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Frailty recommendations and guidelines:an evaluation of the implementability and a critical appraisal of clinical applicability by the ISPRM Frailty Focus Group
Get PDFINTRODUCTION: Aging is associated with an increased burden of multi-morbidity and disease related functional loss and disability, widely impacting patients and health care systems. Frailty is a major actor in age-related disability and is an important target for rehabilitation interventions, considering that is a reversible condition. EVIDENCE ACQUISITION: A working group of members of the ISPRM, responding to WHO 2030 call for action to strengthen rehabilitation, was established to assess the quality and implementability of the existing guidelines for the rehabilitation of frailty. Guidelines were retrieved using a systematic search on Pubmed, Scopus and Web of Science and from the reference lists of screened articles. The included guidelines were evaluated using the AGREE II to assess their quality and using the AGREE-REX to assess their clinical credibility and implementability. Guidelines with a score >4 in the AGREE II item evaluating the overall quality of the guideline were considered for endorsement. Finally, nine external reviewers evaluated the applicability of each recommendation from the endorsed guidelines, providing comments about the barriers and facilitators for their implementation in their country. EVIDENCE SYNTHESIS: Ten guidelines were retrieved and evaluated by the working group, of which four guidelines, i.e. the WHO Guidelines on Integrated Care for Older People, the FOCUS guidelines, the Asia-Pacific Clinical Practice Guidelines for the Management of Frailty and the ICFSR International Clinical Practice Guidelines for Identification and Management of Frailty, were considered for endorsement. All these guidelines were rated as of adequate quality and implementability. CONCLUSIONS: The WHO Guidelines on Integrated Care for Older people (24) the ICFSR International Clinical Practice Guidelines for Identification and management of Frailty (15), the FOCUS guidelines (25) and the Asia Pacific Clinical Practice Guidelines (14) for the Management of Frailty have the best quality and applicability of the existing guidelines on the management of frailty, we suggest that should be employed to define the standards of care for patients with frailty. There are barriers for their implementation, as stated by our experts, to take into account, and some of them are country- or region-specific. Screening for frailty, exercise, nutrition, pharmacological management, social and psychological support, management of incontinence, and an overall comprehensive clinical management are the best tools to face upon frailty.</p
‘Do no harm’? Rethinking risk and harm narratives in abuse-focused research with children
Get PDFDespite increasing recognition of children's right to have a say about matters that affect them (Article 12, United Nations Convention on the Rights of the Child), this right is often denied in the context of child abuse research. This article explores the ways in which ethical decision-making can contribute to the denial of this right and the negative implications of this at both an individual and societal level.Ethical decision-making that stymies the conduct of abuse-focused research with children is usually justified with reference to protecting participants from risk of harm. Whilst in no way suggesting that this is not a critical consideration, the authors question the simplistic and deterministic ways in which this can be understood within ethical decision-making, and the unnecessarily risk-averse decisions that can ensue.Sharing examples from their cumulative 30 years' experience of engaging children and young people in abuse-focused research, the authors stress the need for a more holistic, nuanced and dynamic approach to assessing and managing risk of harm. This would consider risks of both inclusion and exclusion. Understanding that risk and harm are neither static nor universally experienced concepts, it would recognise the implausibility of the ‘do no harm’ guarantees often expected of social researchers. Instead, informed by rights-respecting and trauma-informed perspectives, it would focus on holistically promoting participant wellbeing in, and through, research. Key to this is permitting, and supporting, researchers to exercise contextually-informed, collaborative decision-making in the field; something the authors share their emerging practice framework for
Frailty recommendations and guidelines:an evaluation of the implementability and a critical appraisal of clinical applicability by the ISPRM Frailty Focus Group
Get PDFINTRODUCTION: Aging is associated with an increased burden of multi-morbidity and disease related functional loss and disability, widely impacting patients and health care systems. Frailty is a major actor in age-related disability and is an important target for rehabilitation interventions, considering that is a reversible condition. EVIDENCE ACQUISITION: A working group of members of the ISPRM, responding to WHO 2030 call for action to strengthen rehabilitation, was established to assess the quality and implementability of the existing guidelines for the rehabilitation of frailty. Guidelines were retrieved using a systematic search on Pubmed, Scopus and Web of Science and from the reference lists of screened articles. The included guidelines were evaluated using the AGREE II to assess their quality and using the AGREE-REX to assess their clinical credibility and implementability. Guidelines with a score >4 in the AGREE II item evaluating the overall quality of the guideline were considered for endorsement. Finally, nine external reviewers evaluated the applicability of each recommendation from the endorsed guidelines, providing comments about the barriers and facilitators for their implementation in their country. EVIDENCE SYNTHESIS: Ten guidelines were retrieved and evaluated by the working group, of which four guidelines, i.e. the WHO Guidelines on Integrated Care for Older People, the FOCUS guidelines, the Asia-Pacific Clinical Practice Guidelines for the Management of Frailty and the ICFSR International Clinical Practice Guidelines for Identification and Management of Frailty, were considered for endorsement. All these guidelines were rated as of adequate quality and implementability. CONCLUSIONS: The WHO Guidelines on Integrated Care for Older people (24) the ICFSR International Clinical Practice Guidelines for Identification and management of Frailty (15), the FOCUS guidelines (25) and the Asia Pacific Clinical Practice Guidelines (14) for the Management of Frailty have the best quality and applicability of the existing guidelines on the management of frailty, we suggest that should be employed to define the standards of care for patients with frailty. There are barriers for their implementation, as stated by our experts, to take into account, and some of them are country- or region-specific. Screening for frailty, exercise, nutrition, pharmacological management, social and psychological support, management of incontinence, and an overall comprehensive clinical management are the best tools to face upon frailty.</p
Military wireless communication and challenges
No full textThe need for communication has direct relationship with growth of Information Technology. Both Civil and Military communications suffer from several well-known legacy challenges including Bandwidth Scarcity, Resource Sharing, Throughput, Congestion, Interference and Security, to name a few. However, owing to its nature, Military Wireless communication has additional set of challenges to cater for beyond Civil communication challenges. Military Wireless communication specific challenges mainly involve Military Radio Systems precisely Beyond Line of Sight (BLOS) communication, Command and Control Warfare (C2W), Electronic Warfare (EW), Cryptography to achieve Confidential and Impairment free communication, Alert Measurement Systems with the view point of accuracy and time sensitivity. This particular paper not only provides a good overview of Military Wireless communication, but discusses the compelling challenges faced to achieve effective Military Wireless communication. The paper assists as a single resource for general as well as specialist readers keen to grasp and understand the Military Wireless communication and accompanying challenges.<br/
Creating space for meaningful physical activity at home: women’s stories of social interaction, micro-adventure, and the joy of feeling strong
Get PDFDuring COVID-19 stay-at-home orders and social distancing, the home, garden and local spaces became focal points for physical activity (PA). These restrictions may have influenced the meaningfulness of PA. This paper draws on feminist perspectives on space and the body alongside the concept of meaningful PA to examine women’s PA at home towards the end of pandemic restrictions. In this visual ethnographic project, 11 women who were physically active at home each engaged in photo diaries and two online interviews for a retrospective and in-the-moment exploration of their PA at home during and after social distancing. Analysis considered the changing and subjective nature of meaningfulness in these contexts. Three composite vignettes are presented, titled ‘Everything is on your own terms’, ‘Expanding the four walls’, and ‘A micro-adventure all by myself’. These written and visual stories illuminate meaningful PA at a time shaped by reactions to stay-at-home orders and changing (gendered) relations to the home as a leisure, domestic, and work space. At-home PA was variously a compromise and a personally relevant choice. Participants found meaning in adapting PA to create the right challenge for them and expressed joy in developing physical strength. Digital and home PA spaces helped women to challenge normative PA practices while fostering different forms of social interaction. Constructions of meaningful PA are dynamic and socially situated in resistance to lockdown and loss of access of nature. The personal relevance of PA is affected by personal values and histories, and broader discourses of space and the body
Coping with COVID-19 lockdown: a qualitative study of older adults in alcohol treatment
Get PDFThe COVID-19 global pandemic had a major impact on older people's mental health and resulted in changes in alcohol use, with more older adults increasing than decreasing consumption levels among the general population. So far, no studies have focused on older people who were already experiencing problem alcohol use. This qualitative research is the first to provide a nuanced understanding of changes to drinking patterns among older adults engaged in alcohol treatment during the COVID-19 pandemic, and the implications of these for practice. We conducted 30 semi-structured interviews with people in alcohol treatment aged 55+ living in urban and rural areas across the UK. Data were analysed using thematic analysis. We found that changes in alcohol use varied depending on the social, economic and health impacts of the pandemic on older adults. Boredom, lack of adequate medical or emotional support, and key life changes experienced during the pandemic (such as bereavement or retirement) increased the risk of increased drinking. Moreover, some people in longer-term alcohol treatment were struggling to maintain abstinence due to lack of face-to-face peer support. For others, decreased drinking levels were a side-effect of lockdown policies and restrictions, such as alcohol-related hospitalisations, closure of social spaces or inability to source alcohol; these also supported those who decided to cut down on drinking shortly before the pandemic. Generally, older adults who developed home-based interests and self-care practices managed lockdown best, maintaining abstinence or lower risk drinking levels. Based on these results, we argue that multilevel interventions aimed at strengthening resilience are required to reduce drinking or maintain abstinence among older adults. Such interventions should address three domains: individual (coping strategies and mindset), social (support networks), and structural (access to resources). In preparation for supporting older alcohol users through prospective future pandemics, building digital literacy and inclusion are essential
A privacy-preserving approach to effectively utilize distributed data for malaria image detection
Get PDFMalaria is one of the life-threatening diseases caused by the parasite known as Plasmodium falciparum, affecting the human red blood cells. Therefore, it is an important to have an effective computer-aided system in place for early detection and treatment. The visual heterogeneity of the malaria dataset is highly complex and dynamic, therefore higher number of images are needed to train the machine learning (ML) models effectively. However, hospitals as well as medical institutions do not share the medical image data for collaboration due to general data protection regulations (GDPR) and the data protection act (DPA). To overcome this collaborative challenge, our research utilised real-time medical image data in the framework of federated learning (FL). We have used state-of-the-art ML models that include the ResNet-50 and DenseNet in a federated learning framework. We have experimented both models in different settings on a malaria dataset constituting 27,560 publicly available images and our preliminary results showed that the DenseNet model performed better in accuracy (75%) in contrast to ResNet-50 (72%) while considering eight clients, while the trend was observed as common in four clients with the similar accuracy of 94%, and six clients showed that the DenseNet model performed quite well with the accuracy of 92%, while ResNet-50 achieved only 72%. The federated learning framework enhances the accuracy due to its decentralised nature, continuous learning, and effective communication among clients, as well as the efficient local adaptation. The use of federated learning architecture among the distinct clients for ensuring the data privacy and following GDPR is the contribution of this research work.</p
Microplastics in human urine: characterisation using μFTIR and sampling challenges using healthy donors and endometriosis participants
Get PDFMicroplastics (MPs) are found in all environments, within the human food chain, and have been recently detected in several human tissues. The objective herein was to undertake an analysis of MP contamination in human urine samples, from healthy individuals and participants with endometriosis, with respect to their presence, levels, and the characteristics of any particles identified. A total of 38 human urine samples and 15 procedural blanks were analysed. MPs were characterised using μFTIR spectroscopy (size limitation of 5 μm) and SEM-EDX. In total, 123 MP particles consisting of 22 MP polymer types were identified within 17/29 of the healthy donor (10 mL) urine samples, compared with 232 MP particles of differing 16 MP polymer types in 12/19 urine samples from participants with endometriosis. Healthy donors presented an unadjusted average of 2589 ± 2931 MP/L and participants with endometriosis presented 4724 ± 9710 MP/L. Polyethylene (PE)(27%), polystyrene (PS)(16%), resin and polypropylene (PP)(both 12%) polymer types were most abundant in healthy donor samples, compared with polytetrafluoroethylene (PTFE) (59%), and PE (16%) in samples from endometriosis participants. The MP levels within healthy and endometriosis participant samples were not significantly different. However, the predominant polymer types varied, and the MPs from the metal catheter-derived endometriosis participant samples and healthy donors were significantly smaller than those observed in the procedural blanks. The procedural blank samples comprised 62 MP particles of 10 MP polymer types, mainly PP (27%), PE (21%), and PS (15%) with a mean ± SD of 17 ± 18, highlighting the unavoidable contamination inherent in measurement of MPs from donors. This is the first evidence of MP contamination in human urine with polymer characterisation and accounting for procedural blanks. These results support the phenomenon of transport of MPs within humans, specifically to the bladder, and their characterisation of types, shapes and size ranges identified therein
High resolution temperature evolution maps of Bangladesh via data-driven learning
Get PDFAs a developing country with an agricultural economy as a pillar, Bangladesh is highly vulnerable to adverse effects of climate change, so the generation of high-resolution temperature maps is of great value for Bangladesh to achieve agricultural sustainable development. However, Bangladesh’s weak economy and sparse meteorological stations make it difficult to obtain such maps. In this study, by mining internal features and links inside observed data, we developed an efficient data-driven downscaling technique to generate high spatial-resolution temperature distribution maps of Bangladesh directly from observed temperature data at 34 meteorological stations with irregular distribution. Based on these high-resolution historical temperature maps, we further explored a data-driven forecast technique to generate high-resolution temperature maps of Bangladesh for the period 2025–2035. Since the proposed techniques are very low-cost and fully mine internal links inside irregular-distributed observations, they can support relevant departments of Bangladesh to formulate policies to mitigate and adapt to climate change in a timely manner
Big baths around turnovers: what happens if the former CEO stays on board?
Get PDFWe examine whether retaining the former CEO as a board member has an impact on big bath accounting around CEO turnovers. Early evidence shows that when a CEO turnover occurs, the new CEO uses big bath to shift the responsibility for low earnings toward the previous management. However, the former CEO is often retained. This event may restrict the new CEO’s ability to take a big bath. Using a hand-collected sample of CEO turnover events in US firms, we find that CEO turnover increases the probability of a big bath. However, retaining the CEO acts as a monitoring mechanism by reducing the probability of big baths, especially opportunistic ones. Our findings indicate that CEO retention could be a useful corporate governance mechanism that restricts new CEO’s opportunistic practices
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