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Abstract Background Implementation of recommended gestational weight gain (GWG) care by antenatal care providers is poor. It is unclear whether practice implementation and barriers differ between antenatal care provider profession or experience. This study aimed to assesses the provision of and barriers to guideline care for GWG and examine associations with professional discipline and years of experience. Methods A cross sectional survey was conducted with antenatal care providers working in three public maternity services in a regional city in Australia. Data were collected on the provision of and barriers (informed by the Theoretical Domains Framework) to recommended GWG care. Data were summarised using descriptive statistics. Associations between health profession characteristics (professional discipline and years providing antenatal care) and GWG care practices and barrier outcomes were assessed using multivariate logistic regression. Results 117 antenatal care providers completed the survey (75% participation rate). One quarter (25%) reported that they routinely provided recommended GWG assessment at the first antenatal visit, and 9% at subsequent visits. Only 7% routinely provided recommended advice on GWG, healthy eating and physical activity. Professional discipline or years of experience were not associated with higher odds of GWG practices. Skills, belief about capabilities, belief about consequences and environmental context and resources were barriers to providing care. Medical professionals had higher odds of agreeing that they have been adequately trained to address GWG (OR = 9.14, 95%CI:3.10–26.90) and feel competent in having sensitive conversations with pregnant women about GWG (OR = 8.60, 95%CI:2.29–32.28) than midwives. Midwives had higher odds of agreeing that there are services they can refer pregnant women to for further support (OR = 2.80, 95%CI:1.13–6.91). Conclusions The provision of antenatal care for GWG was low, inconsistently provided and did not differ by professional discipline or years of experience. Antenatal care providers report numerous barriers including skills, belief about capabilities, belief about consequences, and environmental context and resources. Barriers to GWG care provision differed by professional discipline, but not years of providing care. The findings demonstrate that the type and prioritisation of practice-change implementation strategies may need to be tailored to address the differential barriers faced by professional groups.

Abstract Background International clinical guidelines recommend that smoking, nutrition, alcohol consumption, physical activity and gestational weight gain (SNAP-W) be addressed as part of routine antenatal care throughout pregnancy. However, guideline recommendations are poorly implemented, and few antenatal care recipients routinely receive the recommended care. There is a need to establish the determinants (barriers and enablers) to care delivery to inform strategies to improve implementation. This systematic review aimed to synthesize qualitative and quantitative evidence of the barriers and enablers to the routine delivery of antenatal care targeting SNAP-W health risks. Methods A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seven databases were searched for relevant studies published between January 2001 and November 2023. Study findings were coded and analysed according to the domains of the Theoretical Domains Framework (TDF). Results Forty-nine studies were included in the review, 27 qualitative studies and 22 quantitative studies. The studies were conducted in 14 countries. Data were collected from 7146 antenatal care providers (midwives, Aboriginal health workers, obstetricians, medical officers, general practitioners) and 352 barriers and enablers were identified. Across all SNAP-W health risk and antenatal care provider groups, the predominant TDF domain was ‘environmental context and resources’, identified in 96% of studies. Barriers within this domain included insufficient time, limited access to and quality of resources, and limited organisational supports. ‘Beliefs about consequences’ was the second most common TDF domain, reported in 67% of studies, particularly studies of care related to alcohol use, nutrition/ physical activity/ gestational weight gain and those involving midwives, multidisciplinary practitioners and general practitioners. ‘Optimism’ was the second most common TDF domain for studies of smoking-related care and involving obstetricians, gynaecologists, and other mixed medical professions. Conclusions It is critical that determinants related to environmental context and resources including time, resources and organisational supports are considered in the development of strategies to support the implementation of recommended antenatal care related to SNAP-W risks. Strategies addressing clinician beliefs about consequences and optimism may also be needed to support the implementation of care related to specific health behaviours and by specific antenatal care provider groups. Registration The review protocol was prospectively registered with Prospero: CRD42022353084; 22 October 2022.

Abstract Background The effectiveness of the NSW Health “Get Healthy Information and Coaching Service® ”(Get Healthy) to facilitate weight loss on a population scale has been documented, but this was based on self-reported measures. Our study aims to test the effectiveness of the Get Healthy Service on objectively measured weight, BMI, waist circumference, and changes in other health behaviours, including nutrition, physical activity and alcohol intake. Methods Men and women aged 40–70 years (n = 154) with pre-diabetes (5.7% < HbA1c

No studies have examined vocational education students' intention to change multiple health risk behaviors and whether baseline characteristics predict behavior change. Participants: Participants were vocational education students in New South Wales, Australia. Methods: Students in the no-intervention control arm of a cluster randomized controlled trial completed an online survey at baseline and 6 months later. Results: Of 450 participants (83.3%) who reported multiple health risk behaviors at baseline, one-third (33.1%) intended to change at least two risk behaviors within 6 months. Participants experiencing symptoms of anxiety [OR = 7.43, 95% CIs 1.26-43.87; p = 0.03] and who intended to change three to four risk behaviors [OR = 23.30, 95% CIs 4.01-135.40; p = 0.001] rather than one behavior had significantly greater odds of changing at least one behavior in 6 months. Conclusions: Interventions could support vocational education students to change behaviors they wish to as well as motivate them to address other risk behaviors.

Many have suggested that performance grading may be a factor in the increasing number of students reporting having mental health issues, including feelings of stress. Gradeless learning has been shown to ease the pressure on students because it encourages a focus on learning rather than performance. Indeed, gradeless learning has been documented to benefit well-being, stress reduction, motivation, and learning approach, but its influence on academic performance requires more investigation. Drawing on a quantitative analysis, we empirically examine the effect of gradeless learning on a broad set of outcomes including well-being and stress, but focus specifically on students' later academic performance as measured by grades. Our findings reveal that gradeless learning can increase motivation and reduce surface learning but has no significant effect on students' later academic achievements. The study concludes that gradeless learning can provide a relevant alternative to grades if carefully designed.

Abstract Background Learning Health Systems (LHS) – characterised by cycles of evidence generation and application – are increasingly recognised for their potential to improve public health interventions and optimise health impacts; however there is little evidence of their application in the context of public health practice. Here, we describe how an Australian public health unit applied a LHS approach to successfully improve a model of support for implementation of a school-based physical activity policy. Methods This body of work was undertaken in the context of a strong research-practice partnership. Core LHS capabilities included: i) partnerships and stakeholder engagement; ii) workforce development and learning health communities; iii) multi-disciplinary scientific expertise; iv) practice data collection and management system; v) evidence surveillance and synthesis; and vi) governance and organisational processes of decision making. Three cycles of data generation and application were used. Within each cycle, randomised controlled trials conducted in NSW primary schools were used to generate data on the support model’s effectiveness for improving schools’ implementation of a government physical activity policy, its delivery costs, and process measures such as adoption and acceptability. Each type of data were analysed independently, synthesised, and then presented to a multi-disciplinary team of researchers and practitioners, in consult with stakeholders, leading to collaborative decisions for incremental improvements to the support model. Results Cycle 1 tested the first version of the support model (composed of five implementation strategies targeting identified barriers of policy implementation) and showed the model’s feasibility and efficacy for improving schools’ policy implementation. Data-informed changes were made to enhance impact, including the addition of three implementation strategies to address outstanding barriers. Cycle 2 (now, testing a package of eight implementation strategies) established the model’s effectiveness and cost-effectiveness for improving school's policy implementation. Data-informed changes were made to reduce delivery costs, specifically adapting the costliest strategies to reduce in-person contact from external support personnel. Cycle 3 showed that the adaptations minimised the relative cost of delivery without adversely impacting on the effect. Conclusions Through this process, we identified an effective, cost-effective, acceptable and scalable policy implementation support model for service delivery. This provides important information to inform or support LHS approaches for other agencies seeking to optimise the health impact of evidence-based interventions.

A presente pesquisa tem como objetivo compreender como o cotidiano se expressa nos corpos das crianças, com enfoque nas brincadeiras de “lutinha” e brigas no ambiente escolar. Para tanto, realizou-se uma pesquisa de campo, valendo-se da observação participante e de conversas com 34 crianças, sendo 19 meninas e 15 meninos, com idades entre 9 e 12 anos, organizadas em duas turmas do 4o ano em um Centro de Atenção Integral à Criança e ao Adolescente (CAIC), situado em Sobradinho – DF. As informações produzidas em campo foram apresentadas por meio de quatro episódios, tendo sido analisadas com base na sociologia da infância e do cotidiano. A partir desses episódios, foi sistematizado um modelo de análise ortogonal formado por quatro quadrantes, organizado pelos eixos lúdico e violência, que representam as principais categorias analíticas do binômio brincar/brigar. Ademais, os registros de campo sugerem que as brincadeiras de “lutinha” e as brigas representam dimensões paradoxais do cotidiano infantil.

Dado que os números oficiais de violência contra a mulher vêm crescendo de forma alarmante nos últimos anos, é de extrema importância analisar esse fenômeno. Sendo assim, este estudo vem pautado nos referenciais de gênero, violência contra mulher e masculinidades, e tem por objetivo fazer uma análise sobre violência contra a mulher a partir da ótica masculina, observando o que os homens compartilham acerca, seja em suas falas ou ações. Possibilitando entender como o comportamento do homem interfere nas dinâmicas sociais e culturais do ambiente no qual se encontra. Dessa forma o objeto da pesquisa foram os homens jovens, de até 30 anos, graduandos das instituições FAMETRO e UFAM na cidade de Manaus. Consequentemente, a pesquisa insere-se nas discussões sobre violências cometidas contra mulheres, enfocando um eixo incomum nas análises de gênero. Logo, a partir da ótica masculina sobre a violência contra a mulher se desencadearam diversas categorias de análise, como: a construção do homem e sua posição nas relações de gênero, a naturalização da violência, a valoração da violência e a manifestação de diversas formas de violência. Analisando como a violência ocorre para os homens graduandos, a pesquisa dá respaldo para reflexões acerca do combate e da prevenção de violências de gênero e novas formas de masculinidades.

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality and residing in a rural and remote region is associated with an increased risk. The impact of rurality on CVD outcomes needs to be fully elucidated. Objectives: The purpose of this study was to assess the difference in mortality, readmission within 30 days, total readmissions, survival, and total emergency department (ED) presentations following an index CVD admission among patients from rural or remote areas as compared to metropolitan areas. Methods: This retrospective observational study included all index hospitalizations with heart failure (HF), atrial fibrillation (AF), or acute coronary syndrome (ACS) within the Hunter New England region of Australia, between January 1, 2008, and December 31, 2021. Results: There were 27,995 ACS admissions, 15,586 HF admissions, and 16,935 AF admissions. Patients from a rural or remote area presenting with CVD presentations had increased 30-day readmission (OR: 1.19; P

Abstract Background Chronic diseases are a considerable burden to health systems, communities, and patients. Much of this burden, however, could be prevented if interventions effective in reducing chronic disease risks were routinely implemented. Aims The aim of this paper is to discuss the role of public health agencies in preventing chronic disease through the application of learning health system (LHS) approaches to improve the implementation of evidence‐based interventions. Materials and Methods We draw on the literature and our experience operating a local LHS in Australia that has achieved rapid improvements in the implementation of chronic disease prevention interventions. Results The proposed LHS framework has been adapted to be both implementation and chronic disease prevention focused. The framework describes both broad improvement processes, and the infrastructure and other support (pillars) recommended to support its core functions. Conclusion The framework serves as a basis for further exploration of the potentially transformative role LHS's may have in addressing the chronic disease health crisis.

BackgroundChild and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. ObjectiveThis study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. MethodsA cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. ResultsA total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child’s birth. The majority of women (n=282-315, 82%-92%) “strongly agreed or agreed” that receiving information from CFHN via technology would be acceptable, and most (n=308) women “strongly agreed or agreed” with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). ConclusionsTechnology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days.

Myrcia genus plants, like Myrcia pubipetala, traditionally used as hypoglycemic agents, hold promise for Type 1 Diabetes Mellitus (DM1) research but need more comprehensive chemical and pharmacological investigation. This is an experimental study involving controlled administration of treatments to a group of rats to assess their effects compared with a control group, investigating the effects of M. pubipetala on alloxan-induced Type 1 Diabetes Mellitus in rats. After the induction of diabetes, the rats received the hydroalcoholic extract (HAE) or aqueous fraction (AF) (25, 50, 100, or 150 mg kg-1) of M. pubipetala, or water. The results showed that diabetic rats presented cell damage in kidneys, oxidative stress, and high levels of glucose and triglycerides in their plasma and erythrocytes. The HAE (150 mg kg-1), per se, reduced lipid and protein oxidation, and the AF (150 mg kg-1) decreased lipoperoxidation. AF (150 mg kg-1), per se, decreased triglyceride levels. Conclusion: treatment with HAE and AF reduced oxidative damage, positively modulated antioxidant defenses, and exerted hypoglycemic and hypolipidemic effects, representing a potential adjuvant treatment for diabetes.

Abstract Aims In patients with chronic heart failure with reduced ejection fraction (HFrEF), myocardial ketone metabolism is increased and short‐term treatment with the ketone body 3‐hydroxy butyrate (3‐OHB) has beneficial haemodynamic effects. In patients with HFrEF, we investigated whether the level of circulating 3‐OHB predicted all‐cause mortality and sought to identify correlations between patient characteristics and circulating 3‐OHB levels. Methods and results We conducted a cohort study in 218 patients with HFrEF. Plasma 3‐OHB levels were measured using high‐performance liquid chromatography tandem mass spectrometry. Data on all‐cause mortality were obtained by reviewing the patients' medical records, which are linked to the national ‘Central Person Registry’ that registers the timing of all deaths in the country. Mean left ventricular ejection fraction was 35 ± 8.6%, mean age was 67 ± 10 years, 54% were New York Heart Association II, and 27% had type 2 diabetes mellitus. Median follow‐up time was 7.3 (interquartile range 6.3–8.4) years. We observed large variations in 3‐OHB levels between patients (median 59 μM, range: 14–694 μM). Patients with 3‐OHB levels above the median displayed a markedly increased risk of death compared with those with low levels {hazard ratio [HR]: 2.1 [95% confidence interval (CI): 1.3–3.5], P = 0.003}. In a multivariate analysis, 3‐OHB predicted mortality independently of known chronic heart failure risk factors [HR: 1.004 (95% CI: 1.001–1.007), P = 0.02] and with a similar statistical strength as N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) [HR: 1.0005 (95% CI: 1.000–1.001), P = 0.02]. For every 100 μmol increase in plasma 3‐OHB, the hazard of death increased by 49%. The following factors significantly predicted 3‐OHB levels in the univariate analysis: free fatty acids (FFAs) [β: 238 (95% CI: 185–292), P 0.001]. Conclusions In patients with HFrEF, circulating 3‐OHB was a strong predictor of all‐cause mortality independently of NT‐proBNP. Circulating FFAs were the best predictor of 3‐OHB levels.

Abstract Background Lactate is traditionally recognized as a by-product of anaerobic metabolism. However, lactate is a preferred oxidative substrate for stressed myocardium. Exogenous lactate infusion increases cardiac output (CO). The exact mechanism underlying this mechanism has yet to be elucidated. The aim of this study was to investigate the cardiovascular mechanisms underlying the acute haemodynamic effects of exogenous lactate infusion in an experimental model of human-sized pigs. Methods In this randomised, blinded crossover study in eight 60-kg-pigs, the pigs received infusions with one molar sodium lactate and a control infusion of tonicity matched hypertonic saline in random order. We measured CO and pulmonary pressures using a pulmonary artery catheter. A pressure–volume admittance catheter in the left ventricle was used to measure contractility, afterload, preload and work-related parameters. Results Lactate infusion increased circulating lactate levels by 9.9 mmol/L (95% confidence interval (CI) 9.1 to 11.0) and CO by 2.0 L/min (95% CI 1.2 to 2.7). Afterload decreased as arterial elastance fell by -1.0 mmHg/ml (95% CI -2.0 to -0.1) and systemic vascular resistance decreased by -548 dynes/s/cm5 (95% CI -261 to -835). Mixed venous saturation increased by 11 percentage points (95% CI 6 to 16), whereas ejection fraction increased by 16.0 percentage points (95% CI 1.1 to 32.0) and heart rate by 21 bpm (95% CI 8 to 33). No significant changes in contractility nor preload were observed. Conclusion Lactate infusion increased cardiac output by increasing heart rate and lowering afterload. No differences were observed in left ventricular contractility or preload. Lactate holds potential as a treatment in situations with lowered CO and should be investigated in future clinical studies. Graphical Abstract

Perivascular adipose tissue (PVAT) regulates vascular tonus with an anticontractile effect, which may be dysfunctional in hypertension. An Egg White Hydrolysate (EWH), a bioactive food, restores endothelium dysfunction and reduces blood pressure levels in malignant hypertension. We aimed to evaluate whether dietary supplementation with EWH interferes with the PVAT function in the mesenteric resistance arteries (MRA) of DOCA-salt hypertensive animals and the mechanisms involved. Male rats were divided into 4 groups and treated for 8 weeks. For 4 weeks, DOCA-salt or vehicle-treated rats (SHAM) were induced, and after that, some rats were co-treated with DOCA-salt or vehicle plus EWH (1 g/kg/day) for 4 weeks more. MRA and/or their PVAT (mPVAT) were used for functional, molecular, and biochemical analysis. The anticontractile effect of mPVAT in response to norepinephrine (NE) was observed only in MRA rings with PVAT of the SHAM group, while this effect was abolished in DOCA-salt rings. The EWH treatment did not change the anticontractile effect of mPVAT in SHAM but partially restored it in DOCA-salt rats. Acute aliskiren incubation reduced NE-induced contraction only in MRA with PVAT of DOCA-salt rats. EWH prevented the overactivation of the renin levels and ACE activity in mPVAT of DOCA-salt rats; while did not change AT1R expression, but increased AT2R expression. In mPVAT, EWH blocked the increase of MDA, ROS and pro-inflammatory cytokines observed in DOCA-salt rats. EWH improved PVAT dysfunction in MRA of severe hypertension. This beneficial effect could be mediated by an ameliorated redox balance, inflammatory state, and RAS axis.

This study analyzes burner scale-dependent effects for iron-oxide nanoparticles synthesis in spray flames through a combined experimental and numerical approach. A laboratory- and a pilot plant-scale synthesis facility generate iron oxide nanoparticles from iron nitrate dissolved in ethanol/2-ethylhexanoic acid solvents on the 0.5 and 15 g/h scale, respectively. Phase Doppler measurements supply initial conditions for spray development in the numerical approach, while in situ OH* chemiluminescence and multi-line nitric oxide laser-induced fluorescence (NO-LIF) thermometry provide experimental data for comparison with simulation results of the pilot plant burner. Ex situ particle sizing by gas adsorption according to Brunauer-Emmet-Teller (BET) and transmission electron microscopy (TEM), along with phase composition determination via X-ray diffraction (XRD), are used to compare products of both burners and the corresponding simulations. The numerical approach employs a Reynolds-averaged Eulerian–Lagrangian description of the flow in combination with a flamelet/progress variable (FPV) combustion and monodisperse particle model to reflect spray-flame synthesis. Despite similar chemiluminescence between experiment and simulation, more significant discrepancies are observed in NO-LIF thermometry and particle sizing. Nanoparticle formation and growth at both burner scales is investigated using the numerical method. Special attention is directed to the high-temperature particle residence time (HTPRT). Notably, the average temperature–time profiles particles experience are almost identical in the burners, although their geometric scales and designs differ substantially. Simulation results show that while the primary particle diameter remains mostly consistent, the pilot-scale burner produces larger particle agglomerates than the laboratory burner. The difference is attributed to an increased particle number concentration during the initial formation of soft agglomerates. The findings demonstrate that, despite retaining a similar HTPRT, the overall flow conditions and liquid spray dispersion, which impact the distribution of the particle number concentration, influence the final agglomerate size.

Abstract Background The Australian Clinical Practice Guidelines for Pregnancy Care recommend that during the first and subsequent antenatal visits all pregnant women are weighed; advised of recommended gestational weight gain (GWG), dietary intake and physical activity; and offered referrals for additional support if needed. The extent to which these recommendations are implemented and women’s acceptability of recommended care is unknown. This study examines women’s reported receipt and acceptability of guideline care for GWG, and characteristics associated with receipt of such care and its acceptability. Methods From September 2018 to February 2019 a telephone survey was undertaken with women who had recently had a baby and received antenatal care from five public maternity services within a health district in Australia. Women self-reported their demographic characteristics, and receipt and acceptability of recommended GWG care. Receipt and acceptability of such care, and their association with the characteristics of women and the maternity service they attended, were examined using descriptive statistics and multivariable logistic regression analyses. Results Of 514 women, 13.1% (95%CI:10.3–16.5) reported that they received an assessment of weight at both their first and a subsequent antenatal visit, and less than one third (30.0%; 95%CI:26.0-33.9) received advice on their recommended GWG range, dietary intake and physical activity. Just 6.6% (95%CI:4.8–9.1) of women reported receiving all assessment and advice components of recommended antenatal care, and 9.9% (95%CI:7.6–12.8) of women reported being referred for extra support. Women who were younger (OR = 1.13;95%CI:1.05–1.21), identifying as Aboriginal and Torres Strait Islander (OR = 24.54;95%CI:4.98-120.94), had a higher pre-pregnancy BMI (OR = 1.13;95%CI:1.05–1.21), were experiencing their first pregnancy (OR = 3.36;95%CI:1.27–8.86), and lived in a least disadvantaged area (compared to mid-disadvantaged area (OR = 18.5;95%CI:2.6-130.5) and most disadvantaged area (OR = 13.1;95%CI:2.09–82.4)) were more likely to receive recommended assessment and advice. Most Aboriginal (92%) and non-Aboriginal (93%) women agreed that recommended GWG care is acceptable. Conclusion Most women perceive antenatal care for GWG as recommended by the Clinical Practice Guidelines as acceptable, but did not receive it. When provided, such care is not delivered consistently to all women regardless of their characteristics or those of the maternity service they attend. There is a need for service-wide practice change to increase routine GWG care in pregnancy for all women.

Major efforts have been made to reduce the use of colistin in livestock since the discovery of the plasmid-borne mobile colistin resistance (mcr) gene in E. coli a decade ago, to curb the burden of its potential transmission to other bacterial species, spread between animals, humans and the environment. This study explored the longitudinal prevalence and characteristics of colistin-resistant and extended-spectrum beta-lactamase-producing (ESBL) E. coli via in vivo fecal and ex vivo carcass swabs from two batches of conventional indoor and organic outdoor Wallon meat sheep from birth to slaughter in 2020 and 2021. Antimicrobial susceptibility testing via broth microdilution revealed that n = 16/109 (15%) E. coli isolates from conventional meat lamb fecal samples had a reduced colistin sensitivity (MIC = 0.5 μg/mL) and thereof, n = 9/109 (8%) were multi-drug-resistant E. coli, while no resistant isolates were recovered from their carcasses. Sequencing revealed causative pmrB genes, indicating that the reduced sensitivity to colistin was not plasmid-borne. While the sample size was small (n = 32), no colistin-resistant and ESBL-producing E. coli were isolated from the organic meat sheep and their carcasses, potentially due to the different husbandry conditions. Prudent and judicious antimicrobial use and strict slaughter hygiene remain imperative for effective risk management to protect consumers in a sustainable One Health approach.

The practice of combining digital and face-to-face elements into blended learning courses is becoming the new normal in higher education and offers a promising learning format. While studies on the effects of blended learning have so far focused mostly on the online components of the blends, the success of blended learning also rests on the quality of the integrated face-to-face activities. This scoping review examines evidence from 59 experimental studies conducted in higher education settings to explore what makes face-to-face components of blended learning efficacious. The focus is on pedagogical intentions rather than on quantifying the balance between online and face-to-face activities. The results indicate which face-to-face activities support the pedagogical objectives of higher-order processing, social interaction, and engagement. The review identifies current gaps in blended learning research and calls for richer characterizations of face-to-face activities in blended learning to support the development of finely tuned interventions and guide practice.

Flipped classroom has been found to positively influence student achievement but the magnitude of the effect varies greatly according to discipline and local design, and few studies have been methodologically rigorous enough to establish causal evidence. Using a randomized controlled trial, this study addresses a gap in current knowledge by exploring how student responses mediate the impact of flipped classroom on academic achievement. The empirical setting is a first-year undergraduate macroeconomics course with 415 students. Comparing students in the treatment group with those in a traditional class, we find a positive, yet statistically insignificant effect on academic achievement. However, this overall effect masks important mediating effects, as students were unexpectedly reluctant to actively participate in the flipped classroom intervention. Consequently, the intervention has a substantially greater effect on academic achievement when controlling for the mediating effect of student participation which leads to consideration of the challenges of student resistance to flipped classroom.

The increased popularity of flipped classroom in higher education warrants more thorough investigation of the pedagogical format's effects on student learning. This paper utilizes two iterations of a randomized field experiment to study the effects of flipped classroom on student learning specifically focusing on heterogeneous treatment effects across the important classroom-level factor of teachers. The empirical setting is an undergraduate macroeconomics course with 933 students and 11 teachers. Our findings show a positive yet insignificant average effect of flipped classroom on both pass rate and final exam grades. We further find substantial shifts in the ranking of the participating teachers' effectiveness when comparing traditional and flipped classroom conditions, which suggests that the most successful teacher in a traditional teaching environment is not necessarily the most successful teacher in a flipped classroom environment.

BackgroundTelestroke networks aim to address variability in both quality and access to stroke care in rural areas, by providing remote access to expert stroke neurologists. Implementation of telestroke requires adaptation of workflow processes and education. We previously developed virtual reality (VR) workflow training and documented acceptability, utility and feasibility. The effects on acute stroke treatment metrics have not been previously described.AimsThe overall aim was to improve hyperacute stroke metrics and shorten the time-to-reperfusion therapy administration in rural settings.MethodsThis study applies a natural experiment approach, collecting stroke metric data during transition from a pre-existing pilot to a statewide telestroke service at five rural hospitals. Pre- and post-intervention data included baseline patient demographics and assessment, diagnosis, and treatment delivery metrics. The primary study outcome was door-to-decision time (thrombolysis and endovascular thrombectomy). Secondary outcomes included door-to-computerized tomography time, door-to-thrombolysis time and proportion of patients receiving thrombolysis or thrombectomy treatment. Usage data relating to the VR stroke workflow training of interprofessional healthcare professionals was automatically captured via Wi-Fi. Statistical comparisons of clinical metrics between the pre- and post-intervention time periods, defined as the timeframes before and after VR deployment, were performed.ResultsA total of 2,683 patients were included (April 2013–December 2022); 1910 pre- and 773 post-intervention. All acute stroke time metrics significantly improved post-intervention. The primary outcome, door-to-decision time, decreased from 80 min [56–118] to 54 min [40–76; P < 0.001]. Secondary outcomes also improved, including door-to-thrombolysis time (90 min [68–114] vs. 68.5 min [54–90]; P < 0.001) and proportion of patients thrombolysed (11 vs. 16%; P < 0.001). The proportion of patients transferred for thrombectomy was unchanged (6 vs. 7%; P = 0.69). Seventy VR sessions totaling 15 h 39 min of training time were logged. VR training usage varied across sites (3–31 sessions per site).ConclusionsDelivery of a multi-factorial intervention including infrastructure, funding, education and training (with VR workflow training) as part of a state-wide telestroke rollout was associated with improved acute stroke treatment metrics. Additional work is required to identify the contribution of each intervention component on clinical outcomes and to increase training uptake and sustainment.

Background Skeletal muscle wasting is critical in patients with heart failure (HF). Whereas prior studies have employed appendicular lean mass (ALM) normalized by height squared to identify low skeletal muscle mass, the potential of ALM normalized to body mass index (ALM/BMI) remains unexplored in patients with HF. In this study, we compared the use of 2 skeletal muscle mass indices in patients with HF to examine their sex‐specific correlations with measures of physical capacity, quality of life, and daily physical activity. Methods and Results A total of 111 patients with HF underwent dual x‐ray absorptiometry, physical capacity tests, and accelerometry and answered a quality‐of‐life questionnaire. ALM normalized by height squared and ALM/BMI indices disagreed in classifying low muscle mass (Cohen's κ, −0.008 [95% CI, −0.094 to 0.177]; P=0.93). ALM/BMI correlated well with 6‐minute walking distance in women and men (R=0.67 and 0.49; P