119 research outputs found
A narrow bimalleolar width is a risk factor for ankle inversion injury in male military recruits: A prospective study
This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Background: Ankle inversion injuries are one of the most common and burdensome
injuries in athletic populations. Research that prospectively identifies characteristics
associated with this injury is lacking. This prospective study compared baseline
anthropometric and biomechanical gait characteristics of military recruits who sustained
an ankle inversion injury during training, with those who remained injury-free.
Methods: Bilateral plantar pressure and three-dimensional lower limb kinematics were
recorded in 1065 male, injury-free military recruits, during barefoot running. Injuries that
occurred during the 32-week recruit training programme were subsequently recorded.
Data were compared between recruits who sustained an ankle inversion injury during
training (n=27) and a sample (n=120) of those who completed training injury-free. A
logistic regression analysis was used to identify risk factors for this injury.
Findings: A narrower bimalleolar width and an earlier peak pressure under the fifth
metatarsal were predictors of ankle inversion injury. Those who sustained an ankle
inversion injury also had a lower body mass, body mass index, and a smaller calf girth
than those who completed training injury-free.
Interpretation: Anthropometric and dynamic gait characteristics have been identified
that may predispose recruits to an ankle inversion injury during Royal Marine recruit
training, allowing identification of recruits at higher risk at the start of training
Baseline study in environmental risk assessment: Escalating need for computer models to be whole-system approach
This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Accepted author version posted online: 12 Dec 2016Despite landfills having the potential to pollute the environment both during their operation and long after they have ceased to receive waste, they remain a dominant waste management option, particularly in the UK. In order to combat the environmental pollution caused by landfills, risk analysis is increasingly being employed through computer models. However, for a risk analysis process to be successful, its foundation has to be well established through a baseline study. This paper aims to identify knowledge gaps in software packages regarding environmental risk assessments in general, and especially those that have been developed specifically for landfills and landfill leachate. The research establishes that there is no holistic computer model for the baseline study of landfills, which risk assessors can use to conduct risk analyses specifically for landfill leachate. This paper also describes a number of factors and features that should be added to the baseline study system in order to render it more integrated—thereby enhancing quantitative risk analysis, and subsequently environmental risk management.The authors acknowledge the financial support of Dundee City Council in this project. We
are additionally grateful for the discussion and help received from Mr Peter Goldie of the
Environment & Consumer Protection Department, Dundee City Council. The support from Dr I. M.
Spence (Consultant Environmental Geologist, Scotland), and colleagues at the University of
Abertay Dundee, including Dr Kehinde O. K. Oduyemi and Mr Phillip Jenkins is also highly
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appreciated. It must be noted that concepts and ideas presented in this article by the authors do not
necessarily represent views that of their respective employer organization
Evaluating enhanced recovery after surgery: time to cover new ground and discover the missing patient voice
Multicomponent peri-operative interventions offer to accelerate patient recovery and improve cost-effectiveness. The recent National Institute of Health Research-commissioned evidence synthesis review by Nunns et al. considers the effectiveness and cost-effectiveness of all types of multicomponent interventions for older adults undergoing elective inpatient surgery. Enhanced recovery programmes (ERPs) were the most commonly evaluated intervention. An association between ERPs and decreased length of stay was observed, whilst complication rates and time to recovery were static or sometimes reduced. Important areas which lack research in the context of ERPs are patient-reported outcome measures, patients with complex needs and assessment of factors pertaining to successful ERP implementation. The next generation of ERP studies should seek to develop our understanding in these key areas
School‐based interventions for attention-deficit/hyperactivity disorder: a systematic review with multiple synthesis methods
This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Non-pharmacological interventions for attention-deficit/hyperactivity disorder are useful
treatments, but it is unclear how effective school-based interventions are for a range of outcomes
and which features of interventions are most effective. This paper systematically reviews
randomized controlled trial evidence of the effectiveness of interventions for children with
ADHD in school settings. Three methods of synthesis were used to explore the effectiveness of
interventions, whether certain types of interventions are more effective than others and which
components of interventions lead to effective academic outcomes. Twenty-eight studies (n=1,807)
were included in the review. Eight types of interventions were evaluated and a range of different
ADHD symptoms, difficulties and school outcomes were assessed across studies. Meta-analysis
demonstrated beneficial effects for interventions that combine multiple features (median effect
size g=0.37, interquartile range 0.32, range 0.09 to 1.13) and suggest some promise for daily
report card interventions (median g=0.0.62, IQR=0.25, range 0.13 to 1.62). Meta-regression
analyses did not give a consistent message regarding which types of interventions were more
effective than others. Finally, qualitative comparative analysis demonstrated that self-regulation
and one-to-one intervention delivery were important components of interventions that were
effective for academic outcomes. These two components were not sufficient though; when they
appeared with personalisation for individual recipients and delivery in the classroom, or when
interventions did not aim to improve child relationships, interventions were effective. This review
provides updated information about the effectiveness of non-pharmacological interventions
specific to school settings and gives tentative messages about important features of these
interventions for academic outcomes
Baseline study in environmental risk assessment – Escalating need for computer models to be whole-system approach
Despite landfills having the potential to pollute the environment both during their operation and long after they have ceased to receive waste, they remain a dominant waste management option, particularly in the UK. In order to combat the environmental pollution caused by landfills, risk analysis is increasingly being employed through computer models. However, for a risk analysis process to be successful, its foundation has to be well established through a baseline study. This paper aims to identify knowledge gaps in software packages regarding environmental risk assessments in general, and especially those that have been developed specifically for landfills and landfill leachate. The research establishes that there is no holistic computer model for the baseline study of landfills, which risk assessors can use to conduct risk analyses specifically for landfill leachate. This paper also describes a number of factors and features that should be added to the baseline study system in order to render it more integrated – thereby enhancing quantitative risk analysis, and subsequently environmental risk management
What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? Protocol for a systematic evidence map. Version 2
This is version 2 of the protocol. Version 1 is available in ORE at http://hdl.handle.net/10871/123482. Version 2 includes a number of small clarifying changes to version 1 of the protocol in line with the Campbell Collaboration methodological requirements for Evidence and Gap Maps. These were:
- Included details of the method for identifying ongoing studies
- Clarification and justification for the cut-off date for the searches for RCTs
- Justification for the inclusion of studies from high income countries
- Clarification of the unit of analysis for the evidence and gap map.Evaluating the potential of peer support is receiving abundant attention. This is in response to the increasing financial pressures on NHS, which has led health and social care sector to realise the importance of enabling patients and carers to support themselves more effectively. While there is strong evidence on effectiveness and cost-effectiveness of peer support intervention, it is currently not clear how future research could contribute in better understanding peer support interventions. Also, limited synthesised literature is available on which method of delivery of peer support may be the most effective in achieving positive patient outcomes and in terms of costs incurred. Thus, we aim to systematically map the volume, diversity and nature of recent, robust evidence for the use of peer support interventions in health and social care. We will conduct the systematic mapping in two stages: in stage 1 we will map systematic reviews of peer support, and in stage 2 we will map randomised controlled trials and health economic studies of peer support interventions that have not been included in recent systematic reviews. We will search several databases: MEDLINE, PsycINFO, Social Policy and Practice, HMIC, CINAHL, ASSIA and the Campbell Library. Supplementary web searches will be conducted. Results will be limited to English language studies conducted in high-income countries. Stage 1 search will be date limited from 2015 to-date. The date cut-off for the stage 2 searches will be determined following the completion of stage 1. Eligible studies will be those that involve users of adult services with a defined health and/or social care need accessing peer support delivered in any format (such as face-to-face, online, group, individual, mixed modes etc.), delivered by paid or unpaid peer supporters. Any comparator will be eligible for inclusion and all outcomes are of interest. In stage 1 of the review, high quality, recently published systematic reviews that include comparative studies (RCTs, non-randomised controlled trials, controlled and uncontrolled before-and-after trials and interrupted time series designs) evaluating the effectiveness and/or cost-effectiveness of peer support interventions will be included. The quality of all systematic reviews identified as eligible at stage 1 will be appraised using the AMSTAR2 quality appraisal tool. At stage 2. We will use the Cochrane Risk of Bias (ROB) tool and the CHEC list for assessing risk of bias of RCTs and the quality of economic evaluations, respectively. Following data extraction using EPPI Reviewer 4, studies will be entered into an interactive evidence map to visually represent the distribution of evidence across health and social care domains. The map will have multiple layers, such that studies can be identified by population group, type of peer support and outcome. We expect that by conducting this review, we will be able to direct users to existing evidence, funders to existing gaps, and reviewers to pockets of evidence that could be reviewed to help decision making. It may also be possible to use the map to identify research questions that cut across settings, populations and interventions that would help us to understand how to use peer support interventions most effectively.National Institute for Health Research (NIHR
Authors’ reply re: painful sex (dyspareunia) in women: prevalence and associated factors in a British population probability survey
No abstract available
Evidence for specialist treatment of people with acquired brain injury in secure psychiatric services: systematic review and narrative synthesis
This is the final version. Available from NIHR Journals Library via the DOI in this recordThe protocol for this systematic review is available in ORE at http://hdl.handle.net/10871/40286Patients with acquired brain injury (ABI) may experience various physical, cognitive or
emotional sequelae and are at increased risk of mental health difficulties. They may display
aggressive, sexually inappropriate or disinhibited behaviour which challenges those
supporting them and poses a risk to themselves or others. Such individuals may need
assessment, care and/or treatment within secure settings. There is limited availability of
secure placements and referral must be based on the patient meeting certain criteria.
Objectives
To systematically review evidence that can inform the arrangements for the specialist care of
adults with ABI who may require secure psychiatric services.
Data sources
Seven bibliographic databases (CINAHL, HMIC, MEDLINE, MEDLINE In-Process & Other
Non-Indexed Citations, PsycINFO, Social Policy & Practice, ASSIA) were searched on 27th
June 2019, date-limited to 2000. Database searches were supplemented with citation
searching; inspecting relevant reviews; searching ClinicalTrials.gov and WHO International
Clinical Trials Registry Platform, searching relevant websites; liaising with clinical experts
and affiliation searches.
Review methods
We sought evidence about adults with non-degenerative ABI placed in, eligible for referral
to, or being assessed for eligibility for referral to secure psychiatric services in any highincome country. Eligibility for referral to secure services was based on assessment or
observation of challenging behaviours. Psychometric studies of tools used in assessments
were eligible for inclusion. Study selection, data extraction and quality assessment were
completed independently by two reviewers. Given the heterogeneity of studies, outcomes and
data, a narrative synthesis approach was used. We were interested in identifying patient,
diagnostic or symptom characteristics associated with requiring care in secure settings.
Findings
6297 unique titles and abstracts were screened against inclusion criteria, leading to full-text
screening of 325 papers. Forty-six observational and case-control studies and one systematic
review were included; however none were set in, or referred explicitly to secure settings.
Thirty-eight of the primary studies evaluated patient characteristics associated with
challenging behaviour. Eight primary studies and the systematic review evaluated the
psychometric properties of measures used to assess challenging behaviour. Narrative
synthesis indicated a highly heterogeneous set of studies providing uncertain evidence about
patient characteristics which may be associated with challenging behaviours. Whilst tentative
associations were found between certain patient characteristics and occurrence of challenging
behaviour, the conflicting nature of this evidence reduces confidence in these findings. There
was no strong evidence to recommend the use of specific patient assessment tools.
Limitations
We found no evidence regarding referrals to secure treatment settings and thus were not able
to directly answer our research questions. Studies investigating associations between patient
characteristics and challenging behaviours varied in methodological rigour and evidence was
highly heterogeneous.
Conclusions
There is no direct evidence to support decisions about the suitable setting for the care of
adults with ABI who display challenging behaviour. There is tentative evidence about patient
characteristics associated with risk of challenging behaviour.
Future work
Primary research is needed to inform evidence-based decisions on the appropriate setting for
the care of people with ABI who display challenging behaviour.National Institute for Health Research (NIHR
Changes in the immune landscape of TNBC after neoadjuvant chemotherapy: correlation with relapse
Introduction: Patients with high-risk, triple negative breast cancer (TNBC) often receive neoadjuvant chemotherapy (NAC) alone or with immunotherapy. Various single-cell and spatially resolved techniques have demonstrated heterogeneity in the phenotype and distribution of macrophages and T cells in this form of breast cancer. Furthermore, recent studies in mice have implicated immune cells in perivascular (PV) areas of tumors in the regulation of metastasis and anti-tumor immunity. However, little is known of how the latter change during NAC in human TNBC or their impact on subsequent relapse, or the likely efficacy of immunotherapy given with or after NAC.
Methods: We have used multiplex immunofluorescence and AI-based image analysis to compare the immune landscape in untreated and NAC-treated human TNBCs. We quantified changes in the phenotype, distribution and intercellular contacts of subsets of tumor-associated macrophages (TAMs), CD4+ and CD8+ T cells, and regulatory T cells (Tregs) in PV and non-PV various areas of the stroma and tumor cell islands. These were compared in tumors from patients who had either developed metastases or were disease-free (DF) after a three-year follow up period.
Results: In tumors from patients who remained DF after NAC, there was a marked increase in stromal CD163+ TAMs, especially those expressing the negative checkpoint regulator, T-cell immunoglobulin and mucin domain 3 (TIM-3). Whereas CD4+ T cells preferentially located to PV areas in the stroma of both untreated and NAC-treated tumors, specific subsets of TAMs and Tregs only did so only after NAC. Distinct subsets of CD4+ and CD8+ T cells formed PV clusters with CD163+ TAMs and Tregs. These were retained after NAC.
Discussion: Quantification of stromal TIM-3+CD163+ TAMs in tumor residues after NAC may represent a new way of identifying patients at high risk of relapse. PV clustering of immune cells is highly likely to regulate the activation and function of T cells, and thus the efficacy of T cell-based immunotherapies administered with or after NAC
What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? Protocol for a systematic evidence map. Version 1
This is version 1 of the protocol. Version 2 is available in ORE at http://hdl.handle.net/10871/125999. Version 2 includes a number of small clarifying changes to version 1 of the protocol in line with the Campbell Collaboration methodological requirements for Evidence and Gap Maps. These were: - Included details of the method for identifying ongoing studies - Clarification and justification for the cut-off date for the searches for RCTs - Justification for the inclusion of studies from high income countries - Clarification of the unit of analysis for the evidence and gap map.Evaluating the potential of peer support is receiving abundant attention. This is in response to the increasing financial pressures on NHS, which has led health and social care sector to realise the importance of enabling patients and carers to support themselves more effectively. While there is strong evidence on effectiveness and cost-effectiveness of peer support intervention, it is currently not clear how future research could contribute in better understanding peer support interventions. Also, limited synthesised literature is available on which method of delivery of peer support may be the most effective in achieving positive patient outcomes and in terms of costs incurred. Thus, we aim to systematically map the volume, diversity and nature of recent, robust evidence for the use of peer support interventions in health and social care. We will conduct the systematic mapping in two stages: in stage 1 we will map systematic reviews of peer support, and in stage 2 we will map randomised controlled trials and health economic studies of peer support interventions that have not been included in recent systematic reviews. We will search several databases: MEDLINE, PsycINFO, Social Policy and Practice, HMIC, CINAHL, ASSIA and the Campbell Library. Supplementary web searches will be conducted. Results will be limited to English language studies conducted in high-income countries. Stage 1 search will be date limited from 2015 to-date. The date cut-off for the stage 2 searches will be determined following the completion of stage 1. Eligible studies will be those that involve users of adult services with a defined health and/or social care need accessing peer support delivered in any format (such as face-to-face, online, group, individual, mixed modes etc.), delivered by paid or unpaid peer supporters. Any comparator will be eligible for inclusion and all outcomes are of interest. In stage 1 of the review, high quality, recently published systematic reviews that include comparative studies (RCTs, non-randomised controlled trials, controlled and uncontrolled before-and-after trials and interrupted time series designs) evaluating the effectiveness and/or cost-effectiveness of peer support interventions will be included. The quality of all systematic reviews identified as eligible at stage 1 will be appraised using the AMSTAR2 quality appraisal tool. At stage 2. We will use the Cochrane Risk of Bias (ROB) tool and the CHEC list for assessing risk of bias of RCTs and the quality of economic evaluations, respectively. Following data extraction using EPPI Reviewer 4, studies will be entered into an interactive evidence map to visually represent the distribution of evidence across health and social care domains. The map will have multiple layers, such that studies can be identified by population group, type of peer support and outcome. We expect that by conducting this review, we will be able to direct users to existing evidence, funders to existing gaps, and reviewers to pockets of evidence that could be reviewed to help decision making. It may also be possible to use the map to identify research questions that cut across settings, populations and interventions that would help us to understand how to use peer support interventions most effectively.National Institute for Health Research (NIHR
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