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Do lifestyle factors affect clinical outcomes following total knee replacement? An integrated qualitative study exploring the perceptions and experiences of participants in the PRO Knee feasibility cohort study
No full textThe development of pre-operative interventions to improve clinical outcomes following total knee replacement surgery has been identified as a research priority. In the first step of a programme of research, we conducted a feasibility cohort study, which investigated the effect of modifiable lifestyle factors, including alcohol consumption, smoking, physical inactivity and living with overweight, on clinical outcomes following total knee replacement (PRO Knee). Alongside PRO Knee, we conducted an integrated qualitative study to understand the acceptability of the methods used in the PRO Knee study and to explore the experiences of patients waiting for total knee replacement surgery, along with their beliefs and experiences regarding lifestyle interventions. Adult patients awaiting total knee replacement surgery, who had consented to participate in the PRO Knee study were eligible to participate. Semi structured interviews were conducted with all patients who provided informed consent for the qualitative study. Interviews were audio-recorded; transcribed in an intelligent verbatim format and data were analysed using the Framework Method. Ten participants (9 female, 1 male) were recruited (average age 70, range 56-88) and all interviews were conducted over the telephone. The recruitment and data collection processes of the PRO Knee study were acceptable to participants. Five further themes relating to the lived experience of waiting for and undergoing total knee replacement surgery were identified: 1) Osteoarthritis of the knee and co-morbidity; 2) The decision to have surgery; 3) Waiting for total knee replacement; 4) Lifestyle conversations and interventions; 5) Recovery from total knee replacement. The burden of living with osteoarthritis of the knee was significant and participants had often experienced multiple unsuccessful interventions. Participants could recall lifestyle conversations, which they were open to, but were not offered support. Most participants were positive about participating in lifestyle interventions prior to surgery. The participants who had poor outcomes were left with intrusive pain, and feelings of regret. The recruitment and data collection processes for the PRO-Knee feasibility cohort study were acceptable to participants and further study in this area is now warranted. [Abstract copyright: © 2026. The Author(s).
Pain score distribution expert elicitation for distal humerus hemiarthroplasty and total elbow arthroplasty using a validated numerical patient rated outcome measure in trauma.:PEDANT study
No full textAbstractAimsWith equal numbers of adults with unreconstructable distal humerus fractures undergoing total elbow arthroplasty (TEA) and distal humerus hemiarthroplasty (DHH) a randomized trial is needed to compare the interventions. Patients have identified pain as the key outcome. There is no data on pain outcomes using a validated pain instrument to plan a trial. This study aims to use expert elicitation to produce probability distributions for the Patient Rated Elbow Evaluation Pain (PREE pain) score at 12 months in adults undergoing TEA or DHH for trauma.MethodsUsing the Sheffield Expert Elicitation Framework (SHELF) seven experts were recruited and provided with a summary of current knowledge on pain outcomes from a systematic review. They were asked to consider their median of the PREE pain score at 12 months after a TEA for acute trauma, their difference in the median PREE pain scores between TEA and DHH, and their standard deviation of the PREE pain score after TEA and DHH. The Rational Independent Observer concept was used to achieve consensus. ResultsThe elicited median value for the PREE pain at 12 months after TEA for acute trauma was 13.6/50 (IQR 10.6 to 16.8). The estimated median of the difference in PREE pain scores was 3.4 (IQR -0.3 to 7.1). The elicited standard distribution of PREE pain scores was 9 (standard deviation (SD) 2.2), and after DHH was 12 (SD 3.0).ConclusionExpert elicitation can be a useful tool for synthesizing unknown probabilities. Experts’ consensus is that PREE pain scores at 12 months in patients treated with elbow arthroplasty for acute trauma would be higher following DHH than TEA, and that the pain scores for DHH patients would exhibit greater variance than patients having TEA. This difference is estimated to be small but should be tested in a randomized trial
Phishing URL Detection and Interpretability With Machine Learning: A Cross‐Dataset Approach
Get PDFPhishing attacks pose a significant security threat, particularly through deceptive emails designed to trick users into clicking on malicious links, with phishing URLs often serving as the primary indicator of such attacks. This paper presents a machine learning approach for detecting phishing email attacks by analyzing the URLs embedded within these emails, using Random Forest, eXtreme Gradient Boosting, and Light Gradient Boosting Machine models. Secondary datasets are used to evaluate model behavior and examine the applicability of model features across different samples. The models are assessed using metrics such as accuracy, precision, and recall to demonstrate their effectiveness in distinguishing between benign and malicious email URLs. The SHapley Additive exPlanations (SHAP) framework is employed to interpret the models' decision‐making processes and reinforce the relevance and reliability of key features. Our results show that across four test sets, the three models achieve an average classification error ≈ 4.03% and an average accuracy > > 94%, indicating strong generalization capability across diverse datasets using the same set of features
Avoiding routine gastric residual volume measurement in neonatal critical care (the NeoGASTRIC trial): a study protocol for a multicentre RCT
Get PDFBackgroundRoutine measurement of gastric residual volumes involves regularly aspirating the entire stomach contents to assess the volume and colour of the aspirate to inform feeding. This is an established practice in many United Kingdom and Australian neonatal units for preterm infants receiving gastric tube feeds. The rationale is to assess feed tolerance and to predict and potentially prevent necrotising enterocolitis, a serious gut condition. Routine measurement of gastric residual volumes may also be associated with adverse outcomes and harm, including delayed achievement of full enteral feeds and longer neonatal unit stay. Evidence to support the routine measurement of gastric residuals is poor, and previous small trials have not been generalisable to UK or Australian neonatal care.MethodsThe aim of the neoGASTRIC trial is to test whether avoiding routine measurement of gastric residual volumes in preterm infants reduces the time taken for an infant to reach full enteral feeds without increasing necrotising enterocolitis. neoGASTRIC is an individually randomised controlled trial in neonatal units in the UK and Australia. A target of 7040 infants born before 34 weeks’ gestation will be randomly allocated, prior to receiving 24 h of enteral feeds > 15 ml/kg/day, on a 1:1 basis to have no routine gastric residual volumes measured, or to have gastric residual volumes measured routinely. Opt-out consent will be used with parent and staff views explored as part of an embedded process evaluation. The primary superiority outcome is time to reach full milk feeds ≥ 145 ml/kg/day for three consecutive days. Bell’s stage 2 or 3 necrotising enterocolitis following blinded adjudication will be the key secondary, non-inferiority safety outcome. Other neonatal core outcomes and health care resource use and costs prior to discharge will be evaluated.DiscussionneoGASTRIC will address a research priority that affects more than 20,000 preterm infants in the United Kingdom and Australia annually. Even modest improvements in clinical outcomes and resource use could result in large clinical benefits and savings at a population level
The evolving role of performance analysis in football:Integrating the observation of psychological behaviours
Get PDFDespite evidence that psychological factors are highly valued by thoseinvolved in player development and assessment, performance analysis(PA) in football remains largely confined to technical and tactical metrics.This conceptual paper argues for the integration of psychologicalbehaviour tagging within established PA processes. First, we reviewliterature demonstrating that psychological constructs such as resilienceand mental toughness can be operationalised through observableon-pitch actions. Next, we outline a framework for integrating PAmethods into the observation of psychological behaviours, including: 1.Agreeing on the psychological components of performance to betargeted; 2. Defining context-specific behavioural indicators of thesepsychological components through collaboration with multidisciplinarystaff; 3. Agreeing on any developmental or position-specific differences inthese behavioural indicators; 4. Building video-based tagging panels withexplicit definitions; 5. Training observers and establishing inter-observeragreement; and 6. Embedding behavioural data into individualdevelopment plans. We discuss key implementation challenges, includingrole delineation between analysts and psychologists, resource constraints,and the tension between short-term performance objectives and longtermpsychological development. By positioning analysis alongsidepsychology, the framework promotes a shared language and structurethat can encourage multidisciplinary input into the psychologicaldevelopment of football players. We conclude that video-based analysis of psychological behaviours represents a novel opportunity to advancedevelopment practices in football, but call for further applied research tovalidate observational analysis of psychological behaviours and assesslong-term developmental impact
The obligation to prevent genocide
No full textThis briefing sets out the international and UK law on genocide and discusses recent cases on this issue. There will be a general debate on obligation to assess the risk of genocide under international law in relation to the Occupied Palestinian Territories in the Commons chamber on Thursday 5 February 2026
Evaluation of an Education Programme for Introducing Bioelectrical Impedance Analysis to Neonatal Unit Staff: A Mixed Methods Study
Get PDFBackground: Bioelectrical Impedance Analysis (BIA) is a non‐invasive method of body composition, which may be useful in improving fluid management decisions for sick and preterm infants. Aim: To implement and evaluate an education package for the multidisciplinary team who plan to use BIA within the Neonatal Intensive Care Unit (NICU) in future research. Study Design: A mixed methods approach was used to evaluate the impact of an education package for the multidisciplinary team (MDT) working in the NICU regarding the use of bioelectrical impedance analysis (BIA). Knowledge acquisition was assessed and feedback sought regarding the content, format and delivery of the teaching. Results: There was a significant improvement in the median knowledge scores from 2.5 to 4/5 (p = < 0.001) after the education programme, with staff reporting a positive learning experience. Conclusion: This neonatal education package improved knowledge and was evaluated positively and could be used by other centres wishing to implement this technology. Relevance to Clinical Practice: This education package will be useful for other NICUs wanting to implement this new technology into research or clinical practice. This model of education could be altered to facilitate the introduction of any new piece of technology into any intensive care setting
Development of a lifelong core outcome set for oesophageal atresia ± tracheoesophageal fistula: the OCELOT study
Get PDFBackgroundDespite anatomical correction, people born with oesophageal atresia±tracheoesophageal fistula (OA-TOF) experience lifelong morbidity. Core outcome sets (COSs) are recognised as a means of improving research quality and, as a consequence, improving patient outcomes; one was not available for this population.ObjectiveThe scope of the study was to develop a COS for people born with OA-TOF that would be applicable regardless of age or geographic location.Study designPatient input was paramount to this study. For long-list generation, in addition to the systematic review (SR), patients and representatives were invited to participate in focus groups, interviews or complete activity packs to ascertain outcomes that matter most to them. International consensus was then sought using a two-step Delphi survey followed by an online consensus meeting.ResultsEight outcomes were identified through patient events that had not been picked up from SR. 175 people completed the Delphi survey from 26 countries and health care professionals from 13 different disciplines. 24 outcomes met predefined criteria for inclusion and following discussion and voting in the consensus meeting, and 14/24 outcomes were agreed for inclusion in the COS.Conclusion14 outcomes have been agreed on to form the COS. 12 of these outcomes are relevant to people of all ages, 1 to paediatric population and 1 to adult cohorts. The COS is, therefore, truly applicable lifelong, which was the scope of the project. This COS will help reduce research heterogeneity, enabling better quality research outcomes and more comparable data
Contributors to negative biopsychosocial outcomes in rugby players (CoNBO):part 1 the systematic review
Get PDFObjective This review aimed to establish the contributors to negative biopsychosocial outcomes in rugby, defined as unexpected adverse changes in players’ physical, psychological, social or health status. Design Systematic review. Data sources PubMed, Scopus, MEDLINE, SPORTDiscus and CINAHL. Eligibility criteria Studies were eligible if they investigated a physical, psychological or social factor which results in a negative biopsychosocial outcome in men’s or women’s rugby union, league or sevens. Studies were excluded if they did not differentiate outcome measures between rugby and other sports or did not differentiate outcome measures (ie, positive or negative) between physical/psychological/social factors and other factors. Results 9165 studies were identified in the initial search and two studies were identified from reference lists, 151 of which met the inclusion criteria (104 rugby union, 46 rugby league, 6 rugby sevens; 141 men, 16 women; 37 youth populations). 29 contributor groups and eight negative biopsychosocial outcome groups were identified. Previous injury (n=26), physical characteristics (n=32), training and match load (n=30) and factors within the contact event (n=22) were the most identified contributor groups. The negative biopsychosocial outcome of injury was investigated by 84% of studies. Conclusion Overall, the systematic review summarises the contributors to negative biopsychosocial outcomes within the current evidence base. There is a focus on previous injury, physical characteristics, training and match load and factors within the contact event as contributors to negative biopsychosocial outcomes. Eight studies investigated women’s cohorts independently from men; this underrepresentation within the literature could lead to the potential omittance of women-specific contributors. Prospero registration https://www.crd.york.ac.uk/PROSPERO/view/CRD4202234675
Toward a secure and scalable IoT: A survey of IOTA-based distributed ledger technologies
No full textThe increasing adoption of Internet of Things (IoT) systems demands secure, energy-efficient, and scalable solutions capable of supporting mission-critical operations. Traditional blockchain-based Distributed Ledger Technologies (DLTs), however, face limitations such as high energy consumption, poor scalability, and transaction fees, making them less ideal for IoT environments. This paper presents a structured review of IOTA’s Tangle, a lightweight, feeless, and scalable DLT designed specifically for decentralised IoT architectures. The study categorizes recent IOTA-based approaches into four key domains: security, privacy, scalability, and energy efficiency. The surveyed literature is systematically classified and analysed, highlighting the core challenges addressed by each approach. Comparative evaluation reveals the strengths and limitations of current methods in meeting IoT requirements. The findings suggest that while IOTA offers several advantages over traditional blockchains, integrating hybrid and comprehensive solutions remains a promising direction for future research. The paper concludes by outlining open challenges and opportunities for advancing IOTA-enabled IoT systems