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Mobile telephone contingency management to encourage adherence to supervised medication among individuals most at risk of non-adherence to opioid agonist treatment: a study protocol for a feasibility study (TIES2)
Get PDFBackground
Supervision of opioid agonist treatment (OAT) ensures that individuals take their correct daily dose to minimise withdrawal and craving, safeguard against diversion and overdose, and receive optimal benefit from OAT. There is an urgent need to develop effective interventions to increase medication adherence and technological solutions to streamline communication between pharmacies and prescribers. The authors have developed technology to deliver contingency management (CM) remotely by mobile telephone (mCM) and alert prescribers of missed doses. In a previous feasibility study, the authors found mCM was feasible to deliver and acceptable to patients, prescribers, and pharmacists but encountered difficulty recruiting patients starting methadone treatment. Since COVID-19, supervision guidelines have changed to focus on patients at risk of/not adhering to their medication. This study aims to assess the feasibility of conducting a future confirmatory trial to assess the clinical and cost-effectiveness of mCM to encourage adherence with supervised methadone or buprenorphine. It will use broader eligibility criteria, including patients receiving buprenorphine, and target a revised group of serial re-starters.
Methods
Using a cluster randomised design, three drug services will be randomised 1:1:1 and 20 patients, attending seven pharmacies linked to each service, will be recruited (i.e. a total of N = 60). Each drug service providing supervised medication will be randomly allocated to deliver: (i) telephone-delivered text-message reinforcement with modest financial incentives; (ii) telephone-delivered text-message reminders; or (iii) no telephone text-messages. Prescribers will receive reports of patient attendance. Feasibility will be determined based on four progression criteria: the number of patients enrolled, the percentage of screened patients who are eligible, adherence to the telephone system, based on matches between sign-in at the pharmacy and pharmacy dispensing records and follow-up rates. We will also undertake qualitative assessments of clinicians' perspectives on the revised eligibility criteria undertaken.
Discussion
This study will assess the feasibility of using mCM to target a clinically important group of patients non-adhering to their supervised medication. In the future, and if effective, mCM will encourage medication adherence among patients, enabling them to achieve an optimum dose and full benefit from OAT.
Trial registration
ISRCTN33965312 (26/06/2023). This manuscript was submitted on February 27th, 2024. While recruitment was due to end on February 29th, we recruited our last patient on February 12th. The last patient/last visit took place on May 2nd, 2024
Developing sustainable entrepreneurial finance ecosystems in an emerging market context: the role of keystone actors in managing competing institutional logics
Get PDFEmerging sustainable enterprises thrive when they have access to a conducive environment. While sustainable entrepreneurial finance ecosystems (SEFE) have received growing interest, a lack of understanding remains concerning how they operate in emerging market economies, and how the varied logics of different actors drive or inhibit the necessary development. To address this research gap, we draw on in-depth qualitative research with key ecosystem actors in Brazil. We apply a pattern-matching approach to thematically examine how different actors converge under the operational lens of their different sustainability and commercial institutional logics. The findings reveal that Brazil’s nascent SEFE requires significant ongoing support. Drawing from systems ecology, we develop an institutional logic (IL) theory by introducing the concept of “keystone actors” to account for the intermediary boundary-spanning practices, which allow us to combine finance, business and policy actors’ sustainability and commercial market logics necessary to provide effective support mechanisms to unlock sustainable entrepreneurship. We conclude that financing sustainable entrepreneurship in emerging economies necessitates multi-level support in the form of keystone actors holding the ecosystem together while cultivating capabilities to harmonize logics. This process can ensure that sustainable entrepreneurship moves from “buzzword status” to a valid, systemic concept for SEFE in emerging market contexts
Detecting apnoea in premature neonates: exploring frequency-domain and power analysis of electrical impedance tomography lung impedance signals
Get PDFNeonatal apnoea is often defined as a cessation of breathing, a critical challenge in premature infant care, demanding early and accurate detection. This study integrates Electrical Impedance Tomography (EIT) with frequency-domain analysis to identify apnoea-related changes in lung impedance signals. We processed lung impedance waveforms from fifteen premature infants (median gestational age: 31 weeks) and assessed frequency, amplitude, and power as potential biomarkers. Statistical analysis using two-way ANOVA (p < 0.05) demonstrated significant changes in impedance features before, during, and after apnoea episodes. We further evaluated each feature's classification performance via Receiver Operating Characteristic (ROC) curves, reporting Area Under the ROC Curve (AUC), sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV). Frequency alone achieved a high AUC (0.98), with 85.96% sensitivity and 96.67% specificity, outperforming amplitude (AUC = 0.81) and power (AUC = 0.92). Notably, amplitude and power combined (AUC = 0.98) performed similarly to frequency on AUC but better on other measures (98.33% specificity). Similarly, combining power and frequency improved sensitivity, 89.47% at 97.50% specificity, surpassing frequency alone on both metrics. These results demonstrate the value of utilising a variety of attributes. While amplitude changes may be expected during apnoea, adding frequency and power metrics offers a more robust, multidimensional view of lung impedance behaviour. Moreover, residual signals during apnoea likely stem from cardiac activity and may also reflect slight changes in heart rate. This underscores the novelty of isolating lung-specific impedance from overlapping physiological signals. In conclusion, combining EIT and frequency-domain analysis offers a promising non-invasive method for real-time apnoea detection. In neonatal critical care units, it emphasises using multi-feature techniques to improve diagnostic accuracy
Adherence to skincare self-management for pressure ulcer prevention in spinal cord injury through the lens of the health belief model -a qualitative descriptive study
No full textBackground:
Pressure ulcers (PrUs) are among the most severe secondary complications for individuals with spinal cord injuries (PwSCI) due to lifelong risk factors, including sensory and motor impairments and prolonged sitting in wheelchairs (Morrow, 2024). PrUs affect 45–95% of PwSCI (Soggard, 2023), accounting for 25% of healthcare costs in this population, with treatment costs ranging from £1,214 to £14,108 per case in the UK (Dealey, 2012; Kruger et al., 2013).
Self-Management and Challenges:
Skincare education is provided in hospitals post-injury, promoting self-management strategies such as repositioning, skin monitoring, and specialised equipment use (Liu et al., 2021; Fogelberg et al., 2016). However, adherence to skincare self-manangement is reported poor after the discharge (Schofield, 2013, Liu et al 2024.; Ghaisas et al., 2015). PrUs remain high incidence and the only secondary condition consistently linked to increased mortality risk in PwSCI (Morrow et al., 2024).
Study Aim:
To explore PwSCI’s views on adherence of skincare self-management for PrU prevention through the Lens of the Health Belief Model.
Methods:
Ethics approval was obtained from Middlesex University and National Research Ethics Committee (REC/HRA). Semi-structured interviews were conducted with 12 PwSCI, aged 23–68 years, injury levels ranging from C4 to T12, and injury durations of 1 to 35 years. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.
Findings:
Most participants had a history of PrUs, commonly located on the sacrum/ ischial tuberosities. The analysis identified four key themes influencing skincare self-management among PwSCI. 1) Perceived susceptibility and severity were heightened through rehabilitation education or personal PrU experience, motivating preventive behaviours. 2) Perceived benefits of skin checks, repositioning, and pressure-relieving equipment reinforced adherence, though barriers such as sensory loss, limited mobility, healthcare delays, and mental health challenges hindered self-management. 3) Cues to action, including caregiver involvement and structured reminders improved adherence, while self-efficacy was strengthened through routine-building and external support. These findings highlight the need for personalised education, structured adherence strategies, psychological support and caregiver training to enhance PrU prevention.
Implications for Practice:
Findings support developing personalised skincare programs to improve skincare self-management, enhance adherence, and reduce PrU incidence, ultimately lowering healthcare costs
Prioritizing smart city themes for multi-national enterprises and United Nations Sustainable Development Goals
Get PDFCities’ role as major hubs of human activity and economic development is essential in attaining sustainable development, fostering a balance between economic, social, and environmental development, especially in light of the growing concern over Anthropocene-induced environmental issues like global warming and climate change. The United Nations Sustainable Development Goals (SDGs) represent a historic call for coordinated international action in this area, with SDG 11 specifically identifying “Sustainable Cities and Communities” as a primary objective. Therefore, it is clear that a paradigm shift in our approach to these challenges in terms of our thinking, sensibility, behavior, and responses is necessary. Implicitly, in view of their pivotal role in environmental sustainability, development of “smart” cities as healthy, citizen-friendly, economically viable, and sustainable cities for our future generations in today’s globally integrated world, as predominant centers of human settlement and activity with multinational enterprises driving economic growth, gains the immediate attention of researchers. In this light, this study aims to identify and thereafter prioritize key indicators of a smart city using the structured and consistency-focused best–worst multi-criteria decision-making (BWM) method, suitable for expert-driven decision-making with limited comparisons. While the UN’s SDG 11 promotes safe and resilient cities, our findings suggest a disparity in how local officials prioritize certain dimensions such as safety or recreation. This disconnect warrants closer examination of localized policy drivers. The findings of this study indicate that according to experts, among others, the priority themes are, in order, water and sanitation, wastewater, health, the environment, and the economy. Thus, these represent a key take-away for multinational enterprises for identifying and assessing significant thrust domains and areas of opportunity for intervention and contribution to the UN SDGs. It also enables a replicable framework for synergy between the public and private sectors towards contrastive intervention in other cities across the globe
The association between COVID-19-related persistent symptoms, psychological flexibility, and general mental health among people with and without persistent pain in the UK
Get PDFObjectives: Persistent symptoms following COVID-19 may adversely impact the general mental health of people with chronic pain, and psychological flexibility may buffer these impacts. However, it remains unclear whether such lasting implications of COVID-19 differ between people with and without chronic pain. This study investigated the rela-tionships between persistent symptoms post-COVID-19, psychological flexibility, and general mental health among people with and without persistent pain during the COVID-19 pandemic in the UK. Methods: A total of 204 adults living in the UK were re-cruited via social media and completed an online survey, including measures of persistent symptoms, depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disor-der-7), insomnia (the Insomnia Severity Index), and psychological flexibility (the Multidi-mensional Psychological Flexibility Inventory), and were included in the analyses. Re-sults: Participants with persistent pain (n = 70) experienced more-persistent symptoms, poorer general mental health, and a higher level of psychological inflexibility compared with participants without persistent pain (n = 133). Overall, the relationships between persistent physical symptoms, general mental health, and psychological (in)flexibility showed similar patterns in the two groups. Participants with more-persistent physical symptoms experienced significantly poorer general mental health. Furthermore, people with higher levels of psychological inflexibility reported worse general mental health. There was little evidence that psychological (in)flexibility could “buffer” the association between persistent physical symptoms and general mental health. Conclusions: People with chronic pain appear more vulnerable to persistent symptoms and reduced general mental health compared with people without pain. Treatments that reduce psychological inflexibility, such as ACT, may improve outcomes for people with persistent symptoms post-COVID-19
Digitale disruptive Business-Innovationen: Rolle und Anwendungspotentiale der Blockchain-Technologie im digitalen Zeitalter. Vorteile und Herausforderungen für KMUs am Beispiel einer Fallstudie im Bereich Dokumentenmanagement
No full textThis thesis investigates the topic of digital disruptive innovations and focuses on blockchain, an emerging technology that experienced its first hype in 2015. The subject of this dissertation concentrates on its cutting-edge uses for SMEs. The objective is to bring blockchain closer to SMEs, to arouse their interest, and to demonstrate various possible applications.
This thesis examines the practical economic aspects of blockchain by implementing it in a real-world setting. The constantly growing number of scientific publications on blockchain reveals a general scarcity of well-founded functional analyses of use cases.
The implementation encompasses delineating the process steps, creating a digital strategy, evaluating the multiplier effect of blockchain, and its advantages and disadvantages. The purpose of this thesis was to distinguish itself from the partly isolated theoretical study format by being able to substantiate or negate the theoretical explanations empirically. The portrayal of blockchain in an idealised manner, which is frequently criticised, was rigorously evaluated to prevent any potential distortion of its accurate perception.
End users, including managing directors, frequently possess limited technological comprehension and innovative expertise. In this regard, the objective was to attain a study that was as balanced as feasible, encompassing the technology itself and its users.
There is still a lack of clearly formulated business models in business model innovation (BMI). Innovative business models based on blockchain in various areas are scarce. In this thesis, a blockchain project was successfully implemented in document management, which has been little investigated to date, and data integrity within an SME. A case study encompassed three investigations: problem-centred interviews, blockchain software analysis, and customer emails. The theoretical advantages and disadvantages discussed were tested in practice, and new challenges were identified and addressed. The end-user was the focus of this study. Moreover, a decision tree was developed for potential business applications.
Blockchain will continue to evolve, and research should capture this transformation to bring it closer to practice
Corporate culture changes in the context of ERP-projects in global companies
No full textChanges of ERP (Enterprise Resource Planning) systems are usually triggered by technological and/or company-specific reasons and implemented through projects. Such ERP-projects can be large, and as such, present major organizational and financial challenges, especially for global companies, confronted with cultural differences and varying degrees of local requirements. While research studies propose success factors for ERP-projects including managing change of corporate culture, there is a lack of research on how corporate culture changes in the context of ERP-projects.
The aim of this study is to address this gap. It shall increase the understanding around how corporate culture changes in the context of ERP-projects in global companies. Relevant research material on the related topics of ERP-projects, such as ERP-Systems, corporate culture, achieving project success, multinational/global companies and change management were examined. From an empirical perspective, changes in corporate culture over the last 20 years were qualitatively assessed using a case study at a global industrial company. Internal experts were interviewed, who had experienced four large ERP-projects and cultural changes during this period. Furthermore, former internal as well as external experts were interviewed to achieve a triangulation of perspectives.
The results have shown that ERP-relevant cultural dimension changes are mainly triggered by the company's priority portfolio, CEOs, business models and the power dynamics within the organization. When these items change, so does corporate culture. Moreover, external influences and especially generational changes trigger ERP-relevant cultural value shifts. These developments lead for example to more transparency and openness in global companies, which usually has a positive effect on ERP-projects. The results did not reveal a proven set of ERP-culture values, which will make an ERP-project successful. Instead, it is more the compatibility of an ERP-project with the business model, CEO perception, power distribution, change-ab-sorption capability, and the priority portfolio of the company, that correlates to better ERP-projects.
Based on the research results, the Culture Fit Framework for ERP-projects was developed. It shall provide a structured thinking model regarding compatibility of ERP-projects with the respective company context. Further, a list of success factors for change management was developed, whereby, it is recommended that change management, considering these success factors, should be viewed as a permanent task in global companies.
Further research is recommended to explore change in corporate culture in the context of ERP-projects to substantiate the results of this study. It is also recommended to examine the extent to which corporate cultures have become globally assimilated and the impact of this consolidation on ERP-projects. Artificial Intelligence (AI) is a present, highly topical and pertinent subject, also recommended to be studied in respect of ERP-projects
An analysis of technical team performances in the British Netball Superleague 2023–2024
Get PDFDespite increases in performance analysis research, research within British netball remains scarce. This study examined technical performance differences among Netball Super League (NSL) teams during the 2023 and 2024 seasons and assessed the progression of British netball since 2008. This study analysed 188 matches, with teams categorised by league position. Performance indicators (PIs) such as centre pass (CP) and turnover (TO) conversion, and shooting variables were assessed using inferential statistics, comparing top- and bottom-quality teams against different standards of opposition. Results indicated top-quality teams consistently outperformed bottom-quality teams in most PIs, with significant differences in CP, TO and shooting statistics. Top-quality teams converted a median of >70% for CP and TO to goal, indicating a threshold for successful performance. Additionally, there was a median performance improvement of >20% for these PIs compared to 2008 profiles. However, performance inconsistencies were observed, with large interquartile ranges in PIs, suggesting performance variability. These findings highlight improvements within British netball since 2008, aligning with research trends in offensive play dominance. As the NSL relaunches in 2025, this study establishes a benchmark for evaluating future league changes on competitiveness and consistency. Future research should explore tactical aspects of successful netball performance e.g. offensive and defensive CP strategies
Contemplative practices in legal education
No full textThe ‘transformative potential’ of contemplative practices for legal education has been emphasised in the work of Magee, Director of the Center for Contemplative Law and Ethics at the University of San Francisco. Magee referred to such practices as ‘key to developing socially just classrooms capable of delivering transformative education that works for all’. This entry will address how contemplative practices are defined, rationales for their incorporation into legal education, and challenges to the utilisation of such practices in the teaching of law