Search

Objective To evaluate the impact of a compulsory pop-up form on the ordering pattern of proBNP blood tests by general practitioners in the Capital Region of Denmark.Design A follow-up study comparing the average number of proBNP tests ordered before and after the implementation of an intervention.Setting and subjects From 2016 to 2021, the average number of proBNP tests increased by over 300%. In March 2022, a compulsory pop-up form was introduced in the electronic request system (WebReq), requiring general practitioners to select one of three indications for ordering proBNP, as recommended by the Danish Society of Cardiology. The study included 528 general practitioners in the Capital Region of Denmark, with data available from January 2020 to 2023, encompassing 83,576 proBNP results from 56,645 patients.Main outcome measure The average number of proBNP tests ordered per month and the median level of proBNP before and after the intervention.Results Following the intervention, the average number of proBNP tests per month decreased by 60% over a 22-month follow-up period. The highest reduction was seen among general practitioners who previously ordered the most tests (≥3 per 1000 biochemical tests). In this group, the median proBNP level increased from 12.1 pmol/L before the intervention to 13.5 pmol/L after the intervention (p

Enhanced Academic Support (EAS) is an intervention designed to improve academic achievement among children who receive support from the child welfare services (CWSs) in the home. We investigated the effects of EAS in a randomized controlled trial in Norway. In total, 82 families who received support from the CWS were included in the study (37 in the intervention group, 45 in the comparison group). Both groups were invited to a pretest, posttest, and follow-up measure of the children's math and reading skills, their teachers' evaluation of their academic competence, and of parental involvement in children's education. CWS workers, parents, and children reported the dosage of academic support received. In the intervention group, 48% of families received the threshold dosage of EAS needed for the intervention to be considered as delivered. There were no statistically significant differences between the intervention and comparison group on the children's math and reading skills, or their teachers' evaluation of the children's academic competence. Given the variation in intervention delivery and the limited statistical power, limited conclusions about the effect of EAS can be made. Important lessons from implementation in CWS and on conducting a pragmatic randomized trial are discussed.

We propose that common elements approaches can advance implementation research and practice and facilitate pragmatic use of intervention and implementation evidence. Common elements are practices or processes frequently shared by interventions or implementations. Traditional common elements methodologies use synthesis, distillation, and statistics to describe and evaluate the merit of common ingredients in effective interventions. Recent developments include identifying and testing common configurations of elements, processes, and context variables across the literature of effective interventions and implementations. While common elements thinking has grown popular in intervention science, it has rarely been utilized in implementation science, and specifically, combined with the intervention literature. The goals of this conceptual methodology paper are to (1) provide an overview of the common elements concept and how it may advance implementation research and usability for practice, (2) give a step-by-step guide to systematic common elements reviews that synthesizes and distills the intervention and implementation literature together, and (3) offer recommendations for advancing element-level evidence in implementation science. A narrative review of the common elements literature was conducted with attention to applications to implementation research. A six-step guide to using an advanced common elements methodology was provided. Examples of potential results are presented, along with a review of the implications for implementation research and practice. Finally, we reviewed methodological limitations in current common elements approaches, and identified steps towards realizing their potential. Common elements methodologies can (a) synthesize and distill the implementation science literature into practical applications, (b) generate evidence-informed hypotheses about key elements and determinants in implementation and intervention processes and mechanisms, and (c) promote evidence-informed precision tailoring of intervention and implementation to context. To realize this potential, common elements approaches need improved reporting of details from both successful and unsuccessful intervention and implementation research, more data availability, and more testing and investigation of causal processes and mechanisms of change from diverse theories.Supplementary informationThe online version contains supplementary material available at 10.1007/s43477-023-00077-4.

In this work, the methodology for the optimal design, operation and scale-up of reactive extrusion processes in twin-screw extruders previously presented in Reference (Cegla and Engell, 2023). is applied to the production of hydrophobically ethoxylated urethanes (HEURs). The new process is a promising alternative to the current batch technology in large reactors with long residence times. We demonstrate the use of model-based design and scale-up for this case. A novel mechanistic finite volume twin-screw extruder model is used as the process model, which is adapted to the process at hand by embedding a detailed description of the HEUR chemistry and rheology. An economic cost function is used to examine the scale-up process from an 18 mm extruder to a 27 and 75 mm extruders, considering a selected range of products. The comparison between the optimization results obtained for the individual products with the optimization results for the production of multiple material grades using the same screw setup shows the high flexibility of the extruder- based process. Significant energy savings compared with the conventional batch process can be achieved using reactive extrusion. To quantify the effort for the transition to a purely continuous production in terms of flexibility and process logistics, product changeovers are investigated. Highlights * Intensification of the HEUR production by reactive extrusion. * Detailed model for the twin-screw extruder and the chemistry. * Optimization of extruder, screw design, and operating conditions. * Model-based scale-up from laboratory to industrial scale. * Investigation of flexible industrial production of different HEURs. KEYWORDS extrusion, modeling, polyurethanes, reactive extrusion, simulations, 1 | INTRODUCTION Worldwide, 43 million tons of paints and coatings were produced in 2021. (1) In case of the waterborne systems, the desired spreading performance during application is adjusted [...]

In this work, a methodology for the optimal design and operation of reactive extrusion processes in twin-screw extruders is presented. As a process model, a very accurate mechanistic finite volume twin-screw extruder model is used which is adapted to the reactive extrusion case. In the model, in contrast to other models, the pressure is described as a differential state in order to have a consistent set of equations. The model is compared to other models and advantages and disadvantages with respect to accuracy and computation time are discussed. For optimization, a memetic optimization algorithm (MA) that consists of a combination of a local optimization for the continuous operating parameters and an evolutionary algorithm (EA) for the global optimization of the discrete decision variables is employed to overcome the drawback of the longer model simulation time compared to simpler models. A reduction of optimization time by 90% for the MA compared to the EA was observed. The presented modeling and optimization methodology is validated on the widely investigated reactive extrusion process for [epsilon]-Caprolactone. The methodology is very flexible and the underlying model has good prediction characteristics, thus it is applicable to a wide range of reactive extrusion processes of industrial interest. Highlights * Simulation and optimization of reactive extrusion. * Improved mechanistic twin-screw extruder model. * Novel approaches for pressure and residence time modeling. * Efficient combination of local and global optimization in a memetic algorithm. * Benchmarking of the optimization results and performance with literature data. KEYWORDS extrusion, memetic algorithm, modeling, reactive extrusion, simulations, 1 | INTRODUCTION Reactive extrusion in twin-screw extruders combines the advantages of a multifunctional, continuous reactor with the excellent mixing performance and the flexibility of extruders. Although many products have [...]

Abstract Background Healthcare providers may experience moral distress when they are unable to take the ethically or morally appropriate action due to real or perceived constraints in delivering care, and this psychological stressor can negatively impact their mental health, leading to burnout and compassion fatigue. This study describes healthcare providers experiences of moral distress working in long-term care settings during the COVID-19 pandemic and measures self-reported levels of moral distress pre- and post-implementation of the Dementia Isolation Toolkit (DIT), a person-centred care intervention designed for use by healthcare providers to alleviate moral distress. Methods Subjective levels of moral distress amongst providers (e.g., managerial, administrative, and front-line employees) working in three long-term care homes was measured pre- and post-implementation of the DIT using the Moral Distress in Dementia Care Survey and semi-structured interviews. Interviews explored participants’ experiences of moral distress in the workplace and the perceived impact of the intervention on moral distress. Results A total of 23 providers between the three long-term care homes participated. Following implementation of the DIT, subjective levels of moral distress measured by the survey did not change. When interviewed, participants reported frequent experiences of moral distress from implementing public health directives, staff shortages, and professional burnout that remained unchanged following implementation. However, in the post-implementation interviews, participants who used the DIT reported improved self-awareness of moral distress and reductions in the experience of moral distress. Participants related this to feeling that the quality of resident care was improved by integrating principals of person-centered care and information gathered from the DIT. Conclusions This study highlights the prevalence and exacerbation of moral distress amongst providers during the pandemic and the myriad of systemic factors that contribute to experiences of moral distress in long-term care settings. We report divergent findings with no quantitative improvement in moral distress post-intervention, but evidence from interviews that the DIT may ease some sources of moral distress and improve the perceived quality of care delivered. This study demonstrates that an intervention to support person-centred isolation care in this setting had limited impact on overall moral distress during the COVID-19 pandemic.

Purpose: Adolescence is a sensitive period for developing mental health problems. Interventions targeting emotion regulation have shown promising transdiagnostic effects for this group, but optimization efforts are called for. In the current study, we used an element-based approach to identify potentially active ingredients in interventions measuring emotion regulation, to guide further optimization. Methods: We coded practice elements in 30 studies based on a systematic review of mental health interventions measuring emotion regulation in adolescents (N = 2,389 participants, mean age 13-17 years). Using a three-level modeling approach, we then investigated the difference in effect on emotion regulation between studies of interventions with and without these practice elements. Results: We identified 75 practice elements and 15 element categories used in the included interventions. Results showed significantly stronger effects on emotion regulation when interventions included the practice elements Setting goals for treatment (difference in d = 0.40, 95% CI [0.09, 0.70], p = 0.012) and Psychoeducation about acceptance (difference in d = 0.58, 95% CI [0.09, 1.07], p = 0.021). Furthermore, a total of 11 elements and four overall categories were identified as potentially active ingredients, based on an effect size difference of > 0.20 between interventions with and without the elements. Conclusion: The results can direct experimental research into the selection of practices that are most likely key to mechanisms of change in interventions addressing emotion regulation for adolescents. The challenge of measuring emotion regulation is discussed.

Una de las estrategias de extensión e investigación es fortalecer las alianzas de gobiernos municipales, sociedad y academia. Esta investigación se realizó en la comunidad El Quinal, municipio de Santa Teresa-Carazo, Nicaragua. El objetivo fue realizar un análisis agro socioeconómico y técnico con el enfoque de sistema en diez fincas (sistema de producción). El diseño metodológico se realizó en cuatro fases, siendo la fase I la organización y revisión de fuentes bibliográficas, la fase II referida a la recolección de datos a través de entrevistas a productores en las fincas, la fase III orientada al análisis y procesamiento de datos y la fase IV corresponde a la presentación de informe final a los productores y autoridades locales. Estudio basado en un sistema local participativo no experimental. El universo muestral fue de 60 fincas, el tipo de muestra es no probabilística y por conveniencia, ya que se seleccionaron 10 fincas de acuerdo con las necesidades de investigación; las variables de estudio fueron socio económicas y técnico productivas; sus indicadores medidos son, escolaridad alcanzada, unidad de trabajo humano, mano de obra, gastos familiares, umbral de reproducción simple, rendimiento físico de la tierra, productividad del trabajo y balance de caja. Los resultado expresan qué el 45 % no logran terminar sus estudios de primaria, el promedio de la unidad de trabajo humano es de 3.27 días hombres, que hay un 50 % de mano de obra familiar aprovechada en las fincas, el principal gasto de la familia es la alimentación, el 70 % de las familias se encuentran en condiciones de subsistencia según indicador del umbral de reproducción simple, los principales cultivos es maíz, fríjol y sorgo y la mayoría no logran equiparar los rendimientos a nivel nacional, la productividad del trabajo logra superar el valor de pago de un día hombre y referente al balance económico siete de las 10 fincas tienen saldos negativos al final del año. En conclusión, solo el 30 % de las familias por finca logran satisfacer sus necesidades básicas y pueden reponer los medios de producción para el ciclo siguiente.

Abstract Background Norwegian school health services received a national best-practice guideline in 2017. To promote healthy life skills and identify adolescents needing support, the guideline includes strong recommendations for individual consultations with all 8th graders and increased collaboration with schools. To help implement the recommendations, a blended implementation strategy (SchoolHealth) was co-created with school nurses, students, and stakeholders. SchoolHealth consists of three implementation elements: Digital dialog and administration tool (audit and feedback +), Dialog support (external consultation), and Collaboration materials (targeted dissemination). This hybrid study will test the main and combined effects of the elements on guideline fidelity and effectiveness. Methods The GuideMe study is a factorial cluster randomized controlled trial examining SchoolHealth's effectiveness on guideline fidelity and guideline effectiveness goals. Forty Norwegian secondary schools will be randomized to eight different combinations of the elements in SchoolHealth. Participants will include school nurses and school personnel from these schools, and 8th grade students (n = 1200). Primary outcomes are school nurses' fidelity to the guidelines and student's ability to cope with their life (i.e., health literacy, positive health behaviors and self-efficacy). Quantitative methods will be used to test effects and mechanisms, while mixed- and qualitative methods will be used to explore mechanisms, experiences, and other phenomena in depth. Participants will complete digital questionnaires at the start and end of the schoolyear, and after the consultation during the schoolyear. The study will run in two waves, each lasting for one school year. The multifactorial design allows testing of interactions and main effects due to equal distribution of all factors within each main effect. Sustainment and scale-up of optimized SchoolHealth elements using national infrastructure are simultaneously prepared. Discussion The study will investigate possible effects of the implementation elements in isolation and in combination, and hypothesized implementation mechanisms. In-depth study of user experiences will inform improvements to elements in SchoolHealth. The results will yield causal knowledge about implementation strategies and the mechanisms through which they assert effects. Mixed-methods will provide insights into how and when the elements work. Optimizing guideline implementation elements can support adolescents in a crucial life phase. Trail registration ISRCTN24173836. Registration date 8 August 2022.

The article starts from Gilles Deleuze’s assumption of film being a philosophy in its own right and applies it to the horror genre. It reads Stanley Cavell’s concept of genre, Timothy Jay Walker’s work on the Horror of the Other (1) and Eugene Thacker’s understanding of philosophical horror (2). It researches horror film as philosophically relevant access to nothingness (3) and shifts to the operations of assigning places to nothingness according to its respective place of access (off screen, on screen, behind the screen/behind the camera) (4). It then gives short analyses of Midsommar (5), Hereditary (6), Tarantula (7), and The Conjuring (8). In Tarantula, the screen functions as a shield against the agent of nothingness residing behind it. Once surmounted from behind by nothingness, the screen is finally purged. In Hereditary and Midsommar, nothingness is always already here, in full light, constantly transforming everything into nothing. In The Conjuring, the morphings and vectorial movements have nothingness evaporate from the screen to what lies behind it, namely (digital) picture technology. The screen turns into a membrane between nothingness and its condition, technology. As a consequence, we have to switch from philosophical horror to technological horror as access to nothingness (9).

Abstract In horses, hip hike asymmetry, i.e. left–right difference in hip upwards movement during hind limb protraction in trot, is a crucial lameness sign. Vertical hip movements are complex, influenced by both pelvic roll and pelvic vertical motion. Veterinarians find it challenging to identify low-grade lameness, and knowledge of normal variation is a prerequisite for discerning abnormalities. This study, which included 100 clinically sound Warmblood horses, aimed to describe normal variation in pelvic roll stride patterns. Data were collected during straight-line trot in hand using optical motion capture. Stride-segmented pelvic roll data, normalised with respect to time (0–100% of the stride) and amplitude (± 0.5 of horse average stride range of motion), were modelled as a linear combination of sine and cosine curves. A sine curve with one period per stride and a cosine curve with three periods per stride explained the largest proportions of roll motion: model estimate 0.335 (p

The purpose of the current study was to extend the findings on the use of the go/no-go successive matching-to-sample (S-MTS) procedure to establish auditory equivalence classes. Eight college students learned to conditionally relate nonverbal auditory stimuli into three, 3-member classes. Following training, all participants met the emergence criterion for symmetry, and six out of eight participants met the emergence criterion for transitivity/equivalence. Furthermore, all participants responded with either an experimenter-defined or a unique tact, and five participants related these names intraverbally. Although these results replicate previous findings, albeit with stimuli that cannot be echoed, possible verbal mediation via tact and intraverbal behavior seems to have occurred.

Abstract Background Identification of pleural effusion (PE) in dengue infection is an objective measure of plasma leakage and may predict disease progression. However, no studies have systematically assessed the frequency of PE in patients with dengue, and whether this differs across age and imaging modality. Methods We searched Pubmed, Embase Web of Science and Lilacs (period 1900–2021) for studies reporting on PE in dengue patients (hospitalized and outpatient). We defined PE as fluid in the thoracic cavity detected by any imaging test. The study was registered in PROSPERO (CRD42021228862). Complicated dengue was defined as hemorrhagic fever, dengue shock syndrome or severe dengue. Results The search identified 2,157 studies of which 85 studies were eligible for inclusion. The studies (n = 31 children, n = 10 adults, n = 44 mixed age) involved 12,800 patients (30% complicated dengue). The overall frequency of PE was 33% [95%CI: 29 to 37%] and the rate of PE increased significantly with disease severity (P = 0.001) such that in complicated vs. uncomplicated dengue the frequencies were 48% and 17% (P

Abstract The end of each chromosome consists of a DNA region termed the telomeres. The telomeres serve as a protective shield against degradation of the coding DNA sequence, as the DNA strand inevitably ‒ with each cell division ‒ is shortened. Inherited genetic variants cause telomere biology disorders when located in genes (e.g. DKC1, RTEL1, TERC, TERT) playing a role in the function and maintenance of the telomeres. Subsequently patients with telomere biology disorders associated with both too short or too long telomeres have been recognized. Patients with telomere biology disorders associated with short telomeres are at increased risk of dyskeratosis congenita (nail dystrophy, oral leukoplakia, and hyper- or hypo-pigmentation of the skin), pulmonary fibrosis, hematologic disease (ranging from cytopenia to leukemia) and in rare cases very severe multiorgan manifestations and early death. Patients with telomere biology disorders associated with too long telomeres have in recent years been found to confer an increased risk of melanoma and chronic lymphocytic leukemia. Despite this, many patients have an apparently isolated manifestation rendering telomere biology disorders most likely underdiagnosed. The complexity of telomere biology disorders and many causative genes makes it difficult to design a surveillance program which will ensure identification of early onset disease manifestation without overtreatment.

For reducing the carbon footprint of products containing polymers, recycling and upcycling of waste can make important contributions. While for certain polymers, especially for thermoplastics, melting and re-forming is attractive, although it leads to a degradation of the material properties, for others, and also after a certain degree of degradation in general, chemical processing is the most attractive option for recycling (also called upcycling). This means that from the end-of-life or production waste, valuable molecules are produced that can be fed again into the production of high-value polymers, leading to circular value chains. Such value chains can replace or reduce the use of fossil-based raw materials in polymer production, but actually realizing such value chains is a complex task. It requires setting up systemic solutions, from the collection of end-of-life or production waste over dismantling, sorting, pre-conditioning to chemical processing and downstream separation. The resulting systemic solution must be viable from an economic and from an ecologic point of view. Therefore, such systems must be analyzed and optimized from a system-wide perspective. In this work, we present a framework to model, simulate, analyze and optimize circular supply chains, and we demonstrate the potential of our framework with a case study of a value chain for the upcycling of rigid polyurethane foam waste in Germany.