CONSTRAINT BASED ANALYSIS OF DATABASE UPDATE PROPAGATION

Semantic and object-oriented data models provide convenient constructs for the specification of objects, relationships, and operations. The vehicle of representation is a collection of abstractions which parallel the means by which humans prefer to organize complex enterprises. These constructs inherently permit focus on one object, relationship, or operation at a time. Propagation, as a semantic construct, provides the extension of existing modeling capabilities by providing a mechanism for the specification of the update semantics between database objects. Through the analysis of constraints and the propagated actions necessary to maintain them, we attempt to do the following: 1) incorporate additional semantics into the database schema in the form of database propagation rules, 2) in the context of constraints and propagation rules, provide a model independent paradigm for determining if schemata are correct, and 3) provide a vehicle fur the explicit specification of update actions during database schema design

Reaching “an audience that you would never dream of speaking to”: influential public health researchers’ views on the role of news media in influencing policy and public understanding.

While governments and academic institutions urge researchers to engage with news media, traditional academic values of public disengagement have inhibited many from giving high priority to media activity. In this interview-based study, we report on the views about news media engagement and strategies used by 36 peer-voted leading Australian public health researchers in six fields. We consider their views about the role and importance of media in influencing policy; their reflections on effective or ineffective media communicators; and strategies used by these researchers about how to best retain their credibility and influence while engaging with the news media. A willingness and capacity to engage with the mass media was seen as an essential attribute of influential public health researchers.NHMR

Reaching “an audience that you would never dream of speaking to”: influential public health researchers’ views on the role of news media in influencing policy and public understanding.

While governments and academic institutions urge researchers to engage with news media, traditional academic values of public disengagement have inhibited many from giving high priority to media activity. In this interview-based study, we report on the views about news media engagement and strategies used by 36 peer-voted leading Australian public health researchers in six fields. We consider their views about the role and importance of media in influencing policy; their reflections on effective or ineffective media communicators; and strategies used by these researchers about how to best retain their credibility and influence while engaging with the news media. A willingness and capacity to engage with the mass media was seen as an essential attribute of influential public health researchers.NHMR

Challenges in assessing the characteristics of influential public health research.

The development of frameworks to effectively measure both the scientific and social impact of research is a topic of international debate. This paper examines how Australian public health researchers in six fields (alcohol, drugs, injury, obesity, skin cancer and tobacco) classified the scientific and social impact of what they judged to be their five most influential papers. We compared classifications of researchers rated as most influential by their peers with those not as highly ranked. Highly ranked researchers more often indicated social impact characteristics (Χ2 = 8.13; P = 0.004) than their less influential colleagues. Traditional measures of scientific impact (publication in high impact journals and high citations) were nominated by all researchers regardless of peer-nominated research influence status. There was strong consensus on who were the most influential researchers in five of the six research fields examined. This would appear to provide a sound platform on which to base more qualitative, interview or portfolio-based investigations into the complexities of wider conceptions of research and researcher influence

Decline in health-related quality of life and foot and ankle patient reported outcomes measures in patients with haemophilia and ankle haemarthropathy

Background: Haemophilia is an X-linked recessive genetic disorder characterised by bleeding within soft tissue and joints. The ankle is disproportionally affected by haemarthropathy when compared to the elbows and knees; reported as the most affected joints in patients with haemophilia. Despite advances in treatment, patients still report ongoing pain and disability, however, the impact has not been evaluated, nor has the effect on health-related quality of life (HRQoL) or foot and ankle patient-reported outcome measures (PROMs). The primary aim of this study was to establish the impact of ankle haemarthropathy in patients with severe and moderate haemophilia A and B. Secondly to identify the clinical outcomes associated with a decline in HRQoL and foot and ankle PROMs. Methods: A cross-sectional multi-centre questionnaire study was conducted across 18 haemophilia centres in England, Scotland and Wales with a recruitment target of 245 participants. The HAEMO-QoL-A and Manchester-Oxford Foot Questionnaire (MOXFQ) (foot and ankle) with total and domain scores measured impact on HRQOL and foot and ankle outcomes. Demographics, clinical characteristics, ankle haemophilia joint health scores, multi-joint haemarthropathy and Numerical Pain Rating Scales (NPRS) of “ankle pain over the past six months” were collected as a measure of chronic ankle pain. Results: A total of 243 of 250 participants provided complete data. HAEMO-QoL-A and MOXFQ (foot and ankle) total and index scores indicated worse HRQoL with total scores ranging from a mean of 35.3 to 35.8 (100 best-health) and 50.5 to 45.8 (0 best-health) respectively. NPRS (mean (SD)) ranged from 5.0 (2.6) to 5.5 (2.5), with median (IQR) ankle haemophilia joint health score of 4.5 (1 to 12.5) to 6.0 (3.0 to 10.0) indicating moderate to severe levels of ankle haemarthropathy. Ankle NPRS over six months and inhibitor status were associated with decline in outcome. Conclusions: HRQoL and foot and ankle PROMs were poor in participants with moderate to severe levels of ankle haemarthropathy. Pain was a major driver for decline in HRQoL and foot and ankle PROMs and use of NPRS has the potential to predict worsening HRQoL and PROMs at the ankle and other affected joints

The impact of ankle haemarthropathy in patients with moderate haemophilia

Introduction: Moderate haemophilia has traditionally been associated with less complications than severe haemophilia. Changes in treatment recommendations have highlighted the burden of moderate haemophilia with a subset of patients with a severe bleeding phenotype. The ankle joint is disproportionally affected by ankle haemarthropathy however the impact has not been evaluated in moderate haemophilia, nor the effect on health related quality of life (HRQoL) or foot and ankle outcomes. Aims: To establish the impact of ankle haemarthropathy in patients with moderate haemophilia. Methods: A multicentre questionnaire study recruited patients from 11 haemophilia centres in England, Scotland and Wales. The HAEMO‐QoL‐A and Manchester‐Oxford foot and ankle questionnaire (MOXFQ) with total and domain scores measured impact. Measures of pain and ankle haemophilia joint health (HJHS) scores were also collected. Results: Twenty‐nine participants were recruited. HAEMO‐QoL A mean (SD) total scores of 10.8 (5.2) of 100 (best health) and foot and ankle specific MOXFQ total scores of 45.5 (24.7) above zero (best outcome) indicate poor HRQoL and foot and ankle outcomes. Average ankle pain over past 6 months of (0–10) 5.5 (SD2.5) was reported and median (IQR) ankle HJHS of 3.0 (1;12.5) to 4.5 (0;9.5) for the left and right ankles. Conclusion: HRQoL and foot and ankle specific outcomes are poor in patients with moderate haemophilia and ankle haemarthropathy, driven by chronic levels of ankle joint pain. Despite moderate haemophilia being considered less affected by haemarthrosis and haemarthropathy, patients with a bleeding or haemarthropathy phenotype are clinically similar to patients with severe haemophilia A

The People's Trial : supporting the public's understanding of randomised trials

Acknowledgements The People’s Trial team members acknowledge with gratitude the study participants. We would also like to acknowledge and thank Simone Lepage, Aoife O’Shaughnessy, and Louise Foley for their support with the research project. We would also like to thank Rob & Paul Digital Design™, Galway, Ireland. In addition, we would like to thank Marina Zaki for her support of The People’s Trial, in particular her expertise in promoting The People’s Trial through social media channels. Funding This research was funded by the Health Research Board in Ireland, through the Health Research Board – Trials Methodology Research Network as part of a Knowledge Exchange and Dissemination Scheme Award (grant reference KEDS-2018-012) 2018. The funder of the study had no role in the study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit.Peer reviewedPublisher PD