23343 research outputs found
Sort by
Developing a surgical trial intervention protocol: using qualitative methods in the operating theatre
Get PDFINTRODUCTION: Surgery is a complex intervention, so it is important to establish standards for both the standard and 'novel' procedures in randomized controlled trials (RCTs) that demonstrate that interventions are delivered as intended to fully understand and explain trial results. This study set out to identify and agree the key steps of a surgical intervention to be tested in the 'near infrared fluorescent imaging in thyroid surgery' (NIFTy) RCT to inform development of the surgical protocol, and trial materials. METHOD: Qualitative case studies of surgeries were undertaken prior to undertaking an RCT to evaluate the potential of a device to reduce post-surgical hypoparathyroidism. Each case study involved non-participant observation, video capture of total and completion thyroidectomies, and interviews with surgeons. A typology of operative steps was constructed. Two surveys were undertaken (1) to identify current practice around parathyroid identification; and (2) to determine surgeon views on the surgical steps. An international expert panel of six clinicians met to review findings and agree on the surgical steps (mandatory/optional) for operations in the RCT, including timing for use of fluorescence and the data items to be collected. RESULTS: Ten case studies were undertaken. Video, observation and interview data found differences in surgical approach were driven only by pathology. A typology detailing the surgical steps and points where imaging could be used was developed. Sixty-four surgeons responded to survey 1; three-quarters always looked for parathyroid glands when operating. Forty surgeons responded to survey 2; capsular dissection of the thyroid lobe, preservation of parathyroid pedicle, and clinical assessment were important for parathyroid preservation. The expert panel agreed the key surgical components. These informed key data collection in NIFTy. Two specific surgical steps were strongly recommended and three mandated. CONCLUSION: Qualitative research in the operating theatre, prior to RCT allowed the identification of key components of the surgical intervention. The surveys and expert panel provided certainty about the acceptability of the surgical protocol and identified the core data to collect to evidence surgical decision making prior to embarking on the RCT. This qualitative process achieved clinical buy-in, improved trial conduct and allowed full explanation of the subsequent trial results. TRIAL REGISTRATION: ISRCTN59074092.Registration date: 07/03/2022
Optimising the implementation of research evidence in general practice: findings from the Optimal TIMES study
No full textBACKGROUND: While the need for applying research evidence to clinical practice is widely recognised, informing healthcare practitioners that an intervention is effective is not enough for them to deliver it. To improve implementation of research findings in general practice, we must gain a better understanding of how knowledge is discovered, generated, and incorporated by frontline staff in their daily work. AIM: To understand how primary care professionals use evidence and work individually, as well as with colleagues and patients, to manage complex chronic conditions. METHOD: Qualitative study involving observations of clinical consultations and practice meetings and focus groups with healthcare professionals across six primary care practices in Yorkshire. The data collection period is July 2024-November 2024. RESULTS: Preliminary results indicate that health professionals access and interpret knowledge drawing from various sources, from previous experience to fast-paced pattern identification using patients' key words in context, guided by resources (for example, checklists). Practice cultures that make room for research discussions help improve the critical use of evidence and foster the staff's collective confidence in a shared commitment to whole person medicine. CONCLUSION: The integration of experiential knowledge and collaborative real-time problem-solving highlights the complexity of decision-making in a fast-paced environment like primary care. To improve the implementation of research findings, strategic practice meetings that discuss new research, along with easily accessible and concise materials, are essential. These materials, however, can only act as guidance and need to be complemented by key knowledge of the patient's context
The Mischaracterization of Restorative Justice: Claims, Limits, and Potential
No full textDespite evidence that restorative justice delivers benefits for victims, offenders, schools, communities and societies, its potential to transform thinking and responses to harm and conflict remains unrealized. We assess how the restorative justice movement can step beyond self-referential claims made by its proponents to reconsider its spiritual and ideological underpinnings. Expanding previous arguments about the sociopolitical dynamics of restorative justice, we argue that its claim to be a progressive criminal legal strategy has been mischaracterized. Instead, we demonstrate that restorative justice can be understood as, (1) a spiritual healing practice that may in fact, (2) valorize neo-liberal ideology and, (3) conservative values ensconced within settler-colonial legacies of Eurocentric justice models
Revealing the effect of a hidden dimension on slug spatial distributions in arable fields
Get PDFThe movement and spatial distribution of the grey field slug (Deroceras reticulatum) in arable fields are investigated in ongoing interdisciplinary research motivated by the concept of targeted pesticide application in the population of slugs. The previous work suggested an explanation for the self-organized formation of a heterogeneous (patchy) spatial population distribution of slugs due to their density-dependent movement on the soil surface. This article reports new results of the study in which a vertical movement feature has been added to the baseline two-dimensional mathematical and computational model to see how it may contribute to the appearance and disappearance of slug patches in arable fields. A model of spatio-temporal dynamics of vertical movement is presented in the paper and correlation between spatial distributions of the slug population on and under the soil surface is investigated. It is explained how the probabilities of upward and downward movement in the new three-dimensional model impact the formation and stability of patchy spatial patterns overground and underground. It is suggested that the vertical movement of the slugs should be taken into account when evaluating the efficiency of pesticide application
Improving the reporting of primary care research: Consensus Reporting Items for Studies in Primary Care - the CRISP Statement
Get PDFPrimary care（PC）is a unique clinical specialty and research discipline with its own perspectives and methods. Research in this field uses varied research methods and study designs to investigate myriad topics. The diversity of PC presents challenges for reporting，and despite the proliferation of reporting guidelines，none focuses specifically on the needs of PC. The Consensus Reporting Items for Studies in Primary Care（CRISP）Checklist guides reporting of PC research to include the information needed by the diverse PC community，including practitioners，patients，and communities. CRISP complements current guidelines to enhance the reporting，dissemination，and application of PC research findings and results. Prior CRISP studies documented opportunities to improve research reporting in this field. Our surveys of the international，interdisciplinary，and interprofessional PC community identified essential items to include in PC research reports. A 2-round Delphi study identified a consensus list of items considered necessary. The CRISP Checklist contains 24 items that describe the research team，patients，study participants，health conditions，clinical encounters，care teams，interventions，study measures，settings of care，and implementation of findings/results in PC. Not every item applies to every study design or topic. The CRISP guidelines inform the design and reporting of（1）studies done by PC researchers，（2）studies done by other investigators in PC populations and settings，and（3）studies intended for application in PC practice. Improved reporting of the context of the clinical services and the process of research is critical to interpreting study findings/results and applying them to diverse populations and varied settings in PC
From Kingdom to Colony: Framing the English Conquest of Ireland
Get PDFThis article offers a new way of framing the English conquest of Ireland by focusing on the development of a kingdom of Ireland both before and after the invasion of 1169. It thus spans the historiographical divides that tend to partition Irish history at the point of the English invasion, and which also frequently disaggregate the study of British and Irish history. By exploring the complexity of Irish political society and culture before 1169, one can see how King Henry II sought to use its structures to facilitate his annexation of 'the kingdom of Ireland' in 1171-2. This included the Church, which offered Henry's dynasty the ideological support and legitimacy it had once provided for Gaelic kings of Ireland. Paying attention to the numerous references to the 'kingdom of Ireland' in the records of the English government also highlights the processes by which Henry's son John and his successors sought to Anglicise this kingdom by imposing England's laws, institutions and political culture upon it. Crucially, ultimate control of these structures remained with the administration in England, so in this way Ireland was transformed from a kingdom to a colony. Recognising this liminal period in the development of Anglo-Ireland provides context for the emerging colonial community in Ireland, as well as strategies of resistance and compromise employed by the Gaelic Irish under English rule
Unsupervised home-based exercise training can help improve symptoms of maternal physical discomfort during pregnancy
Get PDFThe meaning and use of weapons in an English remand prison
Get PDFPurpose: Weapon use is as risky in prison as it is in the community, but the type, use and meaning of weapons differ between these settings. Consequently, knowledge about community-based weapon violence may not generalise to prison contexts. The purpose of this study is to understand the meaning and use of weapons in a prison setting. Design/methodology/approach: Using a framework for understanding weapon selection derived from a community setting, six prisoners in a remand setting in England who had a history of weapon possession and use in prison discussed their selection and use of weapons in prison. Findings: Respondents described a hyperviolent milieu for some in which access to weapons was essential and wherein the official consequences of weapon carrying were outweighed by the potential costs of victimisation. Weapons served a variety of purposes for prisoners. At the individual level, they reduced the uncertainty of a hyperviolent environment, and they were used to construct and manage a violent identity as an aggressive precaution against victimisation. Originality/value: This study develops the literature on weapon decision-making, extending it into a novel setting and addresses a significant gap in the prison research literature about the meaning and utility of weapons in a custodial setting. The use of a community-derived framework for understanding weapon carrying translated well into a prison environment and offers support for the synthesis of community and prison models of violence but distinctive features of the prison environment, such as how weapons are acquired, limits the fit of the model to a prison setting
Cardiovascular Risk Biomarkers in Women with and Without Polycystic Ovary Syndrome
Get PDFObjective: Polycystic ovary syndrome (PCOS) is a prevalent metabolic disorder with an increased risk for cardiovascular disease (CVD) that is enhanced by obesity. This study sought to determine whether a panel of cardiovascular risk proteins (CVRPs) would be dysregulated in overweight/obese PCOS patients, highlighting potential biomarkers for CVD in PCOS. Methods: In this exploratory cross-sectional study, plasma levels of 54 CVRPs were analyzed in women with PCOS (n = 147) and controls (n = 97). CVRPs were measured using the SOMAscan proteomic platform (version 3.1), with significant proteins identified through linear models, regression analysis, and receiver operating characteristic (ROC) analysis. Analysis on BMI-matched subsets of the cohort were undertaken. Functional enrichment and protein–protein interaction analyses elucidated the pathways involved. Results: Eleven CVRPs were dysregulated in PCOS (whole set, without matching for body mass index (BMI) or insulin resistance (IR)): leptin, Interleukin-1 receptor antagonist protein (IL-1Ra), polymeric immunoglobulin receptor (PIGR), interleukin-18 receptor (IL-18Ra), C-C motif chemokine 3 (MIP-1a), and angiopoietin-1 (ANGPT1) were upregulated whilst advanced glycosylation end product-specific receptor, soluble (sRAGE), bone morphogenetic protein 6 (BMP6); growth/differentiation factor 2 (GDF2), superoxide dismutase [Mn] mitochondrial (MnSOD), and SLAM family member 5 (SLAF5) were downregulated versus the controls. In BMI-matched (overweight/obese, BMI ≥ 26 kg/m2) subset analysis, six CVRPs were common to the whole set: ANGPT1 and IL-1Ra were upregulated; and sRAGE, BMP6, GDF2, and Mn-SOD were downregulated. In addition, lymphotactin (XCL1) was upregulated and placenta growth factor (PIGF), alpha-L-iduronidase (IDUA), angiopoietin-1 receptor, and soluble (sTie-2) and macrophage metalloelastase (MMP12) were downregulated. A subset analysis of BMI-matched plus insulin resistance (IR)-matched women revealed only upregulation of tissue factor (TF) and renin in PCOS, potentially serving as biomarkers for cardiovascular risk in overweight/obese women with PCOS. Conclusions: A combination of upregulated obesity-related CVRPs (ANGPT1/IL/1Ra/XCL1) and downregulated cardioprotective proteins (sRAGE/BMP6/Mn-SOD/GDF2) in overweight/obese PCOS women may contribute to the increased risk for CVD. TF and renin upregulation observed in the BMI- and IR-matched limited sample PCOS subgroup indicates their potential risk of CVD
Self-assembly of defined core–shell ellipsoidal particles at liquid interfaces
Get PDFHypothesis: Ellipsoidal particles confined at liquid interfaces exhibit complex self-assembly due to quadrupolar capillary interactions, favouring either tip-to-tip or side-to-side configurations. However, predicting and controlling which structure forms remains challenging. We hypothesize that introducing a polymer-based soft shell around the particles will modulate these capillary interactions, providing a means to tune the preferred self-assembly configuration based on particle geometry and shell properties. Experiments: We fabricate core–shell ellipsoidal particles with defined aspect ratios and shell thickness through thermo-mechanical stretching. Using interfacial self-assembly experiments, we systematically explore how aspect ratio and shell thickness affect the self-assembly configurations. Monte Carlo simulations and theoretical calculations complement the experiments by mapping the phase diagram of thermodynamically preferred structures as a function of core–shell properties. Findings: Pure ellipsoidal particles without a shell consistently form side-to-side “chain-like” assemblies, regardless of aspect ratio. In contrast, core–shell ellipsoidal particles exhibit a transition from tip-to-tip “flower-like” arrangements to side-to-side structures as aspect ratio increases. The critical aspect ratio for this transition shifts with increasing shell thickness. Our results highlight how we can engineer the self-assembly of anisotropic particles at liquid interfaces by tuning their physicochemical properties such as aspect ratio and shell thickness, allowing the deterministic realization of distinct structural configurations