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A mixed-methods multi-site case study of a person-centred intervention for constant observation in hospitals with people living with dementia
No full textIntroduction
Constant observation is widely used with people living with dementia admitted to hospital when identified at risk of harm to themselves or others. Staff allocated to closely monitor individual or small groups of patients intervene when there are safety concerns and may engage with patients’ psychosocial needs. However, care is inconsistent and dependent upon individual and organisational factors. This study aimed to understand the work of implementing a co-designed intervention for facilitating person-centred approaches during constant observation practices.
Methods
A convergent parallel mixed-methods multi-site case study was adopted to explore implementation over 12 weeks in three English hospitals. The study recruited participants from six wards and one hospital-wide team. Qualitative and quantitative data involved: i) observations of staff-patient interactions (four time points), ii) in-depth interviews with hospital staff (one time point) iii) staff surveys (two time points). Qualitative data analysis was organised using Normalisation Process Theory to map and understand the implementation process. NOrmalisation MeAsure Development (NoMAD) survey data were analysed using descriptive statistics.
Findings
We recruited 163 participants – staff (n = 88), people living with dementia (n = 71), family supporters (n = 4). The intervention was well received and considered useful by staff. Incremental changes, such as staff initiating non-task related conversations with patients and using tools to inform actions for reducing distress, were observed. However, establishing the importance of psychosocial, alongside physical and medical, needs was not achieved. Staff found it difficult to challenge the dominance of medical management and organisations’ priorities to minimise risk. Fears that discussions about constant observation with family supporters might upset them or result in accusations of inadequate care inhibited work to collect and share potentially useful information.
Conclusion
The intervention endorsed and supported staff to focus on the quality of their care work; this was not usual practice. Routine use was impacted by prior knowledge of dementia, how the intervention aligned with ward practice and competing priorities. Additional work is required to support the shift from work organised as a reaction to urgent, risky situations to work that supports prevention and enhances care
Conceptualizing and Problematizing Inclusion Porn in Education Scholarship and Practice
No full textDiscourses of inclusion are currently used without clear and consistent meaning and multiple and varied interpretations exist, therefore stunting our ability to enhance or utilize the concept in social justice and education scholarship and practice. In this article, we argue that the ambiguous, conflicting, and contested features of inclusion have opened a door for nondisabled policy makers, academics, practitioners, and other stakeholders to exploit the concept of inclusion by crafting the logics and taken-for-granted assumptions that become associated with it. Accordingly, these nondisabled stakeholders gain social, cultural, and symbolic capital in the fields that they operate, while (some) disabled students are objectification and exploited. Accordingly, we utilize existing empirical literature to conceptualize and problematize inclusion porn in education scholarship and practice through a comparison to the key features of porn. We do this to offer inclusion porn as a conceptual tool for education practitioners and scholars to think with so that they can reflexively consider and interrogate their own ideologies, discourses, practices, and common-sense logics relating to ‘inclusion’
Digital platform capabilities and circular economy: Impact of customer green pressure on frugal innovative strategies
No full textManufacturing entities in emerging economies face significant obstacles implementing circular economy principles due to resource-constrained environments. Arguably manufacturers need customer green pressure to propel the circular economy, alongside frugal innovative strategies. There is a dearth of research on digital platform (DP) capabilities, customer green pressure and frugal innovative strategies with circular economy. Drawing on dynamic capabilities theory, 889 manufacturers were surveyed in the emerging economy of India. Customer green pressure moderation was assessed on the links between frugal innovative strategies and circular economy, DP integration capabilities and frugal innovation, and DP reconfiguration capabilities and frugal innovative strategies. Structural equation modelling revealed, DP integration and reconfiguration capabilities positively influence frugal innovation strategies enabling circular economy performance. Customer green pressure positively moderated DP reconfiguration and frugal innovative strategies. Actionable insights are provided to prioritize DP capability development to satisfy customer green pressure and promote frugal innovative strategies, ultimately facilitating the circular economy
Giving Voice to High-Performance Sports Coaches to Spotlight Their Perceptions of Psychological Well-Being
Get PDFHigh-performance sports coaches work in achievement-oriented environments that have the potential to enhance or undermine psychological well-being (PWB). Despite context-specific understanding of PWB being important, we know little about what PWB means to high-performance coaches and have minimal understanding of how to help coaches and governing bodies to nourish and protect PWB. Underpinned by our constructivist paradigm and our relativist and subjectivist onto-epistemological stance, we worked with eight high-performance sports coaches to: 1) qualitatively explore what PWB means to high-performance coaches to generate new understanding of the fundamentally important elements of their PWB and 2) build a clearer picture of factors that facilitate and or inhibit coaches' PWB. Using reflexive thematic analysis, we constructed six themes from data collected via semi-structured interviews: 1) from balance to self-awareness: PWB means something different to everyone; 2) curiosity fuels development of self and others, which builds PWB; 3) enjoyment of coaching and escapism from it sustain PWB; 4) being surrounded by good people and seeing them achieve are routes to happiness; 5) coaching can feel like being “stuck in the trenches” whilst waiting to be found out as a fraud; and 6) boundary management is a form of self-preservation that protects PWB. These findings give voice to high-performance sports coaches' understanding of PWB, help to develop an evidence base from which individualized interventions can be developed, and promote the need for systemic changes in sport that will help coaches to live well and be well
A secure medical image encryption technique based on DNA cryptography with elliptic curves
Get PDFHealth services and telemedicine have proven to be an important area for information protection in research, especially with medical services and smart health care applications. In these systems, medical imaging protection are important not only for clinical diagnosis, but also to protect the very sensitive and confidential patient data. With progress in imaging technologies and biomedical processing algorithms, the amount of image data increases rapidly. However, securing this information while transferring through insecure channel is still a constant challenge. Existing encryption techniques often face limitations such as high computational complexity, insufficient security against advanced cryptographic attacks, poor reversal and pixel correlation. To overcome these challenges, the proposed approach provides an innovative hybrid encryption technique that integrates DNA cryptography with Elliptical Curve Cryptography (ECC). The DNA-based coding shows high randomness and equality while the ECC provides strong security and confidentiality. The DNA encoding and secure key generation are employed in the proposed technique to obtain the encrypted medical image. The combination of these techniques addresses the main boundaries of existing disadvantage by increasing both security and calculation efficiency, making it well suited for real time medical applications. The experimental analysis was carried out with various parameters like histogram analysis, correlation coefficient, Chi square, MSE, PSNR, entropy etc. The result analysis states that the proposed methodology outperforms the state-of-the-art existing methods with enhanced performance such as entropy of 7.9981, Correlation coefficient of 0.0019 and PSNR of 53.97. Also, the proposed methodology is tested for runtime analysis, memory analysis and security analysis
Unequal Opportunities? Examining Gender, Financial Access, and Innovation in UAE Digital Entrepreneurship
No full textThis study examines gender dynamics in digital entrepreneurship in the United Arab Emirates (UAE), focusing on the challenges and opportunities encountered by male and female entrepreneurs. Drawing on institutional and gender role theories, the research explores how financial resources, technological development, and entrepreneurial networking impact entrepreneurial success and innovation capability. Using a quantitative approach, data from 400 entrepreneurs in the UAE digital sector were analyzed through structural equation modeling (SEM). The findings reveal that access to financial resources, technological development, and networking significantly influence entrepreneurial success, but their impact is stronger for male entrepreneurs due to societal norms and structural advantages. Female entrepreneurs face restrictive cultural barriers, particularly regarding access to financial resources and digital tools, which moderate their entrepreneurial success negatively. Innovation capability emerges as a key mediator in entrepreneurial success for both genders. The study highlights the need for gender-sensitive policies that enhance financial accessibility, technological literacy, and networking opportunities for female entrepreneurs. By providing empirical evidence from a Middle Eastern context, this research contributes to the broader discourse on gender disparities in digital entrepreneurship and offers policy recommendations to foster a more inclusive entrepreneurial ecosystem. Future studies should explore cross-cultural comparisons and longitudinal analyses to deepen insights into the evolving gender dynamics in digital entrepreneurship
Finding the Line Between Avoidant/Restrictive Food Intake Disorder and Refractory Disorders of Gut–Brain Interaction Using Lenient vs. Strict Severity Criteria: A Retrospective Exploratory Analysis From a Single Tertiary Neurogastroenterology Centre
No full textBackground
Avoidant/restrictive food intake disorder (ARFID) is common among adults with disorders of gut–brain interaction (DGBI) presenting to gastroenterology settings. Symptoms overlap between ARFID and DGBI. How the severity of ARFID is defined can impact rates of diagnosis. Importantly, a diagnosis of ARFID can only be applied when the eating disturbance exceeds that expected from the DGBI condition. This leads to diagnostic challenges for the gastroenterology team. We aimed to explore how we could better identify “ARFID presentation” by reaching a clinically meaningful cut‐off and distinct categories for separating DGBI from ARFID and where DGBI and ARFID overlap.
Methods
A retrospective review of electronic health records (EHR) was conducted on 33 patients 88% female (29/33), with a median age of 44.3 ± 15.5 (range 18–73 years). All had a Rome IV diagnosed DGBI and were refractory to standard medical care, requiring both gastro‐psychology and dietitian input in a tertiary care Neurogastroenterology service during 2019. Severity criteria for meeting either strict or lenient ARFID criteria A were defined based on DSM‐5 and best practice recommendations.
Results
The majority (82%) met a form of ARFID criteria A. However, by applying severity levels, 33% met criteria for strict ARFID, while 49% met lenient criteria, and 18% did not meet any criteria.
Discussion
Adults with refractory DGBI who require both dietetic and psychological support can meet both lenient and strict ARFID severity criteria. Future research should explore if utilizing severity markers can help separate the heterogeneity of DGBI + ARFID and inform diagnostic and treatment approaches
Modelling Inclusion: Using Participatory Methods for Equitable Research on Inequalities in Marginalized Groups
No full textThis paper explores the methodological implications, processes, and opportunities re-lating to the use of participatory approaches in the study of intersecting inequalities. Within the context of an international, interdisciplinary project (Partnerships for Equality and Inclusion (PEI)), four sub-projects elected to use participatory methodolo-gies to engage with marginalized and excluded communities so that their needs, voices, and knowledge were included in the data collection process and the dissemination of findings at micro (community) and macro (policy) levels. The four project teams in Kenya, Vietnam, Myanmar, and Nigeria engaged with training and research processes so that participants with lived experience could contribute both as peer researchers and in focus groups that contributed study data. In this paper, we bring together the findings and learning from each project about how these methods contributed to equity in the research process. We conclude with insights and recommendations on how participatory methods can enable an intersectional and grounded perspective from people facing multiple inequalities in periods of crisis and political change
Integrated methods for public health action tracking (IMPAcT): to understand and evaluate systems change in a public health context
No full textBackground
Approaches from systems science are increasingly being trialed in public health because the drivers of poor health are complex, unpredictable and difficult to disentangle. While a broad range of methods is available to study systems science, one method alone is often insufficient for evaluation, as each offer only a limited perspective. Yet, few examples exist showing how several methods can be pragmatically integrated to generate new and meaningful insights, which is vital within systems changes. This paper describes, exemplifies and discusses the Integrated Methods for Public Health action Tracking (IMPAcT) process, which integrates group model building, Causal Loop Diagramming (CLD), the Action Scales Model (ASM), an Action Registry (AR) and Ripple Effects Mapping (REM), to better understand and address complexity within public health interventions.
Methods
We used common approaches for understanding system organization and interconnections (e.g. through CLD), identifying places to intervene in the system (e.g. ASM), tracking actions implemented within the system (e.g. REM) and understanding the impact at individual level of actions. We illustrate how the IMPAcT process can be applied via a case from a Danish project, the Healthy Active Children Study.
Results
We present a development process, that combines the above-mentioned approaches, to capture the behaviour, and allow tracking and evaluation of a system following several intervention efforts. Integrating complementary, participatory methods enabled a formative evaluation process that supported continuous learning, adaptation and improvement across complex systems. In the IMPAcT process, methods served both as evaluation tools and as means of stakeholder engagement and knowledge co-production. Embedding reflection and dialogue allowed stakeholders to examine practice and shape next steps. Visuals and narratives enhanced the clarity and impact of the evaluation.
Conclusions
The new process supports both those working at the front-line of systems change efforts, but also researchers, municipality staff and none the least, policymakers
The case for transforming SME research in tourism implications for policy, theory, evidence and impact
No full textPurpose
Small and medium-sized enterprises (SMEs) in tourism have attracted the attention of both policymakers and academic researchers. Yet, there is little evidence to suggest that the work of the former is influenced to a significant extent by the advances in knowledge claimed by the latter. The study’s critique, supported by a narrative review of the literature, is twofold. Firstly, that the literature contains a degree of conceptual inconsistency on matters of substance affecting SMEs and that this weakens the clarity of analysis offered by academic researchers. Secondly, there has been limited research progress made on issues of fundamental importance to policymakers, and that significant gaps in understanding of other topics relating to tourism SMEs remain. This paper aims to enhance the ability of academic researchers to influence policymakers and the practice of SMEs by promoting the consistent use of foundational (or no longer contested) knowledge, reviewing where academic research has enhanced understanding and identifying research priorities. It demonstrates that a complex interplay of factors affects SME behaviour in various contexts and advocates greater innovation in theorising SMEs. The paper has implications for policymakers as well as for academic researchers
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