4,761 research outputs found

    Barriers and facilitators to the successful development, implementation and evaluation of care bundles in acute care in hospital: A scoping review.

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    Background Care bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness. Methods A scoping review was carried out using the Arksey and O’Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria. Results Twenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure. Negative associations were found between the number of elements in a bundle and compliance (Spearman’s rho = − 0.47, non-parallel cohort and − 0.65, prospective cohort studies), and between the complexity of elements and compliance (p < 0.001, chi-squared = 23.05). Implementation strategies associated with improved compliance included evaluative and iterative approaches, development of stakeholder relationships and education and training strategies. Conclusion Care bundles with a small number of simple elements have better compliance rates. Standardised reporting of implementation strategies may help to implement care bundles into clinical practice with high fidelity. Trial Registration This review was registered on the PROSPERO database: CRD 42015029963 in December 2015

    Exploring perceptions of Advanced Driver Assistance Systems (ADAS) in older drivers with age-related declines

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    Perceptions of Advanced Driver Assistance Systems (ADAS) were explored in two semi-structured face-to-face focus group studies of 42 older drivers (aged 65 years and older) with and without age-related declines. Study 1 explored perceptions regarding ADAS, focusing on visual, auditory, physical, and cognitive factors. Study 2 extended this by additionally exploring perceptions following exposure to videos and stationary vehicle demonstrations of an ADAS. Participants had a range of visual, hearing, memory, and health characteristics which impacted on their daily life. In both studies, some participants had insights regarding various ADAS technologies prior to the study, but many were unfamiliar with these systems. Nevertheless, overall, participants reported that ADAS would assist them to drive as they age and increase their mobility and independence. There were comments regarding the benefits of warning alerts, although the potential for them to be distracting was also highlighted. Participants with vision impairment preferred audio alerts and participants with hearing impairment preferred visual display alerts. Findings highlighted the potential for ADAS to assist those with age-related declines and the need to increase the flexibility of warning system alerts to suit the varying requirements of older drivers, as well as to reduce the complexity of vehicle interfaces. Collectively, these strategies would maximize the benefits of these vehicles to increase the mobility, independence, and quality of life of older drivers with and without age-related declines

    Network Defence Using Attacker-Defender Interaction Modelling

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    Network security is still lacking an efficient system which selects a response action based on observed security events and which is capable of running autonomously. The main reason for this is the lack of an effective defence strategy. In this Ph.D., we endeavour to create such a defence strategy. We propose to model the interaction between an attacker and a defender to comprehend how the attacker’s goals affect his actions and use the model as a basis for a more refined network defence strategy. We formulate the research questions that need to be answered and we discuss, how the answers to these questions relate to the proposed solution. This research is at the initial phase and will contribute to a Ph.D. thesis in four years

    Cancer mortality in the United Kingdom: projections to the year 2025

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    The purpose of this study was to project mortality rates in the United Kingdom for the period 2006–2025 for 21 major cancers on the basis of the observed trends in mortality rates during 1971–2005, and to estimate the implication in terms of expected deaths. Age-period-cohort models were applied to official statistics. The projected decrease in age-standardised mortality rates for all cancers from 2003 to 2023 was 17% in men and 16% in women. Future mortality rates were projected to decline for most cancer sites. In men, there were small projected increases in mortality rates from cancers of the oral cavity, oesophagus and melanoma, with a larger projected increase (14% over 20 years) in mortality of liver cancer. In women, the only projected increase (18%) was for corpus uteri. The numbers of deaths will increase for most cancers, with a 30% increase in all cancers projected for men and a 12% increase projected for women. Mortality rates from cancer as a whole have been falling in the United Kingdom since 1990, and this decline was projected to continue into the future as well as the declining rates in both sexes for most cancers. Actual numbers of deaths will increase for most cancers

    Design and synthesis of lactams derived from mucochloric and mucobromic acids as pseudomonas aeruginosa quorum sensing inhibitors

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    © 2018 by the authors. Bacterial infections, particularly hospital-acquired infections caused by Pseudomonas aeruginosa, have become a global threat with a high mortality rate. Gram-negative bacteria including P. aeruginosa employ N-acyl homoserine lactones (AHLs) as chemical signals to regulate the expression of pathogenic phenotypes through a mechanism called quorum sensing (QS). Recently, strategies targeting bacterial behaviour or QS have received great attention due to their ability to disarm rather than kill pathogenic bacteria, which lowers the evolutionary burden on bacteria and the risk of resistance development. In the present study, we report the design and synthesis of N-alkyl- and N-aryl 3,4 dichloro- and 3,4-dibromopyrrole-2-one derivatives through the reductive amination of mucochloric and mucobromic acid with aliphatic and aromatic amines. The quorum sensing inhibition (QSI) activity of the synthesized compounds was determined against a P. aeruginosa MH602 reporter strain. The phenolic compounds exhibited the best activity with 80% and 75% QSI at 250 ”M and were comparable in activity to the positive control compound Fu-30. Computational docking studies performed using the LasR receptor protein of P. aeruginosa suggested the importance of hydrogen bonding and hydrophobic interactions for QSI

    Plausible self-reported dietary intakes in a residential facility are not necessarily reliable

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    Background/Objectives: Comparing reported energy intakes with estimated energy requirements as multiples of basal metabolic rate (Ein:BMR) is an established method of identifying implausible food intake records. The present study aimed to examine the validity of self-reported food intakes believed to be plausible. Subjects/Methods: One hundred and eighty men and women were provided with all food and beverages for two consecutive days in a residential laboratory setting. Subjects self-reported their food and beverage intakes using the weighed food diary method (WDR). Investigators covertly measured subjects’ actual consumption over the same period. Subjects also reported intakes over four consecutive days at home. BMR was measured by indirect calorimetry. Results: Average reported energy intakes were significantly lower than actual intakes (11.2 and 11.8 MJ/d, respectively, P<0.001). Two-thirds (121) of the WDR were under-reported to varying degrees. Only five of these were considered as implausible using an Ein:BMR cut-off value of 1.03*BMR. Under-reporting of food and beverage intakes, as measured by the difference between reported and actual intake, was evident at all levels of Ein;BMR. Reported energy intakes were lower still (10.2 MJ/d) while subjects were at home. Conclusions: Under-recording of self-reported food intake records was extensive but very few under-reported food intake records were identified as implausible using energy intake to BMR ratios. Under-recording was evident at all levels of energy intake

    Distributed design of product oriented manufacturing systems

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    Manufacturing leanness and agility are requirements of today’s manufacturing systems. Leanness call for a best fit of the manufacturing systems to products, therefore requiring product oriented manufacturing systems (POMS). Manufacturing agility can be achieved through easy systems reconfiguration to fit changing manufacturing requirements, which may mean dynamically configuring POMS. For this a suitable design system is required. Due to complexity of this design, and to the need for using suitable design methods, which may not be available locally, distributed sources of design services can be used. This paper presents and describes a prototype of a Distributed Design system for POMS based on a POMS design methodology and distributed suppliers of design services

    Fracture Risk Assessment in Chronic Kidney Disease, Prospective Testing Under Real World Environments (FRACTURE): a prospective study

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    <p>Abstract</p> <p>Background</p> <p>Chronic kidney disease (CKD) is associated with an increased risk of fracture. Decreased bone mass and disruption of microarchitecture occur early in the course of CKD and worsens with the progressive decline in renal function so that at the time of initiation of dialysis at least 50% of patients have had a fracture. Despite the excess fracture risk, and the associated increases in morbidity and mortality, little is known about the factors that are associated with an increase in fracture risk. Our study aims to identify prognostic factors for bone loss and fractures in patients with stages 3 to 5 CKD.</p> <p>Methods</p> <p>This prospective study aims to enroll two hundred and sixty men and women with stages 3 to 5 CKD. Subjects will be followed for 24 months and we will examine the ability of: 1) bone mineral density by dual x-ray absorptiometry at the spine, hip, and radius; 2) volumetric bone density by high resolution peripheral quantitated computed tomography at the radius and tibia; 3) serum markers of bone turnover; 4) bone formation rate by bone biopsy; and 5) muscle strength and balance to predict spine and non-spine fractures, identified by self-report and/or vertebral morphometry. All measurements will be obtained at baseline, at 12 and at 24 months with the exception of bone biopsy, which will be measured once at 12 months. Subjects will be contacted every 4 months to determine if there have been incident fractures or falls.</p> <p>Discussion</p> <p>This study is one of the first that aims to identify risk factors for fracture in early stage CKD patients. Ultimately, by identifying risk factors for fracture and targeting treatments in this group-before the initiation of renal replacement therapy - we will reduce the burden of disease due to fractures among patients with CKD.</p

    Reflexive learning, socio-cognitive conflict and peer-assessment to improve the quality of feedbacks in online tests

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    International audienceOur previous works have introduced the Tsaap-notes platform dedicated to the semi automatic generation of multiple choice questionnaire providing feedbacks: it reuses interactive questions asked by teachers during lectures, as well as the notes taken by students after the presentation of the results as feedbacks integrated into the quizzes. In this paper, we introduce a new feature which aims at increasing the number of contributions of students in order to significantly improve the quality of the feedbacks used in the resulting quizzes. This feature splits the submission of an answer into several distinct phases to harvest explanations given by students, and then applies an algorithm to filter the best contributions to be integrated as feedbacks in the tests. Our approach has been validated by a first experimentation involving master students enrolled in a computer science course
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