Protocol for an evaluation of the Designing Communities to Support Healthy Living in Aging Residents Study

Background In collaboration with building developers, the Housing for Health team is contributing to the design of community-based congregate living facilities to support healthy living in older adults. There may also be opportunities to improve the surrounding neighbourhoods by collaborating with the municipalities where the developments are located. We will evaluate whether one or more of these comprehensive interventions lead to changes in the perceived, microscale, and macroscale neighbourhood-built environment (BE) and amenities, and impacts on the physical activity (PA), healthy eating, and social connections of residents. In parallel, we will gather qualitative data to provide a more in-depth understanding of how the BE may facilitate or hinder resident’s healthy living outcomes. Methods This project employs a quasi-experimental pre-post design with at least one or more intervention and control sites. The quantitative BE evaluation will include pre- and post-intervention assessments of neighbourhood macroscale (e.g., layout of communities) and microscale (e.g., street details and characteristics) changes using Geographical Information Systems (GIS) and Microscale Audit Pedestrian Streetscapes (MAPS) audits, respectively. The quantitative resident evaluation will include self-report (i.e., surveys) and objective assessments (i.e., accelerometers, Global Positioning System [GPS]) of residents at baseline (3-6-months pre-move-in) and follow-up (3-6-months and 9-12-months post-move-in if possible). The qualitative resident-environment component will involve in-depth semi-structured interviews post-intervention with building residents, family members, and stakeholders involved in the design/development and/or operation of the intervention site(s). Participant observations will be completed in the building and neighbourhood environments of the intervention site(s). Discussion Findings will provide evidence on whether and how comprehensive changes to the BE and amenities of at least one congregate living facility and the surrounding neighbourhood can impact PA, healthy eating, and social connections of older adults. Successful intervention elements will be scaled up in future work. We will disseminate findings to a broad audience including the scientific community via peer-reviewed publications, conference presentations, and discussion panels; and the private, public, and not-for-profit sectors via reports, public presentations, and/or communications via our partners and their networks. Trial registration Protocol ID: 1819-HQ-000051. ClinicalTrials.gov ID: NCT05031273. Registered 29 June 2021 with ClinicalTrials.gov.

Feasibility and acceptability of hypnosis-derived communication administered by trained nurses to improve patient well-being during outpatient chemotherapy: a pilot-controlled trial

Purpose This pilot-controlled trial aimed to examine the feasibility and acceptability of hypnosis-derived communication (HC) administered by trained nurses during outpatient chemotherapy to optimize symptom management and emotional support — two important aspects of patient well-being in oncology. Methods The trial was conducted in two outpatient oncology units: (1) intervention site (usual care with HC), and (2) control site (usual care). Nurses at the intervention site were invited to take part in an 8-h training in HC. Participants’ self-ratings of symptoms and emotional support were gathered at predetermined time points during three consecutive outpatient visits using the Edmonton Symptom Assessment Scale and the Emotional Support Scale. Results Forty-nine patients (24 in the intervention group, 25 in the control group) with different cancer types/stages were recruited over a period of 3 weeks and completed the study. All nurses (N = 10) at the intervention site volunteered to complete the training and were able to include HC into their chemotherapy protocols (about ± 5 min/intervention). Compared to usual care, patients exposed to HC showed a significant reduction in physical symptoms during chemotherapy. In contrast, perception of emotional support did not show any significant effect of the intervention. Participants exposed to HC report that the intervention helped them relax and connect on a more personal level with the nurse during chemotherapy infusion. Conclusions Our results suggest that HC is feasible, acceptable, and beneficial for symptom management during outpatient chemotherapy. While future studies are needed, hypnosis techniques could facilitate meaningful contacts between cancer patients and clinicians in oncology. Trial registration Clinical Trial Identifier: NCT04173195, first posted on November 19, 2019

Complicações associadas à posição prona na neurocirurgia: uma revisão sistemática / Complications associated with prone positioning in neurosurgery: a systematic review

Introdução: A escolha da posição do paciente na neurocirurgia é um processo que se baseia no sítio de intervenção e na prevenção de complicações, considerando-se a máximasegurança para o paciente. O posicionamento em prona está ligado a complicações transitórias e permanentes pouco discutidas. Método: Pesquisou-se os termos “pronação”,“decúbito ventral”, “prona”, complicações”, “intercorrências” e variações utilizado os operadores booleanos OR e AND, em diferentes estratégias. Resultados: Selecionou-se49 artigos, que relataram complicações hemodinâmicas, visuais, neurológicas, musculares e venosas, de caráter transitório ou permanente. As complicações estão associadastanto a aspectos da cirurgia, como movimentação adotada durante o procedimento, hipovolemia, hemorragia e tempo cirúrgico, quanto a comorbidades dos pacientes, como obesidade, hipertensão arterial e diabetes mellitus. Discussão: A posição prona exige observação dos fatores de risco, para escolha de posicionamentos alternativos, e, caso adotada, a monitorização do paciente, a fim de reduzir complicações. Conclusão: Nenhum posicionamento está destituído de riscos, sendo necessário conhecer as complicações a fim de se melhor avaliar a escolha do posicionamento. Palavras chave: Decúbito ventral, Neurocirurgia, Laminectomia, Cuidados pós-operatórios ABSTRACTIntroduction: The choice of patient positioning in neurosurgery is a process that is based on the intervention site and prevention of complications, in order to ensure maximumpatient safety. The prone position requires patient monitoring to reduce complications. Alternative positions must be considered if there are patient risk factors Method: Theterms “pronation”, “prone position”, “prone”, “complications” and variations were used with the boolean operators OR and AND in different strategies. Results: Forty-nine articles were selected that reported transient or permanent hemodynamic, visual, neurological, muscular and venous complications. Complications are associated with surgical aspects, such as movements adopted during the procedure, hypovolemia, hemorrhage, surgical time, and patients’ comorbidities, such as obesity, arterial hypertension, and diabetes mellitus. Discussion: The prone position requires patient monitoring to reduce complications. Alternative positions must be considered if there are patient risk factors. Conclusion: No positioning is without risks, and it is necessary to know the complications to better assess the positioning choice.Keywords: Prone position, Neurosurgery, Laminectomy, Postoperative care

Case-based audit and feedback around a decision aid improved antibiotic choice and duration for uncomplicated cystitis in primary care clinics

ObjectivesThe objective of our study was to evaluate the impact of a multifaceted stewardship intervention on adherence to the evidence-based practice guidelines on treatment of uncomplicated cystitis in primary care. We hypothesised that our intervention would increase guideline adherence in terms of antibiotic choice and duration of treatment.DesignA preintervention and postintervention comparison with a contemporaneous control group was performed. During the first two study periods, we obtained baseline data and performed interviews exploring provider prescribing decisions for cystitis at both clinics. During the third period in the intervention clinic only, the intervention included a didactic lecture, a decision algorithm and audit and feedback. We used a difference-in-differences analysis to determine the effects of our intervention on the outcome and guideline adherence to antibiotic choice and duration.SettingTwo family medicine clinics (one intervention and one control) were included.ParticipantsAll female patients with uncomplicated cystitis attending the study clinics between 2016 and 2019.ResultsOur sample included 932 visits representing 812 unique patients with uncomplicated cystitis. The proportion of guideline-adherent antibiotic regimens increased during the intervention period (from 33.2% (95% CI 26.9 to 39.9) to 66.9% (95% CI 58.4 to 74.6) in the intervention site and from 5.3% (95% CI 2.3 to 10.1) to 17.0% (95% CI 9.9 to 26.6) in the control site). The increase in guideline adherence was greater in the intervention site compared with the control site with a difference-in-differences of 22 percentage points, p=0.001.ConclusionA multifaceted intervention increased guideline adherence for antibiotic choice and duration in greater magnitude than similar trends at the control site. Future research is needed to facilitate scale-up and sustainability of case-based audit and feedback interventions in primary care.

A brief staff training to increase children’s physical activity during an after-school program: Preliminary effectiveness and potential for dissemination

This two-part study aimed to first evaluate the preliminary effectiveness of a brief staff training intervention to promote physical activity among children attending an after-school program, and then to determine the feasibility of delivering the training to a larger number of sites. Two Boys and Girls Club after-school sites (intervention, control) participated in study 1. Accelerometer-measured physical activity of children and directly observed staff behaviors were assessed at each site in February and May 2019. Following baseline data collection, staff at the intervention site attended a brief physical activity promotion training, which emphasized expanding the quantity and enhancing the quality of physical activity opportunities. For study 2, the training was delivered to all staff, and they completed pre- and post-training measures of self-efficacy and intention to implement strategies to promote physical activity. In study 1, children at the intervention site decreased sedentary time by 14.8 min/day, and increased light and moderate-to-vigorous physical activity by 7.8 and 7.0 min/day, respectively, relative to the control site. Instances of staff encouragement significantly increased at the intervention site. In study 2, staff reported significant improvements in self-efficacy and intention immediately following the training. These studies provide preliminary evidence that a brief staff training intervention may increase physical activity among children attending an after-school program, and that the intervention can be integrated into existing training requirements. Future research is needed to replicate these findings across a wider range of after-school programs, and to explore systematic approaches to offering sustainable physical activity training regularly at scale.

Artificial Nourishments Effects on Longshore Sediments Transport

Serious erosion problems related to significant negative sediments budgets in the coastal systems are referred worldwide. Artificial nourishments are a coastal erosion mitigation strategy that allow for a decrease in those negative budgets by adding sediment to the coastal system. Thus, it is essential to understand and adequately model the shoreline response after a nourishment operation, in order to support the definition of the best intervention scenarios. The main goal of this work was to study the artificial nourishment effects on the longshore sediment transport and consequently on the morphological evolution at the intervention site and nearby areas, in a time horizon of 5 years. The longshore transport of the nourished sediments was evaluated, aiming to contribute to the evaluation of the sediment’s permanence at the deposition site and the frequency required for new nourishments. The shoreline evolution numerical long-term configuration (LTC) model was applied in order to evaluate the spatial and temporal distribution of the nourished sediments along the coast, considering different types of beaches and incident wave climates. The adopted approach is generic and supported by simple numerical models, which can be useful for preliminary site-specific evaluations. The results show that the nourishment impact is mainly observed nearby the intervention site. It is highlighted that higher longshore sediment transport rates are associated with more energetic wave climates, but not necessarily with incident waves more oblique to the shoreline.

Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system

ImportanceElectronic health record (EHR) clinical decision support (CDS) tools can provide evidence-based feedback at the point of care to reduce low-value imaging. Success of these tools has been limited partly due to lack of engagement by busy clinicians.ObjectiveMeasure the impact of a time-saving quality improvement intervention to increase engagement with a CDS tool for low back pain imaging ordering.Design, setting and participantsWe conducted a quasi-experimental difference-in-differences analysis at (BLINDED), examining back pain imaging orders from 29 May 2015 to 07 January 2016. The intervention site was (BLINDED) Emergency Medicine/Urgent Care Center (n=5736) and control sites included all other (BLINDED) hospitals and clinics (n=1621). In May 2015, the Department of Health Services installed a CDS tool that triggered a survey when clinicians ordered an imaging test, generating an ‘appropriateness score’ based on the American College of Radiology guidelines. Clinicians often bypassed the tool, resulting in ‘unscored’ tests.InterventionTo increase clinician engagement with the tool and decrease the rate of unscored imaging tests, a new policy was implemented at the intervention site on 15 August 2015. If clinicians completed the CDS survey and scored an appropriateness score >3, they could forego a previously mandatory telephone call for pre-imaging utilisation review with the radiology department.Main outcomes and measuresWe used EHR data to measure pre–post-intervention differences in: (1) percentage of unscored tests and (2) percentage of tests with high appropriateness scores (>7).ResultsPercentage of unscored tests decreased from 69.4% to 10.4% at the intervention site and from 50.6% to 34.8% at the control sites (between-group difference: −23.3%, p<0.001). Percentage of high scoring tests increased from 26.5% to 75.0% at the intervention site and from 17.2% to 22.7% at the control sites (between-group difference: 19%, p<0.001).ConclusionWorkflow time-saving interventions may increase physician engagement with CDS tools and have potential to improve practice patterns.

A natural experimental study of improvements along an urban canal: impact on canal usage, physical activity and other wellbeing behaviours

Background There are few robust natural experimental studies of improving urban green spaces on physical activity and wellbeing. The aim of this controlled natural experimental study was to examine the impact of green space improvements along an urban canal on canal usage, physical activity and two other wellbeing behaviours (social interactions and taking notice of the environment) among adults in Greater Manchester, UK. The intervention included resurfaced footpaths, removal of encroaching vegetation, improved entrances, new benches and signage. Methods Two comparison sites were matched to the intervention site using a systematic five-step process, based on eight correlates of physical activity at the neighbourhood (e.g. population density) and site (e.g. lighting) levels. Outcomes were assessed using systematic observations at baseline, and 7, 12 and 24 months post-baseline. The primary outcome was the change in the number of people using the canal path from baseline to 12 months. Other outcomes were changes in physical activity levels (Sedentary, Walking, Vigorous), Connect and Take Notice behaviours. Data were analysed using multilevel mixed-effects negative binomial regression models, comparing outcomes in the intervention group with the matched comparison group, controlling for day, time of day and precipitation. A process evaluation assessed potential displacement of activity from a separate existing canal path using intercept surveys and observations. Results The total number of people observed using the canal path at the intervention site increased more than the comparison group at 12 months post-baseline (IRR 2.10, 95% CI 1.79–2.48); there were similar observed increases at 7 and 24 months post-baseline. There was some evidence that the intervention brought about increases in walking and vigorous physical activity, social interactions, and people taking notice of the environment. The process evaluation suggested that there was some displacement of activity, but the intervention also encouraged existing users to use the canal more often. Conclusions Urban canals are promising settings for interventions to encourage green space usage and potentially increase physical activity and other wellbeing behaviours. Interventions that improve access to green corridors along canals and provide separate routes for different types of physical activities may be particularly effective and warrant further research. Study protocol Study protocol published in Open Science Framework in July 2018 before the first follow-up data collection finished (https://osf.io/zcm7v). Date of registration: 28 June 2018.

An improved method for precise genome editing in zebrafish using CRISPR-Cas9 technique

Current methods of CRISPR-Cas9-mediated site-specific mutagenesis create deletions and small insertions at the target site which are repaired by imprecise non-homologous end-joining. Targeting of the Cas9 nuclease relies on a short guide RNA (gRNA) corresponding to the genome sequence approximately at the intended site of intervention. We here propose an improved version of CRISPR-Cas9 genome editing that relies on two complementary guide RNAs instead of one. Two guide RNAs delimit the intervention site and allow the precise deletion of several nucleotides at the target site. As proof of concept, we generated heterozygous deletion mutants of the kcng4b, gdap1, and ghitm genes in the zebrafish Danio rerio using this method. A further analysis by high-resolution DNA melting demonstrated a high efficiency and a low background of unpredicted mutations. The use of two complementary gRNAs improves CRISPR-Cas9 specificity and allows the creation of predictable and precise mutations in the genome of D. rerio.

Towards 3D Simulation for Disaster Intervention Robot Behaviour Assessment

When a disaster strikes, response teams can nowadays rely on recent advances in technology. This approach improves the definition of a disaster management strategy. The use of autonomous systems during rescue operations allows, for example, to reach places that may be inaccessible or dangerous to human rescuers. In this context, both the design and the configuration of an autonomous system, including its embedded instruments (e.g. sensors), play a very important role in the overall outcome of the rescue mission. An incorrect configuration can lead to the acquisition of inaccurate or erroneous data and may result in incorrect information provided to rescuers. How can we ensure that the configuration of the autonomous systems is correct for a target mission? We propose to validate this configuration by testing the behaviour of the autonomous systems and their equipment in a virtual environment. To do this, system, sensors, space environment (geometry, etc.), prevailing conditions at the intervention site (weather, etc.) and mission scenario must be modelled in a 3D simulation system. The results of these simulations allow to apply in real time the modifications required to better adapt the configuration to the objectives of the mission. These simulations must be performed prior to the deployment of rescue teams to speed the development of a rescue management strategy. In this contribution, we propose a protocol to enhance an existing simulation environment to make it adapt to support disaster management. Then, we validate it through a case study in which we show the approach to correctly configure a LIDAR for a realistic mission. Such simulations allowed us to quantitatively configure the parameters of the LIDAR mounted on an existing disaster management rover, in order to keep the energy consumption limited while guaranteeing a correct functioning of the system. Resuming, the expected results are: (i) the assessment of the suitability of system for the mission, (ii) the choice of the quantitative features which characterize such equipment, (iii) the expectation of mission success and (iv) the probability which the system survives and completes the mission.