340880 research outputs found
Sort by
Pharmacy-led interventions to reverse and prevent prescribing cascades in primary care:a proof-of-concept study
No full textBackgroundPrescribing cascades occur in clinical practice when a medication causes an adverse drug reaction (ADR), which is addressed by prescribing additional medication.AimThe aim was to provide proof-of-concept for pharmacy-led interventions to reverse or prevent prescribing cascades.MethodTwo community pharmacies each tested two approaches. To reverse prescribing cascades, ten cascades were selected from literature. Dispensing records were screened to identify patients with these cascades. To prevent prescribing cascades, patients who started medications associated with five of these cascades were telephoned one month after their first dispensing to discuss ADRs. Pharmacists assessed the need to intervene together with prescribers. Primary outcome was the proportion of patients with a treatment change initiated. Secondary outcomes were time investment, potential cost-savings, and pharmacists' experiences.ResultsTo reverse prescribing cascades, 24 patients were included. For eight the prescriber was consulted, resulting in the reversal of three cascades. Forty-four patients were included to prevent prescribing cascades. Six of them experienced an ADR that could lead to a prescribing cascade. For two patients interventions were conducted to prevent this. The estimated time investment to identify patients possibly in need of intervention was 4.5 h for the reversing approach and 4.8 h for the preventing approach, while follow-up actions required 1.8 h and 0.5 h, respectively. Both approaches could be cost-saving. Pharmacists considered both approaches relevant but identified a knowledge gap on how to intervene for some cascades.ConclusionPharmacy-led interventions may reverse and prevent prescribing cascades, but more efficient screening methods and tools are needed before further implementation
Towards Consensus According to Experts on the Theorised Contribution of Vital Communities to Successful Ageing in Place:a Modified Delphi Study
No full textOlder people value their independence and prefer to live in an environment they are familiar with and can benefit substantially from vital communities. The objective of this study is to examine the theorised contribution of vital communities to successful ageing in place, as increasing numbers of older people in western societies, are living longer independently at home, while their need for support gradually increases. A modified Delphi study was conducted and consisted of two stages. In the first stage, we conducted two panel discussions in order to develop statements representing the theorised contribution of the features of vital communities to the key themes of ageing in place. This was followed by the second stage which had three online Delphi rounds, and which aimed to reach a consensus among 126 international experts concerning the theorised contribution. The findings of this study showed a consensus among the experts about aspects that show the positive contribution with regard to the aim of vital communities (quality of life, belonging), and all the key themes of ageing in place (place, technology, social networks, support, personal characteristics). However, experts nuanced the theorised contribution of the mechanisms and typical characteristics of vital communities and the key theme of technology. According to the experts, whether technology contribute depends on the skills of older people and the type of technology. The findings of this study imply that vital communities could facilitate older people to age in place for as long as possible, while maintaining their quality of life
Acceptability and fidelity of the multidomain 'Brain Bootcamp' dementia risk reduction program:a mixed-methods approach
No full textBackgroundInterventions targeting dementia prevention typically lack comprehensive exploration of feasibility, acceptability, and long-term translation factors prior to deployment. Our study aimed to explore the acceptability, fidelity and participants' experiences with Brain Bootcamp, a multi-domain behaviour change intervention targeting reduced dementia risk and increased dementia risk factor awareness for older adults.MethodsConducted in New South Wales, Australia, from January to August 2021, our concurrent single-group mixed-methods feasibility study involved post-intervention surveys and qualitative interviews with community-dwelling older adults. Descriptive statistics were used to assess acceptability of the methods, outcome measures, and fidelity to the program components. Thematic analysis of semi-structured interviews explored participant experiences, preferences, barriers, and recommendations.ResultsOut of 853 enrolled participants, only 355 completed the program (41.6%). Among these participants, 79.1% agreed that the intervention improved their awareness of dementia risk factors, and 92.4% expressed intent to continue maintaining brain healthy behaviours post- program. Participants typically set 2-4 modifiable risk factor lifestyle goals, which were most often related to physical activity (83.7%). A majority (91.5%) successfully achieved at least one brain health goal. Qualitative analyses (n = 195) identified three overarching themes on the role of education on behaviour modification (i.e., the transformative role of the program in enhancing knowledge about dementia prevention and fostering behavioral modifications), psychological considerations (e.g., intrinsic versus extrinsic motivation on their engagement and perception of the program) and future directions (e.g., sustainability concerns and the need for tailored strategies for specific demographics).ConclusionsWhile Brain Bootcamp had low completion rates, those who completed the program reported high acceptability. Future refinements, incorporating targeted strategies and enhanced participant support and communication, will facilitate pragmatic initiatives.Clinical trial numberACTRN12621000165886
Traditional and alternative scores in performance tests to measure executive functions:differential associations with children's academic performance
No full textThis study explores the relationship between children's academic performance and their results on cognitive function tests. Traditionally, cognitive test scores often reflect overall accuracy or speed. Yet, these overall scores are often influenced by both diverse executive functions (EF) and non-EF cognitive processes. To isolate specific cognitive functions, alternative scoring methods have been developed, which aim to measure one cognitive function more purely. We investigated whether combining traditional overall scores with alternative scores claiming to measure strategy use improves the prediction of children's academic performance. Three cognitive tests were administered: Verbal Fluency test, Design Fluency test, and Rey-Osterrieth Complex Figure test, alongside factors such as age, IQ, sex, and parental education, in a sample of 132 Dutch-speaking children (aged 9.48-12.63 years; 61 girls). For each test, we calculated traditional total scores and alternative scores. Academic performance was assessed using arithmetic and reading tests, along with secondary school advice. The findings indicate that both traditional and alternative scores positively correlate with secondary school advice and children's arithmetic and reading performance, but not with parental reports. Combining traditional and alternative scores enhances predictive accuracy for only arithmetic outcomes. However, once IQ was controlled for, the predictive value of alternative scores focused on strategy use diminished. Consequently, our findings suggest that combining both scoring methods can offer a superior prediction of academic outcomes, at least in arithmetic, underscoring their merit in psychodiagnostics assessment
Religion, Faith, and Spirituality as Barriers and Facilitators to Antiretroviral Therapy Initiation Among People with HIV in Indonesia
No full textIndonesia is a country deeply rooted in religion, faith, and spirituality. These aspects significantly determine individuals’ decision-making and behavior, including health care decisions. Given the suboptimal attainment of the HIV-cascade targets in the country, we conducted a study to explore the role of religion, faith, and spirituality on antiretroviral therapy (ART) initiation. Our study involved individual interviews with 67 participants recruited from community health centers, public hospitals, and private clinics, predominantly Muslim, including 17 untreated people with HIV (ART-naïve), 30 people with HIV on treatment (ART-experienced), and 20 HIV service providers. Findings revealed that many individuals perceived HIV as a godly punishment related to individual failure (prior risk-prone behaviors), generating shame, guilt, and stigma. Perceiving religion as punitive and unforgiving and holding fatalistic beliefs was linked to postponed ART initiation. Conversely, perceiving religion as loving and forgiving, seeking forgiveness through religious practices, viewing ART intake as a “collaborative” effort with God, and engaging in righteous deeds facilitated ART initiation. These findings indicated that religion, faith, and spirituality can serve as both barriers and facilitators to ART initiation, depending on individuals’ faith-based practices and perceptions of religion, whether punishing or forgiving. We recommend that people with HIV and health care providers better recognize the role of religion, faith, and spirituality in coping with shame, guilt, and stigma after an HIV diagnosis. This recognition can facilitate informed decisions regarding ART initiation, ultimately improving health outcomes for individuals with HIV in Indonesia.</p
Fully Autonomous Programming using Iterative Multi-Agent Debugging with Large Language Models
No full textProgram synthesis with Large Language Models (LLMs) suffers from a "near-miss syndrome": The generated code closely resembles a correct solution but fails unit tests due to minor errors. We address this with a multi-agent framework called Synthesize, Execute, Instruct, Debug, and Repair (SEIDR). Effectively applying SEIDR to instruction-tuned LLMs requires determining (a) optimal prompts for LLMs, (b) what ranking algorithm selects the best programs in debugging rounds, and (c) balancing the repair of unsuccessful programs with the generation of new ones. We empirically explore these tradeoffs by comparing replace-focused, repair-focused, and hybrid debug strategies. We also evaluate lexicase and tournament selection to rank candidates in each generation. On Program Synthesis Benchmark 2 (PSB2), our framework outperforms both conventional use of OpenAI Codex without a repair phase and traditional genetic programming approaches. SEIDR outperforms the use of an LLM alone, solving 18 problems in C++ and 20 in Python on PSB2 at least once across experiments. To assess generalizability, we employ GPT-3.5 and Llama 3 on the PSB2 and HumanEval-X benchmarks. Although SEIDR with these models does not surpass current state-of-the-art methods on the Python benchmarks, the results on HumanEval-C++ are promising. SEIDR with Llama 3-8B achieves an average pass@100 of 84.2%. Across all SEIDR runs, 163 of 164 problems are solved at least once with GPT-3.5 in HumanEval-C++, and 162 of 164 with the smaller Llama 3-8B. We conclude that SEIDR effectively overcomes the near-miss syndrome in program synthesis with LLMs.</p
Grade retention during compulsory school education in Europe:regulations and practices
No full textEn Europe, de nombreux élèves sont retenus. Ce rapport examine les réglementations et les pratiques concernant le redoublement dans les 37 pays du réseau Eurydice, via une analyse de documents, des questionnaires et une analyse secondaire des données PISA, en soulignant des points communs et des différences intéressantes
Proactive robot task sequencing through real-time hand motion prediction in human-robot collaboration
No full textHuman-robot collaboration (HRC) is essential for improving productivity and safety across various industries. While reactive motion re-planning strategies are useful, there is a growing demand for proactive methods that predict human intentions to enable more efficient collaboration. This study addresses this need by introducing a framework that combines deep learning-based human hand trajectory forecasting with heuristic optimization for robotic task sequencing. The deep learning model advances real-time hand position forecasting using a multi-task learning loss to account for both hand positions and contact delay regression, achieving stateof-the-art performance on the Ego4D Future Hand Prediction benchmark. By integrating hand trajectory predictions into task planning, the framework offers a cohesive solution for HRC. To optimize task sequencing, the framework incorporates a Dynamic Variable Neighborhood Search (DynamicVNS) heuristic algorithm, which allows robots to pre-plan task sequences and avoid potential collisions with human hand positions. DynamicVNS provides significant computational advantages over the generalized VNS method. The framework was validated on a UR10e robot performing a visual inspection task in a HRC scenario, where the robot effectively anticipated and responded to human hand movements in a shared workspace. Experimental results highlight the system's effectiveness and potential to enhance HRC in industrial settings by combining predictive accuracy and task planning efficiency
Assessing the environmental impact of coronary artery bypass grafting to decrease its footprint
No full textOBJECTIVES An urgent transition to environmentally sustainable healthcare is required. The purpose of this study was to identify key areas for environmental impact mitigation for a coronary artery bypass grafting trajectory.METHODS An ISO14040/44 standardized life cycle assessment was conducted for the functional unit of an individual patient trajectory of elective coronary artery bypass grafting surgery, from operating room admission until intensive care unit discharge. Data were collected for products, processes, and services required for care delivery in a Dutch academic hospital for 12 patients. The environmental impact was calculated using the ReCiPe 2016 method.RESULTS A single patient trajectory caused 414 [IQR 383-461] kgCO2 equivalents of global warming, equal to 2753 km of driving an average Dutch petrol-fuelled car. Other notable environmental impacts were fine particulate matter, (non-)carcinogenic toxicity, land use, and terrestrial acidification. Operating room disposable products (162 kgCO2eq), energy use (48 kgCO2eq), and employee commute (36 kgCO2eq) contributed most to global warming. The extracorporeal circulation set, surgical drapes, intraoperative salvage set, surgical gowns, and cotton gauzes caused most of the disposables' environmental impact. Most energy use occurred in the operating room via heating, ventilation, and air conditioning.CONCLUSIONS A coronary artery bypass grafting trajectory's environmental impact primarily contributed to global warming. Most impact mitigation could be achieved by avoiding/reducing disposable product use when possible or replacing these with reusables. Optimizing operating room energy systems, switching to renewable energy, and encouraging low-emission employee commute can further reduce the environmental impact.Human-induced environmental harms, such as climate change and air pollution, have significant implications for global health and require urgent action [1]