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Older adults are the least physically active group with specific barriers to regular exercise, and online exercise programs could overcome some of those barriers. This scoping review aimed to describe the characteristics of supervised group-based synchronous online exercise programs for older adults living in the community, their feasibility, acceptability, and potential benefits. MEDLINE (Ovid), Embase, SPORTDiscus, and the Cumulative Index to Nursing and Allied Health Literature were searched until November 2022. The included studies met the following criteria: participants aged 50 years and above, a minimum of a 6-week group-based supervised and synchronous intervention, and original articles available in English. Eighteen articles were included, with 1,178 participants (67% female, average age of 71 [57–93] years), most (83%) published in the past 3 years. From the limited reported studies, delivering supervised, synchronous online exercise programs (one to three times/week, between 8 and 32 weeks) for older adults living in the community seems feasible, accepted, and can improve physical function. [ABSTRACT FROM AUTHOR]

Background: Physical Activity 4 Everyone (PA4E1) is a whole-school physical activity program, with demonstrated efficacy (2012–2014). PA4E1 was adapted (scaled-up) and tested in a scale-up trial (2017–2020). This process evaluation study of the scale-up trial had 2 aims. First, to describe the acceptability, appropriateness, and feasibility of PA4E1 in the scale-up trial, from the perspective of school staff involved in the program management and delivery. Second, to generate themes that may explain school staff assessments of acceptability, appropriateness, and feasibility. Methods: Data were collected at various time points throughout the 2-year implementation phase. Online surveys were collected from In-School Champions, Head Physical Education teachers, Principals, and Physical Education teachers (quantitative data). Focus groups and interviews were conducted with In-School Champions, Principals, and Physical Education teachers (qualitative data). Existing published data on website engagement, adaptations, modifications, and the scale-up trial primary outcome (implementation of physical activity practices) were triangulated with the quantitative and qualitative during analysis, to generate themes. Results: School staff delivering PA4E1 reported it was highly acceptable, appropriate, and feasible. Seven themes were generated relating to acceptability, appropriateness, and feasibility. The themes related to how the program was funded, the delivery modes of implementation support, the identification of easy-wins, the recruitment of the right in-school champion, facilitating principal buy-in, mitigating the impact of school staff turnover, and engaging the whole school. Conclusions: Recommendations are made to inform future adaptations for PA4E1 and potentially school-based physical activity programs more generally. The findings may inform future scalability assessments of the suitability of programs for scale-up. [ABSTRACT FROM AUTHOR]

BACKGROUND: Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app-based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. OBJECTIVE: This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. METHODS: Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the apps daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. RESULTS: A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58% (n=11) of them were female. Of the participants, 26% (n=5) were Chinese, 32% (n=6) were Vietnamese, and 42% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74% (n=14) in week 2 to 95% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. CONCLUSIONS: This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered.

Many older adults do not achieve recommended amounts of aerobic or strengthening exercise and high-intensity interval or circuit-based strengthening may offer a time-efficient solution. This review sought to determine the effects of high-intensity interval/circuit strengthening on physical and cognitive functioning for community-dwelling older adults, and its associated adherence, retention, and adverse events. Six databases were searched to June 2022 and 15 studies (11 for effectiveness) were included. The current certainty of evidence is low to very low; upper body-focused physical functioning measures demonstrated small to large benefits and lower body-focused, self-report, and cardiovascular measures had mixed results. There was insufficient evidence (one study) to determine cognitive effects. The mean adherence rates ranged from 73.5% to 95.8%, overall retention across all studies (n = 812) was 86%, and no serious adverse events were reported, suggesting that this type of exercise is feasible for community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Purchase decisions typically involve tradeoffs between attributes associated with desirability (e.g. quality) and feasibility (e.g. price). In this article, we examine how the decision context impacts consumers' preference between a high-desirability (HD) option and a high-feasibility (HF) alternative. Nineteen studies demonstrate a novel context effect, the "upscaling effect," whereby introducing a symmetrically dominated decoy option to a set (i.e. an option that is inferior compared to all alternatives in the set) leads to an increase in the choice share of the HD option. To account for the upscaling effect, we advance a two-stage model of consumer decision-making for decisions that involve tradeoffs between desirability and feasibility. According to our model, when the decision context provides a reason for choosing either option, such as when a decoy option is added to the set, consumers prioritize reasons that support choice of HD options over HF alternatives. Our model can explain the upscaling effect, as well as other findings reported in the literature, such as asymmetric attraction effects (Heath and Chatterjee 1995) and asymmetric sales promotion effects (Blattberg and Wisniewski 1989). Furthermore, the upscaling effect holds important managerial implications because it provides an effective way to increase sales of high-end products. [ABSTRACT FROM AUTHOR]

BackgroundGlioblastoma (GBM) is a clinically challenging primary brain tumor with poor survival outcome despite surgical resection and intensive chemoradiation. The metabolic heterogeneity of GBM can become biomarkers for treatment response, resistance, and outcome prediction. The aim of the study is to investigate metabolic distinctions between primary and recurrent GBM tissue and patient plasma to establish feasibility for metabolic profiling.MethodsA single-center cohort study analyzed tissue and blood samples from 15 patients with GBM using untargeted metabolomic/lipidomic assays. Metabolomic, lipidomic, and biogenic amine analyses were conducted on GBM tissue and patient plasma at diagnosis and recurrence using untargeted mass spectrometry. The study utilized a small but longitudinally collected cohort to evaluate alteration in metabolites, lipids, and biogenic amines between specimens at diagnosis and recurrence.ResultsExploratory analysis revealed significant alteration in metabolites, lipids, and biogenic amines between diagnostic and recurrent states in both tumor and plasma specimens. Notable metabolites differed at recurrence, including N-alpha-methylhistamine, glycerol-3-phosphate, phosphocholine, and succinic acid in tissue, and indole-3-acetate, and urea in plasma. Principal component analysis revealed distinct metabolomic profiles between tumor tissue and patient plasma. Distinct metabolic profiles were observed in GBM tissue and patient plasma at recurrence, demonstrating the feasibility of using metabolomic methodologies for longitudinal studies. One patient exhibited a unique tumor resistance signature at diagnosis, possibly indicating a high-risk metabolomic phenotype.ConclusionsIn this small cohort, the findings suggest the potential of metabolomic signatures of GBM tissue and patient plasma for risk stratification, outcome prediction, and the development of novel adjuvant metabolic-targeting therapies. The findings suggest metabolic discrepancies at diagnosis and recurrence in tissue and plasma, highlighting potential implications for evaluation of clinical response. The identification of significant changes in metabolite abundance emphasizes the need for larger studies using targeted metabolomics to validate and further explore these profiles.

BACKGROUND: This studys aims are to: (1) Compare the acceptability and feasibility of five types of implementation strategies that could be deployed to increase the reach of evidence-based practices (EBPs) with revenue from policies that earmark taxes for behavioral health services, and (2) Illustrate how definitions of implementation strategies and measures of acceptability and feasibility can be used in policy-focused implementation science research. METHODS: Web-based surveys of public agency and community organization professionals involved with earmarked tax policy implementation were completed in 2022-2023 (N = 211, response rate = 24.9%). Respondents rated the acceptability and feasibility of five types of implementation strategies (dissemination, implementation process, integration, capacity-building, and scale-up). Aggregate acceptability and feasibility scores were calculated for each type of strategy (scoring range 4-20). Analyses of variance compared scores across strategies and between organizational actor types. FINDINGS: For acceptability, capacity-building strategies had the highest rating (M = 16.3, SD = 3.0), significantly higher than each of the four other strategies, p ≤ . 004), and scale-up strategies had the lowest rating (M = 15.6). For feasibility, dissemination strategies had the highest rating (M = 15.3, significantly higher than three of the other strategies, p ≤ .002) and scale-up strategies had the lowest rating (M = 14.4). CONCLUSIONS: Capacity-building and dissemination strategies may be well-received and readily deployed by policy implementers to support EBPs implementation with revenue from taxes earmarked for behavioral health services. Adapting definitions of implementation strategies for policy-focused topics, and applying established measures of acceptability and feasibility to these strategies, demonstrates utility as an approach to advance research on policy-focused implementation strategies.

Background: Fear of cancer recurrence (FCR) is common, persistent, and is associated with lower quality of life, impaired functioning, and psychological distress in cancer patients. Studies suggest that family caregivers of cancer patients experience equal or greater levels of FCR than patients themselves. In the past 5 years, several interventions have demonstrated their ability to reduce FCR among cancer patients and in patient-caregiver dyads. However, to date, no intervention exists to individually target family caregiver's FCR. The aims of the proposed pilot study are to (1) assess the feasibility and acceptability of the newly adapted Family Caregiver–Fear Of Recurrence Therapy (FC-FORT) intervention to inform a larger randomized control trial study, and (2) estimate the clinical significance of FC-FORT. Initial evaluation of FC-FORT revealed high user satisfaction and usability. Methods: A parallel, two-group, pilot randomized controlled trial comparing FC-FORT to a waitlist control (care as usual) will be conducted. Participant inclusion criteria are (a) women family caregivers taking care of adult cancer patients (no recurrence), (b) experiencing clinical levels of FCR, (c) access to a computer/internet connection, and (d) living in Canada. Participants (n = 36) will be recruited at Ottawa and Toronto hospitals, previous study participant pools, through social media and community partners across Canada. Participants in the intervention group will complete the FC-FORT intervention (7 consecutive weeks of virtual group therapy and homework). Participants in the control group will be offered the intervention after their participation in the study. All participants will be asked to complete questionnaire packages at baseline (T0), immediately post-intervention (7 weeks; T1) and at 3-months post-intervention (T2). Feasibility (e.g., recruitment, allocation, fidelity), acceptability (e.g., dropout, completion, satisfaction) and clinical significance of secondary outcomes will be evaluated (i.e., FCR illness uncertainty). Participants in the intervention group will be asked to complete measures of group cohesion and therapeutic alliance and take part in a semi-structured exit interview exploring their overall experience with FC-FORT. Discussion: This project will evaluate the acceptability and feasibility of the newly adapted FC-FORT to inform a larger trial. Trial registration: NCT, NCT05441384. Registered July 1st, 2022, https://classic.clinicaltrials.gov/ct2/show/NCT05441384 [ABSTRACT FROM AUTHOR]

Background: Management of benign vocal fold lesions (BVFLs) is variable with individuals receiving surgery, voice therapy, or a combination of these approaches. Some evidence suggests that the best outcomes may be achieved when patients are offered pre- and post-operative voice therapy in addition to phonosurgery, but what constitutes pre- and post-operative voice therapy is poorly described. The pre- and post-operative voice therapy (PAPOV) intervention has been developed and described according to the TIDieR checklist and Rehabilitation Treatment Specification System (RTSS) for voice. The PAPOV intervention is delivered by specialist speech and language therapists trained in the intervention and comprises 7 essential and 4 additional components, delivered in voice therapy sessions with patients who are having surgery on their vocal folds for removal of BVFLs. Study design: Non-randomised, multicentre feasibility trial with embedded process evaluation. Method: Forty patients from two sites who are due to undergo phonosurgery will be recruited to receive the PAPOV intervention. Measures of feasibility, including recruitment, retention, and adherence, will be assessed. The feasibility of gathering clinical and cost effectiveness data will be measured pre-treatment, then at 3 and 6 months post-operatively. An embedded process evaluation will be undertaken to explain feasibility findings. Discussion: This study will assess the feasibility of delivering a described voice therapy intervention protocol to patients who are undergoing surgery for removal of BVFLs. Findings will be used to inform the development and implementation of a subsequent effectiveness trial, should this be feasible. Trial registration: This trial has been prospectively registered on ISRCTN (date 4th January 2023), registration number 17438192, and can be viewed here: https://www.isrctn.com/ISRCTN17438192. [ABSTRACT FROM AUTHOR]

Background: The CapaCiTY programme includes three, multi-centre, randomised controlled trials aiming to develop an evidence based adult chronic constipation treatment pathway. The trials were conducted in the United Kingdom, National Health Service, aiming to recruit 808 participants from 26 March 2015 to 31 January 2019. Sites were selected based on their responses to site feasibility questionnaires (2014–2015), a common tool employed by sponsors to assess a site's recruitment potential and ability to undertake the trial protocol. Failure to recruit the planned sample jeopardises reliability of results and wastes significant time and resources. The purpose of this study was to investigate barriers to recruitment in 2017. Methods: We conducted site feasibility assessments with thirty-nine sites prior to trial commencement. Twenty-seven were selected to participate in the CapaCiTY programme, twelve were deemed unsuitable. We compared site contracted recruitment rates with actual recruitment rates and conducted a telephone survey and analysis from 5 July to 7 December 2017 (n = 24) to understand barriers to recruitment. Three sites declined to participate in the survey. Results: At the time of survey, 15% of sites in the CapaCiTY programme were meeting recruitment targets, 85% were recruiting half or less of their target. Of these, 28% recruited no participants. The main barriers to recruitment were lack of resources, high workloads, lack of suitable participants and study design not being compatible with routine care. Despite multiple strategies employed to overcome these barriers, the trials were eventually stopped due to futility, recruiting only 34% of the programme sample size. Conclusions: Improving the reliability of site feasibility assessments could potentially save a substantial amount in failed research investments and speed up the time to delivery of new treatments. We recommend 1) investment in training researchers in conducting and completing site feasibility; 2) funders to require pilot and feasibility data in grant applications, with an emphasis on patient and public involvement in trial design; 3) conducting site feasibility assessment at the pre-award stage; 4) development of a national database of sites' previous trial recruitment performance; 5) data-driven site level assessment of recruitment potential. Trial registration: ISRCTN11791740; 16/07/2015, ISRCTN11093872; 11/11/2015, ISRCTN11747152; 30/09/2015. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsTrial registration\nIMPLICATIONS FOR REHABILITATIONTo examine the feasibility of a combined, personalized exercise and nutrition intervention in hospitalized patients at risk of sarcopenia.The study is part of the FITFOOD randomized controlled trial. Eligible patients were randomized into two groups: receiving a personalized nutrition and exercise intervention, or receiving usual care. The intervention entailed a high-protein diet with daily protein supplementation combined with functional training with strength and aerobic exercises. Feasibility was assessed using quantitative data, such as recruitment rate, and qualitative data retrieved from focus group and individual semi-structured interviews.In total, 14 out of 115 eligible patients participated. The recruitment rate was 12%, and the dropout rate was 50% (7 out of 14 participants). Patients at risk for sarcopenia found it difficult to be involved in a lifestyle intervention, because they were often preoccupied with their recovery, had little interest in changing their diet or level of exercise, and were often unable to participate fully due to health issues and mobility difficulty.The evaluated combined, personalized lifestyle intervention had limited feasibility in hospitalized patients at risk for sarcopenia, with low recruitment and high dropout rates. The current lifestyle intervention might be too challenging for this vulnerable population.The trial associated with this feasibility study was pre-registered on ClinicalTrials.gov under the registration number NCT05413616 on 07 June 2022.Rehabilitation healthcare professionals must tailor lifestyle interventions for populations at risk for sarcopenia on patients’ disease burden, preferences, and challenges.Rehabilitation healthcare professionals should make lifestyle interventions an integral part of usual care because lifestyle interventions otherwise will be perceived as an additional burden.A combined, personalized lifestyle intervention, consisting of nutritional and exercise components, may be supported by daily protein supplements and comprehensive physiotherapy guidance.Rehabilitation healthcare professionals must tailor lifestyle interventions for populations at risk for sarcopenia on patients’ disease burden, preferences, and challenges.Rehabilitation healthcare professionals should make lifestyle interventions an integral part of usual care because lifestyle interventions otherwise will be perceived as an additional burden.A combined, personalized lifestyle intervention, consisting of nutritional and exercise components, may be supported by daily protein supplements and comprehensive physiotherapy guidance. [ABSTRACT FROM AUTHOR]

AbstractBackgroundPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONPersisting Symptoms after Concussion (PSaC) are common and difficult to treat. Mindfulness-based interventions can support recovery but are rarely included in rehabilitative care. We developed OWNMindfulness, an eight-week live-video mindfulness-based group for PSaC.To assess feasibility and preliminary clinical effects of OWNMindfulness.Fourteen individuals with PSaC enrolled in this mixed-methods single-arm feasibility study. We assessed enrollment/retention, adherence, fidelity, instrument completion, safety, and satisfaction. We evaluated preliminary trends in the impact of the intervention on mindfulness (CAMS-R), concussion symptoms (PCSS), and QOL (WHOQOL-BREF). Qualitative analysis of exit interviews explored participants’ perceptions of the effects of the intervention, and framework analysis assessed adequacy of the quantitative measures to capture perceived effects.Feasibility results met a priori benchmarks. Mindfulness, concussion symptoms, and QOL scores improved (CAMS-R: adjusted p = 0.01, large effect size; PCSS: adjusted p = 0.03, moderate effect size; WHOQOL-BREF: not significant, small effect size). Qualitative analysis of interview data found benefits including validation, compassion, self-awareness, self-efficacy, concussion symptoms, resilience, life participation, social relationships, and QOL. Framework analysis demonstrated that quantitative tools captured change in concussion symptoms but did not comprehensively assess the other benefits identified through qualitative methods.OWNMindfulness shows preliminary feasibility and promise for improving clinical outcomes. Results suggest the need for additional quantitative tools for comprehensive measurement of the effects and may point to potential mechanisms of action.Integration of mindfulness-based interventions in standard rehabilitation care for persistent concussion symptoms has potential to boost recovery for this difficult to treat population.OWNMindfulness, a live-video mindfulness-based group intervention, can be delivered in a clinical education setting.People with persistent concussion symptoms may benefit from validation from providers and peers, self-compassion, self-awareness, and self-efficacy to support resilience and recovery.Integration of mindfulness-based interventions in standard rehabilitation care for persistent concussion symptoms has potential to boost recovery for this difficult to treat population.OWNMindfulness, a live-video mindfulness-based group intervention, can be delivered in a clinical education setting.People with persistent concussion symptoms may benefit from validation from providers and peers, self-compassion, self-awareness, and self-efficacy to support resilience and recovery. [ABSTRACT FROM AUTHOR]

Background: Hypertension, or high blood pressure, is a key modifiable risk factor for heart disease and stroke. International guidelines have highlighted 'poor adherence to treatment' and 'physician inertia' as major barriers to effective blood pressure management. The Maximising Adherence, Minimising Inertia (MIAMI) intervention, a theory-based complex intervention, supports General Practitioners (GPs) and people with hypertension in maximising medication use to manage blood pressure. This pilot cluster randomised control trial (RCT) aimed to collect and analyse feasibility data to refine the MIAMI intervention and assess the feasibility of a definitive RCT. Method: A pilot cluster RCT with a MIAMI intervention arm and usual care control arm was conducted. Quantitative data collection consisting of clinical measures and a self-report questionnaire took place at baseline and twelve week follow up. Semi-structured interviews with GP and patient participants were conducted. Fidelity (as measured by a protocol checklist and through qualitative interviews) and health economics costings were assessed. Results: Six GP practices (intervention arm n = 3, control arm n = 3) and 52 patients (intervention arm n = 25, control arm n = 27) took part. All six GP practices and 92% of patients were retained. Fidelity, as measured by a checklist and through qualitative interviews, was good but three deviations from protocol were identified. Outcomes and measures used were acceptable. The implementation cost of the MIAMI intervention was estimated at €490 per participant. The qualitative data demonstrated that the intervention was considered acceptable and feasible by both GP and patient participants, except for the urine test component, which GPs found difficult to incorporate into practice due to logistical challenges. Conclusions: The MIAMI intervention was considered largely acceptable and feasible. Some changes to both intervention components and trial processes are required but with these in place a definitive RCT could be considered worthwhile. Trial registration: ISRCTN registry, ISRCTN85009436, registered 17/1/23. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of evidence-based treatments for anorexia nervosa (AN), remission rates are moderate, and mortality is high. Olanzapine is used as adjunct therapy for AN in case of insufficient response to first-line treatments, even though the evidence is limited. Its effect on eating disorder (ED) psychopathology, its efficacy and tolerability, and its acceptability and adherence rate are unclear. Methods: We assessed the feasibility of a future definitive trial on olanzapine in young people with AN in an open-label, one-armed feasibility study that aimed to include 55 patients with AN or atypical AN aged 12–24 who gained < 2 kg within at least one month of treatment as usual (TAU) during outpatient, inpatient, or day-care treatment. Time points for assessments were at baseline, 8 weeks, 16 weeks, and 6 or 12 months. We estimated the following planning parameters: Recruitment rate (number of patients who agreed to take olanzapine/number eligible), adherence rate (number adhering to treatment/number recruited) and attrition rate (number completing study assessments/number recruited). In addition, two exploratory effect size parameters were estimated: Mean change in body mass index (BMI) and mean change in ED psychopathology. Results: Fifty-two people were pre-screened (June 2022 to May 2023; 10 study sites in England). 13 were ineligible at pre-screening. Of the 39 approached, 4 were found ineligible at screening. Of the remaining 35 eligible, 10 declined and 5 did not take part for other reasons. Thus, 20 participants were recruited and started olanzapine (recruitment rate: 20/35 = 57%). 15 out of 20 (75%) continued olanzapine for ≥ 16 weeks, and 13 participants (65%) remained in the trial until follow-up (either 6 or 12 months). Participants experienced, on average, a decrease over time in their Eating Disorder Examination Questionnaire (EDE-Q) Global scores (0.07 per week, N = 20) and an increase in BMI (0.08 kg/m2 per week, N = 20) during treatment with olanzapine plus TAU. Conclusions: Possible reasons for the recruitment difficulties and low adherence rate include the high clinical workload of ED services during the COVID-19 pandemic and the reluctance of patients to agree to take olanzapine under the relatively restricted conditions of a clinical study. Trial registration: International standard randomised controlled trial register number: ISRCTN80075010. Registration date: 27/04/2022. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals face high levels of occupational stress, time pressure, workload, and poor organizational support. This makes them particularly vulnerable to burnout. The COVID-19 pandemic has further exacerbated this situation. This single-arm, multicenter, mixed-methods feasibility study pilots the LAGOM program: A tailored, evidence-based intervention to prevent burnout and reduce stress among healthcare professionals. Methods: Participants will include healthcare professionals (N = 30) working at Charité–Universitätsmedizin Berlin and Immanuel Hospital, Berlin. LAGOM focuses on support for individual behavior change and personal resources and also addresses the organizational level. The intervention´s feasibility will be evaluated through a non-randomized feasibility trial with a mixed methods process evaluation. The exploratory primary study aims are to assess the acceptability and feasibility of the (1) evaluation procedures and of the (2) intervention content and structure using study records, standardized questionnaires, protocol checklists, and diaries. Exploratory effectiveness analysis will take place as well. Further, semi-structured interviews (n = 3 to 6) and electrophysiological measurements (n = 20) will be conducted. Discussion: Custom-tailored, well-implemented multi-level interventions are needed to prevent burnout and reduce stress among healthcare professionals. Long-term strategies are warranted to sustainably implement effective programs. This feasibility study helps to refine trial procedures and content of the LAGOM program for a randomized controlled trial to evaluate the intervention's effectiveness. Trial registration: German Clinical Trials Register: DRKS00032014, registered 17th October 2023. [ABSTRACT FROM AUTHOR]

Background: Pre-frailty is a window of opportunity for frailty reversal and can be enhanced by multicomponent exercise. The Lifestyle-integrated Functional Exercise (LiFE) program may be a promising alternative to overcome traditional exercise barriers. The latest advancements in mobile health (mHealth) technology have enabled individuals to retain the advantages of supervised exercise training within group settings while providing exercise programs that can be accessed and completed at home. This study aims to assess the feasibility, acceptability, and primary efficacy of the PF-Life program, which is the Lifestyle-Integrated Functional Exercise program for Pre-Frail supported by an mHealth platform. Methods: Sixteen pre-frail adults aged ≥ 65 years were recruited from five community health centers in Fuzhou, China. All participants were prescribed the PF-Life program by geriatricians using the mhealth platform (web-based portal). Participants engaged in the customized exercises program following in-app video instructions and feedback on the mhealth platform (smartphone application). Physical activity (PA) and sedentary behavior (SB) were registered daily through wearable devices. Study endpoints were feasibility (retention rate, compliance rate, adverse events), usability (system usability scale), acceptability (qualitative interviews), changes in physical function (timed up and go (TUG), handgrip strength (HGS), and 30-second chair rise tests), PA and SB. Results: The intervention was feasible, 88% of participants adhered completely to the study protocol, and 95% had completed at least 75% of the prescribed experimental duration. System usability was high (85 out of 100 best imaginable). Changes were observed from baseline to follow-up for total HGS (21.41 ± 6.38 vs. 24.12 ± 6.62 kg, P < 0.05, d = 0.714), TUG (8.23 ± 1.33 vs. 7.48 ± 2.01 s, P < 0.01, d = 1.647) and 30-second chair rise test (17.13 ± 4.3 vs. 20.04 ± 4.54 repetitions, P < 0.01, d = 0.94). In addition, SB decreased by a mean of 33 min/day (P < 0.01), and low physical activity increased by 31 min/day (P < 0.01). No adverse events occurred. The majority of participants found the PF-Life program to be straightforward, adaptable, and easily integrable into their daily routines. Conclusions: Preliminary studies have demonstrated that the PF-life program exhibits good compliance, safety, and usability for the pre-frail elderly population. Large-scale randomized controlled trials are required to ascertain its long-term effectiveness. [ABSTRACT FROM AUTHOR]

Background: Social networks play a critical role in the mental health of older adults. This pilot study investigates the feasibility of a newly developed intervention to enhance older adults' social networks. This intervention was designed on the Theory of Mind's foundation and aimed to enhance older adults' social interaction motivation through theoretical explanations. Furthermore, the courses fostered more social opportunities for the participants through group-based sessions. Methods: The feasibility of this intervention was tested using a double-blind, two-arm, non-randomized grouping approach. Older individuals residing in two separate residential buildings (n = 31, mean age = 66.81, 48% women) were divided into an intervention group (n = 15) and a control group (n = 16). They attended daily group sessions at a designated location and completed homework assignments. The primary outcomes of this pilot study were the feasibility of the intervention, and secondary outcomes included Theory of Mind levels and social network indicators. Additional outcomes encompassed levels of global mental health and depression. Results: All participants completed the pilot intervention and completed assessments. The primary outcomes indicated that the intervention had excellent feasibility, including compliance (attendance and homework completion rates met the standards) and satisfaction (average ratings for all items ranged from 4.47 to 5.00 on a 5-point scale). Interview results revealed that participants in the intervention group found the intervention beneficial for their daily lives and expressed a desire to participate in a formal intervention. Regarding secondary and additional outcomes, compared to the control group, the intervention group exhibited a significant improvement in emotional recognition performance of Theory of Mind. There was a significant increase in the whole network density in the intervention group. There were no significant differences in other social network indicators, global mental health, and depression levels in the intervention group compared to the control group. Conclusions: The social network enhancement intervention for older adults is feasible. This pilot study has identified several improvements in the courses and tests. It is necessary to carry out a formal course to examine the effectiveness of the intervention on social networks in older adults. Trial registration: Registration number: ChiCTR2100053779; Reg Date: 29/11/2021. [ABSTRACT FROM AUTHOR]

Studies have shown a high prevalence of trauma and PTSD among patients with severe mental illness, but relatively few studies have examined the outcomes of PTSD treatment for this patient group. The aim of this case-series was to assess the feasibility of a Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) intervention for PTSD in people with psychosis. The study examined the possibilities and obstacles when treating this population within clinical settings. Patients were selected from four community mental health centers and were screened for traumatic experiences and symptoms of PTSD. A small group of eligible participants (n=7) received manualized TF-CBT adapted for patients with psychosis. Experienced therapists received training and supervision in the intervention. Symptoms of PTSD and psychosis were assessed at baseline and post-treatment along with quality of life, level of functioning, alliance, life events, engagement, suicidal ideation and adverse events. Treatment fidelity and the different combinations of treatment modules were monitored in regard to implementation. Three cases were selected as illustrative of the different treatment courses when implementing the TF-CBT intervention within this population. Detailed case descriptions were based on quantitative ratings and the therapists' experiences with the therapy. Results from the case series highlighted issues regarding toleration of treatment, large variation in psychopathology and the task of matching treatment needs with appropriate therapeutic techniques. The complexity of the patient group may affect treatment and clinical research studies. Lessons learned from this case series can contribute to the future development implementation and evaluation of trauma treatment for patients with psychosis. [ABSTRACT FROM AUTHOR]

This work utilizes the particle swarm optimization (PSO) for optimal sizing of a solar–wind–battery hybrid renewable energy system (HRES) for a rural community in Rivers State, Nigeria (Okorobo-Ile Town). The objective is to minimize the total economic cost (TEC), the total annual system cost (TAC) and the levelized cost of energy (LCOE). A two-step approach is used. The algorithm first determines the optimal number of solar panels and wind turbines. Based on the results obtained in the first step, the optimal number of batteries and inverters is computed. The overall results obtained are then compared with results from the Non-dominant Sorting Genetic Algorithm II (NGSA-II), hybrid genetic algorithm–particle swarm optimization (GA-PSO) and the proprietary derivative-free optimization algorithm. An energy management system monitors the energy balance and ensures that the load management is adequate using the battery state of charge as a control strategy. Results obtained showed that the optimal configuration consists of solar panels (151), wind turbine (3), inverter (122) and batteries (31). This results in a minimized TEC, TAC and LCOE of USD 469,200, USD 297,100 and 0.007/kWh, respectively. The optimal configuration when simulated under various climatic scenarios was able to meet the energy needs of the community irrespective of ambient conditions. [ABSTRACT FROM AUTHOR]

This study verifies the practicality of using finite element analysis for strain and deformation analysis in regions with sparse GNSS stations. A digital 3D terrain model is constructed using DEM data, and regional rock mass properties are integrated to simulate geological structures, resulting in the development of a 3D geological finite element model (FEM) using the ANSYS Workbench module. Gravity load and thermal constraints are applied to derive directional strain and deformation solutions, and the model results are compared to actual strain and tilt measurements from the Jiujiang Seismic Station (JSS). The results show that temperature variations significantly affect strain and deformation, particularly due to the elevation difference between the mountain base and summit. Higher temperatures increase thermal strain, causing tensile effects, while lower temperatures reduce thermal strain, leading to compressive effects. Strain and deformation patterns are strongly influenced by geological structures, gravity, and topography, with valleys experiencing tensile strain and ridges undergoing compression. The deformation trend indicates a southwestward movement across the study area. A comparison of FEM results with ten years of strain and tiltmeter data from JSS reveals a strong correlation between the model predictions and actual measurements, with correlation coefficients of 0.6 and 0.75 for strain in the NS and EW directions, and 0.8 and 0.9 for deformation in the NS and EW directions, respectively. These findings confirm that the 3D geological FEM is applicable for regional strain and deformation analysis, providing a feasible alternative in areas with limited GNSS monitoring. This method provides valuable insights into crustal deformation in regions with sparse strain and deformation measurement data. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and safety of total laparoscopic hysterectomy (TLH) without uterine manipulator for patients with early-stage cervical cancer. Methods: This study was based on retrospective analysis of clinical data of 72 patients with early-stage cervical cancer who received TLH treatment in Meizhou People's Hospital from January 2018 to December 2020. Of them, 40 patients underwent routine TLH (control group), and 32 patients received TLH without lifting the uterus using uterine manipulator (observation group). Changes in tumor marker levels, human papilloma virus (HPV) status, complications, and survival between two groups of patients were compared. Results: There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). After the surgery, levels of squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen (CEA), and cancer antigen 125 (CA-125) in both groups of patients were significantly reduced compared to before the surgery, and significantly lower in the observation group compared to the control group at one and two years after the surgery (P<0.05). After three years of postoperative follow-up, there was no significant difference in cumulative survival rates between the two groups (P>0.05). Conclusions: Compared with conventional laparoscopy, hysteroscopy without the use of uterine manipulators can significantly reduce the levels of SCC-Ag, CEA, and CA-125 in patients with early-stage cervical cancer within two years after the surgery, without increasing postoperative complications or affecting survival, and has the same safety. [ABSTRACT FROM AUTHOR]

Background: Amid the increasing trend and huge impact of mental illness, psychosocial support (PSS) has been asserted to support individuals' recovery. Unfortunately, about 80% of affected people cannot access care as needed. Meanwhile, digital technology has a considerable role in closing service gaps. Aims: This convergent parallel mixed methods study examines existing mental health service utilization, users' needs for PSS, and feasibility of online PSS development. Methods: A cross-sectional interview survey was conducted using a semi-structured questionnaire at a super tertiary psychiatric hospital in Thailand from March to May 2023, with three groups of service users, having self-perceived conditions/diagnosis of schizophrenia (n = 100), mood disorders (n = 84), and others including alcohol and substance use, anxiety and personality disorders (n = 52). Four focus group discussions with three user groups (n = 16) and one multidisciplinary provider group (n = 7) were parallelly executed. Quantitative and qualitative data were convergently analyzed using descriptive and inferential statistics, and thematic and content analysis. Results: Critical shortcomings of PSS were indicated by 75.8% of user participants. Six common types of self-determined PSS were psychoeducational program, support group, skills training, counseling, supported employment, and complimentary therapy. While psychoeducational program was feasible, support group, and counseling were possibly featured within the 'all-at-once' online intervention development. Conclusions: PSS development based on users' needs can promote clinical and personal recovery outcomes, and close the service gaps. Users with mood disorders have the potential for online interventions. Peer-provider formalization, co-production approach, community engagement, digital literacy, infrastructures, and equal access factors are crucial for sustainable development. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to establish the feasibility of delivering a structured post‐diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings. Design: A two‐phase explanatory mixed‐method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five‐part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self‐efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility. Methods: Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post‐programme and 3‐month follow‐up. Post‐programme semi‐structured interviews were conducted with dyads and programme facilitators. Results: Twenty‐nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members. Conclusion: Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow‐up time to 6 months. Impact: This study established the feasibility of registered nurses delivering a post‐diagnosis information and support programme for people living with early‐stage dementia or mild cognitive impairment and their informal carers in primary care settings.The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time.Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance.Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting. Reporting Method: The authors have adhered to the EQUATOR STROBE Statement. Patient or Public Contribution: A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation. [ABSTRACT FROM AUTHOR]

Aim: Our study investigates the feasibility and utility of implementing a dual joystick-operated ride-on-toy navigation training (RNT) program within a 3-week intensive camp based on principles of modified constraint-induced movement therapy and bimanual training, to improve upper extremity (UE) function in children with unilateral cerebral palsy (UCP). Methods: We employed a single-group pretest posttest, mixed methods study design. Eleven 4-to-10-year-old children with UCP received RNT as part of camp activities. Sessions required children to use both arms together for navigation and completing gross and fine motor UE challenges. We collected exit questionnaires from children, caregivers, and clinicians to assess the feasibility, acceptance, enjoyment, and perceived efficacy of RNT. Videos of training sessions were coded using Datavyu behavioral coding software to assess children's facial expressions and affective states, indicative of their level of engagement during intervention sessions. Results: We found high levels of child engagement during RNT sessions based on video data and stakeholder feedback. The RNT program was smoothly integrated into the camp. Stakeholders acknowledged the highly motivating nature of RNT. When combined with other camp activities, the program led to stakeholder-reported improvements in bimanual skills and spontaneous daily use of the affected UE. Conclusions: Our pilot study provides promising evidence for using joystick-operated ride-on toys as engaging therapy adjuncts. Our findings call for future studies to systematically assess the efficacy of these devices in improving UE function among children with UCP. [ABSTRACT FROM AUTHOR]

Strategic incremental rehearsal (SIR) is an efficacious flashcard intervention shown to improve foundational skill acquisition. However, there is limited research examining the feasibility and effectiveness of SIR when used by school‐based implementers. We present two studies to address this limitation. Study 1 examined the effects of SIR implemented by teachers on the acquisition of grapheme‐phoneme correspondences with three at‐risk kindergarteners. Study 2 examined the effects of SIR implemented by a same‐age peer on the acquisition and fluency of addition math facts with 3 second‐grade students receiving special education services. Overall, both studies point to the effectiveness of using SIR with students requiring intensive intervention in an focused, short timeframe. The effectiveness of SIR is particularly salient given that teachers and peers were able to implement SIR with high treatment integrity and effectively improve outcomes for students with and at risk for disabilities. Practitioner points: Letter‐sound outcomes improved for struggling kindergarteners when SIR was implemented by teachers.Acquisition and fluency of addition math facts improved when SIR was implemented by a same‐age peer tutor for second graders with learning disabilities.Teachers and peers implemented SIR with high levels of treatment fidelity even after feedback was faded. [ABSTRACT FROM AUTHOR]

Objectives: Body image disturbance is prevalent in people with endometriosis. This study aimed to explore the feasibility, acceptability and preliminary efficacy of the My Changed Body (MyCB) writing activity for body image in people with endometriosis. Design: Two‐arm randomized controlled pilot and feasibility study. Methods: Australian adults living with endometriosis who identified as having had a negative endometriosis‐related body image experience were recruited online through Endometriosis Australia. Participants completed a baseline survey capturing demographic and health data before being randomized into the MyCB or control writing conditions. Additional assessment was administered post‐activity and at 1‐week follow‐up. Results: A total of 82 participants were recruited and randomized (Mage = 32 years, SD = 7.8). MyCB participants were less likely to complete the writing tasks compared to the control group (51% vs. 83%); MyCB completers had lower self‐compassion and quality of life, and higher psychological distress, compared to those who dropped out. The MyCB activity received good satisfaction rates (47%–87%). However, there was significant drop‐out in the MyCB group (n = 4 vs. 13 at 1‐week follow‐up). Limited‐efficacy testing showed an increase in the self‐compassion self‐identification for the MyCB group. Conclusions: The MyCB writing activity may be feasible for people with endometriosis. A future larger trial will benefit from several methodology changes to enhance recruitment and retention. Trial Registration: Australian and New Zealand Clinical Trial Registry ACTRN12622000496718; Date: 29/3/2022; retrospectively registered. [ABSTRACT FROM AUTHOR]

This study aimed to assess the diagnostic accuracy of smartphone photographs, taken at the emergency department (ED) and shared with hand surgeons, in identifying critical circulatory issues and neurovascular bundle injury, as well as tendon and bone injuries. The photographs of hand injuries of 50 patients who were referred to our ED between January 2020 and January 2022 were used to design a questionnaire. This questionnaire, including closed-ended questions about the injured structures, was shared with a group of hand surgeons via a WhatsApp group in Turkey. The experience levels of the surgeons were categorized as 0–5 years, 5–10 years, and above 10 years. Diagnostic accuracy was assessed by comparing the results with surgery notes as the reference standard. A total of 94 hand surgeons participated in the study. The accuracy of predicting critical circulatory issues in the hand/fingers from the smartphone photographs was 81.9%, with a sensitivity of 48.0% and a specificity of 91.4%. For neurovascular bundle injuries, the accuracy was 63.0%, with a sensitivity of 63.9% and a specificity of 61.5%. The accuracy of predicting tendon injuries was 64.9%, with a sensitivity of 81.1% and a specificity of 42.5%. The accuracy of predicting fracture was 74.7%, with a sensitivity of 70.9% and a specificity of 79.9%. Identifying critical circulatory issues solely based on the shared photograph is inadequate. Similarly, evaluation based only on the photograph was insufficient for the detection of neurovascular bundle injuries, tendon ruptures, and fractures. Digital images acquired in an ED setting and subsequent review of these images by hand surgeons may not be an adequately reliable strategy for determining the necessity of patient transfer. [ABSTRACT FROM AUTHOR]

Sexually minoritized men (SMM) with HIV who use stimulants experience difficulties achieving and maintaining an undetectable viral load (VL). Home-based VL monitoring could augment HIV care by supporting interim, early identification of detectable VL. We describe implementation challenges associated with a home-collection device for laboratory-based VL testing among SMM with HIV who use stimulants. From March-May 2022, cisgender SMM with HIV reporting moderate-to-severe stimulant use disorder and suboptimal (< 90%) past-month antiretroviral therapy (ART) adherence were recruited via a consent-to-contact participant registry. Eligible men completed teleconference-based informed consent and were mailed a HemaSpot-HD blood collection device (volume capacity 160 µL; lower limit of detection 839 copies/mL) with detailed instructions for home blood self-collection and return shipment. Implementation process measures included estimated blood volume and VL quantification. Among 24 participants, 21 (88%) returned specimens with a median duration of 23 days (range: 10–71 days) between sending devices to participants and receiving specimens. Of these, 13/21 (62%) included enough blood (≥ 40 µL) for confidence in detectable/undetectable results; 10/13 (77%) had detectable VL, with 4/10 (40%) were quantifiable at ≥ 839 copies/mL. The remaining 8/21 had low blood volume (< 40 µL), but 3/8 (38%) still had detectable VL, with 1/3 (33%) quantifiable at ≥ 839 copies/mL. Home blood collection of ≥ 40 µL using HemaSpot-HD was feasible among this high-priority population, with > 50% having a VL detected. However, interim VL monitoring using HemaSpot-HD among those experiencing difficulties with ART adherence may be strengthened by building rapport via teleconferencing and providing detailed instructions to achieve adequate sample volume. [ABSTRACT FROM AUTHOR]

This paper is intended to support hand surgeons who, at the beginning of their research career, are planning a clinical study. Besides establishing the research methodology of the study, the organizational planning of the work itself is essential. A feasibility analysis carried out before or during the writing of the study protocol helps to estimate the required resources and duration of a project. We highlight some tips and tricks as well as provide checklists that outline the important points to consider before starting a study. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials (RCTs) are considered the gold standard for generating clinical evidence. The focus on high internal validity in RCTs challenges the external validity and generalisability of findings, potentially hindering their application in routine care. In neurorehabilitation, limited literature addresses conducting RCTs feasibly and efficiently. We investigated barriers and facilitators to conducting RCTs within routine care of neurorehabilitation centres from the perspective of stakeholders in neurorehabilitation in Germany and Austria. Methods: We conducted semi-structured interviews with stakeholders in neurorehabilitation from four centres in Germany and Austria, informed by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behaviour model (COM-B). Employing a hybrid approach, the interview analysis integrated both deductive, theory-driven analysis based on the TDF domains and COM-B model and inductive, reflexive thematic analysis. Results: Twelve stakeholders (4 physicians, 4 therapy managers, 4 therapists; 5 females, 7 males; with research experience spanning 0–40 years) were interviewed. Key barriers to conducting RCTs in neurological rehabilitation centres include limited financial, human, and time resources, high clinical workloads, and a lack of interest of some therapists. Ineffective leadership, perceived lack of research expertise, and communication issues were also significant barriers. Social influence factors such as lack of employer support and inadequate training access further contributed to the challenges. Additionally, barriers included insufficient research infrastructure, limited space, internal power struggles, and rigid cost bearer specifications. Key facilitators included physicians' and therapists' motivation to advance the field, contribute to knowledge, and to prioritise patient health. Support from supervisors, joint decision-making, and efficient organisation were crucial facilitators. Flexible therapy planning, mutual support, and interdisciplinary collaboration also played important roles. Conclusion: Our results suggest that increasing professional development and understanding, along with providing adequate financial, human, time, and spatial resources to support research endeavours, implementing effective communication strategies to enhance interdisciplinary collaboration and coordination among team members may contribute to increased motivation and facilitate RCTs within the setting of neurorehabilitation centres. Trial registration: This study was prospectively registered with the German Clinical Trials Register (08.04.2021 DRKSID DRKS00024982). [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsConclusionsThe Multiple Mini Interview (MMI) is a widely used method for evaluating non-cognitive skills of applicants to health professions training programs. The COVID-19 pandemic prompted a swift transition to virtual MMIs (vMMIs), with initial indications of their feasibility and acceptability. This novel study describes the implementation and evaluation of a large-scale vMMI model for selection into undergraduate medical, dental, and oral health degrees within an Australian university.A vMMI process was implemented in November 2022, comprising onsite interviewers (n = 450) and remote applicants (n = 1001). Using the online platform Zoom, applicants rotated through six to eight 10-min virtual stations. Acceptability of the virtual process was evaluated using online surveys, completed by interviewers (n = 396) and applicants (n = 255).Overall, interviewers (98%) and applicants (96%) reported the vMMI as a positive experience, citing clear information, suitable interview questions, Zoom use, diversity of interviewers, and lack of gender and cultural bias as strengths of the process. Challenges included difficulties with rapport building and the disturbance of background noise.A large-scale vMMI for three health programs was successfully implemented and positively evaluated. As the uptake of virtual interviews are likely to increase, this study can provide guidance for institutions planning to implement comparable vMMI processes. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility and safety of conducting robot-mediated impairment training (RMIT) and robot-mediated task-specific training (RMTT). The device deployed is the Optimo Regen (OR®), capable of delivering both impairment-oriented training and task-specific training. Methods: This was a single-centre, randomized, single-blinded, two-arm, parallel group, controlled trial. Patients fulfilling criteria were randomized into either the RMIT or RMIT + RMTT group and provided with 20 h of robotic therapy on top of standard care. Results: A total of 4 patients were recruited, with 2 patients receiving treatment in each arm. The study was feasible, with a 66.7% enrolment rate, 75% completion rate, and 100% attendance for each intervention session. We achieved a 90% satisfaction rate with no serious adverse effects. All patients had improvement of motor power, Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Functional Independence Measure (FIM), Hospital Anxiety and Depression Scale (HADS), and quality of life scores at 1 month. FIM continued to improve at 3 months postcommencement of intervention. There was relative ease of use of the device. Conclusion: This trial is feasible. A full-scale study is warranted, to compare RMIT against RMTT, which is a novel application. [ABSTRACT FROM AUTHOR]

A long-standing question in biology is whether there are common principles that characterize the development of ecological systems (the appearance of a group of taxa), regardless of organismal diversity and environmental context. 1,2,3,4,5,6,7,8,9,10,11 Classic ecological theory holds that these systems develop following a sequenced, orderly process that generally proceeds from fast-growing to slow-growing taxa and depends on life-history trade-offs. 2,12,13 However, it is also possible that this developmental order is simply the path with the least environmental resistance for survival of the component species and hence favored by probability alone. Here, we use theory and data to show that the order from fast- to slow-growing taxa is the most likely developmental path for diverse systems when local taxon interactions self-organize in light of environmental resistance. First, we demonstrate theoretically that a sequenced development is more likely than a simultaneous one, at least until the number of iterations becomes so large as to be ecologically implausible. We then show that greater diversity of taxa and life histories improves the likelihood of a sequenced order from fast- to slow-growing taxa. Using data from bacterial and metazoan systems, 14,15,16,17,18,19 we present empirical evidence that the developmental order of ecological systems moves along the paths of least environmental resistance. The capacity of simple principles to explain the trend in the developmental order of diverse ecological systems paves the way to an enhanced understanding of collective features of life. • We define development as the appearance of taxa, as seen in ecological succession • Development is more likely under a sequenced process than simultaneously • Development is more likely under an ordered process than disorderly • Biodiversity enhances the likelihood of fast-growing taxa appearing earlier Why do ecological systems develop following a path from fast- to slow-growing species? Deng et al. theoretically show that this path is the most likely to emerge when species minimize environmental resistance for their survival. This work corroborates these findings using empirical data across a wide diversity of organisms and taxonomic levels. [ABSTRACT FROM AUTHOR]

Introduction: Effective adjunctive therapeutic treatments for patients with opioid use disorder (OUD) on medication for OUD (MOUD) in primary care settings are needed to address high rates of mental illness and stress. Behavioral activation (BA) is a brief, evidence-based therapy that has potential to improve quality of life in people with OUD. The purpose of this pilot study was to evaluate the feasibility and acceptability of values-based BA (VBA) as an adjunct treatment for patients receiving MOUD in primary care. Methods: Participants were recruited for a single-arm pilot trial of BA in a primary care setting. VBA was adapted for people with OUD and included 4-6 sessions delivered over 12 weeks with a behavioral health consultant, either inperson or virtually. Feasibility was assessed as recruitment percent and pace and retention percent. Acceptability was assessed with the Client Satisfaction Questionnaire-8 (CSQ-8). Participants completed self-report measures of well-being, depression, substance use, and psychological processes of change at baseline, mid-intervention (6-weeks), and post-intervention (12-weeks). Participants engaged in a brief interview about their experiences at the end of the intervention. Results: Twenty-one participants enrolled in the intervention (66.7% female, M age = 44.0 years, 19% of those invited). Participants completed an average of 5.1 BA sessions (SD = 1.6) and most (90%) were retained through 12 weeks. Participants rated the intervention as highly acceptable on the CSQ-8 (M = 30.4/32.0, SD = 1.6). In qualitative interviews, participants reported that working with the therapist and setting values-based goals were helpful, while also recommending more tailoring to patients' needs and offering the program early in MOUD treatment. Preliminary efficacy data suggest the program was associated with small to moderate improvements in life satisfaction (Cohen's d = 0.25) and positive affect (d = 0.62), whereas there were no changes in depression (d = 0.09) or negative affect (d = -0.07) in a group with low depression at baseline. Discussion: VBA adapted for patients on MOUD in primary care was feasible to deliver and acceptable to participants. Minor modifications to the target population and treatment manual could increase the program's impact. Future studies will test the efficacy of the intervention in improving quality of life and OUD treatment outcomes. [ABSTRACT FROM AUTHOR]

Integrating technology-based therapies into existing treatment approaches has proven useful in the endeavour to improve impaired social cognition in patients with neurological diseases. To this end, we present a novel online-based therapy programme for the treatment of impairments of social cognition (“SoCoBo”), particularly tailored for patients with acquired brain injuries (ABIs). This study was designed to investigate the online therapy's feasibility including processing time and acceptability in a healthy older sample as, according to previous studies, older individuals show subtle impairments of social cognition. Between 50 and 52 participants (depending on outcome measures) underwent pre–post assessments, completed one out of three therapy modules (emotion recognition, perspective taking, social problem-solving) over a period of four weeks (four sessions per week) and evaluated the therapy concerning feasibility, acceptability and content aspects with a newly developed questionnaire. All modules showed comparable ratings on a low to moderate level in terms of feasibility, acceptability and content aspects, which seems plausible due to the sample under investigation. Processing time of the three modules was comparable for psychoeducation (mean 17.45 min) and training sessions (mean 21.91 min). The results provided important indications for necessary adjustments regarding a subsequently completed randomized controlled trial involving patients with ABIs. [ABSTRACT FROM AUTHOR]

Background: Older adults living with multiple long-term conditions (MLTC, also known as multimorbidity) and frailty are more likely to experience a deterioration in their health requiring specialist referral or hospital admission than individuals without these syndromes. However, this group of older people are underserved by research meaning that there is a limited evidence base for their care. This study therefore aimed (1) to determine if it is feasible to recruit and collect quantitative data to describe the health and lifestyle of older adults living with MLTC, frailty and a recent deterioration in health and (2) to assess if taking part in research is acceptable to this group of older adults. Methods: Participants were approached and recruited for this study via an Older People's Medicine Day Unit in Newcastle upon Tyne, UK. The study took a mixed methods approach, involving quantitative and qualitative data collection. To determine the feasibility of carrying out research in this group, we quantified recruitment rate and collected data on the health and lifestyle, including diet and physical activity, of the participants. Qualitative semi-structured interviews were undertaken to assess acceptability. Two separate interviews were carried out focusing on involving older adults in research and the participants' experiences of taking part in the research. Interviews were analysed using thematic analysis. Results: Fifty patients were approached to participate in the study with twenty-nine (58%) successfully recruited. It was feasible to collect information to describe the health and lifestyle of these older adults who demonstrated very low levels of physical activity. Participants reported that taking part in the research was acceptable to them with interview analysis generating three themes (1) developing a meaningful partnership, (2) enabling factors to participation: research at home with flexible delivery and (3) social and psychological benefits of research participation. Conclusions: It is feasible and acceptable to recruit and carry out research with this underserved group of older adults. Participants found taking part in this research to be acceptable and reported overall positive experiences of their involvement in the study and indicated that they would be willing to contribute to further research in the future. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions We developed MARVIN, an artificial intelligence (AI)‐based chatbot that provides 24/7 expert‐validated information on self‐management‐related topics for people with HIV. This study assessed (1) the feasibility of using MARVIN, (2) its usability and acceptability, and (3) four usability subconstructs (perceived ease of use, perceived usefulness, attitude towards use, and behavioural intention to use).In a mixed‐methods study conducted at the McGill University Health Centre, enrolled participants were asked to have 20 conversations within 3 weeks with MARVIN on predetermined topics and to complete a usability questionnaire. Feasibility, usability, acceptability, and usability subconstructs were examined against predetermined success thresholds. Qualitatively, randomly selected participants were invited to semi‐structured focus groups/interviews to discuss their experiences with MARVIN. Barriers and facilitators were identified according to the four usability subconstructs.From March 2021 to April 2022, 28 participants were surveyed after a 3‐week testing period, and nine were interviewed. Study retention was 70% (28/40). Mean usability exceeded the threshold (69.9/68), whereas mean acceptability was very close to target (23.8/24). Ratings of attitude towards MARVIN's use were positive (+14%), with the remaining subconstructs exceeding the target (5/7). Facilitators included MARVIN's reliable and useful real‐time information support, its easy accessibility, provision of convivial conversations, confidentiality, and perception as being emotionally safe. However, MARVIN's limited comprehension and the use of Facebook as an implementation platform were identified as barriers, along with the need for more conversation topics and new features (e.g., memorization).The study demonstrated MARVIN's global usability. Our findings show its potential for HIV self‐management and provide direction for further development. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Nocturia (waking from sleep at night to void) and chronic insomnia frequently co‐exist in older adults, contributing synergistically to sleep disturbance. Treatments typically target either nocturia or insomnia rather than simultaneously addressing shared mechanisms for these disorders.We conducted a multisite feasibility study to: (1) test and refine a protocol for recruitment, randomization, and assessment of older adults with co‐existing nocturia and insomnia; and (2) examine preliminary changes in outcome measures to inform a future larger, multisite clinical trial. Participants were men and women aged 60 years and older recruited from outpatient clinics, reporting an average of two or more nocturia episodes per night over the past 4 weeks and meeting diagnostic criteria for chronic insomnia disorder. Participants were randomized to receive either integrated cognitive‐behavioral therapy for insomnia and nocturia or a health education control program involving five weekly visits with a trained nurse practitioner interventionist. Outcomes (e.g., nocturia episodes) were measured 1‐week post‐treatment and 4‐month post‐randomization. Descriptive statistics examined the feasibility of outcomes to guide preparations for a future efficacy trial.Of 245 adults screened, 55% were ineligible and 25% declined to participate. Sixty‐one percent of 49 participants who provided informed consent were randomized. Of the 30 participants randomized (mean age = 70.6 years, 60% White), 14 were assigned to integrated cognitive‐behavioral treatment and 16 to the control group. All randomized participants provided 4‐month follow‐up data. At 4 months, mean nightly nocturia episodes decreased by 0.9 (SD 1.0) in the integrated treatment group and by 0.2 (SD 1.2) in the control group compared with baseline.Findings demonstrate the feasibility of recruiting, randomizing, and collecting outcome data from older adults (predominantly male) assigned to an integrated cognitive‐behavioral therapy for coexisting insomnia and nocturia or a health education control program. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is reported by between 30 and 71% of people with haemophilia (PWH). Exercise is shown to be effective for pain management in other arthritides, but it remains unclear if such an approach is effective or acceptable to PWH. The aim of this study was to evaluate the feasibility and acceptability of a telerehabilitation exercise intervention for PWH living with chronic pain. Methods: This was a multisite, non-randomised, pre-post feasibility design, with a nested qualitative study. People with severe haemophilia > 18 years, living with chronic pain, were recruited. The intervention comprised 12 low-impact/moderate intensity, individualised exercise sessions and 3 knowledge-sharing and discussion sessions. Primary objectives assessed according to predefined progression criteria were as follows: (a) recruitment rate (5 participants enrolled per site over 8 weeks), (b) adherence (≥ 75% participants would adhere to ≥ 75% of sessions), (c) follow-up rate (≥ 75% completion of self-reported measures), (d) fidelity (intervention delivered as described in protocol) and (e) safety (≤ 30% participants would report adverse events). Acceptability was evaluated from thematic analysis of post-intervention participant interviews. Preliminary evaluation of self-reported pain, function and quality of life (QoL) was a secondary objective. Results were reported using descriptive statistics integrated with qualitative findings. Results: Ten PWH were recruited and completed the intervention. Nine agreed to be interviewed post intervention. Attendance at individual sessions was 84.5% compared to 52.1% for the group sessions. Outcome measures were successfully completed for 100% at baseline, 70% at intervention end and 60% at 3-month follow-up. No serious adverse events were recorded. Group median values in outcome measures (pain, function, QoL) showed minimal change post intervention. Participant interviews highlighted high levels of enjoyment, confidence in continuing exercises independently and positive views of virtual delivery and condition-specific exercise. Conclusions: Recruitment rate and safety met the predefined progression criteria. Fidelity partially met the progression criteria, but the follow-up rate for self-reported measures did not. The study was acceptable to both participants and physiotherapists. Further intervention development is needed to review approaches to outcome measure collection and refine the usefulness of the knowledge-sharing sessions. Trial registration : The study was prospectively registered on 9 July 2021: International Standard Randomised Controlled Trial Number ISRCTN 17454597. [ABSTRACT FROM AUTHOR]

Background: The dynamic environment of the emergency department (ED) poses unique challenges to the execution of well-designed research. There is limited investigation into the viability of studies conducted in the ED. This paper offers a systematic evaluation of our recruitment of emergency patients for a prospective observational research study, shedding light on the intricate landscape of research feasibility within the ED setting. Results: Research coordinators dedicated 2816.83 h to screening, recruiting, and enrolling patients between June 2018 and September 2023, having to stop recruitment twice due to financial constraints and the COVID-19 pandemic. 485 patients were approached and 84 of them were enrolled, resulting in a 31.94% enrollment rate, with approximately 2.8 participants recruited per month. Of those enrolled, 77 completed all study endpoints. Most participants were Hispanic (n = 44; 52.3%) and/or Black (n = 37; 44%), middle-aged (µ = 51.7 years), and female (n = 48; 57.1%). Participant recruitment was challenged by competing mindsets, the COVID-19 pandemic, and high staff turnover. Conclusions: Recruiting emergency patients for a prospective observational study is feasible given adequate staffing and financial resources. Standardizing feasibility assessments for the recruitment of patients in the emergency department is important to the success of future study. [ABSTRACT FROM AUTHOR]

Migraine is a common neurological disorder globally. Migraines, with or without aura, are episodic and recurring with symptom-free periods. Frequent and prolonged attacks can lead to chronic migraine. This pilot randomized controlled trial (RCT) aimed to evaluate feasibility of therapist-guided, acceptance-based internet cognitive behavioral therapy (iCBT) as an adjunct to standard medical care for migraine patients in Swedish primary healthcare settings using a mixed methods approach. Participants (treatment n = 15, control n = 14) underwent qualitative and quantitative assessments to evaluate feasibility, acceptance, and initial treatment effects. Interviews with participants (n = 7) indicate that most participants had struggled with migraines for decades and expressed dissatisfaction with the limited medical care. They found the flexible, digital format particularly helpful, praising its accessibility and structured learning. While they appreciated the comprehensive content, some faced challenges with the psychological language and the program pace. Post-treatment, participants reported emotional and behavioral changes, and better migraine management. Seventy-two percent of the 29 participants completed both baseline and 3-month follow-up measures. On average, participants completed 7.7 modules, with 60% completing all 10 modules. Promising effect size indicated a reduction in migraine days during the three-month follow-up. Both qualitative and quantitative data support the feasibility and acceptability of the intervention in primary care settings. [ABSTRACT FROM AUTHOR]

Agroindustrial projects developed by agroindustrial collective actions play a relevant social and economic role. However, cases of failure are frequent. This work proposes a model for the evaluation and selection of projects developed by cooperatives and rural associations, considering their particularities. The method is based on a conceptual framework developed after a literature review, later validated by a panel of experts. The model was applied to six real projects located in the State of São Paulo, Brazil. The results confirmed the technical feasibility of applying the method, allowing an ex ante and accurate prediction of which projects would have the greatest chance of success. [ABSTRACT FROM AUTHOR]

Behavioral parent training (BPT) is an empirically supported approach for addressing the behavioral concerns of autistic children. However, many families face barriers to accessing BPT. Adapting BPT via telehealth technology may improve access for families, especially those living in rural regions. This study aims to evaluate the implementation of a Research Units in Behavioral Intervention (RUBI), a BPT program for autistic children, via telehealth to families living in the Appalachian region of the United States. We employed a mixed-methods approach to examine the feasibility and potential efficacy of implementing the Research Units in Behavioral Intervention Autism Network parent training via telehealth (RUBI-T) with seven rural parent-child dyads. RUBI-T was found to be feasible and satisfactory to parents and community providers. RUBI-T also shows promise for reducing children's disruptive behavior, improving children's adaptive skills, and reducing parent stress, although a more thorough evaluation of its efficacy is warranted. The limitations and implications of the results are discussed. [ABSTRACT FROM AUTHOR]

Multisectoral integration has been at the core of sustainability debates and is continuously rearticulated through different concepts. Following the 2007–2008 financial, food, and energy crises, a new concept, the water–energy–food nexus, gained prominence to identify trade-offs and synergies between water, energy, and food systems and guide the development of cross-sectoral policies. The nexus is essentially a systems-based perspective that explicitly recognizes these three systems as both interconnected and interdependent, and thus integrated approaches are required that move beyond sectoral, policy, and disciplinary silos. The nexus is also a political process, one in which the interplay of different types of power, as well as the actors wielding them, is not just a procedurally technical one. This tension between the nexus as a complex system and the nexus as a political process constitutes the core debating idea, in terms of feasibility, methods, and theory, in this article. [ABSTRACT FROM AUTHOR]

Background: Remote monitoring systems have the potential to measure symptoms and treatment effects in people with Parkinson's disease (PwP) in the home environment. However, information about user experience and long‐term compliance of such systems in a large group of PwP with relatively severe PD symptoms is lacking. Objective: The aim was to gain insight into user experience and long‐term compliance of a smartwatch (to be worn 24/7) and an online dashboard to report falls and receive feedback of data. Methods: We analyzed the data of the "Bringing Parkinson Care Back Home" study, a 1‐year observational cohort study in 200 PwP with a fall history. User experience, compliance, and reasons for noncompliance were described. Multiple Cox regression models were used to identify determinants of 1‐year compliance. Results: We included 200 PwP (mean age: 69 years, 37% women), of whom 116 (58%) completed the 1‐year study. The main reasons for dropping out of the study were technical problems (61 of 118 reasons). Median wear time of the smartwatch was 17.5 h/day. The online dashboard was used by 77% of participants to report falls. Smartphone possession, shorter disease duration, more severe motor symptoms, and less‐severe freezing and balance problems, but not age and gender, were associated with a higher likelihood of 1‐year compliance. Conclusions: The 1‐year compliance with this specific smartwatch was moderate, and the user experience was generally good, except battery life and data transfer. Future studies can build on these findings by incorporating a smartwatch that is less prone to technical issues. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the feasibility of a comprehensive psychosocial intervention for families coping with parental cancer. Methods: A quasi-experimental trial with intervention and control group, employing a mixed-methods approach, was conducted. A total of 472 families affected by parental cancer participated. The feasibility of the intervention was evaluated based on study monitoring measures (on-site visits, team supervision meeting observations, case conference observations, best practice workshops, coordinating information exchange between intervention sites, and reviewing intervention documentation), process evaluation (semi-structured interviews, focus group discussion) and survey data. Data analysis involved thematic coding and descriptive statistics. Results: The intervention was well-received by the participating families, with a high degree of acceptance observed. The feasibility of the intervention was found to be associated with specific dynamics within each family system and the motivation of the family members. The success of the intervention was described as dependent on the family-centered arrangement of the encounters, including factors such as frequency, duration, and mode, which greatly influenced its overall acceptability. Conclusion: The family-scout intervention demonstrates its feasibility as an effective intervention to reduce the burden experienced by families coping with parental cancer. Psychosocial oncology services should continue to develop and implement family-centered interventions to offer support to families during their cancer journey. Trial registration: ClinicalTrials.gov, NCT04186923. Retrospectively registered on 4 December 2019. [ABSTRACT FROM AUTHOR]

Objective: Fetuses with single ventricle physiology (SVP) exhibit reductions in fetal cerebral oxygenation, with associated delays in fetal brain growth and neurodevelopmental outcomes. Maternal supplemental oxygen (MSO) has been proposed to improve fetal brain growth, but current evidence on dosing, candidacy and outcomes is limited. In this pilot study, we evaluated the safety and feasibility of continuous low‐dose MSO in the setting of SVP. Methods: This single‐center, open‐label, pilot phase‐1 safety and feasibility clinical trial included 25 pregnant individuals with a diagnosis of fetal SVP. Participants self‐administered continuous MSO using medical‐grade oxygen concentrators for up to 24 h per day from the second half of gestation until delivery. The primary aim was the evaluation of the safety profile and feasibility of MSO. A secondary preliminary analysis was performed to assess the impact of MSO on the fetal circulation using echocardiography and late‐gestation cardiovascular magnetic resonance imaging. Early outcomes were assessed, including perinatal growth and preoperative brain injury, and neurodevelopmental outcomes were assessed at 18 months using the Bayley Scales of Infant and Toddler Development 3rd edition, and compared with those of a contemporary fetal SVP cohort (n = 217) that received the normal standard of care (SOC). Results: Among the 25 participants, the median maternal age at conception was 35 years, and fetal SVP diagnoses included 16 with right ventricle dominant, eight with left ventricle dominant and one with indeterminate ventricular morphology. Participants started the trial at approximately 29 + 2 weeks' gestation and self‐administered MSO for a median of 16.1 h per day for 63 days, accumulating a median of 1029 h of oxygen intake from enrolment until delivery. The only treatment‐associated adverse events were nasal complications that were resolved typically by attaching a humidifier unit to the oxygen concentrator. No premature closure of the ductus arteriosus or unexpected fetal demise was observed. In the secondary analysis, MSO was not associated with any changes in fetal growth, middle cerebral artery pulsatility index, cerebroplacental ratio or head‐circumference‐to‐abdominal‐circumference ratio Z‐scores over gestation compared with SOC. Although MSO was associated with changes in umbilical artery pulsatility index Z‐score over the study period compared with SOC (P = 0.02), this was probably due to initial baseline differences in placental resistance. At late‐gestation cardiovascular magnetic resonance imaging, MSO was not associated with an increase in fetal cerebral oxygen delivery. Similarly, no differences were observed in neonatal outcomes, including preoperative brain weight Z‐score and brain injury, mortality by 18 months of age and neurodevelopmental outcomes at 18 months of age. Conclusions: This pilot phase‐1 clinical trial indicates that low‐dose MSO therapy is safe and well tolerated in pregnancies diagnosed with fetal SVP. However, our protocol was not associated with an increase in fetal cerebral oxygen delivery or improvements in early neurological or neurodevelopmental outcomes. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]