Practical Conclusions Research Articles

Treatment methods for oesophageal strictures in paediatric patients with epidermolysis bullosa: a systematic review

BackgroundEpidermolysis bullosa (EB) is a collection of rare, inherited disorders that require treatment in specialised centres by multidisciplinary teams knowledgeable about the unique features and challenges of EB manifestations and...

The Effect of Cultural Norms on Group Decision-Making in Japanese Corporations

This paper explores the impact of cultural norms, particularly collectivism and social harmony, on group decision-making practices in Japanese corporations. Focusing on consensus-building mechanisms such as nemawashi and ringi-sho, the study examines how these practices foster inclusivity, mitigate conflict, and promote long-term organizational stability. It also highlights the challenges posed by slow decision-making processes and the risk of groupthink, which can stifle innovation and agility in a fast-paced global market. While consensus-building leads to more widely supported and risk-averse decisions, the paper suggests that balancing these traditional practices with more agile decision-making models is essential for Japanese corporations to remain competitive. The findings provide valuable insights into how Japanese firms might integrate global business practices while preserving their cultural identity.

Advancing Value-Based Academic-Clinical Partnership Evaluation in Physical Therapy Education: Multiattribute Utility Analysis as a Contextual Methodological Approach.

There is a need to investigate the application of systematic, scholarly methods to develop and implement a sustainable, flexible process for evaluating academic-clinical partnership effectiveness. The purpose of this study was to explore the potential for multiattribute utility analysis (MAUA) methodology to be applied in the context of academic-clinical partnership evaluation. Persistent systemic challenges related to academic-clinical partnership volume and quality require intentional strategies addressing the inherent complexities of the clinical learning environment and contextual differences between academic institutions. Multiattribute utility analysis appears to be a viable existing methodological framework based on its successful application in a wide variety of fields. Directors and Co-Directors of Clinical Education in accredited Doctor of Physical Therapy programs. The MAUA methodological framework was used to identify and quantify weighted priorities in factors contributing to partnership effectiveness as perceived by academic-clinical education programs across the United States. Survey participants were invited to share their perspectives regarding priority characteristics and assessment approaches to advance value-based partnership evaluation in physical therapy education. The products resulting from this contemporary analysis, coupled with the previous applied MAUA simulation, offer a methodology and flexible framework that may be utilized by academic-clinical education faculty to perform a value-based partnership evaluation and make decisions within the context of their institution. Clinical educator survey results also provide a new depth of insight regarding trends in the collective degree of attribute prioritization and the complexity and intersectionality across partnership priorities. The proposed processes may allow academic programs to narrow the large number of possible partnership criteria to a manageable subset, offering a way forward for those interested in pursuing a quantitative method for practical decision making. The ability to assess partnership quality using an evidence-based framework such as MAUA may allow partners to maintain, enhance, or discontinue partnerships based on a shared understanding of attribute alignment, rather than reactively coming together in practice to address challenges needing resolution.

A multi-objective optimization decision-making methodology for fostering synergies in the water-energy-food nexus

Current decision-making methods within the water-energy-food nexus (WEFN) encounter challenges in practicality, portability, scalability, and accuracy. Optimization methods, integrating site-specific data, offer promise for achieving desired outcomes and enhancing practical decision implementation within WEFN systems. However, these methods still struggle with solving multi-objective and multi-constraint problems, poor performance, and decision-making difficulties. This study developed an optimization method for WEFN systems, which integrates an evolutionary algorithm, swarm intelligence algorithm, multistage evolutionary algorithm, and post-optimization theories to address these issues. Performance results demonstrated that the proposed algorithm outperformed traditional metaheuristic optimization algorithms. Specifically, it excelled in tackling high-dimensional constrained problems, surpassing the classical NSGA series algorithms with a 1.34-fold improvement in the comprehensive performance metric HV. Subsequently, this algorithm combined with knee point post-optimization theory was applied to a typical arid region known for food and energy production. Compared with the business-as-usual scenario, the optimized schemes enhance agricultural benefits, saving 13.3 billion m3 of water over the entire planning period. Meanwhile, sustainable energy implementation would yield potential carbon emission reduction benefits of around 2.8 billion CNY. In summary, the proposed method would successfully provide a paradigm for the synergetic decision-making of WEFN systems.

4차 산업혁명 시대의 블록체인 기반 전자선하증권 활용에 관한 실증연구

Purpose: This paper evaluates the factors influencing the adoption and use of blockchain’s electronic bill of lading (e-B/L) in the trade and logistics industry, assessing its practical acceptability and suggesting future research directions. Research design, data, and methodology: This paper developed a research model based on prior studies and technology acceptance models, and used survey data from Korean trade and logistics firms to identify factors influencing e-B/L adoption. Results: Availability and suitability of a blockchain e-B/L influences its perceived ease of use positively, while security and suitability influences perceived usefulness positively. Both perceived ease of use and perceived usefulness had a positive impact on the intention to use. Conclusions: This paper provides practitioners and researchers in the field of trade logistics with in-depth insights into the key factors influencing the adoption and utilization of a blockchain e-B/L, and provides a useful basis for future research and practical decisions.

Baseline Survey of Plant Species Along Salang Road in Afghanistan

The Salang Road, a critical transportation corridor, serves as a vital link connecting the northern and southern parts of Afghanistan. In response to the government's decision to upgrade this road, assessing and documenting the plant species in the region is crucial. This study was conducted to catalog the plant species along the Salang Road, aiming to establish a comprehensive understanding of the area's botanical diversity. Plants were recorded using the quadrate sampling method at 35 sampling points. A transect line was set up at each sampling point, 5 quadrats were established along each line, and the occurrence of plants within the quadrat frame was recorded. Quadrat sizes, determined using the minimal area method, were 10×10 m for trees, 2×5 m for shrubs, and 1 m2 for herbs. Plants were identified with the help of literature and by comparing with the deposited specimen of Kabul University Faculty of Sciences Herbarium (KUFS). Data were analyzed using Microsoft Excel. 135 diverse species, including trees, shrubs, and herbs, representing various ecological niches were documented. These species belong to 46 plant families, and the most abundant ones were Asteraceae, Apiaceae, Rosaceae, Lamiaceae, Fabaceae, and Polygonaceae. The survey additionally examined road construction's impact on plant species' distribution and diversity. The survey provides valuable insights into the Salang corridor area's botanical diversity and ecological significance, serving as a foundational dataset for future environmental conservation and land management efforts. The information obtained from this study can support qualified decision-making and sustainable development practices in the region.

Polynomial-SHAP analysis of liver disease markers for capturing of complex feature interactions in machine learning models

Liver disease diagnosis is pivotal for effective patient management, and machine learning techniques have shown promise in this domain. In this study, we investigate the impact of Polynomial-SHapley Additive exPlanations analysis on enhancing the performance and interpretability of machine learning models for liver disease classification. Our results demonstrate significant improvements in accuracy, precision, recall, F1_score, and Matthews correlation coefficient across various algorithms when polynomial- SHapley Additive exPlanations analysis is applied. Specifically, the Light Gradient Boosting Machine model achieves exceptional performance with 100 % accuracy in both scenarios. Furthermore, by comparing the results obtained with and without the approach, we observe substantial differences in the performance, highlighting the importance of incorporating Polynomial-SHapley Additive exPlanations analysis for improved model performance. The Polynomial features and SHapley Additive exPlanations values also enhance the interpretability of machine learning models by capturing complex feature interactions, enabling users to gain deeper insights into the underlying mechanisms driving the diagnosis. Moreover, data rebalancing using Synthetic Minority Over-sampling Technique and parameter tuning were employed to optimize the performance of the models. These findings underscore the significance of employing this analytical approach in machine-learning-based diagnostic systems for liver diseases, offering superior performance and enhanced interpretability for informed decision-making in clinical practice.

The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case study.

Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. To improve this, we conducted a quality improvement project, CONtext. CONtext attempts to accomplish this by: (1) Integrating the patient's context into shared decision-making during consultation with the medical oncologist; (2) Actively involving the GP and case manager (a specialized oncology nurse), who often have knowledge about the patient's context, and; (3) Giving the person with advanced cancer a time-out period of up to 2 weeks to consider and discuss treatment options with others, including close family and friends. To explore how persons with advanced cancer and their involved professionals experienced shared decision-making after the introduction of CONtext. A qualitative embedded multiple-case study using in-depth interviews analysed with inductive content analysis. A purposive sample of 14 cases, each case consisting of a patient with advanced cancer and ideally their medical oncologist, case manager, and GP. Four themes were identified: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase. The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making. This undermines integrating individual context into decision-making, a critical aspect of the palliative care continuum.

Investigating organised human trafficking crimes: case studies of police investigations in England

ABSTRACT Investigating organised human trafficking criminality is neither easy nor straightforward. Among the complexity is the need to balance and secure multiple, and often competing, investigative goals. Using case studies of actual human trafficking investigations in England, the present exploratory study provides insights into the tensions between safeguarding victims while also (at the same time) building up evidence against those who exploit them in order to secure a successful prosecution. Findings reveal that factors associated with the assessed level of risk of victims, the intelligence available at the start of the investigation and police resources (balanced with opportunities and risk to secure the investigative goals) influence the investigative approach followed and strategies implemented, particularly those aiming to engage with victims. The exploratory findings illustrate the importance of intelligence in risk assessment and decision-making processes during police operations, but also the need to conduct yet further research on risk assessment within the context of human trafficking investigations to inform policy and decision-making policing practices.

Identifying risk factors of dose reduction or treatment discontinuation due to fatigue or gastrointestinal symptoms in patients receiving lenvatinib treatment for hepatocellular carcinoma

Introduction Lenvatinib (LEN) is the standard treatment for hepatocellular carcinoma (HCC). In clinical practice, gastrointestinal (GI) symptoms such as fatigue and loss of appetite often lead to dose reduction or treatment discontinuation. This study aimed to identify the predictors of patients who will experience dose reduction or treatment discontinuation owing to fatigue or GI symptoms during LEN treatment for HCC. Methods We retrospectively identified 99 patients who received LEN at the Ogaki Municipal Hospital (Ogaki, Japan) between April 2018 and December 2023. To investigate the risk factors for treatment discontinuation or dose reduction due to fatigue or GI symptoms during LEN administration, patients were divided into two groups based on whether treatment discontinuation or dose reduction occurred due to fatigue or GI symptoms during LEN administration (37 patients) or not (62 patients). We compared baseline characteristics between the two groups. Results Multivariate analysis revealed that body weight (odds ratio 4.310, 95% confidence interval 1.380–13.500; P = 0.002) was an independent risk factor that significantly contributed to treatment discontinuation or dose reduction owing to fatigue or GI symptoms during LEN administration. The cut-off value calculated using the body weight curve was 55.0 kg. Using this cutoff value, the sensitivity and specificity of body weight to detect treatment discontinuation or dose reduction due to fatigue or GI symptoms during LEN administration were 83.9% and 56.8%, respectively. Conclusion In clinical practice, patients weighing less than 55 kg who start with a full dose will likely experience weight loss or discontinuation during treatment.

Semaglutide for the management of diabesity: The real-world experience.

Diabesity (diabetes as a consequence of obesity) has emerged as a huge healthcare challenge across the globe due to the obesity pandemic. Judicious use of antidiabetic medications including semaglutide is important for optimal management of diabesity as proven by multiple randomized controlled trials. However, more real-world data is needed to further improve the clinical practice. To study the real-world benefits and side effects of using semaglutide to manage patients with diabesity. We evaluated the efficacy and safety of semaglutide use in managing patients with diabesity in a large academic hospital in the United States. Several parameters were analyzed including demographic information, the data on improvement of glycated hemoglobin (HbA1c), body weight reduction and insulin dose adjustments at 6 and 12 months, as well as at the latest follow up period. The data was obtained from the electronic patient records between January 2019 to May 2023. 106 patients (56 males) with type 2 diabetes mellitus (T2DM), mean age 60.8 ± 11.2 years, mean durations of T2DM 12.4 ± 7.2 years and mean semaglutide treatment for 2.6 ± 1.1 years were included. Semaglutide treatment was associated with significant improvement in diabesity outcomes such as mean weight reductions from baseline 110.4 ± 24.6 kg to 99.9 ± 24.9 kg at 12 months and 96.8 ± 22.9 kg at latest follow up and HbA1c improvement from baseline of 82 ± 21 mmol/mol to 67 ± 20 at 12 months and 71 ± 23 mmol/mol at the latest follow up. An insulin dose reduction from mean baseline of 95 ± 74 units to 76.5 ± 56.2 units was also observed at the latest follow up. Side effects were mild and mainly gastrointestinal like bloating and nausea improving with prolonged use of semaglutide. Semaglutide treatment is associated with significant improvement in diabesity outcomes such as reduction in body weight, HbA1c and insulin doses without major adverse effects. Reviews of largescale real-world data are expected to inform better clinical practice decision making to improve the care of patients with diabesity.

Implementation of Postpartum Nutritional Interventions in Healthcare, Community and eHealth: A Systematic Review.

The efficacy of interventions targeting lifestyle habits, particularly dietary habits, among postpartum women is well established. However, whether these results can be translated into tangible changes in the care and services provided to this population remains unclear. Therefore, the aim is to examine the implementation outcomes of postpartum nutritional interventions delivered in healthcare, community, or eHealth settings. A search was conducted in the MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library databases in July 2024, to identify all relevant studies. Included studies had to report at least 1 of the 8 implementation outcomesstudied: acceptability, adoption, appropriateness, implementation cost, feasibility, fidelity, penetration, and sustainability. Study selection and data extraction were performed by two independent reviewers. Descriptive analysis of reported outcomes was performed. CRD42022351411. Of the 8907 unique studies identified, 26 interventions (24 publications) were included.There was a great heterogeneity among interventions studied and implementation outcomes reported. Acceptability, feasibility, and fidelity were the most studied implementation outcomes. Overall, postpartum nutritional interventions were found to be acceptable and useful, but improvements were suggested by participants, such as more frequent contacts and longer programs. Recruitment, retention, participation, and penetration rates widely varied across studies. Challenges hindering the delivery of nutritional interventions were reported by participants, such as lack of time and the presence of medical conditions following delivery. CONCLUSIONSFOR PRACTICE: This review demonstrates the potential forthe delivery and implementation of nutritional interventions in real-world settings during the postpartum period.

Knowledge and Practices of Dysmenorrhea and its Effect of Life Among Female Medical Students in Jalalabad

Dysmenorrhea or painful menstruation is defined as a severe, painful, cramping sensation in the lower abdomen that is often accompanied by other symptoms, such as sweating. headaches, nausea, vomiting, diarrhea, and tremulousness, all occurring just before or during the menses. This study aimed to assess the Knowledge and Practices of dysmenorrhea and its effect of life among female medical students in Jalalabad. Materials and Methods: A descriptive cross-sectional study was done through online Google forms for a period of 3 months from January to March 202 A structured questionnaire was administered to 173 randomly selected Undergraduate Medical students. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0. Objective: To gain more insight should think about dysmenorrhea is, if not it's can have alarming consequences sexual life of female. To gain knowledge about dysmenorrhea. To study and practice about dysmenorrhea increase the awareness of immature hygiene and self medication. Results: In total,173 medical students from 1st year and 2nd year were selected for this study where age range was 17-22 years with mean age of (20±1). Majority of 74% of the participants were found in to have good knowledge about dysmenorrhea. Majority of students who has good knowledge and also had good practices where as students with poor knowledge has poor practice (p value 0.021) Conclusion: Majority students concluded that dysmenorrhea is a very common problem of female students, and they experience a number of physical and emotional symptoms associated with dysmenorrhea. Mostly students are silently suffer the pain by dysmenorrhea and discomfort associated with it due to lack of knowledge about dysmenorrhea also affects their academic performance. However, their practices were found to be a matter of concern. An educational intervention can be introduced to bring about changes their life style regarding practices about dysmenorrhea among students.

Role, function, and expectations of research funding committees: Perspectives from committee members

Research funding committees play an integral role in the research funding process, consisting of a range of skills, knowledge, and expertise (e.g., professional, and public contributors). Although there is some evidence that has explored the efficiency and effectiveness of funding committees in terms of the funding process, there is a lack of published evidence about the purpose, role, and function of funding committees, from the perspective of committee members. A subset of survey data from a cohort of six National Institute for Health and Care Research (NIHR) research programmes, exploring the purpose of a funding committee, and the expectations and role of a funding committee member between October 2020 to December 2021. All committee members were eligible to participate in the survey. Using an inductive approach, 50 completed responses (22.5% response rate) were analysed, focusing on the role of a funding committee member and the functions of a funding committee. Participants highlighted seven key areas for the purpose of a funding committee: prioritising and recommending what research to fund (n=36) and assessment of quality (n=24) being the most common responses. Four areas were considered important to the expectations and role of funding committee members, with reviewing, critically appraising, and discussing applications (n=44); and being fair, objective, and unbiased (n=27) being the most common responses. The findings offer a unique insight into committee members’ expectations about the role, purpose and function of a funding committee and their contribution to the funding recommendation process. There was high agreement that the purpose and role of committees and their members was to offer expert advice to make fair, impartial decisions on which research should be prioritised. Exploring the purpose, role, and function of funding committees has relevance and importance for funding organisations seeking to enhance and optimise the decision-making practice of funding committees.

Based on Medicine, The Now and Future of Large Language Models.

This review explores the potential applications of large language models (LLMs) such as ChatGPT, GPT-3.5, and GPT-4 in the medical field, aiming to encourage their prudent use, provide professional support, and develop accessible medical AI tools that adhere to healthcare standards. This paper examines the impact of technologies such as OpenAI's Generative Pre-trained Transformers (GPT) series, including GPT-3.5 and GPT-4, and other large language models (LLMs) in medical education, scientific research, clinical practice, and nursing. Specifically, it includes supporting curriculum design, acting as personalized learning assistants, creating standardized simulated patient scenarios in education; assisting with writing papers, data analysis, and optimizing experimental designs in scientific research; aiding in medical imaging analysis, decision-making, patient education, and communication in clinical practice; and reducing repetitive tasks, promoting personalized care and self-care, providing psychological support, and enhancing management efficiency in nursing. LLMs, including ChatGPT, have demonstrated significant potential and effectiveness in the aforementioned areas, yet their deployment in healthcare settings is fraught with ethical complexities, potential lack of empathy, and risks of biased responses. Despite these challenges, significant medical advancements can be expected through the proper use of LLMs and appropriate policy guidance. Future research should focus on overcoming these barriers to ensure the effective and ethical application of LLMs in the medical field.

The Role of Participatory Management in Improving Teacher Performance and Student Achievement

This study explores the role of participatory management in fostering collaborative school cultures and its impact on improving teacher performance and student achievement. Collaborative school cultures, characterized by shared decision-making and collective responsibility, are essential for creating environments conducive to professional growth and enhanced learning outcomes. Participatory management, which emphasizes the involvement of teachers and staff in decision-making processes, is a key mechanism for cultivating such cultures. This research examines how participatory management practices influence teacher motivation, job satisfaction, and professional development, ultimately contributing to improved performance in the classroom. Furthermore, it investigates the connection between collaborative cultures and student achievement, exploring how teacher collaboration, professional learning communities, and joint problem-solving enhance instructional quality and student outcomes. Using a mixed-methods approach, data were collected through surveys, interviews, and classroom observations in a sample of schools implementing participatory management strategies. The findings reveal that schools with strong collaborative cultures experience higher levels of teacher engagement, professional commitment, and instructional innovation, which positively impact student academic performance. This study underscores the importance of participatory management as a strategic approach to building collaborative school cultures that support both teacher and student success. The implications of these findings suggest that educational leaders should prioritize inclusive decision-making practices and foster environments where teachers can collaborate, share expertise, and work towards common educational goals. The study concludes with recommendations for policymakers and school administrators to adopt participatory management frameworks as a means to improve overall school performance and create sustainable, high-achieving learning communities.

Naturalistic Decision-Making in Intentional Communities: Insights from Youth, Disabled Persons, and Children on Achieving United Nations Sustainable Development Goals for Equality, Peace, and Justice

The seventeen UN SDGs address critical global challenges. Among them, Goal 10—reducing inequality—and Goal 16—promoting peace, justice, and strong institutions—serve as foundational pillars in democracies, enabling the achievement of all other goals. Children, youth, and persons with disabilities are among those who stand to benefit most from these goals. Insights from the naturalistic decision-making practices of intentional communities, often framed as Contenders or Deviants in social construction theory, could be instrumental in advancing these objectives. This study examines the decision-making practices of three intentional communities representing youth, disabled persons, and children, each fostering a different version of equitable, peaceful, and justice-oriented governance to build strong institutions. The communities studied include a self-producing Korean popular music (K-pop) group representing youth Contenders, a mental health-supporting annual English conference for individuals on the autistic spectrum, and a Canadian alternative education, self-directed public senior elementary and secondary school—both considered Deviant societies in social construction theory, one focusing on disabled persons and the other on children. The historical method assesses the effectiveness of these communities’ preferred practices in achieving Goals 10 and 16. The results offer actionable insights for enhancing equality, peace, and justice while strengthening institutions to realize the full range of UN SDGs in democratic societies.

Factors affecting teachers’ practices of inclusive instructional strategies in teaching students with visual impairments in schools of Addis Ababa, Ethiopia

This study aimed to investigate factors affecting teachers’ practice of inclusive instructional strategies in teaching students with visual impairments (SVI) in regular schools of Addis Ababa. The study employed a quantitative methodology, with cross-sectional survey design. Data was gathered, using a survey questionnaire, from 421 teachers from 19 primary and 15 secondary schools. A hierarchical multiple linear regression analysis was used to examine the influence of knowledge, self-efficacy & attitudes on the practice of inclusive instruction strategies in teaching SVI in regular schools. The outcomes indicated that teachers had the required knowledge about inclusive instruction strategies. Conversely, a moderate level of teachers’ self-efficacy (M=3.00, SD=1.01) in teaching SVI and favorable attitudes towards inclusion of SVI (M=3.92, SD=0.64) were found in this study. Similarly, this study demonstrated a moderate level of teachers’ practice of inclusive instruction strategies in teaching SVI (M=2.69 out of 4, SD=0.83). Teachers’ self-efficacy and attitude were found to be significant predictors of practice, while knowledge was not a significant predictor. Self-efficacy accounted for 25.5% of the variance in practice, which was the most significant predictor of practice. All the independent variables together explained 31.4% of the variance in practice. Conclusion and possible implications for practice were indicated.

Understanding the Use of Practitioner Discretion in Screening ADR Services for Suitability: Results of a Pilot Study

Processes categorised under the banner of “ADR”, particularly mediation and conciliation, are increasingly relied upon by parties in dispute, both inside and outside of the formal justice system. Given that an ADR process may not always be appropriate for a given dispute, legislation often affords ADR practitioners discretion as to whether to offer (or continue offering) an ADR process. However, there is limited contemporary empirical evidence exploring how practitioners are making such decisions in practice. To build on existing empirical research, I conducted a pilot study of ADR practitioners in the form of a survey (n = 12) in the lead up to and during the National Mediation Conference 2021. The pilot study had several limitations, resulting on a majority of respondents (n=10) being Family Dispute Resolution Practitioners (‘FDRPs’). As such, the results of the pilot study have been limited to a discussion in the context of family law only. The pilot study asked practitioners a series of multiple-choice questions, with the opportunity to provide free-text responses, and asked the practitioners demographic and characteristic questions, before asking practitioners to identify factors which influence when and how ADR is offered or ceased to be offered to parties in a dispute. The results of the pilot study supports existing evidence that FDRPs can have very different approaches to how they use their discretion to offer dispute resolution, in the context of their requirements to assess suitability for dispute resolution under the Family Law Act 1975 (Cth) and associated regulations. I discuss the possible impacts of this potential inconsistency in practitioner discretion on parties and the legal system more generally and make suggestions for further research.

Rational decision-making in practice.

Reviewed by Zoe Belshaw, a small animal internal medicine diplomate and evidence-based veterinary medicine consultant.