5,108 research outputs found

    UMSL Bulletin 2023-2024

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    The 2023-2024 Bulletin and Course Catalog for the University of Missouri St. Louis.https://irl.umsl.edu/bulletin/1088/thumbnail.jp

    Proceedings of the 10th International congress on architectural technology (ICAT 2024): architectural technology transformation.

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    The profession of architectural technology is influential in the transformation of the built environment regionally, nationally, and internationally. The congress provides a platform for industry, educators, researchers, and the next generation of built environment students and professionals to showcase where their influence is transforming the built environment through novel ideas, businesses, leadership, innovation, digital transformation, research and development, and sustainable forward-thinking technological and construction assembly design

    A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation

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    Background: People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim: Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design: We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting: Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant\u27s own home or at a local NHS facility, and by telephone. Participants: Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention: The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures: Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results: We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference \ua3770.24, 95% confidence interval -\ua327.91 to \ua31568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants\u27 lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions: The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration: This trial is registered as ISRCTN59537391. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.People with long-standing lung problems, such as chronic obstructive pulmonary disease, often also have anxiety and depression, which further reduces their quality of life. Two existing treatments could help. Pulmonary rehabilitation (a programme of exercise and education) improves both the physical and mental health of people with chronic obstructive pulmonary disease. Cognitive–behavioural therapy (a talking therapy) may reduce anxiety and depression. The TANDEM [Tailored intervention for Anxiety and Depression Management in chronic obstructive pulmonary disease (COPD)] intervention linked these two treatments by providing talking therapy based on cognitive–behavioural therapy during the waiting time following referral for pulmonary rehabilitation. The TANDEM treatment was delivered by respiratory healthcare professionals (e.g. nurses or physiotherapists) trained to deliver the talking therapy in six to eight weekly sessions. The sessions were conducted in the participant’s home (or another convenient location), with brief telephone support during the pulmonary rehabilitation. Of 423 participants recruited to the study, 242 participants received TANDEM talking therapy and 181 participants received usual care (including a referral to pulmonary rehabilitation). We measured mental health, quality of life, social life, attendance at pulmonary rehabilitation and healthcare use in both groups at 6 and 12 months. Forty-three carers joined the study and we assessed their mental well-being. We interviewed patients, carers and health professionals to find out their views and experience of the TANDEM treatment. We also examined whether or not the TANDEM treatment was good value for money. The TANDEM treatment did not improve the mental or the physical health of people with chronic obstructive pulmonary disease. In addition, the TANDEM treatment cost the NHS an extra \ua3770 per patient, which was not good value for money. The TANDEM treatment was well received, and many participants told us how it had helped them. Heath-care professionals noted how participants did not just have chronic obstructive pulmonary disease, but were coping with many physical, mental and social problems. The TANDEM intervention was not effective and, therefore, other strategies will be needed to help people with chronic obstructive pulmonary disease and mental health problems live with their condition

    A Multi-level Analysis on Implementation of Low-Cost IVF in Sub-Saharan Africa: A Case Study of Uganda.

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    Introduction: Globally, infertility is a major reproductive disease that affects an estimated 186 million people worldwide. In Sub-Saharan Africa, the burden of infertility is considerably high, affecting one in every four couples of reproductive age. Furthermore, infertility in this context has severe psychosocial, emotional, economic and health consequences. Absence of affordable fertility services in Sub-Saharan Africa has been justified by overpopulation and limited resources, resulting in inequitable access to infertility treatment compared to developed countries. Therefore, low-cost IVF (LCIVF) initiatives have been developed to simplify IVF-related treatment, reduce costs, and improve access to treatment for individuals in low-resource contexts. However, there is a gap between the development of LCIVF initiatives and their implementation in Sub-Saharan Africa. Uganda is the first country in East and Central Africa to undergo implementation of LCIVF initiatives within its public health system at Mulago Women’s Hospital. Methods: This was an exploratory, qualitative, single, case study conducted at Mulago Women’s Hospital in Kampala, Uganda. The objective of this study was to explore how LCIVF initiatives have been implemented within the public health system of Uganda at the macro-, meso- and micro-level. Primary qualitative data was collected using semi-structured interviews, hospital observations informal conversations, and document review. Using purposive and snowball sampling, a total of twenty-three key informants were interviewed including government officials, clinicians (doctors, nurses, technicians), hospital management, implementers, patient advocacy representatives, private sector practitioners, international organizational representatives, educational institution, and professional medical associations. Sources of secondary data included government and non-government reports, hospital records, organizational briefs, and press outputs. Using a multi-level data analysis approach, this study undertook a hybrid inductive/deductive thematic analysis, with the deductive analysis guided by the Consolidated Framework for Implementation Research (CFIR). Findings: Factors facilitating implementation included international recognition of infertility as a reproductive disease, strong political advocacy and oversight, patient needs & advocacy, government funding, inter-organizational collaboration, tension to change, competition in the private sector, intervention adaptability & trialability, relative priority, motivation &advocacy of fertility providers and specialist training. While barriers included scarcity of embryologists, intervention complexity, insufficient knowledge, evidence strength & quality of intervention, inadequate leadership engagement & hospital autonomy, poor public knowledge, limited engagement with traditional, cultural, and religious leaders, lack of salary incentives and concerns of revenue loss associated with low-cost options. Research contributions: This study contributes to knowledge of factors salient to implementation of LCIVF initiatives in a Sub-Saharan context. Effective implementation of these initiatives requires (1) sustained political support and favourable policy & legislation, (2) public sensitization and engagement of traditional, cultural, and religious leaders (3) strengthening local innovation and capacity building of fertility health workers, in particular embryologists (4) sustained implementor leadership engagement and inter-organizational collaboration and (5) proven clinical evidence and utilization of LCIVF initiatives in innovator countries. It also adds to the literature on the applicability of the CFIR framework in explaining factors that influence successful implementation in developing countries and offer opportunities for comparisons across studies

    TeamSTEPPS and Organizational Culture

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    Patient safety issues remain despite several strategies developed for their deterrence. While many safety initiatives bring about improvement, they are repeatedly unsustainable and short-lived. The index hospital’s goal was to build an organizational culture within a groundwork that improves teamwork and continuing healthcare team engagement. Teamwork influences the efficiency of patient care, patient safety, and clinical outcomes, as it has been identified as an approach for enhancing collaboration, decreasing medical errors, and building a culture of safety in healthcare. The facility implemented Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based framework which was used for team training to produce valuable and needed changes, facilitating modification of organizational culture, increasing patient safety compliance, or solving particular issues. This study aimed to identify the correlation between TeamSTEPPS enactment and improved organizational culture in the ambulatory care nursing department of a New York City public hospital

    Regulatory responses to addressing and preventing sexual assault and harassment in Australian university settings

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    Over the past decade, the Australian university sector and regulatory bodies have implemented a range of actions to improve the management and prevention of sexual assault and sexual harassment in Australian university settings. Despite these concerted efforts, little progress has been made in reducing campus sexual violence or in achieving institutional accountability. To date, research on campus sexual violence in Australia has focused on the experiences of students and staff (such as prevalence surveys and the impact of sexual violence on educational outcomes) or institutional responses (such as policy frameworks, reporting mechanisms and support services). This dissertation offers a new perspective by taking a system-wide structural approach to consider the entire regulatory community. Through the lens of theories of responsive and smart regulation, this thesis critically examines the regulatory initiatives adopted by various actors during the period 2011-2021. Addressing a gap in the literature, I offer an analysis of how regulatory theory does not adequately explain the vital role of civil society activists in creating momentum and initiating reform in this area. Drawing on legislative reviews, analysis of primary documents and 24 interviews with representatives drawn from across the regulatory community, the dissertation reveals how a lack of political will and the absence of even a latent threat of genuine enforceable institutional accountability – a ‘benign big gun’ in responsive regulatory theory – has undermined regulatory efforts across the whole sector. This dissertation also identifies the role that regulatory ritualism has played in stymying systemic change to respond to and prevent sexual violence in the Australian university sector, extending the existing literature by proposing two new applications of regulatory ritualism, language ritualism and announcement ritualism, and providing examples of where this has occurred. This dissertation argues that substantive progress in tackling sexual assault and sexual harassment in Australian university settings has stalled due to an over-reliance on the self-regulating university sector to lead the reform effort, the failure of enforced self-regulation models led by regulatory agencies, the indifference of governments and sector-wide regulatory ritualism which has seen institutions adopt tokenistic rather than substantive responses. To address these factors and improve institutional accountability, I argue that genuine systemic reform will require political leadership, more robust application of existing legislative and regulatory tools towards effective enforcement, and innovative exploration of other legal and regulatory approaches

    A Very Socialist German Culture?: The GDR’s Use of German Classical Music Heritage for Domestic and International Legitimacy under Honecker (1971-1989)

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    In recent decades, with the growth of scholarly interest in GDR social and cultural history, the complexities and contradictions of GDR society have been unveiled. As a result, the conceptualisations of the GDR as, for instance, a ‘participatory dictatorship’ (Fulbrook) and ‘consensus dictatorship’(Jarausch) emerge to debunk the totalitarian characterisation of GDR society. This thesis complicates the GDR as a ‘participatory dictatorship’ by looking at the practices of German classical music heritage during the Honecker era. It asks how the Socialist Unity Party of Germany (SED) endeavoured to manipulate the heritage domestically and in the GDR’s trans-bloc cultural exchange with Britain for its political legitimacy and assesses the outcomes. In tracing the interactions between all involved social actors (i.e., state authorities, cultural institutions, the classical music intelligentsia, journalists and critics, and the public), this thesis demonstrates the complexities of all the actors’ relations to the heritage practices. As the thesis shows, significant to the complexities were factors such as the de facto existence of capitalism within GDR socialism, the SED’s reliance on the classical music intelligentsia’s contribution for its power consolidation, the non-state actors’ pursuits of their Eigensinn and hidden transcripts in navigating their relations with the SED government. In summation, this thesis proves that German classical music heritage’s policymaking and implementation in the GDR’s domestic scene and its trans-bloc cultural exchange cannot be understood as solely ‘top-down’ constructs. Instead, they were subject to changing dynamics and shaped by conflict and contradictions, cooperation and reconciliation between all the social actors involved

    METROPOLITAN ENCHANTMENT AND DISENCHANTMENT. METROPOLITAN ANTHROPOLOGY FOR THE CONTEMPORARY LIVING MAP CONSTRUCTION

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    We can no longer interpret the contemporary metropolis as we did in the last century. The thought of civil economy regarding the contemporary Metropolis conflicts more or less radically with the merely acquisitive dimension of the behaviour of its citizens. What is needed is therefore a new capacity for imagining the economic-productive future of the city: hybrid social enterprises, economically sustainable, structured and capable of using technologies, could be a solution for producing value and distributing it fairly and inclusively. Metropolitan Urbanity is another issue to establish. Metropolis needs new spaces where inclusion can occur, and where a repository of the imagery can be recreated. What is the ontology behind the technique of metropolitan planning and management, its vision and its symbols? Competitiveness, speed, and meritocracy are political words, not technical ones. Metropolitan Urbanity is the characteristic of a polis that expresses itself in its public places. Today, however, public places are private ones that are destined for public use. The Common Good has always had a space of representation in the city, which was the public space. Today, the Green-Grey Infrastructure is the metropolitan city's monument that communicates a value for future generations and must therefore be recognised and imagined; it is the production of the metropolitan symbolic imagery, the new magic of the city

    Hepatic Encephalopathy

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    Hepatic encephalopathy (HE) is a complex neurological syndrome, characteristic of patients with liver disease, that causes a wide and complex spectrum of nonspecific neurological and psychiatric manifestations, ranging from a subclinical entity such as minimal or covert hepatic encephalopathy to a deep form in which a complete alteration of consciousness can be observed: overt hepatic encephalopathy. Both minimal and overt hepatic encephalopathy have a high impact on patients, caregivers, and national health services, driving substantial consumption of economic resources. In this Special Issue, we discussed the current state-of-the-art research, address ongoing knowledge gaps, and ongoing controversies related to the pathogenesis, diagnosis, and therapeutic management of hepatic encephalopathy
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