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Abstract Background The health issues experienced by older people can often be severe and complex, and an increasing number are using residential aged care services to meet their care needs. High-quality nursing care is fundamental to the health and safety of aged care residents and is contingent on nurses’ accurate assessment, informed decision-making, and delivery of timely interventions. However, the role of the aged care nurse is often challenging, impeded by factors such as understaffing, high workloads, and a lack of access to clinical infrastructure and resources. When these challenges mount, residents are put at greater risk of adverse outcomes, such as avoidable clinical deterioration and hospital transfers. This study describes the adaptation and implementation of the emergency nursing framework, HIRAID® (History including Infection risk, Red Flags, Assessment, Interventions, Diagnostics, reassessment, communication and plan)—a tool to assist nurses’ assessment, decision-making and care in residential aged care. Methods The HIRAID® framework will be adapted for residential aged care using a real-time Delphi and panel of aged care and nursing experts. The co-designed HIRAID® Aged Care framework will be trialled in 23 residential aged care homes in Sydney, Australia, in a modified stepped-wedge cluster randomised controlled trial design. All homes will be randomised into one of four clusters. Outcomes of interest include the rate of clinical deterioration events resulting from nurses’ actions, the rate of hospital transfers determined to be inappropriate, performance against the national mandatory aged care quality indicators, resident satisfaction with care, nurse and medical staff satisfaction with communication, and the quality of nursing documentation. These outcomes will be evaluated using a combination of qualitative and quantitative analysis of routinely collected resident data, expert assessments of facility documentation events against validated criteria, and pre- and post-intervention surveys of residents, family carers, nurses, and medical staff. Discussion This protocol describes a pragmatic trial that aims to translate an evidence-based framework from the emergency care context into residential aged care. The adapted HIRAID® Aged Care framework will be the first of its kind to standardise and guide holistic nursing assessment, decision-making, and documentation in residential aged care in Australia. Ethics and dissemination This research has been approved by the Western Sydney Local Health District Human Research Ethics Committee: 2023/ETH00523. A waiver of consent has been approved to access resident health data and nursing documentation at each participating site. Trial registration Australian and New Zealand Clinical Trial Registry, ACTRN12623000481673. Registered 12 May 2023. Protocol version Version 1.0 6 February 2024.

Alopecia is an undesirable side effect of cancer chemotherapy. The mitigation of alopecia is a desirable adjunct treatment for patients with cancer. FDA-cleared scalp cooling (SC) devices have been successfully used to prevent or reduce chemotherapy-induced alopecia (CIA). This paper provides an understanding of the implementation and value of the new Insurance-Based Billing Model used in the USA for SC and its benefits compared with the original self-pay model. This improved compensation change will result in all patients in need, including underserved and disadvantaged populations, receiving equitable healthcare by allowing access to this valuable supportive care technology.

Background Australian immigration policy resulted in large numbers of children being held in locked detention. We examined the physical and mental health of children and families who experienced immigration detention. Methods Retrospective audit of medical records of children exposed to immigration detention attending the Royal Children’s Hospital Immigrant Health Service, Melbourne, Australia, from January 2012 –December 2021. We extracted data on demographics, detention duration and location, symptoms, physical and mental health diagnoses and care provided. Results 277 children had directly (n = 239) or indirectly via parents (n = 38) experienced locked detention, including 79 children in families detained on Nauru or Manus Island. Of 239 detained children, 31 were infants born in locked detention. Median duration of locked detention was 12 months (IQR 5–19 months). Children were detained on Nauru/Manus Island (n = 47/239) for a median of 51 (IQR 29–60) months compared to 7 (IQR 4–16) months for those held in Australia/Australian territories (n = 192/239). Overall, 60% (167/277) of children had a nutritional deficiency, and 75% (207/277) had a concern relating to development, including 10% (27/277) with autism spectrum disorder and 9% (26/277) with intellectual disability. 62% (171/277) children had mental health concerns, including anxiety, depression and behavioural disturbances and 54% (150/277) had parents with mental illness. Children and parents detained on Nauru had a significantly higher prevalence of all mental health concerns compared with those held in Australian detention centres. Conclusion This study provides clinical evidence of adverse impacts of held detention on children’s physical and mental health and wellbeing. Policymakers must recognise the consequences of detention, and avoid detaining children and families.

Abstract Background The home environment is thought to influence children’s weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children’s energy balance behaviours and weight. Methods Families from the Gemini cohort (n = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child’s height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample (n = 20) of caregivers completed the HEI a second time, 7–14 days after the initial interview, to establish test-retest reliability. Results Children (n = 298) living in ‘higher-risk’ home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26–0.61, p

Ghrelin is considered one of the most potent orexigenic peptide hormones and one that promotes homeostatic and hedonic food intake. Research on ghrelin, however, has been conducted predominantly in males and particularly in male rodents. In female mammals the control of energy metabolism is complex and it involves the interaction between ovarian hormones like estrogen and progesterone, and metabolic hormones. In females, the role that ghrelin plays in promoting feeding and how this is impacted by ovarian hormones is not well understood. Basal ghrelin levels are higher in females than in males, and ghrelin sensitivity changes across the estrus cycle. Yet, responses to ghrelin are lower in female and seem dependent on circulating levels of ovarian hormones. In this review we discuss the role that ghrelin plays in regulating homeostatic and hedonic food intake in females, and how the effects of ghrelin interact with those of ovarian hormones to regulate feeding and energy balance.

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Technological advancements and increased access have prompted the adoption of head- mounted display based virtual reality (VR) for neuroscientific research, manual skill training, and neurological rehabilitation. Applications that focus on manual interaction within the virtual environment (VE), especially haptic-free VR, critically depend on virtual hand-object collision detection. Knowledge about how multisensory integration related to hand-object collisions affects perception-action dynamics and reach-to-grasp coordination is needed to enhance the immersiveness of interactive VR. Here, we explored whether and to what extent sensory substitution for haptic feedback of hand-object collision (visual, audio, or audiovisual) and collider size (size of spherical pointers representing the fingertips) influences reach-to-grasp kinematics. In Study 1, visual, auditory, or combined feedback were compared as sensory substitutes to indicate the successful grasp of a virtual object during reach-to-grasp actions. In Study 2, participants reached to grasp virtual objects using spherical colliders of different diameters to test if virtual collider size impacts reach-to-grasp. Our data indicate that collider size but not sensory feedback modality significantly affected the kinematics of grasping. Larger colliders led to a smaller size-normalized peak aperture. We discuss this finding in the context of a possible influence of spherical collider size on the perception of the virtual object’s size and hence effects on motor planning of reach-to-grasp. Critically, reach-to-grasp spatiotemporal coordination patterns were robust to manipulations of sensory feedback modality and spherical collider size, suggesting that the nervous system adjusted the reach (transport) component commensurately to the changes in the grasp (aperture) component. These results have important implications for research, commercial, industrial, and clinical applications of VR.

This article summarizes the findings from a systematic literature review to examine how social media may impact HPV vaccine uptake and HPV and HPV vaccine related awareness, knowledge, and attitudes. Study inclusion criteria was original data collection of at least one data point about social media and HPV and/or HPV vaccination, such that the study provided insight into how social media content may influence HPV and HPV vaccine related knowledge, attitudes, and/or behaviors. A total of 44 relevant articles were identified using the following databases: PubMed, PsycINFO, Communication Source, Sociological Abstracts, Business Source Elite, and the Educational Resources Information Center (ERIC). Most studies analyzed the valence, type, and frequency of social media content about HPV vaccination, and some found associations between potential exposure to negative, anti-vacc`11qine content and lower vaccination rates. Some studies that included primary human subject data collection found that engagement with HPV related social media content was associated with improved awareness and knowledge but not with increased vaccine uptake. The literature overall is lacking in systematic and rigorous research examining the effects of social media on HPV related knowledge, attitudes, and behaviors and needs further examination as social media increasingly becomes a source of health information.

Background: Burn patients are predisposed for nosocomial infections during their stay on a burn intensive care unit. Moreover, several outbreaks affecting burn units for example caused by Methicillin-resistant Staphylococcus aureus (MRSA) have been reported. One attempt to address these challenges is the use of universal decolonization. Methods: In 2015 we implemented universal decolonization for all burn patients using the antiseptic agent octenidine for intact skin and the nasopharyngeal mucosa. We conducted a retrospective analysis to evaluate the effect of the decolonization on primary, central line (central venous catheter)-associated bloodstream infections (CLABSI), the frequency of nosocomial clusters (4 or more cases with epidemiologic link and identical molecular pattern) with multidrug-resistant bacteria (MDRB) and the incidence of MRSA. Results: In the decolonization period a reduction of the incidence of CLABSI, nosocomial MRSA acquisition and the frequency of nosocomial MDRB clusters was observed. The incidence rate of CLABSI decreased from 2/1000 central venous catheter days in the pre-decolonization phase to 0.8/1000 central venous catheter days in the decolonization period, although this was not statistically significant. The implementation was accompanied by several feedback talks and training for the staff. The user experience was positive and no adverse effects occurred. Conclusion: Our results show that universal decolonization in burn patients using octenidine is a promising concept to address hospital acquisition of MRSA; occurrence of CLABSI as well as the spread of MDRB causing clusters. It is of high relevance to further assess the value of this measure in terms of reducing CLABSI in burn patients in larger study groups. Therefore further studies including more burn patients guaranteeing adequate sample size are needed. Keywords: Burn unit, Universal decolonization, Octenidine, Bloodstream infection, Multidrug-resistant bacteria, Nosocomial

The development of the primarily women-of-color-led movement for transformative justice has also shed light on the fact that abolition requires not just the transformation of social relations and place, but the transformations of subjectivity itself. This movement recognizes that violence is not just enacted against oppressed communities but is enacted with them, and hence the line between those who harm and those who face harm is often illusory. The movement for transformative justice—for accountability without disposability—calls on us to create different systems of relationality, which, in turn, transform who we think we are as people. Essentially, we are required to embark on an uncharted journey that will result in the creation of new selves we would not now recognize. Abolition can be seen as a process and a methodology rather than a presumed destination. To identify abolitionist methodologies, it can be helpful to look at unexpected places rather than presume that some spaces and peoples are necessarily more abolitionist than others. Consequently, this essay will look at abolitionism in an unexpected place, Christian evangelicalism.

Introduction: Antibiotic resistance is a serious threat to global public health. It reduces the effectiveness of treatments for serious bacterial infections and thus increases the risk of fatal outcomes. Antibiotic prescriptions are often not in line with clinical evidence-based guidelines. The process of emergence of resistant bacteria can be slowed down by adherence to guidelines. Yet this adherence seems to be lacking in primary health care.Methods and Analysis: This pragmatic quasi-experimental study using a controlled before-after design was carried out in South-East-Lower Saxony in 2018–2020. The voluntary attendance of interactive trainings with condensed presentation of current guidelines for general practitioners (GP) on antibiotic management for urinary and respiratory tract infections is regarded as intervention. Those GP not attending the trainings constitute the control group. Data were collected via questionnaires; routine health records are provided by a statutory health insurance. The primary outcome is the proportion of (guideline-based) prescriptions in relation to the relevant ICD-10 codes as well as daily defined doses and the difference in proportion of certain prescriptions according to guidelines before and after the intervention as compared to the control group. Further outcomes are among others the subjectively perceived risk of antibiotic resistance and the attitude toward the guidelines. The questionnaires to assess this are based on theory of planned behavior (TPB) and health action process approach (HAPA). Variations over time and effects caused by measures other than WASA (Wirksamkeit von Antibiotika-Schulungen in der niedergelassenen Aerzteschaft-Effectiveness of antibiotic management training in the primary health care sector) training are taken into account by including the control group and applying interrupted time series analysis.Ethics and Dissemination: The study protocol and the data protection concept respectively were reviewed and approved by the Ethics Committee of the Hannover Medical School and the Federal Commissioner for Data Protection and Freedom of Information.Trial Registration:https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013951, identifier DRKS00013951.

Introduction: Increasingly, the label “data trust” is being applied to repeatable mechanisms or approaches to sharing data in a timely, fair, safe and equitable way. However, there is a gap in terms of practical guidance about how to establish and operate a data trust. Aim and Approach: In December 2019, the Canadian Institute for Health Information and the Vector Institute for Artificial Intelligence convened a working meeting of 19 people representing 15 Canadian organizations/initiatives involved in data sharing, most of which focus on public sector health data. The objective was to identify essential requirements for the establishment and operation of data trusts. Preliminary findings were presented during the meeting then refined as participants and co-authors identified relevant literature and contributed to this manuscript. Results: Twelve (12) minimum specification requirements (“min specs”) for data trusts were identified. The foundational min spec is that data trusts must meet all legal requirements, including legal authority to collect, hold or share data. In addition, there was agreement that data trusts must have (i) an accountable governing body which ensures the data trust advances its stated purpose and is transparent, (ii) comprehensive data management including responsible parties and clear processes for the collection, storage, access, disclosure and use of data, (iii) training and accountability requirements for all data users and (iv) ongoing public and stakeholder engagement. Conclusion / Implications: Based on a review of the literature and advice from participants from 15 Canadian organizations/initiatives, practical guidance in the form of twelve min specs for data trusts were agreed on. Public engagement and continued exchange of insights and experience is recommended on this evolving topic.

Abstract Background Prognosis research is on the rise, its importance recognised because chronic health conditions and diseases are increasingly common and costly. Prognosis systematic reviews are needed to collate and synthesise these research findings, especially to help inform effective clinical decision-making and healthcare policy. A detailed, comprehensive search strategy is central to any systematic review. However, within prognosis research, this is challenging due to poor reporting and inconsistent use of available indexing terms in electronic databases. Whilst many published search filters exist for finding clinical trials, this is not the case for prognosis studies. This systematic review aims to identify and compare existing methodological filters developed and evaluated to identify prognosis studies of any of the three main types: overall prognosis, prognostic factors, and prognostic [risk prediction] models. Methods Primary studies reporting the development and/or evaluation of methodological search filters to retrieve any type of prognosis study will be included in this systematic review. Multiple electronic bibliographic databases will be searched, grey literature will be sought from relevant organisations and websites, experts will be contacted, and citation tracking of key papers and reference list checking of all included papers will be undertaken. Titles will be screened by one person, and abstracts and full articles will be reviewed for inclusion independently by two reviewers. Data extraction and quality assessment will also be undertaken independently by two reviewers with disagreements resolved by discussion or by a third reviewer if necessary. Filters’ characteristics and performance metrics reported in the included studies will be extracted and tabulated. To enable comparisons, filters will be grouped according to database, platform, type of prognosis study, and type of filter for which it was intended. Discussion This systematic review will identify all existing validated prognosis search filters and synthesise evidence about their applicability and performance. These findings will identify if current filters provide a proficient means of searching electronic bibliographic databases or if further prognosis filters are needed and can feasibly be developed for systematic searches of prognosis studies.

Background: The Constitution of South Africa stipulates that all children have the right to basic nutrition; however, a great number of South African children are underweight for age. It is important to address malnutrition as it is associated with more than 50% of all child deaths in developing countries and also increases the risk for infective diseases. Aim: To determine the prevalence of underweight in children aged 5 years and younger attending primary health care clinics in the Mangaung area, Free State, and determine the possible underlying causes thereof. Setting: Six preselected primary health care clinics in the Mangaung area. Methods: This was a cross-sectional study. Demographic and clinical information and anthropometric measurements were collected from the children’s Road-to-Health clinic cards,obtained from the children’s caregivers. Results: In total, 240 children were included, of which 51.7% were girls. The median age was 7.5 months. The weight-for-age graph revealed that 7.7% (95% confidence interval: 4.8%;11.9%) of children were underweight or severely underweight for age. Length-for-age and weight-for-height graphs were mostly incomplete. Underweight children differed from normal weight children regarding birth weight (low birth weight 70.6% vs. 12.4%) and history of malnutrition (60.0% vs. 7.1%). Conclusion: The prevalence of underweight in children aged 0–5 years attending primary health care clinics in Mangaung is 7.7% based on information available from Road-to-Health cards. This figure could be higher if these cards were filled in more accurately. A low birth weight and history of malnutrition are associated with underweight.

Back pain is a major problem requiring pragmatic interventions, low in costs for health care providers and feasible for individuals to perform. Our objective was to test the effectiveness of a low-dose 5-month exercise intervention with small personnel investment on low back strength and self-perceived pain.Two hundred twenty-six employees (age: 42.7±10.2 years) from three mid-size companies were randomized to 5-month non-supervised training at home (3 times/week for 20 minutes) or wait-list-control. Health insurance professionals instructed the participants on trunk exercises at the start and then supervised participants once a month.Muscle strength for back extension increased after the 5-month intervention with a significant between-group difference (mean 27.4 Newton [95%CI 2.2; 60.3]) favoring the exercise group (p = 0.035). Low back pain was reduced more in subjects after exercise than control (mean difference -0.74 cm [95%CI -1.17; -0.27], p = 0.002). No between-group differences were observed for back pain related disability and work ability. After stratified analysis only subjects with preexisting chronic low back pain showed a between-group difference (exercise versus controls) after the intervention in their strength for back extension (mean 55.7 Newton [95%CI 2.8; 108.5], p = 0.039), self-perceived pain (mean -1.42 cm [95%CI -2.32; -0.51], p = 0.003) and work ability (mean 2.1 points [95%CI 0.2; 4.0], p = 0.032). Significant between-group differences were not observed in subjects without low back pain: strength for back extension (mean 23.4 Newton [95%CI -11.2; 58.1], p = 0.184), self-perceived pain (mean -0.48 cm [95%CI -0.99; 0.04], p = 0.067) and work ability (mean -0.1 points [95%CI -0.9; 0.9], p = 0.999). An interaction between low back pain subgroups and the study intervention (exercise versus control) was exclusively observed for the work ability index (p = 0.016).In middle-aged employees a low-dose, non-supervised exercise program implemented over 20 weeks improved trunk muscle strength and low back pain, and in those with preexisting chronic low back pain improved work ability.

Background. Lead exposure within artisanal ceramics workshop communities in Mexico continues to be a major source of childhood lead poisoning. Artisanal ceramics workshops expose children through direct ingestion, contaminated soil, and food prepared in lead-glazed pottery. Conversion to non-lead glazes alone may not effectively reduce exposure. This paper describes a model comprehensive intervention and environmental remediation of an artisanal ceramics workshop in the state of Hidalgo, Mexico. Objectives. The purpose of the project was to evaluate the effectiveness of environmental interventions—including removal of lead-contaminated equipment, soil and pottery—on childhood blood lead levels. Methods. A typical artisanal workshop using lead glaze was identified and assessed for lead contamination. Baseline blood lead levels (BLL) were taken from 5 children inhabiting the workshop prior to remediation. Follow-up paired BLL were taken 3- and 12-months post-remediation and results compared. Results. A mean 54% decrease in BLL within 3 months of remediation and a 57% decrease within 1 year was observed. Conclusions. This project shows the effectiveness of environmental lead remediation at artisanal Mexican ceramics workshops for purposes of sustained BLL reductions. Application of the methods presented in this paper to other ceramics workshops using lead glaze in central Mexico will likely help to further reduce childhood lead poisoning. Competing Interests. The authors declare no competing financial interests.

Background. This paper describes the impact of improper used lead-acid battery (ULAB) handling and disposal. A specific case study is presented describing the field assessment and remediation of lead contamination in a community in Senegal where at least 18 children died from lead poisoning. Objectives. The assessment and remediation process utilized to address the Senegal lead contamination has been used as a model approach to solving used lead-acid battery (ULAB) contamination in other economically depressed communities worldwide. This paper addresses exterior soil remediation with a future paper planned to address interior remediation and blood lead level declines as a marker for project success. Materials & Methods. A comprehensive field program was developed and implemented to delineate the extent of soil lead contamination. The lead-impacted soil was the source of elevated blood lead levels due to direct ingestion (children playing in impacted soil), dust migration and impacted soil tracking into homes, shops and schools. Soil lead concentrations in surface soil and at depth were determined during several site assessments. The soil lead data were collected in conjunction with blood lead testing and collection of dust wipe samples for laboratory analysis. Soil lead data were also collected during and after soil excavation activities to document remediation success. Results. The data showed widespread soil contamination throughout the community. Surface soil exhibited lead concentrations as high as approximately 20% lead (200,000 mg/ kg or parts-per-million as compared to the U.S. standard of 400 mg/kg). Blood lead levels in children were highly elevated and reached as high as 613.9 μg/dL (as compared to the U.S. standard of 10 μg/dL). Bulk dust samples from inside residences were as high as 26,889 mg/kg (2.7% lead). Post-excavation soil testing demonstrated that the majority of impacted soil was removed and the exterior exposure pathway was significantly reduced. Conclusions. Lead contamination in an economically depressed community resulted in the deaths of at least 18 infants. A coalition of local community members, local and federal government agencies, and international non-governmental organizations was able to develop and implement a comprehensive assessment and remediation strategy specifically focused on minimizing future risks to the local population with minimal disruption. The implemented soil removal plan resulted in site remediation without population relocation, spanning just over two years, and being completed under the budget of USD 200,000. Competing Interests. The authors declare no competing financial interests.

Outbreaks of invasive infections caused by group A β-hemolytic streptococcus (GAS) may occur in long-term care settings and are associated with a high case-fatality rate in debilitated adults. Targeted antibiotic treatment only to residents and staff known to be at specific risk of GAS may be an ineffective outbreak control measure. We describe two institutional outbreaks in which mass antibiotic treatment was used as a control measure. In the first instance, mass treatment was used after targeted antibiotic treatment was not successful. In the second instance, mass treatment was used to control a rapidly evolving outbreak with a high case-fatality rate. Although no further clinical cases were seen after the introduction of mass antibiotic treatment, persistence of the outbreak strain was documented in one institution >1 year after cases had ceased. Strain persistence was associated with the presence of a chronically colonized resident and poor infection control practices.

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This qualitative research study is about two women doctoral students who are experiencing ―The Imposter Syndrome‖ (Clance & Imes, 1978), a phenomenon characterized by an inability to internalize academic success. The purpose of this study is to connect the theoretical frameworks around this phenomenon to our experiences as women graduate students in a doctoral program. The research question for this study is: Do our email conversations provide us with clues to explain our imposter feelings? The methodology for this study is autoethnography (Ellis, 1997). Emails collected over an eight month period provide the data for this study. To analyze the data we used thematic analysis. The data reveal three predominant themes; fear, family and fellowship. The findings of this study provoke an extension into the experiences of other doctoral students as they meet the challenges of self concepts in their course of study.

Summer offers the opportunity for sustained community engagement through immersions in summer service-learning programs. A group of 16 colleges and universities that sponsor domestic and international summer service initiatives have formed a Summer Service Collaborative (SSC) to enhance preparation, immersion, and follow-up in light of the unique parameters of summer service-learning. SSC members developed a shared assessment rubric and a pre/post-immersion survey for student participants to evaluate what students learn about poverty, diversity, and civic engagement over the course of summer service-learning experiences. Findings suggest three key areas of student learning and indicate that greater length of engagement coupled with reflection elements create perspective transformation on understanding of social justice for participants.