ABSTRACT Background Up to 2% of all pregnancies result in pregnancy loss between 14 + 0 and 23 + 6 weeks’ gestation, which is defined as ‘late miscarriage’. Lack of consensus about definition of viability paired with existing multiple definitions of perinatal loss make it difficult to define the term ‘late miscarriage’. Parents who experience late miscarriage often have had reassuring scan-milestones, which established their confidence in healthy pregnancy progression and identity formation, which socially integrates their baby into their family. The clinical lexicon alongside the lack of support offered to parents experiencing late miscarriage may disclaim their needs, which has potential to cause adverse psychological responses. Aim To review what primary research reports about parents’ experiences and their perceived holistic needs following late miscarriage. Methods A narrative systematic review was carried out. Papers were screened based on gestational age at time of loss (i.e. between 14 + 0 and 23 + 6 weeks’ gestation). The focus was set on experience and holistic needs arising from the loss rather than its clinical care and pathophysiology. Studies were selected using PRISMA-S checklist, and quality assessed using the Critical Appraisal Skills Program (CASP) tool. Thematic analysis was used to guide the narrative synthesis of findings. Results Six studies met the inclusion criteria. Three main themes emerged: communication and information-giving; feelings post-event; and impact of support provision. Conclusion Literature about the experience of late miscarriage is scarce, with what was found reporting a lack of compassionate and individually tailored psychological follow-up care for parents following late miscarriage. Hence, more research in this arena is required to inform and develop this area of maternity care provision.

Automatic nuclei segmentation and classification play a vital role in digital pathology. However, previous works are mostly built on data with limited diversity and small sizes, making the results questionable or misleading in actual downstream tasks. In this article, we aim to build a reliable and robust method capable of dealing with data from the ‘the clinical wild’. Specifically, we study and design a new method to simultaneously detect, segment, and classify nuclei from Haematoxylin and Eosin (H&E) stained histopathology data, and evaluate our approach using the recent largest dataset: PanNuke. We address the detection and classification of each nuclei as a novel semantic keypoint estimation problem to determine the center point of each nuclei. Next, the corresponding class-agnostic masks for nuclei center points are obtained using dynamic instance segmentation. Meanwhile, we proposed a novel Joint Pyramid Fusion Module (JPFM) to model the cross-scale dependencies, thus enhancing the local feature for better nuclei detection and classification. By decoupling two simultaneous challenging tasks and taking advantage of JPFM, our method can benefit from class-aware detection and class-agnostic segmentation, thus leading to a significant performance boost. We demonstrate the superior performance of our proposed approach for nuclei segmentation and classification across 19 different tissue types, delivering new benchmark results.

ABSTRACT This study offers a comprehensive theoretical and empirical analysis of a fundamentals-based investment criterion (HSBC’s Rating to Economic Profit – REP). By employing a large sample of US-listed firms over a 12-year time-period and conducting univariate, multivariate and portfolio analyses, we provide robust empirical results that support the ability of REP to explain contemporaneous stock market valuations, justify financial analysts’ target prices, and predict one-year ahead stock returns. Through content analysis of selected financial analysts’ equity research reports, we also provide some descriptive evidence of the usefulness of accrual accounting numbers over dividends for valuation purposes. To the best of our knowledge, this is the first academic study that offers a comprehensive analysis of REP as a value-based stock screening method that should be of interest to market-based accounting researchers, valuation educators, and capital market participants.

BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC. MATERIAL AND METHODS A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (M.L. and A.P.) independently screened the titles and abstracts, and full-text articles were assessed for eligibility. Data were extracted, and a quality assessment was performed using appropriate techniques. RESULTS A total of 15 studies met the inclusion criteria. The studies included in the review demonstrated a correlation between rationing of nursing care and patient safety. The results of these studies revealed that there is an inverse relationship between rationing of nursing care and patient safety. The review found that when nursing care is rationed, there is a higher incidence of falls, medication errors, pressure ulcers, infections, and readmissions. In addition, the review identified that the work characteristics of nurses, such as workload, staffing levels, and experience, were associated with RONC. CONCLUSIONS RONC has a negative impact on patient safety outcomes. It is essential for healthcare organizations to implement effective strategies to prevent the RONC. Improving staffing levels, workload management, and communication amo0ng healthcare providers are some of the strategies that can support this.

To understand for whom, under what conditions, and how an integrated approach to atrial fibrillation (AF) service delivery works (or does not work). A realist review of integrated approaches to AF service delivery for adult populations aged ≥18 years. An expert panel developed an initial programme theory, searched and screened literature from four databases until October 2022, extracted and synthesized data using realist techniques to create context-mechanism-outcome configurations for integrated approaches to AF service, and developed an integrated approach refined programme theory. A total of 5433 documents were screened and 39 included. The refined programme theory included five context-mechanism-outcome configurations for how clinical and system-wide outcomes are affected by the way integrated approaches to AF service delivery are designed and delivered. This review identifies core mechanisms underpinning the already known fundamental components of integrated care. This includes having a central coordinator responsible for service organization to provide continuity of care across primary and secondary care ensuring services are patient centred. Additionally, a fifth pillar, lifestyle and risk factor reduction, should be recognized within an AF care pathway. It is evident from our provisional theory that numerous factors need to interlink and interact over time to generate a successfully integrated model of care in AF. Stakeholders should embrace this complexity and acknowledge that the learnings from this review are integral to shaping future service delivery in the face of an aging population and increased prevalence of AF.

Deaths in care homes and "at home" are anticipated to account for a third of UK deaths by 2040. Currently, palliative and end of life care are not part of statutory training in care homes. Reflective practice is a tool that can facilitate practice-based learning and support. Following a feasibly study to test "online" supportive conversations and reflection sessions (OSCaRS) to support care home staff in relation to death/dying during the first months of the COVID pandemic, a one-year practice development follow-up project was undertaken with the aim to create a team of NHS/specialist palliative care (SPC)-based facilitators to lead and support OSCaRS provision in up to 50 care homes in one region in Scotland-the focus of this paper. Forty care home managers attended an on-line session explaining the project, with a similar session held for 19 NHS/SPC-based nurses external to care homes. Those interested in facilitating OSCaRS then attended three education sessions. records of all activities; reflective notes on OSCaRS organised/delivered; a summary of each OSCaRS reflection/learning points; final interviews with NHS/SPC trainee facilitators. A total of 19 NHS/SPC facilitators delivered one or more OSCaRS in 22 participating care homes. However, as of January 2022 only six trained facilitators remained active. Out of the 158 OSCaRS arranged, 96 took place with a total of 262 staff attending. There were three important aspects that emerged: the role, remit, and resources of NHS/SPC supporting OSCaRS; requirements within care homes for establishing OSCaRS; and, the practice-based learning topics discussed at each OSCaRS. Attempts to establish a team of NHS/SPC facilitators to lead OSCaRS highlights that end of life care education in care homes does not clearly fall within the contractual remit of either group or risks being missed due to more pressing priorities.

Several culture theories, which explain the formation, embedment, and propagation of organizational culture, suggest that certain organizational culture practices of an executing organization may enable sustainable outcomes in project manufacturing. However, practices that support sustainability may not support project delivery, and vice versa. We explore the effects of organizational culture practices and structural complexity on the ability of manufacturing projects to optimize both sustainability and project delivery. We use data envelopment analysis to calculate a sustainability-delivery quotient—a measure of each organization's ability to optimize both sustainability and project delivery outcomes—for 186 projects conducted in the U.K. By conducting generalized linear modeling and censored regression of the sustainability-delivery quotient, we estimate the effects of the GLOBE organizational culture dimensions, principal components of culture dimensions, and project structural complexity indicators. Results indicate a noteworthy gap between the delivery of projects and their sustainability performance, which is worse. Both institutional and in-group collectivism may support the optimization of each. However, neither the principal components of culture dimensions nor structural complexity indicators are likely to be significant. We discuss the managerial implications.

Technology transfer offices (TTOs) play a key role in helping universities commercialize research and distribute knowledge. Nonetheless, there remains an incomplete understanding of the communication, which takes place between academics, industry partners, and TTO staff. The aim of this article is to examine, with the use of sense-making theory, strategies used by TTO employees as they work with academics and industry partners to commercialize intellectual property. In order to achieve this aim, an ethnographic exploratory case study was undertaken at a university TTO. The collected information then became the basis for qualitative interviews with TTO staff from 13 universities in Scotland. The study contributes to the sense-making theory by explaining how, during the commercialization conversations, TTO employees can deliberately interrupt the sense-making process through “dumbing down.” Our research introduces the TTO employee as a mediator and examines the role of the TTO staff in facilitating the sense-making process. The findings illustrate how someone who is not an expert in the field can add to the sense-making process. The study suggests that TTO employees intentionally engage in a “dumbing down process” to make complicated conversations easy to understand.

In the era of Big Data, deep learning techniques provide intelligent solutions for various problems in real-life scenarios. However, deep neural networks depend on large-scale datasets including sensitive data, which causes the potential risk of privacy leakage. In addition, various constantly evolving attack methods are also threatening the data security in deep learning models. Protecting data privacy effectively at a lower cost has become an urgent challenge. This paper proposes an Adaptive Feature Relevance Region Segmentation (AFRRS) mechanism to provide differential privacy preservation. The core idea is to divide the input features into different regions with different relevance according to the relevance between input features and the model output. Less noise is intentionally injected into the region with stronger relevance, and more noise is injected into the regions with weaker relevance. Furthermore, we perturb loss functions by injecting noise into the polynomial coefficients of the expansion of the objective function to protect the privacy of data labels. Theoretical analysis and experiments have shown that the proposed AFRRS mechanism can not only provide strong privacy preservation for the deep learning model, but also maintain the good utility of the model under a given moderate privacy budget compared with existing methods.