Using creative co-design to develop a decision support tool for people with malignant pleural effusion

Abstract: Background: Malignant pleural effusion (MPE) is a common, serious problem predominantly seen in metastatic lung and breast cancer and malignant pleural mesothelioma. Recurrence of malignant pleural effusion is common, and symptoms significantly impair people’s daily lives. Numerous treatment options exist, yet choosing the most suitable depends on many factors and making decisions can be challenging in pressured, time-sensitive clinical environments. Clinicians identified a need to develop a decision support tool. This paper reports the process of co-producing an initial prototype tool. Methods: Creative co-design methods were used. Three pleural teams from three disparate clinical sites in the UK were involved. To overcome the geographical distance between sites and the ill-health of service users, novel distributed methods of creative co-design were used. Local workshops were designed and structured, including video clips of activities. These were run on each site with clinicians, patients and carers. A joint national workshop was then conducted with representatives from all stakeholder groups to consider the findings and outputs from local meetings. The design team worked with participants to develop outputs, including patient timelines and personas. These were used as the basis to develop and test prototype ideas. Results: Key messages from the workshops informed prototype development. These messages were as follows. Understanding and managing the pleural effusion was the priority for patients, not their overall cancer journey. Preferred methods for receiving information were varied but visual and graphic approaches were favoured. The main influences on people’s decisions about their MPE treatment were personal aspects of their lives, for example, how active they are, what support they have at home. The findings informed the development of a first prototype/service visualisation (a video representing a web-based support tool) to help people identify personal priorities and to guide shared treatment decisions. Conclusion: The creative design methods and distributed model used in this project overcame many of the barriers to traditional co-production methods such as power, language and time. They allowed specialist pleural teams and service users to work together to create a patient-facing decision support tool owned by those who will use it and ready for implementation and evaluation

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Chemical injection is a useful geotechnical procedure for stabilizing soils and also making them impermeable. For characterizing the soil stabilized by colloidal silica, the clean and silty sand samples with silt values of 20 and 40 percent, in both unstabilized and stabilized conditions, were prepared with different concentrations of the stabilizer from 5 to 30 percent, and the effects of colloidal silica on its behavior were evaluated under cyclic loading. 30 cyclic triaxial tests were performed on various samples. A 100 kPa confining pressure was used in these tests. All 15 experimental samples were loaded at cyclic stress ratios of 0.2 and 0.4 with a frequency of 1 Hz and up to 200 sinusoidal cycles. In this research, for the stabilized and unstabilized samples, the double amplitude of axial strain of five percent or the pore water pressure ratio of one, whichever occurs earlier, was considered as the liquefaction criterion. By performing cyclic triaxial tests, it was observed that by stabilizing clean and silty sand with colloidal silica, liquefaction phenomenon is postponed. Thus, adding even low concentration of colloidal silica such as 5 percent can prevent liquefaction of soil at the low level of dynamic loads (such as cyclic stress of 0.2). By adding colloidal silica, the double amplitude of axial strain and the pore water pressure ratio were reduced in cyclic loading. For example, in silty sand with a silt content of 40%, by increasing the stabilizing concentration from 10% to 30%, the pore water pressure ratio reduced from 1 (the state of full liquefaction) in 10 cycles to about 0.1 in 100 cycles, and also the double amplitude of axial strain decreased from 5% in 10 cycles to about 0.7% in 100 loading cycles. Gelatinization of colloidal silica between soil grains causes elastic behavior for the soil sample and prevents permanent deformation between soil grains. Reducing permanent deformation in undrained conditions reduces the development of excess pore water pressure in the soil during cyclic loading. The choice of colloidal silica concentration to prevent the liquefaction of sand and silty sand in a specific area depends on the cyclic stress ratio in that area; thus, at a cyclic stress ratio of 0.2, colloidal silica concentration of five percent is sufficient. However, at a cyclic stress ratio of 0.4 (higher level of dynamic loads), colloidal silica with a concentration of 20% or more should be used

Standing electric scooter injuries: Impact on a community

Background: This study investigates the impact of standing electric scooter-related injuries within an entire integrated hospital system. Methods: We performed a retrospective review of patients involved in standing electric scooter incidents presenting throughout an urban hospital network over a 10 month period. Rates of Google searches of scooter-related terms performed locally were used as a surrogate for ride frequency. Injury, mechanism, and cost data were analyzed. Results: Data on 248 patients were reviewed. Twenty-three (9%) were under 18 years old. Loss of balance was the most common cause of injury accounting for nearly half, while tripping over a scooter 14 (6%) affected the elderly disproportionately. Eight (3%) riders wore helmets. All TBI and closed head injuries occurred in unhelmeted patients. Most incidents occurred in the street, only one in a bicycle lane. Facilities costs were greater for patients under the influence of alcohol and marijuana. Conclusion: Policies related to the use of mandated safety equipment, dedicated bicycle lanes, and the proper storage of empty vehicles should be further investigated