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Emergency department interventions and their effect on subsequent healthcare resource use after discharge: An overview of systematic reviews
Get PDFBackground: Due to the worldwide pressures on Emergency Departments (EDs), there is a focus on ED interventions to alleviate pressure. Ensuring interventions do not inadvertently impact upon other healthcare sectors is an important outcome. This overview of systematic reviews aimed to evaluate the impact of ED based interventions on subsequent healthcare resource use after ED discharge. Methods: An overview of systematic reviews was conducted in accordance with the Cochrane Collaboration. Search criteria were devised using the PRESS standard and duplicate screening and extraction conducted for one third of systematic reviews. A primary study matrix was designed to reduce the impact of duplicate primary studies. Data was extracted in the form presented in the underlying review. Results: After removal of overlapping primary studies, 38 systematic reviews and 213 primary studies were included. Overall confidence in the reviews was high in 12, moderate in seven, low in nine and critically low in 10 reviews. In the 38 reviews, 30 different intervention-population-resource use combinations were analysed. ED based interventions decreased subsequent healthcare resource use in 23.3% (n = 7/30) of the intervention-population-resource use combinations and had no effect in 40% (n = 12/30). The most common resource use reported was ED Revisit. The most common follow-up length from ED discharge was 12 months (n = 52/216), followed by the combined group of one month (n = 44/216). Conclusions: ED based interventions decrease subsequent healthcare resource use in a fifth of population-intervention-resource use combinations. Future research should produce a standardised set of outcome measures for subsequent healthcare resource use
Establishing a public involvement network for chronic pain research in the United Kingdom: Lessons learned
Get PDFIntroduction: The Consortium to Research Individual, Interpersonal and Social Influences in Pain (CRIISP) is a 4‐year UK university collaboration investigating how thoughts and feelings, personal relationships and lifestyle can affect chronic pain. Patient and public involvement in research recognises that researchers' conceptions of health and illness can be enriched and sense‐checked by those of people experiencing a health condition. Published literature reports a gap in meaningful patient and public involvement in research into chronic pain, for example, during early study design. Input in this formative stage aimed to ensure the research proposed had a patient‐centred focus which may benefit study implementation. We describe how the authors sought to address this gap and established a diverse public involvement (PI) network to support the CRIISP research. Methods: Thirty‐six adult public contributors were appointed to work alongside the research teams. Lessons learned are presented under the themes: optimising collaborative working, recruitment of public contributors, supporting public involvement throughout CRIISP and the retention of public contributors. Throughout this paper, we refer to the term ‘public involvement’ rather than ‘patient and public involvement’ in accordance with the NIHR definition which incorporates people with a range of experiences. Results: Working in partnership with our public contributors, we have embedded PI throughout a chronic pain research programme using an innovative and collaborative process. Conclusion: This model may inform others to maximise the potential of PI within their research. Patient or Public Contribution: The paper reports the collaboration between public contributors with a lived experience of chronic pain and the Consortium to Research Individual, Interpersonal and Social influences in Pain (CRIISP) researchers, by means of a large public involvement network
Struggles in the Concrete - Architecture and the Marxist Tradition
No full textWhat are Marxist architectural history and criticism? What methods do they employ, and what are their objects of critical analysis? These questions have been asked before, but now more than ever, they require reassessment in light of the continuous expansion and revision of Marxism in response to new global crises. Struggles in the Concrete: Architecture and the Marxist Tradition embarks on this endeavour. The eleven chapters not only reconsider classical Marxist categories and historical conjunctures, but also devise new critical frameworks for analysing architecture and capitalism today. The book reconsiders neglected figures like Marta Lonzi, Sérgio Ferro, and Anthony D. King, as well as re-engaging with major figures like Siegfried Kracauer, Manfredo Tafuri, and Stuart Hall.Tool for critical thinking in the current architectural discourse on global crises Contributions by renowned architectural historians and theorists: Claire Zimmerman, Katie Lloyd Thomas, Silke Kapp, Nicholas Thoburn, Onyeka Igw
Аnalysis of methods of architectural and spatial adaptation of industrial enterprises to the environmental requirements of the modern urban environment
Get PDFThis article discusses the issues of improving the quality parameters of industrial areas with the liquidation or preservation of their functional purpose. The research methodology includes an analysis of methods for the reconstruction of industrial buildings in domestic context, on the example of Almaty, and foreign practice, with the example of Germany and Poland. The current ideology underlying today the architecture of such structures and ways of effective and harmonious integration of utilitarian industrial objects into the urban environment are considered. The analysis is carried out according to the urban planning, functional and compositional characteristics of industrial facilities using a multifactorial comparison method. Different approaches to architectural and spatial adaptation, such as preservation, renovation, and reconstruction are analysed. The article notes that the choice of adaptation method depends on a number of factors, including the condition of the object, historical and architectural value, and the intended purpose of the object after renovation. The promising development of industrial architecture lies in its possible and rapid adaptation to developing technologies. The article is of interest to architects, urban planners, as well as for all those who are interested in the issues of renovation of industrial facilities. For the renovation of industrial facilities, it is necessary to clearly establish the stages of adaptation of industrial facilities
Understanding sibling sexual behaviour and abuse: A form of harmful sexual behaviour in children and young people
Get PDFThis report was kindly produced by Kieran McCartan, Sophie King-Hill, Amy Adams and David Russell, highlighting the importance of recognising sibling sexual behaviour and abuse (SSB-A) as a distinct and complex form of harmful sexual behaviour between children and young people. While SSB-A has gained prominence in both research and policy discourse over recent years, its complexity poses challenges in terms of understanding, engagement and intervention development, and current professional responses are often inconsistent and fragmented. Moving forward, a more integrated and cross-sectoral approach is required to ensure that responses are child centred, developmentally appropriate, trauma informed and inclusive of the whole family, recognising the interconnectedness of familial relationships and their influence on outcomes for children and young people.Building upon the evidence and to support structured, holistic and reflexive professional thinking and planning, a mapping tool (SSB-MT) and outcomes framework have now been developed. Aligned to Epidemiological Criminology (EpiCrim) approaches, the tool and framework underscore the systemic nature of SSB-A, recognising that family dynamics, housing conditions, educational engagement, health needs and social influences all contribute to the emergence and impact of SSB-A. Multi-agency collaboration and provision is thus critical, supported by specialised staff training, targeted public messaging and education, and a focus upon the continuing development of the evidence base
Does Intermittent Nutrition enterally normalise hormonal and metabolic responses to feeding in critically ill adults? The DINE-Normal proof-of-concept study
No full textFor intensive care unit (ICU) patients fed via a nasogastric (NG) tube, current guidelines recommend continuous feeding through the day and night. Emerging evidence in healthy individuals shows that NG feeding in an intermittent diurnal pattern promotes phasic hormonal, digestive and metabolic responses vital for effective nutrition, though this has not been studied in the critically ill population. This proof-of-concept study aimed to compare the effect of diurnal intermittent versus continuous enteral feeding on hormonal and metabolic outcomes in ICU patients. We conducted a single-centre, randomised, open-label trial in the ICU. Adult ICU patients that were anticipated to require NG feeding for >48 hours were randomised to an intermittent diurnal regimen (feeds at 8:00, 13:00 and 18:00), or continuous feeding with equivalent nutritional value, for 48 hours. The primary outcome was peak plasma insulin within 3 hours of delivering the first intermittent feed on the second study day, compared to the same time period in the continuous group. Secondary outcomes included feasibility, tolerability and metabolic profiles. Thirty patients were randomised to intermittent (n=13) or continuous (n=17) feeding. Two patients in the intermittent group were excluded from analysis. Both groups achieved their feed targets. Peak plasma insulin concentrations (mean ± SD) were significantly higher in the intermittent group versus continuous (295.1 ± 167.8 vs. 128.1 ± 57.2 pmol/L, p < 0.001). Plasma glucose concentrations were not significantly different between groups. There were no between-group differences in other plasma metabolites and there were no adverse events such as hyper-/hypo glycaemia. There was evidence of increased bowel motility in the intermittent group. Intermittent diurnal feeding, compared to continuous feeding, preserves the physiological insulin response in critically ill adults. Both regimens were well tolerated, supporting the need for a larger trial to assess other clinically important patient-centred outcomes
Towards high-fidelity wind farm layout optimization using polynomial chaos expansion and Kriging model
No full textThis paper presents a wind farm layout optimization framework that integrates polynomial chaos expansion, a Kriging model, and the expected improvement algorithm. The proposed framework addresses the computational challenges associated with high-fidelity wind farm simulations by significantly reducing the number of function evaluations required for accurate annual energy production predictions. The polynomial chaos expansion-based prediction method achieves exceptional accuracy with reduced computational cost for over 96%, significantly lowering the expense of training the ensuing surrogate model. The Kriging model, combined with a genetic algorithm, is used for surrogate-based optimization, achieving comparable performance to direct optimization at a much-reduced computational cost. The integration of the expected improvement algorithm enhances the global optimization capability of the framework, allowing it to escape local optima and achieve results that are either nearly identical to or even outperform those obtained through direct optimization. The feasibility of the polynomial chaos expansion-Kriging framework is demonstrated through four case studies, including the optimization of wind farms with 8, 16, and 32 turbines using low-fidelity wake models, and a high-fidelity case using computational fluid dynamics simulations. The results show that the proposed framework is highly effective in optimizing wind farm layouts, significantly reducing computational costs while maintaining or improving the accuracy of annual energy production predictions
Assessing migration of bat species and interactions with Offshore Wind Farms in British Waters
Get PDFCo-creating a shared understanding of systems thinking in the built environment
No full textThis paper describes a process to co-create a shared understanding and an agenda for change, in line with our guiding vision for the built environment: to enable people and nature to flourish together for generations. This has engaged multiple stakeholders from a wide range of socio-technical domains in workshops and focus group meetings to understand the challenges to this vision and develop systemic insights and solutions. This process has been cross-sectoral, with public, private and third sector participation. Meeting society’s evolving needs is impossible without addressing interconnected challenges of climate change, resource depletion, pollution, biodiversity loss, and inequity, and to do this concurrently. Additionally, the built environment’s longevity and interconnectedness demand strategic, long-term, joined-up policy and governance. Yet siloed structures, notably in government, regulations and sectored industries, currently hinder this. Informational silos, with disconnected data further confound progress, holding back the insights needed to understand systems and improve outcomes. Unless we address this nexus of challenges, and do so urgently, our trajectory will continue towards multiple system failure, polycrisis, economic damage and widespread hardship. To improve outcomes and create futures in which people and nature flourish together (the vision), urban planners require a better understand of the social and natural system-of-systems on which we depend. A ‘systems thinking’ mindset is essential to improve governance and intervene more efficiently and effectively. Central to our approach is co-creating a shared understanding to build a consensus and grow a connected community to drive change. This fosters meaningful communication through shared language, aligns endeavours towards common goals, connects individuals with shared objectives, and enables collaboration across disciplines and sectors. This paper presents core principles, with our policy recommendations, aimed at advancing systems thinking in the built environment and driving positive systems change. It is an approach with international relevance for change-makers in the built environment
Few-shot learning for IoT intrusion detection: An attention-based siamese network approach
Get PDFThe Internet of Things (IoT) has garnered significant attention from both industries and the research community. The diverse nature of IoT devices makes them a prime target for cybercriminals. An intelligent intrusion detection system (IDS) can quickly identify multiple types of cyberattacks within an IoT system. However, operational efficiency and safety become challenging issues when managing limited labeled data in IoT networks. This article proposes a novel cyberattack detection scheme using few-shot learning (FSL). The proposed scheme employs a self-attention mechanism with a Siamese network that learns to recognize normal and malicious network traffic patterns through FSL. The Siamese network architecture facilitates efficient sample comparison by learning a shared representation. Incorporating an attention mechanism further enhances its ability to focus on discriminative features, improving attack detection accuracy for rapidly evolving intrusion patterns. The effectiveness of the proposed framework is evaluated through extensive experiments on the latest Edge-IIoTset dataset. The experimental findings demonstrate that the proposed IDS achieved the best accuracy of 99.75% with the complete dataset. In a few-shot performance evaluation, the designed architecture achieved the best accuracy of 78.69%, 81.19%, and 81.83% for 1 shot, 5 shots, and 10 shots, respectively