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Journal of Applied Research in... Jul 2024This study assessed the effectiveness of a cross-departmental case review panel-the Multicap Complex Behaviour Forum (CBF)-in reducing challenging behaviour exhibited by...
BACKGROUND
This study assessed the effectiveness of a cross-departmental case review panel-the Multicap Complex Behaviour Forum (CBF)-in reducing challenging behaviour exhibited by people with intellectual disabilities.
METHODS
Thirty participants (15 CBF participants and 15 matched-control participants) took part in the study. Behavioural data was collected for each CBF participant (and their matched control) for the three-month period before entering the CBF, during their time in the CBF, and the 3 months after exiting the CBF.
RESULTS
There was a significant interaction of group and time observed, with the CBF participants showing more change in behavioural incidents across time. Associated with this change was a noticeable reduction in staff injury costs related to the challenging behaviour of the CBF participants.
CONCLUSIONS
This study demonstrates that positive behavioural and organisational outcomes are enhanced by fostering collaboration across multiple organisational systems when it comes to supporting people who exhibit challenging behaviours.
Topics: Humans; Intellectual Disability; Male; Adult; Female; Problem Behavior; Middle Aged; Young Adult
PubMed: 38859726
DOI: 10.1111/jar.13261 -
Zhonghua Gan Zang Bing Za Zhi =... May 2024Hepatitis B is mostly a chronic, progressive disease that, if not treated promptly and effectively, can slowly progress to cirrhosis, liver failure, or hepatocellular...
Hepatitis B is mostly a chronic, progressive disease that, if not treated promptly and effectively, can slowly progress to cirrhosis, liver failure, or hepatocellular carcinoma. Therefore, antiviral therapy, i.e., a "complete therapy" strategy, should be started as long as the virus is positive. Immediate antiviral treatment is not recommended for infected patients who are only in the immune-tolerant phase, mainly because of the milder conditions and poor antiviral therapy efficacy, according to antiviral indications in China's Guidelines for the Prevention and Treatment of Chronic Hepatitis B (2022 Version). The relevant issues of why hepatitis B virus infection in the immune-tolerant phase is the last mile of "complete therapy," with an emphasis on the disease's characteristics and antiviral treatment strategies, are discussed here.
Topics: Humans; Antiviral Agents; Hepatitis B virus; Hepatitis B, Chronic; Immune Tolerance; Hepatitis B
PubMed: 38858188
DOI: 10.3760/cma.j.cn501113-20240428-00233 -
Physical Review Letters May 2024For dark matter to be detectable with gravitational waves from binary black holes, it must reach higher than average densities in their vicinity. In the case of light...
For dark matter to be detectable with gravitational waves from binary black holes, it must reach higher than average densities in their vicinity. In the case of light (wavelike) dark matter, the density of dark matter between the binary can be significantly enhanced by accretion from the surrounding environment. Here we show that the resulting dephasing effect on the last ten orbits of an equal mass binary is maximized when the Compton wavelength of the scalar particle is comparable to the orbital separation, 2π/μ∼d. The phenomenology of the effect is different from the channels that are usually discussed, where dynamical friction (along the orbital path) and radiation of energy and angular momentum drive the dephasing, and is rather dominated by the radial force (the spacetime curvature in the radial direction) towards the overdensity between the black holes. While our numerical studies limit us to scales of the same order, this effect may persist at larger separations and/or particle masses, playing a significant role in the merger history of binaries.
PubMed: 38856260
DOI: 10.1103/PhysRevLett.132.211401 -
BMC Medicine Jun 2024Global progress on malaria control has stalled recently, partly due to challenges in universal access to malaria diagnosis and treatment. Community health workers (CHWs)... (Randomized Controlled Trial)
Randomized Controlled Trial
Expanding community case management of malaria to all ages can improve universal access to malaria diagnosis and treatment: results from a cluster randomized trial in Madagascar.
BACKGROUND
Global progress on malaria control has stalled recently, partly due to challenges in universal access to malaria diagnosis and treatment. Community health workers (CHWs) can play a key role in improving access to malaria care for children under 5 years (CU5), but national policies rarely permit them to treat older individuals. We conducted a two-arm cluster randomized trial in rural Madagascar to assess the impact of expanding malaria community case management (mCCM) to all ages on health care access and use.
METHODS
Thirty health centers and their associated CHWs in Farafangana District were randomized 1:1 to mCCM for all ages (intervention) or mCCM for CU5 only (control). Both arms were supported with CHW trainings on malaria case management, community sensitization on free malaria care, monthly supervision of CHWs, and reinforcement of the malaria supply chain. Cross-sectional household surveys in approximately 1600 households were conducted at baseline (Nov-Dec 2019) and endline (Nov-Dec 2021). Monthly data were collected from health center and CHW registers for 36 months (2019-2021). Intervention impact was assessed via difference-in-differences analyses for survey data and interrupted time-series analyses for health system data.
RESULTS
Rates of care-seeking for fever and malaria diagnosis nearly tripled in both arms (from less than 25% to over 60%), driven mostly by increases in CHW care. Age-expanded mCCM yielded additional improvements for individuals over 5 years in the intervention arm (rate ratio for RDTs done in 6-13-year-olds, RR = 1.65; 95% CIs 1.45-1.87), but increases were significant only in health system data analyses. Age-expanded mCCM was associated with larger increases for populations living further from health centers (RR = 1.21 per km; 95% CIs 1.19-1.23).
CONCLUSIONS
Expanding mCCM to all ages can improve universal access to malaria diagnosis and treatment. In addition, strengthening supply chain systems can achieve significant improvements even in the absence of age-expanded mCCM.
TRIAL REGISTRATION
The trial was registered at the Pan-African Clinical Trials Registry (#PACTR202001907367187).
Topics: Humans; Malaria; Madagascar; Case Management; Male; Child; Adolescent; Child, Preschool; Female; Health Services Accessibility; Infant; Adult; Community Health Workers; Young Adult; Middle Aged; Cross-Sectional Studies; Community Health Services; Rural Population; Aged
PubMed: 38853263
DOI: 10.1186/s12916-024-03441-9 -
Applied Radiation and Isotopes :... May 2024In addition to generalised of bone loss and a higher fracture risk, rheumatoid arthritis (RA) causes periarticular bone erosions. Improvements in bone density/erosion...
In addition to generalised of bone loss and a higher fracture risk, rheumatoid arthritis (RA) causes periarticular bone erosions. Improvements in bone density/erosion and turnover may not go hand in hand with a positive clinical response to biological anti-inflammatory drugs assesed by disease activity score 28 (DAS28) in RA patients. This study aimed to understand how biologic anti-inflammatory drugs affect bone density, erosion, and turnover in RA patients. We examined bone mineral density (BMD) and bone turnover biomarkers. The study population consisted of 62 RA patients, 49 (79%) of whom were female and 13 (21%) of whom were male. The patients ranged in age from 40 to 79 years old. The patients' BMD was measured using a DEXA scan, and their plasma levels of bone turnover biomarkers CTX and osteocalcin were quantified utilizing an ELISA. BMD of the hip and lumbar spine in responder patients rose after therapy by 0.001g/cm (0.11 percent, p0.001 vs. before treatment) and 0.0396g/cm (3.96 percent, p0.001 vs. before treatment), respectively. Clinically non-responder patients' DAS28 revealed minor reductions in hip BMD values of -0.008g/cm (-0.78 percent, p0.001 vs. before therapy), as well as an improvement in lumbar spine BMD of 0.03g/cm2 (3.03 percent, p0.001 vs. before treatment). After 12 weeks of therapy, the CTX levels in responder patients dropped from 164 125 pg/ml to 131 129 pg/ml. Osteocalcin levels in non-responder patients increased substantially from 11.6 ng/ml to 14.9 ng/ml after 12 weeks of therapy compared to baseline (p = 0.01). Treatment with biologic anti-inflammatory medicines decreases widespread bone loss in RA patients' hip and lumbar spine. The beneficial effects of therapy on BMD were not associated with changes in disease activity of RA patients. Changes in plasma levels of bone turnover biomarkers such as sCTX and osteocalcin confirmed the treatment's beneficial effects.
PubMed: 38851075
DOI: 10.1016/j.apradiso.2024.111373 -
Health SA = SA Gesondheid 2024This qualitative study aimed to investigate the barriers that hinder men's utilisation of healthcare services in the Sedibeng district of South Africa.
BACKGROUND
This qualitative study aimed to investigate the barriers that hinder men's utilisation of healthcare services in the Sedibeng district of South Africa.
METHODS
The study was conducted using flyers with questions posted on the Best Health Solutions' Facebook page for two weeks. A convenience sampling method was used and a total of 104 comments were collected from 64 respondents. The authors analysed the participants' self-reported data thematically on demographics, geographic area, and reasons for men not using healthcare services.
RESULTS
The findings revealed that sociocultural norms played a significant role in men's reluctance to seek medical help, as it was perceived as a sign of weakness. The scarcity of male healthcare professionals hinders open discussions. Stigma and discrimination were identified as substantial barriers. Convenience, trust, and confidentiality concerns, along with the influence of intimate partners, also influence men's decision-making.
CONCLUSION
This study highlights the complex interplay between various barriers that impact men's utilisation of healthcare services in the district. By addressing these factors, healthcare providers and policymakers can enhance healthcare access and promote better health outcomes for men in Sedibeng district.
CONTRIBUTION
The manuscript's primary contribution lies in uncovering multifaceted barriers to men's healthcare utilisation in Sedibeng district. It explores socio-cultural norms, healthcare worker demographics, stigma, discrimination, convenience factors, trust, confidentiality concerns, and the influence of intimate partners on men's healthcare choices. These insights illuminate the complex factors affecting men's healthcare access, providing valuable knowledge for healthcare providers and policymakers.
PubMed: 38841348
DOI: 10.4102/hsag.v29i0.2548 -
Journal of the American Veterinary... Jun 2024Episodic mandibular tremor (EMT), manifested as teeth chattering, is not well described in dogs. The aim of this study was to describe clinical signs, MRI findings, and...
OBJECTIVE
Episodic mandibular tremor (EMT), manifested as teeth chattering, is not well described in dogs. The aim of this study was to describe clinical signs, MRI findings, and outcome of dogs with EMT.
ANIMALS
11 dogs retrospectively and 31 dogs in an online survey.
METHODS
A retrospective multicenter study of dogs with EMT between 2018 and 2023 and prospective online questionnaire open to owners of pets with teeth chattering.
RESULTS
All dogs had rapid and short-lasting (< 1 minute) episodes of EMT in the absence of other neurological signs. Lip smacking occasionally accompanied the tremor in 5 of 11 (45.5%) hospital dog cases. Excitement was a common trigger in 14 of 31 (45.2%) dogs from the survey. Cavalier King Charles Spaniel was the most common breed in both clinical and survey populations. Median age at presentation was 3 years for both hospital cases and the survey dogs. A concurrent medical condition was present in 8 of 11 (72.7%) hospital cases and 20 of 31 (64.5%) survey dogs. In 3 hospital dogs that underwent further investigations, no brain disease was present.
CLINICAL RELEVANCE
EMT and its clinical features are presented for the first time, shedding light on a clinical sign that might resemble an idiopathic movement disorder or a manifestation of pain in dogs.
PubMed: 38838709
DOI: 10.2460/javma.24.03.0215 -
Langmuir : the ACS Journal of Surfaces... Jun 2024Graphene oxide (GO) is obtained by the chemical treatment of graphene sheets, resulting in decoration with oxygen-containing functional groups. In the work presented...
Graphene oxide (GO) is obtained by the chemical treatment of graphene sheets, resulting in decoration with oxygen-containing functional groups. In the work presented here, we examined marked changes that occur in a thin film of parallel aligned GO sheets when exposed to water vapor at various pressures. It was found that exceptionally fast and substantial water uptake and release occur that is accompanied by major changes in GO interlayer spacing. These characteristics were obtained in situ with spectroscopic ellipsometry. At 99% relative humidity (RH) and 25 °C, the interlayer spacing became 1.41 nm, which recovers to ∼0.8 nm within 30 s when exposed to 10% RH. Besides layer thickness values, uniaxial optical constants for the GO vs RH were derived from the ellipsometry data. Molar refraction theory was applied that indicated monolayer water formation at ∼91% RH at 25 °C upon water adsorption. Our findings contribute to the understanding of the interaction between GO and its environment. The very outspoken effect of external water vapor pressure on GO water content, interlayer spacing, and optical properties can be utilized in sensing and separation devices, subnanometer positioning, chemical switches, and environmentally aware materials.
PubMed: 38836692
DOI: 10.1021/acs.langmuir.4c00897 -
Small (Weinheim An Der Bergstrasse,... Jun 2024The development of wearable thermoelectric generators (wTEG) represents a promising strategy to replace batteries and supercapacitors required to supply electrical...
The development of wearable thermoelectric generators (wTEG) represents a promising strategy to replace batteries and supercapacitors required to supply electrical energy for portable electronic devices. However, the main drawback of wTEGs is that the thermal gradient between the skin and the ambient is minimal, reducing the power output produced by the generator. Therefore, it is necessary to improve the thermal management of wTEG in order to increase its efficiency. This work deals with the preparation of a thermoelectric generator that harnesses the plasmonic heating effect to enhance the thermal gradient of the final device. The thermoelectric layer is created through the in situ polymerization of terthiophene (3T) within a polyurethane matrix, utilizing silver (Ag) (I) and copper (II) perchlorate as oxidants. The plasmonic film, composed of Ag-NP (nanoparticles), is formed via photocatalytic reduction of silver nitrate in the presence of titanium oxide. These layers are then meticulously assembled to yield the hybrid plasmonic/thermoelectric generator.
PubMed: 38830337
DOI: 10.1002/smll.202400345 -
Military Medicine Jun 2024Physical inactivity, hereafter inactivity, is a serious health problem among U.S. veterans, hereafter veterans. Inactive adults are at risk for adverse cardiac events...
INTRODUCTION
Physical inactivity, hereafter inactivity, is a serious health problem among U.S. veterans, hereafter veterans. Inactive adults are at risk for adverse cardiac events and premature mortality. Specifically, among veterans, inactivity has been associated with a 23% increase in mortality. In order to increase physical activity among veterans, we developed Veterans Affairs (VA) MapTrek, a mobile-phone-based web app that allows users to take a virtual walk in interesting locations around the world while tracking their progress against that of others like themselves on an interactive map. Steps are counted by a commercially available Fitbit triaxial accelerometer, and users see their progress along a predefined scenic path overlaid on Google Maps. The objective of this study was to determine the effectiveness of VA MapTrek to increase physical activity in a population of veterans at risk for obesity-related morbidity.
MATERIALS AND METHODS
We recruited overweight and obese veterans obtaining care at the Iowa City Veterans Affairs Health Center. Half of the veterans were assigned to participate in VA MapTrek. Each week, participants were assigned virtual walking races (Monday through Saturday), which followed a predetermined route that is displayed on Google Maps. The participant's position on the map is automatically updated each time their Fitbit syncs to their phone. In addition, challenges were issued periodically. Veterans in the control group were only given a Fitbit. We regressed daily step counts on the days of the week, the days since the start of the intervention period, whether the user was in the VA MapTrek or Control group, and an interaction between the study group and the days since the start of the intervention period. We included subject-specific random intercepts and subject-specific random slopes. This model was estimated using Bayesian Hamiltonian Monte Carlo using Stan's No-U-Turns sampler. We set vague, uniform priors on all the parameters.
RESULTS
We enrolled 276 participants, but only 251 (102 in the control group and 149 in the VA MapTrek group) contributed data during the intervention period. Our analysis suggests an 86.8% likelihood that the VA MapTrek intervention led to a minimum increase of 1,000 daily steps over the 8-week period, compared to the control group. Throughout the 8-week intervention, we project that VA MapTrek participants would have taken an extra 96,627 steps, equivalent to 77.8 additional kilometers (km) (48.3 additional miles), assuming an average of 1,242 steps per km (2,000 steps per mile).
CONCLUSIONS
Our study underscores the potential of VA MapTrek as an intervention for promoting walking among veterans who face elevated risks of obesity and cardiac issues. Rural veterans are a high-risk population, and new interventions like VA MapTrek are needed to improve veterans' health.
PubMed: 38829720
DOI: 10.1093/milmed/usae280