13027 research outputs found
Sort by
Frailty screening with comprehensive geriatrician-led multidisciplinary assessment for older adults during emergency hospital attendance in Ireland (SOLAR): a randomised controlled trial
No full textBackground Multidisciplinary comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older adults but there is limited evidence on its effectiveness in the emergency department. We aimed to assess the benefits of CGA in the emergency department for older adults living with frailty. Methods In this randomised controlled trial, we enrolled older adults (≥75 years) who presented to the emergency department with medical complaints at University Hospital Limerick (Limerick, Ireland). Participants screened positive for frailty on the Identification of Seniors at Risk screening tool (score ≥2). Patients requiring resuscitation as well as those with COVID-19, psychiatric, surgical, or trauma complaints were excluded. Participants were randomly allocated 1:1 to geriatrician-led multidisciplinary CGA and management or usual care. Outcome assessors were masked to treatment allocation. The primary efficacy outcome was time spent in the emergency department, defined as the time from registration on the computer database until time of discharge or admission to an inpatient ward in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT04629690. Findings Between Nov 9, 2020, and May 13, 2021, we recruited 228 patients. 113 participants were included in the intervention group (mean age 82⋅4 years [SD 4⋅9]; 63 [56%] women; 113 [100%] White Irish) and 115 in the control group (83⋅1 [5⋅6]; 61 [53%]; 112 [97%]). Median time in the emergency department was 11⋅5 h (IQR 5–27) in the intervention group and 20 h (7–29) in the control group (median difference [Hodges–Lehmann estimator] 3⋅1 h [95% CI 0⋅6–7⋅5]; p=0⋅013). There were no adverse events related to the intervention. Interpretation Geriatrician-led multidisciplinary assessment of older adults living with frailty was associated with reduced time spent in the emergency department setting at index visit and lower rates of nursing home admission, greater increases in quality of life, and lower decreases in function at both 30 days and 180 days. Multicentre trials are needed to confirm the external validity of the findings. This study provides an evidence base for similar teams in an emergency department setting.</p
Barriers and enablers of primary healthcare professionals in health research engagement: A systematic review of qualitative studies
No full textHealth professional engagement ensures relevant, clinically focused research that informs evidence-based care. Research shows health professionals may not engage optimally in research. Understanding barriers and enablers influencing participation is necessary to enhance engagement. This systematic review explores these factors among primary healthcare professionals. We searched peer-reviewed studies using CINAHL, Medline, and SCOPUS in February 2023, updated in June 2024. The review followed PRISMA and the ENTREQ checklist. Studies included those published in English, reporting factors influencing engagement among primary healthcare professionals. Qualitative data were extracted and thematically synthesized. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Nineteen studies were included. Enablers include individual positive attitudes and a scholarly environment. Barriers include negative attitudes, an unconducive environment, and system constraints. Primary health professionals view research engagement positively, recognizing its potential to enhance health outcomes, professional growth, and business performance. Balancing clinical responsibilities, workload and research is challenging. Targeted strategies promoting partnerships and stakeholder involvement can foster a scholarly environment and empower research engagement</p
A hybrid hexahedral solid-shell element with self-equilibrated stresses for the geometrically nonlinear static analysis of composite laminated structures
No full textHybrid finite elements with self-equilibrated assumed stresses have proven to provide several advantages for analysing shell structures. They guarantee high performance when using coarse meshes and accurately represent the stress field. Additionally, they do not require assumptions about the displacement field within the element domain, and the integration is efficiently performed only along their contours. This work exploits those advantages to develop a solid-shell finite element for the geometrically nonlinear static analysis of composite laminated structures. In particular, an eight-node finite element, which has 24 displacement variables and 18 stress parameters, is developed. The displacement field is described only by translations, eliminating the need for complex finite rotation treatments in large displacement problems. A Total Lagrangian formulation is used with the Green-Lagrange strain tensor and the second Piola-Kirchhoff stress tensor. Thickness locking is cured using an assumed natural strain formulation for the transversal normal stress, and the assumed stress field eliminates shear locking. Then, for the analysis of linear-elastic problems, no domain integration is needed, and all the element operators are obtained by line integrals. The resulting formulation is efficient and allows for easy implementation. Computed numerical results show the accuracy and robustness of the presented element when used for both the linear elastic static and geometrically nonlinear elastic static analysis of composite laminated shell structures.</p
Alienation, equality, and multifaith establishment
No full textReligious establishment today often takes a multifaith form, whereby multiple religions are supported in different ways and to different degrees. In order to contribute to the development of a normative framework for assessing practices and regimes of multifaith establishment, this article recommends the concept of “social alienation.” Initially, social alienation is defended as a negative normative criterion to determine when specific establishment practices are unacceptable. This criterion is compared favorably with approaches that evaluate establishment practices by reference to an ideal of public reason or according to whether they convey an expressive harm, as well as with similar approaches based on a purely subjective understanding of alienation. Subsequently, it is also argued that addressing social alienation can support a case for multifaith religious establishment regimes that support or recognize minority religions, since it is often unequal establishment practices that socially alienate, not establishment as such.</p
Outcomes following surgical management of patellar instability in hypermobile patients are favourable compared to non‐operative management in non‐hypermobile patients: A systematic review and meta‐analysis
No full textPurpose: To assess the outcomes of surgical management of patellar instability in hypermobile patients. Methods: Three online databases (PubMed, MEDLINE and EMBASE) were searched from inception to 27 September 2024, to identify studies investigating the surgical management options for patellar instability in hypermobile patients. Data pertaining to patient demographics, patient management, redislocation rates and Kujala scores were abstracted. Weighted means and meta‐analyses were conducted to compare rates of redislocation as well as post‐operative Kujala scores. However, data pooling was not performed in cases of high heterogeneity. The quality of included studies was assessed using the MINORS criteria. Results: A total of nine studies and 303 patients were included in this review. The pooled mean post‐operative redislocation rate was 9% at a mean follow‐up time of 45.4 months. The mean post‐operative redislocation rate ranged from 7.3% to 28.5% following medial patellofemoral reconstruction (MPFLR). The mean post‐operative Kujala score ranged from 64.3 to 95.3. The post‐operative complication rate was 11.7%. Conclusion: This systematic review demonstrated that surgical management, particularly MPFLR, of patellar instability in hypermobile patients may result in lower redislocation rates and favourable post‐operative outcomes compared to non‐operative management in non‐hypermobile patients. The current available literature for this patient population is highly heterogeneous, indicating the need for high‐quality studies to more accurately assess intrinsic risk factors and surgical techniques.</p
Improving the bonding characteristics of the friction-welded 2A14 Al alloy/steel interface by enabling mutual deformation
No full textPresent study proposed a mutual plastic deformation method for friction-welded joints of 2A14 Al alloy and steel, incorporating a Ni interlayer to enable dual-interfacial deformation at the Al/Ni and Ni/steel interfaces. Compared to joints without Ni, which display a Fe-Al-O amorphous layer and a 100 nm-thick Al₂Cu layer at the interface with no grain refinement in the steel, dual-interfacial mutual deformation leads to finer grains. Additionally, it results in a thinner, semi-coherent Al-Ni-Cu ternary intermetallic layer, approximately 23 nm thick. This microstructural evolution results in a tensile strength of ∼354 MPa, a significant reduction in residual stress and improved low-cycle fatigue properties. This approach also holds promise for enhancing the properties of other dissimilar metal joints.</p
Effects of water absorption on the mechanical and morphological properties of date palm leaf fiber-reinforced polymer composites
No full textThe growing demand for sustainable and biodegradable materials has led to increasing interest in using natural fibers as reinforcements in polymer composites. Among these, date palm leaf fibers (DPLFs), an abundant agricultural byproduct in the Middle East, show promise due to their favorable mechanical characteristics. This study investigates the effects of water absorption on the mechanical and morphological properties of DPLF-reinforced polymer (DPLFRP) composites to assess their viability in moisture-prone environments. Five types of DPLFs (Nabtat-seyf, Sultana, Barhee, Sukkary, and Khalasah) were extracted, characterized morphologically using scanning electron microscopy (SEM), and fabricated into unidirectional epoxy-based laminates via hand layup. Mechanical performance was assessed through tensile testing before and after 48 hrs of water immersion. Morphological changes and water uptake behavior were also examined. The results show that Nabtat-seyf exhibited the highest tensile strength (100.58 ± 7.95 MPa) and modulus (6.16 ± 0.85 GPa) among the DPLFs. Water absorption led to a reduction in tensile strength and modulus of DPLFRP composites by 39–47% and 21–32%, respectively. SEM analysis revealed microstructural damage mechanisms such as fiber–matrix debonding, fiber swelling, and matrix cracking. The specific tensile modulus and strength also declined significantly with increased moisture content. These findings suggest that while DPLFs, especially Nabtat-seyf, have high potential as reinforcement in biocomposites, water absorption presents a major challenge. Applications include automotive interior components, construction panels, and low-load structural elements, provided moisture barriers or fiber treatments are applied for durability enhancement.</p
Fluorination induced inversion of helicity and self-assembly into cross-α like piezoelectric amyloids by minimalistic designer peptide
No full textAlthough initially identified as pathological aggregates, amyloid fibrillar assemblies formed by various proteins and peptides are now known to have crucial physiological roles, carrying out numerous biological functions in almost all organisms. Due to unique features, the common etiology of amyloids’ cross- structure is long posited as a template for designing artificial self-assembling systems. However, the recent discovery of cross- amyloids indicates additional structural paradigms for self-assembly into ordered nanostructures, turning significant attention toward designing artificial nanostructures based on cross- assembly. Herein, a minimalistic designer peptide which forms a hydrogen-bonded amyloid-like structure while remaining in the region of conformation is engineered, to investigate the effect of aromatic, hydrophobic, and steric considerations on amyloidal assemblies. These results demonstrate a significant modulation of helicity and self-assembly, leading to the structure-dependent piezoelectric function of the amyloid-like cross- fibrils. This study indicates a potential avenue for molecular engineering of functional peptide materials.</p
Synthesis and Characterisation of multivariate metal–organic frameworks for controlled doxorubicin absorption and release
No full textThe development of drug carriers with efficient absorption and controlled delivery properties is crucial for advancing medical treatments. Metal–organic frameworks (MOFs) with tunable porosity and a large surface area represent a promising class of materials for this application. Among them, NUIG4 stands out as a biocompatible MOF that exhibits exceptionally high doxorubicin (Dox) absorption (1995 mg dox/g NUIG4) and pH-controlled release properties. In this study, we report the synthesis and characterisation of multivariate MOFs (MV-NUIG4), which are analogues of NUIG4 that maintain the same topology while incorporating different functional groups within their framework. Eight new MV-NUIG4 MOFs have been synthesised through in situ reactions of the corresponding 4-aminobenzoic acid derivative with 4-formylbenzoic acid. The compounds were thoroughly characterised using a range of techniques, including powder X-ray diffraction, infrared spectroscopy, 1H-NMR, and single-crystal X-ray crystallography. The experimental ratio of the reagents and ligand precursors for the synthesis of MV-NUIG4 MOFs matched the ratio of the linkers in the final products. These structures incorporate additional functional groups, such as methyl and hydroxyl, in varying ratios. Computational modelling was used to provide further insight into the crystal structure of the MOFs, revealing a random distribution of the functional groups in the framework. The Dox absorption and release capacity of all analogues were studied, and the results revealed that all analogues displayed high drug absorption in the range of 1234–1995 mg Dox/g MOF. Furthermore, the absorption and release rates of the drug are modulated by the ratio of functional groups, providing a promising approach for controlling drug delivery properties in MOFs</p
Impact of the Covid-19 pandemic on bereavement care provided within maternity services: A focused mapping review and synthesis
No full textPerinatal bereavement is the experience of parents after the death of an infant due to miscarriage, stillbirth, neonatal death, or elective termination of pregnancy for fetal anomaly. Perinatal loss is a traumatic event for parents and the quality of care provided by healthcare professionals (HCPs) can impact their grieving process. In March 2020, Covid-19 was declared a global pandemic, with significant consequences on perinatal bereavement services. Aim: To explore parents and HCPs experiences of perinatal bereavement care during the Covid-19 pandemic. Methods: A focused mapping review and synthesis was used to identify papers which concentrated on perinatal bereavement care within maternity services during the Covid-19 pandemic. Studies meeting the criteria in peer reviewed midwifery, obstetric and healthcare journals (n = 6), published between Jan 2020-Feb 2025 were descriptively analysed, providing a topography and synthesis of the key trends identified. Findings: Fourteen relevant studies were identified in the review period, six of which met the inclusion criteria, with two themes identified: Maternity service reconfiguration due to Covid-19 restrictions and Loneliness and anxiety inducing experiences among parents. Conclusion: The Covid-19 pandemic negatively impacted bereavement care within maternity services. Maternity reconfiguration because of the pandemic was a major contributor to dissatisfaction and frustration amongst bereaved parents and HCPs. Exclusion of partners had a negative effect on parents’ experiences of care, augmenting the loneliness and anxiety felt by parents when dealing with loss. Perinatal bereavement guidelines need to accentuate the importance of partner inclusion in any context but particularly when providing care to women requiring isolation or barrier nursing. Guidelines must be reviewed to clearly outline when the use of virtual care is appropriate within the maternity setting. Additional research is needed to assess the long-term impacts of Covid 19 on HCPs. Such research includes identifying effective mechanisms to help staff deal with the stress and emotional impact of future public health emergencies.</p