The National Institutes of Health launched the NIH Centers for Accelerated Innovation and the Research Evaluation and Commercialization Hubs programs to develop approaches and strategies to promote academic entrepreneurship and translate research discoveries into products and tools to help patients. The two programs collectively funded 11 sites at individual research institutions or consortia of institutions around the United States. Sites provided funding, project management, and coaching to funded investigators and commercialization education programs open to their research communities.We implemented an evaluation program that included longitudinal tracking of funded technology development projects and commercialization outcomes; interviews with site teams, funded investigators, and relevant institutional and innovation ecosystem stakeholders and analysis and review of administrative data.As of May 2021, interim results for 366 funded projects show that technologies have received nearly $1.7 billion in follow-on funding to-date. There were 88 start-ups formed, a 40% Small Business Innovation Research/Small Business Technology Transfer application success rate, and 17 licenses with small and large businesses. Twelve technologies are currently in clinical testing and three are on the market.Best practices used by the sites included leadership teams using milestone-based project management, external advisory boards that evaluated funding applications for commercial merit as well as scientific, sustained engagement with the academic community about commercialization in an effort to shift attitudes about commercialization, application processes synced with education programs, and the provision of project managers with private-sector product development expertise to coach funded investigators. Much has been written about the challenges of translating biomedical discoveries from academic research into products and research tools that, per the mission of the National Institutes of Health (NIH), enhance health, lengthen life, and reduce illness and disability. Culprits are long and costly innovation cycles fraught with risk -4, sparsIn 2010, two NIH National Heart, Lung, and Blood Institute (NHLBI) working groups were charged with improving the translation of NHLBI’s investments in its research and SBIR/STTR programs into commercial applications that improve health . Two outThe NCAI program was launched in September 2013. The program’s aim was to fund three consortia (“sites”) of at least five institutions around the country to develop and pilot solutions to address the barriers described above and accelerate the development and market-readiness of promising technologies, with the expectation that lessons and insights from the sites would then be broadly disseminated to and adopted by the academic community. NHLBI intentionally sought regional sites with multiple partner institutions to foster interinstitutional collaboration; ensure a pipeline of “center-ready” technologies in NHLBI’s heart, lung, blood, and sleep mission; and leverage resources and strategies within each site’s innovation ecosystem.In 2015, NIH launched the Research Evaluation and Commercialization Hubs (REACH) program through the Phase 0 Proof of Concept Partnership Pilot Program authority granted in the 2011 SBIR/STTR Reauthorization Act. Like NCAI, REACH selected regional sites to develop pilot approaches and build capacity, but unlike NCAI, it covered the entire NIH mission and was not limited to the NHLBI’s heart, lung, blood, and sleep focus. It also selected sites outside of comparatively rich ecosystems such as those in Boston and California and granted them autonomy to establish themselves to best meet the needs of their investigator community. REACH has funded two cohorts of sites: three in 2015 and five in 2019.This study presents outcomes data for technologies supported by the NCAI and REACH programs (as of May 2021) and describes practices that the NCAI and REACH sites employed to support their investigator communities that were particularly effective. NHLBI and NIH invested in a long-term evaluation program to monitor and learn from sites’ experiences resulting in a wide range of metrics and instruments designed and data collected that are summarized in Methods Overview section. That evaluation continues , but this study is an opportunity to disseminate information on observed progress to-date and some overarching lessons learned.NCAI and REACH are focused on furthering academic entrepreneurship and demystifying the process of translating a discovery into the product development pipeline. They are complementary programs with much in common, but there are also distinct differences. This section provides an overview.provide entrepreneurship training and skills development programs,develop a pipeline of potential projects and solicit funding applications,provide technology development funding for projects selected based on their commercial and scientific merit,have external advisory boards to guide the site and review applications,develop and implement market-focused project management oversight and milestone-based decision-making processes,leverage resources from Clinical and Translational Science Awards and local innovation ecosystems, andfurther NIH goals around culture change with respect to research translation and commercialization.In an effort to promote experimentation and development of novel approaches, the funding opportunity for sites under each program articulated NIH’s expectations but permitted teams to design operating plans and programs that sites believed best met the needs of their investigator community. Sites were expected toThe NIH program officers for both NCAI and REACH were within NHLBI, which in addition to leading NCAI administered REACH on behalf of the NIH. REACH and NCAI sites share insights and learnings with one another through annual meetings, working groups, and joint web meetings coordinated by NIH. Thus, there were organizational structures that facilitated collaboration at the NIH, program, and site levels.Given these similarities, NCAI and REACH shared some processes. Most notable among these was a NIH-led committee known as the Technology Guidance Committee (TGC).Key differences between NCAI and REACH include overall funding levels, award periods, mission space, locations, and specifications about the minimum number of institutions that could comprise a site. Below we describe these differences.Launched in 2013, the NCAI program is funded by NHLBI and focused on NHLBI’s heart, lung, blood, and sleep mission. NHLBI awarded three sites, each with one prime institution and at least four other member institutions. The sites are  and types , funding solicitation processes, project management approaches, and the distribution of administrative and management effort and responsibility between the prime site and their member institutions . Over tiNHLBI committed $31.5 million to the program for a 7-year period of performance . B-BIC, The REACH program is the Phase 0 Proof-of-Concept Partnership pilot program launched in accordance with Section 5127 of the 2011 SBIR/STTR Reauthorization Act. The Act specifically called for development of proof-of-concept programs to pilot approaches for supporting academic investigators in commercializing technologies. NIH used the program as an opportunity to pilot approaches and build academic entrepreneurship capacity in a variety of geographies across the country.Each REACH site received a smaller award amount ($1 million per year) than NCAI sites, had a shorter period of performance (3 or 4 years), was not prescribed how many institutions could comprise a site, and could support any technologies within the NIH mission space.There are two cohorts of REACH sites. REACH 2015 includes the Long Island Bioscience Hub (LIBH) led by Stony Brook University, MN-REACH at the University of Minnesota, and the University of Louisville Expediting Commercialization, Innovation, Translation, and Entrepreneurship (ExCITE) program. NIH committed $9 million to REACH, with each site receiving $1 million per year. The three sites matched the NIH award 1:1 with institutional support and partnerships. There were six institutions in the program because LIBH had four partners. REACH 2015 concluded in 2021 after being extended to support projects funded late in the original period of performance.Section 5127 was reauthorized, permitting the launch of a second cohort of REACH sites. REACH 2019 includes five sites: Rutgers HealthAdvance at Rutgers University, SPARK REACH at the University of Colorado Anschutz Medical Campus, the Kentucky Network for Innovation & Commercialization (KYNETIC) led by the University of Kentucky, the Midwest Biomedical Accelerator Program (MBArC) led by the University of Missouri, Columbia, and WE-REACH at the University of Washington. NIH committed $20 million to the program, with each site receiving $1 million per year for 4 years. Each site matched the NIH award 1:1 with institutional support and partnerships.There are many more institutions in REACH 2019 than REACH 2015 because two sites are consortia. KYNETIC covers all public institutions of higher education in Kentucky, including its research universities, regional universities, and community and technical college system. MBArC has member institutions in six states: Missouri, Kansas, Nebraska, Oklahoma, North Dakota, and South Dakota. In total, there are 43 institutions in REACH 2019.The authors are independent evaluators engaged by NHLBI and NIH to evaluate the NCAI and REACH programs. A common goal of the evaluations is to identify best practices and lessons learned through on-going observation and analysis of the design, processes, and outcomes for each of the 11 NCAI, REACH 2015, and REACH 2019 sites. We developed and implemented an evaluation program that included longitudinal tracking of funded technology development projects and associated commercialization outcomes; interviews with site teams, funded investigators, and relevant institutional and innovation ecosystem stakeholders; periodic surveys of program participants about commercialization knowledge, attitudes, and beliefs; and analysis and review of administrative data.As of May 2021, NCAI and REACH sites have received a total of 1738 applications for technology-development support and ultimately funded a portfolio of 366 projects that is diverse in terms of technology type and therapeutic area . The single largest source of funding is corporate partners ($1.2 billion), followed by venture capital ($221 million). Foundations, associations, nonprofits, and other nonfederal grants have also been a significant source of follow-on funding ($36.3 million). Federal funders provided the majority of the balance, including SBIR and STTR awards. Twelve projects have received follow-on funding of at least $10 million.Fifty-nine NCAI and 37 REACH projects led to 88 start-up companies. This level of start-up activity directly suggests advancement in technology readiness and advancement toward commercialization. Although start-ups are not a direct measurement of commercial readiness, the beliefs of the funded investigators and project managers about technologies’ commercial potential is demonstrated by the action to undertake the nontrivial costs and time investments associated with forming a start-up company. In total, 53 jobs have been created by 10 well-capitalized start-up companies formed around NCAI technologies.For technologies that have not formed a start-up to further develop the technology, the execution of licensing and option agreements provides a signal of technology readiness and commercial viability as assessed by outside companies. As of May 2021, 9 NCAI and 9 REACH projects have led to 17 licensed technologies and 6 NCAI and 11 REACH projects are associated with 14 technologies with an active option agreement.In total, NCAI has produced at least 52 SBIR and STTR applications and 25 awards, and REACH has produced at least 34 SBIR and STTR applications and 11 awards. This means that the overall success rate for SBIR/STTR applications so far for the two programs is about 42%, which includes recent submissions that have not yet been evaluated for funding. Even conservatively counting the recent submissions, the SBIR/STTR application success rate among the NCAI and REACH technologies is notably greater than the approximate 19% success rate for SBIR/STTR among all applications nationwide . AlthougSeveral projects have received multiple SBIR/STTR awards. Dr Umut Gurkan’s HemeChip point-of-care sickle cell disease diagnosis technology has two SBIR and two STTR awards. Dr Jonathan Thon’s technology, a biomimetic human platelet bioreactor, Dr Daniel Lawrence’s technology, a small molecule therapeutic for the treatment of idiopathic pulmonary fibrosis, and Dr Warren Zapol’s technology, electric nitric oxide generation for medical purposes, have received a combined 11 SBIR awards. These projects have made significant progress toward the market.NCAI and REACH technologies supported between 2014 and 2017 are beginning to reach patients. Eleven NCAI technologies and one REACH technology are in clinical testing, and two NCAI technologies and one REACH technology have been approved for marketing in the United States or abroad. Dr Thomas Gildea’s technology, custom patient-specific airway stents, was cleared by the FDA in January of 2020. More than 20 stents have been placed in patients across six centers in the United States . Dr GurkAmong the 12 technologies in clinical testing is Dr Zapol’s technology, which received emergency approval investigational device exemption in Fall 2020 to treat COVID-19. Dr Elliot Botvinick’s continuous lactate monitoring technology completed a study in Australia and Canada involving 41 patients with Type 1 Diabetes and is preparing to initiate clinical studies in the United States with COVID-19 restrictions lifting. Dr Daniel Vallera’s trispecific NK cell engager technology received IND approval and is preparing for Phase 1 trials. Nine more technologies from the NCAI-CC have begun testing on human subjects, including Dr Dominique Durand’s oropharynx appliance for maintaining airway patency and Dr Frank Papay’s neuromodulatory implant device for the treatment of obstructive sleep apnea.Given the long development timelines often associated with these types of technologies, the speed with which NCAI and REACH technologies are reaching patients is impressive, suggesting that the sites are selecting good technologies to support and that crowding in early development work, site team expertise, and focus is steepening technologies’ trajectory.Over the past several years, we have observed several practices used by the NCAI and REACH sites that have been particularly effective in managing activities and assisting applicants and funded investigators. This section describes these practices. Note that we intentionally do not include the funding itself for proof-of-concept projects in our remarks because this element is commonplace among accelerator and proof-of-concept programs. Certainly, the fact that an funded investigator typically received between $100,000 and $200,000  for an early-stage technology development project is significant. However, we opt to focus on the approaches that each site implemented because these speak to the ways in which site teams can add value beyond the funding award.Site team leadership were often members of the academic community with a strong track record of academic entrepreneurship, good visibility among faculty and staff, and the support of their institutional leadership and technology transfer offices. Their teams included project managers with backgrounds in biomedical product development, translational research, and research operations . Teams’ communication and interpersonal skills were especially important, particularly for working with funded investigators and helping these investigators navigate challenges and issues with their projects and identify the next steps in go-to-market strategies.Multiple teams included representatives or leaders from their technology transfer offices and/or innovation management groups on their teams. This helped with leveraging institutional expertise, connecting investigators to other resources and programs, and developing business strategies. Teams also leveraged educational resources from their CTSAs and local innovation ecosystems.ad hoc expertise to funded investigators. Sites that began with boards principally composed of university faculty and executives often later transitioned to the aforementioned composition.External advisory boards composed of individuals from the private sector with backgrounds in science and business, investment, marketing, and/or business development are valuable for ensuring that application reviews are balanced sufficiently between a proposal’s scientific merits and the market viability of the concept. A balanced board of executives and senior researchers from life sciences companies, entrepreneurs who have brought technologies to market, and business development and commercialization experts appears to be useful to support proposal selection, advising on the site’s overall direction, and providing Although initiated at the program level and not the site level, the TGC was cited by many site teams and funded investigators as a valuable mechanism for early feedback and that having such feedback was validating for individual technologies in the eyes of investors and sources of follow-on funding.Active outreach to the research community is important for building early awareness and interest before, during, and after solicitation cycles. During our interviews with funded investigators, many described that they were motivated to apply to NCAI or REACH after hearing directly from site personnel or faculty members who had been successful in commercialization endeavors. Effective outreach strategies include presentations at faculty meetings, promoting the mechanisms through which investigators can learn more about site funding opportunities and programs, encouraging referrals, sharing information and examples, and engaging in Q&A.There is also a signal that the diversity of site personnel matters in cultivating a diverse applicant pool. At the University of Louisville ExCITE, investigator-facing team members, including the team lead , technology transfer office representative, and project managers were all women. Ultimately 63% of funded PIs or co-PIs in the program were also women , which wIn addition to scientific merit, a common application used by all sites required applicants to describe the technology’s value proposition, assess the market and competitive landscape for the technology, and provide other information about the technology’s commercial viability . For many investigators, these application elements are unfamiliar. In response, sites’ project managers and leads often provided informal feedback or answered questions, held office hours, timed commercialization seminars such that they coincided with application cycles, and used letters of intent to provide formal feedback at earlier stages.Many sites integrated entrepreneurial training for these elements into their pre-application assistance services, which provided additional motivation and experiential learning for investigators. They also connected applicants to reference librarians and other resources that could be useful for learning about the potential market for the technologies.Some sites also provided small pilot awards  to allow investigation of a technologies viability, and if successful permitted reapplication for typical award sizes. This approach was used primarily by B-BIC, which had two awards, Pilot and Drive. The approach was effective for supporting promising projects for which very limited data were available.REACH and NCAI required milestone-based project management support for funded projects and project managers were part of the site teams. This function was important for monitoring progress, ensuring focus, helping address technical and business challenges, and advising on next steps. In the absence of this support, it was more likely that the investigator could drift into hypothesis-driven research and away from the validation or prototyping work funded by the programs. Tools used included target product profiles, product development plans, risk registers, and Gantt charts describing milestones and critical paths, among other tools. Project managers were also helpful for identifying when projects needed to pivot in light of market changes or research results.Sites used a fail-fast model in which projects that did not meet milestones or generated results that indicated the project was no longer viable were terminated early. Funds were repurposed for other projects. For one project cycle, ExCITE intentionally overallocated its funding to projects, released funding in tranches, and then provided the balance of funding to those projects that demonstrated the most progress and promise.NCAI has more funding than REACH, and these sites were generally able to support project managers with extensive private-sector product development experience with life sciences companies. Investigators prized these managers’ scientific and commercial acumen and the perspective and value they brought to the projects. Multiple NCAI-funded investigators told us that their project managers were as valuable to their projects as the funding awards themselves. REACH project managers were also effective in their roles and received praise from the investigators they supported, but with less funding available, they were less likely to have private-sector experience and often supported multiple programs.More than 3700 academic investigators have participated in NCAI and REACH skills development programs to-date. Sites largely leveraged or contributed to skills development programs and offerings that were available via their Clinical and Translational Science Awards, National Science Foundation’s I-Corps Program , or others. They focused their original content in the form of bootcamps with curricula aligned with the funding application elements. The most important mentoring was often the engagement between site teams and applicants and funded investigators about their ideas and projects. Many investigators told us that their project manager or site lead were their most important coaches and mentors and the ones from whom they learned the most about commercialization and product development.To date, the NCAI and REACH programs have been effective at supporting innovators in moving promising discoveries into the product development pipeline. In less than 7 years – about a decade less than the average lag time from discovery to commercialization – three products are on the market and 12 technologies are in clinical testing. While there is significant variation in time from discovery to commercialization across individual technologies, it is uncommon for a discovery to transition to clinical practice in fewer than 10 years ,26. The One common measure of the effectiveness of an accelerator or proof-of-concept program is for a funder to compare its total investment to-date  to the total amount of follow-on funding attracted . Currently this value is estimated to be greater than a 35× return, and north of 45× for the NCAI program because of large follow-on investments that were made in a couple of the earliest NCAI-CC-supported technologies. Removing these projects brings the outcome measures for B-BIC and NCAI-CC into alignment, demonstrating the outside impact one or two technologies can have on the total return on a portfolio.In reviewing the results from different sites, there are several important things to keep in mind. First, underlying conditions that will affect observed outcomes include institution-specific factors, such as an institution’s research portfolio size and composition, infrastructure and innovation support programs, experience with entrepreneurship, culture, and regional innovation ecosystems. Second, NCAI and REACH had very different award parameters. NCAI sites had a longer period of performance, more funding, and were able to offer each funded project greater levels of support overall. This may affect the propensity of a researcher to submit an application for support, given their perception of the level of support available. Outcomes will also depend on the market for different technologies and therapeutic areas and differences in commercial pathways. Strong follow-on funding, for example, must be weighed against start-up creation and licensing. Lastly, none of these measures reflect the public health impact the technologies deliver, which will be important to consider as more technologies reach the market.The NCAI and REACH programs are still operating and supporting projects. Although NCAI is set to sunset in 2022, longitudinal data collection will continue as funded technologies progress to market. More information about the results of these programs will be made available in the coming years. Few programs have provided robust information about program performance over time, and our team will be providing information about the results from NCAI, REACH 2015, and REACH 2019 in the coming years to assist academic innovation programs with calibrating their performance expectations and ensuring they have access to insights and lessons learned from these important NIH programs.


Motherhood is a meaningful life role among adult women. Occupations within the maternal role of younger mothers have been well documented, but less is known regarding the maternal-role at older age. This review aimed to describe the occupations, activities, and perceptions that older women ascribe to their maternal role. In the future, this information may promote health and wellbeing of older women. A systematic search of peer reviewed articles, that included healthy, community-dwelling mothers, 60 years of age or older, was conducted. Maternal-role occupations and perceptions of older mothers were identified and classified according to the Occupational Therapy Practice Framework (OTPF). Fourteen articles, representing 3102 older mothers, were included. The identified occupations and activities within the maternal role were from two categories: Instrumental Activities of Daily Living (IADL) (such as assistance with daily chores) and social participation . Three themes reflecting maternal-role perceptions were identified: providing support; relationship with children; and motherhood as a never-ending role. Maternal occupations were identified in only a few articles and from only two categories, IADL and social participation. These findings together with the perception that motherhood is a ‘never-ending’ role suggests that further research is needed to better characterize the maternal role of older women from an occupational perspective. As life expectancy continues to grow, the importance of identifying factors contributing to healthy aging increases . EngagemOccupations are sets of activities (such as eating or shopping), carried out in various everyday contexts that people need, want, or are expected to do . The OccMotherhood is one of the most common and desired life roles among adult women ,10. MothDespite the recognition of its chronologically developing nature, there seems to be a gap in the research of the maternal role at later stages of women’s lives . Our litWe conducted a scoping review, since this methodology is appropriate when conducting a knowledge synthesis of key concepts within an area of diverse evidence . We follPeer-reviewed, full-text articles that were published in English were included in this scoping review according to the following inclusion criteria. The search was not limited by year of publication. Articles were eligible if they included community dwelling older mothers of healthy children. Mothers were 60 years of age or older (or at least some of the sample was 60 or over) and were independent in daily living. Studies that included only young mothers, or mothers with chronic conditions or disabilities or mothers of children with disabilities were excluded from this review.A search strategy was developed by the research team in consultation with a certified librarian, following the PCC mnemonic , recommended by the Joanna Briggs Institute (JBI) guidance for scoping reviews . The seaThe data collection process was guided by recommendations of Levac  and inclThe following data were extracted from the articles (a) author(s), (b) year of publication and country, (c) study question(s) or aim of the study, (d) participants, (e), study method and tools. In addition, the extracted data were examined for relevant information regarding occupations and perceptions related to the maternal role, according to the research questions. Maternal-role occupations and perceptions were then classified and organized according to OTPF: Domain and process 3rd Edition . The occn = 5), quantitative (n = 8), and mixed method (n = 1) research methodology. All qualitative studies used interviews as the main research tool, mostly semi-structured, and one study conducted focus groups as well. The quantitative studies used self-report scales for assessing research measures .The systematic search yielded 142 articles, 117 after removal of duplicates and 89 records were excluded following the screening process due to not meeting the inclusion criteria (see n = 5), social work (n = 3), gerontology (n = 2), psychology (n = 2), public health (n = 1), and occupational therapy (n = 1), and originated worldwide: North America (n = 8), Europe (n = 4), and Asia (n = 3) (see n = 14 mothers to 803), to investigate varied study aims.Six of the fourteen studies included only older mothers, the remaining studies included younger mothers as well, ranging from mothers aged 32 to 89 years old. The articles included were conducted by researchers from various fields: sociology (= 3) see . As can The maternal role occupations and perceptions that were identified in the articles matched the definitions of IADL and social participation occupations. IADL occupations are activities that support daily life within the home and community, including health and financial management and the care of others. Social participation occupations refer to activities that support the engagement in social situations and contexts, including in the family or the community .IADL occupations within the maternal role were identified in 12 of the 14 articles. The focus in these studies was on the support older mothers give their adult children ,41,42,43Social participation occupations within the maternal role were identified in eight articles. These studies highlighted social events and activities in which older mothers engage together with their children. Mothers and their children, participated in fun and enjoyable activities such as shopping, travelling, and gift giving. They visit their children and share holiday rituals together. Mothers described being in contact frequently with their children, sharing thoughts and opinions, and being involved in their children’s lives ,38,40,44Three themes were identified in the articles reflecting mothers’ perceptions and attitudes towards the maternal role and are described below and in appear in The goal of this review was to explore the daily occupations and perceptions associated with older women’s maternal role. We identified two categories of occupations within the maternal role: IADL and social participation, as well as three themes reflecting perceptions regarding the maternal role: providing support; relationship with children; and motherhood as a never-ending role. A certain symmetry is apparent between the identified occupations and perceptions: IADL occupations, which include caring for others, correspond with perceptions of providing support to children; and social participation occupations correspond with mothers’ perception of the relationships with their children, which naturally occurs in social contexts. This may suggest an interweaving dynamic interaction between mothers’ values and their daily occupations. Personal values reflect one’s goals or desires and include beliefs about what is good, correct, or important to do . The wayThe importance of understanding values of older adults, is in accordance with the recent global movement towards healthy aging. Enabling older adults to do what they value, supports current definitions of healthy aging, which expands the concept of health beyond traditional medical measures ,49,50. PThis scoping review highlights the gap in the research of motherhood in older age, specifically research from an occupational perspective. Despite our wide search of year of publication, only fourteen eligible articles were identified and only five of them were published within the last ten years. Only one study specifically aimed to explore maternal occupations of older women, while the other studies partially reported on this topic within their original aims. In addition, only two maternal role occupations of the eight occupations defined by the OTPF, were identified in the reviewed articles. This possibly reflects paucity in the research of the maternal role at older age, rather than restricted participation in occupations of older mothers. Occupations such as leisure or BADL were not described in the articles and should be further researched.This is the first scoping review that aimed to identify the occupations and daily activities within the maternal role of older women. The articles included in the review were elicited from a wide range of research fields and were examined through the unique occupational perspective, using the OTPF . Three dThe scarce literature found in this scoping review supports the perception that being a mother is a meaningful and never-ending life role. Further research is needed in order to characterize the maternal role of older women, specifically through an occupational perspective. This information may be used to promote the health and wellbeing of older mothers, by enhancing their participation in meaningful occupations and life roles.


By analysing the technical advantages and characteristics of imaging radar in cultural heritage, we provide new insights for the future development of cutting-edge Digital Heritage approaches through technical integration and interdisciplinary synergy. Heritage assets reflecting memories of the past are increasingly sustained by societies as a necessary condition for the continuing evolution of people's culture. The call for ‘strengthening efforts to protect and safeguard the world's cultural and natural heritage’ in United Nations Sustainable Development Goal (SDG) 11 [To understand and safeguard irreplaceable cultural assets, archaeological prospection and heritage preservation are two interconnected and essential research domains. Prospection aims at archaeological discovery and documentation, to bring back to light buried and hitherto unknown structures, antiquities and even extensive paleo-landscapes. Preservation orients us to prevent further deterioration and to design conservation measures to enhance heritage sustainability by monitoring the condition of heritage assets through time. Both archaeological investigation and heritage preservation include the use of all possible invasive and non-invasive means.Over the last few decades, an increasing number of technologies have been applied to facilitate sustainability goals of cultural heritage ,3, and aImaging radar includes airborne/spaceborne Synthetic Aperture Radar (SAR), Ground Penetrating Radar (GPR) and Ground-Based SAR (GB-SAR), whose operation characteristics are generally diverse but complementary, depending on their peculiar observation capabilities coupled with investigation needs and scales Fig. . FollowiAcross large landscapes, satellite SAR imagery is capable of revealing ancient drainage patterns , palaeo-The benefits brought by technology integration are particularly relevant in the desert and semi-arid regions, where optical remote sensing is limited, whereas SAR can offer large-scale imaging, subsurface penetration and effective feature discrimination. Moreover, today a huge amount of satellite SAR data can be promptly processed using cloud tools  to automatically identify archaeological traces, using artificial intelligence as machine and deep learning approaches . After tMoreover, being sensitive to subtle motions, spaceborne Multitemporal SAR Interferometry (MTInSAR) is recommended for monitoring purposes. MTInSAR detects millimetric deformation anomalies at the cultural-monument scale , providiA dedicated literature review based on the Web of Science database reveals a clear but uneven increase in the use of imaging radar technology in cultural heritage management over the last 30 years; from the first publication in 1992 to ∼40 papers/yr between 2015 and 2020, with >80% publications focusing on GPR-based case studies. Surprisingly, despite the intrinsic complementarities, the integrated use of GPR, GB-SAR and airborne-satellite SAR is rare. It is also revealed that collaboration had become a necessary condition for interdisciplinary heritage studies, particularly in complex landscapes and situational contexts that call for knowledge and expertise from scientists, engineers and other stakeholders. Institution-level cooperation has become a mainstream trend in scientific and industrial communities in order to achieve benefits through in-depth theoretical investigations and technical applications.A viable pathway could be the design of pilot projects enhancing trans- and interdisciplinary collaborations at the international level, as already experienced in the past in the framework of the United Nations Educational, Scientific and Cultural Organization (UNESCO) and European Space Agency (ESA) Open Initiative, which focused on ‘the Use of Space Technologies to Support the World Heritage Convention’.Launch and enlargement of such initiatives would be welcome, to provide an optimum platform on a worldwide scale for building case studies on digital heritage applications using integrated imaging technologies (with particular emphasis on radar). A partnership with international organizations, including UNESCO’s Category 1 and 2 centres and institutes, is proposed. It contributes to the execution of UNESCO’s programme and addresses the gap of Tier III SDG indicators (i.e. 11.4.1) by way of the International Centre on Space Technologies for Natural and Cultural Heritage (HIST), whose mission is the protection and safeguarding of cultural and natural heritage.


Panthera uncia, are usually considered low risk for disease outbreaks. However, based on current knowledge about drivers of disease emergence, we show that High Asia is rapidly developing conditions that favor increased emergence of infectious diseases and zoonoses. This is because of the existing prevalence of potentially serious pathogens in the system; intensifying environmental degradation; rapid changes in local ecological, socio-ecological, and socio-economic factors; and global risk intensifiers such as climate change and globalization. To better understand and manage the risks posed by diseases to humans, livestock, and wildlife, there is an urgent need for establishing a disease surveillance system and improving human and animal health care. Public health must be integrated with conservation programs, more ecologically sustainable development efforts and long-term disease surveillance.The cold and arid mountains and plateaus of High Asia, inhabited by a relatively sparse human population, a high density of livestock, and wildlife such as the iconic snow leopard The online version contains supplementary material available at 10.1007/s13280-021-01599-7. S1) points to causative agents that are related to anthropogenic disturbance of ecosystems, biodiversity loss, and changes in the way people and animals interact  are a growing problem for humans, wildlife, and domesticated species  a highly integrated global economy leading to unprecedented movement of people, animals, and goods—and, thereby, pathogens—between regions, (ii) ecological disruption and habitat fragmentation that increase contact between people, wildlife, and domestic species, and (iii) general characteristics of development such as biotic homogenization that reduces ecosystem resilience, and pesticide and antibiotic use, which can compromise immune responses and promote the emergence of resistant pathogens . High Asia is composed of ~ 6.4 million square kilometers and 44 ecoregions . Compared to tropical and temperate systems, High Asia has seen relatively little research on EIDs and zoonotic diseases , and the intervening regions connecting these mountains that are ecologically and climatically similar. We focus on the snow leopard range area because it typifies the human–livestock–wildlife relationships in this region, it is undergoing dramatic changes that we argue increase EID risk, and because of its importance for local cultural values and a globally significant wildlife conservation program. To define this region, we used the global ecoregion files for High Asia  and blue sheep (Pseudois nayaur), show typically gregarious social behavior, along with seasonally compromised body condition due to strong seasonality and/or resource competition with sympatric livestock; factors important in regulating and spreading pathogens  switching from depleted wildebeest (Connochaetes spp.) populations to feed on humans  in High Asia  is increasing in High Asia  in many areas of High Asia is increasing as a consequence of urbanization in countries such as Bhutan, China, India, Nepal, Pakistan, and Uzbekistan   due to hemorrhagic septicemia caused by the bacterium (Pasteurella multocida), which although outside the region we are describing, exemplifies the reality of changing climate influencing parasite–host interactions in ways which may lead to serious disease outbreaks and higher rates of mortality  and Ethiopian wolves (Canis simensis)  acting as reservoirs  and markhor  in the mountains of Pakistan and Tajikistan, respectively. These outbreaks are linked to transfer from sympatric livestock  and anthrax (Bacillus anthracis) are also carried by wild ungulates and smaller prey taken by snow leopards, such as marmots (Marmota baibacina) , known to host various types of coronaviruses (including SARS and COVID-19) are also present  and multi-disciplinary engagement in setting up long-term disease surveillance programs across High Asia. These programs need to not only focus on EIDs and zoonoses of current concern, but also engage in long-term strategic monitoring of endemic diseases within wildlife and domestic livestock to help understand how interactions among these pools may affect each other, and to help understand where new EIDs may arise. This needs to be accompanied by a systematic strengthening of health systems in these remote areas to ensure appropriate health care and well-being of local communities, which in turn, will indirectly provide wider benefits at the national and global levels by earlier detection and preparedness for EIDs and zoonoses Below is the link to the electronic supplementary material.


In recent years, the World Health Organization (WHO) has included fatigue as a major risk factor for human life and health. The incidence rate of fatigue is high. In Europe and America, nearly 1/3 of the population is suffering from fatigue. Due to the acceleration of modern people’s life rhythm and the increase of work pressure, more and more attention has been paid to central fatigue. The activation of NF-κB is related to central fatigue, which has been paid little attention by previous studies. At the same time, previous studies have mostly focused on the immune regulation function of NF-κB, while the NF-κB pathway plays an equally important role in regulating nerve function. NF-κB can participate in the occurrence and development of central fatigue by mediating immune inflammatory response, regulating central excitability and inhibitory transmitters, regulating synaptic plasticity and regulating central nervous system (CNS) functional genes. In addition to neuroprotective effects, NF-κB also has nerve damage effects, which is also closely related to the occurrence and development of central fatigue. In this review, we focus on the relationship between NF-κB pathway and central fatigue and further explore the biological mechanism of central fatigue. At the same time, the clinical application and potential of typical NF-κB inhibitors in the treatment of fatigue were analyzed to provide reference for the clinical treatment of central fatigue. In recent years, the World Health Organization has included fatigue as a major factor endangering human life and health. The incidence rate of fatigue is high. In Europe and America, nearly 1/3 of the population is under the threat of fatigue  is closely related to fatigue. In addition to its important immunoregulatory function, NF-κB also plays an important role in regulating nerve function  is related to central fatigue. In the central nervous system, the process of information transmission between neurons is completed by neurotransmitters  is an important inhibitory neurotransmitter in the central nervous system  and CREB are functional genes of central nervous system. NF-κB affects the occurrence and development of central fatigue by regulating PKA-CREB pathway. PKA is a major regulator of the nervous system, which plays an important positive role in neural development, axon growth, behavior formation and long-term memory formation  , nuts and cereal products with cardiovascular protective properties. According to their chemical structure, flavonoids can be divided into flavonoids, flavonoids, flavonols, flavono-3-alcohols, isoflavones and anthocyanins. Flavonoids are NF-κB inhibitors that regulate the expression of pro-inflammatory genes, thereby reducing inflammatory responses in various cardiovascular pathologies  (Lee et al. NF-κB is an important immune and inflammatory pathway. Previous studies have focused on the immunoregulatory function of NF-κB, while NF-κB pathway plays an equally important role in regulating neural function. The pathogenesis of central fatigue is related to the activation of NF-κB signaling pathway, which has been paid less attention in the past. NF-κB participates in the occurrence and development of central fatigue by regulating excitatory and inhibitory neurotransmitters, synaptic plasticity and functional genes of central nervous system. At the same time, NF-κB has neuroprotective and nerve injury effect, which is involved in the occurrence and development of central fatigue. It is concluded that NF-κB participates in the occurrence and development of central fatigue and has neuroprotective and nerve injury effects, which is involved in the occurrence and development of central fatigue. So, NF-κB might be a therapeutic target for the treatment of fatigue.It may be very beneficial to use NF-kB inhibitors to treat fatigue. Dimethanidine can suppress NF-κB activation, which prevents the expression of vascular inflammation and adhesive molecules induced by cell factors. Through the activation of NRF2, turmeric has the effect of preventing NF-κB from activating and suppressing the expression of inflammatory genes in small glue cells. As one of the NF-κB inhibitors, acetone compound can regulate the expression of inflammatory genes, thereby reducing the inflammatory response under various cardiovascular pathologies. Dimethanidine, turmericin and carbone compounds have the potential to treat fatigue.


Civil wars in the Great Lakes region resulted in massive displacement of people to neighboring countries including Uganda. With associated disease epidemics related to this conflict, a disease surveillance system was established aiming for timely detection of diseases and rapid response to outbreaks. We describe the evaluation of and lessons learned from the public health surveillance system set up in refugee settlements in Uganda.We conducted a cross-sectional survey using the US Centers for Disease Control and Prevention Updated Guidelines for Evaluating Public Health Surveillance Systems and the Uganda National Technical Guidelines for Integrated Disease Surveillance and Response in four refugee settlements in Uganda—Bidibidi, Adjumani, Kiryandongo and Rhino Camp. Using semi-structured questionnaires, key informant and focus group discussion guides, we interviewed 53 health facility leaders, 12 key personnel and 224 village health team members from 53 health facilities and 112 villages and assessed key surveillance functions and attributes.All health facilities assessed had key surveillance staff; 60% were trained on Integrated Disease Surveillance and Response and most village health teams were trained on disease surveillance. Case detection was at 55%; facilities lacked standard case definitions and were using parallel Implementing Partner driven reporting systems. Recording was at 79% and reporting was at 81%. Data analysis and interpretation was at 49%. Confirmation of outbreaks and events was at 76%. Preparedness was at 72%. Response was at 34%. Feedback was at 82%. Evaluate and improve the system was at 67%. There was low capacity for detection, response and data analysis and interpretation of cases (< 60%).The surveillance system in the refugee settlements was functional with many performing attributes but with many remaining gaps. There was low capacity for detection, response and data analysis and interpretation in all the refugee settlements. There is need for improvement to align surveillance systems in refugee settlements with the mainstream surveillance system in the country. Implementing Partners should be urged to offer support for surveillance and training of surveillance staff on Integrated Disease Surveillance and Response to maintain effective surveillance functions. Functionalization of district teams ensures achievement of surveillance functions and attributes. Regular supervision of and support to health facility surveillance personnel is essential. Harmonization of reporting improves surveillance functions and attributes and appropriation of funds by government to districts to support refugee settlements is complementary to maintain effective surveillance of priority diseases in the northern and central part of Uganda. The civil wars and fragile states in the Great Lakes region of Eastern Africa has resulted in massive displacement of people to neighboring countries including Uganda whose open refugee policy has contributed to its bigger refugee population . South SThe total population in these settlements was 1,434,708 by October, 2020; this number continues to increase with renewed conflict and hostilities that have plagued the region . ReliablUganda’s Ministry of Health (MoH) has implemented the Integrated Disease Surveillance and Response (IDSR) as a national strategy for improving epidemiologic surveillance and response since 2000 . The strWe conducted a cross-sectional survey using the US Centers for Disease Control and Prevention (CDC) Updated Guidelines for Evaluating Public Health Surveillance Systems  and the The study sites were the refugee settlements of Bidibidi, Adjumani, Kiryandongo and Rhino Camp located in Northern and Central Uganda. Bidibidi Refugee Settlement covers an area of 250 sq. km and is located in Yumbe District, Northern Uganda. The settlement had a capacity of 180,000, but there were 238,279 refugees mainly from South Sudan. Adjumani Refugee Settlement comprises 17 camps, and is located in Adjumani District. The total refugee population for Adjumani District stood at 224,044. Kiryandongo Refugee Settlement, located in Kiryandongo District, had a population of 71,865. Rhino Camp Refugee Settlement located in Arua District, and spread over 3 sub-counties , had a population of 124,453.Using simple random sampling, we picked 6 health facilities in Adjumani, 16 in Bidibidi, 24 in Kiryandongo and 7 in Rhino Camp. Sample size for the clusters (villages) was calculated using sample size calculator software (vSphere) to pick clusters . Inter-cWe conducted observations and interviews Table . We inteData was collected electronically using an Open Data Kit Software (Kobo Collect for Humanitarian Emergencies) using Tablet PCs.The following surveillance functions were assessed—detection, recording, reporting, preparedness, response, feedback, confirmation of outbreaks, data analysis and interpretation. The surveillance attributes assessed are defined in Table The capacity of the refugee settlements in performing surveillance functions Table  and all We analyzed qualitative data using the content analysis model. We sorted and coded the data into categories, in order to bring together related terms. We edited and summarized useful information and developed conclusions without changing the meaning of what the respondents said. We used Epi-data to capture quantitative data and exported to Stata version 16 for analysis. We used descriptive statistics to summarize variables in form of rates and proportions. We calculated the positive predictive value of the system using cholera data by comparing the proportion of persons identified as having cholera to those who actually had the condition under surveillance. We categorized some attributes on a scale if many parameters describing one attribute were measured. The categories were: low (< 60%), moderate (60–74%), and high (≥ 75%).All the 53 health facilities assessed had key surveillance staff such as clinicians, nurses, records assistants, laboratory and environmental health personnel employed by government or implementing partners. However, only 60% of health workers were trained on Integrated Disease Surveillance and Response. The VHT structure was in place and they were trained on Community Based Disease and Events Surveillance. Eighty percent of the facilities lacked evidence that VHTs were reporting on Community Based Disease Surveillance activities.All 53 facilities had Out Patient Department (OPD) registers feeding into the weekly and monthly reports. However, there was lack of standard case definitions (SCDs) and use of parallel Implementing Partner driven Health Information System (HIS). Detection of cases was at 55% (Range = 53–57) while recording was at 79% (Range = 67–90), and reporting was at 81% (Range = 67–95). Analysis and interpretation of data was at 49% (Range = 19–95). The capacity of the settlements to confirm outbreaks and events was at 76% (Range = 50–86) and their level of preparedness was at 72% (Range = 65–83). The response rate was at 34% (Range = 11–50) while ability to provide feedback was at 82% (Range = 75–100). The capacity of the system to evaluate and improve the system was at 67% (Range = 55–83).Diagnoses and reporting of priority diseases were made according to standard case definitions in 65% 34/53) of the health facilities, 35% of the facilities had their own (IP driven) case definitions. No facility had drawn its own list of priority diseases, events or conditions, but used the list of diseases specified on the weekly reporting form “HMIS 033b” , 11. Cas4/53 of tThere were two reporting systems with different reporting tools in health facilities. One reporting system was driven by the Implementing Partners while the other used the MoH system. Age categorization of sub-groups differed across the facilities from the standard MoH guidelines.The registers had many gaps  and there were considerable missing data. Only 33% (17/53) of the health facilities assessed demonstrated the capacity to analyze and present data using charts and maps.The health workers, whether employed by government or partners, accepted that there were gaps in timeliness and completeness in reporting. Users interviewed expressed willingness to align the reporting system with the MoH standard reporting format.The surveillance system was sensitive at 79% (Range = 76–83) in detecting suspected outbreaks during the period of study “April 2016 to December 2019”. Malaria cases reported in the study period were 105,159 in Kiryandongo, 144,873 in Adjumani, 137,424 in Rhino Camp, and 155,238 in Bidibidi, of which 428,728 tested positive by malaria rapid diagnostic test. The most reported epidemic prone diseases were: malaria, typhoid, dysentery, measles and cholera. However, only a few were investigated by the districts. Other events captured by the surveillance system were: animal bites (suspected Rabies), Adverse Events Following Immunization, presumptive multi-drug resistant tuberculosis, acute flaccid paralysis, malaria deaths, perinatal and maternal deaths.The positive predictive value for surveillance was 64% (Range = 50–70). There were 124 cases of cholera  reported of which 79 tested positive by culture at Uganda National Health Laboratory Services. Case investigations of cholera outbreaks were carried out during the study period by the response teams in Adjumani, Kiryandongo and Rhino Camp Refugee Settlements.Age categorization of sub-groups differed across the facilities from the standard MoH guidelines.The average weekly reporting rate in the refugee settlements was 71% (Range = 52–79). The district health teams reported inadequate skills to record, summarize and send reports on mTrac. mTrac is a mobile tracking system of the MoH where health workers send alert messages using phone numbers which have been entered into the District Health Information Software version 2. Few health workers were on the mTrac system. Outbreaks of cholera were reported within a week of occurrence in Adjumani, Kiryandongo and Rhino Camp Refugee Settlements.Internet connectivity challenges were experienced by all facilities visited and the District Health Office. Funds to repair equipment were in short supply in all four refugee settlements.The surveillance system in the refugee settlements of Adjumani, Bidibidi, Kiryandongo and Rhino Camp demonstrated ability to detect and ensure that health conditions of public health importance are monitored efficiently and effectively to control and prevent epidemics. However, there were many gaps that could negatively affect the efficiency of the system. The system did not follow the MoH IDSR guidelines in its entirety. The core function of IDSR is to strengthen district level surveillance and response for priority diseases and integrate laboratory activities, reduce duplication in reporting, and share resources among disease control programs.The surveillance functions of recording, reporting, preparedness, feedback and confirmation of outbreaks and events were highly achieved, and evaluate and improve the system was moderately achieved. However, there was low capacity for detection, response and data analysis and interpretation in all the refugee settlements. Lack of standard case definitions and use of parallel Implementing Partner driven Health Information System possibly contributed to this. In addition, most health workers were not trained on IDSR and hence lacked data quality and analytical skills. Drehobl et al. asserts that much as data systems that monitor health threats are becoming increasingly automated, human expertise is, and always will be, critical to recognizing potential cases of disease, diagnosing disease, reporting diseases or conditions, analyzing and interpreting data, and communicating results to all stakeholders . For thiAs shown in Table The surveillance system in the refugee settlements was functional with many performing attributes but with many remaining gaps. There was low capacity for detection, response and data analysis and interpretation of cases in all the refugee settlements. There is need for improvement to align surveillance systems in refugee settlements with the mainstream surveillance system in the country. Implementing Partners should be urged to offer support for surveillance and training of surveillance staff on Integrated Disease Surveillance and Response to maintain effective surveillance functions. Functionalization of district teams ensures achievement of surveillance functions and attributes. Regular supervision of and support to health facility surveillance personnel is essential. Harmonization of reporting improves surveillance functions and attributes and appropriation of funds by government to districts to support refugee settlements is complementary to maintain effective surveillance of priority diseases in the Northern and Central part of Uganda.


The interaction and the interplay of climate change with oil palm production in the Southeast Asia region are of serious concern. This particularly applies in Malaysia due to its rank as the second largest palm oil producer in the world. The anthropogenic activities and the agroecological practices in oil palm plantation, including excessive use of fertilisers, bush fire due to land clearing, and cultivation on peatland, have exacerbated the effects of climate change featuring extreme events, drought, flooding, heatwave, as well as infestation of pest and diseases. These adverse impacts on oil palm production highlight the significance of deploying effective adaptation strategies. The study aims to examine the impact of climate change on oil palm production and identify the farmers’ adaptation strategies to the impacts of climate change in Malaysia. This study was conducted a comprehensive review of the articles published from 2000 to 2021 in the contexts of climate change and oil palm production in Malaysia. The review shows that climate change has a range of impacts on the oil palm production in Malaysia. As a result, several adaptation options were identified, such as breeding of hybrid varieties that are tolerant and resistant to heat; sustainable management of soil; pit and tranches to enhance water management in plantation areas; minimal use of fertilisers, herbicides, and pesticides; zero burning; and minimum tillage. The reviewed studies recommended the following to mitigate the adverse impacts of climate change: sustainable national policy on climate change, conservation of the existing carbon stock, effective management of tropical rainforest biodiversity, afforestation for carbon sequestration, and reduction in greenhouse gas (GHG) emission. Weather denotes the present condition of the atmosphere, whereas climate reflects the average weather condition of a geographical location for over 35 years , and identify the farmers’ adaptation strategies to the impacts of climate change in Malaysia. Studies on oil palm and climate change in Malaysia have mostly assessed socioeconomic impacts of climate change , the oil palm contains single seed or monocotyledon and fibrous roots system spreading downward in search of nutrients, and for single trunk erection   are returned to the soil for mulching and enhancing soil fertility  predicted rise in average annual temperature by 1.5°C and 3.7°C for 2040–2050 and 2090–2100, respectively Shaaban . In partGlobal warming and melting ice have led to rising ocean sea level, apart from exacerbating the impact of coastal inundation  for Peninsular Malaysia, RM 127.43 (RM ha−1) for Sabah, and RM 51.80 (RM ha−1) for Sarawak  could be at danger or risk of diseases that might severely reduce the population, thus decreasing FFB yield   and the Non-Governmental Organizations (via extension agencies) should disseminate hands-on information to farmers , besides creating awareness about new plantation management techniques, as well as sustainable pests and diseases control measures (Abazue et al. Soil and water conservation management in plantation is a promising technique in adaptation to climate change (Delgado et al. Intercropping, such as legumes and cereals, in oil palm plantation between rows can increase the income level of farmers and improve food security, should in case of climatic uncertainties (Nchanji et al. Sustainable adaptation planning should be all encompassing after considering the rapid technological changes and future farming technology, which might influence adaptation options (Stringer et al. Climate change is indeed an emerging serious ecological threat. The results from this review signify that the variability of climate had, has, and will adversely affect the oil palm production. As observed, the 1997/98 and 2015/16 El Niño events had substantially reduced the yield turnover of oil palm by affecting the soil and the plant physiology merely by modifying the general weather pattern. Increase in average surface temperature displayed profound impacts on oil palm production, wherein increment in temperature by 1–4°C projected a reduction of 10–41% of oil palm yield in Malaysia. Higher temperatures exacerbate the rate of evapotranspiration, thus leaving the soil dry and aggravating water stress—ultimately resulting in retarded growth and poor harvest. Apart from increasing warmer days and colder nights, rising temperature changes the ecology of various pests and diseases. As a result, these pests and diseases become more adaptable to the changing environment and increase in population, which may create an epidemic or even a pandemic outbreak in the plantations. Pollinating insects might be susceptible to attack by other organisms, which could lead to reduction in their population, and hence, impeding the pollination process. Rainfall projection indicated torrential rain around years 2081–2100, along with wider spatial distribution and expected drier conditions during the southwest monsoon towards the end of the twenty-first century. Meanwhile, sea level has been anticipated to raise by 0.71m in 2100, in which the resulting effect is devastating flooding that could annihilate thousands of hectares of oil palm plantation, particularly those situated along the coastal zones. The study suggest some policy recommendations to address the impacts of climate change on oil palm production: sustainable land use policy and expansion without deforestation, the use of improve variety, enhance institutional research, collaboration between producer and major consumer countries in research, improve easy access, communication and availability of academic findings, technology transfer, environmental education, management skills, and extension services to oil palm growers.


Eating disorders (EDs) are highly complex mental illnesses associated with significant medical complications. There are currently knowledge gaps in research relating to the epidemiology, aetiology, treatment, burden, and outcomes of eating disorders. To clearly identify and begin addressing the major deficits in the scientific, medical, and clinical understanding of these mental illnesses, the Australian Government Department of Health in 2019 funded the InsideOut Institute (IOI) to develop the Australian Eating Disorder Research and Translation Strategy, the primary aim of which was to identify priorities and targets for building research capacity and outputs. A series of rapid reviews (RR) were conducted to map the current state of knowledge, identify evidence gaps, and inform development of the national research strategy. Published peer-reviewed literature on DSM-5 listed EDs, across eight knowledge domains was reviewed: (1) population, prevalence, disease burden, Quality of Life in Western developed countries; (2) risk factors; (3) co-occurring conditions and medical complications; (4) screening and diagnosis; (5) prevention and early intervention; (6) psychotherapies and relapse prevention; (7) models of care; (8) pharmacotherapies, alternative and adjunctive therapies; and (9) outcomes . While RRs are systematic in nature, they are distinct from systematic reviews in their aim to gather evidence in a timely manner to support decision-making on urgent or high-priority health concerns at the national level.Three medical science databases were searched as the primary source of literature for the RRs: Science Direct, PubMed and OVID (Medline). The search was completed on 31st May 2021 (spanning January 2009–May 2021). At writing, a total of 1,320 articles met eligibility criteria and were included in the final review.For each RR, the evidence has been organised to review the knowledge area and identify gaps for further research and investment. The series of RRs (published separately within the current series) are designed to support the development of research and translation practice in the field of EDs. They highlight areas for investment and investigation, and provide researchers, service planners and providers, and research funders rapid access to quality current evidence, which has been synthesised and organised to assist decision-making. Eating disorders (ED) are complex mental illnesses associated with numerous physical complications and mental health comorbidities –4. EDs hSix primary EDs are defined by the DSM-5 and affect more than 1 million Australians per year . They arSpecifically, no large-scale review of the field has been conducted that appraises what is currently known about EDs. Consequently, gaps have not been identified in such a way that progresses the field in its focus on areas requiring urgent research attention. Beyond the focus on knowledge gaps, it is also the case in Australia that there has been a lack of development of the research workforce and pipeline for high quality researchers. Lack of student funding (despite high demand for postgraduate research degree supervision ) and a gIn acknowledgement of these facts, in 2019 the Australian Government—Department of Health funded the development of the first national Eating Disorder Research and Translation Strategy for Australia, to identify strategic priorities and targets for building research capacity and outputs. The InsideOut Institute (IOI) for EDs  was tasked with developing the strategy. As part of this process, IOI commissioned Health Management Australia  to conduct an independent scoping of the ED field. The RR process was conducted in consultation with the expert researcher community, to provide a ready and organised summary of the evidence base to help guide research and investment in the field  framework—an evidence-based framework for generating research questions .The research questions are, outlined in Fig. This InsideOut Institute (IOI) for Eating Disorders commissioned Health Management Australia (HMA), a private third-party specialist health management firm, to conduct a rapid review (RR) to assess the current research base and inform part of the development of the Eating Disorder Research and Translation Strategy see Fig. . It was Included articles were published:Between January 2009 and May 2021;Peer-reviewed; and,in English.To establish a broad understanding of the progress made in the field of EDs, and to capture the largest evidence base from the past 12 years , the eligibility criteria for included studies into the rapid review were kept broad. Specifically,Further, the search methodology was designed to capture all relevant peer-reviewed literature, with a focus on high-level evidence studies such as: meta-analyses; systematic reviews; moderately sized randomised controlled studies (RCTs) (n > 50); small to moderately sized controlled-cohort studies (n > 50), or population studies (n > 500).Exclusion criteria for articles are outlined Fig. The diagnoses ARFID and UFED necessitated a less stringent eligibility criterion due to a paucity of published articles. In focus areas where the evidence base is emerging and fewer studies have been conducted, smaller studies (n =  < 20) and narrative reviews were also considered and included.Three medical science databases were searched as the primary source of literature for the RR: Science Direct, PubMed and OVID (Medline). This approach facilitated a comprehensive coverage of available publications as well as the filtering of results by additional search parameters to keep track of the overall number of results.Additional articles were identified using citation links and hyperlinks for related articles in databases. Manual searching of reference lists was conducted for emerging research areas (such as ARFID and UFED). Any eligible studies related to a specific topic covered by the RR may also be identified by the expert researchers involved in drafting forthcoming manuscripts. Additional studies will be clearly identified in the respective paper and reported on accordingly.Search terms entered into the databases yielded a result if the term was included in one or more of the following article identifiers: title; abstract; author-specified key words; journal title, or author name/affiliations. The search was conducted by three reviewers from HMA (led by AL) between 5 December 2019 and 16 January 2020.National Eating Disorder Research Consortium, henceforth the ‘consortium’), an additional search was conducted between 6 May 2020 and 11 May 2020 using the key search term ‘eating disorder’ in conjunction with the keywords outlined in Fig. Based on feedback from researchers, experts, lived-experience advocates, and carers  as part of the search strategy process. Articles assessed for inclusion based on the criteria underwent a further review process based on the evidence presented with relevance for the RR – this was conducted by two of the HMA reviewers (AL + colleague) involved in initial screening. Discrepancies were resolved by discussion between the reviewers with disputes referred to an expert research panel  for final decision. Evidence presented in the RR is based on literature that satisfied criteria following this subsequent review process.A broad search strategy was applied to facilitate a comprehensive search of the literature by each specified in-scope ED diagnosis. Key search terms were identified through preliminary searches and in consultation with members of the consortium and expert research panel.The review had a translational research focus with the objective of identifying evidence relevant to developing optimal care pathways. Searches therefore used a Population, Intervention, Comparison, Outcome (PICO) approach to identify literature relating to population impact, prevention and early intervention, treatment, and long-term outcomes . The PICA total of 30 keywords were used across each of the chosen databases. A list of the keywords is shown in Fig. Data were managed by HMA in accordance with their data management policies. Additional information may be found on the HMA website (hma.com.au). The data collection process by HMA included entering studies into an independent database, including key study information.Studies were selected based upon the agreed inclusion/exclusion criteria developed by the RR project team and authors  and HMA. Selection of evidence for inclusion was conducted by two reviewers from HMA. Reference lists were manually screened for emerging areas of research that had limited literature—this process also involved the Expert Research Collaborative suggesting additional references that may have not been identified previously.Due to the lack of research on newer DSM-5  disorderAs the overarching purpose of this review was to inform an Australian Research and Translation Strategy, selection of studies focused on information and interventions that could be readily applied to the Australian population. Therefore, some exploratory studies or studies investigating emerging illnesses -such as ARFID and UFED, with sample sizes smaller than 20 were included. As noted in the discussion, this may introduce a risk of bias .Where possible, results on the efficacy of interventions included information reported in studies on the length of patient follow-up. Studies where results were compared to a control or active comparator were also identified.The cumulative evidence of each of the studies, categorised under relevant subject headings, was synthesised at a high level indicating whether there was consensus in the field regarding the validity of hypotheses, benefit of treatments or interventions, and the impact of EDs on the population.Given the heterogeneity of studies and the scope of the RR, no meta-analysis was conducted; instead, an evidence synthesis approach was utilised.In total, 1320 articles were included in the RR. Figure Full article reviews were conducted on 1968 publications with a final subset of 1308 studies included in the RR. Upon review of the initial subset by the Expert Research Collaborative, an additional 12 articles were identified for inclusion, bringing the number of included articles at the time of writing this methods paper to 1320.To inform the development of new knowledge in EDs, identified information was grouped to represent broad focus areas—epidemiology, risk factors, screening and diagnosis, early intervention, comorbidities, treatment and models of care, and disorder management and outcomes. Results from the search fell into these seven broad areas displayed in Fig. Only a small proportion of studies relating to screening and diagnosis (6%) and models of care (4%) were identified. As this represented only 10% of the evidence base identified in the review, this suggests there is a gap in knowledge in these areas.Given the number of search results returned, individual findings for each of the broad categories presented in Fig. Of the included papers, over two thirds (77%) were published following publication of the DSM-5, however the proportion of studies adopting the updated criteria was not examined. Of the nine identified categories, 131 (10%) included studies examining population, prevalence, disease burden, and QoL (epidemiology); 278 (20%) investigated risk factors (aetiology); 214 (16%) looked at co-occurring conditions and medical complications (comorbidities); 77 (6%) focused on screening and diagnosis (diagnostics); 129 (9%) explored aspects of prevention and early intervention (intervention); 257 (19%) probed elements of psychotherapies and relapse prevention (treatment); 59 (4%) considered models of care (care models); 121 (9%) researched pharmacotherapies, alternative and adjunctive therapies (treatment); and 102 (7%) measured outcomes. However, it should be noted that around 3% (n = 46) of studies firmly fell into more than one of the nine categories.Several trends around the general distribution of the literature, as they relate to the above nine categories, were noted. Many of the included epidemiological studies were based on US and European samples and focused on the ‘core’ eating disorders of Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Similarly, there appeared a large evidence-base examining risk factors associated with these core eating disorders. However, little evidence was identified examining the risk factors of Other Specified Feeding and Eating Disorders (OSFED) and Avoidant/ Restrictive Food Intake Disorder (ARFID). Genetics, the environment, and other psychosocial influences were found to all contribute in part to eating disorder development.Included studies examining co-occurring conditions primarily considered psychological comorbidities, with an abundance of studies investigating anxiety and Obsessive Compulsive Disorder in individuals with eating disorders. Anorexia Nervosa appeared to be among the most widely studied eating disorder group for comorbidities.Much of the literature identified focused on screening in specific settings, such as universities, colleges, and schools. There was a stark lack of peer-reviewed evidence focused on screening eating disorders in males (n = 1). Further, it was found that while studies on screening and diagnosis are available, there are deficits in available literature that focus on screening and diagnosis in primary care settings, among women accessing fertility and reproductive health services, obese individuals, and adolescents with diabetes. Evidence suggests a need for increased screening for EDs in primary care settings.Comparatively few early intervention studies were identified by the review, with some larger studies arising from the USA and UK. There appeared to be lack of consensus between studies on one leading approach to developing and delivering early intervention, however it was noted, broadly, that internet-based programs may have some promise for particular types of EDs. It was also noted that there was a dearth of research on targeted prevention strategies for minority and high-risk groups.Several implementation studies were identified delivering treatments through health system models of care, conducted in ‘real world’ settings. However, this did not represent a significant proportion of evidence identified. Gaps in services, delayed diagnosis, and subsequently specialist care and treatment were identified to not only lead to poorer health outcomes for individual with eating disorders but also significant government healthcare expenditure. Most treatments explored in by the review included studies focused on behavioural therapies, however findings did not lead to the identification of one leading effective psychotherapy for the treatment of eating disorders, particularly in adults with restrictive type eating disorders. Further, there appears to be little-to-no consensus on the focus for developing approaches to reduce exceedingly high relapse rates.The evidence-base for treatment of eating disorders with pharmacotherapy is sparse in comparison to psychotherapies. Many studies which examined the use of drug therapies were smaller clinical trials, often without a control group. Included studies therefore contained few Randomised Control Trials (RCTs) that assessed pharmacological interventions specifically for the treatment of eating disorders. Overall, the results indicate some conflicting evidence for atypical antipsychotics for weight-restoration in individuals with restrictive-type eating disorders; however, it should be noted that this is an emerging area of research.Finally, it was noted that many studies exploring outcomes focused on immediate rather than long-term outcomes post-treatment. Mortality because of an eating disorder, particularly in adults with chronic illness, was found to be a significant outcome which, in general, required further research.The forthcoming series of papers will explore the above topics and in greater detail.The current methodological paper outlines the process followed to conduct a set of Rapid Reviews (RR) in the field of EDs. The information identified by the RRs informed development of the first Australian Eating Disorders Research and Translation Strategy 2021–2031. In total, 1,322 studies were eligible for inclusion in the RRs, with included studies being grouped into broad categories. Risk factors (20%), psychotherapies (19%) and comorbidities (16%) made up a majority of the extant literature; followed by population prevalence population, prevalence, disease burden and quality of life  studies (10%); pharmacotherapies (9%) and prevention and early intervention (9%), which was comparatively low given evidence to suggest early intervention—particularly in young people—can significantly improve outcome trajectory . There wThe distribution of themes identified by the review highlighted a disproportionate focus on several core eating disorders, namely Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder, with evidence on atypical  or less common presentations —emerging more slowly. While this may be expected given the relatively ‘recent’ (2013) shift in eating disorder classification in the DSM-5 , it highNonetheless, as the current series focuses on the evidence base as it relates to developing Australia’s National Eating Disorders Research and Translation Strategy, there emerges an interesting picture specific to the Australian context. First and foremost, is the need to assess and determine a 'truer' and more accurate epidemiological understanding of eating disorders in Australia. The estimates put forth in some of the included studies may be considered conservative given the findings of this review point to an underrepresentation of some minority and at-risk groups , 28.Of the included studies, > 15% involved Australian researchers. Australia is producing high-quality and important research in line with other Western, Educated, Industrialised, Rich, and Democratic (WEIRD) countries, however the review suggests there is great need for novel research specifically addressing significant knowledge gaps in the field; particularly, relating to models of care, screening and diagnosis, outcomes , pharmacological approaches and prevention and early intervention. These gaps will be explored in further detail throughout the forthcoming series.Utilising a RR methodology allowed for the expedient summation and synthesis of the evidence base as it exists currently in the field of EDs to guide the development of a national strategy. The consortium consisted of experts with international reputations in EDs, who contributed to the RR methodology, including search strategy development, alongside IOI and HMA to ensure that the RRs were conducted with integrity and was underpinned by specialist knowledge. Further, the RR methodology allows for well-informed and co-ordinated decision-making and policy implementation support, with evidence able to be provided in an easily accessible manner to policy makers and government agencies. Still, several limitations are apparent. Exploratory studies, or those investigating novel therapies with sample sizes of n < 20, were excluded, excepting for ARFID and UFED due to the minimal evidence available for these diagnoses. Therefore, it is possible some findings emerging from studies with very small samples are not captured by the RRs and that the evidence base for emerging areas may not be as robust in its quality. While the three major medical databases were searched, smaller discipline-specific databases not included in the search may have yielded some additional eligible studies. A period of 12 years was examined  meaning that studies outside this time period would not have been deemed eligible. However, all RR topic areas had systematic reviews and meta-analyses included that would have addressed much of the prior literature.Limiting the included studies to English only, not considering animal model studies that may lead to the development of testable hypotheses, and not specifically including qualitative studies nor grey literature may have also limited the breadth and richness of the data reported in the RRs.The Australian Eating Disorders Research and Translation Strategy (2021–2031) was a multi-layered, multi-phased initiative led by IOI, co-designed with key stakeholders, including people with a lived experience , researchers, and clinicians. The overall purpose of the strategy is to build a strong research culture that generates innovative co-designed research that transforms practice, informs policy, and meaningfully impacts the wellbeing of all people at risk of developing or living with an ED, their families, and supports. The significance of the RR lies in its potential to identify gaps and inform research priorities, to encourage investment in this under-researched area, and ultimately transform care pathways for this potentially deadly and devastating illness group. By understanding the different areas of ED research, a clear picture to guide government and stakeholders for informed decisions may be achieved. Furthermore, these reviews provide up-to-date knowledge on EDs easily accessible to individuals, organisations and institutions, and governments looking to understand the state of the field.Based on a broad search strategy, the findings of the current RRs may be used to further inform and develop policy, practice, and sound evidence-based research, solidifying Australia’s position as a global leader in ED care. The resulting RR papers focusing on: population, prevalence, disease burden, QoL in Western developed countries; risk factors; co-occurring conditions and medical complications; screening and diagnosis; prevention and early intervention; therapy and relapse prevention; models of care; and outcomes, will cover a broad area of the ED field and offer a meaningful synthesis of knowledge to help build upon into the future. By utilising a RR methodology, a current and thorough overview of the ED field is established to guide and develop policy, care, and research.


ABSTRACT IMPACT: This review will encourage further development of novel uses of REDCap for the benefit of the research community. OBJECTIVES/GOALS: REDCap is a clinical research data collection platform that is primarily used as intended. However, little is known about its more novel uses, specifically in clinical decision support in patient care and in clinical research management. Thus, the purpose of this review is to examine peer reviewed literature identifying and describing such novel uses. METHODS/STUDY POPULATION: A systematic search was conducted in both PubMed and Google Scholar using the equation ((REDCap) OR ('Research Electronic Data Capture')) AND  OR ).’ Articles were screened by title, then abstract, and then were reviewed in full if they met inclusion criteria. Articles were included if they had potential relevance to the topic of REDCap or if they mentioned activities related to fields of clinical and translational science including operational support in areas such as clinical research management. Articles were excluded if they focused on common clinical research activities relating to data collection software such as survey administration, database building or data collection for clinical trials, registries, and cohort studies. RESULTS/ANTICIPATED RESULTS: The initial search yielded 390 results, of which 40 underwent an abstract review; only 8 of these underwent full text review. Of these, 5 discussed uses of REDCap in the context of operational support in clinical research management; 3 were related to clinical decision support in patient care. For the 5 articles focused on operational support in clinical research management, topics include e-consenting procedures, collection and storage of protected health information (PHI), patient recruitment and tracking stakeholder engagement. The 3 articles about clinical decision support discuss REDCap tools for generating risk predictions for post-surgical clinical outcomes, generating recommendations and STI test orders, and increasing efficiency in hand-offs to enhance care of surgical oncology patients. DISCUSSION/SIGNIFICANCE OF FINDINGS: Considering that only a small percentage of peer reviewed research reports out on novel uses of REDCap, there is a need for the REDCap consortium to do further work to fulfill its mission to adopt, innovate, and suggest novel uses of REDCap, thus expanding the understanding of its functionalities and therefore its utility in the research community.