Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation

Abstract Background: Goal setting is considered 'best practice' in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice

Scottish Medical Imaging Service:Technical and Governance controls

Objectives The Scottish Medical Imaging (SMI) service provides linkable, population based, “research-ready” real-world medical images for researchers to develop or validate AI algorithms within the Scottish National Safe Haven. The PICTURES research programme is developing novel methods to enhance the SMI service offering through research in cybersecurity and software/data/infrastructure engineering. Approach Additional technical and governance controls were required to enable safe access to medical images. The researcher is isolated from the rest of the trusted research environment (TRE) using a Project Private Zone (PPZ). This enables researchers to build and install their own software stack, and protects the TRE from malicious code. Guidelines are under development for researchers on the safe development of algorithms and the expected relationship between the size of the model and the training dataset. There is associated work on the statistical disclosure control of models to enable safe release of trained models from the TRE. Results A policy enabling the use of “Non-standard software” based on prior research, domain knowledge and experience gained from two contrasting research studies was developed.  Additional clauses have been added to the legal control – the eDRIS User Agreement – signed by each researcher and their Head of Department.  Penalties for attempting to import or use malware, remove data within models or any attempt to deceive or circumvent such controls are severe, and apply to both the individual and their institution. The process of building and deploying a PPZ has been developed allowing researchers to install their own software. No attempt has yet been made to add additional ethical controls; however, a future service development could be validating the performance of researchers’ algorithms on our training dataset. Conclusion The availability to conduct research using images poses new challenges and risks for those commissioning and operating TREs. The Private Project Zone and our associated governance controls are a huge step towards supporting the needs of researchers in the 21st century

Profiling clinical datasets for data quality assessment and improvement

Clinical datasets are the most critical resources or assets in the repository of Electronic Health Records (EHRs) and their quality gains competitive advantages in translational research. Accurate, reliable, and consistent representation of clinical datasets are essential for answering key research questions. However, a major issue with carrying out research on routinely collected primary care datasets is that they are often not fit-for-purpose or research-ready. It often takes months (if not years) for researchers to clean and transform clinical datasets for meaningful translational research. Profiling clinical datasets provides a proactive approach to examining and understanding the content, context and structure of source system data. The objective of this study was to develop a profiling dashboard to monitor, measure, assess, and improve the quality of clinical datasets hosted and maintained by the Health Informatics Centre (HIC) at the University of Dundee. Preliminary results indicated that the dashboard affords the flexibility to perform objective assessment of data quality, in terms of accessibility, accuracy, appropriate amount of data, completeness, and consistency

Implementing a framework for goal setting in community based stroke rehabilitation : a process evaluation

Goal setting is considered 'best practice' in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice. G-AP has 4 stages: goal negotiation, goal setting, action planning & coping planning and appraisal & feedback. All stages are recorded in a patient-held record. In this study we examined the implementation, acceptability and perceived benefits of G-AP in one community rehabilitation team with people recovering from stroke. G-AP was implemented for 6 months with 23 stroke patients. In-depth interviews with 8 patients and 8 health professionals were analysed thematically to investigate views of its implementation, acceptability and perceived benefits. Case notes of interviewed patients were analysed descriptively to assess the fidelity of G-AP implementation. G-AP was mostly implemented according to protocol with deviations noted at the planning and appraisal and feedback stages. Each stage was felt to make a useful contribution to the overall process; however, in practice, goal negotiation and goal setting merged into one stage and the appraisal and feedback stage included an explicit decision making component. Only two issues were raised regarding G-APs acceptability: (i) health professionals were concerned about the impact of goal non-attainment on patient's well-being (patients did not share their concerns), and (ii) some patients and health professionals found the patient-held record unhelpful. G-AP was felt to have a positive impact on patient goal attainment and professional goal setting practice. Collaborative partnerships between health professionals and patients were apparent throughout the process. G-AP has been perceived as both beneficial and broadly acceptable in one community rehabilitation team; however, implementation of novel aspects of the framework was inconsistent. The regulatory function of goal non-attainment and the importance of creating flexible partnerships with patients have been highlighted. Further development of the G-AP framework, training package and patient held record is required to address the specific issues highlighted by this process evaluation. Further evaluation of G-AP is required across diverse community rehabilitation settings

TELEPORT: Connecting researchers to big data at light speed

<p>Health and administrative data about people resident in the UK are generated by the NHS, government and other organisations and subsequently held in different locations across the UK's four nations according to devolved legislation and governance. Trusted Research Environments (TREs) were developed by organisations in academia, NHS, government agencies, and, in some cases, commercial companies to safely store this data and control access to it for research purposes. De-identified data is typically available for research via these TREs. However, each houses specific data based at different institutions, which adds difficulty to a researcher's task of trying to gather a full picture of scientific outputs for the entire nation due to the replication needed to analyse all available data across the country.</p><p> A solution to improving data access and efficiency for researchers is federated data access, enabling parallel access to data housed in multiple physically separated environments (without data moving from their host environments, instead being accessible from its host location to a researcher in a single safe, secure environment) where researchers can see the data required for their research projects. </p><p>Teleport is starting the transformation of traditional TRE access to data, partnering with the custodians of national-level data in Wales and Scotland (SAIL Databank and Scottish National Safe Haven) and the technology providers of the TRE platforms (the Secure eResearch Platform (SeRP) at Swansea University and EPCC at the University of Edinburgh). By making data accessible by connecting TREs, researchers could, for example, have better-facilitated access to understand rare diseases at scale and generally increase the quality of research in common conditions by increasing the sample size accessible in a single environment, rather than having to run multiple disparate analyses. It is the starting place for efficient study across the UK, promoting the move away from duplicated research in siloed environments, instead enabling better scientific outputs and health outcomes due to the increase in scale, granularity, and connectivity of data available. Both sites in scope for Teleport have national-level data holdings of complementary scale and research infrastructure of equivalent maturity to deploy, test, and develop the proposed access solution. </p><p>This work was funded by UK Research & Innovation [Grant Number MC_PC_23009] as part of Phase 1 of the DARE UK (Data and Analytics Research Environments UK) programme, delivered in partnership with Health Data Research UK (HDR UK) and Administrative Data Research UK (ADR UK).</p><p> </p&gt

Generalized alignment

Structural relations between grammatical categories (here, morphological and phonological) are governed by a single family of constraints under Optimality Theory: these demand that one type of grammatical constituent share a designated edge with some other type of constituent. Evidence is considered from footing patterns, infixability, epenthesis, syllabification, and prosodic subcategorization