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Integrating Clinical Pharmacists in Cancer Care:The PharmaCAP Model for Improving Pain Management in Low-Resource Settings
Get PDF"Parental mental ill-health::experiences of navigating multiple services, a systematic review conducted by learnt and lived experience researchers."
No full textBackground. Families in which a parent experiences mental ill-health often face complex and evolving challenges, with individual family members’ needs impacting one another across generations. Accessing appropriate support frequently requires the navigation of multiple services and systems, which can be overwhelming for both families and professionals, potentially leading to barriers in care. To address the challenges inherent with navigating complex systems of care it is imperative that the experiences of individuals using these services are understood. The aim of this paper is to review qualitative studies of family members' experiences of accessing multiple services.Methods. A multidisciplinary research team with both learnt and lived experience of parental mental illness conducted a systematic review using PsycINFO, Academic Search Ultimate, Complementary index, Medline Ultimate, CINAHL, ERIC and Scopus databases. Studies were screened according to predefined inclusion criteria. Quality assessment was undertaken using an expanded version of the Critical Appraisal Skills Programme (CASP) Qualitative Studies Checklist. Findings were thematically synthesized using a reflexive thematic analysis approach.Results. While no studies were found that directly addressed the navigation of complex support systems, sixteen papers were identified that explored experiences related to receiving or engaging with multiple services (N = 417). Inhibiting and enabling factors were identified at an individual and systemic level highlighting key considerations for service design and deliveryConclusion. The limited research in this area indicates a pressing need to understand the experiences of individuals, families and professionals navigating complex and often contradictory systems of care. This review highlights a critical gap in the literature and emphasizes the value of lived experience in research. Future work must centre the voices of all family members to develop coordinated, responsive and effective systems of care. Integrating insights from those directly affected can lead to more family-centred care models, ultimately improving health outcomes and service delivery for all family members
Pharmacological Enhancement of Integrated Stress Response Confers Protection in Calcific Aortic Valve Disease
Get PDFPrevious studies have shown that Nox4 activates eIF2α/ATF4 signaling during the integrated stress response (ISR) and protects heart injury. However, their roles in calcific aortic valve disease (CAVD) remain unclear. Here, we show that both ATF4 and Nox4 are up-regulated in porcine aortic valve interstitial cells (AVIC) and in human aortic valves with CAVD. Nox4 knockdown promotes while Nox4 overexpression suppresses CAVD by modulating ISR. Importantly, ISR activators Guanabenz and Sephin1 effectively attenuate AVIC osteoblastic-like differentiation and mitigate CAVD in rabbits and mice, respectively. These findings highlight that pharmacological enhancement of the ISR is a promising therapeutic strategy for CAVD.</p
“With a Little Help from My Friends”:Co-Creating Belonging in Higher Education
Get PDFUniversities are increasingly seeking ways to build students’ sense of belonging. This paper reports a mixed-methods evaluation of BE At King’s, a seed-funded programme supporting grassroots, co-created initiatives to strengthen connection and inclusion across a large, multi-campus institution. Five projects—ranging from art clubs and community breakfasts to hackathons and writing retreats—were designed and delivered by students and staff, with evaluation embedded from the outset. Quantitative survey data (n = 202) showed high levels of belonging overall, with structured, interactive initiatives most strongly associated with meeting new people and feeling connected. Qualitative thematic analysis highlighted four themes—Refreshing Routines, Inclusive Conditions, Community Leadership, and Layered Engagement—revealing how belonging was fostered through predictable routines, psychologically safe spaces, and opportunities for shared ownership. Bringing findings together shows that grassroots initiatives can engage even less-connected students, but that careful design, inclusive outreach, and sustained facilitation are critical to their success. We argue that universities should embed belonging within the everyday fabric of institutional life through co-produced, flexible, and locally responsive approaches that combine institutional commitment with community leadership
Prognostic value of flow cytometry in myelodysplastic neoplasms (MDS):Composition of a FCM-prognostic score (FCM-PS) for overall survival
Get PDFFlow cytometry (FCM) is a co-criterion in myelodysplastic neoplasms (MDS) diagnostics, currently not used for prognostication. This study aimed to develop an FCM-score predicting overall survival (OS) in MDS to improve early clinical patient prognostication. FCM of bone marrow samples was performed for diagnostic purposes in 509 therapy-naïve MDS patients and 77 healthy donors. The following methodology was used: (1) uni- and multivariate Cox proportional hazards regression and Kaplan-Meier curves for OS to assess FCM-parameters' prognostic value; (2) receiver operating characteristic (ROC) curves to test the prognostic superiority of FCM-parameters versus established FCM-scores and clinical risk-scores; and (3) development of a FCM-prognostic score (FCM-PS) based on six FCM-parameters with independent prognostic impact. The final FCM-PS included aberrancies of progenitor cells (increased CD45 mean fluorescence intensity [MFI]-ratio of lymphocytes and myeloid progenitor cells, decreased % of lymphatic progenitor cells), granulopoiesis (increased CD33 MFI, decreased sideward scatter [SSC]-ratio of granulopoiesis and lymphocytes), lymphocytes (increased % of B-lymphocytes), and plasmacytoid dendritic cells (increased %). FCM-PS outperformed established scores for OS (hazard ratio [HR] 4.08 [95% CI 2.54-6.55] vs. Ogata-score: 2.44 [1.61-3.70], International Prognostic Scoring System-Revised [IPSS-R]: 2.37 [1.61-3.49], International Prognostic Scoring System-Molecular [IPSS-M]: 0.816 [0.303-2.196]). Patients in the FCM-PS low score category showed significantly better OS (P < 0.0001). Further, FCM-PS allowed discrimination within IPSS-R area under the curve [AUC]: 0.70 vs. 0.62) and IPSS-M (AUC: 0.75 vs. 0.48) subgroups. Validation of the prognostic FCM-PS in an independent patient cohort confirmed good discrimination performance (AUC: 0.70). We introduce a unique, easy-to-use prognostic FCM-PS score (panel: CD45/CD34/CD117/CD33/CD19/CD123/HLA-DR) for OS in MDS, allowing refined risk stratification for IPSS-R subgroups.</p
Characteristics of mental health service users attending Recovery Colleges in England: Baseline findings from Recovery Colleges Characterisation and Testing (RECOLLECT) 2
Get PDFAims and Method: Recovery Colleges (RCs) are adult education initiatives supporting personal recovery for individuals with mental health difficulties. We characterised a national inception cohort of mental health service users RC students from the RECOLLECT 2 programme and compared students attending different RC types on sociodemographic, clinical, service use, and student-reported outcomes over the four months prior to enrolment. Mixed effects regression models assessed differences.Results: The cohort comprised 498 students from 36 RCs across England; 77.7% attended Strengths-oriented RCs. Mean age was 39 years (SD=12); most were female (72.1%) and White (81.5%). Common diagnoses were mood (31.3%) and anxiety disorders (29.7%). No significant differences were found between students attending Strengths-oriented versus Community-oriented RCs.Clinical implications: Strengths- and Community-oriented RCs have similar service user student populations. Certain groups which may be underrepresented in RCs and RC research include older adults, men, those with developmental disorders, and ethnic minority populations.<br/
A phase transition for the biased tree-builder random walk
Get PDFWe consider a recent model of random walk that recursively grows the network on which it evolves, namely the Tree Builder Random Walk (TBRW). We introduce a bias ρ ∈ (0,∞) towards the root, and exhibit a phase transition for transience/recurrence at a critical threshold ρc=1+2¯¯¯ν, where ¯¯¯ν is the (possibly infinite) expected number of new leaves attached to the walker’s position at each step. This generalizes previously known results, which focused on the unbiased case ρ=1.The proofs rely on a recursive analysis of the local times of the walk at each vertex of the tree, after a given number of returns to the root.We moreover characterize the strength of the transience (law of large numbers and central limit theorem with positive speed) via standard arguments, establish recurrence at ρc, and show a condensation phenomenon in the non-critical recurrent case
The expanding role of Nogo-B in hypertension:linking kidney physiology, endothelial function and inflammation
Get PDFAlthough Nogo-B has been studied in neural development and vascular biology, its integrative role across renal, vascular and inflammatory pathways in hypertension has not yet been systematically reviewed. Here, we synthesize emerging evidence positioning Nogo-B as a central modulator of blood pressure control. Its expression in the aldosterone-sensitive distal nephron and vascular endothelium suggests a central role in electrolyte and fluid balance, as well as vascular physiology.</p
Real world evidence versus randomised controlled trials:is the future of nutritional sciences research in electronic health records?
Get PDFRandomised controlled trials (RCTs) are the gold standard of research studies. They aim to recruit participants with similar characteristics and randomly assign them to a treatment or control/placebo arm. Due to randomisation, RCTs provide comprehensive, unbiased evidence about treatment efficacy and safety and examine cause-and-effect relationships between the intervention and outcome. However, RCTs are expensive, recruitment can be time-consuming and high drop-out rates can reduce internal validity. Depending on the target population, findings are not always generalisable at a population level. Of relevance to nutritional sciences, due to the type of research questions, researchers and participants cannot always be blinded to randomisation. Electronic health records (EHRs) provide a possible solution to some of these constraints. Using data from healthcare systems, may help to reduce costs and overcome logistical challenges as (1) pragmatic trials integrated into routine care enable real-time data analysis and faster translation of findings and (2) once dynamic longitudinal cohorts have been generated, they can be analysed using quasi-experimental designs. These have the potential to provide population level data with higher generalisability, lower attrition, and greater statistical power. EHRs do come with their own challenges, including the lack of a uniform information infrastructure, missing data and data quality. There are also ethical considerations, as patients may not wish for their data to be used in a research capacity, which in turn can affect the generalisability of findings.When it comes to nutritional sciences and generating evidence, there is no one-size fits all approach. EHRs offer great potential for advancing certain research questions, such as when there is a population level intervention, e.g. the soft drinks industry levy or the inclusion of folic acid in non-wholemeal wheat flour. EHRs offer the opportunity to integrate multiple datasets which will enable a comprehensive understanding of a nutrition intervention impact on health and disease in diverse populations and real-world settings. However, RCTs remain imperative for understanding causality. The scope of this review is to examine how RCTs and EHRs can be used to generate evidence in nutritional sciences, highlighting their respective opportunities and challenges