Promoting physical activity in rheumatoid arthritis through a physiotherapist led behaviour change-based intervention (PIPPRA): a feasibility randomised trial

Physical activity (PA) is recommended as a key component in the management of people with rheumatoid arthritis (RA). The objective of this study was to examine the feasibility of a physiotherapist led, behaviour change (BC) theory-informed, intervention to promote PA in people with RA who have low levels of current PA. A feasibility randomised trial (ClinicalTrials.gov NCT03644160) of people with RA over 18 years recruited from outpatient rheumatology clinics and classified as insufficiently physically active using the Godin-Shephard Leisure Time Physical Activity Questionnaire. Participants were randomised to intervention group (4 BC physiotherapy sessions in 8 weeks) delivered in person/virtually or control group (PA information leaflet only). Feasibility targets (eligibility, recruitment, and refusal), protocol adherence and acceptability were measured. Health care professionals (HCPs) involved in the study and patients in the intervention and control arms were interviewed to determine acceptability. Descriptive statistics were used to analyse the data with SPSS (v27) with interviews analysed using content analysis using NVivo (v14). Three hundred and twenty participants were identified as potentially eligible, with n = 183 (57%) eligible to participate, of which n = 58 (32%) consented to participate. The recruitment rate was 6.4 per month. Due to the impact of COVID-19 on the study, recruitment took place over two separate phases in 2020 and 2021. Of the 25 participants completing the full study, 23 were female (mean age 60 years (SD 11.5)), with n = 11 allocated to intervention group and n = 14 to control. Intervention group participants completed 100% of sessions 1 & 2, 88% of session 3 and 81% of session 4. The study design and intervention were acceptable overall to participants, with enhancements suggested. The PIPPRA study to improve promote physical activity in people with RA who have low PA levels was feasible, acceptable and safe. Despite the impact of COVID-19 on the recruitment and retention of patients, the study provides preliminary evidence that this physiotherapist led BC intervention is feasible and a full definitive intervention should be undertaken. Health care professionals involved in the study delivery and the patient participants described a number of positive aspects to the study with some suggestions to enhance the design. These findings hence inform the design of a future efficacy-focused clinical trial.

Survival with primary lung cancer in Northern Ireland: 1991-1992

Lung cancer is a major cause of death in Western countries, but survival had never been studied in Northern Ireland (NI) on a population basis prior to this study.

AIMS

The primary aims were to describe the survival of patients with primary lung cancer, evaluate the effect of treatment, identify patient characteristics influencing survival and treatment and describe current trends in survival.

METHODS

A population-based study identified all incident cases of primary lung cancer in NI during 1991-2 and followed them for 21 months. Their clinical notes were traced and relevant details abstracted. Survival status was monitored via the Registrar General's Office, and ascertainment is thought to be near-complete. Appropriate statistical methods were used to analyse the survival data.

RESULTS

Some 855 incident cases were studied. Their 1-year survival was 24.5% with a median survival time of 4.7 months. Surgical patients had the best 1-year survival, 76.8%; however, adjustment suggested that about half of the benefit could be attributed to case-mix factors. Factors influencing treatment allocation were also identified, and a screening test showed the discordance between 'model' and 'medic': 210 patients were misclassified. Finally, the current trend in 1-year survival observed in the Republic of Ireland was best in the British Isles.

CONCLUSIONS

Overall, survival remains poor. The better survival of surgical patients is due, in part, to their superior case-mix profiles. Survival with other therapies is less good suggesting that the criteria for treatment might be relaxed with advantage using a treatment model to aid decision-making.

Synthesis of Sustainable Lignin Precursors for Hierarchical Porous Carbons and Their Efficient Performance in Energy Storage Applications

Lignin-derived porous carbons have great potential for energy storage applications. However, their traditional synthesis requires highly corrosive activating agents in order to produce porous structures. In this work, an environmentally friendly and unique method has been developed for preparing lignin-based 3D spherical porous carbons (LSPCs). Dropwise injection of a lignin solution containing PVA sacrificial templates into liquid nitrogen produces tiny spheres that are lyophilized and carbonized to produce LSPCs. Most of the synthesized samples possess excellent specific surface areas (426.6-790.5 m2/g) along with hierarchical micro- and mesoporous morphologies. When tested in supercapacitor applications, LSPC-28 demonstrates a superior specific capacitance of 102.3 F/g at 0.5 A/g, excellent rate capability with 70.3% capacitance retention at 20 A/g, and a commendable energy density of 2.1 Wh/kg at 250 W/kg. These materials (LSPC-46) also show promising performance as an anode material in sodium-ion batteries with high reversible capacity (110 mAh g-1 at 100 mA g-1), high Coulombic efficiency, and excellent cycling stability. This novel and green technique is anticipated to facilitate the scalability of lignin-based porous carbons and open a range of research opportunities for energy storage applications.

Irish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study

BACKGROUND

Since winter 2020/21, general practitioners (GPs) in the Republic of Ireland (RoI) have been granted access to diagnostic imaging studies on a new publicly funded pathway, expediting access to services previously obtained via hospital-based doctors.

AIMS

Outline GP perspectives on imaging studies obtained via the new "GP Access to Community Diagnostics" initiative.

METHODS

A mixed-methods design was employed. Referrals over the first six months of 2019 and 2021 were collated by a private imaging provider, and a randomly selected subset of 2021 studies (maximum 30 referrals per GP) was returned to participating GPs to provide detail on the impact on each patient's care. In-depth qualitative interviews were also conducted with participating GPs.

RESULTS

Eleven GPs supplied detailed information on 81 studies organized through the new initiative. GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases and increased GP workload in 58% of cases. GP qualitative interviews revealed four key themes: improved patient care, increased GP workload, reduction in hospital referrals, and opinions on ongoing management of such initiatives, including guidelines.

CONCLUSIONS

GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals. GPs were generally positive about the initiative and made some suggestions on future management of the initiative.

Exploring the state of health of electric vehicle batteries at end of use; hierarchical waste flow analysis to determine the recycling and reuse potential

With the increasing adoption of electric vehicles, their end-of-life management is a timely matter. This requires recognizing the upcoming volume of retired electric-vehicle-batteries to the waste stream. The projection is further useful if we have an estimation of the remaining value within them to categorize the recycling or repurposing potential to allow appropriate policy development and facility planning. This qualification assessment is neglected in the current literature. Neglecting the health status of retired batteries in estimating their residual value might end up over or underestimating their reuse and recycling potential. This study aims to provide a hierarchical battery waste estimation based on their health and age of disposal in Ireland. These two factors are the fundamental parameters in determining the feasibility of repurposing or recycling retired batteries. Identifying this information, we defined three reuse scenarios with different state-of-health limits. Results indicate almost 50%, 30%, and below 10% repurposing potential in the year 2050 when setting a repurposing threshold of above 80%, 85%, and 90%, respectively. The authors also highlight the effect of non-regional repurposing on the recycling potential.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13243-024-00137-4.

A thematic analysis of alcohol use and culture amongst elite (intercounty) Gaelic Athletic Association (GAA) players

BACKGROUND

There are limited studies examining alcohol consumption in Gaelic Athletic Association (GAA) players. In a previous paper, we reported excess alcohol consumption, alcohol-related harms and binge drinking amongst elite GAA players. In that survey, the players were provided with an opportunity to provide comments on alcohol. This current study analyses these comments.

AIMS

The aim of this study was to provide a qualitative analysis of elite GAA players opinions on alcohol consumption, harms, behaviours and culture.

METHODS

An anonymous, web-based e-questionnaire was distributed to all registered adult elite (inter-county) GAA players. This analysed demographics, alcohol consumption, alcohol culture and alcohol-related harms. This paper is a thematic analysis of the players comments on alcohol in the GAA.

RESULTS

Seven hundred seventy-three of 3592 (21%) players responded. One hundred fifty-two respondents (21%) commented in the free text section of the survey regarding alcohol. One hundred eleven comments (73%) were suitable for analysis. Relevant themes were a pattern of abstinence and bingeing (n = 44), excess alcohol consumption (n = 40) and drinking bans contributing to a binge drinking culture (n = 37). There was a mixed attitude to alcohol sponsorship.

CONCLUSION

These data show players recognise intermittent binge drinking with periods of abstinence and alcohol-related harms. Further initiatives regarding alcohol harm reduction merit consideration including prohibition of alcohol sponsorship, similar to the GAA's ban on gambling.

Understanding the evolution of trust in a participatory health research partnership: A qualitative study

INTRODUCTION

Advancements in evaluating the impact of participatory health research (PHR) have been made through comprehensive models like the community-based participatory research (CBPR) conceptual model, which provides a useful framework for exploring how context and partnership processes can influence health research design and interventions. However, challenges in operationalising aspects of the model limit our understanding and evaluation of the PHR process. Trust is frequently identified as an important component of the CBPR model, which supports the development of key partnership outcomes, such as partnership synergy. However, trust continues to be limited to a binary view (as present or absent), which is problematic given its inherently dynamic and temporal nature.

STUDY AIM

The aim of this qualitative study is to understand the evolution of trust in the national public and patient involvement (PPI) network in Ireland.

SETTING AND PARTICIPANTS

Participants from the PPI network (n = 15/21) completed a semistructured interview discussing the evolution of trust by reviewing four social network maps derived from a previous longitudinal study.

ANALYSIS

Following Braun and Clarke, we used reflexive thematic analysis, to iteratively develop, analyse and interpret our mediated reflection of the data.

RESULTS

Participants described the evolution of trust as a function of three contextual factors: (1) the set-up and organisation of the network, (2) how people work together and (3) reflection on the process and outcomes. Their descriptions across these themes seemed to vary depending on partnership type with National Partners and Site Leads having more opportunities to demonstrate trust (e.g., via leadership roles or more resources), compared to Local. Thus, visibility and the opportunity to be visible, depending on the set-up and organisation of the network and how people work together, seemingly play an important role in the evolution of trust over time. Based on these findings, we provide important questions for reflection across themes that could be considered for future PHR partnerships.

DISCUSSION

Given that the opportunity and visibility to build and maintain trust over time may not be equally available to all partners, it is important to find ways to invest in and commit to equitable relationships as the key to the success (i.e., longevity) of partnerships. We reflect on/offer important implications for those engaging in PHR partnerships and those who fund such research.

PATIENT OR PUBLIC CONTRIBUTION

A Research Advisory Group comprising four research partners (representing academic, service and community organisations) from the PPI Ignite Network provided input and approval for the research objectives of this study as well as previously published work informing this study. Informal consultation occurred with members of this group to discuss findings from this study, assisting with the way findings are presented and described, to be accessible for diverse audiences. Two Research Advisory Group members were involved in the interpretation of the results, and one is a co-author of this manuscript (Zoe Hughes).

Prophylactic cholecystectomy offers best outcomes following ERCP clearance of common bile duct stones: a meta-analysis

BACKGROUND

Symptomatic calculus biliary disease is common with associated morbidity and occasional mortality, further confounded when there is concomitant common bile duct (CBD) stones. Choledocholithiasis and clearance of the duct reduces recurrent cholangitis, but the question is whether after clearance of the CBD if there is a need to perform a cholecystectomy. This meta-analysis evaluated outcomes in patients undergoing ERCP with or without sphincterotomy to determine if cholecystectomy post-ERCP clearance offers optimal outcomes over a wait-and-see approach.

METHODS

A Prospero registered meta-analysis of the literature using PRISMA guidelines incorporating articles related to ERCP, choledocholithiasis, cholangitis and cholecystectomy was undertaken for papers published between 1st January 1991 and 31st May 2021. Existing research that demonstrates outcomes of ERCP with no cholecystectomy versus ERCP and cholecystectomy was reviewed to determine the related key events, complications and mortality of leaving the gallbladder in situ and removing it. Odds ratios (OR) were calculated using Review Manager Version 5.4 and meta-analyses performed using OR using fixed-effect (or random-effect) models, depending on the heterogeneity of studies.

RESULTS

13 studies (n = 2598), published between 2002 and 2019, were included in this meta-analysis, 6 retrospective, 2 propensity score-matched retrospective studies, 3 prospective studies and 2 randomised control trials from a total of 11 countries. There were 1433 in the no cholecystectomy cohort (55.2%) and 1165 in the prophylactic cholecystectomy (44.8%) cohort. Cholecystectomy resulted in a decreased risk of cholecystitis (OR = 0.15; CI 0.07-0.36; p < 0.0001), cholangitis (OR = 0.51; CI 0.26-1.00; p = 0.05) and mortality (OR = 0.38; CI 0.16-0.9; p = 0.03). In addition, prophylactic cholecystectomy resulted in a significant reduction in biliary events, biliary pain and pancreatitis.

CONCLUSIONS

In patients undergoing CBD clearance, consideration should be given to performing prophylactic cholecystectomy to optimise outcomes.

Experience and perceptions among rheumatoid arthritis patients following a telehealth-delivered dietary intervention: a qualitative study

The effects of dietary modifications have been assessed in people living with rheumatoid arthritis (RA) with consistent benefits reported from clinical trials. However, the lived experience of making and sustaining positive dietary changes for people with RA remains unknown. The aim of this qualitative study was to explore the experiences of adults with RA and their perceptions of a 12-week telehealth-delivered dietary intervention and to assess the acceptability of the programme. Qualitative data was collected via four online focus groups with participants who had just completed a 12-week dietary intervention programme delivered through telehealth methods. Thematic analysis was used to code and summarize the identified key themes. Twenty-one adults with RA (47.5 ± 12.3 years, 90.5% females) were included in this qualitative study. Overarching themes included: (a) motivation to join the programme, (b) benefits of the programme, (c) factors influencing adherence to dietary prescription, and (d) advantages and disadvantages of telehealth. The study demonstrated that a dietary intervention delivered through telehealth methods by a Registered Dietitian (RD) appears to be well-accepted and may be used to complement face-to-face care for people with RA. The identified factors influencing the adoption of a healthier eating pattern will aid in the development of future dietary interventions for a RA population.

Dynamic Grammar Pruning for Program Size Reduction in Symbolic Regression

Grammar is a key input in grammar-based genetic programming. Grammar design not only influences performance, but also program size. However, grammar design and the choice of productions often require expert input as no automatic approach exists. This research work discusses our approach to automatically reduce a bloated grammar. By utilizing a simple Production Ranking mechanism, we identify productions which are less useful and dynamically prune those to channel evolutionary search towards better (smaller) solutions. Our objective in this work was program size reduction without compromising generalization performance. We tested our approach on 13 standard symbolic regression datasets with Grammatical Evolution. Using a grammar embodying a well-defined function set as a baseline, we compare effective genome length and test performance with our approach. Dynamic grammar pruning achieved significantly better genome lengths for all datasets, while significantly improving generalization performance on three datasets, although it worsened in five datasets. When we utilized linear scaling during the production ranking stages (the first 20 generations) the results dramatically improved. Not only were the programs smaller in all datasets, but generalization scores were also significantly better than the baseline in 6 out of 13 datasets, and comparable in the rest. When the baseline was also linearly scaled as well, the program size was still smaller with the Production Ranking approach, while generalization scores dropped in only three datasets without any significant compromise in the rest.

Stakeholder Perceptions of the Acceptability of Peer-Mediated Intervention for Minimally Speaking Preschoolers on the Autism Spectrum

Peer mediated intervention (PMI) is an evidence-based approach to supporting social and communication development for children on the autism spectrum. For PMI to be integrated into everyday practice, it needs to be acceptable to stakeholders. This article engaged with autistic individuals, early childhood educators, parents, and speech and language pathologists on the prospective acceptability of implementing PMI with minimally speaking preschoolers in inclusive preschool settings. Focus groups and semi-structured interviews were conducted. The transcriptions were analyzed qualitatively using reflexive thematic analysis. Stakeholders described PMI as an acceptable intervention approach for this population and provided valuable insights to inform the development and implementation of PMIs. Attention needs to be paid to how to support preschools to adopt a PMI-friendly philosophy.

Precursor-Mediated Colloidal Synthesis of Compositionally Tunable Cu-Sb-M-S (M = Zn, Co, and Ni) Nanocrystals and Their Transport Properties

The solution-based colloidal synthesis of multinary semiconductor compositions has allowed the design of new inorganic materials impacting a large variety of applications. Yet there are certain compositions that have remained elusive-particularly quaternary structures of transition metal-based (e.g., Co, Zn, Ni, Fe, Mn, and Cr) copper antimony chalcogenides. These are widely sought for tuning the electrical and thermal conductivity as a function of the size, composition, and crystal phase. In this work, a facile hot injection approach for the synthesis of three different tetrahedrite-substituted nanocrystals (NCs) (Cu₁₀Zn₂Sb₄S₁₃, Cu₁₀Co₂Sb₄S₁₃, and Cu₁₀Ni_1.5Sb₄S₁₃) and their growth mechanisms are investigated. We reveal that the interplay between the Zn, Ni, and Co precursors on the basis of thiophilicity is key to obtaining pure phase NCs with controlled size and shape. While all of the synthesized crystal phases display outstanding low thermal conductivity, the Cu_10.5Sb₄Ni_1.5S₁₃ system shows the most enhanced electrical conductivity compared to Cu₁₀Zn₂Sb₄S₁₃ and Cu₁₀Co₂Sb₄S₁₃. This study highlights an effective synthesis strategy for the growth of complex quaternary nanocrystals and their high potential for application in thermoelectrics.

Insights into product design students' perception of, and engagement with, creativity in design education

Creativity is acknowledged as an essential component of the design process and considered a key design graduate attribute. Despite this assertion, several studies have highlighted that the teaching of creativity in design education is often implicit rather than explicit. Moreover, there is a paucity of research on product design students' experience of creativity in design education, leaving a gap in knowledge relevant to how creativity may be better fostered in design education. In this study, reflexive thematic analysis was used to analyse the data from online focus groups conducted with product design students. The three themes constructed provide insights into how students perceive and engage with creativity. Theme 1, the influence of social factors on creativity, uncovers the diametric effect students' social eco-system can have on their creativity. These include an aversion to being associated with it due to weight of expectation and negative perceptions around creativity, as well as the 'invisible support system' created by peers. Theme 2, sanctuary seeking tendencies of novice design students, reveals behaviours that oppose essential creative attributes: a freedom from risk and ambiguity and desire for certainty and achievability. Theme 3, tension between passion for and pursuit of creativity, outlines the conflict between participants' ideologies and actions when pursuing creativity highlighting a reluctance to utilise structured creativity tools while gravitating towards unstructured methods such as 'relaxed attention'. Together, the three themes form a picture of product design students' complex relationship with creativity and importance of self-efficacy. The findings of this study make an important contribution to our understanding of design students' perception of, and engagement with, creativity in design education. As such these findings are relevant for both design education and future creativity tool development.

One-off events? An empirical study of hackathon code creation and reuse

CONTEXT

Hackathons have become popular events for teams to collaborate on projects and develop software prototypes. Most existing research focuses on activities during an event with limited attention to the evolution of the hackathon code.

OBJECTIVE

We aim to understand the evolution of code used in and created during hackathon events, with a particular focus on the code blobs, specifically, how frequently hackathon teams reuse pre-existing code, how much new code they develop, if that code gets reused afterwards, and what factors affect reuse.

METHOD

We collected information about 22,183 hackathon projects from Devpost and obtained related code blobs, authors, project characteristics, original author, code creation time, language, and size information from World of Code. We tracked the reuse of code blobs by identifying all commits containing blobs created during hackathons and identifying all projects that contain those commits. We also conducted a series of surveys in order to gain a deeper understanding of hackathon code evolution that we sent out to hackathon participants whose code was reused, whose code was not reused, and developers who reused some hackathon code.

RESULT

9.14% of the code blobs in hackathon repositories and 8% of the lines of code (LOC) are created during hackathons and around a third of the hackathon code gets reused in other projects by both blob count and LOC. The number of associated technologies and the number of participants in hackathons increase reuse probability.

CONCLUSION

The results of our study demonstrates hackathons are not always "one-off" events as the common knowledge dictates and it can serve as a starting point for further studies in this area.

(Re)Conceptualizing decision-making tools in a risk governance framework for emerging technologies-the case of nanomaterials

The utility of decision-making tools for the risk governance of nanotechnology is at the core of this paper. Those working in nanotechnology risk management have been prolific in creating such tools, many derived from European FP7 and H2020-funded projects. What is less clear is how such tools might assist the overarching ambition of creating a fair system of risk governance. In this paper, we reflect upon the role that tools might and should play in any system of risk governance. With many tools designed for the risk governance of this emerging technology falling into disuse, this paper provides an overview of extant tools and addresses their potential shortcomings. We also posit the need for a data readiness tool. With the EUs NMP13 family of research consortia about to report to the Commission on ways forward in terms of risk governance of this domain, this is a timely intervention on an important element of any risk governance system.

Stress recovery of laminated non-prismatic beams under layerwise traction and body forces

Emerging manufacturing technologies, including 3D printing and additive layer manufacturing, offer scope for making slender heterogeneous structures with complex geometry. Modern applications include tapered sandwich beams employed in the aeronautical industry, wind turbine blades and concrete beams used in construction. It is noteworthy that state-of-the-art closed form solutions for stresses are often excessively simple to be representative of real laminated tapered beams. For example, centroidal variation with respect to the neutral axis is neglected, and the transverse direct stress component is disregarded. Also, non-classical terms arise due to interactions between stiffness and external load distributions. Another drawback is that the external load is assumed to react uniformly through the cross-section in classical beam formulations, which is an inaccurate assumption for slender structures loaded on only a sub-section of the entire cross-section. To address these limitations, a simple and efficient yet accurate analytical stress recovery method is presented for laminated non-prismatic beams with arbitrary cross-sectional shapes under layerwise body forces and traction loads. Moreover, closed-form solutions are deduced for rectangular cross-sections. The proposed method invokes Cauchy stress equilibrium followed by implementing appropriate interfacial boundary conditions. The main novelties comprise the 2D transverse stress field recovery considering centroidal variation with respect to the neutral axis, application of layerwise external loads, and consideration of effects where stiffness and external load distributions differ. A state of plane stress under small linear-elastic strains is assumed, for cases where beam thickness taper is restricted to 15 ∘ . The model is validated by comparison with finite element analysis and relevant analytical formulations.

An Investigation into the Growth of Lolium perenne L. and Soil Properties Following Soil Amendment with Phosphorus-Saturated Bauxite Residue

Reuse options for bauxite residue include treatment of phosphorus (P)-enriched wastewaters where the P-saturated media offers fertiliser potential. However, few studies have assessed the impact on soil properties. Two types of spent P-saturated bauxite residue were applied to soil and compared to conventional superphosphate fertiliser as well as a control soil. Soil physico-chemical properties, worm Eisenia fetida L. choice tests, and Lolium perenne L. growth and elemental uptake were examined. Comparable biomass and plant content for L. perenne in the P-saturated bauxite residue treatments and those receiving superphosphate, indicated no phytotoxic effects. E. fetida L. showed a significant preference for the control soil (58 %± 2.1%) over the amended soils, indicating some form of salt stress. Overall, P-saturated bauxite residue was comparable to the superphosphate fertiliser in terms of the plant performance and soil properties, indicating the potential recycling of P from wastewaters using bauxite residue as a low-cost adsorbent.

Psychotherapeutic interventions for burns patients and the potential use with Stevens-Johnson syndrome and toxic epidermal necrolysis patients: A systematic integrative review

Background

The existing evidence demonstrates that survivors of SJS/TEN have reported long-lasting psychological effects of their condition. Burns patients experience similar psychological effects. It is important to look at ways to help allay the psychological complications of SJS/TEN. As there is an absence of evidence on SJS/TEN psychotherapeutic interventions, it was judged to be beneficial to determine the evidence underpinning psychotherapeutic interventions used with burns patients.

Aims and objectives

The aim of this systematic integrative review was to synthesize the evidence relating to psychotherapeutic interventions used with adult burns patients and patients with SJS/TEN.

Method

The systematic review was guided by Whittemore and Knafl’s integrative review process and the PRISMA guidelines. Nine databases were searched for English and French language papers published January 2008 to January 2021. The protocol for the review was registered with PROSPERO.

Results

Following a screening process, 17 studies were included in the review. Two themes were identified using content analysis, (i) Empirically supported psychotherapeutic treatments, (ii) Alternative psychotherapeutic treatments. This review revealed no evidence on specific psychotherapeutic interventions for patients with SJS/TEN. Some of the interventions used with burns patients, viz. relaxation therapy, hypnosis and cognitive behavioral therapy showed some significant benefits. However, the evidence for burns patients is mainly focused on pain and pain anxiety as outcomes.

Conclusion

Following further research, some of the interventions deployed in burns patients may be applicable to SJS/TEN patients, particularly stress reduction techniques. In addition, the caring behaviours such as compassion, respect, and getting to know the patient as a person are important components to psychological care.

Exploring how patients, carers and members of the public are recruited to advisory boards, groups and panels as partners in public and patient involved health research: a scoping review protocol

INTRODUCTION

Engaging patients, carers and members of the public in health research has become widely recognised as an important approach for bridging the gap between research, and health and social care by increasing the relevance of research for those who benefit from its findings. Specific approaches to engagement vary, but commonly include advisory boards, groups or patient panels that are active throughout all stages of research. The breadth of and optimal strategies for recruiting patients, carers and members of the public to such boards, groups or panels remains unclear. The objective of this manuscript is to identify the breadth of and optimal strategies used to recruit patients, carers and members of the public to advisory boards, groups or panels, within public and patient involvement (PPI) research.

METHODS AND ANALYSIS

This review follows the scoping review framework by Peters et al, an elaboration on the framework by Arksey and O'Malley. The search strategy was co-developed among the research team, PPI research experts and a faculty librarian. The review will take place between July 2021 and June 2022. In July and August 2021, eight electronic databases, MEDLINE (PubMed), MEDLINE (OVID), Embase, CINAHL, PsychINFO, Scopus, Web of Science and Cochrane Library, will be explored to capture all available literature. Two independent reviewers will screen articles by title and abstract and then at full text based on predetermined criteria. The data will be presented in a tabular format with a narrative summary discussing how the research findings relate to the overarching research question. A thematic analysis will also be completed using qualitative description, identifying key themes and gaps in the literature.

ETHICS AND DISSEMINATION

Ethics is not required for this review. We aim to disseminate the information gathered through presentations at academic conferences, peer-reviewed publications and consultations with lay audiences.

Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review

Background

In most high-income countries, emergency departments (ED) represent the principal point of access forcer by critically ill or injured patients. Unlike inpatient units, ED healthcare workers (ED HCWs) have demonstrated relative lack of adherence to hand hygiene (HH) guidelines, commonly citing frequency of intervention and high rates of admission, which reflect severity of cases encountered.

Aim

Assessment of studies on hand hygiene compliance (HHC) by ED HCWs conducted between 2010 and 2020, seeking to estimate HHC rates and intervention strategies utilised to improve HHC in EDs.

Methods

Searches conducted in Web of Science, EBSCO HOST (CINHAL & Medline), PubMed, Embase, and Cochrane for full studies published between 2010 and 2020 on the topic of HHC in the ED.

Results

One hundred twenty-nine eligible articles were identified of which 79 were excluded. Fifty-one underwent full-text screening before 20 studies were deemed relevant. Of the eligible studies, fifteen (75%) had, as the primary outcome, HHC according to the WHO-recommended 5-moments. Twelve studies (60%) implemented multimodal or single intervention strategies. Eight studies were ambiguous regarding the nature of the approach adopted. In the nine observational studies where HHC was documented, an overall post-intervention median HHC rate of 45% (range 8–89.7%).

Conclusion

Multimodal approaches appear to have enhanced HHC moderately among ED HCWs. Elevated complexity associated with critically ill patients, and ED overcrowding, are contributing factors to relatively low compliance rates observed. Strategies to improve HHC rates may need to acknowledge, and cater for, the context of an unpredictable environment.

Design and Evaluation of Interprofessional Training Program for Healthcare Students from Collectivistic Culture

BACKGROUND

Healthcare is team-based, and with increased mobility of healthcare workers, most of them will work with team members from all over the globe. Interprofessional education (IPE) research has mostly focused on specially designed programs in academic health institutions to prepare students for multidisciplinary work. Few IPE programs aim to integrate students with mixed disciplines from collectivist cultures.

METHODS

This mixed-methods study was conducted between June and August 2019. Surveys and an e-portfolio were recorded of 33 final-year and graduated health professional students' participation in an 8-week IPE summer program at a medical school in Ireland. Survey results are described, and the content of portfolios was analyzed based on the deductive analysis of qualitative data derived from questions.

RESULTS

Students reported the greatest improvement in presentation skills (63.6%), followed by communication (54.5%), team working skills (93.9%), and interprofessional learning (42.4%), respectively. Qualitative findings highlighted challenges for students from a collectivist culture adapting to an IPE: uncomfortable verbally expressing themselves in problem-based learning (PBL) and how to work with other sex. Positive themes about IPE that emerged were enjoyment in sharing ideas and building trust with PBL groups. We learned that the program had to be flexible enough to meet the educational requirements of a target community with mixed English language ability and adaptability to IPE.

CONCLUSION

The authors propose that an international PBL-based summer program is effective in improving healthcare students' attitudes towards IPE. This study provides valuable insights to facilitate the development of further IPE programs to increased collaboration between students across various healthcare disciplines.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01536-7.

Cyber risk and cybersecurity: a systematic review of data availability

Cybercrime is estimated to have cost the global economy just under USD 1 trillion in 2020, indicating an increase of more than 50% since 2018. With the average cyber insurance claim rising from USD 145,000 in 2019 to USD 359,000 in 2020, there is a growing necessity for better cyber information sources, standardised databases, mandatory reporting and public awareness. This research analyses the extant academic and industry literature on cybersecurity and cyber risk management with a particular focus on data availability. From a preliminary search resulting in 5219 cyber peer-reviewed studies, the application of the systematic methodology resulted in 79 unique datasets. We posit that the lack of available data on cyber risk poses a serious problem for stakeholders seeking to tackle this issue. In particular, we identify a lacuna in open databases that undermine collective endeavours to better manage this set of risks. The resulting data evaluation and categorisation will support cybersecurity researchers and the insurance industry in their efforts to comprehend, metricise and manage cyber risks.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1057/s41288-022-00266-6.

Multi-objective optimisation of ultrasonically welded dissimilar joints through machine learning

The use of composite materials is increasing in industry sectors such as renewable energy generation and storage, transport (including automotive, aerospace and agri-machinery) and construction. This is a result of the various advantages of composite materials over their monolithic counterparts, such as high strength-to-weight ratio, corrosion resistance, and superior fatigue performance. However, there is a lack of detailed knowledge in relation to fusion joining techniques for composite materials. In this work, ultrasonic welding is carried out on a carbon fibre/PEKK composite material bonded to carbon fibre/epoxy composite to investigate the influence of weld process parameters on the joint's lap shear strength (LSS), the process repeatability, and the process induced defects. A 3³ parametric study is carried out and a robust machine learning model is developed using a hybrid genetic algorithm-artificial neural network (GA-ANN) trained on the experimental data. Bayesian optimisation is employed to determine the most suitable GA-ANN hyperparameters and the resulting GA-ANN surrogate model is exploited to optimise the welding process, where the process performance metrics are LSS, repeatability and joint visual quality. The prediction for the optimal LSS was subsequently validated through a further set of experiments, which resulted in a prediction error of just 3%.

'Doctors can't be doctors all of the time': a qualitative study of how general practitioners and medical students negotiate public-professional and private-personal realms using social media

OBJECTIVE

The objective of this study is to explore the experiences and perspectives of general practitioners' and medical students' use of, and behaviour on, social media and to understand how they negotiate threats to professional and personal life on social media.

DESIGN

A two-phase qualitative design was used, consisting of semistructured interviews and follow-up vignettes, where participants were asked to respond to vignettes that involved varying degrees of unprofessional behaviour. Data were analysed using template analysis.

SETTING AND PARTICIPANTS

Participants were general practitioner tutors and third year medical students who had just completed placement on the University of Limerick longitudinal integrated clerkship. Five students and three general practitioners affiliated with the medical school were invited to participate in one-to-one interviews.

RESULTS

Three overarching themes, each containing subthemes were reported. 'Staying in contact and up to date' outlines how social media platforms provide useful resources and illustrates the potential risks of social media. 'Online persona' considers how social media has contributed to changing the nature of interpersonal relationships. 'Towards standards and safety' raises the matter of how to protect patients, doctors and the medical profession.

CONCLUSION

Guidance is required for students and medical practitioners on how to establish reasonable boundaries between their personal and professional presence on social media and in their private life so that poorly judged use of social media does not negatively affect career prospects and professional efficacy.

The incidence of lung cancer in Northern Ireland: 1991-1992 : A comparative study

Introduction

Lung cancer is the leading cause of cancer deaths in many Western countries, but its incidence has never been studied in Northern Ireland.

Aims

Accordingly, the present study was mounted to determine, for the first time, the incidence of the condition in Northern Ireland and to compare the findings with other regions in the British Isles.

Methods

A notification study of the incidence of lung cancer (ICD 162) was conducted in Northern Ireland during 1991/1992. Notifications from 6 sources were computerised and linked. Incident cases were identified and analysed in relation to Age, Sex and Geographical region—Northern Ireland, England and Wales, Scotland and the Republic of Ireland.

Results

Some 900 incident cases of lung cancer were identified. The incidence rate per 100,000 population was found to be 57.04. Mortality underestimated incidence by 12.5%. (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p<0.05$$\end{document}p<0.05). The male to female incidence ratio was 2.1: 1, and this ratio was similar in other regions, except Scotland, where the ratio was 1.7:1. The null hypothesis of a common incidence distribution across regions was formally rejected. A variety of models were fitted and a model in which the log-odds on incidence was a quadratic function of age fitted most of the regional data.

Conclusions

Northern Ireland had the lowest incidence of lung cancer in the UK, but its overall rate was still 40% higher than that observed in the Republic of Ireland which had the lowest rate in the British Isles. Across regions, the pattern of incidence by age and sex was complicated, but a linear logistic model fitted all of the Irish data and the female data in Scotland, satisfactorily.

Pharmaceutical design of a delivery system for the bacteriocin lacticin 3147

Lacticin 3147 is a dual-acting two-peptide bacteriocin which is generally active against Gram-positive bacteria, including Listeria monocytogenes and antimicrobial-resistant bacteria such as Closteroides difficile in the colon. L. monocytogenes infections can cause life-long effects in the elderly and vulnerable and can cause severe complications in pregnant women. C. difficile causes one of the most common healthcare-associated infections and can be fatal in vulnerable groups such as the elderly. Although lacticin 3147 is degraded by intestinal proteases and has poor aqueous solubility, encapsulation of the bacteriocin could enable its use as an antimicrobial for treating these bacterial infections locally in the gastrointestinal tract. Lacticin 3147 displayed activity in aqueous solutions at a range of pH values and in gastric and intestinal fluids. Exposure to trypsin and α-chymotrypsin resulted in complete inactivation, implying that lacticin 3147 should be protected from these enzymes to achieve successful local delivery to the gastrointestinal tract. The amount of lacticin 3147 dissolved, i.e. its solution concentration, in water or buffered solutions at pH 1.6 and 7.4 was low and varied with time but increased and was stabilized in gastrointestinal fluids by the phospholipid and bile salt components present. Thus, the feasibility of a solid lipid nanoparticle (SLN) delivery system for local administration of lacticin 3147 was investigated. Bacteriocin activity was observed after encapsulation and release from a lipid matrix. Moreover, activity was seen after exposure to degrading enzymes. Further optimization of SLN delivery systems could enable the successful pharmaceutical development of active lacticin 3147 as an alternative to traditional antibiotics.

How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients

OBJECTIVES

To investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.

DESIGN

Cross-sectional study.

SETTING

International study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.

PARTICIPANTS

1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).

PRIMARY AND SECONDARY OUTCOME MEASURES

Hyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.

RESULTS

Hypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).

CONCLUSIONS

This study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.

'It benefits patient care': the value of practice-based IPE in healthcare curriculums

BACKGROUND

Practice-based interprofessional education (IPE) is essential to prepare students for collaborative working. Pockets of practice-based IPE are integrated into healthcare curriculums in some regions. Yet practice-based IPE is not globally valued as a key element of healthcare curriculums. As students and clinical educators are key stakeholders, this study presents a case example of their experiences in a country where practice-based IPE is at an emergent stage. Their experiential knowledge generated important insights into how practice-based IPE is perceived. This learning can be applied, both locally and further afield, by those seeking to embed practice-based IPE in their placement curriculums.

METHODS

A qualitative case study was conducted at a school of allied health and partner placement sites in Ireland. Data collection comprised two participant observations, 13 interviews and 12 document analyses. Inductive thematic analysis and deductive framework analysis, underpinned by activity theory and Hofstede's cultural dimensions, informed data analysis and interpretations.

RESULTS

Participants are grappling to establish the value of practice-based IPE, illustrated in three themes: clarifying the concept of practice-based IPE, mapping IPE activities and diversifying interprofessionalism. First, ambiguous conceptualisation of why and how to implement practice-based IPE was identified. Highlighting how practice-based IPE improved patient care and safety created a clear rationale for implementation. It was also helpful to demonstrate how adaptations to existing practice education models, rather than entirely new models, could achieve high-quality practice-based IPE. Second, the positioning of practice-base IPE in the placement curriculum was unclear. Overt mapping of practice-based IPE activities onto learning outcomes within assessment tools enhanced its value within practice education. Third, varying levels of professional engagement were noted, perpetuating stereotypes. Creating diverse educator networks and embedding practice-based IPE in organisational strategy may incentivise engagement across a greater range of professions.

CONCLUSIONS

Implementing these recommendations could enhance the value of practice-based IPE and optimise student preparation for collaborative working. Practice-based IPE remains a complex model and the trajectory of embedding in healthcare curriculums will differ globally.

Migrant health research in the Republic of Ireland: a scoping review

BACKGROUND

Migration to European countries has increased in number and diversity in recent years. Factors such as access to healthcare, language barriers and legal status can impact the health outcomes of migrant groups. However, little is known about the evidence base on the health status of migrants in the Republic of Ireland. Our aim was to scope existing peer-reviewed research on the health of migrants in Ireland and identify any gaps in the evidence.

METHODS

We conducted a scoping review of peer-reviewed research on the health of migrants in the Republic of Ireland. Eleven electronic databases were searched for peer-reviewed, empirical articles published between 2001 and 2017. Search terms were adapted from a World Health Organisation review. Findings were analysed using the 2016 World Health Organisation Strategy and Action Plan for Refugee and Migrant Health in the World Health Organisation European region, which outlines nine strategic areas that require collaborative action.

RESULTS

Of 9396 articles retrieved, 80 met inclusion criteria, with the majority (81%) published since 2009. More than half of the studies had a quantitative design (65%). Migrants studied came from Eastern Europe, Asia and Africa and included labour migrants, refugees and asylum seekers. Most studies related to two World Health Organisation strategic areas; 4: "achieving public health preparedness and ensuring an effective response", and 5: "strengthening health systems and their resilience".

CONCLUSION

There is growing attention to migrant health in Ireland with a balance of qualitative and quantitative research. While much of the identified research is relevant to three of the World Health Organisation strategic areas, there are significant gaps in the other six areas. The study design could be replicated in other countries to examine and inform migrant health research.