Implementing a nurse-initiated protocol to improve response to perinatal severe hypertension.

BACKGROUND: An institutional standardized, nurse-initiated protocol was implemented to improve the recognition of and response to perinatal hypertensive emergency. OBJECTIVE(S): The primary aim was to evaluate if the rate of guideline-based treatment of perinatal hypertensive emergency improved with implementation of the protocol. STUDY DESIGN: This quality improvement initiative was developed by a multidisciplinary team and consisted of clinician and nursing education and the implementation of a standardized, nurse-initiated severe hypertension protocol. The project took place in three phases: pre-implementation (July 2020-October 2020), implementation (November 2020-June 2021), and sustainment (July 2021-May 2022). The primary aim was to increase guideline-based treatment of hypertensive emergency among pregnant and postpartum persons. Guideline-based treatment was defined as repeat blood pressure within 30 minutes of severe hypertension to diagnose hypertensive emergency, antihypertensive medication administration within 30 minutes of diagnosis, and appropriately timed repeat blood pressure following treatment. Process measures included time to confirm the diagnosis, initiate the protocol, antihypertensive medication administration, repeat blood pressure after antihypertensive medication administration, and administration of a secondary dose as appropriate. Balancing measures included maternal intensive care unit admission, clinically significant maternal hypotension, fetal demise, neonatal birthweight, and Apgar <7 at 5 minutes. Data were evaluated using between-subjects statistics and a run chart was developed to assess relationship between the protocol and changes in guideline-based treatment over time. RESULTS: Overall, 503 hypertensive emergency encounters were identified during the project period (98 [20%] pre-implementation, 172 [34%] implementation, 233 [46%] sustainment). There were higher rates of persons with chronic hypertension and who self-identified as non-Hispanic Black race in the sustainment phase compared to the other phases. Guideline-based treatment increased from 18.4% pre-implementation to 75.1% in sustainment (p<0.001). Each component of guideline-based treatment also improved significantly from pre-implementation to sustainment (p<0.001). No episodes of clinically significant maternal hypotension occurred in any phase. There were four maternal intensive care unit admissions and three fetal demises during the initiative; none were related to hypertensive emergency. CONCLUSION(S): The nurse-initiated protocol for treatment of hypertensive emergency significantly increased guideline-based treatment of perinatal hypertensive emergency, reduced time to diagnose and treat hypertensive emergency, and increased the number of patients receiving treatment when indicated. This protocol was pragmatic, utilizing resources already available on obstetric units. Use of similar protocols may be considered at institutions providing obstetric care to improve recognition of and response to hypertensive emergency which may decrease maternal and neonatal morbidity and mortality related to hypertensive emergency.

Different endometrial preparation protocols on first frozen-thawed embryo transfer outcomes after hysteroscopic polypectomy: A retrospective cohort study.

OBJECTIVE: To evaluate the optimal endometrial preparation protocol for frozen-thawed embryo transfer (FET) following hysteroscopic polypectomy. METHODS: This was a retrospective clinical cohort study involving 464 patients who underwent their first FET after polyp resection between January 2021 and July 2023. The cohorts were categorized into three groups: the natural cycle (NC) group (n = 139), the ovarian induction (OI) group (n = 117), and the hormone replacement therapy (HRT) group (n = 208). RESULTS: In the initial unadjusted analysis, both NC and OI cycles exhibited similar pregnancy rates but were associated with significantly higher implantation rate (56.5%, 57.1% vs 42.0%, P < 0.001), clinical pregnancy rate (73.4%, 74.4% vs 57.2%, P = 0.001), and ongoing pregnancy rate (OPR; 67.6%, 63.2% vs 51.0%, P = 0.005) compared to the HRT group. Additionally, the three groups demonstrated comparable abortion rate (7.8%, 14.9% vs 10.9%, P = 0.299). After adjusting for potential confounders in the multiple logistic regression model, the HRT protocol resulted in a 54% significantly lower OPR compared to the NC protocol (adjusted odds ratio [aOR] = 0.46, 95% confidence interval [CI]: 0.28-0.77; P = 0.003). Meanwhile, the OPR difference between the OI protocol and the NC protocol remained insignificant (OI vs NC: aOR = 0.62, 95% CI: 0.35-1.12; P = 0.112). CONCLUSION: The ovulatory-FET scheme (NC and OI) following hysteroscopic polyp resection displayed promising clinical outcomes compared with HRT-FET scheme. The regimen without exogenous estrogen administration should be prioritized for endometrial preparation protocol after polypectomy.

Exploring positive welfare measures: preliminary findings from a prototype protocol in loose housing dairy cattle farms.

Introduction: Following the increasing interest about the development of indicators of positive welfare and affective state in farm animals, the aim of this research is to present some preliminary results on the application of a prototype protocol based exclusively on positive welfare measures and to suggest potential benefits that can promote positive welfare. Methods: The protocol was applied in 20 loose housing dairy cattle farms (6 on deep litter with straw, 14 in cubicles) and included only indicators of positive welfare and emotional states: feeding and resting synchronization, rumination during resting, comfortable lying postures, no visible eye white, relaxed ear postures, percentage of cow contacts with humans in the Avoidance Distance test. Potential benefits in terms of housing, feeding and management were then related to these variables (Mann-Whitney U test). Qualitative Behavior Assessment (QBA) was also carried out and analyzed by Principal Component Analysis to explore the effect of factors that were not evenly distributed in our sample (number of feed distributions, access to pasture, presence of paddock or environmental enrichments, automatic milking systems). Results: When hay was included in the diet, higher feeding synchronization (93.7 ± 1.6 vs. 52.2 ± 4.7%; p < 0.01), percentage of cows with relaxed ear postures (35.8 ± 5.4 vs. 15.5 ± 2.1%; p < 0.01) and percentage of cows with no visible eye white (55.9 ± 17.0 vs. 36.6 ± 4.1%; n.s.) were recorded. A higher level of feeding synchronization was observed also when the feeding places/cow ratio was > 1 (72.1 ± 9.9 vs. 53.8 ± 5.8%), although differences were not significant (p = 0.14). Deep litter had a more positive effect than cubicles on comfort at resting, with a significantly higher percentage of ruminating cows (65.8 ± 10.2 vs. 34.2 ± 3.7%; p < 0.01), a higher percentage of cows with no visible eye white (55.6 ± 9.9 vs. 33.1 ± 3.7%; p < 0.05) and a higher percentage of cows in a more comfortable posture, with stretched legs (14.3 ± 5.1 vs. 5.6 ± 1.6%; p = 0.09). QBA highlighted the most positive emotional state in the only farm that allowed access to pasture. Conclusions: This study represents a first attempt to apply a protocol for on-farm welfare evaluation based exclusively on the use of positive welfare indicators and provides suggestions on possible benefits (e.g., deep litter, feeding places/cow ratio > 1, hay in the diet and access to pasture) to enhance dairy cattle welfare.

Invitation to do remission of pre-diabetes to normoglycemia.

By integrating health coaching into maritime medical clinics, we can provide tailored support to individuals at risk of developing diabetes and empower them to take control of their health.

"The Failing Watchman": Recurrent Left Atrial Appendage Occlusion Device (LAAOD) Thrombus After Successful Initial Implantation.

A 79-year-old female with chronic atrial fibrillation was being treated with dabigatran (Pradaxa). Pradaxa was discontinued after a significant bleeding episode. A WATCHMAN device was successfully implanted and Pradaxa was started. A transesophageal echocardiogram (TEE) 49 days later showed a 3.6×2.2 cm clot overlying the device. Pradaxa was switched to Coumadin. Subsequent TEEs showed the complete resolution of the thrombus after five months on Coumadin. Coumadin was discontinued. Six months later, TEE showed a large mobile thrombus attached to the left atrial appendage occlusion device (LAAOD). The patient's hypercoagulable workup was negative. Due to recurrent thrombotic events, she was started on apixaban (Eliquis) due to a prior history of bleeding on Coumadin. She is currently on Eliquis with no further episodes of bleeding or device thrombus.

Traditional healer support to improve HIV viral suppression in rural Uganda (Omuyambi): study protocol for a cluster randomized hybrid effectiveness-implementation trial.

BACKGROUND: Rural African people living with HIV face significant challenges in entering and remaining in HIV care. In rural Uganda, for example, there is a threefold higher prevalence of HIV compared to the national average and lower engagement throughout the HIV continuum of care. There is an urgent need for appropriate interventions to improve entry and retention in HIV care for rural Ugandans with HIV. Though many adults living with HIV in rural areas prioritize seeking care services from traditional healers over formal clinical services, healers have not been integrated into HIV care programs. The Omuyambi trial is investigating the effectiveness of psychosocial support delivered by traditional healers as an adjunct to standard HIV care versus standard clinic-based HIV care alone. Additionally, we are evaluating the implementation process and outcomes, following the Consolidated Framework for Implementation Research. METHODS: This cluster randomized hybrid type 1 effectiveness-implementation trial will be conducted among 44 traditional healers in two districts of southwestern Uganda. Healers were randomized 1:1 into study arms, where healers in the intervention arm will provide 12 months of psychosocial support to adults with unsuppressed HIV viral loads receiving care at their practices. A total of 650 adults with unsuppressed HIV viral loads will be recruited from healer clusters in the Mbarara and Rwampara districts. The primary study outcome is HIV viral load measured at 12 months after enrollment, which will be analyzed by intention-to-treat. Secondary clinical outcome measures include (re)initiation of HIV care, antiretroviral therapy adherence, and retention in care. The implementation outcomes of adoption, fidelity, appropriateness, and acceptability will be evaluated through key informant interviews and structured surveys at baseline, 3, 9, 12, and 24 months. Sustainability will be measured through HIV viral load measurements at 24 months following enrollment. DISCUSSION: The Omuyambi trial is evaluating an approach that could improve HIV outcomes by incorporating previously overlooked community lay supporters into the HIV cascade of care. These findings could provide effectiveness and implementation evidence to guide the development of policies and programs aimed at improving HIV outcomes in rural Uganda and other countries where healers play an essential role in community health. TRIAL REGISTRATION: ClinicalTrials.gov NCT05943548. Registered on July 5, 2023. The current protocol version is 4.0 (September 29, 2023).

Correspondence Between Vocal-Verbal Behavior and Go/No-Go Responses During the Successive Matching-to-Sample Procedure.

In the current study, eight college students were exposed to a successive matching-to-sample (S-MTS) procedure utilizing non-verbal auditory stimuli consisting of common sounds. During emergent relations tests, participants were asked to talk aloud, and their vocal-verbal statements were transcribed and categorized as class-consistent, class-inconsistent, or irrelevant. All participants met emergence criterion for symmetry and four did so for transitivity/equivalence. Analysis of vocal-verbal statements showed a positive correlation between class-consistent statements emitted by participants and correct selection responses during S-MTS tasks. Such results suggest possible verbal mediation during emergent relations tests.

Following a strict renal protection protocol in cloacal malformations: A descriptive analysis.

BACKGROUND: In children with cloacal malformations, renal dysfunction is a constant concern, with reported incidence as high as 50%. Multiple factors exist that may impair renal function. Our institution follows a strict renal protection protocol in this population. Incidence of renal dysfunction in these patients is unknown. OBJECTIVE: We aimed to evaluate incidence of renal dysfunction while implementing this protocol in a cohort of children with cloacal malformation. STUDY DESIGN: We reviewed a prospectively collected database of children with cloacal malformations managed at a single institution since implementation of a renal protection protocol. This involves regular laboratory evaluation, appropriate selection of total urogenital mobilization or urogenital separation, proactive imaging in patients with signs of impending renal dysfunction or urinary retention, and early catheterization teaching and implementation if necessary. Glomerular filtration rate (GFR) was calculated with the Schwartz formula and CKD grades assigned per standard definitions. Renal dysfunction was defined as CKD grade 3b or higher, need for renal replacement therapy (RRT) or transplantation. Descriptive statistics were computed. RESULTS: A total of 105 children were managed under this protocol with a median follow-up of 4.2 years [IQR: 2.0-5.9]. Six children (5.7%) had renal dysfunction at most recent follow-up; of these children, only three (2.9%) progressed from normal renal function at initial evaluation to renal dysfunction (Table). No child with normal presenting renal function thus far has progressed to require dialysis or transplantation. DISCUSSION: Previous literature estimated rates of renal dysfunction in cloaca patients as high as 50%; in contrast, we demonstrate a rate of progression to renal dysfunction of 2.9% in girls following a strict renal protection protocol. Most children who developed renal dysfunction had dysfunctional kidneys on presentation. This suggests that preservation of renal function may be possible in early childhood with a strict, multi-disciplinary renal protection protocol. CONCLUSION: In our cohort of patients with cloacal malformations following a strict renal protection protocol, incidence of progressive renal dysfunction is low at 2.9%. Most who go on to renal dysfunction present with impaired renal function.

Controlled ovarian stimulation leads to cardiovascular changes in patients undergoing in vitro fertilization.

OBJECTIVE: To study hemodynamic changes along controlled ovarian stimulation in women undergoing in vitro fertilization. STUDY DESIGN: Prospective observational cohort study conducted at Mother and Child Department of University Hospital Federico II, in Naples, Italy, between April 2021 and July 2022. Sixty-eight infertile patients undergoing controlled ovarian stimulation with gonadotropin, antagonist protocol and a fresh embryo transfer were included. Haemodynamic assessment was carried out using UltraSonic Cardiac Output Monitor at baseline (T1), estradiol peak (T2), fresh embryo-transfer day (T3). To evaluate relationships between quantitative variables and groups a Student T test for independent data was assessed. One-way analysis of variance (ANOVA) was used to determine the differences between the means of three time points (T1, T2 and T3) for quantitative variables. A mixed-model analysis of variance (ANOVA) was used to determine the differences between groups, among time points (T1, T2 and T3). RESULTS: Sixty-eight patients were included. Significant differences over the three time points have been observed for CO (f = 3.78 l/min; p = 0.025), SVI (f = 3.56 ml/m2;p = 0.013), and RSVI (f = 4.84 dscm-5 m2; p = 0.009). No significant differences in trends have been found between beta hCG positive and beta hCG negative groups. There were no significant differences in maternal hemodynamic parameters at time-point T3 between patients treated with hCG 10,000 UI and with Triptorelin. Patients considered at increased risk of hyperstimulation reported a significant increase in SVI at baseline (26.9 ± 9.0 mL/m2 vs 21.9 ± 7.0 mL/m2; p = 0.010). CONCLUSION: According to the results of our study, during controlled ovarian stimulation with antagonist protocol, patients undergo significant changes in maternal cardiovascular parameters over a very short period.

Maternal and perinatal infectious morbidity in term prelabor rupture of membrane according to two induction of labor protocols.

PURPOSE: The optimal labor-induction protocol in women with prelabor rupture of membranes (PROM) is unknown. Whether the management of women with a previous cesarean delivery (CD) with PROM is different remains controversial. We investigated maternal and perinatal outcomes according to two induction protocols of 24 h vs. 12 h. METHODS: In July 2021, our protocol of induction of labor in term-PROM was extended from 12 h to 24 h post-PROM. We compared obstetrical and neonatal outcomes before and after the change. A subgroup analysis of women with previous CD was performed. Results were compared using a univariate analysis. A multivariable model was described to predict neonatal intensive care unit admission (NICU) and clinical chorioamnionitis. RESULTS: The 24 h and 12 h ROM-to-induction protocol groups included 962 and 802 women, respectively. In the 24 h group, a higher proportion of women labored spontaneously (p < 0.001), the rate of chorioamnionitis was higher (p = 0.017), and the CD rate was similar. Admission to the NICU (p = 0.012), antibiotic administration (p = 0.003), and respiratory distress (p = 0.002) were also greater in the 24 h induction group. Among women with a history of CD (n = 143), the need for oxytocin (p = 0.003) and delivery by CD (p = 0.016) were lower in the 24 vs. 12 h group. CONCLUSION: Our results advocate shared decision-making in the expectant management of term-PROM. Women should be informed of the lower chance for induction and the higher risk of infections and neonatal complications with a 24-h induction approach. Longer expectant management in women with a previous CD resulted in significantly lower induction and CD rates.

Comparison of pregnancy outcomes between 4th day morula and 5th day blastocyst after embryo transfer: a retrospective cohort study.

BACKGROUND: This study was designed to evaluate pregnancy outcomes between morulae transferred on day 4 (D4) and blastocysts transferred on day 5 (D5). METHODS: From September 2017 to September 2020, 1963 fresh transfer cycles underwent early follicular phase extra-long protocol for assisted conception in our fertility center were divided into D4 (324 cases) and D5 (1639 cases) groups, and the general situation and other differences of patients in both groups were compared. To compare the differences in pregnancy outcomes, the D4 and D5 groups were further divided into groups A and B based on single and double embryo transfers. Furthermore, the cohort was divided into two groups: those with live births (1116 cases) and those without (847 cases), enabling a deeper evaluation of the effects of D4 or D5 transplantation on assisted reproductive outcomes. RESULTS: In single embryo transfer, there was no significant difference between groups D4A and D5A (P > 0.05). In double embryo transfer, group D4B had a lower newborn birthweight and a larger proportion of low birthweight infants (P < 0.05). The preterm delivery rate, twin delivery rate, cesarean delivery rate, and percentage of low birthweight infants were lower in the D5A group than in the D5B group (P < 0.05). Analysis of factors influencing live birth outcomes further confirmed the absence of a significant difference between D4 and D5 transplantation in achieving live birth (P > 0.05). CONCLUSION: When factors such as working life and hospital holidays are being considered, D4 morula transfer may be a good alternative to D5 blastocyst transfer. Given the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) success rate and risk of twin pregnancy, D4 morula transfer requires an adapted decision between single and double embryo transfer, although a single blastocyst transfer is recommended for the D5 transfer in order to decrease the twin pregnancy rate. In addition, age, endometrial thickness and other factors need to be taken into account to personalize the IVF program and optimize pregnancy outcomes.

Development and psychometric evaluation of the sexual satisfaction questionnaire for postmenopausal women (PWSSQ): an exploratory mixed method study protocol.

BACKGROUND: The concept of sexual satisfaction in menopausal women is very different from that in premenopausal women, and this difference is due to aging and physical, hormonal, cultural, and psychological changes. Therefore, the first step in discovering methods for assessing sexual satisfaction in postmenopausal women is to develop a measurement instrument. This study was conducted to develop and evaluate the psychometric properties of a sexual satisfaction instrument for postmenopausal women. METHODS: The current study is an exploratory-sequential mixed-methods research project that will be divided into two parts: qualitative and quantitative. Aligned with the primary objective of the research, which is to elucidate the concept of sexual satisfaction in postmenopausal women, the hybrid concept analysis model developed by Schwartz and Kim will be employed. This model comprises three key phases: the theoretical phase, the fieldwork phase, and the final analytical phase. Those who met the inclusion criteria and exhibited maximum variance in terms of age, educational level, employment status, and menopausal duration were recruited. The conventional content analysis will be carried out following the steps proposed by Graneheim and Lundman. Second, in the quantitative phase, the psychometric properties of the instrument were evaluated, including the content, face and construct validity and reliability via internal consistency and stability. The psychometric properties described in the COSMIN checklist will be utilized for designing the instrument. DISCUSSION: A valid and reliable scale for evaluating the sexual satisfaction of postmenopausal women should be developed, and educational content should be designed to improve the sexual satisfaction of this group of women.

Menopause is a natural event that is accompanied by numerous physical and psychological changes that create a complex period in the life of postmenopausal women. Sexual satisfaction is a component related to human sexuality and is known as the last stage of the sexual response cycle. Sexual satisfaction is defined as the emotional response resulting from the mental evaluation of positive and negative things in a sexual relationship. Sexual satisfaction is one of the important factors of satisfaction in married life. People who have sexual satisfaction have a significantly better quality of life than those who do not have sexual satisfaction. The concept of sexual satisfaction in menopausal women is very different from that in premenopausal women, and this difference is due to aging and physical, hormonal, cultural, and psychological changes. Sexual satisfaction is important for researchers for two reasons. First, sexual satisfaction provides a mechanism through which to assess a relationship partner's performance. Second, sexual satisfaction is a predictor of other aspects of the relationship, such as marital quality and stability. To discuss feelings and discover methods for achieving sexual satisfaction in postmenopausal women, it is necessary to understand the factors affecting sexual satisfaction and dissatisfaction in this group. The existing tools in the field of women's sexual satisfaction are not designed for this age group (menopausal women) and do not have the necessary comprehensiveness and adequacy to assess sexual satisfaction in menopausal women. Therefore, this study will be conducted to develop and evaluate the psychometric properties of the sexual satisfaction of postmenopausal women.

The Effects of an Accelerated Auditory Matching Protocol for Early Intervention Students.

We employed a multiple probe design to test the effects of an accelerated auditory matching protocol with five toddlers receiving early intervention services (four males, one female) for developmental delays. All participants emitted poorly articulated vocal mands and tacts. The dependent variables were the number of full echoics, partial echoics, and incorrect responses within a set of 20 two-syllable words. The independent variable was an accelerated Auditory Matching Protocol that targets auditory discrimination using an iPad App. Each phase of the protocol targets different sound discriminations with growing complexity. Four out of five participants emitted more full or partial echoic responses upon mastery of the Auditory Matching Protocol. Moreover, compared to those who received the full dosage of the standard Auditory Matching Protocol in previous studies, the participants in this study required fewer learn units to master all phases and to demonstrate improvement. Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-023-00882-1.

An in vitro study to determine the impact of lipid emulsion on partitioning of a broad spectrum of drugs associated with overdose.

Background: Intravenous lipid emulsion is recognised as a therapy for rescue in cases of local anaesthetic toxicity, but its use in reversing overdose or toxicity related to other drugs remains the subject of debate. This in vitro study sought to expand our understanding of the importance of partitioning in determining the impact of intravenous lipid emulsion on aqueous free drug concentrations. Methods: Twenty-seven drugs and associated metabolites were screened for the ability of intravenous lipid emulsion to reduce the amount of free drug in the aqueous phase, using specialised cassettes designed for this purpose. The relative amount of drug equilibrating across the membrane from plasma to phosphate-buffered saline was measured, using liquid chromatography-mass spectrometry, at a 6 h timepoint in plasma samples treated with intravenous lipid emulsion and paired, untreated controls. Results: The data obtained were plotted against measures of partition (LogP and cLogD7.4) and with log-transformed non-protein bound drug. There were significant inverse correlations between the capacity for intravenous lipid emulsion to reduce drug detected in the phosphate-buffered saline compartment and LogP and cLogD7.4, and a direct association with log [non-protein-bound drug]. However, a number of drugs showed substantial variance between different plasma samples. Conclusions: Modulation of free drug in the aqueous compartment is broadly predictable by the partition coefficient, although ramipril was identified to be an outlier in this regard. Further mechanistic and clinical exploration is merited to establish a standardised protocol for lipid emulsion therapy.

Implementing ABCD studyⓇ MRI sequences for multi-site cohort studies: Practical guide to necessary steps, preprocessing methods, and challenges.

Large multi-site studies that combine magnetic resonance imaging (MRI) data across research sites present exceptional opportunities to advance neuroscience research. However, scanner or site variability and non-standardised image acquisition protocols, data processing and analysis pipelines can adversely affect the reliability and repeatability of MRI derived brain measures. We implemented a standardised MRI protocol based on that used in the Adolescent Brain Cognition Development (ABCD)Ⓡ study in two sites, and across four MRI scanners. Twice repeated measurements of a single healthy volunteer were obtained in two sites and in four 3T MRI scanners (vendors: Siemens, Philips, and GE). Imaging data included anatomical scans (T1 weighted, T2 weighted), diffusion weighted imaging (DWI) and resting state functional MRI (rs-fMRI). Standardised containerized pipelines were utilised to pre-process the data and different image quality metrics and test-retest variability of different brain metrics were evaluated. The implementation of the MRI protocols was possible with minor adjustments in acquisition (e.g. repetition time (TR), higher b-values) and exporting (DICOM formats) of images due to different technical performance of the scanners. This study provides practical insights into the implementation of standardised sequences and data processing for multisite studies, showcase the benefits of containerised preprocessing tools, and highlights the need for careful optimisation of multisite image acquisition.

Intraoperative mapping of the right hemisphere: a systematic review of protocols that evaluate cognitive and social cognitive functions.

The right hemisphere of the brain is often referred to as the non-dominant hemisphere. Though this is meant to highlight the specialized role of the left hemisphere in language, the use of this term runs the risk of oversimplifying or minimizing the essential functions of the right hemisphere. There is accumulating evidence from functional MRI, clinical lesion studies, and intraoperative mapping data that implicate the right hemisphere in a diverse array of cognitive functions, including visuospatial functions, attentional processes, and social cognitive functions. Neuropsychological deficits following right hemisphere resections are well-documented, but there is a general paucity of literature focusing on how to best map these functions during awake brain surgery to minimize such deficits. To address this gap in the literature, a systematic review was conducted to examine the cognitive and emotional processes associated with the right hemisphere and the neuropsychological tasks frequently used for mapping the right hemisphere during awake brain tumor surgery. It was found that the most employed tests to assess language and speech functions in patients with lesions in the right cerebral hemisphere were the naming task and the Pyramids and Palm Trees Test (PPTT). Spatial cognition was typically evaluated using the line bisection task, while social cognition was assessed through the Reading the Mind in the Eyes (RME) test. Dual-tasking and the movement of the upper and lower limbs were the most frequently used methods to evaluate motor/sensory functions. Executive functions were typically assessed using the N-back test and Stroop test. To the best of our knowledge, this is the first comprehensive review to help provide guidance on the cognitive functions most at risk and methods to map such functions during right awake brain surgery. Systematic Review Registration: PROSPERO database [CRD42023483324].

ENERGY Pro: Spatially explicit agent-based model on achieving positive energy districts.

This article describes the ENERGY Pro agent-based model using the Overview, Design Concept, and Details + Human Decision-making (ODD+D protocol). The model is empirically explicit and aims to investigate the adoption decisions of homeowners in Amsterdam on different energy-efficient retrofitting (EER) measures. Following the ODD+D protocol, this study uncovers the conceptual framework used for model construction, the spatial microsimulation process of expanding the data, and the model implementation details. The article also describes sensitivity analysis, validation results, and how to use and adapt the model. With this article, the authors aim to make the model replicable and accessible to other researchers and inspire them using the combination of social simulation and spatial microsimulation in studying the energy transition.•The agent-based model is described using the ODD+D protocol.•The combination of simulation methods is used for constructing an empirical model.•The model on energy transition can be adapted for other cities.

Publicly Available Anatomic Total Shoulder Arthroplasty Rehabilitation Protocols Show High Variability and Frequent Divergence from the 2020 ASSET Recommendations.

Background: In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA). Purpose: The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines. Methods: This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed. Results: Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\<0.05). Conclusion: Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA. Level of Evidence: 3b.

Exploring the relationship between cultural and structural workforce issues and retention of nurses in general practice: A qualitative study protocol.

AIM(S): The aim of this study is to understand factors that challenge retention and support nurses to stay in general practice. BACKGROUND: One in four general practice nurse positions in England expected to be left unfilled within the next 10 years. Cultural and structural issues associated with working in general practice have been linked with nurses leaving general practice, re-evaluating their professional futures, adjusting work-life balance and bringing forward retirement. This has implications for the future of the general practice nursing workforce and patient care more broadly. DESIGN: Exploratory qualitative interview study funded by the General Nursing Council Trust for England and Wales. University of York ethics approval (Ref: HSRGC/2023/586/A) was gained in September 2023. The study will be conducted between September 2023 and August 2024. METHODS: Qualitative interviews will be conducted with a range of nurses working in, or who have worked in, general practice as well as nurse leaders associated with general practice across England and Wales. Recruitment will be via professional and social media networks and snowballing techniques. We aim to purposively recruit 30-40 participants for maximum variation. Cultural and structural influences which may contribute to retention decisions will be explored. Data will be analysed following framework analysis. DISCUSSION/CONCLUSION: This study will explore how underpinning cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: By exploring factors that support or discourage nurses to remain in general practice, retention strategies can be better planned on order to address the general practice nursing workforce crisis. IMPACT: What problem did the study address? This study will address the retention crisis in nursing in general practice by exploring how cultural and structural issues may impact on retention of this highly skilled professional group and identify factors to support retention. Where and on whom will the research have an impact? From the study findings, recommendations will be developed to inform future policy and practice. Key factors to address attrition will be generated to support employers and policy makers in future primary care workforce planning, as well as supporting nurses, at an individual level, in negotiating their roles in practice. REPORTING METHOD: Standards for Reporting Qualitative Research (O'Brien et al., 2014). PATIENT OR PUBLIC CONTRIBUTION: As this is a workforce study protocol, there is no patient or public contribution.