Search results for: culturally targeted intervention

Authors: Monika Jurkeviciute, Amia Enam, Johanna Torres Bonilla, Henrik Eriksson

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Introduction: Many evaluations of eHealth interventions conclude that the evidence for improved clinical outcomes is limited, especially when the intervention is short, such as one year. Often, evaluation design does not address the feasibility of achieving clinical outcomes. Evaluations are designed to reflect upon clinical goals of intervention without utilizing the opportunity to illuminate effects on organizations and cost. A comprehensive design of evaluation can better support decision-making regarding the effectiveness and potential transferability of eHealth. Hence, the purpose of this paper is to present a feasible and comprehensive design of evaluation for eHealth intervention, including the design process in different contexts. Methodology: The situation of limited feasibility of clinical outcomes was foreseen in the European Union funded project called “DECI” (“Digital Environment for Cognitive Inclusion”) that is run under the “Horizon 2020” program with an aim to define and test a digital environment platform within corresponding care models that help elderly people live independently. A complex intervention of eHealth implementation into elaborate care models in four different countries was planned for one year. To design the evaluation, a participative approach was undertaken using Pettigrew’s lens of change and transformations, including context, process, and content. Through a series of workshops, observations, interviews, and document analysis, as well as a review of scientific literature, a comprehensive design of evaluation was created. Findings: The findings indicate that in order to get evidence on clinical outcomes, eHealth interventions should last longer than one year. The content of the comprehensive evaluation design includes a collection of qualitative and quantitative methods for data gathering which illuminates non-medical aspects. Furthermore, it contains communication arrangements to discuss the results and continuously improve the evaluation design, as well as procedures for monitoring and improving the data collection during the intervention. The process of the comprehensive evaluation design consists of four stages: (1) analysis of a current state in different contexts, including measurement systems, expectations and profiles of stakeholders, organizational ambitions to change due to eHealth integration, and the organizational capacity to collect data for evaluation; (2) workshop with project partners to discuss the as-is situation in relation to the project goals; (3) development of general and customized sets of relevant performance measures, questionnaires and interview questions; (4) setting up procedures and monitoring systems for the interventions. Lastly, strategies are presented on how challenges can be handled during the design process of evaluation in four different countries. The evaluation design needs to consider contextual factors such as project limitations, and differences between pilot sites in terms of eHealth solutions, patient groups, care models, national and organizational cultures and settings. This implies a need for the flexible approach to evaluation design to enable judgment over the effectiveness and potential for adoption and transferability of eHealth. In summary, this paper provides learning opportunities for future evaluation designs of eHealth interventions in different national and organizational settings.

Keywords: ehealth, elderly, evaluation, intervention, multi-cultural

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Authors: Nils Haglund, Svenolof Dahlgren, Maria Rastam, Peik Gustafsson, Karin Kalien

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In Sweden, like in most developed countries, there is a substantial increase of children diagnosed with autism and other conditions within the autism spectrum (ASD). The rapid increase of ASD rates stresses the importance of developing care programs to provide support and comprehensive interventions for affected families. The current observational study was conducted in order to evaluate an ongoing Comprehensive Intensive Early Intervention (CIEI) program for children with autism in southern Sweden. The change in autism symptoms among children participating in CIEI (intervention group, n=67) was compared with children who received traditional habilitation services only (comparison group, n=27). Children of parents who accepted the offered CIEI-program, constituted the intervention group, whereas children, whose parents (for some reason) were not interested in the offered CIEI-program, constituted the comparison group. The CIEI-program was individualized to each child by experienced applied behavior analysis (ABA) specialists with different backgrounds as psychologists, speech pathologists or special education teachers, in cooperation with parents and preschool staff. Due to the individualization, the intervention could vary in intensity and techniques. The intensity was calculated to 15-25 hours each week at home and the preschool altogether. Each child was assigned one 'trainer', who was often employed as a preschool teacher but could have another educational background. An agreement between supervisor- parents and preschool staff was reached to confirm the intensity and content of the CIEI- program over an approximately two-year intervention period. Symptom changes were measured as evaluation-ADOS-2-scores, total- and severity-scores, minus the corresponding baseline-scores, divided by the time between baseline and evaluation. The difference between the study-groups regarding change of ADOS-2-scores was estimated using ANCOVA. In the current study, children in the CIEI-group improved their ADOS-2-total scores between baseline and evaluation (-0.8 scores per year; 95%CI: -1.2 to -0.4), whereas no such improvement was detected in the comparison group (+0.1 scores per year; 95%CI: -0.7 to +0.9). The change difference (change in the CIEI-group vs. change in the comparison group) was statistically significant, both crude and after adjusting for possible confounders (-1.1; 95%CI -1.9 to -0.4). Children in the CIEI-group also significantly improved their ADOS-calibrated severity scores, but not significantly differently so from the comparison group. The results from the current study indicate that the CIEI program significantly improves social and communicative skills among children with autism and that children with developmental delay could benefit to a similar degree as other children. The results support earlier studies reporting on the improvement of autism symptoms after early intensive interventions. The results from observational studies are difficult to interpret, but it is nevertheless of uttermost importance to evaluate costly autism intervention programs. Such results may be of immediate importance to healthcare organizations when allocating the already strained resources to different patient groups. Albeit the obvious limitation of the current naturalistic study, the results support previous positive studies and indicate that children with autism benefit from participating in early comprehensive, intensive programs and that investments in these programs may be highly justifiable.

Keywords: autism symptoms, ADOS-scores, evaluation, intervention program

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Authors: I. Salas-Menotti

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Problem-solving courts were created to assist offenders with specific needs that were not addressed properly in traditional courts. Problem-solving courts' main objective is to pursue solutions that will benefit the offender, the victim, and society as well. These courts were developed as an innovative response to deal with issues such as drug abuse, mental illness, and domestic violence. In Brooklyn, men who are charged with domestic violence related offenses for the first time are offered plea bargains that include the attendance to a domestic abuse intervention program as a condition to dismiss the most serious charges and avoid incarceration. The desired outcome is that the offender will engage in a program that will modify his behavior avoiding new incidents of domestic abuse, it requires accountability towards the victim and finally, it will hopefully bring down statistic related to domestic abuse incidents. This paper will discuss the effectiveness of the Duluth model as applied to Spanish-speaking men mandated to participate in the program by the specialized domestic violence courts in Brooklyn. A longitudinal study was conducted with 243 Spanish- speaking men who were mandated to participated in the men's program offered by EAC in Brooklyn in the years 2016 through 2018 to determine the recidivism rate of domestic violence crimes. Results show that the recidivism rate was less than 5% per year after completing the program which indicates that the intervention is effective in preventing new abuse allegations and subsequent arrests. It's recommended that comparative study with English-speaking participants is conducted to determine cultural and language variables affecting the program's efficacy.

Keywords: domestic violence, domestic abuse intervention programs, Problem solving courts, Spanish-speaking offenders

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Authors: Eugenia Vomvoridi-Ivanovic

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It is broadly assumed that participation in field experiences will help pre-service teachers (PSTs) bridge theory to practice. However, this is often not the case since PSTs who are placed in classrooms with large numbers of students from diverse linguistic, cultural, racial, and ethnic backgrounds (culturally diverse students (CDS)) usually observe ineffective mathematics teaching practices that are in contrast to those discussed in their teacher preparation program. Over the past decades, the educational research community has paid increasing attention to investigating out-of-school learning contexts and how participation in such contexts can contribute to the achievement of underrepresented groups in Science, Technology, Engineering, and mathematics (STEM) education and their expanded participation in STEM fields. In addition, several research studies have shown that students display different kinds of mathematical behaviors and discourse practices in out-of-school contexts than they do in the typical mathematics classroom since they draw from a variety of linguistic and cultural resources to negotiate meanings and participate in joint problem solving. However, almost no attention has been given to exploring these contexts as field experiences for pre-service mathematics teachers. The purpose of this study was to explore how participation in a community based after-school field experience promotes understanding of the content pedagogy concepts introduced in elementary mathematics methods courses, particularly as they apply to teaching mathematics to CDS. This study draws upon a situated, socio-cultural theory of teacher learning that centers on the concept of learning as situated social practice, which includes discourse, social interaction, and participation structures. Consistent with exploratory case study methodology, qualitative methods were employed to investigate how a cohort of twelve participating pre-service teacher's approach to pedagogy and their conversations around teaching and learning mathematics to CDS evolved through their participation in the after-school field experience, and how they connected the content discussed in their mathematics methods course with their interactions with the CDS in the after-school. Data were collected over a period of one academic year from the following sources: (a) audio recordings of the PSTs' interactions with the students during the after-school sessions, (b) PSTs' after-school field-notes, (c) audio-recordings of weekly methods course meetings, and (d) other document data (e.g., PST and student generated artifacts, PSTs' written course assignments). The findings of this study reveal that the PSTs benefitted greatly through their participation in the after-school field experience. Specifically, after-school participation promoted a deeper understanding of the content pedagogy concepts introduced in the mathematics methods course and gained a greater appreciation for how students learn mathematics with understanding. Further, even though many of PSTs' assumptions about the mathematical abilities of CDS were challenged and PSTs began to view CDSs' cultural and linguistic backgrounds as resources (rather than obstacles) for learning, some PSTs still held negative stereotypes about CDS and teaching and learning mathematics to CDS in particular. Insights gained through this study contribute to a better understanding of how informal mathematics learning contexts may provide a valuable context for pre-service teacher's learning to teach mathematics to CDS.

Keywords: after-school mathematics program, pre-service mathematical education of teachers, qualitative methods, situated socio-cultural theory, teaching culturally diverse students

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Authors: Luthfia A. Eka, Bertri M. Masita, G. Indah Lestari, Rizka. Ryanindya, Anindita D. Nur, Asih. Setiarini

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The preferred habit nowadays is to watch television or listen to the radio rather than reading a newspaper or magazine. The low interest in reading is the reason to the Indonesian government passed a regulation to foster interest in reading early in schoolchildren through literacy programs. Literacy programs are held for the first 10 - 15 minutes before classes begin and children are asked to read books other than textbooks such as storybooks or magazines. In addition, elementary school children have a tendency to buy less healthy snacks around the school and do not know the nutrition fact from the food purchased. Whereas snacks contribute greatly in the fulfillment of energy and nutrients of children every day. The purpose of this study was to increase reading interest as well as knowledge of nutrition and health for elementary school students. This study used quantitative method with experimental study design for four months with twice intervention per week and deepened by qualitative method in the form of interview. The participants were 130 students consisting of 3rd and 4th graders in selected elementary school in Depok City. The Interventions given using KUCERIA (Child Storybook) which were storybooks with pictures consisting of 12 series about nutrition and health given at school literacy hours. There were five questions given by using the crossword method to find out the students' understanding of the story content in each series. To maximize the understanding and absorption of information, two students were asked to retell the story in front of the class and one student to fill the crossword on the board for each series. In addition, interviews were conducted by asking questions about students' interest in reading books. Intervention involved not only students but also teachers and parents in order to optimize students' reading habits. Analysis showed > 80% of student could answer 3 of 5 questions correctly in each series, which showed they had an interest in what they read. Research data on nutrition and health knowledge were analyzed using Wilcoxon and Chi-Square Test to see the relationship. However, only 46% of students completed 12 series and the rest lost to follow up due to school schedule incompatibility with the program. The results showed that there was a significant increase of knowledge (p = 0.000) between before intervention with 66,53 score and after intervention with 81,47 score. Retention of knowledge was conducted one month after the last intervention was administered and the analysis result showed no significant decrease of knowledge (p = 0,000) from 79,17 score to 75,48 score. There is also no relationship between sex and class with knowledge. Hence, an increased interest in reading of elementary school students and nutritional knowledge interventions using KUCERIA was proved successful. These interventions may be replicated in other schools or learning communities.

Keywords: literation, reading interest, nutrition knowledge, school children

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Authors: Tonya P. Bowers

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Background: The community/patient-focused quality improvement (QI) project has resolved a clinical problem using a quantitative design evaluating behavior change practices in a convenience sample from a multi-cultural congregation in a faith-based setting. AD is a legal document that speaks for the patient when they are unable to speak for themselves. The AD provides detailed information regarding critical medical decisions on behalf of the patient if they’re unable to make decisions themselves. The goal of an AD is to improve EOL care renderings that align with the patient’s desires. The AD diminishes anxiety and stress associated with making difficult EOL care decisions for patients and their families. Method: The project has two intervention strategies: pre-intervention and post-intervention formative surveys and a final summative survey. Most of the data collection takes place during implementation. The Let’s Talk About It Program utilized an online meeting platform for presentation. Participants were asked to complete informed consent and surveys via an online portal. Education included slide presentation, Advance Directive demonstration, video clips, discussions and 1:1 assistance with AD completion with a project manager. Results: Considering the overwhelming likelihood responses where 87.5% identified they “definitely would” hold an End-Of-Life conversation with their healthcare provider or family, and 81.25% indicated their likelihood that they “definitely would” complete an advance directive. In addition, the final summative post-intervention survey (n-14) also demonstrated an overwhelming 93% positive response. Which undoubtedly demonstrates favorable outcomes for the project. Conclusion: the Let’s Talk About It Program demonstrated effectiveness in improving participants' attitudes and acceptance towards Advance Directives and expanding End-of-Life care discussions. Emphasis on program sustainment within the church is imperative in fostering continued awareness and improved health outcomes for the local community with low health literacy.

Keywords: advance directive, end of life, advance care planning, palliative care, low health literacy, faith-based

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Authors: Deddi Nordiawan

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Effective public policy creation required a strong budget system, both in terms of design and implementation. Performance-based Budget is an evolutionary approach with two substantial characteristics; first, the strong integration between budgeting and planning, and second, its existence as guidance so that all activities and expenditures refer to measurable performance targets. There are four processes in the government that should be followed in order to make the budget become performance-based. These four processes consist of the preparation of a vision according to the bold aspiration, the formulation of outcome, the determination of output based on the analysis of organizational resources, and the formulation of Value Creation Map that contains a series of programs and activities. This is consistent with the concept of logic model which revealed that the budget performance should be placed within a relational framework of resources, activities, outputs, outcomes and impacts. Through the issuance of Law 17/2003 regarding State Finance, local governments in Indonesia have to implement performance-based budget. Central Government then issued Government Regulation 58/2005 which contains the detail guidelines how to prepare local governments budget. After a decade, implementation of performance budgeting in local government is still not fully meet expectations, though the guidance is completed, socialization routinely performed, and trainings have also been carried out at all levels. Accordingly, this study views the practice of performance-based budget at local governments as a problematic situation. This condition must be approached with a system approach that allows the solutions from many point of views. Based on the fact that the infrastructure of budgeting has already settled, the study then considering the situation as complexity. Therefore, the intervention needs to be done in the area of human activity system. Using Soft Systems Methodology, this research will reconstruct the process of performance-based budget at local governments is area of human activity system. Through conceptual models, this study will invite all actors (central government, local government, and the parliament) for dialogue and formulate interventions in human activity systems that systematically desirable and culturally feasible. The result will direct central government in revise the guidance to local government budgeting process as well as a reference to build the capacity building strategy.

Keywords: soft systems methodology, performance-based budgeting, Indonesia, public policy

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Authors: Siddiq Ahmed

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The current study aimed to investigate the effectiveness of a Peer-Mediated Intervention (PMI) on writing skills for a student with autism spectrum disorders in inclusive classrooms. The participants in this study were two students, one as a tutor and another as a tutee who was diagnosed with autism spectrum disorder (ASD). The target participant struggled with writing skills and was paired with a student with high academic outcomes. The Tutor had a readiness to act as a tutor for his peer and was trained on how to assist his peer and how to identify and guide his peer’s writing mistakes. Multiple baseline design across behaviors was implemented to monitor the student’s progress in writing skills. The results of the present study showed that PMI yielded significant improvements in academic achievements for the target student. This study suggests that further studies should replicate the current study with an intensive focus on other academic skills such as reading comprehension, writing social stories, and math.

Keywords: peer tutoring, writing skills, autism, inclusion

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Authors: Modi Alsubaie, Chris Dickens, Barnaby Dunn, Andy Gibson, Obioha Ukoumunned, Alison Evans, Rachael Vicary, Manish Gandhi, Willem Kuyken

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Background: Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to effectively treat acute depression in those with comorbid cardiovascular disorders, to date there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Therefore, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with co-morbid depression and cardiovascular disorders. Methods: A 3-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU, and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, immediately after, and three months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Results: 3400 potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. 242 (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable, and 33 (<1%) were eventually randomised to the three groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disease (one to 25 years). Of 11 participants randomised to adapted MBCT seven completed the full course, levels of home mindfulness practice were high, and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 participants randomised completed all the assessment measures at all three-time points. With regards to the primary outcome (depression), five out of the seven people who completed the adapted MBCT and three out of five under MBSR showed significant clinical change, while in TAU no one showed any clinical change at the three-month follow-up. Conclusions: The adapted MBCT intervention was feasible and acceptable to participants. However, aspects of the trial design were not feasible. In particular, low recruitment rates were achieved, and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high meaning the adapted intervention was unlikely to be well tailored to all participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to more successfully recruit a target sample that optimally matches the adapted intervention.

Keywords: mindfulness-based cognitive therapy (MBCT), depression, cardiovascular disorders, feasibility, acceptability

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Authors: Güler Duru Aşiret

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Introduction: Poor sleep quality is a common problem among the older people living in nursing homes. Our study aimed at assessing the effect of individual reminiscence therapy on the sleep quality of the elderly living in nursing homes. Methods: The study had 22 people in the intervention group and 24 people in the control group. The intervention group had reminiscence therapy once a week for 12 weeks in the form of individual sessions of 25-30 minutes. In our study, we first determined the dates suitable for the intervention group and researcher and planned the date and time of individual reminiscence therapies, which would take 12 weeks. While preparing this schedule, we considered subjects’ time schedules for their regular visits to health facilities and the arrival of their visitors. At this stage, the researcher informed the participants that their regular attendance in sessions would affect the intervention outcome. One topic was discussed every week. Weekly topics included: introduction in the first week; childhood and family life, school days, starting work and work life (a day at home for housewives), a fun day out of home, marriage (friendship for the singles), plants and animals they loved, babies and children, food and cooking, holidays and travelling, special days and celebrations, assessment and closure, in the following weeks respectively. The control group had no intervention. Study data was collected by using an introductory information form and the Pittsburgh Sleep Quality Index (PSQI). Results: In our study, participants’ average age was 76.02 ± 7.31. 58.7% of them were male and 84.8% were single. All of them had at least one chronic disease. 76.1% did not need help for performing their daily life activities. The length of stay in the institution was 6.32 ± 3.85 years. According to the participants’ descriptive characteristics, there was no difference between groups. While there was no statistically significant difference between the pretest PSQI median scores (p > 0.05) of both groups, PSQI median score had a statistically significant decrease after 12 weeks of reminiscence therapy (p < 0.05). There was no statistically significant change in the median scores of the subcomponents of sleep latency, sleep duration, sleep efficiency, sleep disturbance and use of sleep medication before and after reminiscence therapy. After the 12-weeks reminiscence therapy, there was a statistically significant change in the median scores for the PSQI subcomponents of subjective sleep quality (p<0.05). Conclusion: Our study found that reminiscence therapy increased the sleep quality of the elderly living in nursing homes. Acknowledgment: This study (project no 2017-037) was supported by the Scientific Research Projects Coordination Unit of Aksaray University. We thank the elderly subjects for their kind participation.

Keywords: nursing, older people, reminiscence therapy, sleep

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Authors: Hameed Ullah, Karim Elakabawi, Han KE, Najeeb Ullah, Habib Ullah, Sardar Ali Shah, Hamad Haider Khan, Muhammad Asad Khan, Ning Guo, Zuyi Yuan

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Background: Predictors of decreased fractional flow reserve at left circumflex coronary artery after left main (LM) crossover stenting are still lacking. The objectives of the present study were to provide the predictors for low Fractional flow reserve (FFR) at coronary artery (LCx) and the possible treatment strategies for the compromised LCx-together with their long term outcomes. Methods: A total of 563 included patients out of 1974 patients admitted to our hospital from February 2015 to November 2020 with significant distal LM-bifurcation lesions. The enrolled patients underwent single-stent cross-over PCI under IVUS guidance with further LCx intervention as indicated by measured FFR. Results: The included patients showed angiographic significant LCx ostial affection after LM-stenting, but only 116 (20.6%) patients had FFR <0.8. The 3-year composite MACE rates were comparable between the high and low FFR groups (16.8% vs. 15.5%, respectively; P=0.744). In a multivariable analysis, a low FFR in the LCx was associated with post-stenting MLA of the LCx (OR: 0.032, P <0.001), post-stenting LCx-plaque burden (OR: 1.166, P <0.001), post-stenting LM-MLA (OR: 0.821, P =0.038) and pre-stenting LCx-MLA (OR: 0.371, P =0.044). In patients with low FFR, management of compromised LCx with DEB had the lowest 3-year MACE rate (8.1%) as compared to either KBI (17.5%) or stenting group (20.5%), P =0.299. Conclusion: FFR-guided LCx intervention can avoid unnecessary LCx intervention. The post-stenting predictors of low FFR include post-stenting MLA and plaque burden of the LCx and MV stent length. The 3-year MACE rates were comparable between high FFR patients and patients who had low FFR and were adequately managed.

Keywords: fractional flow reserve, left main stem, percutaneous coronary interventions, intravascular ultrasound

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Authors: Max Butler

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Melanoma accounts for 80% of skin cancer-related deaths globally. The poor prognosis and increasing incidence of melanoma impose a significant burden on global healthcare systems. Early detection, precise diagnosis, and preventative strategies are critical to improving patient outcomes. Dermoscopy is the gold standard for specialist assessments of pigmented skin lesions, as it can differentiate between benign and malignant growths with greater accuracy than visual inspection. In the United Kingdom, guidelines from the National Institute of Clinical Excellence (NICE) state dermoscopy should be used in all specialist assessments of pigmented skin lesions. Compliance with this guideline is low, resulting in missed and delayed melanoma diagnoses. To address this problem, a quality improvement project was initiated at Buckinghamshire Healthcare Trust (BHT) within the plastic surgery department. The target group was a trainee and consultant plastic surgeons conducting outpatient skin cancer clinics. Analysis of clinic documentation over a one-month period found that only 62% (38/61) of patients referred with pigmented skin lesions were examined using dermoscopy. To increase dermoscopy rates, teaching was delivered to the department highlighting national guidelines and the evidence base for dermoscopic examination. In addition, clinic paperwork was redesigned to include a text box for dermoscopic examination. Reauditing after the intervention found a significant increase in dermoscopy rates (52/61, p = 0.014). In conclusion, implementing a quality improvement project with targeted teaching and documentation template templates successfully increased dermoscopy rates. This is a promising step toward improving early melanoma detection and patient outcomes.

Keywords: melanoma, dermoscopy, plastic surgery, quality improvement

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Authors: Aisha Maroof

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Introduction: Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers and health systems. Severe 2019 novel coronavirus infectious disease (COVID-19) with pneumonia is associated with high rates of admission to the intensive care unit (ICU) and they are at high risk to obtain the hospital acquire bloodstream infection (HAIs) such as central line associated bloodstream infection (CLABSI), catheter associated urinary tract infections (CAUTI) and laboratory confirm bloodstream infection (LCBSI). The chances of infection transmission increase when healthcare worker’s (HCWs) practice is inappropriate. Risk related to hand hygiene (HH) and personal protective equipment (PPE) as regards multidrug-resistant organism transmission: use of multiple gloving instead of HH and incorrect use of PPE can lead to a significant increase of device-related infections. As it reaches low- and middle-income countries, its effects could be even more, because it will be difficult for them to react aggressively to the pandemic. HAIs are one of the biggest medical concerns, resulting in increased mortality rates. Objective: To assess the effect of intervention on compliance of hand hygiene and PPE among HCWs reduce the rate of HAI in COVID-19 patients. Method: An interventional study was done between July to December, 2020. CLABSI, CAUTI and LCBSI data were collected from the medical record and direct observation. There were total of 50 Nurses, 18 doctors and all patients with laboratory-confirmed severe COVID-19 admitted to the hospital were included in this research study. Respiratory tract specimens were obtained after the first 48 h of ICU admission. Practices were observed after and before intervention. Education was provided based on WHO guidelines. Results: During the six months of study July to December, the rate of CLABSI, CAUTI and LCBSI pre and post intervention was reported. CLABSI rate decreasedd from 22.7 to 0, CAUTI rate was decreased from 1.6 to 0, LCBSI declined from 3.3 to 0 after implementation of intervention. Conclusion: HAIs are an important cause of morbidity and mortality. Most of the device related infections occurs due to lack of correct use of PPE and hand hygiene compliance. Hand hygiene and PPE is the most important measure to protect patients, through education it can be improved the correct use of PPE and hand hygiene compliance and can reduce the bacterial infection in COVID-19 patients.

Keywords: hospital acquire infection, healthcare workers, hand hygiene, personal protective equipment

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Authors: Esha Thakkar, Ina Liu, Kalynn Hosea, Shana Katz, Katie Marks, Sarah Hall, Cat Liu, Suzanne Harris

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Purpose: Inequities in mental healthcare accessibility are cited as an international public health concern by the World Health Organization (WHO) and National Alliance on Mental Illness (NAMI). These disparities are further exacerbated in racial and ethnic minority groups and are especially concerning in health professional training settings such as Doctor of Pharmacy (PharmD) programs and postgraduate residency training where mental illness rates are high. The purpose of the study was to determine baseline access to culturally sensitive mental healthcare and how to improve such access and communication for racially and ethnically minoritized pharmacy students and residents at one school of pharmacy and a partnering academic medical center in the United States. Methods: This IRB-exempt study included 60-minute focus groups conducted in person or online from November 2021 to February 2022. Eligible participants included PharmD students in their first (P1), second (P2), third (P3), or fourth year (P4) or pharmacy residents completing a postgraduate year 1 (PGY1) or PGY2 who identify as Black, Indigenous, or Person of Color (BIPOC). There were four core theme questions asked during the focus groups to lead the discussion, specifically on the core themes of personal barriers, identities, areas that are working well, and areas for improvement. Participant responses were transcribed and analyzed using an open coding system with two individual reviews, followed by collaborative and intentional discussion and, as needed, an external audit of the coding by a third research team member to reach a consensus on themes. Results: This study enrolled 26 participants, with eight P1, five P2, seven P3, two P4, and four resident participants. Within the four core themes of barriers, identities, areas working well, and areas for improvement, emerging subthemes included: lack of time, access to resources, and stigma under barriers; lack of representation, cultural and family stigma, and gender identities for identity barriers; supportive faculty, sense of community and culture supporting paid time off for areas going well; and wellness days, reduced workload and diversity of the workforce in areas of improvement. Subthemes sometimes varied within a core theme depending on the participant year. Conclusions: There is a gap in the literature in addressing barriers and disparities in mental health access for pharmacy trainees who identify as BIPOC. We identified key findings in regards to barriers, identities, areas going well and areas for improvement that can inform the School and the Residency Program in two priority initiatives of well-being and diversity equity and inclusion in creating actionable recommendations for trainees, program directors, and employers of our institutions, and also has the potential to provide insight for other organizations about the structures influencing access to culturally sensitive care in BIPOC trainees. These findings can inform organizations on how to continue building on communication with those who identify as BIPOC and improve access to care.

Keywords: mental health, disparities, minorities, wellbeing, identity, communication, barriers

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Authors: Hyun-Ju Oh, Soon-Rim Suh, Mihan Kim

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The steady and rapid increase of the older population is a global phenomenon. Chronic diseases and disabilities are increased due to aging. In general, exercise has been known to be most effective in preventing and managing chronic back pain. However, it is hard for the older women to initiate and maintain the exercise. Transtheoretical model (TTM) is one of the theories explain behavioral changes such as exercise. The application of the program considering the stage of behavior change is effective for the elderly woman to start and maintain the exercise. The purpose of this study was to develop TTM based exercise program and to examine its effect for elderly women with chronic back-pain. For the program evaluation, the non-equivalent control pre-posttest design was applied. The independent variable of this study is exercise intervention program. The contents of the program were constructed considering the characteristics of the elderly women with chronic low back pain, focusing on the process of change, the stage of change by the previous studies. The developed exercise program was applied to the elderly women with chronic low back pain in the planning stage and the preparation stage. The subjects were 50 older women over 65 years of age with chronic back-pain who did not practice regular exercise. The experimental group (n=25) received the 8weeks TTM based exercise program. The control group received the book which named low back pain management. Data were collected at three times: before the exercise intervention, right after the intervention, and 4weeks after the intervention. The dependent variables were the processes of change, decisional balance, exercise self-efficacy, back-pain, depression and muscle strength. The results of this study were as follows. Processes of change (<.001), pros of decisional balance (<.001), exercise self-efficacy (<.001), back pain (<.001), depression (<.001), muscle strength (<.001) were higher in the experimental group than in the control group right after the program and 4weeks after the programs. The results of this study show that applying the TTM based exercise program increases the use of the change process, increases the exercise self-efficacy, increases the stage of changing the exercise behavior and strengthens the muscular strength by lowering the degree of pain and depression Respectively. The significance of the study was to confirm the effect of continuous exercise by maintaining regular exercise habits by applying exercise program of the transtheoretical model to the chronic low back pain elderly with exercise intention.

Keywords: chronic back pain, elderly, exercise, women

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Authors: Vinti Davar

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Introduction: Childhood overweight increases the risk for certain medical and psychological conditions. Millions of school-age children worldwide are affected by serious yet easily treatable and preventable illnesses that inhibit their ability to learn. Healthier children stay in school longer, attend more regularly, learn more and become healthier and more productive adults. Schools are an important setting for nutrition education because one can reach most children, teachers and parents. These years offer a key window for shaping their lifetime habits, which have an impact on their health throughout life. Against this background, an attempt was made to impart nutrition education to school children in Haryana state of India to promote healthy food choices and assess the effectiveness of this program. Methodology: This study was completed in two phases. During the first phase, pre-intervention anthropometric and dietary survey was conducted; the teaching materials for nutrition intervention program were developed and tested; and the questionnaire was validated. In the second phase, an intervention was implemented in two schools of Kurukshetra, Haryana for six months by personal visits once a week. A total of 350 children in the age group of 6-12 years were selected. Out of these, 279 children, 153 boys and 126 girls completed the study. The subjects were divided into four groups namely: underweight, normal, overweight and obese based on body mass index-for-age categories. A power point colorful presentation to improve the quality of tiffin, snacks and meals emphasizing inclusion of all food groups especially vegetables every day and fruits at least 3-4 days per week was used. An extra 20 minutes of aerobic exercise daily was likewise organized and a healthy school environment created. Provision of clean drinking water by school authorities was ensured. Selling of soft drinks and energy-dense snacks in the school canteen as well as advertisements about soft drink and snacks on the school walls were banned. Post intervention, anthropometric indices and food selections were reassessed. Results: The results of this study reiterate the critical role of nutrition education and promotion in improving the healthier food choices by school children. It was observed that normal, overweight and obese children participating in nutrition education intervention program significantly (p≤0.05) increased their daily seasonal fruit and vegetable consumption. Fat and oil consumption was significantly reduced by overweight and obese subjects. Fast food intake was controlled by obese children. The nutrition knowledge of school children significantly improved (p≤0.05) from pre to post intervention. A highly significant increase (p≤0.00) was noted in the nutrition attitude score after intervention in all four groups. Conclusion: This study has shown that a well-planned nutrition education program could improve nutrition knowledge and promote positive changes in healthy food choices. A nutrition program inculcates wholesome eating and active life style habits in children and adolescents that could not only prevent them from chronic diseases and early death but also reduce healthcare cost and enhance the quality of life of citizens and thereby nations.

Keywords: children, eating habits healthy food, obesity, school going, fast foods

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Authors: Saheb Yousefi, Kim T. Zebehazy, Parviz Sharifi Daramadi, Tahereh Najafi Fard, Kevin Murfitt

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Context: Children with visual impairments often face challenges in their cognitive, motor, and social development. Sensory-motor and spatial perception therapies can be beneficial for these children, but many existing programs only focus on a limited set of therapies. This study aims to investigate the effectiveness of a rehabilitation program for sensory- motor and spatial perception in reducing the fear of mobility in visually impaired children. Research Aim: The aim of this study is to determine if a rehabilitation program based on parent-child interaction can reduce the fear of mobility in visually impaired children. Methodology: This study uses a semi-experimental approach with an uneven control group design. Visually impaired children aged 10 to 14 and their parents from the Board of the Blind and Visually Impaired in Tehran Province were included in the study. The sample was divided into experimental and control groups, with a total of 30 participants. The experimental group participated in a rehabilitation program for sensory-motor and spatial perception based on parent-child interaction, while the control group did not receive this intervention. Data was collected using questionnaires on transportation issues and analyzed using multivariate and univariate mixed analysis of variance tests. Findings: The analysis of the data showed that the fear of movement was significantly improved in the experimental group compared to the control group after the intervention. Theoretical Importance: This study highlights the effectiveness of a rehabilitation program for sensory- motor and spatial perception based on parent-child interaction in reducing the fear of mobility in visually impaired children. It contributes to the existing knowledge by demonstrating the positive impact of this type of intervention on the cognitive, motor, and social development of these children. Data Collection and Analysis Procedures: Data was collected through the use of questionnaires administered to the children before and after the intervention. The data was analyzed using multivariate and univariate mixed analysis of variance tests to examine the effects of the rehabilitation program. Questions Addressed: This study addresses the question of whether a rehabilitation program based on parent-child interaction can reduce the fear of mobility in visually impaired children. Conclusion: The findings of this study support the effectiveness of the sensory-motor and spatial perception rehabilitation program based on parent-child interaction in reducing the fear of movement in visually impaired children. This intervention can be considered as a suitable method to enhance the fear of mobility in these children.

Keywords: vision impairment, sensory-motor rehabilitation, space perception, parent-child interaction, fear of movement.

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Authors: Chariya Laohavich, Viboon Bunsrangsuk

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Objective: Bronchoscopy is a common outpatient procedure. The authors compared the patient anxiety level before and after received video-assisted procedural information. Method: One hundred and twenty patients who never received bronchoscopy and scheduled for elective bronchoscopy at outpatient Bronchosope unit at Ramathibodi Hospital, Mahidol University were randomized into control and intervention group. Video-assisted procedural information was given in intervention group. Pre and post procedural anxiety score were recorded and compared between two groups. Paired T-test was used for statistical analysis. Result: There was statistically significant decrease (p < 0.001) for anxiety score in patients who received video assisted procedural information compare with control group. Conclusion: Video-assisted procedural information should be given to patient who will have bronchoscopy to reduce anxiety.

Keywords: anxiety, bronchoscopy, video compact disc (VCD)

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Authors: Myung-Soo Lee, Sun-Jin Jo, Kyoung-Sae Na, Joo-Eon Park

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Early intervention after a disaster is important for recovery of disaster victims and each country has its own professional mental health service system such as Disaster Psychiatric Assistant Team in Japan and Crisis Counseling Program in the USA. The purpose of this study was to determine key prior components of the Korean Disaster Psychiatric Assistant Team (K-DPAT) for building up Korean disaster mental health service system. We conducted an Analytic Hierarchy Process(AHP) with disaster mental health experts using pairwise comparison questionnaire which compares the relative importance of the key components of Korean disaster mental health service system. Forty-one experts answered the first online survey, and among them, 36 responded to the second. Ten experts were participated in panel meeting and discussed the results of the survey and AHP process. Participants decided the relative importance of the Korean disaster mental health service system regarding initial professional intervention as follows. K-DPAT could be organized at a national level (43.0%) or regional level (40.0%). K-DPAT members should be managed (59.0%) and educated (52.1%) by national level than regional or local level. K-DPAT should be organized independent of the preexisting mental health system (70.1%). Funding for K-DPAT should be from the Ministry of Public Safety and the system could be managed by Ministry of Health (65.8%). Experts agreed K-DPAT leader is suitable for key decision maker for most types of disaster except infectious disease. We expect new model for disaster mental health services can improve insufficiency of the system such as fragmentation and decrease the unmet needs of early professional intervention for the disaster victims.

Keywords: analytic hierarchy process, decision making, disaster, DPAT, mental health services

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Authors: Akane Uda, Ami Tabata, Mi An, Misa Komaki, Ryotaro Ito, Mayumi Inoue, Takehiro Sasai, Yusuke Kusano, Toshihiro Kato

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Early intervention is recommended for children with autism spectrum disorder (ASD), and an increasing number of children have received support and intervention before school age in recent years. In this study, we systematically reviewed preschool interventions focused on repetitive behaviors observed in children with ASD, which are often observed at younger ages. Inclusion criteria were as follows : (1) Child of preschool status (age ≤ 7 years) with a diagnosis of ASD (including autism, Asperger's, and pervasive developmental disorder) or a parent (caregiver) with a preschool child with ASD, (2) Physician-confirmed diagnosis of ASD (autism, Asperger's, and pervasive developmental disorder), (3) Interventional studies for repetitive behaviors, (4) Original articles published within the past 10 years (2012 or later), (5) Written in English and Japanese. Exclusion criteria were as follows: (1) Systematic reviews or meta-analyses, (2) Conference reports or books. We carefully scrutinized databases to remove duplicate references and used a two-step screening process to select papers. The primary screening included close scrutiny of titles and abstracts to exclude articles that did not meet the eligibility criteria. During the secondary screening, we carefully read the complete text to assess eligibility, which was double-checked by six members at the laboratory. Disagreements were resolved through consensus-based discussion. Our search yielded 304 papers, of which nine were included in the study. The level of evidence was as follows: three randomized controlled trials (level 2), four pre-post studies (level 4b), and two case reports (level 5). Seven articles selected for this study described the effectiveness of interventions. Interventions for repetitive behaviors in preschool children with ASD were categorized as five interventions that directly involved the child and four educational programs for caregivers and parents. Studies that directly intervened with children used early intensive intervention based on applied behavior analysis (Early Start Denver Model, Early Intensive Behavioral Intervention, and the Picture Exchange Communication System) and individualized education based on sensory integration. Educational interventions for caregivers included two methods; (a) education regarding combined methods and practices of applied behavior analysis in addition to classification and coping methods for repetitive behaviors, and (b) education regarding evaluation methods and practices based on children’s developmental milestones in play. With regard to the neurophysiological basis of repetitive behaviors, environmental factors are implicated as possible contributors. We assumed that applied behavior analysis was shown to be effective in reducing repetitive behaviors because analysis focused on the interaction between the individual and the environment. Additionally, with regard to educational interventions for caregivers, the intervention was shown to promote behavioral change in children based on the caregivers' understanding of the classification of repetitive behaviors and the children’s developmental milestones in play and adjustment of the person-environment context led to a reduction in repetitive behaviors.

Keywords: autism spectrum disorder, early intervention, repetitive behaviors, systematic review

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Authors: Sakinah Idris, Femke Ten Hoeve, Kirstin Greaves-Lord

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Background: Social skills interventions are considered to be efficacious if social skills are improved as a result of an intervention. Nevertheless, the objective assessment of social skills is hindered by a lack of sensitive and validated measures. To measure the change in social skills after an intervention, questionnaires reported by parents, clinicians and/or teachers are commonly used. Observations are the most ecologically valid method of assessing improvements in social skills after an intervention. For this purpose, The Program for the Educational and Enrichment of Relational Skills (PEERS) was developed for adolescents, in order to teach them the age-appropriate skills needed to participate in society. It is an evidence-based intervention for adolescents with ASD that taught ecologically valid social skills techniques. Objectives: The current study aims to describe the development and psychometric evaluation of the Dutch Contextual Assessment of Social Skills (CASS), an observational outcome measure of social skills for adolescents with Autism Spectrum Disorder (ASD). Methods: 64 adolescents (M = 14.68, SD = 1.41, 71% boys) with ASD performed the CASS before and after a social skills intervention (i.e. PEERS or the active control condition). Each adolescent completed a 3-minute conversation with a confederate. The conversation was prompt as a natural introduction between two-unfamiliar, similar ages, opposite-sex peers who meet for the first time. The adolescent and the confederate completed a brief questionnaire about the conversation (Conversation Rating Scale). Results: Results indicated sufficient psychometric properties. The Dutch CASS has a high level of internal consistency (Cronbach's α coefficients = 0.84). Data supported the convergent validity (i.e., significant correlated with the Social Skills Improvement System (SSiS). The Dutch CASS did not significantly correlate with the autistic mannerism subscale from Social Responsiveness Scale (SRS), thus proved the divergent validity. Based on scorings made by raters who were kept blind to the time points, reliable change index was computed to assess the change in social skills. With regard to the content validity, only the learning objectives of the first two meetings of PEERS about conversational skills relatively matched with rating domains of the CASS. Due to this underrepresentation, we found an existing observational measure (TOPICC) that covers some of the other learning objectives of PEERS. TOPICC covers 22% of the learning objectives of PEERS about conversational skills, meanwhile, CASS is 45%. Unfortunately, 33% of the learning objectives of PEERS was not covered by CASS or TOPICC. Conclusion: Recommendations are made to improve the psychometric properties and content validity of the Dutch CASS.

Keywords: autism spectrum disorder, observational, PEERS, social skills

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Authors: Gholamzadeh Sakineh, Jedi Maryam, Fereshteh Dehghanrad

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Background: Mental and psychological issues are common among older adults. Positive psychology theorists and researchers recommend focusing on constructs such as happiness, life satisfaction and hope rather than dwelling on negative experiences and perceptions. Objective: The research aim was to evaluate the impact of hope therapy interventions on the life satisfaction, happiness, and hopefulness of older adults in Iran. Methodology: This study used a quasi-experimental design. A convenience sample of 32 older adults was recruited from a retirement center in Shiraz, Iran. Participants were randomly assigned to either a control group (n = 16) or an experimental group (n = 16). The experimental group received eight sessions of hope therapy, each lasting 1.5 hours. The data for this study were collected using Snyder's Adult Hope Scale (AHS), Oxford Happiness Questionnaire, and Life Satisfaction Index-Z. The questionnaires were administered before, immediately after the intervention, and two months later. Descriptive and analytical statistical tests were used to analyze the data using SPSS version 19. Descriptive statistics were used to describe the sample characteristics and the distribution of the data. Analytical statistics were used to test the research hypotheses. Findings: The results showed that the hope therapy intervention significantly increased the life satisfaction and hopefulness of older adults (p < 0.05). In addition, the influence of time was also significant (p < 0.05). However, the intervention did not affect happiness in statistically significant ways. Conclusions: The findings of this study support the theoretical importance of hope therapy in improving the life satisfaction and hopefulness of older adults. Hope therapy interventions can be considered as an effective way to improve the emotional well-being and quality of life of older adults.

Keywords: older adults, life satisfaction, happiness, hopefulness, hope therapy

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Authors: Yussif Tawfiq, Stephen Omari, Kwaku Poku Asante

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The abundance of malaria vectors is influenced by micro-ecology, rainfall, and temperature patterns. The main objective of the study was to identify mosquito larval sites for future larval surveys and possible intervention programs. The study was conducted in Kintampo in central Ghana. Twenty larval sites were surveyed. Larval density was determined per cm² of water from each of the various sites. The dipper was used to fetch larvae from the larval sites, and a global positioning system (GPS) was used to identify larvae locations. There was a negative linear relationship between humidity, temperature, pH, and mosquito larval density. GPS of larval sites was taken for easy larval identification. There was the presence of Anopheles mosquito larvae in all polluted waters with Culex larval presence. This shows that Anopheles mosquito larvae are beginning to adapt to survival in polluted waters. The identified breeding sites are going to be useful for future larval surveys and will also help in intervention programs.

Keywords: larvae, GPS, dipper, larval density

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Authors: Cathy T. Mpanga Kowet, Aghaegbuna Obinna U. Ozumba

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This study examined and identified the inconsistencies, relationships, gaps and recurring themes in literature regarding the relationship between procurement strategies employed in the construction projects for sustainable buildings and realization of sustainability goals. A systematic literature review of studies on the relationship between various procurement strategies and attainment of sustainability outcomes was conducted. Using specific terms, papers published between 2002 and 2018 were identified and screened according to an inclusion and exclusion criteria. Current findings reveal that, although the attainment of sustainability goals is achievable with both traditional and contemporary procurement strategies, only projects delivered using modern procurement strategies are capable of meeting and exceeding targeted sustainability objectives. However, traditional procurement strategy remains the preferred method for most green building construction projects. The results suggest implications for decision makers in considering the impact of selected procurement strategies on targeted sustainability goals, in the early stages of sustainable building construction projects. The study shows that there is a gap between the reported appropriate procurement strategies and what is being practiced currently. Theoretically, the study expands on the literature on adoption and diffusion of contemporary procurement strategies, by consolidating existing studies to highlight the current gaps. While the study is at the literature review stage, deductions will serve as basis for field work involving empirical data.

Keywords: green buildings construction, procurement method, procurement strategy, sustainability objectives, sustainability outcomes

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Authors: Caroline Selai, Sushrut Jadhav

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Background: University College London (UCL), the first secular university in England to admit students regardless of their religion and gender, has nearly 29,000 students of which approximately 30% are international students. The UCL Cultural Consultation Service (CCS) for staff and students is a unique service that provides assistance to staff and students experiencing challenges in their teaching, enabling, support work or studies which they believe may have a cultural component. The service provides one-to-one and group consultations, lectures, seminars, ‘grand rounds’, interactive workshops and bespoke interventions. Data: This paper presents a content analysis of CCS referrals over the last 36 months. We focus on the experience of international students, many of whom experience not only a challenge to their academic identity but also a profound challenge to their personal cultural identity. We also present 3 vignettes to illustrate how students interpret, accept, contest and resist changes in their cultural and academic identity. Discussion: This paper highlights (i) how students from collectivist cultures attempt to assimilate within an individualistic, highly competitive western university that is bound by its own institutional norms; (ii) problems in negotiating challenges at the interface of culture and gender (iii) the impact of culturally different hierarchies of power, discrimination and authority and (iv) the significance of earlier traumatic and kinship conflicts. Many international students’ social identities are shaped by their cultural and family scripts. A large number have been taught that their teachers are to be revered and their teachings unchallenged. This is at odds with quintessential goal of the western university to encourage healthy scepticism and hone students’ critical thinking skills. Conclusions: Pupil-teacher ‘cultural transference’ and shifts in cultural academic identities of students underscore critical aspects of developmental and learning challenges for students. Staff-student cultural conflict requires a broader, systemic analysis of students, staff and the wider organisation. Our findings challenge Eurocentric psychodynamic concepts such as the nature of parent-child relationship in Western Europe. We argue for a broader, more inclusive approach to develop both effective pedagogic skills in euro-american academic institutions and culturally- appropriate psychodynamic theory to underpin counselling international students.

Keywords: academic identity, cultural transference, cultural consultation in higher education, cultural formulation, cultural identity.

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Authors: Mehrnaz Mostafavi

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Nanoliposomes, minute lipid-based vesicles at the nano-scale, show promise in the realm of photothermal therapy (PTT). This study presents an extensive overview of nanoliposomes in PTT, exploring their distinct attributes and the significant progress in this therapeutic methodology. The research delves into the fundamental traits of nanoliposomes, emphasizing their adaptability, compatibility with biological systems, and their capacity to encapsulate diverse therapeutic substances. Specifically, it examines the integration of light-absorbing materials, like gold nanoparticles or organic dyes, into nanoliposomal formulations, enabling their efficacy as proficient agents for photothermal treatment Additionally, this paper elucidates the mechanisms involved in nanoliposome-mediated PTT, highlighting their capability to convert light energy into localized heat, facilitating the precise targeting of diseased cells or tissues. This precise regulation of light absorption and heat generation by nanoliposomes presents a non-invasive and precisely focused therapeutic approach, particularly in conditions like cancer. The study explores advancements in nanoliposomal formulations aimed at optimizing PTT outcomes. These advancements include strategies for improved stability, enhanced drug loading, and the targeted delivery of therapeutic agents to specific cells or tissues. Furthermore, the paper discusses multifunctional nanoliposomal systems, integrating imaging components or targeting elements for real-time monitoring and improved accuracy in PTT. Moreover, the review highlights recent preclinical and clinical trials showcasing the effectiveness and safety of nanoliposome-based PTT across various disease models. It also addresses challenges in clinical implementation, such as scalability, regulatory considerations, and long-term safety assessments. In conclusion, this paper underscores the substantial potential of nanoliposomes in advancing PTT as a promising therapeutic approach. Their distinctive characteristics, combined with their precise ability to convert light into heat, offer a tailored and efficient method for treating targeted diseases. The encouraging outcomes from preclinical studies pave the way for further exploration and potential clinical applications of nanoliposome-based PTT.

Keywords: nanoliposomes, photothermal therapy, light absorption, heat conversion, therapeutic agents, targeted delivery, cancer therapy

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Authors: Mohamed Raouf Benmakrelouf, Joseph Rynkiewicz

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Targeted maximum likelihood estimation (TMLE) is well-established method for causal effect estimation with desirable statistical properties. TMLE is a doubly robust maximum likelihood based approach that includes a secondary targeting step that optimizes the target statistical parameter. A causal interpretation of the statistical parameter requires assumptions of the Rubin causal framework. The causal effect of binary variable, E, on outcomes, Y, is defined in terms of comparisons between two potential outcomes as E[YE=1 − YE=0]. Our aim in this paper is to present an adaptation of TMLE methodology to estimate the causal effect of a non-binary categorical variable, providing a large application. We propose coding on the initial data in order to operate a binarization of the interest variable. For each category, we get a transformation of the non-binary interest variable into a binary variable, taking value 1 to indicate the presence of category (or group of categories) for an individual, 0 otherwise. Such a dummy variable makes it possible to have a pair of potential outcomes and oppose a category (or a group of categories) to another category (or a group of categories). Let E be a non-binary interest variable. We propose a complete disjunctive coding of our variable E. We transform the initial variable to obtain a set of binary vectors (dummy variables), E = (Ee : e ∈ {1, ..., |E|}), where each vector (variable), Ee, takes the value of 0 when its category is not present, and the value of 1 when its category is present, which allows to compute a pairwise-TMLE comparing difference in the outcome between one category and all remaining categories. In order to illustrate the application of our strategy, first, we present the implementation of TMLE to estimate the causal effect of non-binary variable on outcome using simulated data. Secondly, we apply our TMLE adaptation to survey data from the French Political Barometer (CEVIPOF), to estimate the causal effect of education level (A five-level variable) on a potential vote in favor of the French extreme right candidate Jean-Marie Le Pen. Counterfactual reasoning requires us to consider some causal questions (additional causal assumptions). Leading to different coding of E, as a set of binary vectors, E = (Ee : e ∈ {2, ..., |E|}), where each vector (variable), Ee, takes the value of 0 when the first category (reference category) is present, and the value of 1 when its category is present, which allows to apply a pairwise-TMLE comparing difference in the outcome between the first level (fixed) and each remaining level. We confirmed that the increase in the level of education decreases the voting rate for the extreme right party.

Keywords: statistical inference, causal inference, super learning, targeted maximum likelihood estimation

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Authors: Mathumalar Loganathan, Lina Syazana, Bryony Dean Franklin

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Background: The therapeutic benefit of self-administered medication for long-term use is limited by an average 50% non-adherence rate. Patient forgetfulness is a common factor in unintentional non-adherence. With a growing ageing population, strategies to improve self-administration of medication adherence are essential. Our aim was to review systematically the effects of interventions to optimise self-administration of medication. Method: Database searched were MEDLINE, EMBASE, PsynINFO, CINAHL from 1980 to 31 October 2013. Search terms included were ‘self-administration’, ‘self-care’, ‘medication adherence’, and ‘intervention’. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. Results: The search strategy retrieved 6 studies that met the inclusion and exclusion criteria. Three intervention strategies were identified: self-administration medication programme (SAMP), nursing education and medication packaging (pill calendar). A nursing education programme focused on improving patients’ behavioural self-management of drug prescribing. This was the most studied area and three studies highlighting an improvement in self-administration of medication. Conclusion: Results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, self-administration of medication programme seems to show most promise. A multi-faceted approach and clearer policy guideline are likely to be required to improve prescribing for these vulnerable patients. Mixed results were found for SAMP. Medication packaging (pill calendar) was evaluated in one study showing a significant improvement in self-administration of medication. A meta-analysis could not be performed due to heterogeneity in the outcome measures.

Keywords: self-administered medication, intervention, prescribing, older patients

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Authors: Eli Buchbinder

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Dialectics theory perceives two or more forces or themes as mutually opposed and negating on the one hand and as interdependent for their definition, existence, and resolution on the other. Such opposites might never be fully reconciled but might, simultaneously, continue to produce a higher level of integration and synthesis as well as tension, contradictions, and paradoxes. The identity of social work is constructed by poles; an understanding that emerges through key concepts that shape the profession. The key concept of person-in-environment creates dialectical tensions between the psychological versus the social pole. Important examples that reflect this focus on the psychological versus the social nature of human beings. This meta-perspective influences and constructs the implementation of values, ways of intervention, and professional relationships, e.g., creating a conflict between personal/social empowerment and social control and correction as the aims of the profession. Social work is dynamic and changing, with a unique way of perceiving and conceptualizing human behavior. Social workers must be able to face and accept the contradicting elements inherent in practicing social work. The basic philosophy for social work education is a dialectic conceptualization. In light of the above, social work students require dialectics as a critical mode of perception, reflection, and intervention. In the presentation, the focus will be on reflection on teaching students to conceptualize dialectics as a frame when training to be social workers. It is believed that the focus should emphasis two points: 1) the need to assist students to identify poles and to analyze the interrelationships created between them while coping emotionally with the tension and difficulties involved in containing these poles; 2) teaching students to integrate poles as a basis for assessment, planning, and intervention.

Keywords: professional ontology, a generic social work education, skills and values of social work, reflecting on social work teaching methods

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Authors: John Hang Leung, Shyh-Yau Wang, Hei-Tung Yip, Fion, Ho Tsung-chin, Agnes LF Chan

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Objectives: Platinum-resistant ovarian cancer has a short overall survival of 9–12 months and limited treatment options. The combination of immunotherapy and targeted therapy appears to be a promising treatment option for patients with ovarian cancer, particularly to patients with platinum-resistant recurrent ovarian cancer (PRrOC). However, there are no direct head-to-head clinical trials comparing their efficacy and toxicity. We, therefore, used a network to directly and indirectly compare seven newer immunotherapies or targeted therapies combined with chemotherapy in platinum-resistant relapsed ovarian cancer, including antibody-drug conjugates, PD-1 (Programmed death-1) and PD-L1 (Programmed death-ligand 1), PARP (Poly ADP-ribose polymerase) inhibitors, TKIs (Tyrosine kinase inhibitors), and antiangiogenic agents. Methods: We searched PubMed (Public/Publisher MEDLINE), EMBASE (Excerpta Medica Database), and the Cochrane Library electronic databases for phase II and III trials involving PRrOC patients treated with immunotherapy or targeted therapy plus chemotherapy. The quality of included trials was assessed using the GRADE method. The primary outcomes compared were progression-free survival, the secondary outcomes were overall survival and safety. Results: Seven randomized controlled trials involving a total of 2058 PRrOC patients were included in this analysis. Bevacizumab plus chemotherapy showed statistically significant differences in PFS (Progression-free survival) but not OS (Overall survival) for all interested targets and immunotherapy regimens; however, according to the heatmap analysis, bevacizumab plus chemotherapy had a statistically significant risk of ≥grade 3 SAEs (Severe adverse effects), particularly hematological severe adverse events (neutropenia, anemia, leukopenia, and thrombocytopenia). Conclusions: Bevacizumab plus chemotherapy resulted in better PFS as compared with all interested regimens for the treatment of PRrOC. However, statistical differences in SAEs as bevacizumab plus chemotherapy is associated with a greater risk for hematological SAE.

Keywords: platinum-resistant recurrent ovarian cancer, network meta-analysis, immune checkpoint inhibitors, target therapy, antiangiogenic agents

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