Search

Background: Pneumonia is a frequent diagnosis for patients admitted to Australian intensive care units (ICUs) for invasive ventilation. Physiotherapists in ICU provide interventions to enhance respiratory function and physical recovery. Objective: This retrospective cohort study aimed to describe physiotherapy management of adults with pneumonia who require invasive mechanical ventilation in a single Level 3 ICU in a quaternary teaching hospital. Methods: All adults admitted with a medical diagnosis of pneumonia requiring invasive mechanical ventilation over a two-year period were included. Demographic and clinical data, including APACHE II score, ventilator-free days (VFDs) to day 28, ICU length of stay (LOS), and type and frequency of physiotherapy episodes of care delivered in ICU, were collected from electronic medical records. Correlations between VFDs to day 28 and the frequency of physiotherapy interventions delivered per subject were examined using Spearman’s rho analysis. Results: From 208 records screened, 66 subjects with an ICU admission diagnosis of pneumonia, who required invasive mechanical ventilation, were included. Median (IQR) ICU LOS was 10 (5–17) days, and mortality rate was 15.2% ([Formula: see text]). The cohort had a median of 20.5 (IQR 2–25) VFDs to day 28. Community-acquired pneumonia (66.7%, [Formula: see text]) was the most frequent type of pneumonia diagnosis. There were 1110 episodes of physiotherapy care, with patients receiving a median of 13.5 (IQR 6.8–21.3) episodes during their ICU stay, with a median rate of 1.2 (IQR 1.0–1.6) episodes per day. Over 96.7% of patients with pneumonia received physiotherapy treatment during their ICU stay. Overall, physiotherapy treatments consisting only of respiratory techniques were most commonly provided (55.1%, [Formula: see text]). Airway suctioning (92.4%, [Formula: see text]), patient positioning (72.7%, [Formula: see text]) or positioning advice to nurses (77.3%, [Formula: see text]), and hyperinflation techniques (63.6%, [Formula: see text]) were among the respiratory techniques most delivered. Conclusion: This study described the current intensive care physiotherapy management in a single center for adults with pneumonia who required invasive mechanical ventilation, demonstrating that respiratory physiotherapy interventions are often provided for this ICU patient cohort. Further research is warranted to determine the efficacy of respiratory physiotherapy interventions to justify their use for ICU patients with pneumonia receiving invasive mechanical ventilation.

Background/Aims Surgeons and endoscopists have started to use endoscopically inserted double pigtail stents (DPTs) in the management of upper gastrointestinal (UGI) leaks, including UGI anastomotic leaks. We investigated our own experiences in this patient population. Methods From March 2017 to June 2020, 12 patients had endoscopic internal drainage of a radiologically proven anastomotic leak after UGI surgery in two tertiary UGI centers. The primary outcome measure was the time to removal of the DPTs after anastomotic healing. The secondary outcome measure was early oral feeding after DPT insertion. Results Eight of the 12 patients (67%) required only one DPT, whereas four (33%) required two DPTs. The median duration of drainage was 42 days. Two patients required surgery due to inadequate control of sepsis. Of the remaining 10 patients, nine did not require a change in DPT before anastomotic healing. Nine patients were allowed oral fluids within the 1st week and a soft diet in the 2nd week. One patient was allowed clear oral feeds on the 8th day after DPT insertion. Conclusions Endoscopic internal drainage is becoming an established minimally invasive technique for controlling anastomotic leak after UGI surgery. It allows for early oral nutritional feeding and minimizes discomfort from conventional external drainage.

Phonological processing of written characters has been recognized as a crucial element in acquiring literacy in any language, both native and foreign. This study aimed to assess Japanese primary school students' phoneme-grapheme recognition skills using both paper-based and touch-interface tests. Differences between the two test formats and the relationship between phoneme-grapheme recognition skills and interaction with digital tests were investigated. We hypothesized a relationship between paper test performance and digital item performance. Participants were sixth-grade students from two public schools. The results of comparison tests indicated that the touch-interface test had lower success rates compared to the paper-based test for most items, suggesting a difference in performance patterns. A consistent relationship between phoneme-grapheme knowledge tested on paper and successful digital interaction was found. Findings highlight the potential of touch-interface assessments for assessing phoneme-grapheme recognition skills in primary school classrooms and suggest incorporating more digital tasks to enhance student adaptation. [Note: The issue number (1) shown in the citation on the PDF is incorrect. The correct issue number is 2.]

Understanding the overlap of symptoms between oppositional defiant disorder (ODD) and obsessivecompulsive disorder (OCD) experienced by youth is pertinent for accurate diagnosis. A quantitative, retrospective, cross-sectional design format was used to assess the relationship between ODD and OCD in addition to evaluating the difference in ODD severity and symptoms based on OCD severity. Symptoms and severity ratings of ODD and OCD were collected from youth diagnosed with ODD (N = 179). Fisher's exact test and a Wilcoxon signed-rank test were performed. There were significant relationships between frustration related to obsessions and compulsions and the ODD symptoms of annoyance and anger. Results suggested that OCD severity predicted an increase in scores for ODD severity and symptoms.

Foreign language was recently added to Japan's national primary school curriculum. Phoneme-Grapheme Recognition (PGR) skills are a critical step in both L1 and L2 development. Due to its simplistic approach and the lack of new investment in teacher training, research regarding the impact on PGR skills are important. This study tested the relative differences and growth of primary school students' (grades 3, 4, 5, 6) PGR skills across two semesters. Semester-1 (July) and Semester-3 (March) students (n = 256, female n = 130) completed the same PGR test during regular class time. ANOVA and follow-up pairwise tests assessed achievement differences between grades and across the two-semester gap. Difference testing between grades indicated substantial (R[superscript 2] = 0.32 & 0.19) and statistically significant (p < 0.001) differences at both time points. Pairwise follow-up tests pointed to two steps in statistically different ability (grades 3-4/5-6). Longitudinal tests suggested that the current Japanese national elementary school curriculum supports phoneme-grapheme skill development; However, the twostep ability grouping indicated that the current national curriculum is not sufficiently detailed and/or rigorous to ensure annual student improvement in PGR skills.

Existing systems for automating the assessment of risk-of-bias (RoB) in medical studies are supervised approaches that require substantial training data to work well. However, recent revisions to RoB guidelines have resulted in a scarcity of available training data. In this study, we investigate the effectiveness of generative large language models (LLMs) for assessing RoB. Their application requires little or no training data and, if successful, could serve as a valuable tool to assist human experts during the construction of systematic reviews. Following Cochrane's latest guidelines (RoB2) designed for human reviewers, we prepare instructions that are fed as input to LLMs, which then infer the risk associated with a trial publication. We distinguish between two modelling tasks: directly predicting RoB2 from text; and employing decomposition, in which a RoB2 decision is made after the LLM responds to a series of signalling questions. We curate new testing data sets and evaluate the performance of four general- and medical-domain LLMs. The results fall short of expectations, with LLMs seldom surpassing trivial baselines. On the direct RoB2 prediction test set (n = 5993), LLMs perform akin to the baselines (F1: 0.1-0.2). In the decomposition task setup (n = 28,150), similar F1 scores are observed. Our additional comparative evaluation on RoB1 data also reveals results substantially below those of a supervised system. This testifies to the difficulty of solving this task based on (complex) instructions alone. Using LLMs as an assisting technology for assessing RoB2 thus currently seems beyond their reach.

Continuing education programs for educators are designed to advance educators' teaching practices and ultimately advance students' academic success. However, many non-traditional wilderness-based programs lack evidence of proven efficacy. Experiential wilderness-based programs are believed to enhance participants' character traits through challenging recreational activities and experiential teaching methods. A mixed survey methodology examined the influence of an experiential wilderness-based training on K-12 school educator participants and used Kirkpatrick's (1959, 1976) taxonomy framework to organize findings into three categories: satisfaction, learning, and behaviors. The results suggest participants were highly satisfied with the program, developed positive character traits, advanced in professional development, and integrated experiential teaching methods in their schools. The results support promoting wilderness-based professional development activities for school educators to improve student outcomes.

Recent advances in automated scoring technology have made it practical to replace multiple-choice questions (MCQs) with short-answer questions (SAQs) in large-scale, high-stakes assessments. However, most previous research comparing these formats has used small examinee samples testing under low-stakes conditions. Additionally, previous studies have not reported on the time required to respond to the two item types. This study compares the difficulty, discrimination, and time requirements for the two formats when examinees responded as part of a large-scale, high-stakes assessment. Seventy-one MCQs were converted to SAQs. These matched items were randomly assigned to examinees completing a high-stakes assessment of internal medicine. No examinee saw the same item in both formats. Items administered in the SAQ format were generally more difficult than items in the MCQ format. The discrimination index for SAQs was modestly higher than that for MCQs and response times were substantially higher for SAQs. These results support the interchangeability of MCQs and SAQs. When it is important that the examinee generate the response rather than selecting it, SAQs may be preferred. The results relating to difficulty and discrimination reported in this paper are consistent with those of previous studies. The results on the relative time requirements for the two formats suggest that with a fixed testing time fewer SAQs can be administered, this limitation more than makes up for the higher discrimination that has been reported for SAQs. We additionally examine the extent to which increased difficulty may directly impact the discrimination of SAQs.

Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities' diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: (1) collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; (2) inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and (3) relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities.

Paige Baldwin,1,* Anders W Ohman,2,* Shifalika Tangutoori,3 Daniela M Dinulescu,2,# Srinivas Sridhar1,3,4,#1Department of Bioengineering, Northeastern University, Boston, MA, USA; 2Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 3Department of Physics, Northeastern University, Boston, MA, USA; 4Division of Radiation Oncology, Harvard Medical School, Boston, MA, USA*These authors contributed equally to this work#These senior co-authors contributed equally to this workBackground: PARP inhibitors, such as Olaparib, have advanced the treatment of ovarian cancer by providing patients with an effective and molecularly-targeted maintenance therapy. However, all orally-administered drugs, including Olaparib, must undergo first-pass metabolism. In contrast, a nanoparticle delivery system has the advantage of administering Olaparib directly into the peritoneal cavity for local treatment. Consequently, we sought to optimize the sustained-release formulation NanoOlaparib, previously deemed effective as an intravenous solid tumor treatment, for the local treatment of disseminated disease via intraperitoneal (i.p.) therapy. Methods: The tumor cell line 404, which was derived from a Brca2-/-, Tp53-/-, Pten-/- genetically engineered mouse model, exhibited high sensitivity to Olaparib in vitro. It was chosen for use in developing an i.p. spread xenograft for testing nanotherapy efficacy in vivo. NanoOlaparib as a monotherapy or in combination with cisplatin was compared to oral Olaparib alone or in combination using two different dose schedules. A pilot biodistribution study was performed to determine drug accumulation in various organs following i.p. administration. Results: Daily administration of NanoOlaparib reduced tumor growth and decreased the variability of the treatment response observed with daily oral Olaparib administration. However, systemic toxicity was observed in both the NanoOlaparib and vehicle (empty nanoparticle) treated groups. Scaling back the administration to twice weekly was well tolerated up to 100 mg/kg but reduced the effect on tumor growth. Biodistribution profiles indicated that NanoOlaparib began accumulating in tissues within an hour of administration and persisted for at least 72 hours after a single dose, exiting the peritoneal cavity faster than expected. Conclusion: NanoOlaparib must be modified for use against disseminated disease. Future avenues to develop NanoOlaparib as an i.p. therapy include a modified surface-coating to retain it in the peritoneal cavity and prevent entry into systemic circulation, in addition to targeting moieties for localization in tumor cells.Keywords: PARP inhibitor, Olaparib, intraperitoneal treatment, nanoparticle, DNA repair, ovarian cancer

Environmental education (EE) is instrumental in developing environmentally literate citizens with the knowledge, attitudes, and skills necessary to support sustainable development. In the case of EE school field trips in the USA, these experiences also foster learning and skill development that supports meeting state and national educational standards. However, despite the importance of EE field trip programs, not all schools participate. This study explored the barriers to accessibility to EE field trips by conducting semi-structured interviews with EE providers and administrators of middle schools in the Congaree Biosphere Reserve (CBR), South Carolina, USA. We also used geospatial information systems to investigate accessibility spatially. Results suggest that aspatial barriers such as curricular constraints, capacity to plan and lead field trips, costs, and transportation influence participation. The results also suggest that these aspatial barriers are often interlinked and that access to EE field trips is disproportionately allocated to students in private education and urban settings and that rural, poor, minority, underperforming, and English as Second Language students face additional hurdles. We discuss a range of potential solutions to overcoming these barriers that reduce participation in EE field trips in the CBR.

Paige Baldwin,1 Shifalika Tangutoori,1,2 Srinivas Sridhar1,2 1Nanomedicine Science and Technology Center, Northeastern University, Boston, MA, USA; 2Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, USA Abstract: PARP-l is a DNA repair protein that plays a role in a number of repair pathways and also helps in transcriptional regulation; thus PARP inhibitors (PARPi), such as olaparib and BMN-673, act by inhibiting DNA damage repair. This leads to an accumulation of deleterious mutations leading to genetic instability as a result of a number of cell replications. Currently, olaparib is only available in an oral form and has poor bioavailability, consequently leading to poor accumulation in the tumor due to first-pass metabolism. Therefore, in the present study, an injectable nanoparticle formulation of olaparib was created that offers a delivery route in which the drug would be fully bioavailable in the vasculature, suggesting greater tumor accumulation. Our results illustrated that injectable nanoformulations of olaparib and BMN-673, a next generation PARPi, could be developed, and an efficacy test indicated that BMN-673 is a much more potent PARPi than olaparib. The success of these molecular inhibitors as a monotherapy in inhibiting colony formation suggests enhanced efficacy of these treatments in combination with other therapies, even in tumors which have developed resistance. Keywords: PARP-l, olaparib, BMN-673, DNA repair protein, tumor accumulation

Type 2 diabetes is a complex disease with several modifiable lifestyle factors. The Extension 'Live well, Eat well, be Active with Diabetes' curriculum provides four 90-minute sessions teaching individuals to live well, eat well, and be active with diabetes. Fourteen Extension educators implemented and evaluated the curriculum with 107 participants. Participants reported the program helped them feel better able to take care of their health. We observed significant differences in participants' retrospective pre and post 'Live well,' 'Eat well' and 'be Active' total scores. Extension has a unique opportunity to educate individuals so they may better manage their diabetes.

At-risk urban youth benefit from mentored activities. The Champion Academy (CA) is a youth mentoring program for high risk urban youth. We used a community based participatory research (CBPR) approach to explore: 1) youth perspectives on health and wellness, EH and EJ; and 2) community perspectives on the intersection of structural racism, health equity, and youth health and wellness. We surveyed CA participants to assess health and wellness and conducted youth and adult interviews and focus groups to understand what environmental factors impact their daily lives. In 45 youth surveys, 64% reported enjoying time outdoors; 45% had concerns about pollution. The five youth focus groups (N = 49) and individual interviews (N = 10) identified 3 themes: (1) pervasive community violence; (2) systemic racism, and (3) limited power to make change. The two adult focus groups (N = 7) and individual interviews (N = 5) identified: 1) normalization of environmental problems and violence; 2) youth prioritize survival over health and wellness; 3) CA education should emphasize relevance to youth; 4) access to healthy foods is limited; and 5) mindsets need to change. In sum, youth's real-life environmental concerns must be addressed as part of more typical EH concerns.