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Optimisation of oral anticoagulation for stroke prevention: a scoping review of factors influencing implementation
No full textBackground: For people whose stroke risk would be reduced by taking a long-term oral anticoagulant (OAC), it is important to implement effective strategies to support medication initiation, adherence and persistence. To do this, better understanding of the factors associated with implementation of interventions to optimise OAC management is needed.
Objectives: This scoping review aimed to summarise the evidence-base characteristics associated with implementing interventions designed to optimise long-term OAC adherence.
Eligibility Criteria: Primary research (published post-2000) evaluating any intervention designed to optimise implementation of long-term OAC for stroke prevention by way of change in OAC services, staff or patient behaviour.
Sources of Evidence: Five databases (MEDLINE, Embase, CINAHL, PsycInfo, Cochrane Library) were searched from 1 January 2000 to 4 August 2023 using a combination of terms relating to population, intervention, and study design.
Charting Methods: Titles/abstracts were screened by at least one reviewer. Data from each full text was abstracted, (with 20% double-checked for accuracy) and its implementation content reviewed, guided by the Expert Recommendations for Implementing Change (ERIC) strategies.
Results: 216 studies were included, with varying descriptive reporting of implementation strategies, and only 61 (28%) self-identifying as an implementation study. The median number of implementation strategies used was three, with recently published studies (2015 onwards), those including patients receiving either direct OACs (DOACs) or vitamin-K antagonists (VKAs), and those including multiple intervention targets (service, staff or patients) associated with using more implementation strategies. ‘Train and educate stakeholders’ strategies were the most commonly used, and ‘Adapt and tailor to the context’ strategies were the least used by included studies. Conversely, self-defined implementation studies were less likely to use ‘Train and educate stakeholders’ strategies, although they were positively associated with use of ‘Adapt and tailor to the context’. ‘Use evaluative & iterative’ strategies were used more frequently in studies where patients used either VKAs or DOACs, or were published more recently.
Conclusions: Studies need to self-define as implementation studies, improve implementation strategy reporting, and be transparently registered, alongside conducting process evaluations or more richly describing implementation processes. Future research could explore why some implementation strategies are used more than others and whether aligning strategy clusters with intervention targets results in clinically significant differences in patient care
Humanitarian Supply Chain Operations and COVID-19: The Roles of Data-Driven Innovations
No full textThe COVID-19 pandemic revealed a poor level of preparedness by the manufacturing sector in building resilient smart operations and logistics framework to respond to severe global supply chain disruptions. This research focuses on the effectiveness of data-driven innovation strategies in mitigating the impacts on humanitarian operations of Covid-19 related supply chain interruptions. It is supported by the outcome of a comprehensive overview of the major conceptual issues in the literature. This review uncovered two main topics of debate notably (i) the significant role of big data analytics and Artificial Intelligence in boosting firm performance by untangling supply chain disruptions and (ii) the paucity of research in this emerging area of literature. Consequently, this paper proposes a conceptual model for humanitarian supply chain operations to highlight how big data analytics and AI technologies could be deployed by firms to gain a competitive advantage by responding promptly and effectively to severe disruptions akin to those experienced during the recent COVID-19 pandemic. The critical functions of the model indicate that a swift and competent application of big data analytics and AI technologies improve resiliency, visibility, and responsiveness within supply chain networks, which in turn strengthens the coordination among major stakeholders
Automated Generative AI-Driven Forensic Analysis (AGAFA). An Explainable Neuro-Symbolic Approach to Digital Forensics
No full textDigital Forensics (DF) encompasses the processes of collecting, analysing, and preserving digital evidence crucial for investigations involving cybercrime, security breaches and other criminal cases. The rising number of digital devices requiring investigation, coupled with diminishing confidence in the legal process due to the extensive time needed to process these devices, has prompted the development of a novel framework known as AGAFA. This framework, powered by Explainable AI, aims to meet the growing demand for digital forensic services. The primary objectives of this hybrid neuro-symbolic approach are to enhance the transparency of Artificial Intelligence (AI) in forensic analyses and to protect digital systems. Additionally, it leverages the capabilities of Large Language Models (LLMs) to extract insights from vast datasets in a timely and cost-effective manner. A potential use case for this framework is also illustrated, showcasing its practical application
Maternal physical health and breastfeeding problems in Croatia: national online survey of new mothers
No full textObjective
To document maternal physical health and breastfeeding problems in the first six months after giving birth in Croatia during the pandemic.
Methods
We conducted a cross-sectional study using an online questionnaire between February and April 2022 among resident Croatian women who had enrolled in the RODA (‘Parents in Action’) online antenatal course. Women aged 18 + years, who had given birth in a Croatian maternity facility between February 2020 and December 2021 were eligible. The questionnaire contained 75 items, covering sociodemographic characteristics, hospital practices, community support, maternal mental and physical health.
Results
Postpartum health and breastfeeding items were completed by 1760 participants. Most women were primiparous (80 %, n = 1420) and 72 % birthed vaginally (n = 1274). Major physical health issues were fatigue (28 %; n = 487), back pain (14 %; n = 252), and haemorrhoids (10 %; n = 171). Urinary incontinence was a minor problem for 23 % (n = 397), somewhat of a problem for 8 % (n = 139) and a major problem for 4 % (n = 67).The most common breastfeeding problems were nipple pain/damage 50 % (n = 885), difficulty attaching 43 %, (n = 761), low milk supply 28 % (n = 490), mastitis 22 % (n = 391), engorgement 22 % (n = 393), breast refusal 22 % (n = 381), and too much milk 22 % (n = 380).
Conclusion
Consistent with reports of maternal postpartum health in other countries, women in Croatia experienced many physical health challenges in the six months after childbirth. Most women described problems with breastfeeding; the frequency of pain associated with breastfeeding is concerning. Healthcare systems need to provide effective assistance to enable new mothers to establish breastfeeding without nipple pain and damage even during times of emergency measures
Evolving (and co-evolving) the face of a criminal
No full textEvidence provided by eyewitnesses can be crucial for solving crime. In two previous articles in The Psychologist, in 2008 and 2012, we explained how we have helped these observers create the face of an offender to assist police investigations. Here, we review this work and explain more recent research. These developments have enabled eyewitnesses to routinely construct an identifiable face and assist the police in solving crimes
Dendritic Cell Therapy in Immuno-Oncology: A Potentially Key Component of Anti-Cancer Immunotherapies
No full textDendritic cells (DCs) are a heterogeneous population known for antigen presentation and immune modulation, playing a key role in priming a T cell response against pathogens and tumor cells. Despite their putative therapeutic value, their scarcity in peripheral blood limited their direct use in therapeutic applications until recently. The discovery that DCs can be generated from circulating monocytes ex vivo, however, gave a boost of extensive research in the use of DCs in clinical applications. Still, despite the numerous clinical trials, the introduction of DCs in the everyday clinical oncology practice is delayed. In this narrative review, we provide an updated summary of the field covering the theoretical and practical aspects of the concept of the use of DCs in adoptive cellular immunotherapy and the completed or ongoing clinical trials for the use of these species in clinical oncology practice. To better understand the current developments of the field, we included those clinical trial reports that published evaluable data to date. Based on our literature survey, DC-based adoptive cellular therapy is a safe therapeutic intervention with valuable clinical potential. Its widespread implementation, however, is likely delayed due to a number of factors that make meaningful evaluation of clinical trial results complicated. These include the great variety of preclinical trial concepts, difficult and heterogenous patient cohorts, and the diversity of intervention techniques applied. Since these factors might hinder the routine implementation of DC-based applications in the more widespread forms of immunotherapy, one of the urgent short-term future directions seems to be the standardization of the DC-based methodologies
P9 Fractional flow reserve versus intravascular ultrasound for guiding percutaneous coronary intervention: a systematic review and meta-analysis
No full textObjective Percutaneous coronary intervention (PCI) is increasingly guided by advanced techniques beyond angiography alone.1Fractional Flow Reserve (FFR) and Intravascular Ultrasound (IVUS) are two widely used modalities that offer physiological and anatomical guidance, respectively.2 This study aims to provide an updated evidence-based comparison of FFR versus IVUS in guiding PCI.
Methods A systematic review and meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search was performed to identify studies comparing FFR-guided PCI with IVUS-guided PCI. Primary outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), and target vessel revascularisation (TVR). Secondary outcomes were the number of PCI procedures performed. Fixed- or random-effects modelling was used based on heterogeneity.
Results 6 studies with a total of 5040 patients were included, with 2517 in the FFR-guided PCI group and 2523 in the IVUS group. No statistically significant differences were observed between FFR and IVUS in terms of major adverse cardiovascular events (OR = 1.11, 95% CI: 0.89–1.38, P = 0.35; I2 = 15%), all-cause mortality (OR = 0.82, 95% CI: 0.50–1.36, P = 0.45; I2 = 10%), cardiac- related deaths (OR = 1.05, 95% CI: 0.60–1.84, P = 0.87; I2 = 0%), non-fatal myocardial infarction (OR = 1.49, 95% CI: 0.79–2.71, P = 0.22; I2 = 0%), or target vessel revascularisation (OR = 1.20, 95% CI: 0.80–1.79, P = 0.38; I2 = 0%). A significantly higher number of PCI procedures was observed in the IVUS group (OR = 0.56, 95% CI: 0.36–0.88, P = 0.01), although this outcome showed high heterogeneity (I2 = 90%).
Conclusion Both FFR and IVUS are effective strategies for guiding PCI. However, IVUS was associated with a significantly higher rate of PCI procedures, potentially reflecting its sensitivity in lesion detection
How does orthotic walker boot design influence lower limb and trunk function during gait?
Get PDFBackground: Undesirable lower limb gait deviations have previously been reported when wearing orthotic walker boots, therefore there is a need to optimise orthotic walker boot designs to facilitate normal gait. Objective: This study explored the biomechanical effects of two designs of orthotic walker boot on the lower limb and trunk compared to usual footwear. Study Design: A repeated measures analysis of variance (ANOVA) was used to evaluate selected kinematic and kinetic variables under different walking conditions. Methods: Sixteen healthy participants walked in three conditions using: Walker A (Airselect Elite, Enovis, USA), Walker B (Townsend XLR8 Series Walker, Thuasne, France) and a usual shoe. A 10 camera motion analysis system and 4 force plates were used to collect kinematic and kinetic data. Results: Gait speed was significantly slower in both orthotic walker boots, and significantly decreased ankle range of motion (ROM) which is their primary function. Significant deviations in normal knee and hip kinematics and kinetics, shank to vertical angle and pelvic and trunk movements were noted with both walker boots, with the greatest deviations from the shoe condition observed in Walker B. Recline and incline shank angular velocities showed the greatest differences in Walker B which could be associated with adverse knee joint moments and a significantly greater perceived ease of walking in Walker A. Conclusions: Orthotic walker boot design significantly affects walking mechanics. Orthotic walkers with greater forefoot rocker profiles and inclined vertical shank angles may at least in part mitigate known gait deviations when wearing orthotic walkers
How a particular STEAM model is developing primary education: lessons from the Teach-Make project (England)
Get PDFPurpose
There is a lack of clarity about what constitutes Science, Technology, Engineering, Arts and Mathematics (STEAM) education and what the arts contribute. In this paper the authors discuss a distinct model, theorised from a five-year study of a particular, innovative STEAM education project (The Imagineerium), and developed by the researchers through working with primary school teachers in England within a second project (Teach-Make). The paper examines how teachers implemented this model, the Trowsdale art-making model for education (the TAME), and reflected on its value and positive impact on their planning and pedagogy.
Design/methodology/approach
The paper draws on two studies: firstly, a five-year, mixed methods, participative study of The Imagineerium and secondly a participative and collaborative qualitative study of Teach-Make.
Findings
Study of The Imagineerium showed strong positive educational outcomes for pupils and an appetite from teachers to translate the approach to the classroom. The Teach-Make project showed that with a clear curriculum model (the TAME) and professional development to improve teachers' planning and active pedagogical skills, they could design and deliver “imagineerium-like” schemes of work in their classrooms. Teachers reported a positive impact on both their own approach to supporting learning, as well as pupil progression and enjoyment.
Originality/value
The paper argues that the TAME, a consolidation of research evidence from The Imagineerium and developed through Teach-Make, offers both a distinctive and effective model for STEAM and broader education, one that is accessible to, valued by and manageable for teachers
Policing Hate Crime: Exploring the Issue with a Cohort of Sworn Police Officers
Get PDFGlobally, there has been a trend in rising levels of hate crime that scholars have argued is reflective of significant social problems within society. Research into hate crime has typically focused on the police and their subsequent response to this crime type, with many findings reporting that the police are racist, homophobic and Islamophobic, to name but a few. However, existing research,seldom captures the insights and experiences of sworn police officers, as much of the data is gathered from third parties. This,paper presents the empirical findings from a Delphi study conducted with one police force in Australia, sampling sworn New South Wales (NSW) police officers between October 2020 and October 2021. The findings focus on four overarching areas:,defining hate crime, perpetrators of hate crime, victims of hate crime, and responses to hate crime. These themes capture the perspectives of NSW police officers in relation to operational and organisational practice in respect of hate crime. Drawing on a Delphi method, the research outlines police perceptions of the nature of hate crime, as well as capturing how hate crime can be effectively reported, recorded, and responded to. Conclusions and implications are considered. These include the requirement for a clearer definition and targeted education strategies aimed at improving knowledge and understanding relating to hate crime. Future directions include the development of a standardised approach to reporting, recording, and responding to hate crime