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Introduction: People with intellectual disability are less likely to participate in breast screening than people without intellectual disability. They experience a range of barriers to accessing breast screening, however, there is no consensus on strategies to overcome these barriers. Our objective was to reach consensus on the strategies required for accessible breast screening for people with intellectual disability. Methods: Fourteen experts participated in a modified on-line Delphi that used Levesque's model of health care access as the theoretical framework. At the end of each round descriptive and thematic analyses were completed. Data was then triangulated to determine if consensus was reached. Results: After 3 rounds, 9 strategies were modified, 24 strategies were added and consensus was reached for 52 strategies across the 5 dimensions of access. Key areas of action related to (i) decision making and consent, (ii) accessible information, (iii) engagement of peer mentors, (iv) service navigators, and (v) equipping key stakeholders. Conclusions: The resulting strategies are the first to articulate how to make breast screening accessible and can be used to inform health policy and quality improvement practices. [ABSTRACT FROM AUTHOR]

Traditionally marker-based approaches are used to define haematopoietic cell type or state. Here, the authors use single-cell RNA-seq to establish a cellular hierarchy of lineage development in zebrafish haematopoiesis, and propose a refined model of developmental progression of haematopoietic cells.

Abstract Background Acute outbreaks of Actinobacillus pleuropneumoniae (APP) require rapid, effective, parenteral antimicrobial treatment. The efficacy and safety of a single, short-acting, high dose of marbofloxacin (Forcyl® swine 160 mg/mL) compared with 1 or 2 doses of 7.5 mg/kg enrofloxacin in APP outbreaks in European farms was studied. Methods A controlled, randomised block, blinded, multicentre, field study was conducted on four farms with acute respiratory disease associated with APP. Animals with clinical signs of respiratory disease were allocated similarly to intramuscular treatments of either a single dose 8 mg/kg marbofloxacin on day 0 or, 7.5 mg/kg enrofloxacin (Baytril 1nject®) on day 0 and again on day 2, if clinical signs had not improved. Results The results were similar for intention to treat (242 pigs) and per protocol populations (239 pigs). On day 0, all pigs had pyrexia (means, 40.6 °C), moderate to severe clinical signs (depression, cough, dyspnoea). Following treatment, animals improved rapidly and on day 7, clinical signs were absent or mild in all pigs and mean temperatures for each treatment were 0.05). The primary efficacy criterion, animals cured, for marbofloxacin and enrofloxacin was 81.8 and 81.4% on day 7, and 84.2 and 82.2% on day 21, respectively. Results for cure, respiratory disease removals and mortalities, and relapses were compared using confidence intervals and confirmed that marbofloxacin was non-inferior to enrofloxacin (P > 0.05). There were no significant treatment differences in live weight gains, adverse events and injection site reactions ( 0.05). Significantly more animals developed concurrent disorders in the enrofloxacin (7.5%) than marbofloxacin (0.0%) group (P

Introduction Choosing Wisely, an international effort to reduce low value care worldwide, considers communication between clinicians and patients during routine clinical encounters a key mechanism for change. In Australia, Choosing Wisely has developed a 5 Questions resource to facilitate better conversations. The primary aim of this study is to evaluate the impact of the Choosing Wisely Australia 5 Questions resource and a video designed to prepare patients for question-asking and participation in shared decision-making on (a) self-efficacy to ask questions and participate in shared decision-making, (b) intention to participate in shared decision-making and (c) a range of secondary outcomes. The secondary aim of this study is to determine whether participants’ health literacy modifies the effects of the interventions.Methods and analysis We will use 2×2×2 between-subjects factorial design (preparation video: yes, no × Choosing Wisely 5 Questions resource: yes, no × health literacy: adequate, inadequate). Participants will be recruited by an online market research company, presented with a hypothetical non-specific low back pain scenario, and randomised to study groups stratified by health literacy. Quantitative primary and secondary outcome data will be analysed as intention-to-treat using appropriate regression models (ie, linear regression for continuous outcomes, logistic regression for dichotomous categorical outcomes).Ethics and dissemination Ethical approval for this study was obtained from the University of Sydney Human Research Ethics Committee (protocol number: 2018/965). The results from this work will be disseminated through peer-reviewed international journals, conferences and updates with collaborating public health bodies. Resources developed for this study will be made available to patients and clinicians following trial completion.Trial registration number This trial has been registered with the Australia New Zealand Clinical Trials Registry (trial number: 376477) and the stage is Pre-results.

Background: Adult education targeting health literacy (HL) may bring added value in the form of improved health. Objective: This study evaluated the effects of a HL program as part of an adult education curriculum for adults with low literacy and numeracy. Methods: This was a partial-cluster randomized controlled trial among 308 adults enrolled in basic education programs in Australia. Of the 308 participants, 141 (46%) were randomized to either the standard program (language, literacy, and numeracy [LLN]), or the HL intervention (LLN with embedded health content); the remainder (n = 167) were allocated to standard intervention programs by the education provider at the class level. The main outcomes were functional HL, self-reported confidence, patient activation, generic HL (ie, HLQ, health knowledge, and self-reported health behavior). Data were collected at baseline, immediately after, and at 6 months post-intervention. Key Results: Of the 308 participants, 71% had limited literacy and 60% spoke a language other than English at home. Both interventions benefited participants, with improvements from baseline to immediate follow up on individual-level functional HL (e.g., reading a thermometer; HL group 18.4% vs. standard group 7.2%; p = .001), confidence (HL group 0.34 vs. standard group 0.06; p = .014) and health literacy questionnaire (HLQ) subscales. At 6 months, improvements in confidence (p < .001) and some HLQ measures were retained. A consistent pattern of increased improvement in the HL program was observed compared to the standard program, although only some measures reached statistical significance: reading a food label (HL group 6.03/10 correct vs. standard group 5.49/10 correct; p = .022); confidence (p = .008); ability to actively manage health (HLQ) (p = .017), and health knowledge at 6 months (HL group 68% vs. standard group 60% correct, p = .052). HL participants reported being more likely to share course information and rated the program more useful to understand their health. Conclusions: Improving language, literacy, and numeracy generally has potential public health benefits that are retained at 6 months. Integrating health content adds further value to adult basic learning, is feasible, and potentially scalable.

The power density of femtosecond lasers and exposure time to the tissue are crucial for a successful procedure in terms of safety and precision. The reduction of the pulse duration allows reducing the quantity of the energy to be delivered to the tissue for disruption with strongly diminished mechanical and thermal collateral damage. The cutting effect of ultra-short pulses is very precise, minimally traumatic, safe, and predictable. Future developments will lead to further energy reductions to achieve optical breakdowns. However, the pulse length cannot be shortened arbitrarily because below 100 fs nonlinear effects can change the process in an unfavorable way. Compared to manual-conventional cataract surgery, femtosecond laser-assisted cataract surgery (FLACS) shows many advantages in clinical application, especially with regard to precision and tissue protection. The femtosecond laser has become particularly important and has made the overall procedure safer when we deal with complex cataract cases such as subluxated lenses. We provide an overview of the evolution of femtosecond laser technology for use in refractive and cataract surgeries. This article describes the advantages of available laser platforms with ultrashort pulses and mainly focuses on the technical and physical backgrounds of ophthalmic surgery technologies.

Introduction: Adenomyosis is histologically defined by the presence of endometrial glands and stroma in the myometrium. Ultrasound findings of adenomyosis are being redefined to better diagnose adenomyosis pre-operatively. Methods: A single-centre retrospective study was performed at a regional hospital. The myometrial–cervical ratio was calculated on pre-operative ultrasounds, and histopathology reviewed for each case. Logistic regression was used to estimate the association between the myometrial–cervical ratio and adenomyosis confirmed on histopathology, and the area under the receiver operating characteristic curve was calculated. Comparisons were performed based on the presence of fibroids on ultrasound. Results: Complete data were available for 136 benign hysterectomies between 1 January 2015 and 31 December 2020. When the myometrial–cervical ratio was treated as a continuous variable in a logistic regression of adenomyosis on histopathology, there was no statistical evidence (χ2(1) < 0.01, p = 0.98) of an association. When cases including fibroids in the myometrial–cervical ratio were excluded, there was a non-significant association between myometrial–cervical ratio and adenomyosis on histopathology (odds ratio = 3.435, 95% confidence interval = 0.964, 12.235; χ2(1) = 3.62, p = 0.057); area under the receiver operating characteristic = 0.637 (95% confidence interval = 0.504, 0.770). The optimal myometrial–cervical ratio cutpoint was 1.875 (95% confidence interval = 1.698, 2.051), which achieved 71.43% sensitivity and 60.00% specificity. There was strong statistical evidence (χ2(1) = 9.02, p = 0.003) that the myometrial–cervical ratio outperformed standard pre-operative ultrasound identification of adenomyosis. Conclusion: While accuracy remains suboptimal, the myometrial–cervical ratio outperformed standard ultrasound diagnostic features of adenomyosis in a regional setting. The myometrial–cervical ratio may offer a simple imaging measurement for adenomyosis in inexperienced hands when fibroids are absent. [ABSTRACT FROM AUTHOR]

Background: This study aimed to identify factors associated with unplanned acute hospital readmission and emergency department (ED) presentation after hospitalisation for epilepsy in people with intellectual disability (ID). Methods: This study is a retrospective cohort study using linked administrative datasets. We identified 3293 people with ID aged 5–64 years with a hospitalisation for epilepsy between 2005 and 2014 in New South Wales, Australia. We examined unplanned readmission and ED presentation within 30 or 365 days and associations with demographic, socio‐economic and health status variables. Modified Poisson regression with robust estimation was used to model outcomes within 30 days. Negative binomial regression was used to account for the overdispersion of the data and to model 365‐day outcome rates. Results: Around half of the cohort had an unplanned readmission and ED presentation within 365 days of the index hospitalisation. In fully adjusted models, being female, being a young adult and having a longer or acute care index admission, mental and physical comorbidities and a history of incarceration were associated with an elevated risk of readmission or ED presentation. The strongest association was observed between history of self‐harm and 365‐day readmission (incidence rate ratio 2.15, 95% confidence interval 1.41–3.29). Conclusions: Socio‐demographic, justice and health factors are associated with unplanned readmission and ED presentation risk after hospitalisation for epilepsy in people with ID. Interventions targeting improving continuity of care should be tailored for individuals and their support workers. The findings also emphasise the importance of person‐centred multidisciplinary care across different health sectors. [ABSTRACT FROM AUTHOR]

Iraklis Vastardis,1 Brigitte Pajic-Eggspühler,1 Jörg Müller,1,2 Zeljka Cvejic,2 Bojan Pajic,1–4 1Swiss Eye Research Foundation, Orasis Eye Clinic, Aargau, Reinach, Switzerland; 2Faculty of Physics, University of Novi Sad, Novi Sad, Serbia; 3Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland; 4Medical Faculty, Military Medical Academy, University of Defence, Belgrade, Serbia Purpose: To report the visual outcomes of the femtosecond laser-assisted multifocal aspheric corneal ablation profile using a mini-monovision approach and to evaluate if corneal multifocality was effective, and to report the relative benefits of this approach.Patients and methods: Bilateral femtosecond laser-assisted in situ keratomileusis using a multifocal aspheric corneal ablation profile was performed on 19 hyperopic patients (38 eyes). They were divided into two groups based on eye dominance: dominant eye (DE) group targeting emmetropia and the nondominant eye (NDE) group targeting -0.5 D slight myopia. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and retreatment rates were reported from baseline to 6 months.Results: The UNVA, UIVA, and UDVA improved significantly in both groups (Kruskal–Wallis test, DE and NDE: P

Bojan Pajic,1–4 Iraklis Vastardis,1 Predrag Rajkovic,5 Brigitte Pajic-Eggspuehler,1 Daniel M Aebersold,6 Zeljka Cvejic2 1Eye Clinic ORASIS, Swiss Eye Research Foundation, Reinach AG, Switzerland; 2Department of Physics, Faculty of Sciences, University of Novi Sad, Novi Sad,3Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; 4Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland; 5Department of Mathematics, Faculty of Mechanical Engineering, University of Niš, Niš, Serbia; 6Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland Purpose: Pterygium is a common lesion affecting the population in countries with high levels of ultraviolet exposure. The final shape of a pterygium is the result of a growth pattern, which remains poorly understood. This manuscript provides a mathematical analysis as a tool to determine the shape of human pterygia.Materials and methods: Eighteen patients, all affected by nasal unilateral pterygia, were randomly selected from our patient database independently of sex, origin, or race. We included all primary or recurrent pterygia with signs of proliferation, dry eye, and induction of astigmatism. Pseudopterygia were excluded from this study. Pterygia were outlined and analyzed mathematically using a Cartesian coordinate system with two axes (X, Y) and five accurate landmarks of the pterygium.Results: In 13 patients (72%), the shape of the pterygia was hyperbolic and in five patients (28%), the shape was rather elliptical.Conclusion: This analysis gives a highly accurate mathematical description of the shape of human pterygia. This might help to better assess the clinical results and outcome of the great variety of therapeutic approaches concerning these lesions. Keywords: etiology, pterygium, limbal stem cells, stem cells dysfunction, mathematical shape analysis

ObjectiveGuidance to address health literacy often focuses on health education rather than tools to facilitate action, despite action being important for self-management. This study evaluated an online intervention informed by health literate design principles and behavior change theory to reduce unhealthy snacking.Methods440 participants were recruited online and randomized to an intervention: 1) Health-literate action plan (guided implementation intention); 2) Standard action plan (self-guided implementation intention); 3) Education (healthy snacking fact-sheet). The primary outcome was self-reported unhealthy snacking. Follow-up was at 1 month.Results373 participants (84.8%) completed follow-up. Half the sample had adequate health literacy (52%), and the other half had low (24%) or possibly low (25%) health literacy, as measured by Newest Vital Sign (NVS). At follow-up, lower health literacy was associated with more unhealthy snacks and there was no overall difference between intervention groups. However, participants with lower health literacy who used the health-literate action plan reported less unhealthy snacking compared to the standard action plan; the reverse was true for those with higher health literacy scores (b = 1.7, p = 0.03). People scoring 2 points below the mean NVS (M = 3.4, SD = 2.0) using the health-literate action plan reported eating 8 fewer serves of unhealthy snacks, whereas people scoring 2 points above the mean NVS reported eating 6 more serves of unhealthy snacks using the same tool.ConclusionsThese findings suggest that the universal precautions approach currently recommended for health information may be less effective for facilitating action than tailoring to health literacy level.Trial registrationANZCTR identifier: ACTRN12617001194358.

A prospective feasibility study was conducted to determine whether a new wearable device, the Visual Behavior Monitor (VBM), was easy to use and did not present any difficulties with the daily activities of patients. Patients for cataract surgery and refractive lens exchange were randomly selected and screened for inclusion in the study. A total of 129 patients were included in the study as part of a multicenter study. All measurements were performed before surgery. Upon inclusion, patients were trained to wear the device, instructed to wear it for a minimum of 36 h, and were scheduled to return in one week. The VBM measures the distance at which patients’ visual activities are performed, the level of illumination, and head translational and rotational movements along the three axes. On the follow-up visit, patients completed a questionnaire about their experience in wearing the device. All patients underwent standard diagnostic testing, with their cataract grade determined by the Lens Opacities Classification System (LOCS) classification. Results indicate that 87% of patients felt comfortable using the wearable device while 8% of patients responded as not feeling comfortable (5% of patients did not respond to the question). In addition, 91% of patients found it easy to attach the wearable to the magnetic clip while 4% of patients did not find it easy, and 5% of patients did not respond. Overall, patients found the device easy to use, with most reporting that the device was not intrusive.

Probing cellular population diversity at single-cell resolution became possible only in recent years. The popularity of single-cell ‘omic’ approaches, which allow researchers to dissect sample heterogeneity and cell-to-cell variation, continues to grow. With continuous technological improvements, single-cell omics are becoming increasingly prevalent and contribute to the discovery of new and rare cell types, and to the deciphering of disease pathogenesis and outcome. Animal models of human diseases have significantly facilitated our understanding of the mechanisms driving pathologies and resulted in the development of more efficient therapies. The application of single-cell omics to animal models improves the precision of the obtained insights, and brings single-cell technology closer to the clinical field. This Review focuses on the use of single-cell omics in cellular and animal models of diseases, as well as in samples from human patients. It also highlights the potential of these approaches to further improve the diagnosis and treatment of various pathologies, and includes a discussion of the advantages and remaining challenges in implementing these technologies into clinical practice.