High-level Outcomes Research Articles

Elevated maternal serum bile acids level, hypertensive disorders of pregnancy and adverse fetal outcomes: a cohort study of 117,789 pregnant women in China

BackgroundElevated maternal serum total bile acids (sTBA) level during pregnancy was associated with adverse fetal outcomes. Women with elevated sTBA could complicate with hepatic dysfunction or vascular disorders (hypertensive disorders of pregnancy, HDP), which aggravated adverse fetal outcomes. However, the relationships among sTBA level, hepatic dysfunction, HDP and adverse fetal outcomes were still illusive. ObjectiveWe aimed to explore whether hepatic dysfunction or vascular disorders (HDP) mediated the associations between elevated sTBA level and adverse fetal outcomes. MethodsA large retrospective cohort study encompassing 117,789 Chinese pregnant women with singleton delivery between Jan 2014 and Dec 2022 was conducted. Causal mediation analysis was applied to assess the mediating role of hepatic dysfunction (alanine transaminase > 40 U/L) or HDP in explaining the relationship between high maternal sTBA level (≥10 μmol/L) and adverse fetal outcomes, including low birth weight (LBW), small for gestational age (SGA), and preterm birth (PTB). ResultssTBA level were positively associated with LBW (adjusted odds ratio (aOR) = 1.40; [95 % confidence interval (CI): 1.24–1.59]), SGA (aOR=1.31; [95 % CI: 1.18–1.46]), and PTB (aOR=1.27; [95 % CI: 1.15–1.41]), respectively. The estimated proportions of the total associations mediated by HDP were 47 % [95 % CI: 31 %–63 %] for LBW, 24 % [95 % CI: 13 %–35 %] for SGA, and 34 % [95 % CI: 19 %–49 %] for PTB, excepting the direct effects of high sTBA level. The contribution of hepatic dysfunction as a mediator was weaker on the association between high sTBA level on fetal outcomes, as the proportions mediated and 95 % CI were 16 % [4 %–29 %], 4 % [-6%–14 %], 32 % [15 %–50 %] for LBW, SGA, and PTB, respectively. Moreover, the mediating effect of hepatic dysfunction was nearly eliminated after excluding cases of HDP in the sensitivity analysis. ConclusionsThe substantial mediating effects through HDP highlighted its significant role in adverse fetal outcomes associated with elevated sTBA level. The findings also provoked new insights into understanding the mechanism and developing clinical management strategies (i.e. vascular protection) for adverse fetal outcomes associated with elevated sTBA level.

Does a service provide safe, effective rehabilitation? An evaluation method for providers and purchasers

Background Independent organisations monitor the safety and governance of clinical services but do not assess specialist expertise. Peer review can assess service capability but is resource-intense and infeasible. The problem How can you ensure a service provides safe, effective rehabilitation? You ask them to provide data as evidence that they can be trusted to do so. This article suggests a structured approach to providing data on entrustability. An analogy How is the specialist skill of a doctor in training established? They provide evidence about high-level outcomes (capabilities in practice) related to their speciality. An educational supervisor assesses whether they can be trusted to perform safely and effectively without supervision. The capabilities in practice define their expertise. The solution A service can use seven high-level rehabilitation service capabilities, based on the clinical capabilities associated with medical training, with observable indicative descriptors, to collect evidence of their rehabilitation approach. A service must also select four to eight high-level competencies indicating they can rehabilitate their patient caseload safely and effectively. These competencies also need indicative descriptors as evidence of their performance in the service; 11 examples are given. Capabilities. The seven rehabilitation capabilities are: using the biopsychosocial model, having a multi-professional team, making a person-centred rehabilitation plan, working collaboratively across all boundaries, tailoring treatments to the patient's needs, ensuring staff have specific competencies required for their caseload, and acknowledging and managing uncertainty and complexity. Conclusion. Service providers could use this structured approach to develop and provide users with evidence of their rehabilitation expertise.

609 Addressing Fears of Prospective International Medical Graduates (IMGs) Joining the NHS: An Online Course to Improve Equality, Diversity, and Inclusion in the NHS

Abstract Aim The aim of this project was to identify the biggest fears of IMGs regarding the NHS and address those fears via a locally designed online course, ultimately promoting equality, diversity, and inclusion in the NHS. Method The course was created after consultation with IMGs working in the NHS, and the content was based on the Higher-Level Outcomes (HLOs) of the Foundation Programme. The course was divided into 4 sessions, delivered weekly. Each session had an initial presentation followed by an interactive question answer segment, had 3 faculty personnel, and lasted 2 hours. A good laptop with internet connection was all that was needed for the course. Results In total, 699 participants registered for the course. About 92% of them had never attended similar courses before, and about 73% has never worked in the NHS. Lack of knowledge of the NHS system (32%) and medico-legal issues (25%) were the biggest fears of prospective IMGs regarding working in the NHS. Post course feedback revealed that their confidence about working in the NHS increased by 30% after this course. Their confidence in working on-calls and building portfolio has also increased after the course by almost 26%. 78% participants said their biggest fear was addressed by this course. The question answer segment was rated helpful by 92% of participants. Conclusions This study illustrated that we could promote equality, diversity, and inclusion in the NHS by addressing the biggest fear of IMGs of not knowing the NHS system, using low resource, interactive online courses.

P-516 Minimizing mosaicism: impact of trophectoderm (TE) biopsy specimen size on mosaic blastocysts in preimplantation genetic testing for aneuploidy (PGT-A)

Abstract Study question Is the size of TE biopsy specimens related to the chromosomal status of the blastocysts in PGT-A? Summary answer Smaller biopsy specimens are associated with higher proportion and altered composition of mosaic blastocysts in PGT-A. What is known already Concordance between TE biopsy and inner cell mass or whole embryos is influenced by mosaicism type, degree, biopsy location, number of cells biopsied, and cell loading. Particularly, mosaic embryos and those with structural rearrangements have a higher level of inconsistency. Recent studies have demonstrated the potential reclassification of chaotic embryos as euploid, leading to successful live births. This study aimed to investigate the potential influence of TE biopsy specimen size on the chromosomal status of blastocysts undergoing PGT-A. Study design, size, duration This retrospective study, conducted from October, 2023, to January, 2024, included 246 blastocysts from patients undergoing TE biopsy and PGT-A at the blastocyst stage on days 5, 6, or 7. Next-generation sequencing (NGS) was used to obtain PGT-A results, categorizing blastocysts into euploid, aneuploid, and mosaic based on their genetic composition. Participants/materials, setting, methods The biopsy specimen area was measured using the Image J program. Mosaic blastocysts were categorized into either a chaotic mosaic group or another group, which included blastocysts with fewer than three chromosomal aneuploidies and segmental mosaicism. Further analysis was conducted by classifying blastocysts into high-level mosaic (>30% aneuploidy) and low-level mosaic (≤30% aneuploidy) groups. Group differences were analyzed using t-tests and chi-square, with a significance threshold set at p<0.05. Main results and the role of chance In the analysis of expanded mosaic blastocysts, the chaotic mosaic group had smaller biopsy specimens than those in the comparison group (p<0.05). The high-level mosaic group also had significantly smaller biopsy specimens than the low-level mosaic group (p<0.05). When categorizing the biopsied sample size into two groups—below 1350 µM2 (n = 98) and above 1500 µM2 (n = 97)—the rates of mosaic embryos were 37% (36/98) and 30% (29/97), respectively, showing a numerical difference without statistical significance. These findings suggest a correlation between the size of biopsy specimens and the chromosomal status of mosaic blastocysts, particularly indicating that a smaller sample size is associated with an elevated chance of mosaic embryos showing chaotic or high-level mosaic characteristics. Limitations, reasons for caution The biopsy specimens were photographed, and their areas were measured using the Image J program, lacking a comprehensive representation of the three-dimensional sample morphology. This constraint could potentially affect the accuracy and in-depth understanding of the spatial characteristics of the biopsy specimens. Wider implications of the findings The study emphasizes the crucial role of optimizing biopsy specimen size in PGT-A. The identified correlation with the chromosomal status in mosaic embryos, especially the association with chaotic or high-level mosaic embryo outcomes in smaller samples, highlights the need for careful size considerations. Trial registration number not applicable

The prognostic value of combined uric acid and neutrophil-to-lymphocyte ratio in acute ischemic stroke patients treated with intravenous thrombolysis

BackgroundSerum uric acid (UA) and the neutrophil-to-lymphocyte ratio (NLR) have been reported to be associated with outcomes in acute ischemic stroke (AIS). However, whether UA is related to the prognosis of AIS patients undergoing intravenous thrombolysis (IVT) remains inconclusive. We sought to explore the combined effect of UA and NLR on the prognosis of AIS treated with IVT.MethodsA total of 555 AIS patients receiving IVT treatment were enrolled. Patients were categorized into four groups according to the levels of UA and NLR: LNNU (low NLR and normal UA), LNHU (low NLR and high UA), HNNU (high NLR and normal UA), and HNHU (high NLR and high UA). Multivariable logistic regression analysis was used to evaluate the value of serum UA level and NLR in predicting prognosis. The primary outcomes were major disability (modified Rankin scale (mRS) score 3–5) and death within 3 months.ResultsAfter multivariate adjustment, a high NLR (≥ 3.94) increased the risk of 3-month death or major disability (OR, 2.23; 95% CI, 1.42 to 3.55, p < 0.001). However, there was no statistically significant association between a high UA level (≥ 313.00 µmol/L) and clinical outcome. HNHU was associated with a 5.09-fold increase in the risk of death (OR, 5.09; 95% CI, 1.31–19.83; P value = 0.019) and a 1.98-fold increase in the risk of major disability (OR, 1.98; 95% CI 1.07–3.68; P value = 0.030) in comparison to LNNU.ConclusionsHigh serum UA levels combined with high NLR were independently associated with 3-month death and major disability in AIS patients after IVT.

What is the impact of simulation-based training for paediatric procedures on patient outcomes, cost and latent safety threats?

Simulation-based training (SBT) provides a safe space for medical trainees to experience realistic scenarios. SBT has been found to improve trainee performance in paediatric procedures. However, limited evidence exists regarding its effects on higher-level outcomes. This scoping review aims to identify studies that investigate the impact of SBT for procedural skills on T3 (patient outcomes) and T4 level outcomes (latent safety threats [LSTs], and hospital level costs) in paediatrics. Full-text articles were included if they focused on medical trainees, used simulation training for paediatric procedures and reported T3/T4 level outcomes. Six databases were searched from January 2011 to September 2022. Search strategies were developed with the assistance of a librarian. Three independent reviewers performed pilot screenings before title/abstract and full-text screenings. A data extraction sheet was created to gather information on interventions, outcomes, research design, and other study characteristics. After title/abstract screening of 4,076 sources, 50 were included for full-text review, with 15 articles selected for data extraction. Four were randomised control studies (RCTs), fourteen focused on T3 level outcomes including mortality rates, and one measured LSTs. There were no studies reporting cost-related data. Three of the studies focused on bag-and-mask ventilation, and eight mentioned the use of mannequins. We highlight the potential effectiveness of simulation-based training of paediatric procedural skills in improving patient outcomes, such as reduced mortality rates and incidence of illness/injury. Though the quality of research designs was low, researchers used different simulation modalities and outcome measures and showed a positive impact of SBT(e.g., decreased mortality rates).

Sociotechnical micro-foundations for digital transformation

ABSTRACT This paper introduces sociotechnical micro-foundations for digital transformation. The concept highlights how the macro-level capabilities that enable organisations to conduct digital transformation originate from competent individuals, digital resources, and their interactions. In developing the sociotechnical micro-foundation concept, we explored the sociotechnical interactions that facilitated the digital transformation of a Nordic hotel chain and how macro- and micro-level interactions are linked throughout the transformation process. Adopting a sociotechnical perspective helped us shed light on how the synergistic effect of individuals and digital resources interacting in digital transformation enables higher-level outcomes. By developing and theorising sociotechnical micro-foundations, we offer three contributions. First, we propose a concept at the micro level, the basic building block of digital transformation, that ensures the joint consideration of social and technical elements, as well as how to combine them. By showing the interaction between the macro and micro levels, we extend the current knowledge of how organisations develop macro-level capabilities for digital transformation. Second, we contribute to the micro-foundation literature, a body of knowledge that lacks a technical dimension, by demonstrating how interactions between individuals and digital resources are key to understanding what happens at the micro level. Third, we offer practical implications for managers.

Association of Admission CRP Level with Short Term Outcome in Patients with Acute Ischemic Stroke

Acute ischemic stroke is very common in Bangladesh and one of the most common causes of physical disability and death. This study was performed to determine the prognostic value of CRP measured in the very early phase of ischemic stroke for short term functional outcome of patients with acute ischemic stroke. This observational study was carried out in the departments of Medicine and Neurology of Faridpur Medical College Hospital, Faridpur from July 2012 to December 2012. Total 100 patients of acute ischemic stroke were recruited in this study. Blood sample was collected for CRP level during the time of admission. In this study 26% of patients were in low CRP group (CRP &lt;3 mg/L), 34% of patients were in medium CRP group (CRP 3-9.9 mg/L), 40% of patients were in high CRP group (CRP ≥10 mg/L). According to modified Rankin Scale (mRS) scoring system the high CRP group having a 44% risk for a poor outcome (mRS ≥3 ) vs 27% for the low CRP group ( p = 0.01). According to Barthel Index (BI) scoring system the high CRP group having a 45% risk for a poor outcome (BI &lt;95) vs. 25% for the low CRP group (p = 0.002). Z test of proportion revealed significant association between high CRP level and poor short-term outcome of patients with acute ischemic stroke. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):12-15

Cracking the code: using educational gaming for high-level thinking in physiology education.

The multidisciplinary nature of physiology requires students to acquire, retain, apply, and evaluate knowledge from different scientific disciplines. Optimal learning techniques, such as active learning, interleaving topics and conditions, and recall, can greatly enhance the speed and effectiveness with which students achieve this type of higher-order thinking. However, developing and implementing optimal learning techniques in the classroom can be both time-intensive and challenging for the instructor. In addition, students may be resistant or slow to accept novel learning processes. One way to potentially introduce these learning techniques in a fun and engaging way is through educational gaming, or using a game or game elements intentionally to support learning. In this article we present an easy-to-implement adaptation of the Codenames board game for the physiology classroom. The activity requires minimal preparation while addressing high-level learning outcomes. Postintervention surveys of students were collected in three different health-related academic programs, both graduate and undergraduate, at two different institutions. Results suggest that participating in the activity both actively engaged the students and pushed them toward high-level, integrative thinking regardless of class level.NEW & NOTEWORTHY An easy-to-implement word game (Codenames) was used to engage students in higher-level Bloom's thinking about physiology. The gameplay required students to recall, apply, evaluate, and debate as they developed and guessed clues as part of the game. Students found the activity fun, engaging, and challenging. The activity is relatively easy to implement both online and in person, requiring at minimum a simple list of vocabulary terms.

Discovery Learning Learning Analysis to Develop High Level Cognitive Learning Outcomes Based on Student Metacognitive Characteristics

Study findings about students' learning needs became the basis for this research. To improve high-level cognitive learning outcomes based on students' metacognitive characteristics, this research will apply Discovery Learning. This research uses Solomon Four Groups Design, a type of quasi-experimental research methodology. The research population was 216 fourth grade students at Al Kautsar Elementary School. In keeping with the research objectives, a cluster random sampling approach was used to select the sample for this investigation, resulting in a total of 112 students. The data analysis method uses the Man Whitney test which is non-parametric. Research findings show that discovery learning is effectively implemented in elementary schools because it can foster student participation in learning activities, which in turn can improve cognitive learning outcomes at a high level based on students' metacognitive characteristics.&#x0D;

Multimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia

IntroductionThe WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first...

Exploration of Practice-Oriented Educational Reform in “Career Development and Employment Guidance for University Students”

“Career Development and Employment Guidance for University Students” is a compulsory course offered by higher education institutions, serving as an essential form of employment counseling for students. It plays a significant role in shaping students’ vocational literacy and enhancing their employability, thereby addressing the issue of employment pressure faced by university students. This paper investigates the existing issues in the teaching of “Career Development and Employment Guidance for University Students” and proposes specific measures to improve the quality of instruction: adopting a practice-oriented approach, optimizing teaching methods, and fostering a diverse teaching faculty. The implementation of these measures has yielded positive results, as evidenced by students’ enthusiastic participation, the cultivation of a proper career outlook, and the enhancement of students’ vocational planning and employability, ultimately leading to high-level employment outcomes.

Assessment of cognitive games to improve the quality of life of Parkinson's and Alzheimer's patients.

The core objectives of this study centre on enhancing the quality of life and well-being of individuals diagnosed with Parkinson's and Alzheimer's diseases. Our aim is to facilitate the monitoring of patient information, benefiting both caregivers and healthcare professionals. As part of the PROCare4Life platform sensorial ecosystem, a web application with six engaging cognitive games focusing on developing cognitive training and stimulating brain activity are developed. A set of metrics calculated by the application feed machine learning predictive models to evaluate the cognitive status and evolution over time. Long-term analysis of the daily cognitive ability information is used to generate high-level outcomes and identify deviations for each patient from the multimodal fusion engine. And based on these results, a recommender system provides a set of personalized notifications. A 3-month pilot study that took place in five different countries shows the results obtained from 93 patients. An average of 22.4 games were completed per day and the recommender system generated a total of 260 game notifications, 37.7% of them were marked as read by the patients. The Cognitive State Score and the Deviations in Cognitive Abilities measurement, calculated by the multimodal fusion engine, when used in conjunction present a good overview of the patient's current state and potential deviations. The cognitive games application was well-received by elderly individuals who took part in the study. This tool can be valuable for caregivers and healthcare providers in assessing the cognitive function of patients through engaging in cognitive games.

Association between fibrinogen-to-albumin ratio and functional prognosis of 3 months in patients with acute ischemic stroke after intravenous thrombolysis.

The presence of high fibrinogen and low albumin levels in serum is associated with a negative prognosis in acute ischemic stroke (AIS). Fibrinogen-to-albumin ratio (FAR), a new inflammatory biomarker, may provide better prognostic insights in patients with AIS than separate evaluation of fibrinogen or albumin. The objective of this investigation is to examine the correlation between FAR and 3-month functional prognosis after intravenous thrombolysis (IVT) in AIS patients. The retrospective study recruited AIS patients who received IVT from June 2014 to December 2021. The 3-month functional prognosis was assessed using the Modified Rankin Scale (mRS). A mRS score of ≤2 indicated a good outcome, whereas a mRS score of >2 suggested a poor outcome. A total of 591 AIS patients who underwent IVT were included and 147 patients (24.9 %) had a poor outcome. Among the 102 pairs of patients after propensity score matching, there was a significant association between FAR and 3-month prognosis (adjusted OR, 1.19; 95% CI, 1.03-1.38; p=.020). The optimal FAR cutoff value was found to be 7.57, and even after stratifying patients based on this value, we still observed a significant correlation between high FAR level and poor outcome (adjusted OR, 2.08; 95% CI, 1.28-3.40; p=.003). FAR may serve as a prospective biomarker of predicting 3-month prognosis in AIS patients after IVT.

TEAM BASED LEARNING, AN OPPORTUNITY TO PROMOTE INTERPROFESSIONALISM IN GERIATRICS EDUCATION: A SYSTEMATIC REVIEW

Abstract Geriatric care is complex and requires high coordination between healthcare providers. Thus, interprofessional education remains a priority, and innovative teaching methods are needed. Team-Based Learning (TBL) - “an active learning and small group instructional strategy that focuses on higher-cognitive abilities through a sequence of activities including individual work, teamwork and immediate feedback through significant problems.” – appears as one of the most valuable solutions. Following BEME recommendations, this systematic review examined the current evidence on TBL in health professions education (HPE). PubMed, EMBASE, WoS, and Scopus were searched from inception till August 2023 using key terms/subject headings related to TBL and Geriatrics. Four studies published between 2013 and 2022 met our inclusion criteria. Two studies included solely nurses and the remaining two – students from different disciplines. One study was quasi-experimental, while others were cross-sectional. Studies involved undergraduate (n=4) and graduate (n=2) students. Geriatric care was the curriculum’s focus in two studies, while it was a component in the remaining two (covered in one or two modules). All studies followed the sequence of a TBL session. Although TBL was not preferred over traditional lectures for students (n=1), there was a gain in knowledge and skills in most of the studies (n=3). To analyze the quality of studies, the MERSQI was employed (Mean = 9.87, SD =1.31), but there was a lack of validity in assessment instruments and zero patient-reported outcomes. TBL is an opportunity to promote interprofessional education. However, further studies using better assessment methods and higher-level outcomes are needed.

Radiotranscriptomics of non-small cell lung carcinoma for assessing high-level clinical outcomes using a machine learning-derived multi-modal signature

BackgroundMulti-omics research has the potential to holistically capture intra-tumor variability, thereby improving therapeutic decisions by incorporating the key principles of precision medicine. The purpose of this study is to identify a robust method of integrating features from different sources, such as imaging, transcriptomics, and clinical data, to predict the survival and therapy response of non-small cell lung cancer patients.Methods2996 radiomics, 5268 transcriptomics, and 8 clinical features were extracted from the NSCLC Radiogenomics dataset. Radiomics and deep features were calculated based on the volume of interest in pre-treatment, routine CT examinations, and then combined with RNA-seq and clinical data. Several machine learning classifiers were used to perform survival analysis and assess the patient’s response to adjuvant chemotherapy. The proposed analysis was evaluated on an unseen testing set in a k-fold cross-validation scheme. Score- and concatenation-based multi-omics were used as feature integration techniques.ResultsSix radiomics (elongation, cluster shade, entropy, variance, gray-level non-uniformity, and maximal correlation coefficient), six deep features (NasNet-based activations), and three transcriptomics (OTUD3, SUCGL2, and RQCD1) were found to be significant for therapy response. The examined score-based multi-omic improved the AUC up to 0.10 on the unseen testing set (0.74 ± 0.06) and the balance between sensitivity and specificity for predicting therapy response for 106 patients, resulting in less biased models and improving upon the either highly sensitive or highly specific single-source models. Six radiomics (kurtosis, GLRLM- and GLSZM-based non-uniformity from images with no filtering, biorthogonal, and daubechies wavelets), seven deep features (ResNet-based activations), and seven transcriptomics (ELP3, ZZZ3, PGRMC2, TRAK1, ATIC, USP7, and PNPLA2) were found to be significant for the survival analysis. Accordingly, the survival analysis for 115 patients was also enhanced up to 0.20 by the proposed score-based multi-omics in terms of the C-index (0.79 ± 0.03).ConclusionsCompared to single-source models, multi-omics integration has the potential to improve prediction performance, increase model stability, and reduce bias for both treatment response and survival analysis.

A critical look at outcome measures: Comparison between four dental research journals by use of a hierarchical model.

To assess the status quo of outcome measures used in treatment studies in Endodontics, and potentially identify strategies for improvement, by (i) systematically assessing the outcome measures using a conceptual model and (ii) comparing these with measures used in corresponding studies in the adjacent fields. The International Endodontic Journal, Caries Research, The Journal of Clinical Periodontology and The Journal of Oral & Facial Pain and Headache were selected to cover four adjacent dental disciplines. In each journal, the 50 most recent consecutive publications fulfilling inclusion criteria were included. A hierarchical model for diagnostic imaging studies was modified to assess studies related to treatment. The model comprised six levels, with technical as the lowest level and societal as the highest. Extracted data included study origin, study type, and identified outcome measures. Fisher's Exact Tests with Bonferroni corrections compared studies. p < .05 was considered statistically significant. Amongst 756 publications, the 200 most recent studies matching the inclusion criteria were identified. Less than half (36.5%) assessed the clinical, patient, or societal aspects of treatment; 10.0% in International Endodontic Journal, 28.0% in Caries Research, 38.0% in Journal of Clinical Periodontology, and 70.0% in Journal of Oral & Facial Pain and Headache (p < .001). According to included publications, research on treatment within the endodontic field is mainly focusing on technical and biological outcomes. The benefits of patients and society were less frequently examined than in corresponding journals in adjacent disciplines. When designing studies, including higher-level outcomes should be considered.

A Business Intelligence Expert System for Predicting Market Price in Stock Trading using Data Analysis: Deep Learning Model With Feature Selection Mechanism

Because of the availability of data and reasonable processing capability, business intelligence methods are rapidly being used in finance, such as managing assets, trading using algorithms, credit financing, and blockchain-based financing. Machine learning (ML) algorithms use enormous amounts of data to automatically understand and enhance predictability and performance via knowledge and data without being programmed by someone. Due to the stock data’s dynamic, high-noise, non-parametric, non-linear, and chaotic qualities, the stock market prediction has been a challenge and has received much interest from scholars over the last decade. Some studies seek a method for accurately predicting stock prices; however, due to the high correlation between stock prices, stock market analysis is more complex. So, this paper proposes an improved stock price prediction (SPP) model using a novel optimal parameter tuned with cross entropy included bidirectional long short-term memory (OPCBLSTM) with efficient feature extraction and selection schemes. It starts with missing values imputation, and data standardization on the collected dataset. From the preprocessed dataset, the features are extracted using modified rectifier linear unit activation based residual network (MRResNet50). Then the optimal features are selected using the improved whale optimization algorithm (IWOA). Finally, the SPP is done using the OPCBLSTM. The experimental results proved that the proposed method achieves more high-level outcomes than the traditional methods.

Closing the Gap

Equity, diversity, and inclusion (EDI) plans and initiatives are at the forefront of many libraries’ strategic planning (Mallon, 2019). Efforts, big or small, such as mandatory all-staff EDI training sessions (Downers Grove Public Library, 2021), EDI focused patron programming, or simply promoting the local library as a place of opportunity for all (ALA, 2019), demonstrate the American Library Association (ALA)’s Core Values in practice (ALA, 2006). In fact, Diversity is one of eight key action areas that are used as guiding principles for investment of energies and resources (ALA, 2007). These key action areas represent priorities and clear focuses within the ALA’s own strategic plan (ALA, 2017), which serves to outline the organization's long-term goals and high-level outcomes (Hirsh, 2022). The ALA has historically promoted themselves as supporters, allies, and anti-racists, playing an important role in many libraries’ strategic plans and philosophies. But, despite libraries being regarded as the ‘most inclusive’ institutions in the United States (Jaeger, 2018), there appears to be internal and external gaps in truly achieving these EDI goals. It is necessary to further explore where these gaps are and propose solutions to ensure clearer action is being taken to support and highlight these strategies.

Alpha NSW: What would it take to create a state-wide paediatric population-level learning health system?

The health and well-being of children in the first 2000 days has a lasting effect on educational achievement and long-term chronic disease in later life. However, the lack of integration between high-quality data, analytic capacity and timely health improvement initiatives means practitioners, service leaders and policymakers cannot use data effectively to plan and evaluate early intervention services and monitor high-level health outcomes. Our exploratory study aimed to develop an in-depth understanding of the system and clinical requirements of a state-wide paediatric learning health system (LHS) that uses routinely collected data to not only identify where the inequities and variation in care are, but also to also inform service development and delivery where it is needed most. Our approach included reviewing exemplars of how administrative data are used in Australia; consulting with clinical, policy and data stakeholders to determine their needs for a child health LHS; mapping the existing data points collected across the first 2000 days of a child's life and geospatially locating patterns of key indicators for child health needs. Our study identified the indicators that are available and accessible to inform service delivery and demonstrated the potential of using routinely collected administrative data to identify the gap between health needs and service availability. We recommend improving data collection, accessibility and integration to establish a state-wide LHS, whereby there is a streamlined process for data cleaning, analysis and visualisation to help identify populations in need in a timely manner.