Development of an Audit Tool to Evaluate End of Life Care in the Emergency Department: A Face and Content Validity Study

Objectives:Emergency Departments (ED) are increasingly caring for patients with acute, chronic and terminal conditions requiring End of Life Care (EOLC). There is no published and validated tool available to evaluate EOLC delivery of patients dying in the ED. This study describes the face and content validity testing process to develop, refine and test a new and unique audit tool to evaluate EOLC in the ED.Methods: The face and content validation process used a three-round modified-Delphi technique. We consulted 11 experts to assess the proposed 89 items. Face validity explored the overall question of appropriateness and relevance; and content validity examined relevance ratings using the Content Validity Index (CVI) 4-point Likert scale in two rounds. Iterative assessment of ratings led to inclusion (CVI > 0.78), revision (CVI 0.65 to < 0.78) or exclusion (CVI < 0.65) of items from the tool.Results: Of the initial 89 items, 66 were included (CVI > 0.78), 16 items revised (scores 0.65 to < 0.78), seven were removed (scores < 0.65) and two new items suggested. Items covered the constructs patient characteristics, circumstances of death, ED performance, communication and care planning, recognition of dying, care delivery, and needs of families and carers. Scale CVI achieved 0.90. The consolidated list of 81 items achieved acceptable face validity and excellent content validity.Conclusion:Face and content validity of the ED EOLC audit tool achieved acceptable item-CVI scores and an excellent scale-CVI score. We recommend external validation of its components in real-life settings to monitor and set locally relevant clinical practice benchmarks

Development of a patient decision aid for people with chronic low back pain and degenerative disc disease considering lumbar fusion: A mixed-methods study

OBJECTIVES: To develop and user-test a patient decision aid providing evidence-based information for people with chronic low back pain (LBP) and degenerative disc disease considering lumbar fusion.DESIGN: Convergent parallel mixed methods study.SETTING: A prototype patient decision aid was developed, guided by the International Patient Decision Aid Standards (IPDAS) criteria, a multidisciplinary steering committee, and insights from previous studies. Participants were recruited via social media and the authors' collaborative networks to refine and evaluate the decision aid.PARTICIPANTS: Individuals who underwent lumbar fusion for chronic LBP and health professionals who manage these patients were purposively sampled.PRIMARY AND SECONDARY OUTCOMES: Semi-structured interviews and questionnaires were used to gather feedback and assess the decision aid's acceptability, usability, and preparedness for decision-making. Framework analysis was used for interview data and descriptive analysis for questionnaires.RESULTS: Sixteen clinicians (5 physiotherapists, 2 rheumatologists, 2 surgeons, 7 general practitioners) and seven patients participated, most rating the prototype's acceptability as 'excellent' or 'good'. Usability (mean [SD], health professionals: 78 [16], patients: 72 [8]) and preparedness for decision-making (health professionals: 73 [14], patients: 72 [10]) also scored highly. However, some viewed the prototype as biased against lumbar fusion, and suggestions to include more personalised information were made.CONCLUSIONS: This study showed that our prototype patient decision aid is acceptable, useful, and prepares patients to make informed decisions about spinal fusion for chronic LBP and degenerative disc disease. Future studies will assess the clinical impact of our decision aid and its optimal distribution timing.</p

Conclusion: Future Directions

The Routledge Handbook on Sports Law and Governance provides a definitive guide to the regulation of international and national sport through the lens of both regulatory, governance and legal frameworks.Over the past several decades, law, regulation, and governance associated with international and national sport has grown exponentially, aligned with professional and elite level sport development. The organisation and sophistication of international and national sporting competitions creates an environment where pressures such as the sports ethic and strong incentives to win give rise to both novel problems and reoccurring themes. Exploring a wide range of perspectives across disciplines and transcending jurisdictional boundaries, the handbook analyses complex international and national sports challenges. Taking a nuanced approach to traditional themes, it recognises the context and sport as a regulatory domain when applying law and legal frameworks.This book is an essential resource for students and academics exploring issues in international and national sports law, sports regulation and sport governance.<br/

The role of lower limb exoskeletons in rehabilitation: a scoping review

ObjectivesThis review provides an overview of exoskeleton use in rehabilitation. The review maps the health conditions, exoskeleton design, activities, and outcome measures used.MethodsA search of PubMed, Embase, CINAHL, Web of Science and Scopus databases was completed on 12th September 2024. Data items charted from studies included health conditions, exoskeleton characteristics, activities completed with the exoskeletons and outcome measures.ResultsA total of 7028 records were identified, with 139 studies included. The predominant health conditions using exoskeletons in rehabilitation were stroke and spinal cord injury. The most common activities undertaken were indoor overground walking, balance, and transfers. However, only 4% of studies utilised exoskeletons at home or in community settings. A range of outcome measures were used, with the 10-metre walk test being the most commonly used for the assessment of walking velocity, the 6-minute walk test for walking distance or capacity and the Berg balance scale for balance.ConclusionsExoskeletons were used for rehabilitation across various conditions, notably neurological and, less extensively, musculoskeletal conditions. Functional activities such as walking were most common, with most studies assessing on indoor walking. Exoskeletons still need to show their ability to assist individuals walking at home and/or in community environments and handling complex walking tasks. Therefore, it is important that future research focuses on complex walking tasks within the home and community environments, which will inform future exoskeleton utilisation, design and development

The Treatment Experiences of Vegetarians and Vegans with an Eating Disorder: A Qualitative Study

Background:Vegetarianism and veganism have long been tied to disordered eating and are frequently considered to be methods of limiting available food choices. Health professionals specializing in eating disorder treatment may modify their treatment practices to support their vegetarian or vegan clients. However, there are no formally recognized clinical guidelines for the treatment of eating disorders in these groups. Moreover, no studies have yet explored the experiences of seeking and receiving eating disorder treatment while adhering to vegetarianism or veganism, which are needed to inform the development of guidelines. The present study aims to explore the lived experiences of vegetarians and vegans on eating disorder treatment through semi-structured interviews and reflexive thematic analysis. Methods:Seventeen participants (aged 19–48, 76% female, 41% vegan) with a history of receiving eating disorder treatment were recruited. Results: We identified five themes that participants described as important experiences for the treatment of their eating disorder when sought as a vegetarian or vegan: (1) Health professional perspectives, (2) The interaction of dietary status with treatment quality, (3) The give and take of treatment, (4) Lack of flexibility in treatment services, and (5) Current treatment approaches not well equipped to support dietary variations. Conclusions: This paper identifies the complex relationship between eating disorders, veganism, and vegetarianism and the perceptions of treatment from the perspectives of those who have received treatment. Our findings suggest that acknowledgement and the flexibility to work with an individual’s vegan and vegetarian values within treatment may contribute to enhanced outcomes and treatment experiences. Limitations include potential participation and response biases and a predominantly female-identifying sample. This study will contribute to the development of clinical guidelines when working with vegan and vegetarian clients

Extended reality (XR) — A magic box of digitalization in driving sustainable development of the construction industry: A critical review

Against a background of global resource shortage and climate change, there is an urgency for the construction industry to aim towards sustainable development. With the rapid development of information technology, the emergence of extended reality (XR) has provided new ideas and options for sustainable construction (SC). Such technologies are applied in research and practice of the whole construction lifecycle, which can well meet the requirements of SC. This paper presents a critical review of XR applications in SC, aiming to systematically summarize the specific uses and advantages of virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies. This study also examines the gap in research into the imbalance between the use of technology and the construction stages involved. Most XR applications focus on the pre-construction stage, while visualization and interactivity are the main features for further application. Through qualitative analyses, different applications of XR are introduced in stages throughout the entire lifecycle of building projects. In addition, the current challenges and limitations are presented, and several suggestions are proposed to facilitate further advancements in SC research and practice in the near future. This review provides valuable information to help stakeholders understand the advances in XR research and benefit future exploration and practice in the field.<br/

The 2023 fatal dengue outbreak in Bangladesh highlights a paradigm shift of geographical distribution of cases

In 2023, Bangladesh experienced its largest and deadliest outbreak of the Dengue virus (DENV), reporting the highest-ever recorded annual cases and deaths. Historically, most of the cases were recorded in the capital city, Dhaka. We aimed to characterize the geographical transmission of DENV in Bangladesh. From 1 January–31 December 2023, we extracted and analyzed daily data on dengue cases and deaths from the Management Information System of the Ministry of Health and Family Welfare. We performed a generalized linear mixed model to identify the associations between division-wise daily dengue counts and various geographical and meteorological covariates. The number of dengue cases reported in 2023 was 1.3 times higher than the total number recorded in the past 23 years (321,179 vs. 244,246), with twice as many deaths than the total fatalities recorded over the past 23 years (1705 vs. 849). Of the 1,705 deaths in 2023, 67.4% (n = 1,015) died within one day after hospital admission. The divisions southern to Dhaka had a higher dengue incidence/1000 population (2.30 vs. 0.50, p &lt;0.01) than the northern divisions. Festival-related travel along with meteorological factors and urbanization are likely to have contributed to the shift of dengue from Dhaka to different districts in Bangladesh

Using data analytics to distinguish legitimate and illegitimate shell companies

Shell companies can be a legitimate entity but can also been used for illicit activities such as money laundering. Users of shell companies have included illegal arms dealers, drug cartels, terrorists and cyber-criminals, as well as legitimate businesses. To assist in distinguishing between legitimate and illegitimate uses of shell companies, we develop a data-driven model to detect shell companies that are being used for money laundering. We use a hybrid approach combining graph analytics and supervised machine learning. The resulting detection models have an impressive classification accuracy ranging between 88.17 % and 97.85 %. We found no prior study that developed such models to detect illicit shell companies using publicly available information as done with our models. Beneficiaries of this work include government officials and compliance professionals, particularly accountants, tax officials and anti-corruption agencies

Nibble with Willow Early Childhood Intervention: Teacher Reports of Positive Program Impacts on Children and Their Families

Healthy diets are critical for the healthy growth and development of children.1 That said, the dietary behaviors of preschool children are generally poor. Only 50% of children aged 3–4 years eat vegetables daily, and approximately two-thirds eat fruit daily.2 In addition, almost 60% of the energy consumed by preschoolers in the US comes from ultraprocessed foods

If there's a will there'll be an easier way

The reluctance by young adults to make a will is understandable. After all, estate planning is something to be considered later in life once they have accumulated significant assets or when they have started a family.However, the reality is that life is unpredictable, and having a will in place provides a sense of security and clarity for loved ones left behind