Early Intervention Foundation

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) enhances health-related quality of life; however, unplanned readmissions may reduce patient satisfaction and the cost-effectiveness of the treatment. By predicting and minimizing these unplanned readmissions, patient outcomes can be significantly improved. Predictive models for unplanned OPAT readmissions can help identify high-risk patients, enabling tailored care and support. However, data on the effectiveness of OPAT-specific models is limited. This systematic review assessed the impact of risk assessment models on 30 day unplanned hospital readmissions among adult OPAT patients.MethodsA systematic review aiming to measure the impact of readmission risk models on 30 day unplanned hospital readmissions in adult OPAT patients. Searching CINAHL, Medline, Embase, ASSIA and Web of Science identified 435 potential articles. Independent selection, data extraction, tabulation of findings, and analysis were completed. Meta-analysis was conducted using JBI Sumari. When a meta-analysis was not feasible due to inappropriate data formats, the results were reported narratively.ResultsThree studies met the inclusion criteria. The primary outcome of the review was to measure the impact of OPAT readmission risk models on 30 day hospital readmissions by evaluating their ability to accurately predict readmissions within 30 days. Two studies reported low c-statistics, indicating poor discriminative capability, while one study showed a c-statistic of 0.75 in a temporal validation cohort, suggesting modest discriminative ability but lower accuracy in a broader group. A meta-analysis of the likelihood of unplanned readmissions in OPAT patients found no significant differences in unplanned readmissions. Across the studies, the most common reason for readmission was infection-related, followed by adverse drug events and complications from vascular access devices. There were few reported readmissions for diarrhoea. The studies identified different risk factors for readmission depending on the patient case mix, the structure of the OPAT service, and the methods of OPAT delivery. Aminoglycosides and daptomycin were linked to a lower likelihood of readmissions, while other factors showed no clear trends. Results on endovascular infections and concurrent antimicrobial use had low heterogeneity indicating that the results can be trusted, but findings regarding drug-resistant organisms, age, Charlson Comorbidity Index, and previous admissions should be interpreted with caution due to high heterogeneity.ConclusionsThe most common reason for readmissions was infection related. The review did not definitively identify risk factors for readmission and the impact of the OPAT readmission risk models was inconclusive. Further research is needed to enhance the transportability of these models and to develop versions tailored to different settings.

BackgroundArterial spin labelling (ASL) MRI permits non‐invasive cerebral blood flow (CBF) measurement. Previous work has associated regional hypo‐perfusion with Alzheimer's disease (AD) progression prior to brain atrophy1. This study assesses the use of ASL for AD diagnosis and progression.MethodWe selected a subset of Alzheimer's Disease Neuroimaging Initiative (ADNI‐3) subjects (Table 1), with ground‐truth diagnostic label (cognitively normal CN, mild cognitive impairment MCI, and AD). For MCI subjects with longitudinal data, we defined stable‐MCI (s‐MCI) as never converting to AD, and converting‐MCI (c‐MCI) as converting within 12, 24 or 36 months. ASL images were processed using the qasl pipeline (Quantified Imaging, London, UK), which follows the principles outlined by Alsop2 using a Bayesian algorithm3 to obtain calibrated CBF maps. T1‐weighted images were segmented using FreeSurfer to obtain ROI‐based CBF. To harmonise across acquisitions, CBF was normalised using the pallidum.Six binary classifiers were trained using ROI‐based CBF, covariates (age, sex, education) and scanner type. Feature selection was driven by ANOVA between diagnostic groups. A support vector machine (SVM) was used to predict diagnosis.Data was split into a 80:20 train‐test set, stratified by scanner and diagnosis. Hyperparameters were tuned with n‐1 folds cross‐validation. The model with the highest average F1‐score was trained and the probability threshold was optimised using Youden's index. Performance was evaluated on the test set.ResultResults are summarised in Table 2, with ROC curves and confusion matrices in Figure 1. Classifiers distinguished between AD vs. CN or MCI with AUCs of 0.957 [95% CI: 0.904, 0.994] and 0.936 [0.864, 0.988], respectively, both achieving specificity of 0.98. CN vs. MCI classification was less performant (AUC 0.702 [0.599, 0.801]). For c‐MCI vs. s‐MCI, AUC exceeded 0.9 for all timeframes.ConclusionWe demonstrated that ASL measures could predict clinical diagnosis and disease progression, outperforming both PET4 and previous ASL5 classifiers reported in literature in similar analyses.

BackgroundArterial Spin Labelling (ASL) is a non‐invasive MRI technique that enables the measurement of cerebral blood flow (CBF), which is known to change throughout Alzheimer’s disease (AD) progression1. CBF within a defined brain region of interest (ROI), or multiple regions, might be used as an imaging biomarker in dementia. This study introduces a novel AD meta‐ROI derived from ASL data and assesses its correlation with cognitive scores to investigate whether ASL could serve as an alternative to PET and other invasive biomarkers.The objective was to track disease progression across the cognitively normal (CN), mild cognitive impairment (MCI), and AD stages.MethodWe analysed a subset of subjects from Alzheimer’s Disease Neuroimaging Initiative (ADNI3) (Table 1). ASL data was processed using qasl pipeline (Quantified Imaging, London, UK), which follows the principles outlined by Alsop2 using a Bayesian algorithm3 to obtain calibrated CBF maps, normalized using the pallidum CBF. ROI‐based CBFwas derived from the FreeSurfer segmentation of the T1‐weighted images using the DKT atlas4. ADAS‐Cog was used as a continuous measure of disease progression across multiple cognitive domains (higher scores indicate advanced disease).The data was stratified into binned groups reflecting the ADAS‐Cog distribution and split into a 70:30 train‐test set. The meta‐ROI was constructed on the training set from 17 ROIs, selected based on their linear relationship against ADAS‐Cog. ROI‐based CBF within the meta‐ROI was used to train a regression model to predict ADAS‐Cog. Correlation was measured by Pearson’s correlation coefficient, R, on the test set.ResultWe observed a correlation between meta‐ROI scores and cognitive performance of R=0.72 (Figure 1). This compared favourably with values reported in literature for PET (R=0.75) and CSF/plasma biomarkers5.ConclusionThe good correlation between perfusion meta‐ROI and cognitive scores supports the use of ASL‐derived biomarkers as a non‐invasive imaging alternative for predicting and monitoring disease progression.

IntroductionThis scoping review investigates the landscape of patient navigation programs (PNP) specifically for lung cancer, addressing a gap in existing literature that has predominantly focused on other cancers or chronic diseases and screening.MethodsEmploying Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we aimed to characterize the features of lung cancer PNP, understand their outcomes, and analyse the applied methodologies for research. The search was conducted in January 2025.ResultsThe search led to the inclusion of 16 studies, predominantly from high-income countries, revealing a variety of implementation strategies and navigator types. Findings indicate a significant emphasis on administrative outcomes, clinical and patient-reported outcomes with heterogeneity in its use. Emotional support, logistical assistance, and healthcare system navigation emerged as key themes in service delivery, however PNP focus is inconsistent. The analysis highlighted the need for standardized methodologies and outcome measures, as well as greater inclusivity in research populations. Importantly, the review identified a trend of excluding marginalized demographics, raising concerns about the generalizability and external validity of findings.ConclusionOur study underscores the necessity for future research to harmonize PNP methodologies, enhance transparency in collaborative efforts, and focus on addressing health inequalities to optimize the effectiveness of lung cancer navigation initiatives.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13690-025-01786-y.

Reservation prices have proven effective in boosting revenue in Generalised Second Price (GSP) auctions, particularly in cost-per-click (CPC) settings. However, in domains like music streaming, where ads are consumed passively without user clicks, a cost-per-impression (CPM) model is more appropriate. Additionally, in the music streaming domain, user intent is typically unknown, unlike in sponsored search, making it essential to optimally leverage all available user and contextual information when setting prices. This paper addresses the challenge of optimising reservation prices in GSP auctions with CPM pricing, adopting a personalised approach that accounts for both user- and advertiser-specific factors.

While any experience of child poverty can affect life chances, longer exposure is particularly concerning due to its lasting effects on education, health and earnings. This study adopts a life-course perspective, tracking poverty from birth to age 10 for cohorts born in Britain between 1991 and 2017. On average, 17% of children spent at least half of their childhood in poverty. Long-term poverty affected 25% of those born in the early 1990s, markedly declined to 13-14% for cohorts born after the 1997 welfare reforms, and substantially increased again to 23% for children born following the 2013 austerity reforms. Decomposition analysis shows that cross-cohort changes are driven more by shifts in the penalties associated with work and family risk factors than by changes in their prevalence. These shifts in penalties reflect broader changes in redistribution and predistribution. The early decline in long-term poverty was largely due to rising employment and earnings in low-income households, while the post-austerity increase stems mainly from reduced redistribution. For cohorts born in the 2000s, social transfers played a substantial role in containing long-term poverty despite worsening predistribution. Overall, the findings show that long-term childhood poverty remains a significant challenge in Britain and highlight the need for both stronger redistribution and improved predistribution to address it.

ABSTRACTIntroductionLiving with a suicidal relative impacts multiple life aspects. However, it is not known how religious beliefs and meaning‐making influence relatives' experiences.AimThis study aimed to develop a theoretical framework to understand the role of religion in the experiences of Christian relatives living with a suicidal loved one.MethodsA constructivist grounded theory study was conducted, adhering to the COREQ checklist. Fifteen interviews were conducted with seventeen Christian relatives of suicidal individuals.ResultsFour themes emerged—acceptance of suicidality, seeking and experiencing God's help, surrendering to God, and religion's influence on relationships—forming a framework on how relatives' religious convictions about suicide and the intensity of their personal relationship with God influenced to what extent religion was helpful or harmful.DiscussionChristian faith provided peace of mind and support to relatives who had a personal relationship with God and believed their loved one would go to heaven. Relatives who believed their loved one would go to hell due to suicide and lacked a relationship with God experienced guilt and fear, making them vulnerable to harm from religion.Implications for PracticeEducational institutions and policymakers should specifically empower nurses to discuss spiritual issues when supporting relatives of suicidal individuals.Relevance StatementThis study offers valuable insight into the role of religious beliefs and meaning‐making influencing the experiences of Christian relatives living with a suicidal loved one. It highlights religion‘s role in their coping processes. The findings equip mental health nurses with a deeper understanding of religious coping strategies, enabling them to provide better support to relatives. Integrating spirituality/religion into support allows nurses to respond more holistically to relatives‘ needs, potentially improving their well‐being and resilience. Spiritual care is a part of nursing, but nurses feel unprepared. It is recommended that education and policy focus on nurses to better support relatives.

Abstract Introduction Endoscopic retrograde cholangiopancreatography (ERCP) is a key procedure in managing biliary and pancreatic disorders. In cases of difficult cannulation (DC), when standard cannulation techniques (SCT) fail, precut sphincterotomy (PS) may be used as an alternative technique, often by experienced endoscopists. The aim of this study was to compare outcomes of PS versus SCT in cases of DC, regarding complication rates and successful cannulation. Method Data were retrieved from the Swedish GallRiks Registry from September 2016 to December 2023. A total of 30,561 ERCPs, performed as index ERCPs without rendezvous technique, were identified and cross-checked. Univariable and multivariable logistic regression were conducted. We used generalized estimating equations to adjust for endoscopist- and hospital volumes. Result Altogether 9,909 procedures were classified as DC among which 3,005 (30%) were performed with PS, compared to 434 (2%) of 20,218 in the non-DC group. In DC PS was not associated with increased risk of procedure related complications (pancreatitis, cholangitis, bleeding, bile leakage or perforation). The rate of successful cannulation in DC was 87.9% when SCT were used and 70.4% when PS was performed. Discussion PS is a safe technique in ERCP when cannulation is difficult and is not associated with an increased risk of complications compared to SCT.

Over the past decade, universities have seen an increase in autistic student enrollment; however, many of these universities are not supporting autistic students to have a quality college experience. Although more autistic young adults are pursuing college, many do not persist to graduation due to a lack of individualized accommodations, siloed provision of support from universities, and overall hesitancy among faculty, staff, and administration to include autistic students in all campus spaces. In addition, autistic students struggle to build self-advocacy, self-determination, and functional life skills upon transition from high school. This Perspectives article was written by a team of inclusive postsecondary education professionals who have seen firsthand the challenges that autistic students experience in college. These authors advocate for increased coordination and collaboration among university units to promote greater inclusion and targeted support for autistic students on their campuses. These recommendations include employing a student-centered approach to understanding and supporting autistic students, training faculty on autism and Universal Design Learning practices, and intentionally embedding opportunities for autistic students to enhance their social-emotional learning and on-campus relationships. Our direct experiences in trialing these systems of support have cultivated more accepting and positive environments for autistic students. Neurodivergent students deserve the same access and opportunity to seek higher education as their neurotypical peers. This article presents actionable steps for how this can happen on college campuses.

Objective Large-scale crises require brief, scalable, on-line mental-health interventions. We examined the effectiveness of a single 90–120 min videoconference group based on the Simple-Swift Reconstruction Approach (SSRA).Method In a parallel-group randomized trial, 277 Chinese adults were allocated to an SSRA intervention group (IG; n = 143) or a waiting-list control group (WG; n = 134). Baseline and 2-week outcomes were the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and General Self-Efficacy Scale (GSES). Subjective Units of Disturbance (SUD) were recorded pre- and post-session in the SSRA group. Complete-case analyses used paired or independent t tests and Cohen’s d (two-tailed α = .05).Results A total of 121 IG participants (19% male; M = 34.9 years, SD = 11.3) attended the SSRA session, producing a large immediate reduction in SUD (baseline M = 5.81, SD = 1.62; post M = 3.20, SD = 1.57; t(120) = 19.26, p < .001, d = 1.75). Two-week follow-up data were available for 71 IG and 19 WG participants (overall retention = 32.5 %). In the IG, depressive symptoms decreased (Δ = –2.14 ± 3.40; d = 0.63), anxiety decreased (Δ = –1.89 ± 2.88; d = 0.66), and self-efficacy increased (Δ = +2.28 ± 5.52; d = 0.41), all ps < .001. Compared with WG, IG showed a significantly greater reduction in PHQ-9 scores (t(24.74) = –2.60, p = .015, d = 0.76); between-group differences for GAD-7 and GSES were not significant. Age and sex did not moderate outcomes.Conclusions A one-off, on-line SSRA group produced a large immediate distress reduction and small-to-moderate short-term mood benefits, supporting SSRA as a rapid, low-intensity option during public-health emergencies. Replication with larger samples and longer follow-up is recommended. Keywords: Simple-Swift Reconstruction Approach; single-session group; on-line group counselling; COVID-19; brief intervention; psychological first aid