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Abstract Background When clinically effective, cost-effective health interventions are not fully implemented in clinical practice, population health suffers. Economic factors are among the most commonly cited reasons for suboptimal implementation. Despite this, implementation and economic evaluation are not routinely performed in conjunction with one another. This review sought to identify and describe what methods are available for researchers to incorporate implementation within economic evaluation, how these methods differ, when they should be used, and where gaps remain. Methods We conducted a scoping review using systematic methods. A pearl-growing approach was used to identify studies. References and citations were identified using Web of Science and Scopus. We included for review any study that contained terms relating to economic evaluation and a series of implementation-related terms in the title or abstract. The search was conducted and validated using two independent researchers. Results Our review identified 42 unique studies that included a methodology for combining implementation and economic evaluation. The methods identified could be categorized into four broad themes: (i) policy cost–effectiveness approach (11 studies), (ii) value of information and value of implementation approach (16 studies), (iii) mixed methods approach (6 studies), and (iv) costing approach (9 studies). We identified a trend over time from methods that adopted the policy cost–effectiveness approach to methods that considered the trade-off between the value of information and value of implementation. More recently, mixed methods approaches to incorporate economic evaluation and implementation have been developed, alongside methods to define, measure and cost individual components of the implementation process for use in economic evaluation. Conclusion Our review identified a range of methods currently available for researchers considering implementation alongside economic evaluation. There is no single method or tool that can incorporate all the relevant issues to fully incorporate implementation within an economic evaluation. Instead, there are a suite of tools available, each of which can be used to answer a specific question relating to implementation. Researchers, reimbursement agencies and national and local decision-makers need to consider how best to utilize these tools to improve implementation.

Despite growing interest in environmental DNA (eDNA) monitoring as a low-cost, non-invasive tool for monitoring fish presence and relative abundance, quantitative comparisons between fish abundance and eDNA are still rare, especially for anadromous species of conservation concern. To examine the relationship between eDNA data and management-relevant abundance data, we assessed eDNA abundance of river herring, an ecologically relevant anadromous sister-species pair, alongside sonar-generated fish counts at a well-characterized site in the Choptank River, Chesapeake Bay, MD. Over the 2021 spawning season, there was a strong correlation between daily eDNA concentration and daily counts of fish swimming upstream (Spearman’s rho = 0.86). A generalized additive model for location scale and shape (GAMLSS) was used to estimate fish count as a function of flow-corrected eDNA concentration and relevant covariates. Model- and sonar-generated run counts were 729,385 and 733,208 fish respectively, differing by just 0.5 %. A sub-sampling analysis showed that a model built on at least five weeks of data could utilize eDNA abundance to produce accurate estimates for the remainder of the season, while a reduction in eDNA sampling frequency substantially reduced run count accuracy. This work emphasizes the utility of quantitative eDNA monitoring for river herring populations and shows the necessity of high-frequency eDNA sampling to estimate run count.

Background: Via ferrata (VF) climbing is an increasingly popular mountain activity in the European Alps. The purpose of this study was to determine the nature of injuries incurred by VF climbers and to understand the extent of their First Aid (FA) knowledge and training. Materials and methods: A questionnaire-based cohort study was performed at two alpine locations. Data included basic data (age, gender, climbing activities, exercise), 18 multiple choice questions with 5 answers each concerning First Aid (FA) knowledge and a self-rating of FA knowledge. Statistics were performed with non-parametric tests. Results: 391 questionnaires were completed. Sunburns (23.9%), contusions (17.7%), open wounds (13.1%), and exhaustion-related injuries were the most reported incidents. Exhaustion was the most common emergency call. Only 52% of climbers wore helmets and gloves, less than 25% had adequate physical conditioning, and 28.1% reported having no FA training. The most common causes of emergencies were weather conditions (19%), stumbles (18.6%), falls (13.4%), and fatigue and deficiency in concentration (13.4%). Only 11 of the surveyed climbers scored 75% on their FA knowledge questions. VF climbers showed significant less FA knowledge than alpine mountaineers. They scored quite high on questions related to general FA but low on questions related to high altitude sickness, back, and thoracic injuries. Conclusions: VF climbers should seek out FA training every two years with an emphasis placed on sunburns, contusions, open wounds, and exhaustion injuries. The training should also emphasize the prevention of back and thoracic trauma and developing rescue strategies.

Abstract We evaluate the shared genetic regulation of mRNA molecules, proteins and metabolites derived from whole blood from 3029 human donors. We find abundant allelic heterogeneity, where multiple variants regulate a particular molecular phenotype, and pleiotropy, where a single variant associates with multiple molecular phenotypes over multiple genomic regions. The highest proportion of share genetic regulation is detected between gene expression and proteins (66.6%), with a further median shared genetic associations across 49 different tissues of 78.3% and 62.4% between plasma proteins and gene expression. We represent the genetic and molecular associations in networks including 2828 known GWAS variants, showing that GWAS variants are more often connected to gene expression in trans than other molecular phenotypes in the network. Our work provides a roadmap to understanding molecular networks and deriving the underlying mechanism of action of GWAS variants using different molecular phenotypes in an accessible tissue.

Objectives: A quality improvement initiative was introduced to the adult congenital cardiac surgery program at Toronto General Hospital in January 2016. A dedicated Adult Congenital Anesthesia and intensive care unit team was introduced within the cardiac group. The use of factor concentrates was introduced. The study compares perioperative mortality, adverse events, and transfusion burden before and after this process change. Methods: We performed a retrospective analysis of all adult congenital cardiac surgeries from January 2004 to July 2019. Two groups were analyzed: patients undergoing operation before and after 2016. The primary outcome was in-hospital mortality. One-year mortality and prevalence of key morbidities were analyzed as secondary outcomes. A separate analysis looked at patients who had and had not attended an anesthesia-led preassessment clinic. Results: In-hospital mortality was significantly reduced in patients undergoing operation after 2016 (1.1% vs 4.3%, P = .003) despite a higher risk profile. One-year mortality (1.3% vs 5.8%, P = .003) and ventilation times (5.5 hours [3.4-13.0] vs 6.3 hours [4.2-16.2], P = .001) were also reduced. The incidence of stroke and renal failure was similar between groups. Blood product exposure was comparable, but the incidence of chest reopening decreased (1.8% vs 4.8%, P = .022), despite more patients with multiple previous chest wall incisions, on anticoagulation, and with more complex cardiac anatomy. There were no significant outcome differences between those who did or did not attend the preassessment clinic. Conclusions: Both in-hospital and 1-year mortality were significantly reduced after the introduction of a quality improvement program, despite a higher risk profile. Blood product exposure remained unchanged, but there were less chest reopenings.

Antarctica is one of the last great wilderness areas on Earth. Early Antarctic expeditions during the Heroic Age of Antarctic discovery (1895–1922) returned reports of frostbite, scurvy, snow blindness, and death. Today, over 50,000 people travel to the Antarctic each year via research expeditions, commercial cruise ships (tourism), and research cruises. This study reviewed the existing research reporting the health challenges encountered during modern day travel to Antarctica. The results identified a transition from the Heroic Age when death was common to a contemporary time when death is an uncommon event. The review identified musculoskeletal and soft tissue injuries resulting from moving equipment and supplies to be the most common health challenge encountered by long-term land expeditions. Digestive issues such as constipation and dyspepsia were also common in during the coldest months. For tourist oriented commercial cruise ships, motion sickness resulting from rough seas was most prominent. Specifically, the small nature of the cruise ships made them prone to rough seas in Drakes Passage. During scientific cruises where research is primarily conducted aboard the ship, dermatological conditions (viral, fungal, bacterial) such as dry skin, dry lips, eczema are the most common health challenge. Musculoskeletal and soft tissue injuries are also common given the physical challenge associated with strenuous research.

We investigated the contribution of morphological awareness to university students' reading comprehension ability. Although there is considerable evidence that morphological awareness contributes to children's reading ability, there is much less evidence concerning adults; the few studies of adults have not controlled other known predictors of reading comprehension. Furthermore, there is little information about the predictors of morphological awareness. Measures related to word reading (phonological decoding, orthographic processing), language comprehension (vocabulary, inferences, working memory), morphological awareness, and reading (reading speed and reading comprehension) were administered to 71 undergraduate students. Hierarchical regression analyses indicated that (a) morphological awareness was predicted by orthographic processing and the three language comprehension measures, (b) morphological awareness was a significant predictor of both reading speed and reading comprehension, after controlling all of the other predictors, and (c) morphological awareness continued to predict reading comprehension after also controlling text reading speed. These results demonstrate that morphological awareness is still an important individual difference factor for proficient adult readers. We discuss the implications of these results for assessment and university instruction.

Background: Water quality for tourists visiting South Luangwa National Park and other less developed regions is of the utmost importance in order to avoid gastrointestinal infections; one of the most common diseases among tourists. It is also important to the health of the local tourist accommodations and the local tourist economy. Methods: Water quality samples assessing microbiological contamination were taken from the borehole and point of use in 14 tourist lodges and camps. Turbidity was assessed optically with a DelAlgua turbidity tube. For microbiological analysis, samples were incubated in the DelAgua Dual Incubator at 37°C and 44°C. Thermotolerant Escherichia coli (E. coli) was used as the indicator bacterium for fecal pollution. Water samples were classified based of risk levels for pollution determined by the World Health Organization (WHO). Results: Fifty percent of borehole samples showed no contamination. Two were found to be at high risk and the others ranged between low and intermediate risk. At the point of use, 80% of the samples were clean and compliant with WHO guidelines. Water contamination generally improved from the borehole to point of use. Turbidity at borehole samples were clear in 75% of possible samples. At the point of use, turbidity was clear in 81% of samples. Conclusion: This study establishes the first baseline water quality data for tourist facilities at South Luangwa National Park in Zambia. While water quality at most sites is clean for human use, a regular monitoring system accompanied by maintenance is recommended.

Abstract A central event in the pathogenesis of motor neuron disease (MND) is the loss of neuromuscular junctions (NMJs), yet the mechanisms that lead to this event in MND remain to be fully elucidated. Maintenance of the NMJ relies upon neural agrin (n-agrin) which, when released from the nerve terminal, activates the postsynaptic Muscle Specific Kinase (MuSK) signaling complex to stabilize clusters of acetylcholine receptors. Here, we report that muscle from MND patients has an increased proportion of slow fibers and muscle fibers with smaller diameter. Muscle cells cultured from MND biopsies failed to form large clusters of acetylcholine receptors in response to either non-MND human motor axons or n-agrin. Furthermore, levels of expression of MuSK, and MuSK-complex components: LRP4, Caveolin-3, and Dok7 differed between muscle cells cultured from MND patients compared to those from non-MND controls. To our knowledge, this is the first time a fault in the n-agrin-LRP4-MuSK signaling pathway has been identified in muscle from MND patients. Our results highlight the n-agrin-LRP4-MuSK signaling pathway as a potential therapeutic target to prolong muscle function in MND.

Background: Premature loss of primary teeth (PLPT) can be a rare presentation of systemic medical conditions. Premature loss of primary teeth may present a diagnostic dilemma to paediatric dentists. Aims: To identify systemic conditions associated with PLPT and develop a clinical aid. Design: OVID Medline, Embase and Web of Science were searched up to March 2023. Citation searching of review publications occurred. Exclusion occurred for conference abstracts, absence of PLPT and absence of English‐language full text. Results: Seven hundred and ninety‐one publications were identified via databases and 476 by citation searching of review articles. Removal of 390 duplicates occurred. Following the exclusion of 466 records on abstract review, 411 publications were sought for retrieval, of which 142 met inclusion criteria. Thirty‐one systemic conditions were identified. For 19 conditions, only one publication was identified. The majority of publications, 91% (n = 129), were case reports or series. Most publications, 44% (n = 62), were related to hypophosphatasia, and 25% (n = 35) were related to Papillon–Lefèvre. Diagnostic features were synthesised, and a clinical aid was produced by an iterative consensus approach. Conclusions: A diverse range of systemic diseases are associated with PLPT. Evidence quality, however, is low, with most diseases having a low number of supporting cases. This clinical aid supports paediatric dentists in differential diagnosis and onward referral. [ABSTRACT FROM AUTHOR]

Introduction: Childhood cancers as a group affect around 1 in 500 children but each individual diagnosis is a rare disease. While research largely focuses on improving cure rates, the management of side effects of treatment are high priority for clinicians, families and children and young people. Areas covered: The prevention and efficient management of infectious complications, oral mucositis, nausea and vomiting and graft-vs-host disease illustrated with examples of implementation research, translation of engineering to care, advances in statistical methodologies, and traditional bench-to-patient development. The reviews draw from existing systematic reviews and well conducted clinical practice guidelines. Expert opinion: The four areas are driven from patient and family priorities. Some of the problems outlined are ready for proven interventions, others require us to develop new technologies. Advancement needs us to make the best use of new methods of applied health research and clinical trial methodologies. Some of the greatest challenges may be those we're not fully aware of, as new therapies move from their use in adult oncological practice into children. This will need us to continue our collaborative, multi-professional, multi-disciplinary and eclectic approach. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Involvement of children and young people in research has a multitude of benefits for children, researchers and the quality of the research itself. Despite the benefits of involvement, this is not always completed or reported in practice. METHODS: This paper looks at the involvement of children and young people during a research study exploring the acceptability of photobiomodulation for mucositis management. It considers the importance of costing involvement into grant funding, and the value of charitable partnerships in conducting research with patient and public involvement. RESULTS: Children and young people with experience of cancer, and their parents, were involved at the stages of grant application, research design, data analysis and dissemination. Involvement of families resulted in changes to inclusion criteria, plain language summaries and participant information documents. They provided insight into data analysis, and designed and filmed co-created video outputs to support acceptability of the treatment, dissemination of the research and research involvement of other children. Involvement was supported both practically and financially by charitable partnership with the Candlelighters children's cancer charity as well as research grant funding from the Royal College of Surgeons of England's Faculty of Dental Surgery. CONCLUSIONS: Child and parent contributors shaped the research project, resulting in changes to the study design, data analysis and co-creation of video resources. Charitable partnership and flexibility of involvement supported diversity in the context of paediatric cancer research. Researchers should consider what they can contribute in return to child contributors and charities who provide support. [ABSTRACT FROM AUTHOR]