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A collaborative evaluation of remote consultations in mental health services was undertaken by mental health service providers, experts by experience, academic institutions and a Health Innovation Network in south London, UK. ‘Learning healthcare systems’ thinking was applied. Workstream 1 reviewed international published evidence; workstream 2 synthesised findings from three health provider surveys of the perceptions and experiences of staff, patients and carers; and workstream 3 comprised an electronic survey on local projects.
Results
Remote consultations can be acceptable to patients and staff. They improve access for some while restricting access for others, with digital exclusion being a key concern. Providing tailored choice is key.
Clinical implications
The collaboration generated learning to inform choices by healthcare providers to embed or adapt remote delivery. A key output was freely downloadable survey questions for assessing the quantity and quality of appointments undertaken by phone or video or face to face.
Recruiting and retaining research participants is challenging because it often requires overcoming structural barriers and addressing how histories of mistrust and individuals’ lived experiences affect their research engagement. We describe a pilot workshop designed to educate clinical research professionals on using empathy skills to recognize and mitigate bias to improve recruitment and retention. In a post-workshop survey (22/31 participants completed), 94% agreed the workshop helped them practice perspective-taking, recognize implicit bias, and identify opportunities for empathy. Participants reported increased confidence in key recruitment and retention skills (p < 0.05). Future studies will evaluate whether this translates into improved recruitment.
In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
Migrants and refugees face elevated risks for mental health problems but have limited access to services. This study compared two strategies for training and supervising nonspecialists to deliver a scalable psychological intervention, Group Problem Management Plus (gPM+), in northern Colombia. Adult women who reported elevated psychological distress and functional impairment were randomized to receive gPM+ delivered by nonspecialists who received training and supervision by: 1) a psychologist (specialized technical support); or 2) a nonspecialist who had been trained as a trainer/supervisor (nonspecialized technical support). We examined effectiveness and implementation outcomes using a mixed-methods approach. Thirteen nonspecialists were trained as gPM+ facilitators and three were trained-as-trainers. We enrolled 128 women to participate in gPM+ across the two conditions. Intervention attendance was higher in the specialized technical support condition. The nonspecialized technical support condition demonstrated higher fidelity to gPM+ and lower cost of implementation. Other indicators of effectiveness, adoption and implementation were comparable between the two implementation strategies. These results suggest it is feasible to implement mental health interventions, like gPM+, using lower-resource, community-embedded task sharing models, while maintaining safety and fidelity. Further evidence from fully powered trials is needed to make definitive conclusions about the relative cost of these implementation strategies.
To quantify the proportion of referrals sent to Crumlin Cardiology Department for cardiac screening prior to commencement or modifying attention deficit hyperactivity disorder medication and assess the number detected with a clinically significant abnormality.
Methods:
A prospective audit was performed over a 6-month period, from November 2021 to April 2022 inclusive. Referrals sent via outpatient department triage letters, electrocardiogram dept. email, and walk-in electrocardiogram service were screened for those pertaining to commencing or modifying medication for children with attention deficit hyperactivity disorder. Each referral was coded against National Institute for Health and Care Excellence guidelines to determine the degree of clinical details given. Reported abnormalities, recommended management, and correspondence were recorded.
Results:
Ninety-one referrals were received during the 6-month audit period. More than half lacked a clinical indication for referral (53/91, 58.2%), with fewer than one third (26/91, 28.5%) meeting National Institute for Health and Care Excellence criteria for referral for cardiology. Eighty (80/91) referrals had clinical outcomes available for review (missing outpatient department information and age outside of service range accounted for eleven referrals with unavailable clinical outcomes). Of the eighty clinically reviewed referrals, seventy-two (72/80, 90%) were reported as normal with no cardiology follow up required. Eight referrals (8/80, 10%) were reviewed in the Cardiology Outpatient Department prior to commencement or modifying attention deficit hyperactivity disorder medication. Of these, only one (1/80 1%) had a clinically significant abnormality which was a potential contraindication to attention deficit hyperactivity disorder medication use, and this referral was appropriate as per National Institute for Health and Care Excellence guidelines.
Conclusion:
Routine screening prior to attention deficit hyperactivity disorder medication prescription in the absence of clinical indications (as per National Institute for Health and Care Excellence) contributed to delays in medication initiation among young people with attention deficit hyperactivity disorder. Unnecessary referrals have resource implications for cardiology clinical team. Improved adherence to National Institute for Health and Care Excellence guidelines would provide benefits for patients and clinicians.
The accelerated rate of product development and design complexities offered by Additive Manufacturing (AM) has allowed for innovation in the space industry. However, the surface roughness of parts poses a challenge, as it impacts performance and is tied to design choices. Design tools for traditional manufacturing methods fall short in AM contexts, prompting the need for alternative design processes. This work proposes an experimental approach to design for AM investigation using design artefacts to explore a process-structure-property-performance relationship.
Empowering the Participant Voice (EPV) is an NCATS-funded six-CTSA collaboration to develop, demonstrate, and disseminate a low-cost infrastructure for collecting timely feedback from research participants, fostering trust, and providing data for improving clinical translational research. EPV leverages the validated Research Participant Perception Survey (RPPS) and the popular REDCap electronic data-capture platform. This report describes the development of infrastructure designed to overcome identified institutional barriers to routinely collecting participant feedback using RPPS and demonstration use cases. Sites engaged local stakeholders iteratively, incorporating feedback about anticipated value and potential concerns into project design. The team defined common standards and operations, developed software, and produced a detailed planning and implementation Guide. By May 2023, 2,575 participants diverse in age, race, ethnicity, and sex had responded to approximately 13,850 survey invitations (18.6%); 29% of responses included free-text comments. EPV infrastructure enabled sites to routinely access local and multi-site research participant experience data on an interactive analytics dashboard. The EPV learning collaborative continues to test initiatives to improve survey reach and optimize infrastructure and process. Broad uptake of EPV will expand the evidence base, enable hypothesis generation, and drive research-on-research locally and nationally to enhance the clinical research enterprise.
CHD is a significant risk factor for the development of necrotising enterocolitis. Existing literature does not differentiate between term and preterm populations. Long-term outcomes of these patients are not well understood. The aim was to investigate the baseline characteristics and outcomes of term normal birth weight infants with CHD who developed necrotising enterocolitis.
Methods:
A retrospective review was performed of infants from a single tertiary centre with CHD who developed necrotising enterocolitis of Bell’s Stage 1–3, over a ten-year period. Inclusion criteria was those born greater than 36 weeks’ gestation and birth weight over 2500g. Exclusion criteria included congenital gastro-intestinal abnormalities. Sub-group analysis was performed using Fisher’s exact test.
Results:
Twenty-five patients were identified, with a median gestational age of 38 weeks. Patients with univentricular physiology accounted for 32% (n = 8) and 52% of patients (n = 13) had a duct-dependent lesion. Atrioventricular septal defect was the most common cardiac diagnosis (n = 6, 24%). Patients with trisomy 21 accounted for 20% of cases. Mortality within 30 days of necrotising enterocolitis was 20%. Long-term mortality was 40%, which increased with increasing Bell’s Stage. In total, 36% (n = 9) required surgical management of necrotising enterocolitis, the rate of which was significantly higher in trisomy 21 cases (p < 0.05).
Conclusion:
Not previously described in term infants is the high rate of trisomy 21 and atrioventricular septal defect. This may reflect higher baseline incidence in our population. Infants with trisomy 21 were more likely to develop surgical necrotising enterocolitis. Mortality at long-term follow-up was high in patients with Bell’s Stage 2–3.
This paper integrates concepts from philosophy and Zen Buddhism in order to define the implications of an American Zen Master’s sermon about the 2009 financial crisis. It interprets three aspects of his sermon: his critique of modernity, his reflection on the experience of Zen meditation (shikan-taza), and his version of Buddhist ontology (tathāgata-garbha). The paper shows that his sermon is an innovative problematization of what it is to be a modern subject or, still more generally, what it is to exist historically. Each of its three aspects indicates a different, perhaps even opposed, response to this problem. Yet they all suggest new configurations of temporality, historicity, and Being. The paper argues that it is precisely this mobile adjacency to the dominant modernist perspective which makes the Zen Master’s sermon both ethically and intellectually effective. Recruiting him into a Nietzschean lineage, it concludes with a programmatic statement of how work in the human sciences could develop his insights.
Acute cognitive complications following COVID-19 infection have been appreciated in a subset of patients since the early months of the global pandemic. Emerging data reveal that some patients go on to experience cognitive improvement, whereas others may experience further cognitive decline. We aimed to assess trajectories and predictors of cognitive change in a sample of post-COVID-19 patients.
Participants and Methods:
This prospective cohort study assessed longitudinal cognitive change in adults receiving care for COVID-19 in the Johns Hopkins Post-Acute COVID-19 Team (JH PACT) clinic. Participants self-administered the Digital Automated Neurobehavioral Assessment (DANA) battery of seven cognitive tests and a performance-based measure of cognitive fatigue on up to six occasions over six weeks. Improvement or decline between the first and last assessment was defined as change of >1 standard deviation of the baseline mean of each outcome. Potential predictors of change included demographic features (age, sex, race/ethnicity, education), COVID-19 illness characteristics (hospitalization or ICU stay, months since symptom onset), and comorbid disease burden. Analyses included measures of central tendency, independent samples t-tests, and chi-square tests of independence.
Results:
Of the 36 enrolled participants, 29 (81%) completed at least one DANA assessment (M = 4.7 assessments, SD = 1.8). Those completing at least three assessments (n = 24, 66.7%) were included in the present analyses (71% female; 58% white; M age = 54 years, SD = 10.9; M education = 14.6 years, SD = 2.4; M months since COVID-19 symptom onset at recruitment = 9.8, SD = 4.7; M comorbidities = 2.8, SD = 2.0). Fatigue was the most frequently improved outcome measure, with 41.7% of participants scoring >1 standard deviation above the baseline mean fatigue score at their final assessment. Among cognitive outcomes, the greatest frequency of improvement was observed on tests assessing rapid spatial processing (37.5%), processing speed (33.3%), and memory (33.3%). There were no consistent predictors of improvement, but several subtest-specific findings emerged. Specifically, (a) more comorbidities were positively associated with rate of fatigue reduction (p = .04), (b) longer duration since COVID-19 illness was positively associated with rates of memory improvement (p = .02), (c) older age, male sex, and more comorbidities were positively associated with rate of improvement in reaction time (ps < .05), and (d) more assessments completed was positively associated with rates of improvements in working memory (ps < .05). Response inhibition (12.5%), simple reaction times (16.7%), and working memory (16.7%) showed the lowest rates of improvement over time. Declines in cognition were infrequent, with 4.2 - 8.3% (n = 1 to 2) declining on measures of procedural reaction time, spatial processing, inhibitory control, or working memory.
Conclusions:
At an average of >9 months following acute COVID-19 illness, we observed longitudinal improvements in cognitive fatigue as well as processing speed, memory, and spatial reasoning. Consistent predictors of recovery were not identified, although age, sex, comorbid conditions, and time since illness predicted rates of improvement in select domains. Further analyses with a larger sample size and more stringent analyses are needed to confirm and extend these findings.
Turfgrass managers apply nonselective herbicides to control winter annual weeds during dormancy of warm-season turfgrass. Zoysiagrass subcanopies, however, retain green leaves and stems during winter dormancy, especially in warmer climates. The partially green zoysiagrass often deters the use of nonselective herbicides due to variable injury concerns in transition and southern climatic zones. This study evaluated zoysiagrass response to glyphosate and glufosinate applied at four different growing degree day (GDD)-based application timings during postdormancy transition in different locations, including Blacksburg, VA; Starkville, MS; and Virginia Beach, VA, in 2018 and 2019. GDD was calculated using a 5 C base temperature with accumulation beginning January 1 each year, and targeted application timings were 125, 200, 275, and 350 GDD5C. Zoysiagrass injury response to glyphosate and glufosinate was consistent across a broad growing region from northern Mississippi to coastal Virginia, but it varied by application timing. Glyphosate application at 125 and 200 GDD5C can be used safely for weed control during the postdormancy period of zoysiagrass, while glufosinate caused unacceptable turf injury regardless of application timing. Glyphosate and glufosinate exhibited a stepwise increase to maximum injury with increasing targeted GDD5C application timings. Glyphosate applied at 125 or 200 GDD5C did not injure zoysiagrass above a threshold of 30%, whereas glufosinate caused greater than 30% injury for 28 and 29 d when applied at 125 and 200 GDD5C, respectively. Likewise, glyphosate application at 125 or 200 GDD5C did not affect the zoysiagrass green cover area under the progress curve per day, whereas later applications reduced it. Glyphosate and glufosinate caused greater injury to zoysiagrass when applied at greater cumulative heat units and this was attributed to increasing turfgrass green leaf density, because heat unit accumulation is positively correlated with green leaf density. Accumulated heat unit-based application timing will allow practitioners to apply nonselective herbicides with reduced injury concerns.
Simulation is fundamental to many engineering design processes and powers the field of computational design. Simulation inherently consumes energy resulting in CO2 emissions that impact our environment. While one can source energy from renewable sources and use energy efficient hardware, efforts need to also be made in how we can use simulation in a sustainable manner.
This paper presents a sustainable simulation framework that borrows concepts from web services. The framework makes it easy for engineering firms to adopt and embed sustainable simulation practices thereby removing the burden from the designer tin thinking about how to design sustainably. An illustrative example reveals a 25% reduction in computational effort can be achieved by adopting the framework.
This collection profiles understudied figures in the book and print trades of the seventeenth century. With an equal balance between women and men, it intervenes in the history of the trades, emphasising the broad range of material, cultural, and ideological work these people undertook. It offers a biographical introduction to each figure, placing them in their social, professional, and institutional settings. The collection considers varied print trade roles including that of the printer, publisher, paper-maker, and bookseller, as well as several specific trade networks and numerous textual forms. The biographies draw on extensive new archival research, with details of key sources for further study on each figure. Chronologically organised, this Element offers a primer both on numerous individual figures, and on the tribulations and innovations of the print trade in the century of revolution.
This study examined relationships between foodborne outbreak investigation characteristics, such as the epidemiological methods used, and the success of the investigation, as determined by whether the investigation identified an outbreak agent (i.e. pathogen), food item and contributing factor. This study used data from the Centers for Disease Control and Prevention's (CDC) National Outbreak Reporting System and National Environmental Assessment Reporting System to identify outbreak investigation characteristics associated with outbreak investigation success. We identified investigation characteristics that increase the probability of successful outbreak investigations: a rigorous epidemiology investigation method; a thorough environmental assessment, as measured by number of visits to complete the assessment; and the collection of clinical samples. This research highlights the importance of a comprehensive outbreak investigation, which includes epidemiology, environmental health and laboratory personnel working together to solve the outbreak.
In many complex practical optimization cases, the dominant characteristics of the problem are often not known prior. Therefore, there is a need to develop general solvers as it is not always possible to tailor a specialized approach to each application. The previously developed multilevel selection genetic algorithm (MLSGA) already shows good performance on a range of problems due to its diversity-first approach, which is rare among evolutionary algorithms. To increase the generality of its performance, this paper proposes utilization of multiple distinct evolutionary strategies simultaneously, similarly to algorithm selection, but with coevolutionary mechanisms between the subpopulations. This distinctive approach to coevolution provides less regular communication between subpopulations with competition between collectives rather than individuals. This encourages the collectives to act more independently creating a unique subregional search, leading to the development of coevolutionary MLSGA (cMLSGA). To test this methodology, nine genetic algorithms are selected to generate several variants of cMLSGA, which incorporates these approaches at the individual level. The mechanisms are tested on 100 different functions and benchmarked against the 9 state-of-the-art competitors to evaluate the generality of each approach. The results show that the diversity divergence in the principles of working of the selected coevolutionary approaches is more important than their individual performances. The proposed methodology has the most uniform performance on the divergent problem types, from across the tested state of the art, leading to an algorithm more likely to solve complex problems with limited knowledge about the search space, but is outperformed by more specialized solvers on simpler benchmarking studies.
The literature that references personal data collection risks is growing amidst international scandals, notably the Cambridge Analytica/Facebook interference in the Brexit referendum and 2016 US presidential election as well as other elections in countries throughout our world. Questions of fundamental importance to the study and practice of international relations are being asked as concerns are expressed, including the most pressing that speak to accountability, the ethics of use in local areas and the impact on the vulnerable populations that information and communications technologies (ICTs) promise to serve. Yet, the editors observe that in key texts written to teach international relations, less mention is made of personal data collection risks in countries around the globe. As we address this significant omission in the literature, this introduction notes the observation made by Acharya and Buzan that ‘with the possible exception of the emerging ideology of environmental stewardship, no new ideologies of equivalent weight have come along to reshape international relations’ (p. 12).
As the call for the protection of personal data increases globally, other uses of data under the colour of state action continue to complicate the issue. The attack by Russia on Ukraine occurred simultaneously with Russia’s participation in the UN’s Ad Hoc Committee to Elaborate a Comprehensive International Convention on Countering the Use of ICTs for Criminal Purposes. Russia strongly advocated for a new global cybercrime treaty despite the existence of the Budapest Convention on Cybercrime ratified by sixty-six countries, but Russia did not join, stating that the convention violated state sovereignty principles. Yet, alongside its urging that statements to the Secretariat should not include information about the war against Ukraine, Russia pushed the UN to adopt its proposal, which lessened humanitarian rights. All the while Russia has seemingly turned a blind eye to cybercriminals operating within its borders and has openly and actively supported these perpetrators.
These chapters provide a glimpse into the struggles of liberal internationalism and, yet, seem to suggest a way forward. First, there remain concerns about the impacts of the coronavirus pandemic on liberal internationalist principles because the virus severely tested many governments’ resolve to support its premise.
Background: The Domain-Specific Risk Taking scale (DOSPERT) is a widely used instrument that measures perceived risk and benefit and attitude toward risk for activities in several domains, but does not include medical risks.
Objective: To develop a medical risk domain subscale for DOSPERT.
Methods: Sixteen candidate risk items were developed through expert discussion. We conducted cognitive telephone interviews, an online survey, and a random-digit dialing (RDD) telephone survey to reduce and refine the scale, explore its factor structure, and obtain estimates of reliability.
Participants: Eight patients recruited from UIC medical center waiting rooms participated in 45-60 minute cognitive interviews. Thirty Amazon Mechanical Turk workers completed the online survey. One hundred Chicago-area residents completed the RDD telephone survey.
Results: On the basis of cognitive interviews, we eliminated five items due to poor variance or participant misunderstanding. The online survey suggested that two additional items were negatively correlated with the scale, and we considered them candidates for removal. Factor analysis of the responses in the RDD telephone survey and non-statistical factors led us to recommend a final set of 6 items to represent the medical risk domain. The final set of items included blood donation, kidney donation, daily medication use for allergies, knee replacement surgery, general anesthesia in dentistry, and clinical trial participation. The interitem reliability (Cronbach’s α) of the final set of 6 items ranged from 0.57-0.59 depending on the response task. Older respondents gave lower overall ratings of expected benefit from the activities.
Conclusion: We refined a set of items to measure risk and benefit perceptions for medical activities. Our next step will be to add these items to the complete DOSPERT scale, confirm the scale’s psychometric properties, determine whether medical risks constitute a psychologically distinct domain from other risky activities, and characterize individual differences in medical risk attitudes.