Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department : A systematic review using the theoretical domains framework (TDF)

Background Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED. Methods Studies of any design, conducted in ED, where barriers or enablers based on primary data were identified for one or more of these six clinical behaviours. Major biomedical databases (CINAHL, OVID SP EMBASE, OVID SP MEDLINE) were searched using comprehensive search strategies. The barriers and enablers were categorised using the theoretical domains framework (TDF). The behaviour change technique (BCT) that best aligned to the strategy each enabler represented was selected for each of the reported enablers using a standard taxonomy. Results Five qualitative studies and four surveys out of the 44 studies identified met the selection criteria. The majority of barriers reported corresponded with the TDF domains of “environmental, context and resources” (such as stressful working conditions or lack of resources) and “knowledge” (such as lack of guideline awareness or familiarity). The majority of enablers corresponded with the domains of “knowledge” (such as education for physicians on the calculated risk of haemorrhage following intravenous thrombolysis [tPA]) and “skills” (such as providing opportunity to treat stroke cases of varying complexity). The total number of BCTs assigned was 18. The BCTs most frequently assigned to the reported enablers were “focus on past success” and “information about health consequences.” Conclusions Barriers and enablers for the delivery of key evidence-based protocols in an emergency setting have been identified and interpreted within a relevant theoretical framework. This new knowledge has since been used to select specific BCTs to implement evidence-based care in an ED setting. It is recommended that findings from similar future reviews adopt a similar theoretical approach. In particular, the use of existing matrices to assist the selection of relevant BCTs

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Integrative neurobiology of metabolic diseases, neuroinflammation, and neurodegeneration

Alzheimer’s disease (AD) is a complex, multifactorial disease with a number of leading mechanisms, including neuroinflammation, processing of amyloid precursor protein (APP) to amyloid β peptide, tau protein hyperphosphorylation, relocalization and deposition. These mechanisms are propagated by obesity, the metabolic syndrome and type-2 diabetes mellitus. Stress, sedentariness, dietary overconsumption of saturated fat and refined sugars, and circadian derangements/disturbed sleep contribute to obesity and related metabolic diseases, but also accelerate age-related damage and senescence that all feed the risk of developing AD too. The complex and interacting mechanisms are not yet completely understood and will require further analysis. Instead of investigating AD as a mono- or oligocausal disease we should address the disease by understanding the multiple underlying mechanisms and how these interact. Future research therefore might concentrate on integrating these by systems biology approaches, but also to regard them from an evolutionary medicine point of view. The current review addresses several of these interacting mechanisms in animal models and compares them with clinical data giving an overview about our current knowledge and puts them into an integrated framework

Religious Pluralism and Civic Rights in a “Muslim Nation”: An Analysis of Prophet Muhammad’s Covenants with Christians

This article examines the roles that religious pluralism and civic rights played in Prophet Muhammad’s vision of a “Muslim nation”. I demonstrate how Muhammad desired a pluralistic society in which citizenship and equal rights were granted to all people regardless of religious beliefs and practices. The Covenants of the Prophet Muhammad with the Christians of his time are used as a framework for analysis. These documents have received little attention in our time, but their messages are crucial in light of current debates about Muslim-Christian relations. The article campaigns for reviving the egalitarian spirit of the Covenants by refocusing our understanding of the ummah as a site for religious freedom and civil rights. Ultimately, I argue that the Covenants of Prophet Muhammad with the Christians of his time can be used to develop a stronger narrative of democratic partnership between Muslims and Christians in the “Islamic world” and beyond

The Racialization of Islam in the United States: Islamophobia, Hate Crimes, and “Flying while Brown”

This paper explores the intersectionality of race and Islamophobia by using a set of empirical data relating to the experiences of American Muslims and non-Muslims in the United States. Through a multi-tiered methodology, the paper reveals how racialization processes interact with Islamophobic discourses and actions in American society. Specifically, the dataset is anchored in U.S. public perceptions of American Muslims, hate crime incidents against Muslims and non-Muslims, and the institutionalization of Islamophobia. The paper, which shows how race is endemic to Islamophobic incidents, appeals to the general U.S. public, especially community members from religious, political, academic, civil rights, and social justice backgrounds

Religious Pluralism and Civic Rights in a “Muslim Nation”: An Analysis of Prophet Muhammad’s Covenants with Christians

This article examines the roles that religious pluralism and civic rights played in Prophet Muhammad’s vision of a “Muslim nation”. I demonstrate how Muhammad desired a pluralistic society in which citizenship and equal rights were granted to all people regardless of religious beliefs and practices. The Covenants of the Prophet Muhammad with the Christians of his time are used as a framework for analysis. These documents have received little attention in our time, but their messages are crucial in light of current debates about Muslim-Christian relations. The article campaigns for reviving the egalitarian spirit of the Covenants by refocusing our understanding of the ummah as a site for religious freedom and civil rights. Ultimately, I argue that the Covenants of Prophet Muhammad with the Christians of his time can be used to develop a stronger narrative of democratic partnership between Muslims and Christians in the “Islamic world” and beyond

Family, religion, and identity in the Pakistani diaspora : a case study of young Pakistani men in Dublin and Boston

THESIS 10538In recent years, Western countries have received Pakistanis as religious fanatics and detrimental to national as well as international safety and politics. Pakistani communities in diaspora have, in turn, received negative attention for controversies surrounding religious activities and a noted lack of integration into host societies. In Ireland and the US, Pakistanis are faced with different challenges due to the migration histories of Pakistanis into these countries, the role of religion in Irish and American societies, and how ideas of the ?nation? have affected individual migrant lives. While the Pakistani diaspora is well researched as one of the largest diasporic communities in the world, little is known about these populations in Dublin and Boston. This study fills the gap in literature by examining the experiences of young Pakistani men through their engagement with family, religion, and identity. In comparing the experiences of young Pakistani men in Dublin and Boston, this study explores the heterogeneity of the Pakistani diaspora, an issue that has been largely overlooked in diaspora studies. This study looks at how young Pakistani men between the ages of 18 and 35 position themselves in relation to ethnicity, religion, and nationality. By examining the lived experiences of first- and second-generation Pakistani Muslim as well as non-Muslim men, the thesis considers migrant generational differences, the impact of religious affiliations, as well as the development of individual identities in the Irish and American contexts. The study draws upon diaspora theory, specifically the concepts of boundary maintenance, homeland, and cultural borderland, to look at how these men negotiate the native and host cultures. To investigate the heterogeneity of the Pakistani diaspora, the research design sampled individuals from different sub-ethnic groups, religions, sexualities, and socioeconomic backgrounds. A series of semi-structured interviews, focus groups, and participant observation notes were used to account for the individuals? lived experiences

Strategies and outcomes in translating alcohol harm reduction research into practice: the Alcohol Linking Program

Harm associated with consumption of alcohol on licensed premises is an issue of community concern. Interventions to reinforce responsible sale of alcohol such as server training and accords between licensees, police and health advocates are well known. However, while generally supported by police and licensees as 'a good thing', evaluations demonstrating that they reduce alcohol-related harm are rare. Lack of enforcement is often an issue. This paper reports on system intervention to enhance police enforcement of liquor laws by providing data-based feedback to police and licensees about alcohol-related crime following drinking on specific licensed premises. The system has been shown to contribute to a reduction of alcohol-related crime and has been adopted into routine practice by NSW police state-wide. It is a good example of how research can be conducted in a way that bridges the gap between policy research and policy practice