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Abstract Chronic obstructive pulmonary disease (COPD) is a common, costly, and morbid condition. Pulmonary rehabilitation, close monitoring, and early intervention during acute exacerbations of symptoms represent a comprehensive approach to improve outcomes, but the optimal means of delivering these services is uncertain. Logistical, financial, and social barriers to providing healthcare through face-to-face encounters, paired with recent developments in technology, have stimulated interest in exploring alternative models of care. The Healthy at Home study seeks to determine the feasibility of a multimodal, digitally enhanced intervention provided to participants with COPD longitudinally over 6 months. This paper details the recruitment, methods, and analysis plan for the study, which is recruiting 100 participants in its pilot phase. Participants were provided with several integrated services including a smartwatch to track physiological data, a study app to track symptoms and study instruments, access to a mobile integrated health program for acute clinical needs, and a virtual comprehensive pulmonary support service. Participants shared physiologic, demographic, and symptom reports, electronic health records, and claims data with the study team, facilitating a better understanding of their symptoms and potential care needs longitudinally. The Healthy at Home study seeks to develop a comprehensive digital phenotype of COPD by tracking and responding to multiple indices of disease behavior and facilitating early and nuanced responses to changes in participants’ health status. This study is registered at Clinicaltrials.gov (NCT06000696).

Abstract Background Nutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff’s experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions. Methods Three group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC. Results Three main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN’s implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access. Conclusion The findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization. Trial registration The main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967 . (Registration date: 19-06-2022).

Introduction: Approximately 80 % of children with cancer live in resource-limited settings where prompt access to diagnosis and treatment is challenging. Data regarding delays in diagnosis and treatment and outcomes of children with cancer in Kenya are lacking. This study aims to 1) compare the reported and expected number of children with cancer; 2) explore diagnosis, treatment, and total delays; 3) determine patient characteristics that influence delays; and 4) investigate treatment outcomes. Methods: This study combined a retrospective medical records review with a case report. Data on delays and treatment outcomes of children from Bungoma County (Kenya) who were diagnosed with cancer at a large academic hospital between 2010 and 2016 were collected. Results: Between 2010 and 2016, 92 children, an average of 13 per year, were referred from Bungoma. These 13 children constitute only 9 % of the expected 140 children developing cancer in this region. The most common diagnoses were non-Hodgkin lymphoma (17 %) and acute lymphoblastic leukemia (16 %). The median total delay was 108 (7–1731) days. The median diagnosis delay was 97 days, longer than the median treatment delay (3 days; P

Having breakfast is associated with improved diet quality, cognitive- and academic performance and can therefore positively impact learning and health, although the impact on reading literacy is unknown in the Nordic countries. The aim of this study was to assess the association between having breakfast often versus rarely and reading literacy achievement based on Progress in International Reading Literacy Study (PIRLS) from 2016. The sample consisted of Danish (N = 3508), Finnish (N = 4896), Norwegian (N = 4232) and Swedish (N = 4525) students, 10-11 years old. Students self-reported their frequency of having breakfast. Linear regression analysis (adjusted for socio-economic status and gender) showed that those who often vs. rarely had breakfast achieved a higher reading literacy score. The results suggest that having breakfast may be important for reading literacy achievement even after adjusting for socioeconomic status. This potential relationship between breakfast intake and students' academic achievement should be given priority for further research and practice as breakfast is a modifiable factor that can be both improved and be intervened on.

Surgical resection represents the standard of care for people with newly diagnosed diffuse gliomas, and the neuropathological and molecular profile of the resected tissue guides clinical management and forms the basis for research. The Response Assessment in Neuro-Oncology (RANO) consortium is an international, multidisciplinary effort that aims to standardise research practice in neuro-oncology. These recommendations represent a multidisciplinary consensus from the four RANO groups: RANO resect, RANO recurrent glioblastoma, RANO radiotherapy, and RANO/PET for a standardised workflow to achieve a representative tumour evaluation in a disease characterised by intratumoural heterogeneity, including recommendations on which tumour regions should be surgically sampled, how to define those regions on the basis of preoperative imaging, and the optimal sample volume. Practical recommendations for tissue sampling are given for people with low-grade and high-grade gliomas, as well as for people with newly diagnosed and recurrent disease. Sampling of liquid biopsies is also addressed. A standardised workflow for subsequent handling of the resected tissue is proposed to avoid information loss due to decreasing tissue quality or insufficient clinical information. The recommendations offer a framework for prospective biobanking studies.

Abstract Background Telephone triage is used to optimise patient flow in emergency primary healthcare. Poor communication can lead to misunderstandings and compromise patient safety. To improve quality, a comprehensive understanding of factors affecting communication in medical call centres in primary care is needed. The aim of this review was to identify such factors and to describe how they affect communication during telephone triage. Method A mixed-method systematic review was performed. In April 2021 and June 2023, MEDLINE, Embase, CINAHL, and Web of Science were searched for original studies describing communication during telephone triage in primary care medical call centres handling all types of medical problems from an unselected population. All studies were screened by two authors, blinded to each other’s decisions. Disagreements were resolved by a third author. A framework was created by the thematic synthesis of the qualitative data and later used to synthesise the quantitative data. By using convergent integrated synthesis, the qualitative and quantitative findings were integrated. The Mixed Methods Appraisal Tool was used to assess methodological limitations. Results Out of 5087 studies identified in the search, 62 studies were included, comprising 40 qualitative, 16 quantitative and six mixed-method studies. Thirteen factors were identified and organised into four main themes: organisational factors, factors related to the operator, factors related to the caller and factors in the interaction. Organisational factors included availability, working conditions and decision support systems. Factors related to the operator were knowledge and experience, personal qualities and communication strategies. Factors related to the caller were individual differences and the presented medical problem. Factors in the interaction were faceless communication, connection between operator and caller, third-person caller and communication barriers. The factors seem interrelated, with organisational factors affecting all parts of the conversation, and the operator’s communication in particular. Conclusion Many factors affect the structure, content, and flow of the conversation. The operators influence the communication directly but rely on the organisation to create a working environment that facilitates good communication. The results are mainly supported by qualitative studies and further studies are needed to explore and substantiate the relevance and effect of individual factors. Systematic review registration PROSPERO CRD42022298022.

The French natural philosopher Henri Victor Regnault (1810-1878) was one of many researchers who contributed to the development of the thermometer in the 19th century. In this paper, we use an example from Regnault's work to explore how the history of thermometry can provide a context for teaching upper-secondary chemistry students about the nature of science (NOS), particularly its aims and values. The study takes form as a hermeneutical spiral, wherein literature on the history and philosophy of science, NOS, the family resemblance approach (FRA), NOS teaching, characteristics of narratives, and the new performative paradigm feed into the spiral, along with input from an empirical study. A teaching unit (n = 21, duration = 90 min) was developed and tested on Norwegian students aged 17-18 years, and a thematic analysis of students' statements (n = 13) was carried out. The students identified "being first," "usefulness," "accuracy," and "minimalism" as values and aims that guided Regnault's work. We argue that the use of this particular historical episode framed within FRA (1) invited students to identify with the human actor--Regnault, (2) invited students into the historical context of the development of the thermometer, and (3) demonstrated complexity and provided context to support students' own construction of their understanding of NOS. To summarize, by deriving the term "research with" from the performative paradigm and using the context of the historical episode related to the thermometer within the FRA framework students were invited to research with Henri Regnault.

Our knowledge of viral sequence space has exploded with advancing sequencing technologies and large-scale sampling and analytical efforts. Though archaea are important and abundant prokaryotes in many systems, our knowledge of archaeal viruses outside of extreme environments is limited. This largely stems from the lack of a robust, high-throughput, and systematic way to distinguish between bacterial and archaeal viruses in datasets of curated viruses. Here we upgrade our prior text-based tool (MArVD) via training and testing a random forest machine learning algorithm against a newly curated dataset of archaeal viruses. After optimization, MArVD2 presented a significant improvement over its predecessor in terms of scalability, usability, and flexibility, and will allow user-defined custom training datasets as archaeal virus discovery progresses. Benchmarking showed that a model trained with viral sequences from the hypersaline, marine, and hot spring environments correctly classified 85% of the archaeal viruses with a false detection rate below 2% using a random forest prediction threshold of 80% in a separate benchmarking dataset from the same habitats.

Signs and symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) are present at preschool ages and often not identified for early intervention. We aimed to use machine learning to detect ADHD early among kindergarten-aged children using population-level administrative health data and a childhood developmental vulnerability surveillance tool: Early Development Instrument (EDI). The study cohort consists of 23,494 children born in Alberta, Canada, who attended kindergarten in 2016 without a diagnosis of ADHD. In a four-year follow-up period, 1,680 children were later identified with ADHD using case definition. We trained and tested machine learning models to predict ADHD prospectively. The best-performing model using administrative and EDI data could reliably predict ADHD and achieved an Area Under the Curve (AUC) of 0.811 during cross-validation. Key predictive factors included EDI subdomain scores, sex, and socioeconomic status. Our findings suggest that machine learning algorithms that use population-level surveillance data could be a valuable tool for early identification of ADHD.

Objective This study seeks to outline the features of digital competences among educators in health professions education and pinpoint areas in need of enhancement. Methods The transcribed interviews of nine educators in physiotherapy education were coded to align with The European Framework for the Digital Competence of Educators (DigCompEdu), adhering to a step-by-step procedure. Results In total, 320 significant units were coded to an individual competence. Three competence areas (Professional engagement, Teaching and learning, and Empowering learners accounted for (94.2%) of the codes, while the three remaining (Digital resources, Assessment, and Facilitating learners’ digital competence) for 5.8% of cases. Several individual competences were not identified, across domains and the educators raised skepticism regarding the relevance of digital education for clinical practice. Conclusion The study reveals deficiencies in the digital competence of health professions educators, highlighting gaps in strategies to utilize technology in their work and the integration of technologies with clinical skills. Educators exhibit individual-driven rather than collaborative digital professional development, expressing skepticism about technology’s efficacy in clinical skills training. The results emphasize the urgent need for comprehensive improvement. Without addressing these issues, health education students may graduate without essential digital skills, hindering their contribution to technology development.

Abstract BackgroundMultidose drug dispensing (MDD) is an adherence aid where medicines are machine-dispensed in disposable unit bags, usually for a 14-day period. MDD replaces manually filled dosettes in many home care services in Norway. While evidence suggests that MDD can improve medication adherence and reduce errors, there are few studies on how patients manage MDD at home and how this affects their daily routines. ObjectiveThe aim of the study is to identify factors influencing medication self-management behavior among MDD users living at home and explore how MDD affects medication self-management. MethodsWe conducted semistructured interviews with 19 MDD users in Oslo between August 2019 and February 2020. The interviews were held at the participants’ homes, and the interview transcripts were analyzed thematically. ResultsAll participants in the study received some form of assistance with medication management from home care services. This assistance ranged from MDD delivery every other week to actual assistance with medication administration multiple times daily. However, regardless of the level of assistance received, participants primarily managed their MDD medications themselves. Daily medication routines and knowledge about medicines varied among the participants, with some taking an active role in their medication management, while others relied on others to take responsibility. The degree of involvement seemed determined by motivation rather than capability. ConclusionsMDD can support medication self-management, but its effectiveness varies among patients. The level of medication management by MDD users is not solely determined by their actual capabilities. Factors such as interest in self-care and independence, available support, information, and cognitive capacity all play a role in determining the degree of autonomy.

Summary: Background: The inflammatory response in patients with traumatic brain injury (TBI) offers opportunities for stratification and intervention. Previous unselected approaches to immunomodulation in patients with TBI have not improved patient outcomes. Methods: Serum and plasma samples from two prospective, multi-centre observational studies of patients with TBI were used to discover (Collaborative European NeuroTrauma Effectiveness Research [CENTER-TBI], Europe) and validate (Transforming Research and Clinical Knowledge in Traumatic Brain Injury [TRACK-TBI] Pilot, USA) individual variations in the immune response using a multiplex panel of 30 inflammatory mediators. Mediators that were associated with unfavourable outcomes (Glasgow outcome score-extended [GOS-E] ≤ 4) were used for hierarchical clustering to identify patients with similar signatures. Findings: Two clusters were identified in both the discovery and validation cohorts, termed early-inflammatory and pauci-inflammatory. The early-inflammatory phenotype had higher concentrations of interleukin-6 (IL-6), IL-15, and monocyte chemoattractant protein 1 (MCP1). Patients with the early-inflammatory phenotype were older and more likely to have an unfavourable GOS-E at 6 months. There were no differences in the baseline injury severity scores between patients in each phenotype. A combined IL-15 and MCP1 signature identified patients with the early-inflammatory phenotype in both cohorts. Inflammatory processes mediated outcomes in older patients with moderate-severe TBI. Interpretation: Our findings offer a precision medicine approach for future clinical trials of immunomodulation in patients with TBI, by using inflammatory signatures to stratify patients. Funding: CENTER-TBI study was supported by the European Union 7th Framework Programme. TRACK-TBI is supported by the National Institute of Neurological Disorders and Stroke.

Abstract Large carnivores such as wolves (Canis lupus) at times disperse distances of several hundred kilometers, which may enable gene flow over vast distances. Such long‐distance dispersal events, however, often remain undetected, and documenting long‐distance dispersers and their movements typically depend on strong transboundary collaborations. Here, we report the dispersal of a wolf (MSV0FF) from the Alpine region of northern Slovenia to Bavaria in southern Germany, a straight‐line distance of around 300 km. The disperser originated in a pack with a genetically diverse breeding pair, where the father exhibited ancestry from the Dinaric and Italian Alpine populations. Genetic analysis of the mother indicated that she was an immigrant from a divergent population further south in the Dinaric‐Balkan region. Such a varied ancestry augments the probability of immigrants being genetically misclassified as wolf‐dog hybrids in their area of arrival, which increases the risk of unfavorable management decisions toward individuals that would be genetically highly valuable for the recipient population. Wolf MSV0FF therefore demonstrates the benefits of international collaborative monitoring networks and the value of sharing samples and analytical approaches for the monitoring of wide‐ranging species.

Summary: Background: Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Methods: Exposure–response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24 h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Findings: Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13–15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13–15 and positive CT (1.21–2.81), GCS 9–12 (1.16–2.02), GCS 3–8 (1.09–1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51–1.80) percentages of unfavourable outcome were 37–51% in the lowest quintiles of biomarker levels and reached 90–94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83–3.79), the percentages were 2–4% and 19–28% in the lowest and highest biomarker quintiles, respectively. Interpretation: Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity. Funding: European Union 7th Framework program (EC grant 602150), Hannelore Kohl Stiftung, One Mind, Integra LifeSciences, Neuro-Trauma Sciences, NIHR Rosetrees Trust.