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Mairéad Conneely,1 Siobhán Leahy,2 Margaret O’Connor,3 Gillian Corey,3 Ahmed Gabr,3 Anastasia Saleh,3 Blessing Okpaje,3 Íde O’ Shaughnessy,1,3 Aoife Synnott,3 Aoife McCarthy,3 Alison Holmes,1 Katie Robinson,1 Lorna Ryan,1 Anne Griffin,1 Louise Barry,4 Dominic Trépel,5 Damian Ryan,6 Rose Galvin1 On behalf of Ageing Research Centre Public and Patient Involvement (PPI) Panel of older adults1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 2Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland; 3Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland; 4School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; 5Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland; 6Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, IrelandCorrespondence: Mairéad Conneely, Email mairead.c.conneely@ul.ieBackground: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS).Patients and Methods: Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive.Results: Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group.Conclusion: ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group.Trial Registration: The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.Plain Language Summary: Older people need support when they are discharged from the Emergency Department (ED) to their home as a visit to the ED is linked to negative outcomes. This study reports on a trial to reduce negative outcomes in older people discharged from the ED by an assessment in the ED and treatment in the home. Twenty-nine patients attending the ED of University Hospital Limerick were randomly assigned to three groups as follows: One group got the normal care and treatment; Group two received a comprehensive assessment by a dedicated geriatric doctor in the ED and were referred to other health professionals as needed; a third group, called ED PLUS, also received a comprehensive assessment by a dedicated geriatric doctor in the ED and an additional six-week treatment program led by a physiotherapist. The physiotherapist visited the older adult in their own home within twenty-four hours of discharge to start treatment based on what the older adult needed to do to live safely in their own home and again at week four and week six. The same geriatric doctor who saw the older adult in the ED telephoned the older adult in week two to check medications and discussed the case with the physiotherapist. A dietitian and occupational therapist telephoned the older adults to check nutritional intake and if any aids were needed in the home. All older adults in the ED PLUS group had improved quality of their life, improved mobility and did not need to go back to the hospital or ED at six weeks and six months unlike the two other groups. The COVID-19 pandemic affected recruitment, but all ED PLUS patients were extremely satisfied.Keywords: emergencies, recruitment, integrated care, care transitions, public and patient involvement

Abstract Background There is limited data on client preferences for different HIV self-testing (HIVST) and provider-delivered testing options and associated factors. We explored client preferences for oral-fluid-based self-testing (OFBST), blood-based self-testing (BBST) and provider-delivered blood-based testing (PDBBT) among different populations. Methods At clinics providing HIV testing services to general populations (1 urban, 1 rural clinic), men seeking voluntary medical male circumcision (VMMC, 1 clinic), and female sex workers (FSW, 1 clinic), clients had the option to test using OFBST, BBST or PDBBT. A pre-test questionnaire collected information on demographics and testing history. Two weeks after collecting a self-test kit, participants responded to a questionnaire. We used logistic regression to determine predictors of choices. We also conducted 20 in-depth interviews to contextualise quantitative findings. Results May to June 2019, we recruited 1244 participants of whom 249 (20%), 251 (20%), 244 (20%) and 500 (40%) were attending urban general, rural, VMMC and FSW clinics, respectively. Half (n = 619, 50%) chose OFBST, 440 (35%) and 185 (15%) chose BBST and PDBBT, respectively. In multivariable analysis comparing those choosing HIVST (OFBST and BBST combined) versus not, those who had never married aOR 0.57 (95% CI 0.34–0.93) and those previously married aOR0.56 (0.34–0.93) were less likely versus married participants to choose HIVST. HIVST preference increased with education, aOR 2.00 (1.28–3.13), 2.55 (1.28–5.07), 2.76 (1.48–5.14) for ordinary, advanced and tertiary education, respectively versus none/primary education. HIVST preference decreased with age aOR 0.97 (0.96–0.99). Urban participants were more likely than rural ones to choose HIVST, aOR 9.77 (5.47–17.41), 3.38 (2.03–5.62) and 2.23 (1.38–3.61) for FSW, urban general and VMMC clients, respectively. Comparing those choosing OFBST with those choosing BBST, less literate participants were less likely to choose oral fluid tests, aOR 0.29 (0.09–0.92). Conclusions Most testing clients opted for OFBST, followed by BBST and lastly, PDBBT. Those who self-assessed as less healthy were more likely to opt for PDBBT which likely facilitated linkage. Results show importance of continued provision of all strategies in order to meet needs of different populations, and may be useful to inform both HIVST kit stock projections and tailoring of HIVST programs to meet the needs of different populations.

Abstract Image-based prediction models for disease detection are sensitive to changes in data acquisition such as the replacement of scanner hardware or updates to the image processing software. The resulting differences in image characteristics may lead to drifts in clinically relevant performance metrics which could cause harm in clinical decision making, even for models that generalise in terms of area under the receiver-operating characteristic curve. We propose Unsupervised Prediction Alignment, a generic automatic recalibration method that requires no ground truth annotations and only limited amounts of unlabelled example images from the shifted data distribution. We illustrate the effectiveness of the proposed method to detect and correct performance drift in mammography-based breast cancer screening and on publicly available histopathology data. We show that the proposed method can preserve the expected performance in terms of sensitivity/specificity under various realistic scenarios of image acquisition shift, thus offering an important safeguard for clinical deployment.

Abstract Background Dental materials science is an important subject, but research on curriculum mapping in preclinical dental materials science courses is still scarce. The present study aimed to conduct a curriculum mapping in analysing elements and suggesting recommendations for an institutional dental materials science course. Methods Curriculum mapping was conducted for the Year 2 undergraduate dental materials science course (Bachelor of Dental Surgery programme) in a Malaysian dental school. Based on Harden’s framework, the following steps were used to map the curriculum of the institutional dental materials science course: (1) scoping the task; (2) deciding the mapping format; (3) populating the windows, and (4) establishing the links. Two analysts reviewed the curriculum independently. Their respective analyses were compared, and discrepancies were discussed until reaching a consensus. A SWOT analysis was also conducted to evaluate the strengths, weaknesses, opportunities, and threats associated with the curriculum. Results Course learning outcomes, course contents, levels of cognitive and psychomotor competencies, learning opportunities, learning resources, learning locations, assessments, timetable, staff, curriculum management and students’ information were successfully scoped from the institutional dental materials science course. The present curriculum’s strengths included comprehensiveness, alignment with standards, adequate learning opportunities, well-defined assessment methods, and sufficient learning resources. However, the identified weaknesses were repetition in curriculum content, limited emphasis on the psychomotor domain, dependency on a single academic staff, and limited integration of technology. The SWOT analysis highlighted the opportunities for curriculum improvement, such as revising repetitive content, emphasising the psychomotor domain, and incorporating advanced teaching strategies and technology. Conclusions The present dental materials science curriculum demonstrated several strengths with some areas for improvement. The findings suggested the need to revise and optimise the course content to address gaps and enhance student learning outcomes. Ongoing monitoring and evaluation are necessary to ensure the curriculum remains aligned with emerging trends and advancements in dental materials science.

Abstract Background The integration of artificial intelligence (AI) in dentistry has the potential to revolutionise the field of dental technologies. However, dental technicians’ views on the use of AI in dental technology are still sparse in the literature. This qualitative study aimed to explore the perceptions of dental technicians regarding the use of AI in their dental laboratory practice. Methods Twelve dental technicians with at least five years of professional experience and currently working in Malaysia agreed to participate in the one-to-one in-depth online interviews. Interviews were recorded, transcribed verbatim and translated. Thematic analysis was conducted to identify patterns, themes, and categories within the interview transcripts. Results The analysis revealed two key themes: “Perceived Benefits of AI” and “Concerns and Challenges”. Dental technicians recognised the enhanced efficiency, productivity, accuracy, and precision that AI can bring to dental laboratories. They also acknowledged the streamlined workflow and improved communication facilitated by AI systems. However, concerns were raised regarding job security, professional identity, ethical considerations, and the need for adequate training and support. Conclusion This research sheds light on the potential benefits and challenges associated with the integration of AI in dental laboratory practices. Understanding these perceptions and addressing the challenges can support the effective integration of AI in dental laboratories and contribute to the growing body of literature on AI in healthcare.

Abstract Background The dental workforce plays a crucial role in delivering quality oral healthcare services, requiring continuous training and education to meet evolving professional demands. Understanding the impact of dental workforce training and education programmes on policy evolution is essential for refining existing policies, implementing evidence-based reforms and ensuring the growth of the dental profession. Therefore, this study protocol aims to assess the influence of dental workforce training and education programmes on policy evolution in Malaysia. Methods A mixed-method research design will be employed, combining quantitative surveys and qualitative interviews. Stakeholder theory and policy change models will form the theoretical framework of the study. Participants from various stakeholder groups will be recruited using purposive sampling. Data collection will involve surveys and one-on-one semi-structured interviews. Descriptive statistics, inferential analysis and thematic analysis will be used to analyse the data. Integration of quantitative and qualitative data will be used to provide a comprehensive understanding of the data. Discussion This study will shed light on factors influencing policy decisions related to dental education and workforce development in Malaysia. The findings will inform evidence-based decision-making, guide the enhancement of dental education programmes and improve the quality of oral healthcare services. Challenges related to participant recruitment and data collection should be considered, and the study’s unique contribution to the existing body of knowledge in the Malaysian context will be discussed.

Abstract Background Effective teaching of dental materials science is crucial for dental students to develop a comprehensive understanding of materials used in clinical practice. However, literature on educators’ views on teaching this subject is still scarce. This qualitative study aimed to explore the lived experiences of dental educators in teaching dental materials science subjects, thereby addressing potential gaps and enhancing teaching practices. Methods Thirteen dental educators from East and Southeast Asian countries (Malaysia, China, Indonesia, Thailand, South Korea, and Japan) participated in the present study. The present study adopted a transcendental phenomenological approach. One-to-one semi-structured online interviews were conducted. Interviews were recorded and transcribed verbatim. Thematic analysis was employed to identify patterns in the educators’ experiences. Results Three themes emerged from the present study. First, perceptions of the importance of dental materials science, highlighting its relevance in clinical practice, patient care, and lifelong learning. Second, the challenges faced in teaching dental materials science include limited instructional time, complex content, and insufficient resources. Third, specific strategies, such as applying interactive teaching methods, integrating clinical scenarios, and promoting critical thinking skills have been suggested to enhance teaching and learning. Conclusion Understanding dental educators’ experiences can improve dental materials science education, curriculum development, teaching methods, and faculty training programmes, ultimately enhancing the knowledge and skills of dental students in this field.

Maria Hollmen,1 Tom Bromilow,2 Adam B Smith,2 Stuart Mealing,2 Damian Lewis,2 Liam Galvin,3 Steve Jones,3 Luís Pacheco,4 Stéphane Soulard,4 Antoine Froidure5,6 1Faculty of Medicine, University of Helsinki, Helsinki, Finland; 2York Health Economics Consortium (YHEC), York, UK; 3European Pulmonary Fibrosis & Related Disorders Federation, Overijse, Belgium; 4Boehringer Ingelheim, Amsterdam, the Netherlands; 5Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium; 6Institut de Recherche Expérimentale et Clinique, UCLouvain, Ottignies-Louvain-la-Neuve, BelgiumCorrespondence: Maria Hollmen, Faculty of Medicine, University of Helsinki, Helsinki, Finland, Email maria.hollmen@helsinki.fiIntroduction: Idiopathic Pulmonary Fibrosis (IPF) is a rare disease that causes shortness of breath, dry cough, and tiredness. While there is no cure for IPF, current therapeutic treatments aim to slow lung degeneration while managing side effects. There is little known about patient experience and attitude with regards to their disease and medication.Purpose: To understand the perceptions, behaviors and drivers of treatment decision-making among patients, caregivers and pulmonologists in IPF.Patients and Methods: Online surveys to patients with IPF, caregivers and pulmonologists were developed and administered in Belgium, Finland, France, Greece (pulmonologists only), the Netherlands, Ireland and the United Kingdom between November 2021 and January 2022.Results: A total of 111 patients, 22 caregivers and 140 pulmonologists participated. Half (47%) of patients rated their disease as “severe”, while pulmonologists reported that a quarter of their patients had a low Forced Vital Capacity (FVC) (below 50% of the predicted value). Between 21% and 42% of the patients do not take an IPF medication (patients’ perception) or antifibrotic (physicians’ perception). Pulmonologists reported that a total of 58% of their patients were receiving antifibrotic medication, any IPF medication, while around 53%, 55%, 35% and 73% of the patients limited their exposure (sometimes or often) to the sun due to IPF, considered taking medication against diarrhea, nausea/vomiting and heartburn, respectively. Treatment adherence was relatively high (81%), in line with the caregivers’ view and the pulmonologists’ expectations. Overall, cultural, clinical or socio-demographic factors impacted patients’ perceptions or behaviors.Conclusion: This study shows there is a significant proportion of IPF patients who remain untreated, a misalignment of disease severity between patients and their physicians and patient background impacts behavior. Overall, more in-depth patient–physician communication is needed to improve treatment experience.Keywords: online survey, antifibrotic, adherence, behavior, lung disease, outcomes research

Maria Hollmen,1 Marlies Wijsenbeek,2 Tom Bromilow,3 Adam B Smith,3 Stuart Mealing,3 Damian Lewis,3 Liam Galvin,4 Steve Jones,4 Guus Asijee,5 Stéphane Soulard,5 Antoine Froidure6,7 1Faculty of Medicine, University of Helsinki, Helsinki, Finland; 2Centre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; 3York Health Economics Consortium (YHEC), York, UK; 4European Pulmonary Fibrosis & Related Disorders Federation, Overijse, Belgium; 5Boehringer Ingelheim, Amsterdam, the Netherlands; 6Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium; 7Institut de Recherche Expérimentale et Clinique, UCLouvain, BelgiumCorrespondence: Maria Hollmen, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8 P.O. Box 63, Helsinki, 00014, Uusimaa, Finland, Email maria.hollmen@hus.fiPurpose: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and ultimately fatal lung disease that, while rare, has seen incidence rise over time. There is no cure for IPF other than a lung transplant, though two antifibrotic (AF) drugs do exist to slow disease progression. While these drugs are efficacious, they are both associated with differing profiles of adverse events. This study aimed to elicit patient, caregiver and pulmonologist preferences on the treatment profiles of AFs via a discrete choice experiment (DCE).Patients and Methods: The DCE and associated survey were distributed across 7 European countries, and bespoke DCEs were developed for patients/caregivers and pulmonologists. After collaboration with European Pulmonary Fibrosis & Related Disorders Federation (EU-PFF) and expert pulmonologists, respectively, a patient/caregiver DCE with 5 attributes and a pulmonologist DCE with 6 attributes were finalized. The DCEs had a blocked approach to reduce participant burden and were distributed on an online survey platform. Preferences were estimated through conditional multinomial logit regression analysis.Results: Ninety-five patients, 22 caregivers and 115 pulmonologists fully completed their respective DCEs. Overall, patients and caregivers preferred management of treatment-related adverse events over both survival benefits and disease progression. Nearly all preference levels were found to be significantly different from their reference level. In contrast, pulmonologists showed a greater preference for control of lung function and exacerbations over adverse events. Although there were relative differences between the univariate subgroups in terms of the preference weights, most of these were not statistically significant.Conclusion: The outcomes from this study suggest that while patients and caregivers had similar preferences for characteristics of IPF treatments, pulmonologists did not share those same preferences. Patients and caregivers preferred safety, while pulmonologists preferred efficacy. These differences should be considered by clinicians to better involve the patient in treatment decision-making for IPF.Keywords: treatment preferences, online survey, outcomes research, lung disease

Abstract E-commerce is a field that changed how consumers purchase and interact with products. Although, inherent limitations such as the difficulty of testing the products “first-hand” before a purchase can compromise consumers’ trust in online purchases. Virtual Reality (VR) has been investigated as a tool to solve limitations in several fields and how we can harness its potential to improve the overall user experience. This study analysed how immersive VR (IVR) could solve these limitations by allowing consumers to test products beforehand. We have studied how the Novelty Factor (evaluated by the users’ past VR experience) and Immersive Tendencies correlate with the users’ Purchase Intention and Memory (how well they remember the product’s characteristics). We have analysed a sample of 38 participants (21 males) from 18 to 28 years old. Participants experienced a refrigerator with an interactive touchscreen in an IVR setup and were guided through its functionalities. Results indicated that memory of the product’s characteristics was positively correlated with how recently they experienced VR. No correlations were found in the female sample. A negative correlation between Purchase Intention and Memory of the product’s characteristics was found in the male sample. We concluded that IVR applications could become helpful for both consumers and online shops in an e-commerce context regardless of the Novelty Factor and Immersive Tendencies of consumers. However, differences between genders should be further investigated.

Lauren N Ayton,1– 3,* Karyn L Galvin,4,* Lauren Johansen,5 Fleur O’Hare,1,3 Emily R Shepard5 1Department of Optometry and Vision Sciences, University of Melbourne, Parkville, VIC, Australia; 2Department of Surgery (Ophthalmology), University of Melbourne, Parkville, VIC, Australia; 3Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia; 4Department of Audiology and Speech Pathology, University of Melbourne, Parkville, VIC, Australia; 5UsherKids Australia, Mordialloc, VIC, Australia*These authors contributed equally to this workCorrespondence: Lauren N Ayton, Department of Optometry and Vision Sciences, The University of Melbourne, 202 Berkeley Street, Carlton, VIC, 3053, Australia, Email layton@unimelb.edu.auBackground: Usher syndrome is the most common cause of deaf-blindness, affecting up to 1 in 6000 people. Multidisciplinary care is required to maximize outcomes for individuals and families. This study assessed awareness of Usher Syndrome amongst allied health clinicians who provide care related to the primarily affected senses of hearing and vision, ie, optometry, orthoptics and audiology.Methods: A prospective cross-sectional online survey of clinicians working in Australian university-affiliated clinics (7 optometry, 1 orthoptics and 4 audiology) was completed between September 2021 and January 2022. Questions were asked about the cause, common symptoms, and awareness of health professions who manage Usher syndrome.Results: The 27 audiologists, 40 optometrists, and 7 orthoptists who completed the survey included 53 females (71.6%), had an average age of 37 years (range 24– 70), and had an average duration of clinical experience of 13 years (range 1– 45 years). The majority of respondents correctly identified Usher syndrome as a genetic condition (86%), identified at least two of the affected senses (97%), and identified the progressive nature of the vision and hearing losses (> 90%). Awareness of vestibular dysfunction and its characteristics was low, as was knowledge of the key treatment roles that speech pathologists, genetic counsellors and geneticists play in the management of Usher Syndrome. The majority of respondents also did not identify important aspects of care within their own discipline.Conclusion: This study has shown that there is a need for targeted education to be delivered to hearing and vision care allied health clinicians to raise awareness of the vestibular impacts and aspects of vision loss experienced by people with Usher syndrome. This education needs to target the broad range of clinicians who have a key role in providing multidisciplinary care (including speech pathologists, geneticists, and genetic counsellors) and to identify the key aspects of good-quality multidisciplinary care.Keywords: deaf-blindness, optometry, audiology, orthoptics, genetics, physiotherapy

Abstract Background Paediatric dentistry is a branch of dental specialty that focuses on dental care for children from infancy through adolescence. However, there is no standardised national undergraduate paediatric dental curriculum in Malaysia. The present study aimed to identify relevant topics for undergraduate paediatric dental curricula and to determine the appropriate cognitive and psychomotor levels for each topic based on the consensus among paediatric dental experts. Methods Potential relevant undergraduate paediatric dentistry topics were initially drafted and revised according to the revised national competency statement. The final draft included 65 topics clustered under 18 domains. A fuzzy Delphi method was used and experts who fulfilled the inclusion criteria were invited to anonymously ranked the importance of relevant topics using a five-point Likert scale and proposed suitable cognitive and psychomotor levels for each topic. Fuzzy evaluation was then performed, and experts were considered to have reached a consensus if the following three conditions were achieved: (a). the difference between the average and expert rating data was ≤ 0.2; (b). the average expert consensus was ˃70%; and (c). the average fuzzy number was ≥ 0.5. Subsequently, the mean ratings were used to determine the cognitive and psychomotor levels. Results 20 experts participated in the survey. 64 out of 65 paediatric dentistry topics were deemed acceptable. The average fuzzy number ranged from 0.36 to 0.85, while the average Likert score ranged from 3.05 to 5.00. The topic “Dental amalgam” was rejected based on expert consensus since the average fuzzy number was 0.36. The most significant topic was “Pit and fissure sealant”, followed by “Preventive advice”, “Early childhood caries”, “Dental caries in children & adolescent”, “Management of dental caries in paediatric patients”, and “Consent” which were equally ranked as the second most important topics. According to Bloom’s and Simpson’s taxonomies, most of the paediatric dentistry topics were rated adequate for undergraduate students at the cognitive level of “Apply” (C3) and a psychomotor level of “Guided response” (P3). Conclusion The current study successfully identified relevant undergraduate paediatric dentistry topics using the fuzzy Delphi method, which can facilitate future educators to improve existing Malaysian undergraduate paediatric dental curricula.

Abstract Introduction: Dental materials science is one of the core courses for Malaysian undergraduate dental programmes, which has been primarily taught through a series of didactic lectures during the preclinical phase. In accordance with the newly revised national competency statement, Malaysian dental education is moving toward competency-based education, hence a reformation of the dental materials science curriculum is warranted. Methods: Curriculum design including common teaching, learning and assessments methods for the Malaysian dental materials science were described and analysed. The common practices were reviewed and compared with latest national guidelines and literature. Results: There is yet an initiative to establish a national curriculum for dental materials science. The use of traditional teaching strategies for this course also needs to be revamped from a teacher-centred to a student-centred approach. Furthermore, faculty members are facing significant challenges because the revamp requires them to explore cutting-edge pedagogical methods and develop appropriate learning opportunities, environments, resources, and assessments. Several recommendations are proposed, such as mapping the existing dental materials science curriculum to identify gaps, incorporating more hands-on sessions, implementing an integrated curriculum, introducing various formative and summative assessments, as well as recruiting faculty members with different areas of educational expertise. Conclusion: It is hoped that this article offers a clearer pathway for Malaysian dental educators to pioneer new insight and transform the existing dental materials science curriculum.

Abstract Background Feedback is regarded as a key component of formative assessment and one of the elements with the greatest impact on students’ academic learning. The present study aimed to evaluate and compare students’ perceptions of the use of two feedback models, namely feedback sandwich and Ask-Tell-Ask (ATA), in teaching dental materials science courses. Methods All undergraduate second-year dental students were invited to participate in the dental materials science practical session and were randomly allocated into two groups: Group 1 (feedback) sandwich and Group 2 (ATA). The session began with the teacher giving a short briefing on the commonly used dental materials, followed by a short demonstration of the manipulation of those materials. Students were then allowed to mix and manipulate the materials, and teachers provided feedback accordingly. At the end of the session, 16 close-ended (five-point Likert scales) and an open-ended questionnaire were distributed to students to evaluate their perceptions of the feedback given. Internal reliability of the questionnaire items was evaluated using Cronbach’s alpha. Mean feedback scores were analysed using an independent t-test with ANCOVA for controlling gender and ethnicity. Thematic analysis was used to code the qualitative data. Results Sixty-nine students participated in the present study with the majority being females (72.5%) and Chinese (79.7%). Cronbach’s alpha analysis suggested removing three Likert-scale items, with the remaining 13 items being accepted. Generally, no significant difference was noted between the two groups (p = 0.197), but three items were found to be significant (p

Abstract Background Double reading (DR) in screening mammography increases cancer detection and lowers recall rates, but has sustainability challenges due to workforce shortages. Artificial intelligence (AI) as an independent reader (IR) in DR may provide a cost-effective solution with the potential to improve screening performance. Evidence for AI to generalise across different patient populations, screening programmes and equipment vendors, however, is still lacking. Methods This retrospective study simulated DR with AI as an IR, using data representative of real-world deployments (275,900 cases, 177,882 participants) from four mammography equipment vendors, seven screening sites, and two countries. Non-inferiority and superiority were assessed for relevant screening metrics. Results DR with AI, compared with human DR, showed at least non-inferior recall rate, cancer detection rate, sensitivity, specificity and positive predictive value (PPV) for each mammography vendor and site, and superior recall rate, specificity, and PPV for some. The simulation indicates that using AI would have increased arbitration rate (3.3% to 12.3%), but could have reduced human workload by 30.0% to 44.8%. Conclusions AI has potential as an IR in the DR workflow across different screening programmes, mammography equipment and geographies, substantially reducing human reader workload while maintaining or improving standard of care. Trial registration ISRCTN18056078 (20/03/2019; retrospectively registered).

The paper describes a study of wet foams in microgravity whose bubble size distribution evolves due to diffusive gas exchange. We focus on the comparison between the size of bubbles determined from images of the foam surface and the size of bubbles in the bulk foam, determined from Diffuse Transmission Spectroscopy (DTS). Extracting the bubble size distribution from images of a foam surface is difficult so we have used three different procedures: manual analysis, automatic analysis with a customized Python script and machine learning analysis. Once various pitfalls were identified and taken into account, all the three procedures yield identical results within error bars. DTS only allows the determination of an average bubble radius which is proportional to the photon transport mean free path $\ell ^*$. The relation between the measured diffuse transmitted light intensity and $\ell ^*$ previously derived for slab-shaped samples of infinite lateral extent does not apply to the cuboid geometry of the cells used in the microgravity experiment. A new more general expression of the diffuse intensity transmitted with specific optical boundary conditions has been derived and applied to determine the average bubble radius. The temporal evolution of the average bubble radii deduced from DTS and of the same average radii of the bubbles measured at the sample surface is the same (to a factor probably close to one) throughout the coarsening. Finally, ground experiments were performed to compare bubble size distributions in a bulk wet foam and at its surface at times so short that diffusive gas exchange is insignificant. They were found to be similar, confirming that bubbles seen at the surface are representative of the bulk foam bubbles.

Vaughna Galvin,1 Dennis J Cheek,2 Yan Zhang,3 Gregory Collins,1 David Gaskin4 1School of Nurse Anesthesia, Texas Christian University, Fort Worth, TX, USA; 2School of Nursing, Texas Christian University, Fort Worth, TX, USA; 3Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, TX, USA; 4Republic Pain Specialists, Physicians Centre Hospital, Bryan, TX, USACorrespondence: Vaughna Galvin, School of Nurse Anesthesia, Annie Richardson Bass Building, 2800 West Bowie Street, Suite 3101, Fort Worth, TX, 76109, USA, Tel +1 817-257-7887, Fax +1 817-257-5472, Email V.B.GALVIN@tcu.eduAbstract: One hundred ninety-five patients presenting with post-COVID symptomology, including parosmia and dysgeusia, underwent reversible stellate ganglion blockade. Stellate ganglion blockade was performed at an outpatient facility, and patients were evaluated via survey at seven days post-injection. Of the 195 participants, ages ranged from 18– 69 years of age with the breakdown of sexes being females n = 157 and males n = 38. The most significant finding was a reported improvement in olfaction post-injection in 87.4% of subjects. The effectiveness of this novel treatment for post-COVID is promising and warrants further investigation.Keywords: cervical sympathetic block, COVID, parosmia, dysgeusia, dysautonomia

Abstract Background Dental materials science is an important core course in undergraduate dental programs which integrates foundational concepts of chemical engineering and materials science into clinical dentistry. The present study aimed to identify relevant dental materials science topics for Malaysian undergraduate dental curricula and to determine their appropriate competency levels in terms of cognitive and psychomotor taxonomies. Methods Potential dental materials science topics were drafted in alignment with the revised national competency statement. The list of topics was further amended after comparing it with those recommended topics in the literature. Fuzzy Delphi method was applied. Experts were selected based on the different inclusion criteria. They ranked the topics using a five-point Likert scale and recommended the appropriate cognitive and psychomotor levels. Next, fuzzy evaluation was performed. Consensus was deemed for a topic to be included if (a) the average expert agreement was ≥ 75%, (b) the d-construct threshold value for each topic was ≤ 0.2 and (c) the average fuzzy number was ≥ 0.5. Results Sixty-two experts participated in the study. They accepted 33 out of 36 potential dental materials science topics. The average Likert score and fuzzy number ranged from 3.63 to 4.92 and 0.526 to 0.784, respectively. Furthermore, “Endodontic materials” was ranked as the most significant topic. Meanwhile, many topics required dental students to demonstrate a cognitive level of “Apply” and a psychomotor level of “Guided response”. Based on mean scores, “Impression materials” was rated as the most cognitively demanding topic, whilst “Temporary restorative materials” was the most demanding topic for psychomotor taxonomy. Conclusion The present study has identified relevant dental materials science topics and their appropriate cognitive and psychomotor levels using the Fuzzy Delphi approach. The findings of the present study form the basis for future studies to develop measurable learning outcomes, design corresponding innovative pedagogy and propose assessment criteria for each topic.

Thibaut Galvain,1 Melek Pinar Bosut,1 Nadine Jamous,1 Nadia Ben Mansour2,3 1Health Economics and Market Access, Johnson & Johnson Medical NV, Diegem, Belgium; 2National Institute of Health, Tunis, Tunisia; 3Faculty of Medicine, Université de Tunis El Manar, Tunis, TunisiaCorrespondence: Thibaut Galvain, Health Economics and Market Access, Johnson & Johnson Medical NV, Leonardo da Vincilaan 15, Diegem, Belgium, Tel +33648649800, Email tgalvain@its.jnj.comPurpose: Obesity is a growing global issue with evidence linking it to an increase in loss of disease-free years, reduced quality of life, increased mortality, and additional economic burden. This study sought to establish the cost-effectiveness of gastric bypass and sleeve gastrectomy, compared to conventional therapy in patients with obesity, from a Tunisian healthcare payor perspective.Patients and Methods: A Markov model compared lifetime costs and outcomes of bariatric surgery with conventional treatment among patients with body mass index (BMI) ≥ 40 kg/m2, BMI ≥ 35 kg/m2 with obesity-related co-morbidities (Group 1), or BMI ≥ 35 kg/m2 with type 2 diabetes mellitus (T2DM) (Group 2). Inputs were sourced from the Tunisian Health Examination Survey, local clinician data and literature sources. Health states were associated with different cost and utility decrements. Changes in body mass index, systolic blood pressure, lipid ratio and diabetes remission rates were modelled on a yearly basis. The incremental cost-effectiveness ratio (ICER), quality-adjusted life years (QALYs) and net monetary benefit (NMB) were key outcomes. Sensitivity and scenario analyses were performed to test the model’s robustness.Results: The model showed that the benefits of bariatric surgery were favorable compared to conventional treatment, with an ICER of 1844 TND/QALY in Group 1 patients and 2413 TND/QALY in Group 2 patients. Bariatric surgery resulted in a QALY gain of 3.26 per patient in Group 1 and a gain of 1.77 per patient in Group 2. At a willingness to pay threshold of 31,379 TND/QALY, the incremental NMB was 96,251 TND and 51,123 TND for Group 1 and Group 2, respectively.Conclusion: From the Tunisian healthcare payor perspective, bariatric surgery is cost-effective for patients with obesity and those with T2DM and obesity-related comorbidities. These findings may have impact on future decision-making on funding and reimbursement of bariatric surgery in Tunisia.Keywords: cost-effectiveness analysis, diabetes, gastric bypass, obesity, sleeve gastrectomy, bariatric surgery

Background/purpose: The usage of bioceramic-based root canal sealers has escalated over the years due to their excellent properties. The present study aimed to fabricate a novel algin incorporated bioactive glass 58S calcium-silicate (Bio-G) sealer and characterise its surface microstructure and chemical compositions in comparison to commercially available bioceramic sealers (BioRoot RCS and iRoot SP). Materials and methods: The powder form of experimental Bio-G sealer consisted of synthesised BG 58S particle, calcium silicate, zirconia dioxide, calcium carbonate and alginic acid powder as binder. The liquid composed of 5% calcium chloride solution. Five standardised disc specimens were prepared for each sealer group according to the manufacturer's instructions. Subsequently, sealer disc-specimens were placed in an incubator at 37 °C, 95% relative humidity for 72 h to allow setting prior to testing under scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), Fourier transformed infrared spectroscopy (FTIR) and X-ray diffraction (XRD). Results: Experimental Bio-G sealer revealed irregular micro-sized particles ranging from 0.5 μm to 105 μm aggregated in clusters comparable to those of BioRoot RCS and iRoot SP. EDS microanalysis showed that Bio-G had high content of oxygen, silicon, and calcium, with the presence of aluminium and chloride similar to BioRoot RCS. Meanwhile, the FTIR and XRD findings suggested that all sealers predominantly contained calcium silicate hydrate, calcium carbonate, and zirconium dioxide, while calcium aluminium silicate oxide was detected in Bio-G. Conclusion: The present novel Bio-G sealer demonstrated desirable particle size distribution and acceptable degree of purity. Future studies are warranted to explore its properties and clinical application.

ABSTRACT BACKGROUND: Lipomatous pseudohypertrophy of the pancreas, pancreatic lipomatosis, pancreatic steatosis, non-alcoholic fatty pancreatic disease, or fatty pancreas is an extremely rare disease, characterized by the organ enlargement and a localized or diffuse replacement of pancreatic acinar cells by mature adipose tissue, preserving the pancreatic ductal system and islets of Langerhans. AIMS: To report a rare case of lipomatous pseudohypertrophy of the pancreas in a symptomatic patient and the surgical treatment employed. METHODS: A 24-year-old male patient with weight loss (10 kilograms in 8 months), hyperglycemia, severe and recurrent acute abdominal pain, epigastric discomfort associated with nausea, vomiting, and jaundice for 40 days. Magnetic resonance imaging was performed, revealing an irregular lipomatous pseudohypertrophy of the pancreas, measuring 6.0 × 5.6 cm in the head, uncinate process, and part of the body of the pancreas. The pancreatic duct dilation was diffuse and irregular, associated with atrophy of the remnant parenchyma, particularly in the tail of the pancreas. The patient underwent pancreatoduodenectomy without total mesopancreas excision followed by pancreatojejunostomy. RESULTS: The postoperative course was uneventful, the length of stay in the ICU was two days, and the patient was discharged on the seventh postoperative day. CONCLUSIONS: The disease treatment depends on the signs and symptoms at presentation and a pancreatoduodenectomy is indicated in patients with severe and recurrent abdominal pain.

Maria Concetta Nigro,1 Paola Valeria Marchese,1 Chiara Deiana,1 Chiara Casadio,1 Linda Galvani,1 Alessandro Di Federico,1 Andrea De Giglio1,2 1Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, University of Bologna, Bologna, 40138, Italy; 2Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, 40138, ItalyCorrespondence: Paola Valeria Marchese, Department of Experimental, Diagnostic and Specialty Medicine, S.Orsola-Malpighi University Hospital, University of Bologna, Via Albertoni 15, Bologna, 40138, Italy, Email paolavmarchese@gmail.comAbstract: Precision medicine has revolutionized the therapeutic management of cancer patients with a major impact on non-small cell lung cancer (NSCLC), particularly lung adenocarcinoma, where advances have been remarkable. Tissue biopsy, required for tumor molecular testing, has significant limitations due to the difficulty of the biopsy site or the inadequacy of the histological specimen. In this context, liquid biopsy, consisting of the analysis of tumor-released materials circulating in body fluids, such as blood, is increasingly emerging as a valuable and non-invasive biomarker for detecting circulating tumor DNA (ctDNA) carrying molecular tumor signatures. In advanced/metastatic NSCLC, liquid biopsy drives target therapy by monitoring response to treatment and identifying eventual genomic mechanisms of resistance. In addition, recent data have shown a significant ability to detect minimal residual disease in early-stage lung cancer, underlying the potential application of liquid biopsy in the adjuvant setting, in early detection of recurrence, and also in the screening field. In this article, we present a review of the currently available data about the utility and application of liquid biopsy in lung cancer, with a particular focus on the approach to different techniques of analysis for liquid biopsy and a comparison with tissue samples as well as the potential practical uses in early and advanced/metastatic NSCLC.Keywords: circulating tumor DNA, liquid biopsy, EGFR, minimal residual disease, sequencing technologies, lung cancer, early-stage, non-small cell lung cancer

The separation of the nickel-titanium (NiTi) rotary files is seen occasionally due to improper use and lack of technique, which results in improper cleaning and shaping of the root canals, compromising the treatment outcome. Various techniques have been introduced to either bypass or retrieve the separated instrument. The present case series highlighted a low-cost and straightforward alternative to retrieve the separated NiTi rotary instruments using a customized syringe and loop technique with the assistance of a dental operating microscope. Three cases of fractured instruments in different root canals were addressed, with the customized syringe and loop technique being used to retrieve the instruments successfully. This supports the use of a convenient, reliable, and cost-effective approach to managing fractured endodontic instruments without costly equipment or specific retrieval kits.

Susan Williams,1 Clíona O’Riordan,1 Fiona Steed,2 Aoife Leahy,1,3 Elaine Shanahan,3 Catherine Peters,3 Margaret O’Connor,3,4 Rose Galvin,1 Ann-Marie Morrissey1 1School of Allied Health, University of Limerick, Limerick, Ireland; 2Department of Medicine, University Hospital Limerick, Limerick, Ireland; 3Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland; 4School of Medicine, University of Limerick, Limerick, IrelandCorrespondence: Susan Williams, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland, Email Susan.Williams@ul.ieIntroduction: Early supported discharge (ESD) is well established as a model of health service delivery for people with stroke. Emerging evidence indicates that ESD also reduces the length of stay for older medical inpatients. There is a dearth of evidence exploring the views of stakeholders on ESD as a model of care for older medical inpatients. The overall aim of this study is to explore the views and perceptions of older adults, family carers and healthcare professionals on the potential role of ESD for older adults admitted to hospital with medical complaints.Methods: Purposeful sampling was used to recruit older adults and family carers for interview. For Healthcare Professionals (HCPs), snowball purposeful sampling was used. Phone interviews took place following a semi-structured interview guide. Focus groups were moderated by A-MM. Braun and Clarke’s approach to thematic analysis was used. Ethical approval was granted by the HSE Mid-Western Area Regional Ethics Committee in November 2021 (REC Ref. 096/2021).Results: Fifteen HCPs took part across three focus groups, with six older adults and two family members participating in one-to-one interviews. Three themes were identified: 1. Pre-ESD experiences of providing and receiving older adult inpatient care, 2. Navigating discharge procedures from acute hospital services, 3. A vision for more integrated model of care and a medical ESD team.Discussion: This study provided insight into the current discharge experiences of older adult care in the acute setting, the potential role for ESD in this population and the key factors that would need to be considered for the running of an ESD service for older adults admitted to hospital with medical complaints.Conclusion: This research highlights the barriers and facilitators to ESD for older medical inpatients from the perspectives of key stakeholders. Given the adverse outcomes associated with prolonged hospital stay, these findings will help inform the development of a feasibility trial, examining patient and process outcomes for older adults admitted to hospital with medical complaints who receive an ESD intervention.Keywords: early supported discharge, older adults, hospitalised, qualitative, medical inpatient

Francisco Pastor-Pascual,1 Rafael Pastor-Pascual,1 Patricia Gálvez-Perez,1 Rosa Dolz-Marco,2 Roberto Gallego-Pinazo2 1Anterior Segment Department, Valencia, Spain; 2Posterior Segment Department, Valencia, SpainCorrespondence: Francisco Pastor-Pascual, Clínica Oftalvist, Valencia, Spain, Tel +34 963 51 33 04, Email franciscopastorpascual@gmail.comPurpose: To analyze the use of artificial tears in patients undergoing treatment with anti-vascular endothelial growth (anti-VEGF) intravitreal injections.Methods: Thirty-four eyes undergoing anti-VEGF treatment were analyzed. Each patient underwent a subjective and objective evaluation of the ocular surface, using the Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ)-5, tear meniscus height (TMH), first and average non-invasive Keratograph Break-Up Time (NIKBUT), bulbar conjunctival redness, meibography and the Vision Break-Up Time (VBUT). Patients attended 5 visits (days 0, 7, 30, 37, and 60). All patients continued with their intravitreal injection treatment during the study (days 0, 30, and 60). Patients did not receive any artificial tear treatment during the first month of the study, and at the baseline visit they were randomly assigned to one of two study groups to receive either the Systane Hydration or the Viscofresh 10mg/mL formulation. Patients were instructed to instill one drop of the assigned study treatment 3 times a day for 30 days during the second month of the study.Results: According to the Mixed Models for Repeated Measures analysis, there is not enough statistical evidence for any of the parameters examined to determine significant differences between being treated with artificial tears and not being treated (p > 0.05). There is, however, a tendency toward improved outcomes in some parameters when artificial tears were used. OSDI, DEQ-5, TMH, and meibography were not affected by either the type of artificial tear used or by the time (from day 30 to day 60; p > 0.05), but the NIKBUT and VBUT values increased over time during this period regardless of which treatment the patient was receiving.Conclusion: The use of artificial tears may help to keep the tear film stable Future studies with larger samples should be conducted to elucidate whether the tendency reported in our study becomes significant.Keywords: ocular discomfort, artificial tears, intravitreal injection, anti-VEGF agents, dry eye

El objetivo de la investigación consiste en realizar la epoxidación de grasa de pollo residual y obtener un producto más estable frente a la oxidación, para ser utilizado en la formulación de grasa lubricante. Metodológicamente el estudio se realizó en dos etapas experimentales. En la primera se llevó a cabo la reacción de transesterificación. En la segunda se realizó la epoxidación a 75ºC durante 4.5h. Como resultados se logró determinar los parámetros de calidad del biodiesel con valores apropiados como la densidad, viscosidad cinemática e índice de yodo. Se concluyó que con la epoxidación aumentó la densidad y la viscosidad en comparación con la del producto transesterificado. La densidad final del producto de la epoxidación corresponde a lubricantes de tipo pesado en relación a la gravedad API y la viscosidad cinemática medida a 40ºC, lo que permitió clasificarlo como lubricante ISO VG 7 de acuerdo a la norma ASTM-D-242.

Juliette Felician,1– 3 Filipe Galvao,3 Mylène Lefebvre,3 Mikail Nourredine,2,4– 6,&ast; Laure Peter-Derex1,2,7,&ast; 1Centre for Sleep Medicine and Respiratory Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; 2Medicine faculty, Lyon 1 University, Lyon, France; 3Unité Michel Jouvet – Pôle Est – Z19, Centre Hospitalier Le Vinatier, Bron, France; 4Biostatistics Unit, University Hospital Service of Pharmacotoxicology and Public Health Department, Hospices Civils de Lyon, Lyon, France; 5Research Department, Centre Hospitalier Le Vinatier, Bron, France; 6Biometry and Evolutionary Biology Laboratory, UMR CNRS 5558, Lyon, France; 7Lyon Neuroscience Research Centre, CNRS UMR 5292/INSERM U1028, Lyon, France&ast;These authors contributed equally to this workCorrespondence: Laure Peter-Derex, Centre for Sleep Medicine and Respiratory Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, Lyon, 69004, France, Tel +33 4 72 07 17 69, Fax +33 4 72 07 28 08, Email laure.peter-derex@chu-lyon.frPurpose: The containment of the population during the COVID-19 pandemic led to the emergence or recurrence of psychiatric conditions and sleep disorders. The influence of sleep/wake rhythm on mental health is well known. The objective of our study was to evaluate the link between the shift in sleep/wake rhythm and the presence of depressive symptoms during the March to May 2020 lockdown in the French population.Participants and Methods: Participants (n = 2513) were recruited via newspapers and social networks in March 2020. We evaluated i) the chronotype before and during the lockdown, assessed by the change in mid-sleep time on work-free days corrected for sleep debt on workdays (delta MSFsc); ii) morningness-eveningness circadian preference (Horne & Ostberg questionnaire); iii) depressive symptoms (Patient Health Questionnaire-9, PHQ-9). The delta MSFsc and the PHQ-9 score were compared between circadian preference types. A multivariate model adjusted for age, sex, circadian preference, housing type, and marital status was used to assess the influence of delta MSFsc on the PHQ-9 score in the whole population.Results: The population consisted of 77% women, of median (IQR) age 39 (30– 48) years. Compared with the pre-lockdown period, the median (IQR) MSFsc was shifted by 30 (0– 66) min during the lockdown, with a significant difference between evening [60 (15– 120) min], morning [15 (0– 46) min] and neutral [30 (0– 70) min] circadian type individuals, p < 0.001. One-third of all participants had moderate to severe depressive symptoms (PHQ-9 ≥ 10). A 1-hour shift in MSFsc was associated with a 0.50-point increase [95% CI (0.28; 0.72), p < 0.001] in the PHQ-9.Conclusion: A phase delay in the chronotype was observed in the general population during lockdown. Such disruption was associated with depressive symptoms but the direction of the relationship remains hypothetical. The impact on mental health of preventive measures targeting the sleep/wake rhythm in this context needs further evaluation.Keywords: phase delay, pandemic, containment, mental health, chronotype, circadian preference

The current study aimed at using a simplex lattice mixture design in designing the experiments, evaluating the results, and optimizing the contents of lime, micro silica, and coir fiber for enhancing the strength property of a residual soil. The effect of the independent variables (lime content, micro silica content, and coir fiber content) on the strength property (unconfined compressive strength (UCS)) was investigated by analysis of variance. Besides, strength optimization was carried out using the desirability function approach to determine the optimum additive combinations in achieving maximum strength. The results showed that the fitted model demonstrated a high determination coefficient (98.61%). The optimization of the variables illustrated that utilizing 7.10% micro silica, 2.32% lime, and 0.59% coir fiber produced an optimum UCS of 827.93 kPa with a designated maximum desirability function of (D = 1.00). Also, the predicted optimum combinations were experimentally tested to check the accuracy and dependability of the optimized conditions. The findings show a good correlation between the experimental values and the predicted optimized values by the developed model. Therefore, the developed model is rationally accurate for forecasting the UCS of the lime-micro silica stabilized coir fiber-reinforced soil.

Elissa Burton,1,2 N Frances Horgan,3 Vanda Cummins,3,4 Austin Warters,5 Lauren Swan,6,7 Maria O’Sullivan,7 Dawn A Skelton,8,9 Bex Townley,9 Frank Doyle,10 Samira B Jabakhanji,11 Jan Sorensen,11 Debbie Rooney,6 Lisa Murphy,6 Rose Galvin12 1Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; 2enAble Institute, Curtin University, Perth, Western Australia, Australia; 3School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 4Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 5Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 6North Dublin Home Care (NDHC), Dublin, Ireland; 7Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland; 8School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; 9Later Life Training Ltd, Killin, Scotland; 10Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 11Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland; 12School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick (UL), Limerick, IrelandCorrespondence: Elissa Burton, Curtin School of Allied Health, Curtin University, GPO Box U1987, Bentley, Western Australia, 6845, Australia, Tel +61 8 9266 4926, Fax +61 8 9266 3699, Email E.Burton@curtin.edu.auPurpose: Physical activity has been shown to improve older adults’ functional capacity, independence, and quality of life. In a feasibility study, we embedded a movement approach within older adults existing home care services through “Care to Move” (CTM). The aim of this qualitative study is to explore older adults’ experiences of CTM within their home care support services and to identify the strengths and barriers of engaging in CTM from the perspective of the older recipient.Materials and Methods: We conducted semi-structured telephone interviews with 13 older adults and one informal carer. Topics covered included participants’ overall experiences of CTM, changes to their overall activity and participation, aspects of CTM that they found valuable and issues that were challenging. Interview transcripts were coded and analyzed thematically to capture barriers and facilitators to the approach delivery.Results: Four themes were developed: i) “I have good days and bad days”, ii) “safety and security is the name of the game”, iii) “we’re a team as it stands’, iv) “it’s [COVID-19] depressing for everybody at the moment”. Older adults identified benefits of CTM engagement including improvements in physical and psychological wellbeing. However, subjective frailty and self-reported multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of delivering CTM and competing care staff interests. The broader role of care staff in supporting CTM was highlighted, as well as the emotional support that staff provided to older adults. Care staff continuity was identified as a barrier to ongoing engagement. The impact of COVID-19 on older adults physical and mental health negatively impacted the delivery of the approach.Conclusion: Our findings suggest that embedding CTM within home care services is feasible and that older adults enjoyed engaging in CTM. Addressing care staff continuity and adopting individual approaches to CTM delivery may enhance the implementation of services.Keywords: movement, older people, community care, motivation, barriers, home support

Natalia Valdiviezo,1 Cindy Alcarraz,1,2 Denisse Castro,3,4 Renzo Salas,3 Victor Begazo-Mollo,5 Marco Galvez-Villanueva,6 Luz Medina Aguirre,7 Elica Garcia-León,8 Isela Quispe-Santivañez,9 Carmen Cornejo-Raymundo,10 Eduardo Paz-Cornejo,11 Luis Sanchez-Vilela,12 Vanessa Bermudez-Alfaro,13 Juan Carlos Vargas-Nina,14 Carlos Pérez-Ramos,15 Andrea Meza-Hoces,16 Paolo R Valdez Barreto,17 Ruth Huaringa-Leiva,18 Johanny Muro-Cieza,19 Valeria Aguilar-Vásquez,20 Eduardo Yache Cuenca,21 Silvia Neciosup-Delgado,1 Nathaly Poma-Nieto,22 Sheyla Chavez-Gavino,23 Lenin Fernandez-Rosas,24 Jhajaira M Araujo,2 Eduardo Payet,25 Henry L Gomez1 1Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru; 2Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú; 3Departamento de Oncología Médica, Hospital Nacional Edgardo Rebagliati Martins, Lima, 15072, Peru; 4Centro de Investigación de Medicina de Precisión, Universidad de San Martin de Porres, Lima, 15024, Peru; 5Departamento de Medicina Oncológica, Instituto Regional de Enfermedades Neoplásicas Sur, Arequipa, Perú; 6Departamento de Medicina Oncológica, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú; 7Departamento de Medicina Oncológica, Hospital Goyeneche, Arequipa, 04600, Perú; 8Departamento de Medicina Oncológica, Hospital Regional de Lambayeque, Lambayeque, 14001, Perú; 9Departamento de Medicina Oncológica, Hospital Santa Rosa, Lima, 15084, Peru; 10Departamento de Medicina Oncológica, Hospital Nacional Dos de Mayo, Lima, Peru; 11Departamento de Medicina Oncológica, Hospital Nacional Alberto Sabogal Sologuren, Lima, Peru; 12Departamento de Medicina Oncológica, Hospital de Apoyo II Santa Rosa, Piura, Peru; 13Departamento de Medicina Oncológica, Hospital Nacional Guillermo Almenara Irigoyen, Lima, 15033, Peru; 14Departamento de Medicina Oncológica, Hospital II EsSalud de Cajamarca, Cajamarca, Peru; 15Departamento de Medicina Oncológica, Hospital María Auxiliadora, Lima, Peru; 16Departamento de Medicina Oncológica, Hospital II E de Lamas, San Martin, Peru; 17Departamento de Medicina Oncológica, Hospital de Alta complejidad Virgen de la Puerta, La Libertad, Peru; 18Departamento de Medicina Oncológica, Hospital Militar Central, Lima, Peru; 19Departamento de Medicina Oncológica, Hospital Regional Docente de Cajamarca, Cajamarca, Peru; 20Departamento de Promoción de la Salud, Prevención y Control del Cáncer, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú; 21Departamento de Epidemiología, Instituto Regional de Enfermedades Neoplásicas Norte, La Libertad, Perú; 22Departamento de Medicina Oncológica, Hospital Nacional Daniel Alcides Carrión, Lima, Perú; 23Departamento de Medicina Oncológica, Hospital Regional Eleazar Guzmán Barrón, Ancash, Perú; 24Departamento de Cirugía Oncológica, Hospital Regional Eleazar Guzmán Barrón, Ancash, Perú; 25Jefatura Institucional, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, PeruCorrespondence: Natalia Valdiviezo, Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Av. Angamos 2520, Surquillo, Lima, 15038, Peru, Tel +51 992825055, Email nivaldivieso@gmail.comPurpose: The aim of this study is to evaluate the oncological care during the first state of national emergency due to the COVID-19 pandemic in several public cancer hospitals in Peru.Materials and Methods: A multicentric cross-sectional descriptive study was conducted by interviewing adult cancer patients diagnosed and treated between January 2019 and February 2020 from 18 hospitals. This study was carried out in September 2020, the last month of the first state of national emergency. Demographic and clinical characteristics were evaluated, including COVID-19 status and cancer treatment features.Results: A total of 1472 patients were included; the median age was 55 years (range 19– 97). Most patients (85.8%, n = 1263) had solid neoplasia, 13.5% (n = 198) hematologic neoplasia, and 0.7% (n = 11) others. SARS-CoV-2 infection was confirmed in 8.6% (n = 126), 1.2% (n = 18) were probable, 1.6% (n = 24) suspected, and 88.6% (n = 1304) negative cases. Overall, 51.6% of patients (n = 759) had cancer treatment delays, 42.5% (n = 626) changed treatment delivery (endovenous to oral systemic therapy), and 12.6% (n = 185) of cases cancer therapy was discontinued. In total, 10.3% (n = 117) of patients whose disease was controlled or in remission, experienced progression of disease during the state of emergency. A total of 6.7% (n = 98) of patients died, of whom 73.5% (n = 72) died from disease progression; 18.4% (n = 18) from SARS-CoV-2 infection and 8.1% (n = 8) from undetermined causes. Patients with hematological malignancies [hazard ratio (HR): 5.11 (95% confidence interval (CI): 1.99– 13.07)] and no response to therapy before the onset of the pandemic [5.01 (1.44– 17.42)] had an increased risk of death among COVID-19 infected individuals, whereas advanced clinical stage [5.09 (2.37– 10.95)] and discontinuation of treatment [3.66 (1.97– 6.78)] were risk factors among non-COVID-19 patients.Conclusion: Our study suggests that the COVID-19 pandemic has an adverse impact on the outcomes of Peruvian cancer patients. In our cohort, cancer mortality was higher than COVID-19 disease mortality.Keywords: COVID-19 pandemic, cancer care, Peru

Lauren Swan,1,2 N Frances Horgan,3 Vanda Cummins,4 Elissa Burton,5 Rose Galvin,6 Dawn A Skelton,7,8 Bex Townley,8 Frank Doyle,9 Samira B Jabakhanji,10 Jan Sorensen,10 Debbie Rooney,2 Lisa Murphy,2 Austin Warters,11 Maria O’Sullivan1 1Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland; 2North Dublin Home Care (NDHC), Dublin, Ireland; 3School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 4Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 5Curtin School of Allied Health, Curtin University, Perth, Australia; 6School of Allied Health, Ageing Research Centre, University of Limerick (UL), Limerick, Ireland; 7School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; 8Later Life Training, Killin, UK; 9Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 10Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland; 11Older Person Services CHO9, Health Service Executive (HSE), Dublin, IrelandCorrespondence: Maria O’Sullivan, Email maria.osullivan@tcd.ieIntroduction: In Ireland, over 55,000 older adults are supported in their community by formal home support, amounting to an estimated 23 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the “Care to Move” (CTM) program through existing home support services. This qualitative study aimed to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in and delivered the CTM program.Methods: We conducted semi-structured telephone interviews with 22 HCAs [mean age 49.0 ± 10.7 years and female 21/22] involved in the delivery of the program with older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analyzed thematically to capture barriers and enablers to program delivery.Results: Barriers and enablers were identified under three themes i) the CTM approach ii) the home support setting, iii) older adults and physical activity, with iv) delivering care in a crisis and v) future directions further identified. Overall, there was a positive perception of the program’s focus on “movement prompts and motivators”, the “fit” within home support services, and the training provided. Practical challenges of limited time and the task-orientated nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the program for their clients. Though negative perceptions of older adults’ motivation or ability to engage with physical activity were noted. Risk, such as injury or pain, was identified but was not a dominant theme.Conclusion: Our findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional “task-oriented” care models to more personalised proactive approaches may facilitate this initiative and support aging in place.Keywords: aging, physical activity, integrated care, frailty, aging in place

Kristin Kostka,1,2 Talita Duarte-Salles,3 Albert Prats-Uribe,4 Anthony G Sena,5,6 Andrea Pistillo,3 Sara Khalid,4 Lana YH Lai,7 Asieh Golozar,8,9 Thamir M Alshammari,10 Dalia M Dawoud,11 Fredrik Nyberg,12 Adam B Wilcox,13,14 Alan Andryc,5 Andrew Williams,15 Anna Ostropolets,16 Carlos Areia,17 Chi Young Jung,18 Christopher A Harle,19 Christian G Reich,1,2 Clair Blacketer,5,6 Daniel R Morales,20 David A Dorr,21 Edward Burn,3,4 Elena Roel,3,22 Eng Hooi Tan,4 Evan Minty,23 Frank DeFalco,5 Gabriel de Maeztu,24 Gigi Lipori,19 Hiba Alghoul,25 Hong Zhu,26 Jason A Thomas,13 Jiang Bian,19 Jimyung Park,27 Jordi Martínez Roldán,28 Jose D Posada,29 Juan M Banda,30 Juan P Horcajada,31 Julianna Kohler,32 Karishma Shah,33 Karthik Natarajan,16,34 Kristine E Lynch,35,36 Li Liu,37 Lisa M Schilling,38 Martina Recalde,3,22 Matthew Spotnitz,14 Mengchun Gong,39 Michael E Matheny,40,41 Neus Valveny,42 Nicole G Weiskopf,21 Nigam Shah,29 Osaid Alser,43 Paula Casajust,42 Rae Woong Park,27,44 Robert Schuff,21 Sarah Seager,1 Scott L DuVall,35,36 Seng Chan You,45 Seokyoung Song,46 Sergio Fernández-Bertolín,3 Stephen Fortin,5 Tanja Magoc,19 Thomas Falconer,16 Vignesh Subbian,47 Vojtech Huser,48 Waheed-Ul-Rahman Ahmed,33,49 William Carter,38 Yin Guan,50 Yankuic Galvan,19 Xing He,19 Peter R Rijnbeek,6 George Hripcsak,16,34 Patrick B Ryan,5,16 Marc A Suchard,51 Daniel Prieto-Alhambra4 1IQVIA, Cambridge, MA, USA; 2OHDSI Center at The Roux Institute, Northeastern University, Portland, ME, USA; 3Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; 4Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK; 5Janssen Research & Development, Titusville, NJ, USA; 6Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands; 7School of Medical Sciences, University of Manchester, Manchester, UK; 8Regeneron Pharmaceuticals, Tarrytown, NY, USA; 9Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 10College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia; 11National Institute for Health and Care Excellence, London, UK; 12School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 13Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA; 14Unviersity of Washington Medicine, Seattle, WA, USA; 15Tufts Institute for Clinical Research and Health Policy Studies, Boston, MA, USA; 16Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; 17Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; 18Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea; 19University of Florida Health, Gainesville, FL, USA; 20Division of Population Health and Genomics, University of Dundee, Dundee, UK; 21Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA; 22Universitat Autònoma de Barcelona, Barcelona, Spain; 23O’Brien Institute for Public Health, Faculty of Medicine, University of Calgary, Calgary, Canada; 24IOMED, Barcelona, Spain; 25Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine; 26Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 27Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea; 28Director of Innovation and Digital Transformation, Hospital del Mar, Barcelona, Spain; 29Department of Medicine, School of Medicine, Stanford University, Redwood City, CA, USA; 30Georgia State University, Department of Computer Science, Atlanta, GA, USA; 31Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d’Investigació Mèdica (IMIM), Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, Barcelona, Spain; 32United States Agency for International Development, Washington, DC, USA; 33Botnar Research Centre, NDORMS, University of Oxford, Oxford, UK; 34New York-Presbyterian Hospital, New York, NY, USA; 35VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; 36Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; 37Biomedical Big Data Center, Nanfang Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 38Data Science to Patient Value Program, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; 39Institute of Health Management, Southern Medical University, Guangzhou, People’s Republic of China; 40Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA; 41Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA; 42Real-World Evidence, TFS, Barcelona, Spain; 43Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 44Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea; 45Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea; 46Department of Anesthesiology and Pain Medicine, Catholic University of Daegu, School of Medicine, Daegu, South Korea; 47College of Engineering, The University of Arizona, Tucson, AZ, USA; 48National Library of Medicine, National Institutes of Health, Bethesda, MD, USA; 49College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK; 50DHC Technologies Co. Ltd., Beijing, People’s Republic of China; 51Departments of Biostatistics, Computational Medicine, and Human Genetics, University of California, Los Angeles, CA, USACorrespondence: Daniel Prieto-Alhambra, Botnar Research Centre, Windmill Road, Oxford, OX37LD, UK, Email daniel.prietoalhambra@ndorms.ox.ac.ukPurpose: Routinely collected real world data (RWD) have great utility in aiding the novel coronavirus disease (COVID-19) pandemic response. Here we present the international Observational Health Data Sciences and Informatics (OHDSI) Characterizing Health Associated Risks and Your Baseline Disease In SARS-COV-2 (CHARYBDIS) framework for standardisation and analysis of COVID-19 RWD.Patients and Methods: We conducted a descriptive retrospective database study using a federated network of data partners in the United States, Europe (the Netherlands, Spain, the UK, Germany, France and Italy) and Asia (South Korea and China). The study protocol and analytical package were released on 11th June 2020 and are iteratively updated via GitHub. We identified three non-mutually exclusive cohorts of 4,537,153 individuals with a clinical COVID-19 diagnosis or positive test, 886,193 hospitalized with COVID-19, and 113,627 hospitalized with COVID-19 requiring intensive services.Results: We aggregated over 22,000 unique characteristics describing patients with COVID-19. All comorbidities, symptoms, medications, and outcomes are described by cohort in aggregate counts and are readily available online. Globally, we observed similarities in the USA and Europe: more women diagnosed than men but more men hospitalized than women, most diagnosed cases between 25 and 60 years of age versus most hospitalized cases between 60 and 80 years of age. South Korea differed with more women than men hospitalized. Common comorbidities included type 2 diabetes, hypertension, chronic kidney disease and heart disease. Common presenting symptoms were dyspnea, cough and fever. Symptom data availability was more common in hospitalized cohorts than diagnosed.Conclusion: We constructed a global, multi-centre view to describe trends in COVID-19 progression, management and evolution over time. By characterising baseline variability in patients and geography, our work provides critical context that may otherwise be misconstrued as data quality issues. This is important as we perform studies on adverse events of special interest in COVID-19 vaccine surveillance.Keywords: OHDSI, OMOP CDM, descriptive epidemiology, real world data, real world evidence, open science

The purpose of this paper is to identify challenges and opportunities for exploring Lean approaches in managing instore logistics processes of a hypermarket, wherein data collection made to quantify the state of the system, methods, and instruments will be applied to improve picking and restocking processes between the two main stock areas, the store and the warehouse. This article reports on a case study work, comprising direct observation, and analysis of the data collected, which was developed in three main phases: identification and characterization of problems, improvements in management of stock and restocking information, and finally improvements in the picking and restoking processes and teams. After analysing the hypermarket, some problems were found such as a high percentage of non-productive time in restocking, a daily average of 132 products to be restocked, a lack of standardization of tasks in the warehouse, and outdated restocking management system. Therefore, there will be some proposals to change the restocking management system, the picking and restocking work method and the warehouse layout, which makes it possible to decrease stock breaks in the store by 17%, the number of employees dedicated to these processes from 14 to 11, and finally, to reduce 2 daily hours of non-adding value time. This work makes an innovative contribution to fulfil a lack of publications dedicated to hyper-market inbound logistics between the warehouse and the store. Thus, it reveals the significant importance of focusing on instore logistics to the point of sale, concerning the efficiency, the lean production, and social benefits to the retail hypermarket, from the reception of products in the hypermarket warehouse until they are placed on the store shelves.

Abstract Background Supportive periodontal therapy (SPT) is the key for a stable periodontal health following active treatment. Likewise, implant maintenance is crucial following implant placement. This systematic review aimed to assess clinical outcomes, patients’ perception, and cost-effectiveness of repeated periodontal therapy with air polishing devices (APDs) in comparison with hand instruments and/or power-driven instruments (conventional interventions) in SPT and implant maintenance. Methods Electronic search for randomised controlled clinical trials with minimum 6 months follow-up for SPT and implant maintenance programme was conducted for data published from 01 January 2000 to 30 April 2020 using multiple databases and hand searching. Risk of bias was assessed using the Revised Cochrane Risk-of-Bias tool (RoB 2). Results A total of 823 articles were screened. 4 SPT and 2 implant maintenance studies were eligible for inclusion. For SPT, repeated APDs interventions revealed no statistically significant difference when compared to the conventional interventions (weighted mean difference [WMD] 0.11 mm, p = 0.08). Likewise, no statistical difference was noted in terms of percentage of bleeding on probing (BOP) and clinical attachment level (CAL) gain. APDs were associated with lower pain score (based on Visual Analogue Scale) and higher patient acceptance in SPT studies. For implant maintenance, APDs resulted in reduction in PPD and percentage of BOP. However, CAL gain was comparable between the two groups. In terms of patient reported outcomes, no implant maintenance studies recorded any forms of patient reported outcomes. In addition, no studies reported on economic evaluation of APDs in both SPT and implant maintenance. Conclusion Within the limitations of this systematic review and meta-analysis, repeated subgingival debridement using APDs in SPT resulted in similar clinical outcomes but better patients’ comfort when compared to the conventional interventions. For implant maintenance, there is limited evidence to show that repeated application of APDs leads to improved clinical outcomes when compared to conventional treatments.

This article studies the responses of real wages and labour market flows of immigrants in Spain for the period between 1999 and 2019. By using Labour Force Survey microdata, I examine the cyclicality of job-finding and job-separation rates for immigrants and natives over the long Spanish economic expansion and the sharp contraction. During the expansion, 1999–2007, the job-finding rate was higher for immigrants than for natives, but both rates converged to a lower level after the Great Recession took place in 2008. I also find that the impact of the crisis on the job-separation rate was more than three times as high for immigrants than for natives. By using longitudinal social security data, I find that wage cyclicality is higher for immigrants than for natives: a one percentage point increase in the unemployment rate is associated with a 0.61 and 0.85% drop in real wages for natives and immigrants, respectively. However, these differences only occur among low-tenure workers. This study provides novel empirical evidence to enrich macroeconomic theories on the interaction of economic cycles and the impact of immigration.

Introducción: La obesidad es un problema de salud pública en el que se producen defectos en el sistema endocrino generando en consecuencia enfermedades metabólicas. La cirugía bariátrica (CB) ha demostrado mayor eficacia en la pérdida de peso y reversión de las comorbilidades (especialmente inflamatorio y metabólico). Los mecanismos subyacentes relacionados con la reversión de comorbilidades son aún poco conocidos. Los pacientes sometidos a CB reciben de forma rutinaria suplementos de vitamina D, por lo que su papel en la reversión de comorbilidades puede ser relevante. Objetivos: Determinar la relación entre los niveles de 25-OH-vitamina D, la prevalencia de comorbilidades metabólicas antes de la CB y 6 meses tras la misma. Resultados: Se evaluaron 328 pacientes, los cuales mostraron pérdida significativa de peso y masa magra a los 6 meses de la CB. Los niveles séricos de 25-OH-vitamina D se incrementaron de forma paralela a un aumento en la suplementación, sin embargo, no se observaron correlaciones con la presencia de comorbilidades metabólicas basales ni a los 6 meses de la CB. Los niveles séricos de 25-OH-vitamina D se correlacionaron con algunos parámetros de la composición corporal de forma independiente a la reversión de las comorbilidades. Conclusiones: La CB se asoció a mejoría significativa de comorbilidades metabólicas en los pacientes estudiados de forma independiente a los niveles séricos de 25-OH-vitamina D.

Lars Edelmann,1 Marike Hempel,2 Natalia Podsiadlo,1 Nora Schweizer,2 Cindy Tong,3 Thibaut Galvain,4 Hannah Taylor,5 Michael Schüler1 1Kantonsspital Münsterlingen, Münsterlingen, 8596, Switzerland; 2Johnson & Johnson AG, Zug, 6300, Switzerland; 3Johnson and Johnson Medical Devices, Somerville, NJ, USA; 4Johnson and Johnson Medical, Issy les Moulineaux, France; 5Johnson & Johnson Medical Limited, Berkshire, UKCorrespondence: Lars Edelmann, Klinik für Orthopädie und Traumatologie, Kantonsspital Münsterlingen, Spitalcampus 1, Münsterlingen, 8596, Switzerland, Tel +41-71-686-20 50, Fax +41-71-686-20 23, Email lars.edelmann@stgag.chPurpose: Total knee and hip arthroplasties (TKA and THA) are common surgical procedures in Switzerland and worldwide. Alongside increasing demand for these procedures, many providers have adopted enhanced recovery programs (ERPs) that aim to optimize recovery after these surgeries. We evaluated the impact of implementing a Patient Pathway Optimization (PPO) program designed around ERP principles for patients undergoing TKA or THA in a Swiss Cantonal hospital. The primary objective was to determine whether PPO implementation for patients undergoing TKA or THA reduced length of stay (LOS) during index hospitalization. Additional study outcomes were hospital inpatient costs, rate of complications and readmissions, and patient discharge destination.Methods: This was a retrospective, observational study comparing outcomes before and after PPO implementation for patients who underwent primary TKA or THA from 2014 to 2019. The PPO program modified the care pathway and implemented five ERP principles (preoperative patient education, pre-operative physiotherapy, local infiltration analgesia, early mobilization, and oral analgesia). Hospital electronic medical record and billing data were used for the analysis.Results: After implementation of PPO, LOS was shorter compared with the pre-PPO period (reduction of 2.5 and 2.4 days in TKA and THA cohorts, respectively, both p < 0.001). Mean inpatient costs per patient were also reduced following PPO (decrease of USD2016 [p = 0.015] and USD340 [p = 0.54] for TKA and THA cohorts, respectively). There were no observed increases in readmissions or complications after PPO implementation in either the TKA or THA cohort. More patients in the post-PPO groups were discharged to home vs an alternative health-care setting than in the pre-PPO groups (TKA, 83.8% vs 68.4% [p = 0.07]; THA, 80.4% vs 73.9%, [p = 0.31]).Conclusion: Patient pathway optimization and implementation of additional enhanced recovery principles for TKA and THA may benefit both health systems and patients, by reducing LOS and costs without increases in complications or readmissions.Keywords: enhanced recovery program, total hip replacement, total knee replacement, joint replacement, costs

Objective: To evaluate the awareness, knowledge, and attitude on monkeypox viral infection among preclinical and clinical dental students in Malaysia. Methods: A cross-sectional study was conducted among 229 preclinical and clinical dental students via an online self-reported questionnaire. The questionnaire included 3 items on awareness, 15 items on knowledge, 9 items on attitude and 2 open-ended questions. Data were presented as frequencies and percentages. Chi-square test was used to compare knowledge and awareness scores between preclinical and clinical dental students and content analysis was performed for open-ended responses. Results: Preclinical and clinical dental students were aware of the existence of monkeypox (89.5% and 94.4%, respectively), that the disease emerged in non-endemic countries (81.0% and 87.1%, respectively) and that it was declared a public health emergency of international concern by the World Health Organization (73.3% and 79.0%, respectively). Clinical dental students’ overall knowledge level was significantly higher than preclinical dental students (P=0.014). Both preclinical (95.2%) and clinical (96.8%) dental students demonstrated positive attitudes toward monkeypox with no significant difference (P=0.736) noted between them. Three themes emerged from the open-ended questions: (1) reimplementation of nationwide lockdown, (2) impact on the economy and health, and (3) disruption to the educational system. Students also anticipated their face-to-face learning to be reduced should there be a new outbreak. Conclusions: Both preclinical and clinical dental students showed comparable awareness and attitudes, while the latter demonstrated greater satisfactory knowledge toward the re-emergence of monkeypox during the COVID-19 pandemic. Nonetheless, efforts to improve dental students’ understanding of this alarming outbreak are required, to safeguard their health and minimise transmission.

The purpose of this article is to explore the central bank’s ability to management inflation forecast errors in Colombia. We present empirical evidence based on the Colombian experience with data from the period of 2008 to 2020. The communication channel selected for analysis is the press releases. The empirical evidence is divided into three steps: (i) regression analysis using an EGARCH model; (ii) use of VAR models; and (iii) variance decomposition analysis. The communications effects are significant for several months and that close to half of the forecast error variance can be explained by innovations in central bank communication. The results obtained allow monetary policymakers to develop more efficient strategies for anchoring expectations and strengthening the central bank credibility.

Virtual Reality (VR) and its capability to replace real stimuli for synthesized ones as if they were real opened several research lines over the years. Many of those consist of trying to validate whether or not VR replicates the same user behaviours seen in reality. In this study, we investigated whether or not product contextualization and gender could influence users’ intention to purchase as well as their satisfaction with the application and how presence levels correlate with purchase intention and user satisfaction. The product tested was a double door refrigerator with a touchscreen. We considered two independent variables: Contextualization (Context - The refrigerator was displayed in a kitchen and filled with food products and Neutral - The refrigerator was empty and displayed in an empty room) and gender (male and female). The results indicated that contextualization and gender had no effective impact on purchase intention, user satisfaction with the VR experience nor the sense of presence. A positive correlation was found between presence and user satisfaction. Evidence indicates that it is not necessary to represent products in their context, saving computational power and human resources.

Virtual reality (VR) potential to isolate users from the real world while producing a rich virtual environment where users act similarly to how they would, in reality, is still being investigated in several fields. In this work, we investigated the effects of product contextualisation and gender under an immersive VR application where users can explore in-depth a commercial product with a “hands-on” experience. An experimental between-subjects study was performed with 38 participants between 18 and 28 years. The product tested consisted of a double-door refrigerator equipped with a touchscreen. Two independent variables were studied: Context (the refrigerator was filled with food products and placed in a kitchen), Neutral Context (empty refrigerator displayed in an empty white room), and Gender (Female and Male). As for the dependent variables, we considered how clarified users felt about the product functionalities, its size, the extent users remember details and characteristics of the refrigerator, and the user’s subjective workload. The evidence shows that contextualisation and gender have no impact on any dependent variables. Therefore, we concluded that presenting a product in its context does not benefit significantly benefit it. Thus, opting for a neutral context would be preferable to save computational costs and human resources necessary to build and run the higher complexity environments required to contextualise the product.

Proper maintenance of mature cellular phenotypes is essential for stable physiology, suppression of disease states, and resistance to oncogenic transformation. We describe the transcriptional regulatory roles of four key DNA-binding transcription factors (Ptf1a, Nr5a2, Foxa2 and Gata4) that sit at the top of a regulatory hierarchy controlling all aspects of a highly differentiated cell-type-the mature pancreatic acinar cell (PAC). Selective inactivation of Ptf1a, Nr5a2, Foxa2 and Gata4 individually in mouse adult PACs rapidly altered the transcriptome and differentiation status of PACs. The changes most emphatically included transcription of the genes for the secretory digestive enzymes (which conscript more than 90% of acinar cell protein synthesis), a potent anabolic metabolism that provides the energy and materials for protein synthesis, suppressed and properly balanced cellular replication, and susceptibility to transformation by oncogenic KrasG12D. The simultaneous inactivation of Foxa2 and Gata4 caused a greater-than-additive disruption of gene expression and uncovered their collaboration to maintain Ptf1a expression and control PAC replication. A measure of PAC dedifferentiation ranked the effects of the conditional knockouts as Foxa2+Gata4 > Ptf1a > Nr5a2 > Foxa2 > Gata4. Whereas the loss of Ptf1a or Nr5a2 greatly accelerated Kras-mediated transformation of mature acinar cells in vivo, the absence of Foxa2, Gata4, or Foxa2+Gata4 together blocked transformation completely, despite extensive dedifferentiation. A lack of correlation between PAC dedifferentiation and sensitivity to oncogenic KrasG12D negates the simple proposition that the level of differentiation determines acinar cell resistance to transformation.

Filipe S Mira,1,2,* Jóni Costa Carvalho,3,* Patrícia Amaral de Almeida,4 Ana Carolina Pimenta,1 Iolanda Alen Coutinho,3 Carolina Figueiredo,1 Luís Rodrigues,1,2 Vítor Sousa,2,5 Emanuel Ferreira,1,2 Helena Pinto,1,2 Luís Escada,1,2 Ana Galvão,1,2 Rui Alves1,2 1Nephrology Department, Coimbra University Hospital, Coimbra, Portugal; 2Coimbra University Faculty of Medicine, Coimbra, Portugal; 3Allergy and Clinical Immunology Department, Coimbra University Hospital, Coimbra, Portugal; 4Internal Medicine Department, Figueira da Foz Hospital, Figueira da Foz, Portugal; 5Pathological Anatomy Department, Coimbra University Hospital, Coimbra, Portugal*These authors contributed equally to this workCorrespondence: Filipe S Mira Rua Alfredo Lopes Xisto, nº 36, Coimbra, 3000-020, PortugalTel +351 932463036Email filipemira@netcabo.ptBackground: The development of vaccines to prevent COVID-19 breakouts came with highly positive results but some unexpected side effects. Rare side effects have been seen with the BNT162b2 SARS-CoV 2 vaccine.Case Presentation: We present the case of a 45-year-old female patient who developed an acute kidney injury needing urgent hemodialysis one week after the second administration of the BNT162b2 SARS-CoV 2 vaccine. She developed a macular rash on her lower limbs and palms as well. A kidney biopsy was performed 10 days after vaccine inoculation, diagnosing acute interstitial nephritis and acute tubular necrosis with cellular casts. The patient was treated with three corticosteroid pulses followed by daily prednisolone. We witnessed clinical improvement 4 days after the initial corticosteroid treatment with progressive recovery of kidney function and hemodialysis withdrawal. After 2 weeks, the patient had recovered her kidney function. Immunophenotyping was performed, diagnosing a hypersensitivity to the vaccine and the polyethylene glycol excipient.Conclusion: Patients may develop acute reactions to vaccines. In this case, symptoms seem to correlate significantly with its inoculation and, although this case had a favourable outcome, these side effects must be made aware for clinicians and patients.Keywords: acute kidney injury, acute interstitial nephritis, proteinuria, COVID-19 vaccine

OBJECTIVES/GOALS: Recent NCATS funding announcements emphasize pursuing domain-agnostic translational science projects that seek to transform the system of science. We aimed to articulate the social responsibility of translational science, defined as prioritizing improved health outcomes and decreased disparities. METHODS/STUDY POPULATION: We focused on the framing of social responsibilities of translational science and distinctions between (a) domain-agnostic translational science that aims to transform the system of science and (b) translational research that takes place within a specific therapeutic area. We reviewed CTSA funding calls, translational research ethics papers, and statements by leaders in the field of translational science. We integrated the social responsibilities of improving health outcomes and decreasing disparities with the values of translational science, which prioritize the relevance, usability, and sustainability of translational interventions. RESULTS/ANTICIPATED RESULTS: We drew on our review of the literature and case studies to offer guidance aimed at helping to ensure that differently positioned actors and entities within the translational ecology can advance the values of translational science while also fulfilling the social responsibilities of translational science. We specify how (a) Funders and policymaking institutions, (b) Organizations such as research universities and CTSA institutes, (c) Translational health science teams working on innovative translational science projects, and (d) Individual translational scientists can all contribute to ensuring that translational science fulfills its ethical obligations and social responsibilities. DISCUSSION/SIGNIFICANCE: The social responsibility of translational science can be fulfilled by centering its efforts to develop useful, sustainable, and relevant innovations. These criteria clarify how social responsibilities manifest in practice and can help funders shape and guide the next era of translational discovery.

We report a rare case of dedifferentiated liposarcoma in a man. A 60-year-old male patient presented with a left mass involving the whole breast area, with no lymph node enlargement, growing during a one-year-period. Imaging studies revealed a fat-containing mixed-density mass apparently associated with the pectoralis major muscle. A core biopsy was performed that yielded a diagnosis of a well-differentiated liposarcoma. Further tests to check for metastases were ordered and no distant disease was found. Left mastectomy with en bloc resection of the pectoralis major muscle was performed. The pathologic diagnosis revealed a high-grade dedifferentiated liposarcoma with extensive necrosis. This tumor type is primarily described in the retroperitoneum and extremities. We report an unusual presentation of a liposarcoma mimicking a breast mass.

This paper offers a multi-perspective approach on the role of engaged research in health and social care. Each of the authors focuses on their individual experiences of this domain, from the perspective of an academic partner of the Health Research Board’s PPI Ignite programme, a CEO of an umbrella organisation for health research charities and a researcher in design innovation, focusing on health research. The paper outlines the values which underpin public and patient involvement, as well as examples of its application as engaged research. It details how organisations like Health Research Charities Ireland support and enable engaged research within health and social research and policy. This paper offers a framework for facilitating dialogue and response across all stakeholders in the engaged research process, illustrating the importance of engaged research and how we can further our understanding and application of it within health and social care policy by adopting a design-led approach. We argue that a design-led approach can both facilitate engaged research as well as support policymakers in the design of new policies and practices.

The standardisation of protocols and discussion of therapeutic procedures in the rehabilitation of turtles affected by oil spills are necessary to optimise the recovery time and increase the chances of survival of these animals. This study aimed at reporting the processes adopted for the stabilisation, decontamination, rehabilitation and release of an oiled olive ridley sea turtle (Lepidochelys olivacea), rescued alive on September 23, 2019, at Santa Rita Beach, Extremoz municipality, Rio Grande do Norte, Brazil. Its entire body was covered by oil. At first, the animal was mechanically dry cleaned using a gauze soaked in mineral oil in the keratinised regions (carapace and plastron) and a gauze soaked in vegetable oil was used on the oral, nasal, ocular, and cloacal mucous membranes. The second stage of the oil removal consisted of washing the animal with heated pressurised water (39 °C) and a neutral detergent using a soft foam sponge. The animal received treatment with antitoxins, antibiotics, analgesics, gastrointestinal protectors, and fluid therapy. After 7 days of treatment, the blood count showed that all the parameters were within the normal range. The oil cleaning process and the therapeutic protocol used in the rehabilitation of the olive ridley sea turtle were efficient.

Jennifer Gong,1 Simone Cheung,2 Alivia Fasso-Opie,3 Orla Galvin,4 Larissa S Moniz,5 Doug Earle,5 Todd Durham,6 Jason Menzo,6 Nan Li,7 Stephanie Duffy,7 Jill Dolgin,8 Mark S Shearman,8 Chiara Fiorani,9 Judit Banhazi,9 Avril Daly4 1Health Economics and Social Policy, Deloitte Access Economics, Melbourne, Victoria, Australia; 2Health Economics and Social Policy, Deloitte Access Economics, Sydney, New South Wales, Australia; 3Health Economics and Social Policy, Deloitte Access Economics, Canberra, Australian Capital Territory, Australia; 4Retina International, Dublin, D08 R9CN, Ireland; 5Fighting Blindness Canada, Toronto, Ontario, Canada; 6The Foundation Fighting Blindness, Raleigh, North Carolina, USA; 7The Janssen Pharmaceutical Companies of Johnson and Johnson, Raritan, New Jersey, USA; 8Applied Genetic Technologies Corporation, Cambridge, Massachusetts, USA; 9Novartis Pharma AG, Basel, SwitzerlandCorrespondence: Avril Daly Email avril.daly@retina-international.orgObjective: To estimate the annual cost of inherited retinal diseases (IRDs) in the United States of America (US) and Canada from a societal perspective – including costs to the health system, individual and family productivity costs, lost wellbeing and other societal economic costs – by setting and payer. Findings will inform the need for policy action to mitigate the impact of IRDs.Methods: The costs of IRDs were estimated using a cost-of-illness methodology, based on the prevalence of IRDs in each country. Intangible costs of reduced wellbeing were also estimated using disability-adjusted life years which were then converted to monetary values using the value of a statistical life.Results: Using base prevalence rates, total costs attributable to IRDs in the US were estimated to range between US$13,414.0 and US$31,797.4 million in 2019, comprising both economic costs (between US$4,982 and US$11,753.9 million; 37% of total costs) and wellbeing costs (between US$8,431.7 and US$20,043.6 million; 63%). Total costs attributable to IRDs in Canada were estimated to range between CAN$1637.8 and CAN$6687.5 million in 2019, comprising both economic costs (between CAN$566.6 and CAN$2,305.7 million; 34%) and wellbeing costs (between CAN$1,071.4 and CAN$4,381.9 million; 66% of total costs).Conclusion: The impact of IRDs in the US and Canada is substantial when considering both economic costs and reduced wellbeing. The wellbeing costs due to IRDs in the US and Canada are considerable, accounting for over 60% of total costs. Vision loss from IRDs often manifests in childhood, meaning some people live with vision impairment and blindness for their whole lives. Further research into current and emerging cost-effective therapies and interventions is required given the substantial economic burden faced by those living with vision loss.Keywords: genetic diagnosis, inherited retinal disease, cost-of-illness

Laura Medina-Perucha,1 Pablo Gálvez-Hernández,2,3 Ana García-Sangenís,1,4 Ana Moragas,5 Josep María Cots,6 Anna Lanau-Roig,6 Alícia Borrás,2,7 Isabel Amo,2 Nieves Barragán,8 Ramon Monfá,1,4 Carl Llor,1,9 Anna Berenguera1,4,10 1Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; 2Institut Universitari de Pacients (Patients’ University Institut), Universitat Internacional de Catalunya, Barcelona, Spain; 3University of Toronto, IHPME-BFON Collaborative PhD Specialization Program in Health Services and Policy Research, Ontario, Canada; 4Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; 5Universitat Rovira i Virgili, Jaume I Health Centre, Institut Català de la Salut, Tarragona, Spain; 6La Marina Health Centre, Institut Català de la Salut, Associació d’Infermeria Familiar i Comunitària de Catalunya, Barcelona, Spain; 7Escola Universitària d’Infermeria, Escoles Universitàries Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Spain; 8Societat Catalana de Medicina Familiar i Comunitària (Camfic), Grupo Programa Comunicación y Salud semFYC. CAP Vallcarca Health Centre, Barcelona, Spain; 9Via Roma Health Centre, Institut Català de la Salut, Barcelona, Spain; 10Departament d’Infermeria, Universitat de Girona, Girona, SpainCorrespondence: Laura Medina-Perucha Gran via de les Corts Catalanes, 587, Attic, Barcelona, 08007, SpainTel +34 93 482 4253 ext. 4761Email lmedina@idiapjgol.infoPurpose: Co-design processes with patients allow developing health education materials, that are adapted to the population’s knowledge and use of language, to reduce inappropriate antibiotic use.Patients and Methods: This study presents a co-design process of educational material with patients (over 18 years old) with a previous diagnosis of acute lower respiratory tract infection. The co-design was framed within a qualitative study (Phase I, interviews; Phase II, focus group) conducted in Barcelona between April and September 2019.Results: Twenty-nine semi-structured interviews were conducted. Six people participated in the focus group. Based on participants’ narratives, educational materials can be useful to support healthcare consultations. Materials should be designed to be accessible in terms of the content and language used.Conclusion: The co-design of educational materials is essential for health promotion. This study presents an example of how materials can be co-developed with patients. The material elaborated in this study is being used for the ISAAC-CAT project and may be useful for future research, practice in health services and health policy.Keywords: health education, co-design, acute respiratory infections, antimicrobial resistance, primary healthcare

Background: Root canal sealers and repair materials should have the desirable physical, chemical, and biological characteristics, and an antibacterial effect if possible. There is little information available on the biocompatibility of new sealers on the market. Fourier transform infrared spectroscopy (FTIR) can offer trustworthy data to examine chemical structures; another technique for revealing the elements in the constituents that may contribute to the cytotoxicity of these sealers is scanning electron microscopy (SEM), with the goal of elemental mapping utilizing energy-dispersive X-ray spectroscopy (EDX). Methodology: All the root canal sealers were mixed as per the manufacturers’ instructions and allowed to set in molds for 24 h. Then, the samples were placed into an incubator (Memmert GmbH + Co. KG, Schwabach, Germany for 72 h, in a moist environment to allow complete chemical setting of the sealers. The organic and inorganic components of the sample were identified using FTIR with the wavelength length in the infra-red region measuring 400–450 nm. The finely crushed samples were coated with gold metal; following that, the sealer samples were examined under a scanning electron microscope (SEM) at 5000×, 10,000×, and 20,000× magnification, followed by energy-dispersive X-ray spectroscopy. Results: The surfaces of BioRoot and DiaRoot sealers revealed a relatively uniform distribution of irregular micro-sized particles aggregated in clusters, with the particle size ranging from 1 to 65 µm and 0.4 to 55 µm, respectively. OneFill, iRoot, and CeraSeal demonstrated irregularly shaped particles with particle sizes of 0.5 to 105 µm, 0.5 to 195 µm, and 0.3 to 68 µm, respectively. The EDX microanalysis revealed that oxygen, calcium, and carbon were found in all the tested sealer materials. Silicone and zirconium were absent in DiaRoot, but DiaRoot contained fluoride and ytterbium. Moreover, aluminum was noted in DiaRoot, One Fill, and CeraSeal, and chloride was only observed in BioRoot. FTIR analysis revealed strong absorption bands at 666 cm−1 and 709 cm−1 in BioRoot. Bands at 739 cm−1, 804 cm−1, 863 cm−1, 898 cm−1, and 1455 cm−1 were observed in DiaRoot. Bands at 736 cm−1 and 873 cm−1 in OneFill suggested the presence of C-H bending. Similarly, bands were observed at 937 cm−1, 885 cm−1, 743 cm−1, and 1455 cm−1 in iRoot, representing C-H stretching. Conclusions: All root canal sealers had diverse surface morphologies that contained irregular, micro-sized particles that were uniformly distributed, and they lacked heavy metals. All the experimental sealers comprised mainly calcium, oxygen, and carbon.