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Contextual Adaptation of a Complex Intervention for the Management of Cancer Pain in Oncology Outpatient Services:A Case Study Example of Applying the ADAPT Guidelines
No full textObjectivesStandardising pain assessment in oncology outpatient services (OOS) leads to improvements in patients' pain and quality of life. The Edinburgh Pain Assessment Tool (EPAT) is a standardised cancer pain management tool that has been implemented on inpatient oncology wards (the original setting). Routine use of EPAT reduced post-surgical pain in cancer patients (the original scenario) and led to more appropriate analgesic prescribing. We describe here a case study of adapting the EPAT intervention for use in tertiary OOS in the United Kingdom (UK) National Health Services (NHS), using the ADAPT guidelines.MethodsThe adaptation process followed Moore et al.'s ADAPT guidance: Step 1: We assessed rationale for adapting EPAT by reviewing existing literature of pain management in OOS. Step 2: Semi-structured interviews with 20-healthcare professionals (HCPs) to understand current practice and how the intervention might fit the new context (OOS). Step 3: Identified the ‘core’ and ‘peripheral’ components of EPAT, undertook four co-design workshops with 7-HCPs to reconfigure EPAT to fit OOS (adapted version is referred to as EPAT+). Four HCPs trialled the EPAT+ intervention in practice to refine the intervention.ResultsCombining qualitative data from interviews with feedback from the co-design workshops and preliminary testing the prototype intervention highlighted several key adaptation goals for EPAT+. These included: (1) reduce length/time to complete EPAT+ due to time constraints in outpatient appointments, (2) the importance of pain re-assessment and using EPAT to facilitate patients to self-monitor their pain at home, and (3) the creation of new peripheral components to support communication with primary care providers.ConclusionsUsing a theoretical driven conceptual guidance provided important learning on how to adapt an existing cancer pain management tool to a new setting (OOS). The result is a novel complex theory- and evidence-based intervention that will be formally tested in a cluster randomised pilot trial
Effects of community-based rehabilitation on caregivers of people with schizophrenia in Ethiopia in the RISE trial
No full textRCPE in association with the American College of Gastroenterology and the Scottish Society of Gastroenterology::A Global Perspective
No full textOn November 6, 2024, the Royal College of Physicians of Edinburgh (RCPE) hosted its annualgastroenterology symposium, marking the first collaboration with the American College ofGastroenterology (ACG) and the Scottish Society of Gastroenterology (SSG). The event addressed key global challenges in gastroenterology, including obesity, liver disease, inflammatory bowel disease (IBD), the gut microbiome, endoscopy quality, and artificial intelligence (AI) applications. Discussions emphasized the growing burden of metabolic dysfunction-associated steatotic liver disease (MASLD), with promising pharmacologic and endoscopic interventions emerging. Advances in microbiome-targeted therapies, including faecal microbiota transplantation (FMT), were explored for recurrent Clostridium difficile infection and IBD. Professor David Rubin delivered the esteemed Sir Stanley Davidson Lecture, highlighting the era of disease modification in IBD, emphasizing early intervention and personalized treatment strategies. The symposium also addressed the role of AI inimproving endoscopic detection rates and optimizing resource allocation. This international collaboration underscored the importance of a multidisciplinary approach to tackling globaldigestive diseases, integrating clinical innovation, policy interventions, and technological advancements. The event fostered knowledge exchange among global experts, aiming toadvance patient care and improve long-term outcomes in gastroenterology
Absorbing-state transitions in particulate systems under spatially varying driving
No full textNon-equilibrium transitions into absorbing states are widespread, and amorphous materials under cyclic shear have emerged as useful model systems in which to study their properties. Recent work has focused on homogeneous driving in which the shear amplitude is uniform in space, despite most real world flows involving spatially inhomogeneous conditions that are known to produce qualitatively distinct phenomenology. Here we study the absorbing state transition under inhomogeneous driving using a modified random organization model. For smoothly varying driving the steady state results map onto the homogeneous absorbing state phase diagram, with the position of the boundary between absorbing and diffusive states being insensitive to the driving wavelength. The phenomenology is well-described by a one-dimensional generalized continuum model that we pose. For discontinuously varying driving the position of the absorbing phase boundary and the exponent characterising the fraction of active particles are altered relative to the homogeneous case.</p
Decarbonising non-domestic buildings at scale − A systematic review
No full textThe imperative for decarbonization demands the swift realization of net-zero buildings by 2050. Significant efforts have been directed at new buildings but, looking ahead, there is a need to shift towards whole-life management given buildings’ extensive lifetimes. With this objective in mind, this paper delves into scalable strategies for decarbonizing building stocks by conducting a systematic literature review concentrated on the in-use life cycle stage of buildings. Its scope is non-domestic building portfolios, a complex, under-researched stock that features dedicated teams overseeing their maintenance and operation – a management approach ideally placed to address sustainability challenges. Recent literature is analysed according to assessment of building portfolios, intervention types, and roll-out mechanisms. This is then complemented with non-academic literature and governmental initiatives worldwide. Findings highlight challenges in understanding the performance of buildings in sufficient detail to inform effective retrofit planning and financing interventions. Fabric-first approaches, while desirable for their multiple benefits beyond reduced environmental impacts, do not necessarily arise as the most economically competitive measures. In contrast, just understanding and optimising energy use is reported to deliver 20% energy savings cost-effectively. Overall, findings highlight challenges and opportunities associated with proactive management of buildings alongside areas for future research
“Empty action: two heads are better than one”:Spiritual care provision for patients living with advanced cancer in Sub-Saharan Africa: A meta-synthesis
No full textPurpose: This meta-synthesis seeks to explore spiritual care provision by healthcare professionals and spiritual leaders to patients with advanced cancer and their families in Sub–Saharan Africa. Methods: Studies were searched and retrieved from MEDLINE, EMBASE, PsycINFO, CINAHL, Global Health, Web of Science, and the Africa Index Medicus databases. The search was conducted on November 10, 2023 and repeated on October 18, 2024. This meta-synthesis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statements. Two authors independently conducted the screening and data extraction process. Two authors independently assessed the quality of included studies using the Critical Appraisal Skill Programme Checklist for qualitative studies, and findings from the studies were analysed and synthesised thematically. Findings: Twelve studies were included in the meta-synthesis. The analysis yielded six themes: metaphysical causes of cancer illness, patients and carers’ spiritual concerns, pluralistic therapy and nature of spiritual care provision, spirituality/religiosity in coping, positive reframing and pathways towards reconciliation, and integration of spiritual care into routine cancer care pathways. Conclusion: Patients and families combine orthodox treatment and spiritual forms of healing. They would like to receive spiritual care from healthcare professionals and not relegate it entirely to their spiritual leaders and church members. Spiritual/religious leaders of patients and families are willing to collaborate with orthodox treatment in providing spiritual care. Incorporating spiritual care into primary healthcare and educational programs is significant to enhancing patients’ outcomes and healthcare delivery.</p
Examining the link between 179 lipid species and 7 diseases using genetic predictors
No full textBackground Genome-wide association studies of lipid species have identified several loci shared with various diseases, however, the relationship between lipid species and disease risk remains poorly understood. Here we investigated whether the plasma levels of lipid species are causally linked to disease risk. Methods We built genetic predictors of 179 lipid species, measured in 7174 Finnish individuals, by utilising either 11 high-impact genomic loci or genome-wide polygenic scores (PGS). We assessed the impact of the lipid species on seven diseases by performing disease association across FinnGen (n = 500,348), UK Biobank (n = 420,531), and Generation Scotland (n = 20,032). We performed univariable Mendelian randomizsation (MR) and multivariable MR (MVMR) analyses to examine whether lipid species impact disease risk independently of standard lipids. Findings PGS explained > 4% of the variance for 34 lipid species but variants outside the high-impact loci had only a marginal contribution. Variants within the high-impact loci showed association with all seven diseases. MVMR supported a causal role of ApoB in ischemic heart disease after accounting for lipid species. Phosphatidylethanolamine-increasing LIPC variants seemed to lower age-related macular degeneration risk independently of HDL-cholesterol. MVMR suggested a protective effect of four lipid species containing arachidonic acid on cholelithiasis risk independently of Total Cholesterol. Interpretation Our study demonstrates how genetic predictors of lipid species can be utilised to gain insights into disease risk. We report potential links between lipid species and age-related macular degeneration and cholelithiasis risk, which can be explored for their utility in disease risk prediction and therapy
Content authenticities:A discussion on the values of provenance data for creatives and their audiences
No full textThe proliferation of AI-generated digital content has intensified the user demand for accurate provenance information to ensure content authenticity. Technical advancements now provide tools to make the digital media content supply chain more transparent through the use of provenance data. This paper foregrounds the importance of understanding how the situated nature of user-content engagement influences perceptions and uses of this data. Insights from a workshop with experts in the creative media sector suggest that, as the adoption of provenance data becomes more common, users need richer and more nuanced information. We suggest that analyzing the increasing demand for content authenticity through the lens of multiple “authenticities”, each reflecting different user needs and contexts, can help identify and address the needs for, and uses of, provenance data by creators and audiences alike
VIV-induced strain on a lazy wave dynamic marine power cable in a steady current
No full textMarine power cables are commonly used to transfer electricity from offshore renewable energy (ORE) devices to shore. Such cables are susceptible to fatigue failure due to flow-induced vibration. We present results from physical model tests conducted at Edinburgh University’s FloWave wave-current facility on an instrumented flexible cable in a lazy wave configuration subjected to a steady, unidirectional current. The Reynolds number was subcritical, ranging from 3,100 to 24,800. Bending strain was measured at seven locations along the length of the cable and the results are presented in terms of cable curvature. The data analysis shows that, currents propagating normal to the longitudinal axis of the cable caused large local variations in curvature. The maximum variation in curvature occurred near the touchdown zone and at the sag bend. Repeated high-amplitude cyclic loading was observed in currents directed at angles within ± 30o normal to the longitudinal axis of the cable. Significant shifts in peak frequency and spectral energy distribution were evident with increasing reduced velocity. At certain locations along the cable, the strain frequency corresponded to a Strouhal number of 0.127 - 0.144, whereas very low peak strain frequencies occurred elsewhere. The strain behaviour was sensitive to the current speed and direction relative to the orientation of the cable. Mono-frequency strain responses occurred at lower reduced velocity and multi-frequency responses at higher reduced velocity
Semantic objective functions:A distribution-aware method for adding logical constraints in deep learning
No full textIssues of safety, explainability, and efficiency are of increasing concern in learning systems deployed with hard and soft constraints. Loss-function based techniques have shown promising results in this area, by embedding logical constraints during neural network training. Through an integration of logic and information geometry, we provide a construction and theoretical framework for these tasks that generalize many approaches. We propose a loss-based method that embeds knowledge—enforces logical constraints—into a machine learning model that outputs probability distributions. This is done by constructing a distribution from the logical formula, and constructing a loss function as a linear combination of the original loss function with the Fisher-Rao distance or Kullback-Leibler divergence to the constraint distribution. This construction is primarily for logical constraints in the form of propositional formulas (Boolean variables), but can be extended to formulas of a first-order language with finite variables over a model with compact domain (categorical and continuous variables), and others statistical models that is to be trained with semantic information. We evaluate our method on a variety of learning tasks, including classification tasks with logic constraints, transferring knowledge from logic formulas, and knowledge distillation
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