23343 research outputs found
Sort by
Implementing patient-centred outcome measures in palliative care clinical practice. An updated systematic review of facilitators and barriers
No full textBackgroundPatient-centred outcome measures (PCOMs), when well implemented, are powerful tools facilitating patient, family and clinical communication to better respond to patient needs. Their routine use in palliative care practice still faces challenges.ObjectiveTo update a systematic review of PCOMs implementation, reviewing and synthesising new evidence on facilitators, barriers, lessons learned, measures used, models of implementation, costs, implementation outcomes, and consequences in clinical practice.MethodsWe searched eight information sources supplemented by hand-searching and citations of the original review and studies identified by the expert advisory committee. This prospectively registered review included studies using a PCOM during clinical care of adult patients with advanced disease in all settings and extracted data on: PCOMs used, models of implementation, facilitators, barriers, lessons learned, costs, and implementation outcomes. We employed narrative synthesis and tabulated findings, following all PRISMA reporting guidelines.ResultsWe included 114 studies. A major new facilitator was the integration of electronic/digital PCOMs into Information Technology systems. Main barriers remain largely unchanged and relate to healthcare professionals’ beliefs. Implementation was highlighted as a complex intervention, needing planning, assessment and fine tuning throughout. Sixty-two included studies mentioned at least one implementation outcome. Eighteen models, frameworks and theories were identified in 25 included studies. No studies reported on costs of implementation.ConclusionThis work reveals the complexity of implementing PCOMs in palliative care practice. The main clinical and research implications of our findings highlight the central importance of staff engagement and training staff in PCOM tools, communication strategies, and cultural competence
Atmospheric microplastics and the human lungs
Full text linkMicroplastics (MPs) are an emerging environmental contaminant (EEC), that have recently been isolated from samples collected from the atmosphere, and are considered ubiquitous on Earth. There is a lack of knowledge regarding the properties of atmospheric MPs (AMPs), in terms of location, concentrations, plastic types, sizes and shapes. There is also limited understanding of the potential for these MPs to be inhaled, and the consequences of such exposure. Standardised approaches throughout the AMP field are called for, because incomparable datasets and varying microplastic (MP) definitions are slowing down the progression of research. It is now necessary to thoroughly investigate AMPs, and gain knowledge of the location and MP types relevant to human exposure, as well as assessing MP inhalation as an exposure route for humans. This information can direct future investigations into the potential hazards associated with AMP inhalation.This thesis presents 3 publications, within this publication style thesis; investigating indoor AMPs, outdoor AMPs and a final investigation into the presence of MPs within human lung tissue samples, acquired from living patients.First, passive sampling of 20 households over a 6-month discontinuous duration, reported an average concentration of 1414 MP m− 2 day− 1 ± 1022 (mean ± SD). This high abundance of MPs within household environments supports the importance of indoor MP sampling locations. Fibrous and fragmented Polyethylene terephthalate (PET), Polypropylene (PP) and Nylon were also stated as relevant to human exposure, at head height.Secondly, passive sampling within a busy outdoor urban roadside location reported concentrations of MPs; 3055 ± 5072 MP m−2 day−1 (mean ± SD, 1164 median), over a yearlong investigation. Specific outdoor areas of high human activity were suggested to rival that of indoor concentrations. An additional snap-shot 2-week investigation, passively sampling 5 different areas of varying human activity, was also conducted. Roadside, commercial and industrial locations were reported with high concentration rates and relevance to human exposure. An abundance of film and fragmented particles, of Polyethylene (PE), Nylon and Resin composition, suggested these properties to be most relevant to human health studies.Finally, digested human lung tissue analysis provided evidence to support the human inhalation of MPs. 39 MPs were identified within 13 lung tissue samples, acquired from 11 living human patients. PP was reported within samples, after strict limit of detection and limit of quantification (LOD LOQ) adjustments were applied. PP, PET and Resin synthetic plastic types, and fibre and fragment shape categories were identified and suggested to be of relevance to human inhalation. The size of most MPs identified within lung tissue samples were larger than that thought possible to inhale, whilst some were smaller and traditionally more inhalable.These publications bridge environmental MP research and human MP health studies, providing much needed knowledge regarding the concentration and types of AMPs that humans are most likely exposed to on a daily basis, as well as supporting the potential for exposure to AMPs via inhalation. Uniquely, at the forefront of all publications, was the aim to provide novel, high quality methodologies, combatting methodological restrictions, and focusing considerably on improving the quality of research concerning AMPs and human exposure, with great emphasis on quality control. These chapters, alongside other AMP research, can form the foundations for future research improvements, leading to eventual standardised operating procedures (SOPs), policy formation, and to achieve guided, accurate and environmentally relevant MP exposure investigations
An innovative high-temperature pumped thermal energy storage driven by transcritical CO2 heat pump and steam Rankine cycles
Full text linkPumped thermal energy storage (PTES) is an emerging scheme for low-cost, site-independent, and environmentally friendly electricity storage. However, it faces critical technical challenges of low round-trip efficiency (generally<60 %) and significant irreversible loss during heat transfer process. This paper proposes an innovative high-temperature PTES coupling a transcritical CO2 (TCO2) heat pump cycle with a transcritical steam Rankine cycle (TSRC). It originally employs dual-storage fluids of molten salts and water with a four-tank structure, covering a wide temperature range from about 33 °C to 560 °C. Water is both low-temperature storage fluid and TSRC working fluid, thereby eliminating a secondary water-water heat transfer. In the charging process, CO2 at the compressor outlet releases heat to the molten salts and then splits into two streams. One stream increases water storage temperature, and the other preheats CO2 from the evaporator. Fundamentals of the PTES are illustrated, and mathematical models are built. The results show that the cascade sensible storage configuration can tackle the challenge of large throttling irreversibility and a high round-trip efficiency of 60.21 % can be achieved
Coproducing a conceptual understanding of unmet palliative care needs: stakeholder workshops using modified nominal group technique
Full text linkBackground: Despite growing recognition of the importance of identifying unmet needs in palliative care, there remains no clear, operational definition of what constitutes unmet palliative care needs. This gap hinders service planning, policy development and equitable access to care. We aimed to explore priorities for understanding and measuring unmet palliative care needs with stakeholders, including people with lived and professional experience. Methods: Three online workshops using a modified nominal group technique with people with lived experience of life-limiting illness (as patients or informal carers) and professionals in palliative care. Separate workshops were held for each group to independently identify elements that capture the concept of unmet palliative care needs, followed by a combined workshop to refine and consolidate findings. Workshop data (scribe notes) were analysed using content analysis. Participants then completed an online ranking exercise to prioritise key elements, which was analysed descriptively. Results: Twenty-eight individuals participated, including 11 people with lived experience (two patients and nine informal carers) and 17 with professional experience. In the final workshop, participants agreed on a list of 27 elements capturing unmet palliative care needs, which were conceptualised in two main ways: (1) service-related (e.g. lack of a single point of contact to access support, including out-of-hours), and (2) those related to symptoms and concerns, (e.g. pain not assessed and managed). Twenty-three participants completed the ranking exercise. Highly prioritised elements included lack of timely and holistic assessment of symptoms or suffering, inability to access services needed, lack of coordination, and continuity of care. Other priorities for understanding and measuring unmet palliative care needs were lack of timely follow-up to address symptoms, lack of skilled support, and lack of respect, dignity and empathy. Conclusions: This study is the first to engage both individuals with lived experience and professionals in conceptualising unmet palliative care needs. Stakeholders prioritised two broad aspects important for capturing unmet palliative care needs: symptom-related concerns and service-related issues. These findings provide a foundation for developing stakeholder-informed tools to assess unmet palliative care needs that are feasible for use across diverse care settings and populations
The Influence of Family Involvement and School Climate in Children’s Wellbeing and Skills Development: Stakeholders’ perceptions in Bangladesh
Full text linkEvidence in the literature consistently shows that family members’ involvement in their children’s education and the overall school environment are integral parts of primary school-going children’s lives. However, this topic appears to be limitedly explored from the perspectives of different stakeholders. The purpose of the present study was to investigate parents’, teachers’, and students’ perceptions of family involvement and school climate as related to the children’s wellbeing and skills development in the context of Bangladesh. This study adopted a qualitative, interpretive phenomenological approach. Data were collected through semi-structured interviews with 30 participants from Bangladesh, comprising parents, teachers, and students (10 from each group), to capture diverse stakeholder perspectives. Reflexive thematic analysis, guided by Braun and Clarke’s (2006) six-phase framework, was employed to analyse the data, which identified 4, 6, and 4 themes from parents’, teachers’, and students’ perspectives, respectively.Findings indicate that family involvement manifests in both home-based and school-based activities, supporting children’s wellbeing, academic, and social development. Motivations for parental engagement include aspirations for children’s future success, fulfilling parental duties, and meeting children’s expectations. However, multiple barriers, such as time constraints, economic hardship, limited parental formal education, lack of awareness, and insufficient institutional support, impede effective involvement. The study also delineates participants’ perceptions of school climate across four domains: academic, community, safety, and institutional environment. While the school is generally perceived as a safe and supportive space, challenges related to teacher workload, overcrowded classrooms, inconsistent communication, and inadequate resources persist. These issues were identified as hindering educational quality and obstructing meaningful collaboration between families and schools. Crucially, the study highlights that both family involvement and a favourable school climate substantially contribute to children’s overall wellbeing, cognitive, and social development. It extends the existing literature by integrating perspectives from multiple stakeholder groups in a developing country context. This study contributes to providing actionable insights for parents, teachers, and policymakers aiming to enhance the quality of family involvement and improve school-related factors to create a more supportive environment for children’s wellbeing and development
Making clinical guidelines work for people living with multiple long-term conditions: Analysis and recommendations from a review of single-condition
Full text linkObjectives To evaluate how UK guidelines for individual health conditions consider coexisting multiple long term conditions and to propose improvements to guideline development processes so that guidelines appropriately account for and consider coexisting multiple long term conditions.Design Analysis and recommendations from review of single condition guidelines.Setting Clinical guidelines developed by the National Institute for Health and Care Excellence (NICE), UK, 1 January 2013 to 31 December 2024.Population 56 clinical guidelines developed by NICE covering a broad range of long term conditions.Main outcome measures The extent to which guideline recommendations consider multiple long term conditions and coexisting conditions, distinguishing between concordant conditions (those affecting the same organ system as the index condition) and discordant conditions (those affecting different systems).Results All but one of the NICE guidelines (n=55, 98%) included some advice on managing the index condition in the presence of coexisting conditions, and 50 (89%) guidelines offered general guidance on tailoring care. Only 11 (20%) guidelines, however, explicitly referred to multiple long term conditions, and none included a dedicated section on multiple long term conditions or how care should be adapted in this context. 19 (34%) guidelines featured sections looking at specific coexisting conditions or coexisting conditions generally. Coverage of coexisting conditions varied widely across categories of conditions, with mental health guidelines dealing with the most coexisting conditions (median 10, interquartile range (IQR) 4.5-14.75) in contrast with guidelines on cancer and eye disease covering the fewest conditions (median 3, 1-4.5; median 3, 2.25-2.75, respectively). Of the 397 possible concordant pairings, 120 (30%) were referenced, whereas of the 3859 possible discordant pairings, 259 (7%) were referenced, indicating greater coverage of same system combinations. Data on the composition of guideline committees showed wide variation in size, disciplinary diversity, inclusion of generalist clinicians (eg, general practitioners, general physicians, or others with no single specialty focus), and public contributors, although lived experience of multiple long term conditions was rarely specified.Conclusions Despite widespread acknowledgement of coexisting or multiple long term conditions, NICE guidelines are predominantly condition specific and offer limited tailored support for the care of multiple long term conditions. Recommendations rarely considered common condition clusters or the cumulative effect of multiple long term conditions. Structured improvements, such as clearer guidance on adapting care, broader cross condition referencing, and more transparent inclusion of lived experience could enhance the relevance and usability of guidelines for clinicians managing patients with multiple long term conditions
The Experiences of LGBTQ+ Pre-Service and Qualified Teachers and Their Mental Health: A Systematic Review of International Research
Full text linkExisting research highlights that Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) teachers are often exposed to additional stressors in schools which adversely affect their mental health. Some mitigate the effects of these stressors by separating their personal and professional identities while others choose to integrate their identities so that they can be authentic, advance social justice in school contexts or be visible and vocal role models. Less is known about the experiences of pre-service teachers who are undertaking teacher preparation programmes. This systematic literature review presents the results of 20 published papers which represent the global experiences of both pre-service teachers and serving teachers. The findings highlight identity management, experiences of discrimination, agency and lack of confidence of teacher educators. Two new frameworks are presented that lay the foundations for embedding LGBTQ+ inclusion and proposed mandatory elements of curricula for initial teacher training. This systematic literature review has been informed by the following research questions RQ1. What are the experiences of LGBTQ+ pre-service teachers? RQ2. How do LGBTQ+ pre-service teachers negotiate their identities? RQ3. How do LGBTQ+ pre-service teachers disrupt hetero/cis-normative cultures in schools? RQ4: How well does the teacher education programme prepare pre-service teachers for teaching LGBTQ+ inclusive education
Stature Estimation in Forensic Anthropology
Full text linkBackground: Stature estimation is a key parameter in biological profiling of human skeletal remains and thus in aiding in the identification process of the deceased. Various methods, including anatomical approaches, multifactorial regressions and organic correlation approaches, have been developed to estimate stature. Challenges arise from incomplete or altered remains, outdated reference samples, and the lack of population specific studies. This paper critically examines genetic influences and population-specific factors, the present status quo, recent developments and the challenges in stature estimation in forensic anthropology. Methods: The study appraises the current status, challenges, and future directions of stature estimation in forensic anthropology and bioarchaeology. The open-source literature is systematically identified, and relevant osteological and imaging-based studies are screened and prioritised when they report original empirical data or clearly defined methodological developments, enabling consistent extraction of sample and population descriptors, modelling strategies, and limitations. Included studies are then synthesised comparatively and summarised in a study table to support direct cross-study evaluation. Results: Stature estimation accuracy is shown to depend on population, ancestry, sex, time period, and environment, with cross-population or cross-temporal equation transfer identified as a key source of bias. Limitations include fragmented/altered remains and non-representative reference samples, while newer imaging and probabilistic approaches improve performance when supported by suitable data and explicit error quantification. Conclusions: In the present article, stature estimation is positioned as a context-dependent, evidence-weighted process rather than a fixed calculation
Creating space(s) for learning in prison: Developing an andragogical framework
No full textLearning in prison is too often excluded from wider discussions of educational experiences, process, and impact. This paper proposes, for the first time, an iterative andragogical framework to conceptualise learning spaces within prison contexts. The authors followed a shared reflective process, drawing on the principles of collaborative autoethnography to consider our collective experiences and insights as researchers and practitioners who have worked across a diverse range of learning spaces within prisons. Through this analysis, we found four intersecting andragogical considerations which we posit as fundamental to the curation of constructive learning spaces within prison contexts. The themes we present here are respecting the agency of participants, embedding co-production, and fostering trust and trustworthiness. In combination, these feed into an overarching theme which permeates the discussion: power. The article considers ways in which these themes shape the potential of learning spaces within prisons. These insights aim to spark further dialogue, inviting others to deepen, challenge, and evolve the propositions put forward in this framework
Towards a Strengths-Based Model for Evidencing Preventative Social Care
No full textSummary:Despite growing acknowledgement of the potential for strengths-based approaches to improve individuals’ well-being and create effective preventative support, their implementation is hindered by a lack of adequate theoretical conceptualization. In response, this article utilizes a series of research projects into second-wave prevention to develop a four-stage model which explains the difference strengths-based prevention makes and enables the evidencing of their outcomes and impacts.Findings:Through capturing the unique characteristics of strengths-based approaches, the model creates a framework for analysis and evaluation. It moves away from deficits-based, linear approaches toward reflecting the cyclical contexts of people's lives and the multiplicity of challenges at individual, community and service system levels which can trigger the need for support. It provides a framework for understanding how tailored support across these three levels can prevent individuals falling through the gaps of existing support and insulate them against future challenges.Applications:The strength-based model provides an innovative framework for understanding and evaluating the impact of strength-based prevention programs. This model has already been piloted in work within a number of local authorities and different types of prevention activity