Aims Patients undergoing urgent abdominal surgery should undergo an assessment of the risk of malnutrition upon admission using the Malnutrition Universal Screening Tool (MUST). This assessment should trigger a response when patients are categorised as high-risk. This clinical audit aimed to determine whether older patients included in the National Emergency Laparotomy Audit (NELA) were identified as being at risk of malnutrition and whether they received appropriate nutritional support to address deficiencies if they were classed as high-risk as per the recommendations of the NICE (2017) guidelines. Methods Patients entered into the NELA database at a single NHS trust who were over 65 or older between January 1, 2021, and December 31, 2022, were included. The patient records were reviewed for the MUST score upon admission, and the presence of nutritional supplementation prescriptions, or dietetic referrals following the identification of a high-risk MUST score of 2 or above. Results Out of the 300 older NELA patients included in this clinical audit, 98% had a recorded MUST score. Between them, 114 patients had a high-risk MUST score, but 35% of these high-risk patients did not undergo a dietetic review. Additionally, 24% of high-risk patients received neither oral nor parenteral supplementation. Conclusions High-risk MUST scores in older NELA patients are readily available to surgical teams within the electronic patient record but do not consistently lead to interventions addressing nutritional deficiencies and nutritional screening is not currently included in NELA.
This volume follows on from our 2018 edited collection, Media, Crime and Racism (Palgrave), which dealt with the processes of criminalisation as experienced by racialised minorities, and their representations. That volume proceeded largely through an international spread of case studies, including of a number of racialised moral panics and the media, governmental and societal responses to them. The present collection, Racism, Violence and Harm builds upon and marks a departure from this earlier work by examining violence in a wider context, beyond that of crime as such. Here our contributors collectively and variously consider the role of ideology in the marking of racialised, ‘suspect’ populations.
Maintaining and improving brain health, one of the most critical global challenges of this century, necessitates innovative, interdisciplinary, and collaborative strategies to address the growing challenges in Latin America and the Caribbean. This paper introduces Brain Health Diplomacy (BHD) as a pioneering approach to bridge disciplinary and geographic boundaries and mobilize resources to promote equitable brain health outcomes in the region. Our framework provides a toolkit for emerging brain health leaders, equipping them with essential concepts and practical resources to apply in their professional work and collaborations. By providing case studies, we highlight the importance of culturally sensitive, region-specific interventions to address unique needs of vulnerable populations. By encouraging dialogue, ideation, and cross-sector discussions, we aspire to develop new research, policy, and programmatic avenues. The novel BHD approach has the potential to revolutionize brain health across the region and beyond, ultimately contributing to a more equitable global cognitive health landscape.
Purpose: Advanced footwear technology is prevalent in distance running, with research focusing on these "super shoes" in competitive athletes, with less understanding of their value for slower runners. The aim of this study was to compare physiological and biomechanical variables between a model of super shoes (Saucony Endorphin Speed 2) and regular running shoes (Saucony Cohesion 13) in recreational athletes. Methods: We measured peak oxygen uptake (VO2peak) in 10 runners before testing each subject 4 times in a randomly ordered crossover design (ie, Endorphin shoe or Cohesion shoe, running at 65% or 80% of velocity at VO2peak [vVO2peak]). We recorded video data using a high-speed camera (300 Hz) to calculate vertical and leg stiffnesses. Results: 65% vVO2peak was equivalent to a speed of 9.4 km·h-1 (0.4), whereas 80% vVO2peak was equivalent to 11.5 km·h-1 (0.5). Two-way mixed-design analysis of variance showed that oxygen consumption in the Endorphin shoe was 3.9% lower than in the Cohesion shoe at 65% vVO2peak, with an interaction between shoes and speed (P = .020) meaning an increased difference of 5.0% at 80% vVO2peak. There were small increases in vertical and leg stiffnesses in the Endorphin shoes (P < .001); the Endorphin shoe condition also showed trivial to moderate differences in step length, step rate, contact time, and flight time (P < .001). Conclusions: There was a physiological benefit to running in the super shoes even at the slower speed. There were also spatiotemporal and global stiffness improvements indicating that recreational runners benefit from wearing super shoes.
Assessing the holistic impact of student-athletes within sport schools is important due to the increasing popularity of sport school programmes, the likelihood that most youth athletes do not ultimately succeed in their sport and the multiple and wide ranging positive and negative impacts associated with intensified youth sport. Therefore, this study, using a mixed method design, aimed to evaluate the ‘in-time’ holistic impacts and experiences of being a sport school student-athlete. Five data collection methods (i.e., online questionnaire, physical fitness testing battery, academic assessments grades, injury data and log diaries) were used to assess athletic, academic, psychological and psychosocial holistic impacts and experiences of 83 student-athletes from one sport school in the United Kingdom (UK). Due to the mixed method approach, a triangulation design was used whereby quantitative and qualitative data were firstly analysed separately and then integrated and presented together. Overall, the findings demonstrated there were a multitude of positive impacts and experiences associated with being a sport school student-athlete. These included: high average academic attainment, satisfaction with academic support, sport competence, all-round sport development, higher general and sport specific recovery than stress, inter- and intra-personal development, social support, positive peer and parent relationships and dual career motivation. However, impacts and experiences of concern were also apparent including: participation in sport external to the school context, difficulty balancing education and sport, academic lessons missed, injury, fatigue, lack of free time, extra-curricular and social sacrifice, social intensity and body image concerns. Large inter-individual variability was demonstrated across all data analyses highlighting the variable nature of the impacts and experiences of being a sports school student-athlete. Overall, sport schools have the potential to promote many positive holistic impacts, however stakeholders need to be aware, monitor and mitigate the potential negative impacts. Flexible development programmes, individualised support and student-athlete monitoring are essential features required of sport schools to ensure healthy and holistic development for all sport school student-athletes.
Landfill leachate, which is a complicated organic sewage water, presents substantial dangers to human health and the environment if not properly handled. Electrochemical technology has arisen as a promising strategy for effectively mitigating contaminants in landfill leachate. In this comprehensive review, we explore various theoretical and practical aspects of methods for treating landfill leachate. This exploration includes examining their performance, mechanisms, applications, associated challenges, existing issues, and potential strategies for enhancement, particularly in terms of cost-effectiveness. In addition, this critique provides a comparative investigation between these treatment approaches and the utilization of diverse kinds of microbial fuel cells (MFCs) in terms of their effectiveness in treating landfill leachate and generating power. The examination of these technologies also extends to their use in diverse global contexts, providing insights into operational parameters and regional variations. This extensive assessment serves the primary goal of assisting researchers in understanding the optimal methods for treating landfill leachate and comparing them to different types of MFCs. It offers a valuable resource for the large-scale design and implementation of processes that ensure both the safe treatment of landfill leachate and the generation of electricity. The review not only provides an overview of the current state of landfill leachate treatment but also identifies key challenges and sets the stage for future research directions, ultimately contributing to more sustainable and effective solutions in the management of this critical environmental issue.
Early childhood education and care (ECEC) settings faced significant disruption during the COVID-19 pandemic, compromising the continuity, stability and quality of provision. Three years on from the first UK lockdown as pandemic-era preschoolers enter formal schooling, stakeholders are concerned about the impact of the disruption on children’s cognitive and socioemotional development, especially those from socioeconomically disadvantaged backgrounds. Using parent-report data from 171 children aged 5 to 23 months ( M = 15 months) in March to June 2020 living in the UK, we investigate whether previously attested positive associations between ECEC attendance and the development of language and executive functions was maintained as early years settings navigated operational challenges over the first full year of the pandemic. In response to concerns about ‘school readiness’, we analyse the relationship between ECEC attendance and children’s communication, problem-solving and personal-social development. ECEC was associated with greater growth in receptive vocabulary over the 12-month period. In children from less advantaged backgrounds, ECEC was also associated with greater growth in expressive vocabulary. Our data suggest a similarly positive association between ECEC attendance and the communication and problem-solving skills of children from less advantaged backgrounds and between ECEC and the personal-social development of all children. Overall, results suggest that ECEC had sustained learning benefits for children growing up during the pandemic despite ongoing disruption to settings, with specific benefits for children from less affluent home environments. As pandemic-era children progress to primary school, we discuss the importance of adapting their learning conditions and adjusting the expectations placed on them.
Objective The development of serious games for mental wellbeing is a topic of growing interest. The increase in acceptance of games as a mainstream entertainment medium combined with the immersive qualities of games provides opportunities for meaningful support and intervention in mental wellbeing. Method We conducted a systematic review and exploratory meta‐analysis to examine if aspects of the interventions influenced outcomes as measured via overall effect sizes. We employed a multilevel meta‐analytic approach to accommodate the interdependency of effect sizes (18 effect sizes from 14 studies, with 2027 participants). Results Overall, the main effect for gaming interventions on any outcome variable was small to medium sized, d = .35 (confidence interval [.23, 47], p < .001). Results revealed that the only significant moderator was the nature of the intervention. Specifically, only interventions that included a rational emotional behavioural focus significantly predicted an improvement in depression and/or anxiety in participants. Conclusion The findings reveal promising effects for therapeutic games for mental health, but replications are needed, alongside the addressing of methodological and procedural concerns.
The Internet of Things (IoT) involves the gathering of all those devices that connect to the Internet with the purpose of collecting and sharing data. The application of IoT in the different sectors, including health, industry has also picked up the threads to augment over the past few years. The IoT and, by integrity, the IIoT, are found to be highly susceptible to different types of threats and attacks owing to the networks nature that in turn leads to even poor outcomes (i.e., increasing error rate). Hence, it is critical to design attack detection systems that can provide the security of IIoT networks. To overcome this research work of IIoT attack detection in large amount of evolutions is failed to determine the certain attacks resulting in a minimum detection performance, reinforcement learning-based attack detection method called sliding principal component and dynamic reward reinforcement learning (SPC–DRRL) for detecting various IIoT network attacks is introduced. In the first stage of this research methodology, preprocessing of raw TON_IoT dataset is performed by employing min–max normalization scaling function to obtain normalized values with same scale. Next, with the processed sample data as output, to extract data from multi-sources (i.e., different service profiles from the dataset), a robust log likelihood sliding principal component-based feature extraction algorithm is applied with an arbitrary size sliding window to extract computationally-efficient features. Finally, dynamic reward reinforcement learning-based IIoT attack detection model is presented to control the error rate involved in the design. Here, with the design of dynamic reward function and introducing incident repository that not only generates the reward function in an arbitrary fashion but also stores the action results in the incident repository for the next training, therefore reducing the attack detection error rate. Moreover, an IIoT attack detection system based on SPC–DRRL is constructed. Finally, we verify the algorithm on the ToN_IoT dataset of University of New South Wales Australia. The experimental results show that the IIoT attack detection time and overhead along with the error rate are reduced considerably with higher accuracy than that of traditional reinforcement learning methods.
The purpose of the paper is to check whether the introduction of the VAR system mitigated the referee bias against away teams. The dataset comprises 2279 matches played in the first tier of the Brazilian League from 2016 to 2021. We analyze 6 seasons of the first tier of the Brazilian domestic football league– 3 seasons before and 3 seasons after the introduction of the VAR technology. Potential bias is viewed through the lens of yellow cards, red cards and number of penalties awarded for both home and away clubs. A paired t-test is used to reveal potential statistical differences between pre-VAR and post-VAR periods, followed by Ordinary Least Squares regressions to inspect whether certain referee’ categories have changed their behavior after the implementation of this technology. Our empirical findings offer evidence that the referee bias is diminished, but still present.
BACKGROUND The Endometriosis Health Profiles (EHPs), the EHP-30 and EHP-5, are patient-reported outcome measures that were developed to measure the health-related quality of life (HRQoL) of women living with endometriosis. Prior to their development, a systematic review was undertaken which identified that the HRQoL of women living with endometriosis was poorly understood, with only three medical and one surgical study identified. OBJECTIVE AND RATIONALE The 20-year anniversary of the EHP-30 provided a timely opportunity to assess how the tools have been used and explore what the findings tell us about the impact of endometriosis and its associated treatments upon women’s QoL. Applying robust systematic review methodology, following PRISMA guidelines, we sought to answer: How many studies have used the EHP and for what purpose?; What are the demographic characteristics and international context of the studies?; What is the methodological nature and quality of the studies?; Which interventions have been assessed and what are the reported EHP outcomes?; and Can the EHP outcomes of these interventions be analysed using a meta-analysis and, if so, what do the results show? SEARCH METHODS The electronic databases MEDLINE, CINAHL, PsycINFO, PubMed, and Google Scholar were searched from the year the EHP was first published, in 2001 to 26 February 2020 using the search terms ‘EHP30’, ‘EHP5’, ‘EHP-30’, ‘EHP-5’, ‘endometriosis health profile 30’, and ‘endometriosis health profile 5’. We updated the searches on 9 April 2021. All included studies were quality assessed using the Mixed Methods Appraisal Tool (MMAT). OUTCOMES The review included 139 papers. In clinical intervention studies, the EHPs were deployed most frequently to measure the outcomes of medical (n = 35) and surgical (n = 21) treatment. The EHPs were also used in 13 other intervention studies, 29 non-interventional studies, 32 psychometric/cross cultural validation studies; six diagnostic studies, and in three other studies to measure outcomes in related conditions. They were mainly deployed in studies undertaken in Europe and North America. Overall, regardless of the nature of the intervention, most women reported improvements in HRQoL after treatment. Surgical interventions generally resulted in significant improvements for the longest amount of time. There was also evidence that when participants stopped taking medication their EHP scores worsened, perhaps reinforcing the temporary impact of medical treatment. Younger patients reported more negative impact upon their HRQoL. Further evidence using classical test theory to support the EHPs’ robust psychometric properties, including acceptability, dimensionality, reliability, validity (including cross-cultural), and responsiveness, was demonstrated, particularly for the EHP-30. Strikingly, using anchor-based methods, EHP-30 responsiveness studies demonstrate the largest mean changes in the ‘control and powerlessness’ domain post-intervention, followed by ‘pain’. MMAT outcomes indicated the quality of the papers was good, with the exception of five studies. A meta-analysis was not undertaken owing to the heterogeneity of the interventions and papers included in this review. WIDER IMPLICATIONS Women with endometriosis face a lifetime of surgical and/or medical interventions to keep the condition under control. Less invasive treatments that can lead to improved longer term physical and psycho-social outcomes are needed. The EHPs are reliable, valid, acceptable, and responsive tools, but more assessment of EHP outcomes using modern psychometric methods and in the context of women from ethnically diverse backgrounds and in routine clinical care would be beneficial. Given the brevity of the EHP-5, it may be the most appropriate version to use in routine clinical practice, whereas the longer EHP-30, which provides more granularity, is more appropriate for research.
The dynamic connectivity and functionality of sensors has revolutionized remote monitoring applications thanks to the combination of IoT and wireless sensor networks (WSNs). Wearable wireless medical sensor nodes allow continuous monitoring by amassing physiological data, which is very useful in healthcare applications. These text data are then sent to doctors via IoT devices so they can make an accurate diagnosis as soon as possible. However, the transmission of medical text data is extremely vulnerable to security and privacy assaults due to the open nature of the underlying communication medium. Therefore, a certificate-less aggregation-based signature system has been proposed as a solution to the issue by using elliptic curve public key cryptography (ECC) which allows for a highly effective technique. The cost of computing has been reduced by 93% due to the incorporation of aggregation technology. The communication cost is 400 bits which is a significant reduction when compared with its counterparts. The results of the security analysis show that the scheme is robust against forging, tampering, and man-in-the-middle attacks. The primary innovation is that the time required for signature verification can be reduced by using point addition and aggregation. In addition, it does away with the reliance on a centralized medical server in order to do verification. By taking a distributed approach, it is able to fully preserve user privacy, proving its superiority.
The subject of this special forum is contingency and the openness of the future, and in this essay we take a route not often travelled in regard of these and focus first on philosophy of time. We contrast static and dynamic theory of time in order to (eventually) acquire some traction on the meaning of both contingency and the open future. We suggest critical realism presupposes dynamic theory and that critical realism provides various conceptualizations that might contribute to dynamic theory.
Background People who have communication difficulties may benefit from using augmentative and alternative communication (AAC). Understanding and measuring outcomes from the use of AAC is an important part of evaluating the impact of devices and services. Outcome measurement needs to reflect the changing nature of the impact of using AAC on an individual's ability to participate in activities of daily life. There is a limited understanding of the concepts that should inform the evaluation of outcomes from AAC device provision, nor how people's expectations from AAC may change over time. Aims To inform the development of a patient‐reported outcome measure for AAC by understanding more about people's expectations from AAC and how these change over time. Methods & Procedures A longitudinal qualitative research study was designed and carried out with seven participants over a period of 2 years. Participants were recruited from a regional specialist assessment service for AAC in the south‐west of the UK. Four semi‐structured interviews were carried out: (1) before assessment for AAC, (2) after assessment, (3) directly after provision of an AAC device and (4) between 6 and 12 months after provision. An original analytic method was used in this study that built on the principles of longitudinal interpretative phenomenology analysis, applied with a dialogic theoretical lens. This approach enabled the inclusion of a range of multimodal and embodied data collected to this study and allowed the research team to draw out salient themes across the cohort group while attending to the influence of time and context on experience. Outcomes & Results The results confirm and extend the three core concepts that were used to guide analysis: changes; contexts; future possibilities. The contextual and temporal influences on outcomes attainable from AAC for this cohort were also identified and illustrated through cross‐case comparison. Deeper, analytic, and conceptual engagement with theory, which was then applied to analysis of the data, provided methodological rigour in the study. The results enhance our understanding of people's hopes and expectations from AAC and how these change over time. Conclusions & Implications This qualitative longitudinal research study provides new insights into the journeys of people who experience communication disability, and the shifting nature of their sense of identity as they engage with, and learn from using, AAC. The study is significant as it attends to the dynamic nature of experience and how contextual and experiential factors influence people's hopes and expectations from AAC. The paper presents an original application of longitudinal qualitative research methodology with people who use AAC which can be further applied and tested in the field of communication disability research. WHAT THIS PAPER ADDS What is already known on this subject We did not know the impact that time has on the concepts that have been identified to represent important outcomes from AAC. The existing concepts used to define outcomes from AAC were not adequately conceptualized to develop a patient‐reported outcome measure. This study sought to extend our knowledge about outcomes from AAC. What this paper adds to the existing knowledge This study adds to the methodological toolkit available for qualitative inquiry in the field of communication disability research by presenting a longitudinal qualitative research methodology. It adds depth to our understanding of the concepts that underpin outcomes from AAC and highlights the dynamic nature of contexts and how this influences desired outcomes. What are the potential or actual clinical implications of this work? This longitudinal qualitative research study provides a broader perspective on the experience of getting AAC. It will enable clinicians to better navigate the contextual and transitionary factors that influence people's experience of acquiring AAC devices. The enhanced concepts described will also support clinical conversations that consider the wider facets of communication and what AAC can add to existing communicative tool kits beyond getting a message across.
Objective To investigate whether modifications made to the current National Health Service (NHS) invitation letter for follow‐up colonoscopy examination affect participant state anxiety and behavioural intentions to attend. Methods Five hundred and thirty‐eight adults of bowel cancer‐eligible screening age (56–74) were randomized to receive the current NHS invitation letter or the modified version of the letter as a hypothetical scenario. Modifications to the letter included fewer uses of the term cancer and awareness of alternative screening options. The history of the colonoscopy invitation, anticipated state anxiety, behavioural intention to attend the nurse appointment, and colonoscopy concerns upon reading the letter were measured. Results Behavioural intentions were high in both conditions; however, participants reading the current letter reported significantly higher behavioural intentions compared to the modified letter. There was no main effect of previous invite status or interaction between previous invite status and letter condition on behavioural intentions. However, the effect of the letter on levels of anxiety depended on the participant's invitation history. Those never invited for a colonoscopy were more anxious when reading the modified letter compared to the current letter. Conversely, previous colonoscopy invitees were less anxious following reading the modified letter than those reading the current letter. Those never invited for a colonoscopy were more concerned about embarrassment and test invasiveness. All findings remained the same when controlling for age and education. Conclusion Modifications to the invitation letter were not beneficial to levels of screening intention or anxiety.
Introduction Women are significantly more likely to develop Alzheimer's disease and related dementias (ADRD) than men. Suggestions to explain the sex differences in dementia incidence have included the influence of sex hormones with little attention paid to date as to the effect of hormonal contraception on brain health. The aim of this scoping review is to evaluate the current evidence base for associations between hormonal contraceptive use by women and non-binary people in early adulthood and brain health outcomes. Methods A literature search was conducted using EMBASE, Medline and Google Scholar, using the keywords “hormonal contraception” OR “contraception” OR “contraceptive” AND “Alzheimer*” OR “Brain Health” OR “Dementia”. Results Eleven papers were identified for inclusion in the narrative synthesis. Studies recruited participants from the UK, USA, China, South Korea and Indonesia. Studies included data from women who were post-menopausal with retrospective data collection, with only one study contemporaneously collecting data from participants during the period of hormonal contraceptive use. Studies reported associations between hormonal contraceptive use and a lower risk of ADRD, particularly Alzheimer's disease (AD), better cognition and larger grey matter volume. Some studies reported stronger associations with longer duration of hormonal contraceptive use, however, results were inconsistent. Four studies reported no significant associations between hormonal contraceptive use and measures of brain health, including brain age on MRI scans and risk of AD diagnosis. Discussion Further research is needed on young adults taking hormonal contraceptives, on different types of hormonal contraceptives (other than oral) and to explore intersections between sex, gender, race and ethnicity. Systematic Review Registration https://doi.org/10.17605/OSF.IO/MVX63 , identifier: OSF.io: 10.17605/OSF.IO/MVX63
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