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Iron deficiency has been associated with heart failure severity and mortality in children and adults. Intravenous iron therapy has been associated with improved outcomes for adults with heart failure. However, little is known about its impact and safety in children. We performed a single-centre review of all intravenous iron sucrose infusions prescribed to hospitalised patients ≤ 21 years of age with a primary cardiac diagnosis from 2020 to 2022. Ninety-one children (median age 6 years, weight 18 kg) received 339 iron sucrose infusions with a median dose of 6.5 mg/kg [5.1 mg/kg, 7.0 mg/kg]. At initial infusion, the majority (n = 63, 69%) had CHD, 70 patients (77%) were being managed by the advanced cardiac therapy team for heart failure, 13 (14%) were listed for heart transplant, 32 (35%) were on at least one vasoactive infusion, and 5 (6%) were supported with a ventricular assist device. Twenty infusions (6%) were associated with 27 possible infusion-related adverse events in 15 patients. There were no episodes of anaphylaxis or life-threatening adverse events. The most common adverse events were hypotension (n = 12), fever (n = 5), tachycardia (n = 3), and nausea/vomiting (n = 3). Eight of 20 infusion-related adverse events required intervention, and two infusions were associated with escalation in a patient’s level of care. Following intravenous iron repletion, patients’ serum iron, serum ferritin, transferrin saturation, and haemoglobin increased (p < 0.05 for all). In children hospitalised with cardiac disease, intravenous iron sucrose repletion is safe and may improve haemoglobin and iron parameters, including transferrin saturation and ferritin levels.
Herbaceous perennials must annually rebuild the aboveground photosynthetic architecture from carbohydrates stored in crowns, rhizomes, and roots. Knowledge of carbohydrate utilization and storage can inform management decisions and improve control outcomes for invasive perennials. We monitored the nonstructural carbohydrates in a population of the hybrid Bohemian knotweed [Polygonum ×bohemicum (J. Chrtek & Chrtková) Zika & Jacobson [cuspidatum × sachalinense]; syn.: Fallopia ×bohemica (Chrtek and Chrtková) J.P. Bailey] and in Japanese knotweed [Polygonum cuspidatum Siebold & Zucc.; syn.: Fallopia japonica (Houtt.) Ronse Decr.]. Carbohydrate storage in crowns followed seasonal patterns typical of perennial herbaceous dicots corresponding to key phenological events. Starch was consistently the highest nonstructural carbohydrate present. Sucrose levels did not show a consistent inverse relationship with starch levels. Lateral distribution of starch in rhizomes and, more broadly, total nonstructural carbohydrates sampled before dormancy break showed higher levels in rhizomes compared with crowns. Total nonstructural carbohydrate levels in crowns reached seasonal lows at an estimated 22.6% of crown dry weight after accumulating 1,453.8 growing degree days (GDD) by the end of June, mainly due to depleted levels of stored starch, with the estimated minimum of 12.3% reached by 1,220.3 GDD accumulated by mid-June. Depletion corresponded to rapid development of vegetative canopy before entering the reproductive phase in August. Maximum starch accumulation in crowns followed complete senescence of aboveground tissues by mid- to late October. Removal of aboveground shoot biomass in late June to early July with removal of vegetation regrowth in early September before senescence would optimize the use of time and labor to deplete carbohydrate reserves. Additionally, foliar-applied systemic herbicide translocation to belowground tissue should be maximized with applications in late August through early fall to optimize downward translocation with assimilate movement to rebuild underground storage reserves. Fall applications should be made before loss of healthy leaf tissue, with the window for control typically ending by late September in Minnesota.
Dental management is critical prior to radiotherapy (RT) for head and neck cancer (HNC) but cumbersome and time intensive. This qualitative study investigates dentists’ evaluative processes to identify areas for improvement.
Methods:
Semi-structured interviews were conducted with dentists involved in the care of HNC patients. The interviews were guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to identify factors influencing pre-RT dental management.
Results:
Five dentists were participated in the interviews. Key themes were identified through qualitative and quantitative evaluation and are as follows: Coordination among care providers, knowledge of the RT plan, visual depictions of dose distribution and understanding of the patient’s dental history.
Conclusions:
This study demonstrates the complexity of pre-RT management and identifies key elements. Knowledge of the RT plan and improved interdisciplinary coordination represents opportunities for improvement. Visual dose prediction methods may expedite and improve pre-RT management.
With wide-field phased array feed technology, the Australian Square Kilometre Array Pathfinder (ASKAP) is ideally suited to search for seemingly rare radio transient sources that are difficult to discover previous-generation narrow-field telescopes. The Commensal Real-time ASKAP Fast Transient (CRAFT) Survey Science Project has developed instrumentation to continuously search for fast radio transients (duration $\lesssim$ 1 s) with ASKAP, with a particular focus on finding and localising fast radio bursts (FRBs). Since 2018, the CRAFT survey has been searching for FRBs and other fast transients by incoherently adding the intensities received by individual ASKAP antennas, and then correcting for the impact of frequency dispersion on these short-duration signals in the resultant incoherent sum (ICS) in real time. This low-latency detection enables the triggering of voltage buffers, which facilitates the localisation of the transient source and the study of spectro-polarimetric properties at high time resolution. Here we report the sample of 43 FRBs discovered in this CRAFT/ICS survey to date. This includes 22 FRBs that had not previously been reported: 16 FRBs localised by ASKAP to $\lesssim 1$ arcsec and 6 FRBs localised to $\sim 10$ arcmin. Of the new arcsecond-localised FRBs, we have identified and characterised host galaxies (and measured redshifts) for 11. The median of all 30 measured host redshifts from the survey to date is $z=0.23$. We summarise results from the searches, in particular those contributing to our understanding of the burst progenitors and emission mechanisms, and on the use of bursts as probes of intervening media. We conclude by foreshadowing future FRB surveys with ASKAP using a coherent detection system that is currently being commissioned. This will increase the burst detection rate by a factor of approximately ten and also the distance to which ASKAP can localise FRBs.
Improving access to and quality of maternal and infant healthcare are important leverage points to address worsening maternal and infant health disparities in the USA. This study evaluates the comprehensiveness of existing maternal and infant quality-of-care measures to identify aspects of quality that need greater attention in quality measurement.
Study design:
We conducted a structured, team-based qualitative review of 88 maternal and infant health measures indexed by the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare and Medicaid Services (CMS), and the National Committee for Quality Assurance (NCQA). We assessed discrete elements relevant to meaningfulness, feasibility, and usability following AHRQ National Quality Strategy (NQS) criteria, with input from researcher, clinician, and citizen scientist investigators. Descriptive statistics on coded measures were calculated using SPSS.
Results:
The most common AHRQ NQS priorities addressed were mortality (60%) and safety (48%). Average scores across elements were 59% for feasibility, 61% for practice usability, and 31% for policy usability. Fewer measures addressed coordination, affordability, or patient engagement in the postpartum period. Only 23% of measures were endorsed by NQF, only 17% of measures had publicly available benchmarks, and only 14% had specifications updated in the year prior to review.
Conclusions:
Findings from this study can inform the specification of a comprehensive, updated system for maternal and infant quality-of-care evaluation and can facilitate the development of new quality-of-care measures that address underrepresented maternal and infant health issues.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Pectin is composed of a group of complex polysaccharides that are naturally found in various plants and are associated with a range of beneficial health effects. Health outcomes from dietary pectin can vary depending on botanical origin, dietary dose and structure of pectin. The objective of this scoping review is to build a comprehensive overview of the current evidence available on intervention studies conducted in humans and to better understand the possible knowledge gaps in terms of structure–function relationships across the different health-related effects. PubMed and Embase databases were searched using PRISMA-ScR guidelines, yielding 141 references (from the initial 3704), representing 134 intervention studies performed between 1961 and 2022 that met inclusion criteria. Studies were divided into six categories, which included gut health, glycaemic response and appetite, fat metabolism, bioavailability of micronutrients, immune response and other topics. Review of these human intervention studies identified a variety of cohort characteristics and populations (life stage, health status, country), sources/types of pectin (i.e. citrus, sugarbeet, apple, other and non-defined), intervention timeframes (from one single intake to 168 d) and doses (0.1–50 g/d) that were tested for health outcomes in people. Gut health, post-prandial glucose regulation and maintenance of blood cholesterol represented the largest categories of studied outcomes. Further research to strengthen the structure–function relationships for pectin with health properties and associated outcomes is warranted and will benefit from a more precise description of physico-chemical characteristics and molecular compositions, such as degree of esterification, weight, degree of branching, viscosity, gel formation and solubility.
With the increasing affordability of next-generation sequencing technologies, genotype-by-sequencing has become a cost-effective tool for ecologists and conservation biologists to describe a species' evolutionary history. For host–parasite interactions, genotype-by-sequencing can allow the simultaneous examination of host and parasite genomes and can yield insight into co-evolutionary processes. The eastern oyster, Crassostrea virginica, is among the most important aquacultured species in the United States. Natural and farmed oyster populations can be heavily impacted by ‘dermo’ disease caused by an alveolate protist, Perkinsus marinus. Here, we used restricted site-associated DNA sequencing (RADseq) to simultaneously examine spatial population genetic structure of host and parasite. We analysed 393 single-nucleotide polymorphisms (SNPs) for P. marinus and 52,100 SNPs for C. virginica from 36 individual oysters from the Gulf of Mexico (GOM) and mid-Atlantic coastline. All analyses revealed statistically significant genetic differentiation between the GOM and mid-Atlantic coast populations for both C. virginica and P. marinus, and genetic divergence between Chesapeake Bay and the outer coast of Virginia for C. virginica, but not for P. marinus. A co-phylogenetic analysis confirmed significant coupled evolutionary change between host and parasite across large spatial scales. The strong genetic divergence between marine basins raises the possibility that oysters from either basin would not be well adapted to parasite genotypes and phenotypes from the other, which would argue for caution with regard to both oyster and parasite transfers between the Atlantic and GOM regions. More broadly, our results demonstrate the potential of RADseq to describe spatial patterns of genetic divergence consistent with coupled evolution.
In recent decades, the term “politics” has become almost synonymous with conflict. Results from eight studies show that individuals averse to conflict tend to select out of surveys and discussions explicitly labeled as “political.” This suggests that the inferences researchers draw from “political” surveys, as well as the impressions average Americans draw from explicitly “political” discussions, will be systematically biased toward conflict. We find little evidence that these effects can be attenuated by emphasizing deliberative norms. However, conflict averse individuals are more willing to discuss ostensibly political topics such as the economy, climate change, and racial inequality, despite reluctance to discuss “politics” explicitly. Moreover, they express greater interest in politics when it is defined in terms of laws and policies and debate is deemphasized. Overall, these findings suggest the expectation of conflict may have a self-fulfilling effect, as contexts deemed explicitly “political” will be composed primarily of conflict seekers.
Rapid neurodevelopment occurs during adolescence, which may increase the developing brain’s susceptibility to environmental risk and resilience factors. Adverse childhood experiences (ACEs) may confer additional risk to the developing brain, where ACEs have been linked with alterations in BOLD signaling in brain regions underlying inhibitory control. Potential resiliency factors, like a positive family environment, may attenuate the risk associated with ACEs, but limited research has examined potential buffers to adversity’s impact on the developing brain. The current study aimed to examine how ACEs relate to BOLD response during successful inhibition on the Stop Signal Task (SST) in regions underlying inhibitory control from late childhood to early adolescence and will assess whether aspects of the family environment moderate this relationship.
Participants and Methods:
Participants (N= 9,080; Mage= 10.7, range= 9-13.8 years old; 48.5% female, 70.1% non-Hispanic White) were drawn from the larger Adolescent Brain Cognitive Development (ABCD) Study cohort. ACE risk scores were created (by EAS) using parent and child reports of youth’s exposure to adverse experiences collected at baseline to 2-year follow-up. For family environment, levels of family conflict were assessed based on youth reports on the Family Environment Scale at baseline and 2-year follow-up. The SST, a task-based fMRI paradigm, was used to measure inhibitory control (contrast: correct stop > correct go); the task was administered at baseline and 2-year follow-up. Participants were excluded if flagged for poor task performance. ROIs included left and right dorsolateral prefrontal cortex, anterior cingulate cortex, anterior insula, inferior frontal gyrus (IFG), and pre-supplementary motor area (pre-SMA). Separate linear mixed-effects models were conducted to assess the relationship between ACEs and BOLD signaling in ROIs while controlling for demographics (age, sex assigned at birth, race, ethnicity, household income, parental education), internalizing scores, and random effects of subject and MRI model.
Results:
Greater ACEs was associated with reduced BOLD response in the opercular region of the right IFG (b= -0.002, p= .02) and left (b= -0.002, p= .01) and right pre-SMA (b= -0.002, p= .01). Family conflict was related to altered activation patterns in the left pre-SMA, where youth with lower family conflict demonstrated a more robust negative relationship (b=.001, p= .04). ACEs were not a significant predictor in other ROIs, and the relationship between ACEs and BOLD response did not significantly differ across time. Follow-up brain-behavior correlations showed that in youth with lower ACEs, there was a negative correlation between increased activation in the pre-SMA and less impulsive behaviors.
Conclusions:
Preadolescents with ACE history show blunted activation in regions underlying inhibitory control, which may increase the risk for future poorer inhibitory control with downstream implications for behavioral/health outcomes. Further, results demonstrate preliminary evidence for the family environment’s contributions to brain health. Future work is needed to examine other resiliency factors that may modulate the impact of ACE exposure during childhood and adolescence. Further, clinical scientists should continue to examine the relationship between ACEs and neural and behavioral correlates of inhibitory control across adolescent development, as risk-taking behaviors progress.
Parental history (PH) of problematic substance use has been identified as a risk factor for adolescent substance use, which can lead to increased use in adulthood. Researchers hypothesize that individuals with PH exhibit premorbid differences in their reward processing, increasing their likelihood of engaging in reward-driven behavior. Studies have shown that preadolescents with PH have greater activation in their putamen and nucleus accumbens (NA); however, most research has only investigated PH of alcohol use (PHA), not PH of drug use (PHD). Additionally, limited research has assessed whether reward processing develops differently among youth with (PH+) to youth without (PH-). The present study utilizes the national, prospective Adolescent Brain Cognitive Development SM (ABCD) Study to examine whether reward anticipation in the nucleus accumbens (NA) differs in preadolescents with and without parental substance use history and whether patterns of reward anticipation change over time during a two-year follow-up period. Further, it will also examine whether PHA and PHD predict similar activation patterns.
Participants and Methods:
The current sample (N=6,600, Mage = 10.9; range = 9-13.8 years old; 46.7% female) was drawn from the national ABCD Study. To assess reward processing, the Monetary Incentive Delay Task (MID), a fMRI task-based paradigm, was administered at baseline and 2 year follow-up. The primary regions of interest (ROI) were the left and right NA and neutral vs anticipation of large rewards was the selected contrast. The Family History Assessment was used to assess problematic parental alcohol and drug use for both parents, with scores ranging from 0-2, with two indicating that both parents demonstrate problematic use. Three PH contrasts (PH- vs.PH+1, PH-vs.PH+2, & PH+1 vs. PH+2) were created for each group (PHA and PHD) (Martz et al., 2022). Separate linear mixed-effect models with predictors variables (parental contrasts, timepoint, and parental contrasts-by-time-point) and covariates (age, sex, race/ethnicity, income, parental education, parental warmth, parental monitoring, and the random effects of MRI model, family status, and subject) were run to predict reward anticipation.
Results:
Results indicated that PHA and,not PHD, was predictive of reward anticipation. PHA+1 youth showed greater activation in the l-NA (b= .02827, p= .03) and r-NA (b= .03476, p=.005), compared to PH- youth. Additionally, PHA+1 youth showed greater activation in the r-NA (b=-.07029, p=.008) compared to PHA+2 youth, but not in the l-NA. Those with PHA+2 demonstrated blunted activity in both the l-NA (b= -.07244, p=.02) and right nucleus accumbens (b= -.1091, p=001) when compared to those with PH-. No interactions with time were found.
Conclusions:
Preadolescents with a PHA+ for both parents had blunted activity in reward anticipation, conferring a unique risk not seen in youth with only one parent with problematic alcohol use, or in youth with a PH of drug use. Future research should attempt to disentangle both genetic and environmental factors that may explain these discrepancies in reward processing, as well as the protective factors that may mitigate it. The current study found no interaction between PHA+ and time, suggesting that during preadolescents, the pattern of reward functioning remains consistent, but future work should assess if this pattern holds up across adolescence
Imagery-based survey is capable of producing archaeological datasets that complement those collected through field-based survey methods, widening the scope of analysis beyond regions. The Geospatial Platform for Andean Culture, History and Archaeology (GeoPACHA) enables systematic registry of imagery survey data through a ‘federated’ approach. Using GeoPACHA, teams pursue problem-specific research questions through a common data schema and interface that allows for inter-project comparisons, analyses and syntheses. The authors present an overview of the platform's rationale and functionality, as well as a summary of results from the first survey campaign, which was carried out by six projects distributed across the central Andes, five of which are represented here.
In the Andean highlands, hilltop fortifications known as pukaras are common. Dating predominantly to the Late Intermediate Period (AD 1000–1450), pukaras are important to archaeological characterisations of a political landscape shaped by conflict but the distribution of these key sites is not well understood. Here, the authors employ systematic satellite imagery survey to provide a contiguous picture of pukara distribution on an inter-regional scale covering 151 103km2 in the south-central highlands of Peru. They highlight the effectiveness of such survey at identifying pukaras and capturing regional variability in size and residential occupation, and the results demonstrate that satellite surveys of high-visibility sites can tackle research questions at larger scales of analysis than have previously been possible.
Recent meta-analyses demonstrate that small-quantity lipid-based nutrient supplements (SQ-LNS) for young children significantly reduce child mortality, stunting, wasting, anaemia and adverse developmental outcomes. Cost considerations should inform policy decisions. We developed a modelling framework to estimate the cost and cost-effectiveness of SQ-LNS and applied the framework in the context of rural Uganda.
Design:
We adapted costs from a costing study of micronutrient powder (MNP) in Uganda, and based effectiveness estimates on recent meta-analyses and Uganda-specific estimates of baseline mortality and the prevalence of stunting, wasting, anaemia and developmental disability.
Setting:
Rural Uganda.
Participants:
Not applicable.
Results:
Providing SQ-LNS daily to all children in rural Uganda (> 1 million) for 12 months (from 6 to 18 months of age) via the existing Village Health Team system would cost ∼$52 per child (2020 US dollars) or ∼$58·7 million annually. SQ-LNS could avert an average of > 242 000 disability-adjusted life years (DALYs) annually as a result of preventing 3689 deaths, > 160 000 cases of moderate or severe anaemia and ∼6000 cases of developmental disability. The estimated cost per DALY averted is $242.
Conclusions:
In this context, SQ-LNS may be more cost-effective than other options such as MNP or the provision of complementary food, although the total cost for a programme including all age-eligible children would be high. Strategies to reduce costs, such as targeting to the most vulnerable populations and the elimination of taxes on SQ-LNS, may enhance financial feasibility.
Supportive supervision has been shown to improve mental health outcomes and job retention for mental health and psychosocial support (MHPSS) workers in humanitarian contexts. However, the impact of gender on supervision practices has been poorly evaluated and documented in international guidelines to date. To address this gap, qualitative interviews were conducted with 12 MHPSS staff working in diverse humanitarian contexts to identify key gender considerations in supportive supervision. Results show that gender in supervision is influenced by the context of MHPSS work; with culture, religion and gender roles identified as key elements. Participants discuss recruitment mechanisms, highlighting the unequal gender distribution and inequitable opportunities within MHPSS programming. The importance of addressing power dynamics impacted by gender and of ensuring the safety of women within supervision is also highlighted. Finally, participants discuss the gender differences across the various supervisory formats. Altogether, results indicate that gender has the potential to influence supportive supervision within MHPSS, and it is recommended that international guidelines account for nuances of gender in supportive supervision within humanitarian contexts.
Though diet quality is widely recognised as linked to risk of chronic disease, health systems have been challenged to find a user-friendly, efficient way to obtain information about diet. The Penn Healthy Diet (PHD) survey was designed to fill this void. The purposes of this pilot project were to assess the patient experience with the PHD, to validate the accuracy of the PHD against related items in a diet recall and to explore scoring algorithms with relationship to the Healthy Eating Index (HEI)-2015 computed from the recall data. A convenience sample of participants in the Penn Health BioBank was surveyed with the PHD, the Automated Self-Administered 24-hour recall (ASA24) and experience questions. Kappa scores and Spearman correlations were used to compare related questions in the PHD to the ASA24. Numerical scoring, regression tree and weighted regressions were computed for scoring. Participants assessed the PHD as easy to use and were willing to repeat the survey at least annually. The three scoring algorithms were strongly associated with HEI-2015 scores using National Health and Nutrition Examination Survey 2017–2018 data from which the PHD was developed and moderately associated with the pilot replication data. The PHD is acceptable to participants and at least moderately correlated with the HEI-2015. Further validation in a larger sample will enable the selection of the strongest scoring approach.
Socioeconomic disadvantage is a major correlate of low political participation. This association is among the most robust findings in political science. However, it is based largely on observational data. The causal effects of early-life disadvantage in particular are even less understood, because long-term data on the political consequences of randomized early-life anti-poverty interventions is nearly nonexistent. We leverage the Moving to Opportunity (MTO) experiment to test the long-term effect of moving out of disadvantaged neighborhoods—and thus out of deep poverty—on turnout. MTO is one of the most ambitious anti-poverty experiments ever implemented in the United States. Although MTO ameliorated children’s poverty long term, we find that, contrary to expectations, the intervention did not increase children’s likelihood of voting later in life. Additional tests show the program did not ameliorate their poverty enough to affect turnout. These findings speak to the complex relationship between neighborhood disadvantage and low political participation.
The putative host galaxy of FRB 20171020A was first identified as ESO 601-G036 in 2018, but as no repeat bursts have been detected, direct confirmation of the host remains elusive. In light of recent developments in the field, we re-examine this host and determine a new association confidence level of 98%. At 37 Mpc, this makes ESO 601-G036 the third closest FRB host galaxy to be identified to date and the closest to host an apparently non-repeating FRB (with an estimated repetition rate limit of $<$$0.011$ bursts per day above $10^{39}$ erg). Due to its close distance, we are able to perform detailed multi-wavelength analysis on the ESO 601-G036 system. Follow-up observations confirm ESO 601-G036 to be a typical star-forming galaxy with H i and stellar masses of $\log_{10}\!(M_{\rm{H\,{\small I}}} / M_\odot) \sim 9.2$ and $\log_{10}\!(M_\star / M_\odot) = 8.64^{+0.03}_{-0.15}$, and a star formation rate of $\text{SFR} = 0.09 \pm 0.01\,{\rm M}_\odot\,\text{yr}^{-1}$. We detect, for the first time, a diffuse gaseous tail ($\log_{10}\!(M_{\rm{H\,{\small I}}} / M_\odot) \sim 8.3$) extending to the south-west that suggests recent interactions, likely with the confirmed nearby companion ESO 601-G037. ESO 601-G037 is a stellar shred located to the south of ESO 601-G036 that has an arc-like morphology, is about an order of magnitude less massive, and has a lower gas metallicity that is indicative of a younger stellar population. The properties of the ESO 601-G036 system indicate an ongoing minor merger event, which is affecting the overall gaseous component of the system and the stars within ESO 601-G037. Such activity is consistent with current FRB progenitor models involving magnetars and the signs of recent interactions in other nearby FRB host galaxies.
Interventions to address social needs in clinical settings can improve child and family health outcomes. Electronic health record (EHR) tools are available to support these interventions but are infrequently used. This mixed-methods study sought to identify approaches for implementing social needs interventions using an existing EHR module in pediatric primary care.
Methods:
We conducted focus groups and interviews with providers and staff (n = 30) and workflow assessments (n = 48) at four pediatric clinics. Providers and staff completed measures assessing the acceptability, appropriateness, and feasibility of social needs interventions. The Consolidated Framework for Implementation Research guided the study. A hybrid deductive-inductive approach was used to analyze qualitative data.
Results:
Median scores (range 1–5) for acceptability (4.9) and appropriateness (5.0) were higher than feasibility (3.9). Perceived barriers to implementation related to duplicative processes, parent disclosure, and staffing limitations. Facilitators included the relative advantage of the EHR module compared to existing documentation practices, importance of addressing social needs, and compatibility with clinic culture and workflow. Self-administered screening was seen as inappropriate for sensitive topics. Strategies identified included providing resource lists, integrating social needs assessments with existing screening questionnaires, and reducing duplicative documentation.
Conclusions:
This study offers insight into the implementation of EHR-based social needs interventions and identifies strategies to promote intervention uptake. Findings highlight the need to design interventions that are feasible to implement in real-world settings. Future work should focus on integrating multiple stakeholder perspectives to inform the development of EHR tools and clinical workflows to support social needs interventions.