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Model driven development for AI-based healthcare systems: A review
No full textWe review our experience with integrating Artificial Intelligence (AI) into healthcare systems following the Model-Driven Development (MDD) approach. At a time when AI has the potential to instigate a paradigm shift in the health sector, better integrating healthcare experts in the development of these technologies is of paramount importance. We see MDD as a useful way to better embed non-technical stakeholders in the development process. The main goal of this review is to reflect on our experiences to date with MDD and AI in the context of developing healthcare systems. Four case studies that fall within that scope but have different profiles are introduced and summarised: the MyMM application for Multiple Myeloma diagnosis; CNN-HAR, that studies the ability to do AI on the edge for IoT-supported human activity recognition; the HIPPP web based portal for patient information in public health; and Cinco de Bio, a new model driven platform used for the first time to support a better cell-level understanding of diseases. Based on the aforementioned case studies we discuss the characteristics, the challenges faced and the positive outcomes achieved.</p
Perspectives on the role of the intermediary in the justice system: A systematic review and qualitative synthesis
No full textChildren and vulnerable adults can experience substantive barriers when engaging with justice systems. An intermediary is a trained professional who supports vulnerable individuals to participate fully in legal processes by facilitating communication between them and legal professionals. Challenges in the establishment of the role are evident, while perceptions of how stakeholders perceive the role are relatively under-explored. This review synthesises literature on stakeholders’ perspectives of the intermediary role in the justice system. A systematic search of electronic databases (n =6) was undertaken alongside manual searches of the grey literature. Papers were independently screened for inclusion. Included papers were appraised for quality and qualitative content analysis was undertaken. The final sample (n =26) included the perspective of vulnerable individuals and families, legal practitioners and intermediaries. Seven categories were identified: (1) unique knowledge with transformative impact; (2) relationship work; (3) evolving scope, clear boundaries; (4) low status, high demands; (5) outer strengths, inner conflicts; (6) fulfilment in the role and (7) out of sync. The findings suggest that the role of the intermediary is perceived positively across stakeholder groups. However, several challenges are evident in relation to successful implementation of this complex and nuanced role. Recommendations for research and policy are discussed.</p
Healthcare workers’ experience of screening older adults in emergency care settings: a qualitative descriptive study using the Theoretical Domains Framework
No full textBackground In emergency care settings, screening for disease or risk factors for poor health outcomes among older adults can identify those in need of specialist and early intervention. The aim of this study was to identify barriers and facilitators to implementing older person-centred screening in emergency care settings in the Mid-West of Ireland. Methods This study employed a qualitative descriptive design underpinned by the theoretical domains framework (TDF). This design informs implementation strategy by establishing a theoretical foundation for focused objectives. One on one semi-structured interviews were conducted with a purposive sample of healthcare workers (HCWs) to explore their screening experiences with older adults in emergency care settings. Information power guided sample size calculation. In data analysis, verbatim interview transcripts were deductively mapped to TDF constructs forming meta-themes that revealed specific barriers and facilitators to person-centred screening for older individuals. These fndings will directly inform implementation strategies. Results Three themes were identifed; Preconditions to Implementing Older Person-Centred Screening; Knowledge and Skills Required to Implement Older Person-centred Screening and Motivation to Deliver Older Person-Centred Screening. Overall, screening in emergency care settings is a complicated process which is ideally undertaken by knowledgeable and skilled practitioners with a keen awareness of team dynamics and environmental challenges in acute care settings. These practitioners serve as champions and sources of specialist knowledge and practice. Less experienced clinicians seek supervision and support to undertake screening competently and confidently. Education on frailty and aged related syndromes facilitates screening uptake. Recognition of the value of screening is a clear motivator and leadership is vital to sustain screening practices. Conclusions Screening serves as an entry point for specialist intervention, necessitating a specialist multidisciplinary team (MDT) approach for effective implementation in emergency care settings. Strengthening screening practices for older adults who attend emergency care settings involves employing audit, supervision and tailored supports. Skilled and experienced practitioners play a key role in mentoring and supporting the broader MDT in screening engagement. Long-term and sustainable implementation relies on utilising existing managerial, practice development and educational resources to underpin screening practices. Communication between Emergency Department (ED) staff, the specialist team and wider geriatric team is vital to ensure a cohesive approach to delivering older person-centred care in the ED</p
Challenges in adapting fiber optic sensors for biomedical applications
No full textFiber optic sensors (FOSs) have developed as a transformative technology in healthcare, offering unparalleled precision and sensitivity in monitoring various physiological and biochemical parameters. Their applications range from monitoring vital signs to guiding minimally invasive surgeries, promising to revolutionize medical diagnostics and treatment. However, the integration of FOSs into biomedical applications faces numerous challenges. This article delves into the specific hurdles encountered in adopting FOSs for biomedical purposes, exploring technical and practical obstacles, and examining innovative solutions. From ensuring biocompatibility and miniaturization to addressing signal processing complexities and regulatory standards, the article provides an overview of the challenges and some of potential solutions. By explaining these challenges, a better understanding of FOSs technology in biomedical settings and the way for their implementation, would be possible and will lead to enhancing patient care and medical outcomes and wider usage of them.</p
Understanding the complex macrophage landscape in MASLD
No full textMetabolic dysfunction-associated steatotic liver disease (MASLD) represents a spectrum of disease states ranging from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH), which can eventually lead to the development of cirrhosis and hepatocellular carcinoma. Macrophages have long been implicated in driving the progression from steatosis to end-stage disease, yet we still know relatively little about the precise involvement of these cells in MASLD progression and/or regression. Rather, there are a considerable number of conflicting reports regarding the precise roles of these cells. This confusion stems from the fact that, until recently, macrophages in the liver were considered a homogenous population. However, thanks to recent technological advances including multi-parameter flow cytometry, single-cell RNA sequencing and spatial proteogenomics, we now know that this is not the case. Rather hepatic macrophages, even in the healthy liver, are heterogenous, existing in multiple subsets with distinct transcriptional profiles and hence likely functions. This heterogeneity is even more prominent in MASLD, where the macrophage pool consists of multiple different subsets of resident and recruited cells. To probe the unique functions of these cells and determine if targeting macrophages may be a viable therapeutic strategy in MASLD, we first need to unravel this complexity and decipher which populations and/or activation states are present and what functions each of these may play in driving MASLD progression. In this review, we summarise recent advances in the field, highlighting what is currently known about the hepatic macrophage landscape in MASLD and the questions that remain to be tackled.</p
‘The upside-down’ healthcare professional students’ experiences of delirium: an all-Ireland focus group stud
No full textBackground Delirium is a complex neuropsychiatric syndrome characterised by an acute state of confusion, with a substantial impact on medical inpatients. Despite its growing recognition as a global healthcare concern, delirium remains underdiagnosed, partly due to a lack of awareness among healthcare professionals. The aim of this study was to explore how healthcare professional students experience caring for individuals experiencing delirium, the influence of their current pre-registration healthcare education, and importance of interprofessional teamwork in their role.Methods This qualitative study used a focus group approach to collect data from 40 healthcare professional students, including nursing, pharmacy, and medical students, across two universities in Ireland. The focus groups explored participants’ experiences of caring for people with delirium, their delirium education, and their collaboration with interdisciplinary teams. The data were analysed using a reflexive thematic analysis approach.Results Following thematic analysis, three themes are reported. The first is “The Upside Down,” revealing student perceptions of caring for people with delirium who are facing distressing situations. The second team reported is, “Teamwork Makes the Dream Work,” emphasising the critical role of interprofessional collaboration in delirium management and patient outcomes. Finally, the theme of “A Little Is Not Enough,” highlighted students’ critiques of current delirium education in their pre-registration training. Collectively, these themes illuminate challenges in delirium care, advocate for teamwork in healthcare settings, and call for improvements in educational preparation for future healthcare professionals.Conclusions This study contributes to the existing literature by providing insights into the perspectives of healthcare professional students on delirium care. The findings also highlight the challenging nature of caring for individuals with delirium and the need for improved delirium education and interdisciplinary collaboration.</p
The quality-of-life impact of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) on patients' lives: An interpretative descriptive qualitative study
No full textBackground: Much has been documented about the physical sequelae of Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Whilst less documented, it is recognised that patients can have long lasting psychological sequelae. There is a lack of qualitative research on the quality of life (QoL) experiences of adults who have been diagnosed with SJS/TEN.Objectives: To explore the experiences of adults who had SJS/TEN and how these experiences relate to their QoL.Methods: Using an interpretative descriptive qualitative study, a purposive sample of 18 adults with SJS/TEN were interviewed using in depth semi structured interviews. Data were analysed using content analysis.Results: Two themes were constructed, each with two categories. Theme 1, Psychosocial Impacts included the categories 'The Self and Others', and 'A Changed Perspective on Life'. Theme 2, The Chronicity of Sequelae comprised the categories 'Multi Organ Involvement', and 'Further Consequences of TEN'.Conclusions: Findings highlighted that SJS/TEN had a significant impact on the different quality-of-life experiences of participants including psychological, physical, social, educational and occupational. Many expressed challenges they faced following discharge from hospital, including gaps in psychological care, navigating disjointed care pathways and lack of coordinated care. If SJS/TEN is viewed as a chronic condition, it is important that researchers and clinicians study the long-term effects of SJS/TEN on people's lives to aid in developing a plan of care to enhance the QoL for this cohort. Psychological and quality of life assessments following discharge from hospital require consideration.</p
ParsEval: Evaluation of parsing behavior using real-world out-in-the-wild X.509 certificates
No full textX.509 certificates play a crucial role in establishing secure communication over the internet by enabling authentication and data integrity. Equipped with a rich feature set, the X.509 standard is defined by multiple, comprehensive ISO/IEC documents. Due to its internet-wide usage, there are different implementations in multiple programming languages leading to a large and fragmented ecosystem. This work addresses the research question “Are there user-visible and security-related differences between X.509 certificate parsers?”. Relevant libraries offering APIs for parsing X.509 certificates were investigated and an appropriate test suite was developed. From 34 libraries 6 were chosen for further analysis. The X.509 parsing modules of the chosen libraries were called with 186,576,846 different certificates from a real-world dataset and the observed error codes were investigated. This study reveals an anomaly in wolfSSL’s X.509 parsing module and that there are fundamental differences in the ecosystem. While related studies nowadays mostly focus on fuzzing techniques resulting in artificial certificates, this study confirms that available X.509 parsing modules differ largely and yield different results, even for real-world out-in-the-wild certificates</p
Putting the STING back into BH3-mimetic drugs for TP53-mutant blood cancers
No full textTP53-mutant blood cancers remain a clinical challenge. BH3-mimetic drugs inhibit BCL-2 pro-survival proteins, inducing cancer cell apoptosis. Despite acting downstream of p53, functional p53 is required for maximal cancer cell killing by BH3-mimetics through an unknown mechanism. Here, we report p53 is activated following BH3-mimetic induced mitochondrial outer membrane permeabilization, leading to BH3-only protein induction and thereby potentiating the pro-apoptotic signal. TP53-deficient lymphomas lack this feedforward loop, providing opportunities for survival and disease relapse after BH3-mimetic treatment. The therapeutic barrier imposed by defects in TP53 can be overcome by direct activation of the cGAS/STING pathway, which promotes apoptosis of blood cancer cells through p53-independent BH3-only protein upregulation. Combining clinically relevant STING agonists with BH3-mimetic drugs efficiently kills TRP53/TP53-mutant mouse B lymphoma, human NK/T lymphoma, and acute myeloid leukemia cells. This represents a promising therapy regime that can be fast-tracked to tackle TP53-mutant blood cancers in the clinic.</p
Neonatal bacteraemia in Ireland: A ten-year single-institution retrospective review
No full textNeonatal sepsis is a catastrophic condition of global concern, with reported mortality rates exceeding 10%. Bloodstream infections are an important cause of sepsis, and epidemiological studies of these infections are crucial for predicting the most common aetiological agents and antimicrobial susceptibility patterns and for developing antimicrobial guidelines. For the ten-year study period from July 2013 to June 2023, all neonatal bacteraemia cases were reviewed prospectively using an enhanced surveillance protocol. The patients were stratified according to their age at the time of blood culture collection: early onset if diagnosed in the first 72 hours of life, and late onset if diagnosed after that time. During the study period, 170 blood cultures were positive from 144 patients, of which 89 specimens from 64 patients represented the growth of significant pathogens. Coagulase-negative staphylococci (CoNS) were the most common pathogens identified (52%, 33/64), followed by Escherichia coli (14%, 9/64), Group B Streptococcus (GBS: 11%, 7/64) and Staphylococcus aureus (11%, 7/64). GBS was more commonly identified in early onset patients, while CoNS were predominantly associated with late onset. The presence of an intravascular catheter, maternal urinary tract infections and the receipt of total parenteral nutrition or transfused blood were identified as significant risk factors. The fatality rate was 8% (5/64). in summary, this study provides a detailed overview of the epidemiology of neonatal bacteraemia in a large teaching hospital in the Midwest of Ireland over a decade</p