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Hawraa Ali-Jerman,1 Zainab Al-Quraishi,1 Ashish Muglikar,1 Yvonne Perrie,1 Rothwelle J Tate,1 Margaret Mullin,2 Gayle McNeill,1 Graeme Mackenzie,1 Christine Dufès1 1Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE, UK; 2Cell Analysis Facility, Medical and Veterinary & Life Sciences Shared Research Facilities, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UKCorrespondence: Christine Dufès, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE, UK, Tel +44 1415483796, Fax +44 1415522562, Email C.Dufes@strath.ac.ukBackground: Gene therapy is a promising therapeutic approach for treating various disorders by introducing modified nucleic acids to correct cellular dysfunctions or introduce new functions. Despite significant advancements in the field, the effective delivery of nucleic acids remains a challenge, due to biological barriers and the immune system’s ability to target and destroy these molecules. Due to their branched structure and ability to condense negatively charged nucleic acids, cationic dendrimers have shown potential in overcoming these challenges. Despite this, standardized scalable production methods are still lacking. This study investigates the use of microfluidics to formulate generation 3-diaminobutyric polypropylenimine (DAB) dendriplexes and compares their characteristics and in vitro gene delivery efficacy to those prepared using conventional manual mixing.Methods: DAB dendriplexes were produced by both microfluidic and manual approaches and characterized. Their cellular uptake and gene expression were evaluated on C6 glioma cancer cells in vitro.Results: Dendriplexes formed using microfluidics at the optimal flow rate and ratio demonstrated enhanced DNA condensation over time, achieving up to 97% condensation at 24 hours. Both preparation methods produced positively charged dendriplexes, indicating stable formulations. However, dendriplexes prepared through hand mixing resulted in smaller particle sizes, significantly higher cellular uptake and gene expression efficacy compared to those prepared by microfluidics. Nonetheless, microfluidic preparation offers the advantage of standardized and scalable production, which is essential for future applications.Conclusion: This study highlights the potential of microfluidic technology to improve precision and scalability in gene delivery, paving the way for future advancements in gene therapy. Our findings suggest that, with further optimization, microfluidic systems could provide superior control over dendriplex formation, expanding their potential use in gene therapy applications. Keywords: polypropylenimine dendrimer, dendriplex, glioma, microfluidics, cellular uptake, transfection

Yun Wang,1 Zhongfeng Huang,2 Huijuan Chen,3 Ye Yuan,2 Edward B McNeil,4 Xiaolong Lu,5 Aihua Zhang1 1Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China; 2Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou, People’s Republic of China; 3Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, People’s Republic of China; 4Department of Infectious Diseases, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, People’s Republic of China; 5School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of ChinaCorrespondence: Aihua Zhang, Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China, Tel +86 851 88416187, Fax +86 851 88416187, Email 97349238@qq.comPurpose: We aimed to assess the household financial burden due to multidrug-resistant tuberculosis (MDR-TB) treatment and its predictors, examine its association with patient mobility, and test their impact on patient loss to follow-up (LTFU).Methods: A cross-sectional study combining follow-up data collection was conducted at the largest designated MDR-TB hospital in Guizhou. Data were collected from medical records and questionnaires. Household financial burden was measured by the incidence of 2 indicators: catastrophic total costs (CTC) and catastrophic health expenditure (CHE). Mobility was classified as mover or non-mover after the patient’s address was verified twice. A multivariate logistic regression model was used to identify associations between variables. Model I and Model II were separated by CHE and CTC.Results: Out of 180 households, the incidence of CHE and CTC was 51.7% and 80.6%, respectively. Families with low income and patients who were primary income earners were significantly associated with catastrophic costs. 42.8% of patients were movers. Patients from households with CHE (ORadj=2.2, 95% CI: 1.1– 4.1) or with CTC (ORadj=2.6, 95% CI: 1.1– 6.3) were more likely to move. Finding a job against financial difficulty (58.4%) was the top reason for movers. 20.0% of patients experienced LTFU. Patients from households with catastrophic payments (CHE: ORadj=4.1, 95% CI 1.6– 10.5 in Model I; CTC: ORadj=4.8, 95% CI 1.0– 22.9 in Model II), patients who were movers (ORadj=6.1, 95% CI 2.5– 14.8 in Model I; ORadj=7.4, 95% CI 3.0– 18.7 in Model II) and primary income earners (ORadj=2.5, 95% CI: 1.0– 5.9 in Model I; ORadj=2.7, 95% CI 1.1– 6.6 in Model II) had an increased risk of LTFU.Conclusion: There is a significant association between household financial burden due to MDR-TB treatment and patient mobility in Guizhou. They impact patients’ treatment adherence and cause LTFU. Being a primary breadwinner increases the risk for catastrophic household payments and LTFU.Keywords: household catastrophic costs, migration, loss to follow-up, Guizhou, MDR-TB

Stationary and ergodic time series can be constructed using an s-vine decomposition based on sets of bivariate copula functions. The extension of such processes to infinite copula sequences is considered and shown to yield a rich class of models that generalizes Gaussian ARMA and ARFIMA processes to allow both non-Gaussian marginal behaviour and a non-Gaussian description of the serial partial dependence structure. Extensions of classical causal and invertible representations of linear processes to general s-vine processes are proposed and investigated. A practical and parsimonious method for parameterizing s-vine processes using the Kendall partial autocorrelation function is developed. The potential of the resulting models to give improved statistical fits in many applications is indicated with an example using macroeconomic data.

Developing Allied Health (AH) graduates who are skilled in responding to public health needs is crucial, particularly in rural areas where workforce shortages and poor health outcomes are common. However, workforce shortages make it difficult to provide rural work-integrated learning (WIL) opportunities to teach these skills. This paper presents a model of Service-Learning (SL) that innovatively employs WIL for AH students while addressing rural health needs. The model was developed based on the experiences of a rural WIL team who implemented over 400 SL WIL experiences over six years. Key aspects highlight the importance of relationship building and meeting the needs of three key stakeholders, namely the community and host-site, students, and the enrolled university. Student support, interprofessional education and evaluation were also embedded in the model. This SL model adopts a flexible approach and provides a useful guide for developing SL for WIL despite challenges in rural areas.

The purpose of this study was to describe the association between the learning strategy preference of the learners as identified by "Assessing The Learning Strategies of AdultS" (ATLAS) and the individual personality traits as defined by the Myers-Briggs Type Indicator (MBTI). The sample was 553 adults in Canada and the United States. Two types of analyses were used to investigate the association between learning strategy preferences and personality traits. First, discriminant analysis explored the interaction of personality traits with the learning strategy preference. Second, analysis of variance measured the association of each personality trait with the learning-strategy-preference groups separately. The findings provided several explicit personality traits associated with each learning-strategy-preference group. These findings support the conclusion that a strong association exists between personality traits and learning-strategy-preference characteristics. Learning strategy preferences and personality traits complement each other. Each clarifies and enriches the other. As a result, teachers have two indicators that can help them personalize the teaching-learning environment for each student. Teachers can use the learning-strategy-group descriptions as guides for organizing each learner's instructional activities and plans and as a cognitive framework for uncovering and monitoring student behaviors and alerting teachers to potential learning difficulties for some students. Students can apply the descriptions of the learning-strategy-preference groups to facilitate self-assessment and metacognition. Theory can be enhanced by considering the two concepts of learning strategy preferences and personality traits coupled and by conducting quantitative and qualitative research to test and expand the generalizability of the learning-strategy-group descriptions. (Permission is granted to use "Assessing The Learning Strategies of AdultS" and the "Personality Identity Estimator" in practice and research. Links to printable copies and online completion are appended.)

J Chase McNeil Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USACorrespondence: J Chase McNeilDepartment of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USAEmail Jm140109@bcm.tmc.eduAbstract: Acute hematogenous osteomyelitis (AHO) is a common invasive infection encountered in the pediatric population. In addition to the acute illness, AHO has the potential to create long-term morbidity and functional limitations. While a number of pathogens may cause AHO, Staphylococcus aureus is the most common organism identified. Despite the frequency of this illness, little high-quality data exist to guide providers in the care of these patients. The literature is reviewed regarding the epidemiology, microbiology and management of AHO in children. A framework for empiric therapy is provided drawing from the available literature and published guidelines.Keywords: osteomyelitis, pediatrics, Staphylococcus aureus, oral antibiotics

Jingyi Dai,1,2,* Jun Zhao,3,* Yingrong Du,1 Lin Zhuang,1 Edward B McNeil,2 Virasakdi Chongsuvivatwong2 1Department of Liver Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; 3Department of Preventive Medicine, School of Public Health and Management, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China*These authors contributed equally to this workCorrespondence: Virasakdi Chongsuvivatwong Email cvirasak@medicine.psu.ac.thBackground: Data concerning adherence to hepatocellular carcinoma (HCC) surveillance among chronic liver disease (CLD) patients at high risk of developing HCC in China are limited. We aimed to examine the relationship between HCC-related knowledge dimensions and adherence to HCC surveillance procedures among chronic liver disease patients at high risk of developing HCC and to identify potential barriers.Methods: A total of 380 patients with chronic liver disease at high risk of developing HCC were recruited between May and August 2018 to complete a survey during the first week of their first hospitalization at the Third People’s Hospital of Kunming in China. We followed up each patient up to 7 months by telephone to confirm whether the patient returned to complete investigations for HCC surveillance. Patient’s socio-demographic characteristics, HCC-related knowledge, and perceived barriers to HCC surveillance were measured using a structured questionnaire during their hospitalization. Factor analysis was performed on the knowledge questions to reduce the dimensions. Univariate and multivariate analyses were performed to examine the association between dimensions of HCC-related knowledge and patients’ adherence to HCC surveillance.Results: A total of 327 eligible patients had been successfully contacted in the follow-up phase. Only a quarter of patients completed HCC surveillance within 7 months after their first admission to hospital. High costs and perceived poor test efficacy were the two major barriers for HCC surveillance. Three common factors were derived from the factor analysis of HCC-related knowledge, namely, “Surveillance”, “Lifestyle”, and ‘Prognosis’. Knowledge of HCC surveillance and lifestyle but not prognosis had an influence on adherence to HCC surveillance. Patients with better surveillance and lifestyle knowledge domain had better adherence to HCC surveillance.Conclusion: Adherence to HCC surveillance procedures is low in the study area. Closing the gap in HCC-related knowledge, particularly regarding surveillance and lifestyle, may help to increase adherence rates.Keywords: HCC surveillance, adherence, knowledge, barriers

Jingyi Dai1 ,* Yingrong Du1 ,* Jianpeng Gao1 ,* Jun Zhao,2 Lin Wang,3 Ying Huang,1 Jiawei Xia,4 Yu Luo,1 Shenghao Li,4 Edward B McNeil5 1Department of Infectious Diseases, Kunming Third People’s Hospital, Kunming, Yunnan, People’s Republic of China; 2School of Public Health and Management, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China; 3Department of Clinical Laboratory, Kunming Third People’s Hospital, Kunming, Yunnan, People’s Republic of China; 4Department of Critical Care Medicine, Kunming Third People’s Hospital, Kunming, Yunnan, People’s Republic of China; 5Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand*These authors contributed equally to this workCorrespondence: Jun ZhaoSchool of Public Health and Management, Hubei University of Medicine, 30 South Renmin Road, Shiyan, Hubei 442000, People’s Republic of ChinaTel +86-719-8891135Fax +86-719-8875336Email stzhao@163.comBackground: The pandemic due to the novel coronavirus disease 2019 (COVID-19) has resulted in an increasing number of patients need to be tested. We aimed to determine if the use of integrated laboratory data can discriminate COVID-19 patients from other pulmonary infection patients.Methods: This retrospective cohort study was conducted at Kunming Third People’s Hospital in China from January 20 to February 28, 2020. Medical records and laboratory data were extracted and combined for COVID-19 and other pulmonary infection patients on admission. A partial least square discriminant analysis (PLS-DA) model was constructed and calibrated to discriminate COVID-19 from other pulmonary infection patients.Results: COVID-19 patients diagnosed and treated in Kunming were balanced in terms of sex and covered all age groups. Most of them were mild cases; only five were severe cases. The first two dimensions of the PLS-DA model could classify COVID-19 and other pulmonary infection patients with an accuracy of 96.6% (95.1% in the cross-validation model). Basophil count, the proportion of basophils, prothrombin time, prothrombin time activity, and international normalized ratio were the five most discriminant biomarkers.Conclusion: Integration of biomarkers can discriminate COVID-19 patients from other pulmonary infections on admission to hospital and thus may be a supplement to nucleic acid tests.Keywords: COVID-19, biomarker, pneumonia, partial least square discriminant analysis

Yijing Xie,1,2 Edward McNeil,2 Yancun Fan,1 Virasakdi Chongsuvivatwong,2 Xingsheng Zhao,3 Hutcha Sriplung2 1Health Management Faculty and Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, People’s Republic of China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; 3Inner Mongolia People’s Hospital, Hohhot, Inner Mongolia, People’s Republic of ChinaCorrespondence: Hutcha SriplungEpidemiology Unit, Faculty of Medicine, Prince of Songkla University, 15 Kanchanawanit Road, Hat Yai, Songkhla 90110, ThailandTel +66 7 445 1165Fax +66 7 442 9754Email hutcha.s@psu.ac.thPurpose: Measures to prevent respiratory infection diseases (RIDs) in hospitals are important to protect both patients and physicians. In 2003, an outbreak of severe acute respiratory syndrome occurred in Inner Mongolia Autonomous Region (IMAR) of China. We aimed to evaluate competency in RID prevention procedures in terms of hospital performance and physician behavior.Patients and Methods: We conducted a cross-sectional study in 10 tertiary general public hospitals in 3 cities of IMAR. In each hospital, we chose the respiratory and ear–nose–throat outpatient departments (OPDs) and the emergency department (ED) to invite patients with symptoms of cough to join the study before they consulted a physician. After their consultation, we asked the patients to complete a checklist to score the performance of the departments and the behavior of their physicians in terms of RID prevention practices according to international professional guidelines.Results: From 711 respondents, in the domain of hospital performance, display of posters on directive to wash hands after coughing/sneezing had an average score of 0.452 (range 0– 1), while other cough etiquette items had scores averaging between 0.33 and 0.39. The average score for air ventilation was 0.66. For physicians’ performance, informing patients the location of handwashing facilities scored the highest (0.62), while low scores were seen for offering a mask to coughing patients (0.14) and encouraging coughing patients to distance themselves from others (0.17). Most RID prevention procedures received low scores in EDs in both hospital performance and physician behavior domains.Conclusion: Hospitals in IMAR should improve their performance in RID prevention procedures, especially in giving information to RID patients through the display of posters. The practice of physicians in preventing respiratory infection spread was suboptimum. ED staff and hospital administrators should improve their procedures to prevent the spread of respiratory infections, especially given the increasing occurrences of global pandemics such as COVID-19.Keywords: hospital performance, physician behavior, spread of respiratory infections, real patients survey

Yun Wang,1,2 Huijuan Chen,3 Zhongfeng Huang,4 Edward B McNeil,2 Xiaolong Lu,1 Virasakdi Chongsuvivatwong2 1School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; 3Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, People’s Republic of China; 4Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou, People’s Republic of ChinaCorrespondence: Virasakdi ChongsuvivatwongEpidemiology Unit, Faculty of Medicine, Prince of Songkla University, 15 Kanchanawanit Road, Hat Yai, Songkhla, ThailandTel +66 74 429 754Fax +66 74 212 900Email cvirasak@medicine.psu.ac.thPurpose: Treatment interruption and incorrect dosage for measuring drug non-adherence have seldom been studied in multidrug-resistant tuberculosis (MDR-TB) treatment. This study aimed to 1) estimate the overall and drug-specific incidence of short (≤14 days) and serious (>14 days) treatment interruption among MDR-TB patients, 2) identify main reasons and predictors for serious interruption, and 3) document the level of agreement of classification for incorrect drug dosage between self-report and pill count.Patients and methods: A cross-sectional study combining hospital-based interviews and home-based pill count was conducted from January to June 2018. Treatment interruption was determined from patient’s medical records and interviews using a structured questionnaire among 202 patients treated at one designated hospital for MDR-TB treatment. Concordance of pills counted with self-reports for each drug use within one month was assessed for a subgroup of patients at their homes using kappa statistics.Results: Of 202 patients, the incidence of short and serious treatment interruption was 37.6% and 28.7%, respectively. Adverse drug reactions (ADRs) and financial hardship were the top two reasons for serious interruption. Amikacin and cycloserine had the highest rate of specific drug interruption (18.3% and 10.2%, respectively). ADRs (ORadj: 2.82, 95% CI: 1.41–5.61), monthly out-of-pocket expenses exceeding 250 US dollars (ORadj: 2.27, 95% CI: 1.14–4.50), and baseline co-morbidities (ORadj: 2.53, 95% CI: 1.19–5.38) were significantly associated with serious treatment interruption. Of 111 patients assessed for pill count at home, 5.4% had perfect drug adherence, 54.1% had drug under-use, 6.3% had drug over-use, and 34.2% had both problems. The respective number from self-reports was 7.2%, 56.8%, 5.4% and 30.6%. The two methods gave an acceptable level of agreement for most of the drugs (kappa: 0.52–0.95).Conclusion: Close monitoring of ADRs, revision of drug regimens, and financial support for MDR-TB in this study population are needed. Self-report on drug under-use and over-use should be monitored monthly in clinical settings.Keywords: multidrug-resistant tuberculosis, adherence, treatment interruption, Guizhou

Jingyi Dai,1,2,* Jun Zhao,3,* Yingrong Du,1 Edward B McNeil,2 Virasakdi Chongsuvivatwong21Department of Liver Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; 3School of Public Health and Management, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China*These authors contributed equally to this workBackground: Hospital readmissions of patients with cirrhosis is a current problem in China. This study aims to estimate the readmission rate at one year after discharge and to identify associated risk factors of hospital readmission.Methods: Between January 2012 and December 2015, 3,402 patients admitted with cirrhosis were included in the study. The primary outcome was one-year inpatient readmission. Principal components analysis was conducted on the laboratory test indicators to reduce the number of dimensions. Univariate and multivariate analyses were performed using clinical and demographic data to identify independent associated factors of readmission within one year. The odds ratio (OR) and 95% confidence interval were used to assess the strength of association for each factor.Results: Two dimensions, namely “liver function” and “renal function”, were revealed. Patients with a longer length of stay in the index admission (OR: 1.03; 95% CI: 1.03–1.04) and a higher dimension score of liver function (OR: 1.09; 95% CI: 1.05–1.13) were more likely to be readmitted within one-year. Older patients had a significantly higher odds of one-year readmission than younger patients (OR: 1.61; 95% CI: 1.22–2.11), patients who were married had a higher odds than those who were single (OR: 1.62; 95% CI: 1.12–2.36), and patients with hepatitis C virus were more likely to be readmitted within one year than patients with hepatitis B virus (OR: 1.51; 95% CI: 1.19–1.91).Conclusion: Biomarkers and sociodemographic factors can identify patients at high risk for readmission within one year. Our data indicates the need to emphasize proper liver care to older patients who have been hospitalized for a long time.Keywords: cirrhosis, readmission, liver function, renal function

Tingting Qiao,1 Yancun Fan,1 Alan F Geater,2 Virasakdi Chongsuvivatwong,2 Edward B McNeil21School of Health Management, Inner Mongolia Medical University, Hohhot 010010, Inner Mongolia, People’s Republic of China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, ThailandPurpose: The doctor–patient relationship (DPR) in People’s Republic of China is very tense. This study aimed to provide some explanation by exploring factors influencing the DPR from doctors’ and patients’ perspectives.Methods: A cross-sectional study was conducted in one provincial and one city-level general public hospital in Inner Mongolia Autonomous Region of People’s Republic of China. The Difficult Doctor–Patient Relationship Questionnaire (DDPRQ-10) and the Patient–Doctor Relationship Questionnaire (PDRQ-9) were used to assess the quality of the DPR from 226 doctors, and 713 patients’ perspectives, respectively. Multivariate linear regression was used to identify factors significantly associated with the doctors’ and patients’ perceptions of the DPR by assessing coefficients of total effect and their 95% confidence interval.Results: The result revealed that provincial-level doctors had a higher DDPRQ-10 score than city-level doctors. Worse DDPRQ-10 scores were seen for doctors who worked in the Internal Medicine departments were aged between 31 and 40 years, held a master’s degree, were dissatisfied with their income, worked more than 40 hrs per week, felt pressure at work, considered the hospital environment to be bad, often felt affected by negative media reports and had defensive behaviors. Patients visiting the provincial hospital had a lower PDRQ-9 score than those from the city-level hospital. Lower PDRQ-9 scores were also seen for patients who were of Mongolian ethnicity, were dissatisfied with their income, waited longer to see the doctor, had a shorter doctor consultation time, had lower expectations of their treatment result, had a low level of trust in the doctor, regarded the hospital environment as bad and those who were frequently influenced by negative media reports.Conclusion: This study may provide a useful model to raise the quality of the DPR and to supply evidence for health policy makers and administrators to formulate strategies for reducing the problem of tense DPR in Chinese hospitals.Keywords: outpatient, doctor-patient relationship, medical dispute, patient satisfaction, People’s Republic of China, health policy

Corey C Lieneman,1 Lauren B Quetsch1,2, Laurie L Theodorou,3 Kathleen A Newton,3 Cheryl B McNeil11Department of Psychology, West Virginia University, Morgantown, WV, USA; 2Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 3Oregon Health Authority, Salem, OR, USAPurpose: Behavior disorders in early childhood are linked to a variety of negative outcomes for both children and families. Parent–Child Interaction Therapy (PCIT), an evidence-based parent-training program, demonstrates large effect sizes in reducing child problem behavior for dyads who complete treatment; however, a high number of families seeking treatment in community-based settings terminate from PCIT prior to meeting the protocol’s strict graduation criteria. The purpose of this study was to examine the impact of PCIT on child behavior problems for families who received at least a small dose of PCIT but not enough to meet the strict mastery criteria required for graduation.Patients and methods: This study employed one of the largest community research samples conducted with PCIT (2,787 children and their families across the state of Oregon, 1,318 with usable data) to determine how PCIT impacts both graduates and early terminators.Results: While families who graduated from PCIT (17.7% of the sample) demonstrated a very large effect size in problem behavior intensity improvements (d=1.65), families who terminated treatment early, but after attending at least four treatment sessions (51.7% of the sample), still showed significant improvements in behavior problems with a medium-to-large effect size (d=0.70). In contrast, very early terminators (those attending fewer than four treatment sessions, 0.3% of the sample), demonstrated little improvement at the time of dropout from services (d=0.12).Conclusion: Though early terminators in PCIT have previously been identified as treatment failures, the present study discusses the reconceptualization of “dropouts” in relation to some positive evidence of treatment outcomes, the implications for community-based service delivery, and possible future directions.Keywords: PCIT, state-wide implementation, behavior disorders, community effectiveness

Facilitated subcutaneous immunoglobulin (fSCIG) 10% is an immunoglobulin replacement therapy that utilizes recombinant human hyaluronidase (rHuPH20) to enhance immunoglobulin dispersion and absorption, allowing for longer treatment intervals similar to intravenous immunoglobulin (up to once monthly). fSCIG 10% is indicated in the USA for treating adults and children aged ≥ 2 years with primary immunodeficiency diseases (PIDs). This prospective, non-interventional, open-label, multicenter, post-authorization safety study (NCT02593188) was conducted in the USA from November 2015 to October 2021 to assess the long-term safety of fSCIG 10% in routine clinical practice. Patients with PIDs aged ≥ 16 years who were prescribed and/or had started fSCIG 10% treatment were enrolled. In total, 253 patients were enrolled and included (full analysis set). Participants received fSCIG 10% treatment for a median (interquartile range) of 10.0 (3.5-11.8) months, with the majority of infusions administered every 4 weeks (54.4% [1197/2201 infusions]) and at home (62.6% [1395/2230 infusions]). Overall, 98.5% of infusions were administered without rate reduction, interruption, or discontinuation due to adverse events (AEs). Treatment-related, non-serious AEs were experienced by 52 patients (20.6%, 284 events). Two patients (0.8%) each experienced one treatment-related serious AE (aseptic meningitis and deep vein thrombosis). Development of antibodies against rHuPH20 was uncommon; 14/196 patients (7.1%) tested positive for binding antibodies (titer ≥ 1:160) with no neutralizing antibodies detected. There was no relationship between anti-rHuPH20 antibody positivity and the occurrence of treatment-related serious or non-serious AEs. Long-term, repeated self-administration of fSCIG 10% was well tolerated in US clinical practice by patients with PIDs.

In the modern "omics" era, measurement of the human exposome is a critical missing link between genetic drivers and disease outcomes. High-resolution mass spectrometry (HRMS), routinely used in proteomics and metabolomics, has emerged as a leading technology to broadly profile chemical exposure agents and related biomolecules for accurate mass measurement, high sensitivity, rapid data acquisition, and increased resolution of chemical space. Non-targeted approaches are increasingly accessible, supporting a shift from conventional hypothesis-driven, quantitation-centric targeted analyses toward data-driven, hypothesis-generating chemical exposome-wide profiling. However, HRMS-based exposomics encounters unique challenges. New analytical and computational infrastructures are needed to expand the analysis coverage through streamlined, scalable, and harmonized workflows and data pipelines that permit longitudinal chemical exposome tracking, retrospective validation, and multi-omics integration for meaningful health-oriented inferences. In this article, we survey the literature on state-of-the-art HRMS-based technologies, review current analytical workflows and informatic pipelines, and provide an up-to-date reference on exposomic approaches for chemists, toxicologists, epidemiologists, care providers, and stakeholders in health sciences and medicine. We propose efforts to benchmark fit-for-purpose platforms for expanding coverage of chemical space, including gas/liquid chromatography-HRMS (GC-HRMS and LC-HRMS), and discuss opportunities, challenges, and strategies to advance the burgeoning field of the exposome.

Problem The Malaita and Western provinces in Solomon Islands had low routine immunization coverage due to disruptions in health services caused by the coronavirus disease 2019 pandemic in early 2022. Approach The country introduced the World Health Organization (WHO) Reaching Every District (RED) approach in 2002. Between July and September 2022, we strengthened supportive supervision, monitoring and use of data for decision-making, especially for microplanning and re-establishing outreach to prioritized areas. Health workers were supported to identify key concerns and develop strategies to improve performance. Monthly updates of reported immunization coverage, reporting completeness and fieldwork findings were widely disseminated. Local setting Solomon Islands&apos; population is 748 606 people, of whom 165 345 reside in Malaita and 105 367 in Western Province. Relevant changes In Malaita Province, reported coverage of third dose of pentavalent vaccine and first dose of measles-rubella vaccine increased from 40% (757/1892) of eligible children to 121% (1144/946) and from 30% (568/1892) to 159% (1504/946), respectively; and in Western Province reported coverage increased from 38% (443/1165) to 191% (1113/583) and from 44% (513/1165) to 149% (868/583), respectively. Reported coverage for the remaining provinces increased from 64% (3380/5282) to 88% (2325/2641) and from 59% (3116/5282) to 137% (3619/2641), respectively. These findings led the programme on immunization to re-expand the WHO RED approach nationwide. Lessons learnt Supportive supervision, systematic monitoring and use of data for decision-making helped restoring reported immunization coverage in two low-coverage provinces. However, sustaining these results at a national level is necessary. The WHO RED approach remains relevant, even during a pandemic. [phrase omitted] Probleme Debut 2022, les provinces de Malaita et de l&apos;Ouest, sur les Iles Salomon, affichaient une faible couverture vaccinale due a de multiples interruptions des services de sante durant la pandemie de maladie a coronavirus 2019. Approche Le pays a adopte l&apos;approche <> (ACD) de l&apos;OMS en 2002. Entre juillet et septembre 2022, nous avons renforce la supervision formative, la surveillance et l&apos;utilisation de donnees pour la prise de decisions, en particulier dans le cadre de la microplanification et du retablissement des programmes de proximite dans les regions prioritaires. Les professionnels de la sante ont recu de l&apos;aide afin d&apos;identifier les preoccupations majeures et de developper des strategies destinees a ameliorer les performances. Les comptes rendus mensuels de la couverture vaccinale observee, le degre d&apos;exhaustivite des rapports et les resultats des travaux menes sur le terrain ont ete largement diffuses. Environnement local Les Iles Salomon comptent 748 606 habitants; 165 345 vivent a Malaita et 105 367 dans la province de l&apos;Ouest. Changements significatifs Dans la province de Malaita, la couverture vaccinale observee pour la troisieme dose du vaccin pentavalent et la premiere dose du vaccin rougeole-rubeole a augmente, passant de 40% (757/1892) des enfants eligibles a 121% (1144/946) pour l&apos;un et de 30% (568/1892) a 159% (1504/946) pour l&apos;autre; de son cote, la province de l&apos;Ouest a elle aussi connu une hausse, passant de 38% (443/1165) a 191% (1113/583) pour le premier vaccin et de 44% (513/1165) a 149% (868/583) pour le second vaccin. Dans le reste des provinces, la couverture a progresse de 64% (3380/5282) a 88% (2325/2641) et de 59% (3116/5282) a 137% (3619/2641), respectivement. Ces resultats ont abouti a un redeploiement de l&apos;approche ACD de l&apos;OMS pour le programme de vaccination a l&apos;echelle nationale. Lecons tirees La supervision formative, la surveillance systematique et l&apos;utilisation des donnees pour la prise de decisions ont contribue a restaurer la couverture vaccinale dans deux provinces a faible couverture. Il est cependant imperatif de maintenir ces resultats dans l&apos;ensemble du pays. Enfin, l&apos;approche ACD de l&apos;OMS demeure pertinente, meme lors d&apos;une pandemie. [phrase omitted] Situacion Las provincias de Malaita y Occidental, en las Islas Salomon, tuvieron una cobertura de inmunizacion sistematica baja debido a las interrupciones de los servicios sanitarios a causa de la pandemia de la enfermedad por coronavirus de 2019 a principios de 2022. Enfoque El pais introdujo el enfoque "Llegar a todos los distritos" (RED) de la OMS en 2002. Entre julio y septiembre de 2022, se reforzo la supervision de apoyo, el monitoreo y el uso de datos para la toma de decisiones, en especial para la microplanificacion y el restablecimiento del alcance de las regiones prioritarias. Se ayudo al personal sanitario a identificar los principales problemas y a desarrollar estrategias para mejorar su rendimiento. Se difundieron ampliamente las actualizaciones mensuales de la cobertura de inmunizacion notificada, la exhaustividad de los informes y los resultados del trabajo de campo. Marco regional La poblacion de las Islas Salomon es de 748 606 habitantes, de los cuales 165 345 residen en Malaita y 105 367 en la provincia Occidental. Cambios importantes En la provincia de Malaita, la cobertu ra notificada de la tercera dosis de la vacuna pentavalente y de la primera dosis de la vacuna contra el sarampion y la rubeola aumento del 40% (757/1892) de los ninos que cumplian los requisitos al 121% (1144/946) y del 30% (568/1892) al 159% (1504/946), respectivamente; y en la provincia Occidental la cobertura notificada aumento del 38% (443/1165) al 191% (1113/583) y del 44% (513/1165) al 149% (868/583), respectivamente. La cobertura notificada para el resto de provincias aumento del 64% (3380/5282) al 88% (2325/2641) y del 59% (31 16/5282) al 137% (3619/2641), respectivamente. Estos hallazgos llevaron al programa de inmunizacion a ampliar el enfoque RED de la OMS a todo el pais. Lecciones aprendidas La supervision de apoyo, el monitoreo sistematico y el uso de datos para la toma de decisiones ayudaron a restablecer la cobertura de inmunizacion notificada en dos provincias de baja cobertura. Sin embargo, es necesario mantener estos resultados a escala nacional. El enfoque RED de la OMS sigue siendo pertinente, incluso durante una pandemia., Introduction The World Health Organization (WHO) has estimated that vaccination has averted 101 million deaths in infants, globally since 1974. (1) Unfortunately, the coronavirus disease 2019 (COVID-19) pandemic disrupted routine [...]

Manasi M Mittinty,1 Daniel W McNeil,2,3 David S Brennan,1 Cameron L Randall,4 Murthy N Mittinty,5 Lisa Jamieson1 1Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, SA, Australia; 2Department of Dental Practice and Rural Health, School of Dentistry, West Virginia University, Morgantown, WV, USA; 3Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV, USA; 4Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, WA, USA; 5School of Public Health, The University of Adelaide, Adelaide, SA, Australia Background: Heightened fear and anxiety related to pain may result in emotional and behavioral avoidance responses causing disability, distress, and depression. Fear and anxiety associated with pain can potentially change the course of the pain experience. It is plausible that fear and anxiety related to pain affect the duration and frequency of pain experienced by the patient. Aim: The study aimed to examine the applicability of the Fear of Pain Questionnaire-III (FPQ-III) in identifying who are likely to report longer duration and greater frequency of pain experience. Methods: To test this hypothesis, a cross-sectional study was conducted with 579 individuals from a community-based sample living with chronic pain. The factor structure and validity of FPQ-III in the community-based sample were also tested. Results: The findings suggest higher fear of severe pain but lower fear of medical pain, associated with longer duration and more frequent pain experience. The analysis also confirmed the three-factor structure of FPQ-III, demonstrating good internal consistency for fear of severe pain (0.71) and fear of medical pain (0.73) and acceptable range for fear of minor pain (0.65). Conclusion: These findings suggest that the FPQ-III can be potentially applied to identify individuals at risk for prolonged continuous pain and as a screening tool to measure fear and anxiety related to pain. Keywords: fear of pain, fear related to pain, chronic pain, duration of pain, frequency of pain

Labasangzhu,1,2 E Bjertness,3 EB McNeil,2 Deji,1 Y Guo,4 P Songwathana,5 V Chongsuvivatwong2 1Department of Preventive Medicine, Tibet University Medical College, Lhasa, Tibet, China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand; 3Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; 4Department of Health Policies and Management, School of Public Health, Peking University Health and Science Center, Beijing, China; 5Department of Adult and Elderly Nursing, Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand Background: The maternal mortality ratio (MMR) of the Tibet Autonomous Region (hereinafter “Tibet”) is still five times higher than the national average. This study aims to identify the successes and pitfalls of the health system that might be related to the high mortality rate based on the WHO health system building blocks, focusing on human resources for health and health infrastructure and the impact on maternal health and outcomes. Methods: Sources of information include China’s central government and Tibet’s local government policies and regulations, health statistical yearbooks, maternal and child health routine reporting system, and English and Chinese online research articles. Joinpoint analysis was applied for MMR and maternal health service trends, and correlation test was used to test the relationship between maternal health services and outcomes. Results: Between 2000 and 2015, public health spending in Tibet increased 67-fold, the hospital delivery rate increased 70.1%, and the MMR dropped from 466.9 to 100.1 per 100,000 live births. However, the total number of health workers, qualified medical doctors, and registered nurses per 1,000 people were 4.4, 1.4, and 1.0, respectively, much lower than the national average (5.8, 1.8, and 2.4). In Tibet, there were 80 basic and 16 comprehensive emergency obstetric care (EOC) centers. On average, there were 12 basic and 2.5 comprehensive EOC centers per 500,000 of the population. Though it met the WHO’s recommendation, it might remain inadequate in the low population density of the area like Tibet. Conclusion: The shortage of health professionals and EOC centers and health information in predominantly remote rural areas with a scattered population still needs to be rectified. Keywords: health system, human resources for health, emergency obstetric care, Tibet

Jing Li,1 Virasakdi Chongsuvivatwong,2 Sawitri Assanangkornchai,2 Edward B McNeil,2 Le Cai1 1School of Public Health, Kunming Medical University, Kunming, Yunnan Province, China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand Background: China is in an epidemiologic transition period. Health system responsiveness (HSR) has become an increasing concern in China. With the burden of increasing human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome, responsiveness of HIV care is urgently needed. We aimed at comparing the experience of HSR between HIV-positive and non-HIV patients. Methods: A cross-sectional study was carried out in Yunnan, China, from January to February 2015 among two consecutive groups of HIV and non-HIV patients in two hospitals with the largest HIV admissions. Patients’ experience and expectation of HSR were measured using a self-reported questionnaire containing items of seven domains and 35 vignettes (five per domain). Each of the items and vignettes was ranked from 1 “very good” to 5 “very bad.” For each domain, B-scales were built based on the difference between experience and the vignettes. Ordered probit and censored ordered probit regression models were constructed to compare HSR experience between the two groups adjusted for socioeconomic status (SES) factors. Results: The majority of HIV patients were at clinical stage 1, were infected via unprotected sexual contact, and had a CD4 count

The closed-loop recycling of mechanically shredded post-consumer wool-pile carpets as fertiliser was demonstrated previously, where it increased the yield of grass by up to 82%. When cultivated into the soil, the shredded carpet inevitably left fragments on the surface, which included jute and polypropylene components of the carpet backing. To determine their likely persistence in the environment, jute and polypropylene carpet backing fabrics were subjected to intense light from a 500-Watt lamp, which provided a reasonable approximation to sunlight outdoors. The changes in mechanical properties and microscopic appearance of the fabrics were monitored. Over 500 hours of exposure to light (equivalent to 125 days of strong sunlight), the jute lost 60% of its strength. The polypropylene lost strength more rapidly than the jute, i.e. 88% loss over 250 hours. In an outdoor situation, the jute and polypropylene would be subject to rain and microbial action, as well as sunlight, so degradation will be faster than was measured under laboratory conditions. The results of this study suggest that fragments of jute and polypropylene carpet backing, on the surface of soil, may not constitute an environmental hazard, and that photodegradation of microplastic fibres on land (such as those in waste water sludge applied to land), reduces the risk they pose to aquatic environments.

Abstract Background Anemia is common among people living with HIV infection and is frequently associated with poor quality of life and poor prognosis. It has been well described in antiretroviral naïve individuals and those on non-nucleoside reverse transcriptase inhibitor-based first line antiretroviral therapy (ART) regimens. However there is limited information on anemia for ART experienced individuals on protease inhibitor-based second line ART regimens in resource limited settings. Our objective was to describe the prevalence and risk factors of anemia in this ART experienced population in Malawi. Methods We conducted a cross-sectional study using routine facility data at two HIV clinics in Lilongwe, Malawi. The analysis included individuals receiving protease inhibitor-based second line ART. Clinical and laboratory data were collected at routine clinic visits. We used descriptive statistics, two-sample t-tests and multivariate logistic regression for data analysis. Results Three hundred seventy-seven records were included in this analysis (37% male, median age 41 years, median CD4 count 415 cells/μL). The prevalence of anemia was 125/377 (33.2%) − mild, moderate and severe anemia was 17.5%, 13.8%, and 1.9% respectively. Female participants had a higher prevalence than male participants (43.6% vs. 15.7%, p

This systematic review examined research on moderators in asynchronous online discussions (AODs) through a review of 52 sources published over the past four decades. Areas of interest included conceptual frameworks cited in research, publication trends, instructional contexts, research methods and characteristics, and descriptions of the role of the moderator with implications for practice. Results indicate: (1) nearly half of the publications did not cite a conceptual framework focused on moderation; (2) the field is diverse with a wide variety of themes for research designs, outcomes, foci, and questions; (3) half of reviewed publications involved case studies or similarly limited study designs; (4) the majority of publications collected data on students in higher education, but there was a lack of consistency in the reporting of demographic information; (5) research foci tended toward investigating peer moderators or the role of the instructor; (6) research questions tended to focus on strategies of moderators or student performance and discussion quality; (7) most definitions or expectations of a moderator included discussion and social management duties. We conclude by discussing the implications of some of the findings and future research options.

Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the Childrens Comfort Promise, includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the Global Comfort Promise was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Childrens Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their childs pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.

This article, co-authored with a group of undergraduate secondary music student teachers, shares their experiences as they learned about additional support needs and inclusive practice through a series of 10 problem-based learning (PBL) sessions. Drawing from their reflections on the weekly sessions, the paper explores the students' learning experiences through the themes of motivation, self-directed learning, critical skill development and collaboration. The students' accounts indicate a deep engagement with the process of PBL and recognition of growth in their understanding and knowledge relating to inclusive practice and additional support needs. The process has supported their development in ways that may help them to navigate the complexities of inclusive education and support their own professional practice as they embark on their careers.

Abstract Background Malawi’s national antiretroviral therapy program provides atazanavir/ritonavir–based second line regimens which cause concentration-dependent rise in indirect bilirubin. We sought to determine if elevated bilirubin, as a surrogate of atazanavir/ritonavir adherence, can aid in the evaluation of second line virological failure in Malawi. Methods We conducted a cross-sectional study of HIV-infected patients ≥15 years who were on boosted protease inhibitor-based second line antiretroviral therapy for at least 6 months in two urban HIV clinics in Lilongwe, Malawi. Antiretroviral therapy history and adherence data were extracted from the electronic medical records and blood was drawn for viral load, complete blood count, total bilirubin, and CD4 cell count at a clinic visit. Factors associated with virological failure were assessed using multivariate logistic regression model. Results Out of 376 patients on second line antiretroviral therapy evaluated, 372 (98.9%) were on atazanavir/ritonavir-based therapy and 142 (37.8%) were male. Mean age was 40.9 years (SD ± 10.1), mean duration on second line antiretroviral therapy was 41.9 months (SD ± 27.6) and 256 patients (68.1%) had elevated bilirubin >1.3 mg/dL. Overall, 35 (9.3%) patients had viral load >1000 copies/ml (virological failure). Among the virologically failing vs. non-failing patients, bilirubin was elevated in 34.3% vs. 72.0% respectively (p

Corey C Lieneman, Laurel A Brabson, April Highlander, Nancy M Wallace, Cheryl B McNeil Department of Psychology, West Virginia University, Morgantown, WV, USA Abstract: Parent–Child Interaction Therapy (PCIT) is an empirically supported intervention originally developed to treat disruptive behavior problems in children between the ages of 2 and 7 years. Since its creation over 40 years ago, PCIT has been studied internationally with various populations and has been found to be an effective intervention for numerous behavioral and emotional issues. This article summarizes progress in the PCIT literature over the past decade (2006–2017) and outlines future directions for this important work. Recent PCIT research related to treatment effectiveness, treatment components, adaptations for specific populations (age groups, cultural groups, military families, individuals diagnosed with specific disorders, trauma survivors, and the hearing-impaired), format changes (group and home-based), teacher–child interaction training (TCIT), intensive PCIT (I-PCIT), treatment as prevention (for externalizing problems, child maltreatment, and developmental delays), and implementation are discussed. Keywords: PCIT, adaptations, implementation, effectiveness

Michael Mileski, Joseph Baar Topinka, Kimberly Lee, Matthew Brooks, Christopher McNeil, Jenna Jackson School of Health Administration, Texas State University, San Marcos, TX, USA Objectives: The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. Problem: The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting: The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results: The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion: These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions. Keywords: readmissions, skilled nursing, quality improvement, hospital, finance, Medicare, transfers