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Abstract Background Peripheral nodal B‐cell lymphomas (PNBCL) represent the most common presentation of lymphomas in dogs. Multiagent CHOP (C = cyclophosphamide, H = hydroxydaunorubicin [Doxorubicin], O = Oncovin, P = prednisolone)‐based chemotherapy protocols have been widely accepted as gold standard 1st‐line treatment. CHOP‐25 and CHOP‐19 are most commonly prescribed but have never been directly compared. Objectives Our primary aim was to compare outcomes of dogs diagnosed with PNBCL, treated using a 1st‐line CHOP‐19 or CHOP‐25 protocol. A secondary objective was to determine the impact of protocol‐related variables on outcomes. Animals Five hundred two dogs from 16 European oncology referral centers. One hundred fifty‐five dogs were treated with CHOP‐19 and 347 dogs with CHOP‐25. Methods Retrospective, multicentric cohort study of dogs diagnosed with PNBCL between 2014 and 2021. Results The 6‐month, 1‐year, and median progression‐free survival (PFS) were 56.5% (95% confidence interval [CI], 49.2‐65.0), 14.1% (95% CI, 9.4‐21.0), and 196 days (95% CI, 176‐233) with CHOP‐19; and 56.4% (95% CI, 51.4‐61.9), 17% (95% CI, 13.4‐21.6), and 209 days (95% CI, 187‐224) with CHOP‐25. The 1‐year, 2‐year and median overall survival (OS) were 36.9% (95% CI, 29.7‐46.0), 13.5% (95% CI, 8.6‐21.1), and 302 days (95% CI, 249‐338) with CHOP‐19; and 42.8% (95% CI, 37.7‐48.7), 15.4% (95% CI, 11.7‐20.4), and 321 days (95% CI, 293‐357) with CHOP‐25. No significant difference in PFS and OS was found between the 2 protocols. Conclusions and Clinical Importance Our study confirmed similar outcomes for dogs with PNBCL treated with 1st‐line CHOP‐19 or CHOP‐25. Both protocols therefore could be used as a standard of care in future trials.

Abstract Introduction Fluid assessment and management is a key aspect of good dialysis care and is affected by patient-level characteristics and potentially centre-level practices. In this secondary analysis of the BISTRO trial we wished to establish whether centre-level practices with the potential to affect fluid status were stable over the course of the trial and explore if they had any residual associations with participant’s fluid status. Methods Two surveys (S) of fluid management practices were conducted in 32 participating centres during the trial, (S1: 2017–18 and S2: 2021–22). Domains interrogated included: dialysate sodium concentration, (D-[Na+]), fluid and salt intake, residual kidney function, use of diuretics, incremental start, approaches to fluid assessment, management and dialysate temperature, (D-oC). Associations of these practices with the closeness of the participant’s post-dialysis target weight to their normally hydrated weight, pre- and post-dialysis systolic (SBP) and diastolic blood pressure, (DBP), were analysed using intra-class correlations and multilevel modelling with adjustment for visit, age, sex and comorbidity burden. Results Variations in centre practices were reported but did not change during the trial, apart from some relaxation in salt and fluid restriction in S2. For our measures of fluid status, measured 2501 times in 439 non-anuric incident haemodialysis patients, centre-level intraclass correlations were extremely low, whereas patient-level correlations ranged between 0.12 and 0.47, strongest for pre- and post-dialysis-SBP, less so for post-dialysis-DBP. Multi-level analysis found no associations between D-[Na+], or assessment methods of fluid status. In S2, one centre, routinely using a D-Co of 35°C had more divergence between the target and normally hydrated weight, but this was not observed in S1, and no other associations were found. Conclusions Centre-level fluid management practices were stable over the course of the BISTRO trial, and in contrast to patient-level factors, no centre-level associations were detected with fluid status or blood pressure. This may be because the trial imposed a standardised approach to fluid assessment in all trial participants who at least initially had residual kidney function, potentially over-riding the effects of other centre practices. Survey responses revealed substantial scope for developing and evaluating standardised protocols to optimise fluid management.

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 Daycare centres play a critical role in early childhood development but are high-risk environments for infectious disease transmission due to close physical contact, shared toys, inadequate hygiene, and poor ventilation. These risks are especially concerning in low- and middle-income countries (LMICs) like Nigeria, where resources for infection control may be limited. This study aimed to identify and characterise virulence genes in bacterial isolates from daycare centres in Ile-Ife, Nigeria, to assess infection risks. Methods Between November 2017 and July 2019, 233 samples were collected from 76 children, 33 daycare workers, and 124 fomites in 17 daycare centres. The bacterial isolates were analysed using conventional PCR and RAPD analysis to detect the presence of virulence genes. The frequency of crucial virulence genes and the prevalence of each bacterial species were recorded. Results Key virulence genes were detected, including fimH in Klebsiella species (22.73% of Gram-negative isolates), algD in Pseudomonas aeruginosa (50%), and icaA and cna in Staphylococcus aureus (16.67%). Staphylococcus aureus was the most prevalent species (35%), followed by Klebsiella (28%) and Pseudomonas aeruginosa (20%). Conclusion This study highlights the presence of virulent bacterial pathogens in daycare environments, posing a severe infection risk to children. To mitigate these risks, it is essential to implement enhanced infection control measures, such as regular microbial screening, improved hand hygiene practices, and disinfection protocols for fomites. Training programs for daycare workers on hygiene practices and routine monitoring could also significantly reduce infection transmission. These interventions are vital for safeguarding the health of daycare children in Nigeria and similar settings globally.

An important approach for developing children's algebraic thinking involves introducing them to generalized arithmetic at the time they are learning arithmetic. Our aim in this study was to investigate children's attention to and expression of generality with the subtraction-compensation property, as evidence of a type of algebraic thinking known as relational thinking. The tasks involved subtraction modelled as difference and comparing the heights of towers of blocks. In an exploratory qualitative study, 22 middle primary (9-11-year-old) students from two schools participated in individual videoed interviews. The tasks were designed using theoretical perspectives on embodied visualization and concreteness fading to provide multiple opportunities for the students to make sense of subtraction as difference and to advance their relational thinking. Twelve out of 22 students evidenced conceptual understanding of the comparison model of subtraction (subtraction as difference) and expression of the compensation property of equality. Four of these students repeatedly evidenced relational thinking for true/false tasks and open equivalence tasks. A proposed framework for levels of attention to/expression of generality with the subtraction-compensation property is shared and suggestions for further research are presented.

Quadratics provide a foundational context for making sense of many important algebraic concepts, such as variables and parameters, nonlinear rates of change, and views of function. Yet researchers have highlighted students' difficulties in connecting such concepts. This in-depth qualitative study with two pairs of Year 10 (15 or 16-year-old) students investigated the potential of figural pattern generalisation--a context not traditionally used for teaching quadratics--to stimulate students' coordination of visual and algebraic reasoning and attention to quadratic function concepts. Theorisations of embodied visualisation, algebraic thinking, and student noticing were drawn on to analyse the pairs responding to 19 quadratic figural pattern generalisation tasks interspersed throughout their class topic on quadratic equations. It was found that students became adept at connecting the generality of different types of structural aspects of figures (square, rectangular, linear, constant/invariant) to their symbolic expression in quadratic equations. Students' construction of numeric instantiations of figural aspects was found to support pairs in moving towards symbolic generalisation. Task prompts to find different (but equivalent) algebraic equations for the same pattern evidenced pairs beginning to distinguish among general, factorised and standard forms of quadratic equations. One pair's attention to first and second differences (between total quantities of figures in a sequence) highlighted both the difficulty of and potential for connecting quadratic rate-of-change concepts and parameters visually. Implications for including figural pattern generalisation when teaching quadratics and suggestions for further research are shared.

Current physical literacy recommendations include a focus on enhancing teachers' knowledge and understanding of the concept. This paper explores whether physical education (PE) practitioners in a country where physical literacy is not foregrounded in educational practice are naturally aligning their approach towards the creation of learning experiences that would nurture physical literacy. Ten in-service Spanish PE teachers delivering Educación Secundaria Obligatoria and Bachillerato education programmes to students aged 13 to 18 years (seven male, three female; mean age: 45 years; mean teaching experience: 17.4 years), unfamiliar with the concept of physical literacy, participated in semi-structured interviews exploring their experiences of delivering PE. Thematic analysis revealed teaching craft, curriculum implementation, differentiation strategies, assessment behaviours, utility of feedback, psychomotor development, and sensitivity to affective domains of learning as overarching themes. Findings provide insight into the practices and behaviours of PE teachers who self-identified as being unfamiliar with the concept of physical literacy. Results suggest that learners are well served through the provision of high-quality PE that ubiquitously satisfies the requirements of developing physically literate individuals, implying how teaching is conducted in relation to developing physical literacy is as important, perhaps more so, than what is understood of the concept.

Correctly torquing bone screws is important to achieve good patient outcomes. An automated system has been previously proposed that may allow more objective torquing of bone screws. Here the system is tested vs. a static torque limit in pig bone. 5 screws were first inserted until stripping to calibrate the dynamic and static limits. Then 6 were inserted limited to 80% of the mean stripping torque. Then 7 were inserted using 80% of the dynamic model-predicted stripping torque. The pull-out strength of the dynamic and static insertions were compared and no statistically significant difference was found. Future work should consider at using larger screws and different bone samples, with more repetitions to try and obtain a statistically significant result.

Abstract Mechanistic mathematical models (MMs) are a powerful tool to help us understand and predict the dynamics of tumour growth under various conditions. In this work, we use 5 MMs with an increasing number of parameters to explore how certain (often overlooked) decisions in estimating parameters from data of experimental tumour growth affect the outcome of the analysis. In particular, we propose a framework for including tumour volume measurements that fall outside the upper and lower limits of detection, which are normally discarded. We demonstrate how excluding censored data results in an overestimation of the initial tumour volume and the MM-predicted tumour volumes prior to the first measurements, and an underestimation of the carrying capacity and the MM-predicted tumour volumes beyond the latest measurable time points. We show in which way the choice of prior for the MM parameters can impact the posterior distributions, and illustrate that reporting the most likely parameters and their 95% credible interval can lead to confusing or misleading interpretations. We hope this work will encourage others to carefully consider choices made in parameter estimation and to adopt the approaches we put forward herein.

Abstract Acoustic telemetry can provide valuable space-use data for a range of marine species. Yet the deployment of species-specific arrays over vast areas to gather data on highly migratory vertebrates poses formidable challenges, often rendering it impractical. To address this issue, we pioneered the use of acoustic telemetry on basking sharks (Cetorhinus maximus) to test the feasibility of using broadscale, multi-project acoustic receiver arrays to track the movements of this species of high conservation concern through the coastal waters of Ireland, Northern Ireland, and Scotland. Throughout 2021 and 2022, we tagged 35 basking sharks with acoustic transmitters off the west coast of Ireland; 27 of these were detected by 96 receiver stations throughout the study area (n = 9 arrays) with up to 216 detections of an individual shark (mean = 84, s.d. 65). On average, sharks spent ~ 1 day at each acoustic array, with discrete residency periods of up to nine days. Twenty-one sharks were detected at multiple arrays with evidence of inter-annual site fidelity, with the same individuals returning to the same locations in Ireland and Scotland over 2 years. Eight pairs of sharks were detected within 24 h of each other at consecutive arrays, suggesting some level of social coordination and synchronised movement. These findings demonstrate how multi-project acoustic telemetry can support international, cost-effective monitoring of basking sharks and other highly mobile species. Decision support tools such as these can consolidate cross-border management strategies, but to achieve this goal, collaborative efforts across jurisdictions are necessary to establish the required infrastructure and secure ongoing support.

Objective To describe the development process of a patient-centered initiative focused on improving primary care health outcomes of patients with intellectual and developmental disabilities (IDD) and needle-related anxiety using evidence-based practices and novel approaches that can be implemented in outpatient settings. The overall outcome of the program is to increase vaccine uptake and accessibility in the IDD population as well as improve needle-related procedures in primary care settings to be more humane and effective. Methods The development process occurred in the context of a large healthcare system serving a diverse patient population in the U.S. and was led by an expert committee made of an multidisciplinary team of physicians, psychologists, ambulatory and clinic nurses, pharmacists, and anesthesiologists committed to promoting quality healthcare for the IDD population. Committee members were recruited within the healthcare system based on their relevant expertise. The methodology included an iterative and collaborative process that took place over three development phases: ideation and design, literature review and synthesis, and expert engagement. The ideation and design phase included a series of planning meetings among the expert committee, in which committee members identified preliminary concerns based on their expertise in the field and background knowledge on the current procedures related to improving routine care for individuals with IDD and/or needle-related anxiety. The literature review and synthesis phase led to the development of an annotated bibliography of research and clinical guidelines that synthesized findings on needle anxiety in clinical care. The expert engagement phase included all Committee members meeting for a final discussion to establish a tiered approach to utilizing evidence-based strategies that could be implemented across clinics within the healthcare system.  Results The multidisciplinary team of experts developed a three-tier system, deployed sequentially as needed. The first tier focuses on training nurses in evidence-based behavioral modification strategies to implement as standard of care. The second tier uses the addition of a distraction device and topical analgesic to reduce anxiety in patients with slightly elevated procedural anxiety. The third tier involves a novel minimal sedation protocol using intranasal midazolam for patients with needle phobia that can be administered in an outpatient setting. Conclusion The Needle Anxiety Program eases the administration of needle-related medical procedures in the primary care setting for patients with IDD and needle-related anxiety. The use of evidence-based practices and a novel minimal sedation protocol for individuals with needle phobia assists in the completion of routine healthcare procedures, such as vaccinations and phlebotomy, in a patient-preferred setting. The purpose of delineating needle-related processes and procedures through the Needle Anxiety Program is to reduce health disparities for patients with IDD and promote uptake of the Needle Anxiety Program in similar healthcare settings.

Objective Patients with intellectual and developmental disabilities (IDD) experience needle phobia at greater rates than individuals in the general population. Needle phobia deters patients with IDD from receiving routine medical procedures, which impacts their physical health outcomes. The aim of this quality improvement study was to assess the feasibility of a minimal sedation protocol in an outpatient care setting for patients with IDD and needle phobia. Methods The sample included 18 patients characterized as having a diagnosis of IDD only or IDD and needle phobia compared to patients with only a diagnosis of needle phobia. Reasons for referral to intervention included routine lab work, therapeutic drug monitoring, and routine vaccination. The minimal sedation intervention involved intranasal administration of a benzodiazepine (midazolam) by a registered nurse. Outcomes of interest were administration of the sedation and administration of medical orders. Results Nearly a third of patients were children (33.3%, n=6), and 39% of patients were female (n=7). Individuals with IDD (including those both with and without needle phobias) comprised 72.2% of patients (n=13). Half of intervention encounters were successful in both administering the sedation and performing the medical orders (n=9). Among individuals with IDD, 38.4% successfully completed the intervention (n=5). Conclusion This pilot study assessed the feasibility of implementing a minimal sedation protocol in primary care outpatient care settings. The preliminary results suggest that the minimal sedation protocol may improve the uptake of needle-related medical procedures for patients with IDD and/or needle phobia. The minimal sedation protocol should be studied in a larger sample and among multiple outpatient settings to establish effectiveness of the intervention.

Objective: During Dignity Therapy a trained provider guides a patient to share their life story and legacy. Providers can demonstrate empathy through empathic self-disclosure (ESD), sharing something substantial and personal about themselves in response to the patient. The current study aims to identify the topics of ESDs and determine whether ESD frequency varied by patient and/or provider characteristics. Methods: Two coders analyzed 203 audio-recorded, transcribed Dignity Therapy sessions of palliative care patients (M = 65.78 years; SD = 7.43 years, 65.69% women) for ESD. Topic modeling characterized themes of ESD and multilevel modeling examined ESD frequency based on several patient and provider characteristics. Results: ESD occurred in 37% of interviews (M = 0.59, SD = 1.21). Topic modeling revealed five main themes: family, memory, school, geographical experiences, and values/beliefs. Multilevel modeling indicated patient-level differences, including greater rates of ESD when patients were men and older. Conclusion: ESD seems to be dependent on the context of the patient rather than individual communication style differences. Providers may use ESD in multiple instances, including when similar and different from patients. Innovation: This study introduces and defines the novel concept of ESD. It is among the first to examine patient-provider communication during Dignity Therapy, and the first to specifically examine self-disclosure.

BACKGROUND: Digital pain assessment is advantageous and timely for healthcare priorities in Turkey. However, a multi-dimensional, tablet-based pain assessment tool is not available in the Turkish language. PURPOSE: To validate the Turkish-PAINReportIt® as a multi-dimensional measure of post-thoracotomy pain. METHODS: In the first of a two-phased study, 32 Turkish patients (mean age 47.8 ± 15.6 years, 72 % male) participated in individual cognitive interviews as they completed the tablet-based Turkish-PAINReportIt® once during the first four days post-thoracotomy, and 8 clinicians participated in a focus group discussion of implementation barriers. In the second phase, 80 Turkish patients (mean age 59.0 ± 12.7 years, 80 % male) completed the Turkish-PAINReportIt® preoperatively, on postoperative days 1-4, and at the two-week post-operative follow-up visit. RESULTS: Patients generally interpreted accurately the Turkish-PAINReportIt® instructions and items. We eliminated some items unnecessary for daily assessment based on focus-group suggestions. In the second study phase, pain scores (intensity, quality, pattern) were low pre-thoracotomy for lung cancer and high postoperatively high on day 1, decreasing on days 2, 3 and 4, and back down to pre-surgical levels at 2-weeks. Over time, pain intensity decreased from post-operative day 1 to post-operative day 4 (p

Abstract Objectives To assess racial and ethnic minority parents’ perceptions about barriers to well-child visit attendance. Methods For this cross-sectional qualitative study, we recruited parents of pediatric primary care patients who were overdue for a well-child visit from the largest safety net healthcare organization in central Massachusetts to participate in semi-structured interviews. The interviews focused on understanding potential knowledge, structural, and experiential barriers for well-child visit attendance. Interview content was inductively coded and directed content analysis was performed to identify themes. Results Twenty-five racial and ethnic minority parents participated; 17 (68%) of whom identified Spanish as a primary language spoken at home. Nearly all participants identified the purpose, significance, and value of well-child visits. Structural barriers were most cited as challenges to attending well-child visits, including parking, transportation, language, appointment availability, and work/other competing priorities. While language emerged as a distinct barrier, it also exacerbated some of the structural barriers identified. Experiential barriers were cited less commonly than structural barriers and included interactions with office staff, racial/ethnic discrimination, appointment reminders, methods of communication, wait time, and interactions with providers. Conclusions Racial and ethnic minority parents recognize the value of well-child visits; however, they commonly encounter structural barriers that limit access to care. Furthermore, a non-English primary language compounds the impact of these structural barriers. Understanding these barriers is important to inform health system policies to enhance access and delivery of pediatric care with a lens toward reducing racial and ethnic-based inequities.

During the 2022 multicountry mpox outbreak, the United Kingdom identified cases beginning in May. UK cases increased in June, peaked in July, then rapidly declined after September 2022. Public health responses included community-supported messaging and targeted mpox vaccination among eligible gay, bisexual, and other men who have sex with men (GBMSM). Using data from an online survey of GBMSM during November–December 2022, we examined self-reported mpox diagnoses, behavioral risk modification, and mpox vaccination offer and uptake. Among 1,333 participants, only 35 (2.6%) ever tested mpox-positive, but 707 (53%) reported behavior modification to avoid mpox. Among vaccine-eligible GBMSM, uptake was 69% (95% CI 65%–72%; 601/875) and was 92% (95% CI 89%–94%; 601/655) among those offered vaccine. GBMSM self-identifying as bisexual, reporting lower educational qualifications, or identifying as unemployed were less likely to be vaccinated. Equitable offer and provision of mpox vaccine are needed to minimize the risk for future outbreaks and mpox-related health inequalities.

The new genus Kevinilla Bartholomay & Cambra includes the following four Neotropical species: Kevinilla ludovica (Cameron, 1895) comb. n. (the type species), K. bicarinata (Cambra & Quintero, 2008) comb. n., K. bimaculata (Cambra & Quintero, 2008) comb. n., and K. hansoni (Cambra & Quintero, 2008) comb. n., all transferred from Pseudomethoca. A neighbour joining tree clustered IST1 sequences of Kevinilla in a subclade of the main clade, which includes species of Pseudomethoca and Dasymutilla. Therefore, here Kevinilla is considered to be a member of the subfamily Sphaeropthalminae, tribe Pseudomethocini. A key for both sexes of the known species of Kevinilla is given, as well as an account of seasonal flight activity of males recorded over six years using Malaise traps on Barro Colorado Island, Panama.