing industry.

Translation, cultural adaptation, and validation of the Concussion Recognition Tool 6 (CRT6™), Sport Concussion Assessment Tool 6 (SCAT6®) and Sport Concussion Office Assessment Tool 6 (SCOAT6™): the Italian process

BackgroundTo ensure wide implementation of the Concussion in Sport Group (CISG) recommendations beyond English-speaking countries, the availability of recommended concussion assessment tools in other languages is a key step, especially in countries where few sport-related concussion guidelines exist. We describe the process and adaptations followed in the Italian translation of the latest CISG concussion assessment tools: the Concussion Recognition Tool 6 (CRT6™), the Sport Concussion Assessment Tool 6 (SCAT6®) and the Sport Concussion Office Assessment Tool 6 (SCOAT6™).MethodsBased on CISG procedures, we engaged in an 8-step process which sequentially included verbatim translation in Italian, reconciliation of translation and cultural adaptation, back-translation (from Italian into English), appraisal of the back-translation, validation of the refined Italian version, review and adjustment by an expert committee, pilot testing in 12 amateur athletes and document finalization.ResultsThe immediate memory test required replacement with Rey Words to be meaningful in Italian, as per the advice of the working group neuropsychologists. The remaining tests did not need any substantial changes except for translation and cultural adaptation. The refinement process continued until the Italian CRT6 ™, SCAT6® and SCOAT6 ™ were rated as ‘extremely clear/coherent/grammatically correct’ (score 7 on a 7-point Likert scale). The average time needed to carry out assessments using the final Italian version of CRT6 ™, SCAT6® and SCOAT6 ™, was 3.2 min (SD 0.69), 21.12 min (SD 3.16) and 24.50 min (SD 3.18), respectively. These were found to have acceptable clarity, understandability, grammatical correctness, and coherence.ConclusionThe Italian CRT6 ™, SCAT6® and SCOAT6 ™ are the first concussion assessment tools available in the Italian language for both healthcare providers and athletes and enable improvement of concussion management based on the CISG recommendations.

Cognitive behavioral therapy for insomnia across the spectrum of alcohol use disorder: A systematic review and meta-analysis.

Cognitive behavioral therapy for insomnia across the spectrum of alcohol use disorder: A systematic review and meta-analysis.

A Systematic Literature Review of Secure Instant Messaging Applications from a Digital Forensics Perspective

The use of instant messengers in organized crime has made retrieving digital evidence from these platforms crucial in investigations. However, the wide implementation of end-to-end encryption (e2ee) has made forensic analysis challenging since all data and multimedia stored in these platforms are encrypted. To retrieve evidence, forensic examiners rely on artifacts produced by secure messaging applications. Therefore, identifying the artifacts that can be gathered from secure messaging applications is crucial during emergency analysis, as law enforcement agencies monitor these platforms. This literature review aims to provide a comprehensive understanding of artifact retrieval and forensic analysis trends by summarizing studies conducted since inception on popular secure messaging applications, including WhatsApp, Signal, Telegram, Wickr, and Threema. The review covers artifact retrieval, forensic methodologies, and tools. The review findings are significant to the cybersecurity and research communities, as well as the users of these applications. Forensic investigators can leverage the information during their investigations, cybersecurity practitioners can identify weaknesses in implementation to develop better security policies, and users can make informed decisions regarding their privacy.

Learning the concept of genes, DNA, and chromosome through developed virtual laboratory website

The study focused on the development of a website that can be used in various fields of science in Junior High School. Particularly, topics that were utilized as part of the re-search report include chromosomes, DNA, and genes for grade 9 learners. This exploratory case study explored learners’ engagement and performance on a developed virtual laboratory website. The results revealed predictors of the implementation that can be associated with the performance of the learners. The data gathered from the responses of learners in the instruments were analyzed through content analysis, correlation, and linear regression. This study can relatively be significant for the teachers of Balanga City to help deliver scientific concepts using simple laboratory experiments combined with the activities within the website. This study is leaning towards a broader range of applications in the schools’ division in the Philippines. The wider implementation may extend help to teachers in the far-flung areas of the country.

Cancer, precision medicine, and Atlantic Canada: A priority setting exercise by the Atlantic Cancer Consortium Patient Advisory Committee

BackgroundPrecision Medicine in oncology is a rapidly evolving field aiming to prevent and treat cancers based on detailed patient and tumor characteristics. To better develop research studies, healthcare services and policies, and access to Precision Medicine, integration of insight and experiences of cancer patients and family members is required.ObjectivesIn this paper, we describe the patient and family priorities regarding Precision Medicine as identified by the Atlantic Cancer Consortium Patient Advisory Committee (ACC PAC).MethodsThe ACC PAC was formed in January 2024 and met virtually five times between January and May of 2024. It included a diverse set of 12 patients and family members of patients from across the Atlantic Canadian provinces, a coordinator, an oncologist/clinician-scientist, and a cancer scientist. During meetings, the committee focused on identifying patient and family priorities in Atlantic Canada. Three guests with lived experiences were invited to further diversify the committee’s discussions. Discussions were summarized by the coordinator and cancer scientist. Summaries were then reviewed by the ACC PAC members in September 2024.ResultsThe ACC PAC identified priorities on two general themes: (1) preventing and addressing cancer’s effects on the whole person/family (for example, by accessible information and support programs), and (2) understanding and accessing Precision Medicine (for example, by research, education, and wider implementation). While the ACC PAC members were optimistic about the utility of Precision Oncology, they also made it clear that it was unlikely to be sufficient without a team-based, holistic and equitable approach to cancer care. Better quality healthcare, education, resources, and effort by all stakeholders were established as essential for effective cancer control and Precision Medicine.ConclusionsA key responsibility falls on the shoulders of funders, organizations, policy-makers and governments in addressing cancer’s effects, improving public knowledge of cancer and Precision Medicine, and improving access to high-quality healthcare and precision medicines. Patient partners and committees such as the ACC PAC can inform and help every step of these efforts with their patient-centered insights and perspectives.

Моделирование теплового режима рудного штабеля при кучном выщелачивании золота в холодном климате

The paper presents the results of research, which primary practical goal is wide implementation of the heap leaching technology in areas with harsh climatic conditions, i.e. presence of permafrost and long winter periods. The main limiting factor for applying the method in regions with cold climate is that the leaching efficiency of any type of gold-bearing ores considerably depends on the temperature conditions of the ore stockpiled and the leaching solution, which in turn determines the seasonal nature (only in the Summer months) of gold mining operations utilizing the heap leaching technology. Appropriate physical properties need to be set for all the materials available in the area to be modeled. The boundary conditions also have to be defined for all heat transfer conditions used in the model. Modeling of the leaching solution filtration in the Frost.Thermo software suite is based on the extensively tested equation for groundwater filtration derived from the Darcy law. Solution of the thermal conductivity equation in the 3D formulation is carried out numerically using the explicit method of finite differences. According to the results of computer modeling in the Frost 3D software suite, emergency failure of the thermal insulation coating on the stockpile surface leads to freezing of the rocks in the stockpile down to a considerable depth. Calculations of the thermal conditions of the ore stockpile have been carried out for different conditions of its surface thermal insulation. The most optimal method to thermally insulate the walls of the stockpile is to cover the slopes (walls) of its lower tier with a 1-meter thick snow layer, while the slopes (walls) of the upper tiers should be insulated with a film having an air interlayer of 3 cm.

Structural water and composing with graphene synergistically boosting electrochemical lithium-storage performance of hydrated tungsten oxides

Structural water and composing with graphene synergistically boosting electrochemical lithium-storage performance of hydrated tungsten oxides

The impact of educational development on the countries’ competitiveness in the knowledge economy

Purpose. Development of recommendations for determining the impact of education on the formation of the competitiveness of national economies in the conditions of the knowledge economy using the analysis of existing indicators “measurement of the level of the knowledge economy”, conducting an analytical study and developing, on this basis, an integral indicator of the impact of education on the competitiveness of the countries of the world. Methodology. In the research process, the method of coefficient analysis and such methods as quantitative and graphic analysis, the method of data visualization, and the sociological survey method were used. Findings. The work performed a ranking of countries using the developed indicator, which allows determining the competitiveness of countries in the world in the knowledge economy under the influence of the development of education. The basis of this rating is our own integrated rating coefficient, which is based on world indices, considering the degree of their importance in revealing the level of education and its influence on the process of formation of the knowledge economy. The work outlined directions for further research on the formation of an effective mechanism for the development of education based on the wide implementation of its open component. Originality. It was revealed that there is no single indicator in global practice that would fully determine the competitiveness of the countries of the world in the conditions of the knowledge economy under the influence of education development. A survey was conducted, in which teachers, scientists, educators and public figures from Ukraine, Poland, Germany, Italy, Israel, Great Britain and Canada, a total of 203 people, took part. The results of the survey made it possible to propose our own integrated rating coefficient, based on a set of indicators from four world ratings. Practical value. Research into the aspects of success in creating a knowledge economy by the leading countries, which are identified on the basis of the integrated rating coefficient, will allow us to spread their experience in creating effective educational prerequisites to other countries in the process of ensuring their own development.

Implementation and Validation of Decision Aid Tool to Reduce Unnecessary Testing Before Thoracic Surgery.

Implementation and Validation of Decision Aid Tool to Reduce Unnecessary Testing Before Thoracic Surgery.

An Exploration of Learning Motivation and Reading Comprehension of Accounting Students Using Quizizz

Abstract This exploration study explores the role of Quizizz in improving learning motivation and reading comprehension among Accounting students at state a vocational high school (SMKN 21 Jakarta) in the 2024 school year. Using a survey-based methodology, this study investigates how this gamified learning platform affects students' engagement and their ability to comprehend English reading content. A structured survey was used to gather information from 36 accounting students about their Quizizz experiences, opinions and difficulties. The results showed mixed results; some students felt that this platform improved their motivation and comprehension, while others expressed doubts about its efficacy. This study emphasizes the ability of digital platforms such as Quizizz to create an interactive and engaging learning environment, while overcoming barriers in students' adaptation to new technologies. The findings provide useful insights for educators and augment the ongoing discussion about incorporating technology into education,offering practical implications for classroom practices as well as recommendations for further research and wider implementation. Keywords: Quizizz; Learning Motivation; Reading Comprehension.

Effects of Liuzijue Qigong on respiratory function among patients with Parkinson’s disease: a randomized clinical trial

BackgroundRespiratory dysfunction is a common nonmotor symptom in patients with Parkinson’s disease that may be easily overlooked. Incorporating respiratory function rehabilitation into routine rehabilitation programs for these patients is important. However, previous studies have focused primarily on professional devices and training processes that require additional professional guidance, making wide implementation challenging.MethodsIn this assessor-masked, randomized clinical trial, eligible participants were randomized into an experimental group and a control group. The experimental group received Liu Zi Jue Qigong exercise for 12 weeks, while the control group underwent conventional rehabilitation exercises. Primary outcomes included measures of respiratory function, such as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the ratio of forced expiratory volume in 1 s to forced vital capacity(FEV1/FVC), peak expiratory flow (PEF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Secondary outcomes included motor symptoms, quality of life, depression, and anxiety.ResultsThe results from a study involving 51 Parkinson’s disease patients showed significant improvements in the FVC, FEV1, PEF, and MEP in the experimental group compared to those in the control group after the 12-week intervention. Additionally, there was a noticeable decrease in depression and anxiety scores in the experimental group, with statistically significant reductions compared to those in the control group.ConclusionsLiuzijue Qigong exercise has the potential to enhance respiratory function and mental health in patients with Parkinson’s disease in the early and middle stages. These findings could serve as a valuable reference for implementing home-based rehabilitation techniques for individuals with Parkinson’s disease.Trial RegistrationChinese Clinical Trial Registry: ChiCTR2200056762(Retrospectively registered, Registration Date: February 15, 2022).

Review of Precision Medicine and Diagnosis of Neonatal Illness.

Background/Objectives: Precision medicine is a state-of-the-art medicine tactic that tailors information about people's genes, environment, and lifestyle to aid the prevention, diagnosis, and treatment of various diseases to provide an overview of the currently available knowledge and applicability of precision medicine in the diagnosis of different cases admitted to the NICU, such as encephalopathies, respiratory distress syndrome of prematurity, hemodynamic instability, acute kidney injury, sepsis, and hyperbilirubinemia. Methods: The authors searched databases, such as PubMed and PubMed Central, for the terms neonatal "precision medicine", "personalized medicine", "genomics", and "metabolomics", all related to precision medicine in the diagnosis of neonatal illness. The related studies were collected. Results: The review highlights the diagnostic approach that serves to implement precision medicine in the NICU and provide precision diagnosis, monitoring, and treatment. Conclusions: In this review, we projected several diagnostic approaches that provide precision identification of health problems among sick neonates with complex illnesses in the NICU; some are noninvasive and available in ordinary healthcare settings, while others are invasive or not feasible or still in ongoing research as machine learning algorithms. Future studies are needed for the wide implementation of artificial intelligence tools in the diagnosis of neonatal illnesses.

Evaluating the impact of general practice pharmacist-led person-centred medicines reviews on medicines appropriateness and patient-reported outcome measures.

The aim of this study was to investigate the impact of pharmacist-led person-centred medicines reviews in general practices on medicines appropriateness, polypharmacy indicators (high-risk prescribing markers), and patient-reported outcome measures (PROMs). Four pharmacists conducted person-centred medicines reviews in ten general practices between January 2021 and December 2022 for patients with hyperpolypharmacy (prescribed ≥10 regular medicines) and/or at high risk of medicines-related harm. Prescribing recommendations were provided to the general practitioner and followed up with patients and/or healthcare professionals. In this single arm study, pre and post intervention: (1) polypharmacy indicators were documented, and for a sample of patients, the (2) Person-Centred Medication Appropriateness Index (PC-MAI) scoresand (3) PROMs were gathered. Of the 1471 included patients, the mean age was 76 years, 88.4% had hyperpolypharmacy, whilst the mean number of medicines was 13.8 pre and 12.3 post review. Of the 1056 polypharmacy indicator occurrences identified, 70.7% were resolved post review. Of the 194 patients with pre-review and post-review PC-MAI scores, 99% had a reduction; the mean reduction was 17.3 (95% confidence interval [CI] 15.8-18.8, P< .0001) per patient and 1.2 (95% CI 1.0-1.3, P< .0001) per medicine. PROMs were collected for 179 patients; 87.7% reported the review helped their medicines understanding, 63.1% their experience of side effects, 36.9% their ability to take medicines correctly, and 30.5% the impact of medicines on their daily activities. General practice pharmacist-led person-centred medicines reviews for patients with hyperpolypharmacy and/or at high risk of medicines-related harm delivered substantial improvements in medicines appropriateness and patient-reported outcomes, thus providing evidence to support their wider implementation.

The Future of Surgical Diagnostics: AI-Enhanced Detection of Ganglion Cells for Hirschsprung Disease

The Future of Surgical Diagnostics: AI-Enhanced Detection of Ganglion Cells for Hirschsprung Disease

Self-regulation of slow cortical potential and seizure suppression by scalp electroencephalography: Early prediction of therapeutic efficacy.

Self-regulation of slow cortical potential and seizure suppression by scalp electroencephalography: Early prediction of therapeutic efficacy.