159370 research outputs found
Sort by
Urinary metabolite model to predict the dying process in lung cancer patients
Get PDFBackground
Accurately recognizing that a person may be dying is central to improving their experience of care at the end-of-life. However, predicting dying is frequently inaccurate and often occurs only hours or a few days before death.
Methods
We performed urinary metabolomics analysis on patients with lung cancer to create a metabolite model to predict dying over the last 30 days of life.
Results
Here we show a model, using only 7 metabolites, has excellent accuracy in the Training cohort n=112 (AUC= 085, 085, 088 and 086 on days 5, 10, 20 and 30) and Validation cohort n=49 (AUC= 086, 083, 090, 086 on days 5, 10, 20 and 30). These results are more accurate than existing validated prognostic tools, and uniquely give accurate predictions over a range of time points in the last 30 days of life. Additionally, we present changes in 125 metabolites during the final four weeks of life, with the majority exhibiting statistically significant changes within the last week before death.
Conclusions
These metabolites identified offer insights into previously undocumented pathways involved in or affected by the dying process. They not only imply cancer's influence on the body but also illustrate the dying process. Given the similar dying trajectory observed in individuals with cancer, our findings likely apply to other cancer types. Prognostic tests, based on the metabolites we identified, could aid clinicians in the early recognition of people who may be dying and thereby influence clinical practice and improve the care of dying patients
Age, anticoagulants, hypertension and cardiovascular genetic traits predict cranial ischaemic complications in patients with giant cell arteritis
Get PDFObjectives
This project aimed to determine whether cranial ischaemic complications at the presentation of giant cell arteritis (GCA) were associated with pre-existing cardiovascular (CV) risk factors, CV disease or genetic risk of CV-related traits.
Methods
1946 GCA patients with clinicodemographic data at GCA presentation were included. Associations between pre-existing CV-related traits (including Polygenic Risk Scores (PRS) for CV traits) and cranial ischaemic complications were tested. A model for cranial ischaemic complications was optimised using an elastic net approach. Positional gene mapping of associated PRS was performed to improve biological understanding.
Results
In a sample of 1946 GCA patients (median age=71, 68.7% female), 17% had cranial ischaemic complications at presentation. In univariable analyses, 10 variables were associated with complications (likelihood-ratio test p≤0.05). In multivariable analysis, the two variables with the strongest effects, with or without PRS in the model, were anticoagulant therapy (adjusted OR (95% CI)=0.21 (0.05 to 0.62), p=4.95×10−3) and age (adjusted OR (95% CI)=1.60 (0.73 to 3.66), p=2.52×10−3, for ≥80 years versus <60 years). In sensitivity analyses omitting anticoagulant therapy from multivariable analysis, age and hypertension were associated with cranial ischaemic complications at presentation (hypertension: adjusted OR (95% CI)=1.35 (1.03 to 1.75), p=0.03). Positional gene mapping of an associated transient ischaemic attack PRS identified TEK, CD96 and MROH9 loci.
Conclusion
Age and hypertension were risk factors for cranial ischaemic complications at GCA presentation, but in this dataset, anticoagulation appeared protective. Positional gene mapping suggested a role for immune and coagulation-related pathways in the pathogenesis of complications. Further studies are needed before implementation in clinical practice
Re-Reading Vulnerability: The Hebrew Bible, Black Lives Matter, and #MeToo
No full textBlack Lives Matter and MeToo are two of multiple mass protest movements of the early 21st century. Unlike some other movements, both have considerable impact in predominantly white spaces, including in digital activism, biblical studies, and critical interpretation of the Hebrew Bible. This paper explores the nature of this impact, focusing on both problematic aspects and positive action, especially when womanist advocacy in the discipline is amplified. In the course of this, the article considers the centrality of trauma and traumatisation in both biblical texts and protest movements
Building higher value-added firm practices in challenging contexts – formal networks and talent management in Turkey
Get PDFWhere do high-impact human resources management (HRM) practices thrive, and how do they make a difference in environments with limited institutional support? This study delves into the realm of talent management (TM) in Turkey, where institutional coverage is incomplete and unstable. Drawing on survey data, we explore the conditions under which TM succeeds, supplementing previous research on internal networks by examining the impact of external networks that encompass the entire firm. We find that when firms have closer ties with customers, suppliers, and competitors (and hence, the basis for formal network tie building), TM is more prevalent and more likely to be successful. While conventional wisdom in comparative institutional literature suggests that such dense ties might be less effective in emerging markets due to the absence of advanced complementarities found in mature economies, our study challenges these assumptions. In the eyes of managers, TM is not merely a tool to overcome disadvantages; it is perceived as a source of opportunities. This prompts a critical question: What specific advantages does the emerging economy system confer on firms embracing TM? Our study seeks to unravel these dynamics and contribute to a deeper understanding of the interplay between institutional contexts and TM
Novel biophysical skin biomarkers discriminate topical anti‐inflammatory treatments based on their potential for local adverse effects
Get PDFBackground
Topical corticosteroids (TCS) are efficacious treatments for inflammatory skin conditions, however, there is a risk of adverse effects; understanding how best to use these treatments is an unmet research priority shared by patients and healthcare professionals.
Objectives
To develop non-invasive biomarkers of local adverse effects to facilitate the optimisation of topical therapy.
Methods
An observer-blind randomised within-subject controlled trial in atopic dermatitis patients was undertaken (NCT04194814) comparing betamethasone valerate 0.1% cream (BMV) to a non-steroidal anti-inflammatory treatment, crisaborole 2% ointment (CRB). Participants underwent 4 weeks twice-daily treatment with CRB on one forearm and BMV on the other (left/right randomised). Skin properties were assessed on days 1, 15, 29 of treatment and again on day 57, including imaging of skin microstructure using Optical Coherence Tomography (OCT) and Attenuated Total Reflectance (ATR)-Fourier Transform Infrared (FTIR) spectroscopic assessment of stratum corneum molecular structure. The primary outcome was the difference in the change in epidermal thickness from days 1 to 29.
Results
Thirty-seven participants received the first dose, of which 32 completed the study (all 37 were included in the analysis). Pathologic epidermal thinning at day 29 was significantly greater (p < 0.0001) at sites treated with BMV (−31.66; 95% confidence interval: −35.31, −28.01 µm) compared to CRB (−13.76; −17.42, −10.10 µm). From a panel of exploratory biomarkers, superficial plexus depth and stratum corneum carboxyl group levels had the greatest ability to discriminate the effects of the TCS treatment (p < 0.0001).
Conclusions
BMV induced 2.3x more pathologic epidermal thinning than CRB after 4 weeks of treatment, suggesting that CRB may be more appropriate for longer-term, proactive-based, treatment strategies where the risks of adverse effects are greatest. By monitoring treatment effects using OCT and ATR-FTIR spectroscopy, two new non-invasive biomarkers of skin health have been identified with the potential to help optimise future safe treatment strategies
‘I Think the First Priority is Physically Safe First, Before You Can Actually Get Psychologically Safe’: Staff Perspectives on Psychological Safety in Inpatient Mental Health Settings
Get PDFIntroduction
While the concept of psychological safety has been gaining momentum, research concerning psychological safety in inpatient mental health wards is lacking.
Aim
To investigate how psychological safety is conceptualised by healthcare staff in inpatient mental health units, and what barriers and facilitators exist.
Method
Reflexive Thematic Analysis was used to analyse 12 interviews.
Results
Participants conceptualised psychological safety as feeling safe from physical harm, being able to develop meaningful relationships and feeling valued at work. Participants often did not feel physically safe at work, which led them to feel psychologically unsafe. Barriers to psychological safety were reliance on agency workers, punitive management approaches and the inherent risk in working with mental health inpatients. Facilitators included appropriate staffing ratios and skill mix, being able to form meaningful relationships and having access to support.
Discussion
The emphasis on the physical safety element within psychological safety means that existing definitions of psychological safety require extension for the mental healthcare context. However, large-scale research is needed to further understand experiences of psychological safety in this group.
Implications for Practice
A better understanding of the dimensions of psychological safety in inpatient mental health settings could support the development of tools to investigate psychological safety interventions. Organisations could support psychological safety through regular staff supervision and improved staffing ratios and skill mix
A Double-Edged Sword: The Two Faces of Political Connections in International Investments of Chinese Firms
Get PDFPolitical connections have been tested for correlation with outward foreign direct investment (OFDI). Both
theoretical rationale and research evidence are mixed. To advance this debate, we conceptualize political connections as a dual-dimensional construct and hypothesize the differential effects of the breadth and the depth
of political connections on OFDI. Employing a sample of 2,374 Chinese listed firms, encompassing 15,647
firm-year observations from 2008 to 2016, we find evidence supporting our hypotheses: (1) the breadth of
political connections reduces the likelihood of a firm engaging in OFDI and (2) greater depth of political
connections increases the likelihood of a firm engaging in the OFDI. Thus, we advise firms to exercise caution
when adopting corporate political strategies for internationalization in general and OFDI in particular.
摘要
现有文献已讨论过政商关系与对外直接投资（OFDI）的相关性，但理论依据和研究证据尚不一致。
为推进对这一议题的深步探讨，我们将政商关系视为一个双维度的概念，并讨论政商关系的广度和
它的深度对 OFDI 的不同影响。我们通过对 2008 年至 2016 年间 2374 家中国上市公司、 15647 个公
司年度观察值的样本进行分析，发现了支持假设的证据：（1）政商关系的广度降低公司实行 OFDI
的可能性；（2）政商关系的深度增高公司实行 OFDI 的可能性。鉴于政商关系不同维度的不同影
响，我们建议企业在国际化，特别是对外投资方面，应谨慎施行政商战略
Supervised machine learning for multi-principal element alloy structural design
Get PDFThe application of supervised Machine Learning (ML) in material science, especially towards the design of structural Multi-Principal Element Alloys (MPEAs) has rapidly accelerated over the past five years. However, several factors are limiting the impact that these ML methodologies can have, chief amongst them being the availability and fidelity of data. This review analyses how ML has been utilised to accelerate the design of novel structural MPEAs, outlining the standard procedures followed, and highlighting the successes and common pitfalls identified in current studies. The need for experimental validation and incorporation into closed loop ML pipelines is also discussed, including the influence and integration of manufacturing methodologies into the ML decision making process
How to Build a Culture of Human Rights in the Era of Populism:Reflections From the Human Rights City of York (UK)
Get PDFThis article analyses how to build a culture of human rights in the era of populism. The UK, and the York Human Rights City initiative, provide a case study. The article draws on a human rights practice methodology, activist practices and broader social processes and practices, both in York, to analyse the potential of the ‘local’, and in particular cities, to develop a human rights culture. It argues that such a culture needs to go beyond current responses to populism, notably a focus on values and framing (a variant of ‘if only people knew’), to draw on thicker components of culture (history and place, rather than law and institutions). Interviews with artists in York as a proxy for wider public engagement suggest an enduring disconnect with human rights but also that meaning-making, co-creation, not just better communication, is needed to build a culture of human rights
Data sources:
Access Repository Dashboard
Do you manage Open Research Online? Become a CORE Member to access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard! 👇