Return on investment (ROI) has become part of the policymaking toolkit, particularly pertinent for activities like school-based career guidance deemed optional by some policymakers. There are institutions supporting ideal ROI methods alongside an academic critique, but little research on how ROI has been applied in practice in a guidance setting. In this systematic review, we document 32 ROI studies across nine countries that address either school-based guidance or one of three congruent fields: widening participation in education, behaviour in schools and adult career guidance. We find the corpus highly heterogenous in methods and quality, leading to problems in comparability. We argue for a pragmatic approach to improving consistency and the importance of policymakers’ capacity for critically reading ROI studies.
Introduction: There is a considerably large group of community-dwelling spinal cord injury (SCI) survivors living with low quality of life. Physical inactivity, depression, and chronic pain are major problems faced by SCI survivors discharged from the acute phase of treatment or inpatient rehabilitation. This study aims to evaluate the feasibility, acceptability, and preliminary effects of a Physical-Psychological Integrative (PPI) online group intervention on community-dwelling SCI survivors' physical activity, depression, and chronic pain. Methods: This is a two-arm pilot randomized controlled trial with repeated measures (pre-, post-intervention, and 3-month follow-up) design. Seventy-two participants will be randomly assigned to two study groups. The PPI intervention group will receive a video program for physical activity training and eight-week online group psychological interventions using skills of group-based motivational interviewing and mindfulness-based stress reduction. The control group will receive an eight-week online didactic education programed. Focus-group interviews will be conducted post-intervention to explore their views about acceptance and suggested improvements to the intervention. The feasibility of study procedures and the acceptability of interventions will be evaluated. The effectiveness of the PPI intervention will be evaluated by leisure-time physical activity, depression, chronic pain, exercise efficacy, mindfulness, and quality of life. We will use the generalized estimating equation to assess intervention effects and content analysis for interview data. This study has received ethical approval from the Hong Kong Polytechnic University (HSEARS20210705004) and was registered in ClinicalTrials.gov (NCT05535400). Discussion: This study will be the first to provide empirical data on the evaluation of an online-group intervention integrating both physical activity promotion and psychological approaches, aimed at reducing physical inactivity, depression, and chronic pain for community-dwelling SCI survivors in Hong Kong. The findings could provide evidence supporting the use of PPI intervention as a novel online group support, in addressing both the physical and psychological needs of community-dwelling SCI survivors.
Increasing globalization and climate change have significantly affected business activities. Government and other stakeholders are creating pressure to have a sustainable business model for efficient resource utilization and minimizing negative environmental impact. Many organizations have started focusing on sustainable and cleaner production through the adoption of net zero economy (NZE) practices. Certain technological advancements are required to put these concepts into practice. Firms have begun to adopt digital technologies (such as Big Data Analytics, Artificial Intelligence, and Internet of Things, among others), and have been widely used in practice to achieve NZE. Is digitalization unlocking the potential of sustainable practices in the context of a net zero economy? This question is still unanswered, therefore this study aims to identify and analyse the drivers of digitalization that ensure sustainable practices to achieve net zero economy. Through an extensive literature review and experts’ opinions, a list of drivers was identified. An empirical investigation was conducted to validate the identified drivers and further understand the influencing relationship among the drivers, Pythagorean Fuzzy-Decision Making Trial and Evaluation Laboratory (PF-DEMATEL) was employed. The findings of the study show that ‘high degree of automation’, ‘enhancing the flexibility in the manufacturing process’, and ‘real-time sensing capability’ are the main influencer drivers among all cause group forces. The present study can be a source for industrial practitioners and academia that can provide significant guidance on how the adoption of digitalization can unlock the potential to achieve CE, which can lead us towards net-zero.
Circular economy and digital technologies are crucial topics in the current academic and managerial debates. It is largely recognised that-although related to different paradigms-digital technologies could support the industrial circular transition, fostering the adoption of circular economy practices. So far, the relationship has been studied by directly linking the adoption of digital technologies to the implementation of circular economy practices; however, indications for practitioners are unclear. There is thus the need to investigate the relationship at a deeper level. This paper aims at contributing to the debate by adopting a dynamic capabilities theory perspective. By employing an explorative multiple case study methodology and based on an abduc-tive logic, this study investigates 11 Northern-Italy industrial firms in order to understand the transformations that occurred following the adoption of digital technologies and how these transformations supported the adoption of circular economy practices. The results shed preliminary light on which dynamic capabilities-sensing, seizing and transforming, and their related microfoundations-can be enabled by the different digital technologies and how these capabilities and micro-foundations support the circular transition. The study thus provides a first-of-a-kind investigation and suggests propositions for further research to better deepen the knowledge of digital-enabled dynamic capabilities supporting industrial circular economy.
This best practice guide is written with the aim of providing an overview of current hybrid closed-loop (HCL) systems in use within the United Kingdom's (UK) National Health Service (NHS) and to provide education and advice for their management on both an individual and clinical service level. The environment of diabetes technology, and particularly HCL systems, is rapidly evolving. The past decade has seen unprecedented advances in the development of HCL systems. These systems improve glycaemic outcomes and reduce the burden of treatment for people with type 1 diabetes (pwT1D). It is anticipated that access to these systems will increase in England as a result of updates in National Institute of Health and Care Excellence (NICE) guidance providing broader support for the use of real-time continuous glucose monitoring (CGM) for pwT1D. NICE are currently undertaking multiple-technology appraisal into HCL systems. Based on experience from centres involved in supporting advanced technologies as well as from the recent NHS HCL pilot, this guide is intended to provide healthcare professionals (HCPs) with UK expert consensus on the best practice for initiation, optimization and ongoing management of HCL therapy.
With the advent of modern information systems, sharing Electronic Health Records (EHRs) with different organizations for better medical treatment, and analysis is beneficial for both academic as well as for business development. However, an individual’s personal privacy is a big concern because of the trust issue across organizations. At the same time, the utility of the shared data that is required for its favorable use is also important. Studies show that plenty of conventional work is available where an individual has only one record in a dataset (1:1 dataset), which is not the case in many applications. In a more realistic form, an individual may have more than one record in a dataset (1:M). In this article, we highlight the high utility loss and inapplicability for the 1:M dataset of the θ -Sensitive k -Anonymity privacy model. The high utility loss and low data privacy of ( p , l )-angelization, and ( k , l )-diversity for the 1:M dataset. As a mitigation solution, we propose an improved ( θ ∗ , k )-utility algorithm to preserve enhanced privacy and utility of the anonymized 1:M dataset. Experiments on the real-world dataset reveal that the proposed approach outperforms its counterpart, in terms of utility and privacy for the 1:M dataset.
Aims: To explore patient perceptions and understanding of their pressure ulcer risk and how information is communicated between a nurse and patient in the home setting. Design: A pragmatic qualitative research design including community-dwelling patients, who were deemed at risk of developing a pressure ulcer. Methods: Observation of routine interactions between nurse and patient regarding their pressure ulcer risk and semi-structured interviews with 15 community patients following the nursing interaction. Results: Four key overarching themes emerged from the data analysis that were related to patient perceptions and understanding of pressure ulcer risk. These included Pressure Ulcer Awareness, Importance of Repositioning, Healthy Eating and Risk Interpretation. Conclusion: Patient perception and understanding of pressure ulcer risk is different from the scientific, professional view. Patient risk perception was based on heuristics and wider personal factors and social influences. Impact: The study provides important new insights into clinical practice in relation to how pressure ulcer advice and information are provided and interpreted in the community setting. Reporting method: Adhered to the Standards for Reporting Qualitative Research (SRQR) PATIENT OR PUBLIC CONTRIBUTION: A small selection of patients within the NHS Trust in which the research was conducted contributed to the design of the study, in particular some of the interview questions and timing.
Bullying is a considerable problem among school students, and school-wide positive behaviour support interventions are regarded as helpful in addressing it. One approach is the CATZ Cross-age Teaching Zone anti-bullying intervention. The present study assessed the social validity of the CATZ anti-bullying intervention among a sample of 9–15-year-olds in a pre-post experimental design (N = 817, of which 546 experienced CATZ). Overall, participants expressed moderately positive views of the CATZ anti-bullying intervention, and these became significantly stronger following direct experience of it. Among participants who experienced the CATZ anti-bullying intervention, social validity ratings predicted a greater willingness to engage in it in the future. Alongside the extant data for its effectiveness, our findings support the wider use of the CATZ anti-bullying intervention in schools, and suggestions for how this might be brought about are discussed.
Student feedback analysis is time-consuming and laborious work if it is handled manually. This study explores the use of a new deep learning-based method to design a more accurate automated system for analysing students’ feedback (called DTLP: deep learning and teaching process). The DTLP employs convolutional neural networks (CNNs), bidirectional LSTM (BiLSTM), and attention mechanism. To the best of our knowledge, a deep learning-based method using a unified feature set, which is representative of word embedding, sentiment knowledge, sentiment shifter rules, linguistic and statistical knowledge, has not been thoroughly studied with regard to sentiment analysis of student feedback. Furthermore, DTLP uses multiple strategies to overcome the following drawbacks: contextual polarity; sentence types; words with similar semantic context but opposite sentiment polarity; word coverage limit of an individual lexicon; and word sense variations. To evaluate the DTLP, we conducted an experiment on a large volume of students’ feedback. The results showed (i) DTLP outperforms the existing systems in the field, (ii) DTLP that learns from this unified feature set can acquire significantly higher performance than one that learns from a feature subset, (iii) the ensemble of sentiment shifter rules, word embedding, statistical, linguistic, and sentiment knowledge allows DTLP to obtain significant performance, and (iv) an attention mechanism into CNN-BiLSTM improves the performance of DTLP. In addition, the deployed method looks for potential causes behind student feedback.
Background: Persistent postural-perceptual dizziness (PPPD) is a chronic balance disorder, which is characterised by subjective unsteadiness or dizziness that is worse on standing and with visual stimulation. The condition was only recently defined and therefore the prevalence is currently unknown. However, it is likely to include a considerable number of people with chronic balance problems. The symptoms can be debilitating and have a profound impact on quality of life. At present, little is known about the optimal way to treat this condition. A variety of medications may be used, as well as other treatments, such as vestibular rehabilitation. OBJECTIVES: To assess the benefits and harms of non-pharmacological interventions for persistent postural-perceptual dizziness (PPPD). SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 21 November 2022. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs in adults with PPPD, which compared any non-pharmacological intervention with either placebo or no treatment. We excluded studies that did not use the Bárány Society criteria to diagnose PPPD, and studies that followed up participants for less than three months. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vestibular symptoms (assessed as a dichotomous outcome - improved or not improved), 2) change in vestibular symptoms (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) generic health-related quality of life and 6) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We planned to use GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: Few randomised controlled trials have been conducted to assess the efficacy of different treatments for PPPD compared to no treatment (or placebo). Of the few studies we identified, only one followed up participants for at least three months, therefore most were not eligible for inclusion in this review. We identified one study from South Korea that compared the use of transcranial direct current stimulation to a sham procedure in 24 people with PPPD. This is a technique that involves electrical stimulation of the brain with a weak current, through electrodes that are placed onto the scalp. This study provided some information on the occurrence of adverse effects, and also on disease-specific quality of life at three months of follow-up. The other outcomes of interest in this review were not assessed. As this is a single, small study we cannot draw any meaningful conclusions from the numeric results. AUTHORS' CONCLUSIONS: Further work is necessary to determine whether any non-pharmacological interventions may be effective for the treatment of PPPD and to assess whether they are associated with any potential harms. As this is a chronic disease, future trials should follow up participants for a sufficient period of time to assess whether there is a persisting impact on the severity of the disease, rather than only observing short-term effects.
We investigate the correlation between precipitation, clouds and cosmic rays based on field observations to develop a new short-term forecasting tool for their extremely high values. The results show that the cosmic ray intensity appears to be highly correlated with the one-year time-lagged rainfall amount with the cosmic rays leading. A plausible explanation is given for this, based on the modulation of cosmic rays by the solar cycle and an earlier finding of a strong correlation between the stratospheric - lower mesospheric temperature fluctuations and the sunspot number cycle with a time lag of one year (sun leading). This suggests that cosmic rays are not the trigger, but rather signals sunspot activity that with a delay of one year may affect cloud formation and therefore rainfall. In addition, high rates of rainfall exhibit a power-law behavior, such as the Gutenberg-Richter law characterizing the large area and perimeter size of rainfall and clouds, which have been proposed recently. Finally, the new tool for the nowcasting the extremely high cosmic ray intensity values can be used for nowcasting the extremely high rainfall values. Their combination can be used to study the modulation of cosmic ray properties by climate change parameters.
Background: Persistent postural-perceptual dizziness (PPPD) is a chronic balance disorder, which is characterised by subjective unsteadiness or dizziness that is worse on standing and with visual stimulation. The condition was only recently defined and therefore the prevalence is currently unknown. However, it is likely to include a considerable number of people with chronic balance problems. The symptoms can be debilitating and have a profound impact on quality of life. At present, little is known about the optimal way to treat this condition. A variety of medications may be used, as well as other treatments, such as vestibular rehabilitation. OBJECTIVES: To evaluate the benefits and harms of pharmacological interventions for persistent postural-perceptual dizziness (PPPD). SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 21 November 2022. Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs in adults with PPPD, which compared selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) with either placebo or no treatment. We excluded studies that did not use the Bárány Society criteria to diagnose PPPD and studies that followed up participants for less than three months. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vestibular symptoms (assessed as a dichotomous outcome - improved or not improved), 2) change in vestibular symptoms (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) generic health-related quality of life and 6) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We planned to use GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We identified no studies that met our inclusion criteria. Authors' conclusions: At present, there is no evidence from placebo-controlled randomised trials regarding pharmacological treatments - specifically SSRIs and SNRIs - for PPPD. Consequently, there is great uncertainty over the use of these treatments for this condition. Further work is needed to establish whether any treatments are effective at improving the symptoms of PPPD, and whether their use is associated with any adverse effects.
Cardiovascular disease (CVD) is the leading non-communicable disease and cause of premature mortality globally. Despite well-established evidence of a cause-effect relationship between modifiable lifestyle behaviours and the onset of risk of chronic disease, preventative approaches to curtail increasing prevalence have been ineffective. This has undoubtedly been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic, which saw widespread national lockdowns implemented to reduce transmission and alleviate pressure on strained healthcare systems. An unintended consequence of these approaches was a well-documented negative impact on population health in the context of both physical and mental well-being. Whilst the true extent of the impact of the COVID-19 pandemic on global health has yet to be fully realised or understood, it seems prudent to review effective preventative and management strategies that have yielded positive outcomes across the spectrum (i.e., individual to society). There is also a clear need to heed lessons learnt from the COVID-19 pandemic in the power of collaboration and how this can be used in the design, development, and implementation of future approaches to address the longstanding burden of CVD.
Background: The overarching aim of this study was to evaluate the effectiveness over time of government interventions and policy restrictions and the impact of determinants on spread and mortality during the first-wave of the COVID-19 pandemic, globally, regionally and by country-income level, up to 18 May 2020. Methods: We created a global database merging World Health Organization daily case reports (from 218 countries/territories) with other socio-demographic and population health measures from 21 January to 18 May 2020. A four-level government policy interventions score (low to very high) was created based on the Oxford Stringency Index. Results: Our results support the use of very high government interventions to suppress both COVID-19 spread and mortality effectively during wave one globally compared to other policy levels of control. Similar trends in virus propagation and mortality were observed in all country-income levels and specific regions. Conclusions: Rapid implementation of government interventions was needed to contain the first wave of the COVID-19 outbreak and to reduce COVID-19-related mortality.
This article explores the emotional experiences of drug- and/or alcohol-using parents who have child protective Social Services involvement. Research suggests that protective processes can reduce children’s experience of poor outcomes whilst parents undergo treatment for substance misuse. Semi-structured interviews combined with photovoice and journal writing were used to generate data. Eight UK-based parents participated. Each was accessing drug or alcohol treatment and had a child who was the subject of a child protection intervention. The resulting data from the seventeen interviews were analysed using Interpretative Phenomenological Analysis (IPA). Key findings are presented within four themes. The first two outline parents’ perceptions of themselves and how they felt they were viewed by others. Themes 3 and 4 focus on specific emotions: anger and frustration; fear and guilt. The research identifies the complex nature of parental emotions surrounding drug/alcohol misuse when social care services are involved. Parents conceptualised their experience as psychological trauma. They discussed the emotional roller-coaster of the effects of having combined interventions. The research provides insights into how drug/alcohol use can influence parenting. It also highlights issues for professional practice, including developing successful treatment models for substance-using parents.
Encorafenib is a B-Raf proto-oncogene serine/threonine-protein kinase (BRAF) inhibitor, approved in the EU and USA, in combination with the epidermal growth factor receptor (EGFR) inhibitor cetuximab, for the treatment of patients with BRAFV600E-mutant metastatic colorectal cancer (mCRC). In the pivotal BEACON CRC trial, patients achieved longer survival with encorafenib in combination with cetuximab vs. conventional chemotherapy. This targeted therapy regimen is also generally better tolerated than cytotoxic treatments. However, patients may present with adverse events unique to the regimen and characteristic of BRAF and EGFR inhibitors, which produce their own set of challenges. Nurses play an essential role in navigating the care of patients with BRAFV600E-mutant mCRC and managing adverse events that patients may experience. This includes early and efficient identification of treatment-related adverse events, subsequent management of adverse events and education of patients and their caregivers around key adverse events. This manuscript aims to provide support to nurses managing patients with BRAFV600E-mutant mCRC receiving encorafenib in combination with cetuximab, by summarising potential adverse events and providing guidance on how to manage them. Special attention will be paid to the presentation of key adverse events, dose modifications that may be required, practical recommendations and supportive care measures.
Many corals form intimate symbioses with photosynthetic dinoflagellates in the family Symbiodiniaceae. These symbioses have been deeply studied, particularly in reef-forming corals. The complex microbial community that is associated with corals contains other members that have also been well characterized such as bacteria. However, our understanding of the coral holobiont and subsequently coral reef ecosystems is not complete if we do not take into consideration the microeukaryotes like protists and fungi. Microeukaryotes are currently the greatest enigma within the coral microbiome. Only a handful of them have been characterized, very few have been cultured and even less have genomes available. This is a reflection of a smaller community of scientists working on this particular group of organisms when compared with bacteria or Symbiodiniaceae, but also of the many technical challenges that we face when trying to study microeukaryotes. Recent advances in the use of metabarcoding are revealing the importance of microeukaryotes in corals in terms of abundance and presence, with notable examples being the green algae Ostreobium and the apicomplexans Corallicolidae. We believe that it is timely and necessary to present what we know so far about coral microeukaryotes before the expected flow of high-throughput metabarcoding studies exploring the microeukaryotic fraction of the coral microbiome.
Ample evidence suggests that women are more fearful of crime than men. The ‘shadow of sexual assault hypothesis’ offers a possible explanation for this gender gap: in patriarchal societies females are more afraid of sexual violence, which, in turn, drives their fear of other types of criminal victimization. Although the shadow hypothesis has received some empirical support, knowledge on the role of age in this context has remained scant. Therefore, the present study examines whether fear of sexual assault translates into fear of other offenses in all age segments of the female population, and whether the magnitude of this shadow effect varies with age. Statistical analyses are based on a large-scale random sample of women living in Germany. The findings suggest that although the proportion of women who are fearful of sexual assault declines with age, a shadow effect of this fear can be observed in all age groups. The ‘radiation effect’ of fear of sexual violence on fear of other crimes increases slightly with age. We interpret this interaction as result of older women's heightened vulnerability to many sorts of harm.
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