Tools for assessing health research partnership outcomes and impacts: a systematic review.

OBJECTIVE: To identify and assess the globally available valid, reliable and acceptable tools for assessing health research partnership outcomes and impacts. METHODS: We searched Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO from origin to 2 June 2021, without limits, using an a priori strategy and registered protocol. We screened citations independently and in duplicate, resolving discrepancies by consensus and retaining studies involving health research partnerships, the development, use and/or assessment of tools to evaluate partnership outcomes and impacts, and reporting empirical psychometric evidence. Study, tool, psychometric and pragmatic characteristics were abstracted using a hybrid approach, then synthesized using descriptive statistics and thematic analysis. Study quality was assessed using the quality of survey studies in psychology (Q-SSP) checklist. RESULTS: From 56 123 total citations, we screened 36 027 citations, assessed 2784 full-text papers, abstracted data from 48 studies and one companion report, and identified 58 tools. Most tools comprised surveys, questionnaires and scales. Studies used cross-sectional or mixed-method/embedded survey designs and employed quantitative and mixed methods. Both studies and tools were conceptually well grounded, focusing mainly on outcomes, then process, and less frequently on impact measurement. Multiple forms of empirical validity and reliability evidence was present for most tools; however, psychometric characteristics were inconsistently assessed and reported. We identified a subset of studies (22) and accompanying tools distinguished by their empirical psychometric, pragmatic and study quality characteristics. While our review demonstrated psychometric and pragmatic improvements over previous reviews, challenges related to health research partnership assessment and the nascency of partnership science persist. CONCLUSION: This systematic review identified multiple tools demonstrating empirical psychometric evidence, pragmatic strength and moderate study quality. Increased attention to psychometric and pragmatic requirements in tool development, testing and reporting is key to advancing health research partnership assessment and partnership science. PROSPERO CRD42021137932.

Correction to: Lean mass and lower limb muscle function in relation to hip strength, geometry and fracture risk indices in community-dwelling older women.

The original version of this article, published on 14 December 2018, unfortunately contained a mistake.

Lean mass and lower limb muscle function in relation to hip strength, geometry and fracture risk indices in community-dwelling older women.

In a population-based sample of British women aged over 70 years old, lean mass and peak lower limb muscle force were both independently associated with hip strength and fracture risk indices, thereby suggesting a potential benefit of promoting leg muscle strengthening exercise for the prevention of hip fractures in postmenopausal women. INTRODUCTION: To investigate cross-sectional associations of lean mass and physical performance, including lower limb muscle function, with hip strength, geometry and fracture risk indices (FRIs) in postmenopausal women. METHODS: Data were from the Cohort of Skeletal Health in Bristol and Avon. Total hip (TH) and femoral neck (FN) bone mineral density (BMD), hip geometry and total body lean mass (TBLM) were assessed by dual x-ray absorptiometry (DXA). Finite element analysis of hip DXA was used to derive FN, intertrochanteric and subtrochanteric FRIs. Grip strength, gait speed and chair rise time were measured objectively. Lower limb peak muscle force and muscle power were assessed by jumping mechanography. RESULTS: In total, 241 women were included (age = 76.4; SD = 2.6 years). After adjustment for age, height, weight/fat mass and comorbidities, TBLM was positively associated with hip BMD (ßTH BMD = 0.36, P ≤ 0.001; ßFN BMD = 0.26, P = 0.01) and cross-section moment of inertia (0.24, P ≤ 0.001) and inversely associated with FN FRI (- 0.21, P = 0.03) and intertrochanteric FRI (- 0.11, P = 0.05) (estimates represent SD difference in bone measures per SD difference in TBLM). Lower limb peak muscle force was positively associated with hip BMD (ßTH BMD = 0.28, P ≤ 0.001; ßFN BMD = 0.23, P = 0.008) and inversely associated with FN FRI (- 0.17, P = 0.04) and subtrochanteric FRI (- 0.18, P = 0.04). Associations of grip strength, gait speed, chair rise time and peak muscle power with hip parameters were close to the null. CONCLUSIONS: Lean mass and lower limb peak muscle force were associated with hip BMD and geometrical FRIs in postmenopausal women. Leg muscle strengthening exercises may therefore help prevent hip fractures in older women.

Automated DXA-based finite element analysis for hip fracture risk stratification: a cross-sectional study.

Fracture risk indices (FRIs) generated from DXA-based finite element analysis were associated with hip fracture independent of FRAX score computed with femoral neck bone mineral density (BMD). Prospective studies are warranted to determine whether FRIs represent an improvement over BMD for predicting incident hip fractures. INTRODUCTION: The study aims to examine the association between prior hip fracture and FRIs derived from automated finite element analysis (FEA) of DXA hip scans. Femoral neck, intertrochanteric, and subtrochanteric FRIs were calculated as the von Mises stress induced by a sideways fall divided by the bone yield stress over the specified region of interest (ROI). METHODS: Using the Manitoba Bone Mineral Density Database, we selected women age ≥ 65 years with femoral neck T-scores below - 1 and no osteoporosis treatment. From this population, we identified 324 older women with hip fracture before DXA testing and a random sample of 658 non-fracture controls. FRIs were derived from the anonymized DXA scans. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the associations between FRIs (per SD increase) and hip fracture. RESULTS: After adjusting for FRAX score (hip fracture with BMD), femoral neck FRI (OR 1.36, 95% CI 1.13, 1.64), intertrochanteric FRI (OR 1.81, 95% CI 1.44, 2.27), and subtrochanteric FRI (OR 2.09, 95% CI 1.68, 2.60) were associated with hip fracture. Intertrochanteric and subtrochanteric FRIs gave significantly higher c-statistics (all P ≤ 0.05) than femoral neck BMD. Subgroup analyses showed that all FRIs were more strongly associated with hip fracture in women who were younger and had higher body mass index (BMI) or non-osteoporotic BMD (all P interaction < 0.1). CONCLUSIONS: FRIs derived from DXA-based FEA were independently associated with prior hip fracture, suggesting that they could potentially improve hip fracture risk assessment.

Implementation and evaluation of a two-eyed seeing approach using traditional healing and seeking safety in an indigenous residential treatment program in Northern Ontario.

Indigenous clients in need of residential care for substance use disorders (SUD) often present with the diagnosis of substance use disorder (SUD) combined with intergenerational trauma (IGT) or both. SUD is exceedingly prevalent amongst Indigenous peoples due to the health impacts of colonisation, residential school trauma, and IGT on this population's health. We evaluated the effectiveness of a Two-Eyed Seeing approach in a four-week harm reduction residential treatment programme for clients with a history of SUD and IGT. This treatment approach blended Indigenous Healing practices with Seeking Safety based on Dr. Teresa Marsh's research work known as Indigenous Healing and Seeking Safety (IHSS). The data presented in this study was drawn from a larger trial. This qualitative study was undertaken in collaboration with the Benbowopka Treatment Centre in Blind River, Northern Ontario, Canada. Patient characteristic data were collected from records for 157 patients who had enrolled in the study from April 2018 to February 2020. Data was collected from the Client Quality Assurance Survey tool. We used the qualitative thematic analysis method to analyse participants' descriptive feedback about the study. Four themes were identified: (1) Motivation to attend treatment; (2) Understanding Benbowopka's treatment programme and needs to be met; (3) Satisfaction with all interventions; and (4) Moving forward. We utilised a conceptualised descriptive framework for the four core themes depicted in the medicine wheel. This qualitative study affirmed that cultural elements and the SS Western model were highly valued by all participants. The impact of the harm reduction approach, coupled with traditional healing methods, further enhanced the outcome. This study was registered with clinicaltrials.gov (identifier number NCT0464574).

Validation of PET-SORTEO Monte Carlo simulations for the geometries of the MicroPET R4 and Focus 220 PET scanners.

PET-SORTEO is a Monte Carlo-based simulator that enables the fast generation of realistic PET data for the geometry of the ECAT EXACT HR+ scanner. In order to address the increasing need for simulation models of animal PET imaging systems, our aim is to adapt and configure this simulation tool for small animal PET scanners, especially for the widely distributed microPET R4 and Focus 220 systems manufactured by Siemens Preclinical Solutions. We propose a simulation model that can produce realistic rodent images in order to evaluate and optimize acquisition and reconstruction protocols. The first part of this study presents the validation of SORTEO against the geometries of the R4 and the Focus 220 systems. This validation is carried out against actual measurements performed on the R4 scanner at the Montreal Neurological Institute in Canada and on the Focus 220 system of the department of radiopharmaceuticals of the Austrian Research Center in Seibersdorf. The comparison of simulated and experimental performance measurements includes spatial resolution, energy spectra, scatter fraction and count rates. In the second part of the study, we demonstrate the ability to rapidly generate realistic whole-body radioactive distributions using the MOBY phantom and give comparative example case studies of the same rodent model simulated with PET-SORTEO for the R4 and Focus 220 systems.

MR-compatibility of a high-resolution small animal PET insert operating inside a 7 T MRI.

A full-ring PET insert consisting of 16 PET detector modules was designed and constructed to fit within the 114 mm diameter gradient bore of a Bruker 7 T MRI. The individual detector modules contain two silicon photomultiplier (SiPM) arrays, dual-layer offset LYSO crystal arrays, and high-definition multimedia interface (HDMI) cables for both signal and power transmission. Several different RF shielding configurations were assessed prior to construction of a fully assembled PET insert using a combination of carbon fibre and copper foil for RF shielding. MR-compatibility measurements included field mapping of the static magnetic field (B 0) and the time-varying excitation field (B 1) as well as acquisitions with multiple pulse sequences: spin echo (SE), rapid imaging with refocused echoes (RARE), fast low angle shot (FLASH) gradient echo, and echo planar imaging (EPI). B 0 field maps revealed a small degradation in the mean homogeneity (+0.1 ppm) when the PET insert was installed and operating. No significant change was observed in the B 1 field maps or the image homogeneity of various MR images, with a 9% decrease in the signal-to-noise ratio (SNR) observed only in EPI images acquired with the PET insert installed and operating. PET detector flood histograms, photopeak amplitudes, and energy resolutions were unchanged in individual PET detector modules when acquired during MRI operation. There was a small baseline shift on the PET detector signals due to the switching amplifiers used to power MRI gradient pulses. This baseline shift was observable when measured with an oscilloscope and varied as a function of the gradient duty cycle, but had no noticeable effect on the performance of the PET detector modules. Compact front-end electronics and effective RF shielding led to minimal cross-interference between the PET and MRI systems. Both PET detector and MRI performance was excellent, whether operating as a standalone system or a hybrid PET/MRI.

18F, 11C and 68Ga in small animal PET imaging. Evaluation of partial volume correction methods.

AIM: The partial volume effect (PVE) significantly affects quantitative accuracy in PET. In this study we used a micro-hollow sphere phantom filled with 18F, 11C or 68Ga to evaluate different partial volume correction methods (PVC). Additionally, phantom data were applied on rat brain scans to evaluate PVC methods on in vivo datasets. METHODS: The four spheres (7.81, 6.17, 5.02, 3.90 mm inner diameter) and the background region were filled to give sphere-to-background (sph/bg) activity ratios of 20 : 1, 10 : 1, 5 : 1 and 2 : 1. Two different acquisition and reconstruction protocols and three radionuclides were evaluated using a small animal PET scanner. From the obtained images the recovery coefficients (RC) and contrast recovery coefficients (CRC) for the different sph/bg ratios were calculated. Three methods for PVC were evaluated: a RC based, a CRC based and a volume of interest (VOI) based method. The most suitable PVC methods were applied to in vivo rat brain data. RESULTS: RCs were shown to be dependent on the radionuclide used, with the highest values for 18F, followed by 11C and 68Ga. The calculated mean CRCs were generally lower than the corresponding mean RCs. Application of the different PVC methods to rat brain data led to a strong increase in time-activity curves for the smallest brain region (entorhinal cortex), whereas the lowest increase was obtained for the largest brain region (cerebellum). CONCLUSION: This study was able to show the importance and impact of PVE and the limitations of several PVC methods when performing quantitative measurements in small structures.

Five-year experience of quality control for a 3D LSO-based whole-body PET scanner: results and considerations.

PET scanners require routine monitoring and quality control (QC) to ensure proper scanner performance. QC helps to ensure that PET equipment performs as specified by the manufacturer and that there have not been significant changes in the system response since acceptance. In this work we describe the maintenance history and we report on the results obtained from the PET system QC testing program over 5 years at two centers, both utilizing a Siemens Biograph 16 HiRez PET/CT system. QC testing programs were based on international standards and included the manufacturer's daily QC, monthly uniformity and sensitivity, quarterly cross-calibration and annual resolution and image quality. For the Winnipeg and Novara sites, two and one PET detector blocks have been replaced, respectively. Neither system has had other significant PET system related hardware replacements. The manufacturer's suggested daily QC was sensitive to detecting problems in the function of PET detector elements. The same test was not sensitive for detecting long term drifts in the systems: the Novara system observed a significant deterioration over five years of testing in the sensitivity which exhibited a decrease of 16% as compared to its initial value measured at system installation. The measure of the energy spectrum, showed that the 511 keV photopeak had shifted to a position of 468 keV. This shift was corrected by having service personnel perform a complete system calibration and detector block setup. We recommend including tests of system energy response and of sensitivity as part of a QC program since they can provide useful information on the actual performance of the scanner. A modification of the daily QC test by the manufacturer is suggested to monitor the long term stability of the system. Image quality and spatial resolution tests have proven to be of limited value for monitoring the system over time.

Sci-Fri AM: Imaging - 03: Temperature dependence of a SiPM detector for an MR compatible PET system.

Silicon photomultiplier (SiPM) detectors are rapidly becoming the detector of choice for research and development of new detectors for positron emission tomography (PET) due to their combination of high gain, fast timing, compact form factor and ability to function in a magnetic field. We are investigating using SiPM based detectors in a compact PET system designed to be inserted into a 7T animal MRI system and enable simultaneous PET/MRI imaging. In order to understand the level of thermal stability required for this PET system, we examined the stability of a prototype SiPM detector vs. temperature. A detector was constructed using a SensL SPMArray4 SiPM array coupled to a LYSO scintillator crystal array. The temperature of the detector was varied between 23 and 60°C in 5°C steps. At each temperature setting data were collected to characterize the detector flood histogram, photopeak amplitude and energy resolution at 511 keV, timing resolution and signal arrival time. While the flood image showed no noticeable changes with temperature, the 511 keV photopeak amplitude showed a linear decrease of 1.5%/°C and the energy resolution degraded by 0.08%/°C. The timing resolution degraded by 1.5 ns, from 3.5 ns to 5 ns when the temperature changed from 23 to 60°C. Over this temperature range there was a shift in the signal arrival time of approximately 3 ns. These results demonstrate that the detector can be operated over a wide range of temperature, giving a large degree of flexibility in choosing an operating temperature set-point for our PET system.

Sci-Fri AM: Imaging - 08: Comparison of single and dual layer detector blocks for pre-clinical MRI-PET.

Our group is developing a small animal PET scanner which would fit in a 7 Tesla MRI scanner to provide simultaneous PET and MR acquisitions and images. There is very little room for the PET detectors and we must use nonmagnetic materials. This presentation describes preliminary work with two PET detectors consisting of LYSO blocks each with two crystal layers: 49 1.67*1.67*6.0 mm on the bottom layer and 36 4.0 mm deep crystals on the top layer. These are mounted on SensL 4*4 arrays of silicon photo-multipliers whose outputs are multiplexed to provide three signals: Energy, X, Y. These detectors were mounted on translation stages and scanned past a 0.25 mm diameter 370 MBq Na-18 source embedded in tissue equivalent plastic. The results were compared with similar single layer crystal blocks with 10 mm deep crystals to assess the advantage of dual layer crystals to reduce radial blurring in a PET scanner with a diameter of only 64 mm. The ability to identify correctly each crystal is reported as its resolvability index, (RI), defined as the (crystal response FWHM)/(crystal's separation) in the crystal identification matrix. For the dual layer block RI =0.44, and for dual layer block RI=0.22. The coincidence response resolution for the single layer block varied from 1.23±0.05 mm at the centre of the scanner to 3.09±0.10 mm at 15.8 mm radius, while the dual layer block varied from 1.31±0.06 to 1.96±0.51 mm over the same range, confirming the Monte-Carlo simulations showing reduced radial blurring.

Falling rings: Group and ritual process in a divorce.

This paper describes, analyzes, interprets, and spells out some implications of a divorce as it was faced and handled by a pastor and congregation. The challenge to work creatively with divorce came when both the husband and wife wished to remain in the congregation as members. The paper briefly sets forth theological perspectives on marriage, divorce, and discipline in the Mennonite Church, a brief case history of the couple, a description of the group and ritual process with which the pastor and congregation responded, and the reflections of the couple and members a year later. The paper offers not a model but, rather, a symbol as presented in the title, "Falling Rings." It is hoped that the symbol will not only give rise to thought, but will also spark the imagination so as to enable other congregations to respond more assertively, creatively, and caringly to those who divorce in their midst.