Lessons Learned Research Articles

Commentary: ICE London meeting held on 17 September 2024, Lessons Learnt from the New London Museum

Paul Perry (Aecom) from the ICE London committee chaired a meeting at the Institution of Civil Engineers given by Ruth Oates (Buro Four) on the £437m project to alter and refurbish the existing West Smithfield market building above the thameslink rail tunnel for use as the new London Museum.

Deploying a Location-Based Coupon Recommendation Service in Retail: Challenges and Lessons Learnt

Deploying a Location-Based Coupon Recommendation Service in Retail: Challenges and Lessons Learnt

Endoscopic Management of Efferent Loop Syndrome and Its Complications: Lessons Learnt

Both afferent and efferent loop syndromes are rare complications that can develop post-gastro-jejunostomy. Although the incidence of afferent loop syndrome is ~0.3% to 1%, efferent loop syndrome is extremely rare with only limited case reports. We report a case of malignant efferent loop obstruction which was successfully managed by an endoscopic luminal self-expanding metal stent. This led to an unusual complication of obstructive jaundice with cholangitis secondary to a mechanical afferent loop syndrome requiring an additional endoscopic luminal stenting of the afferent loop. Endoscopic management of afferent or efferent loop syndromes is technically challenging and a consecutive occurrence of the dual-loop syndromes should be expected by the interventional endoscopist.

Rural India, the problem of Open Defecation and India’s Public Health Programs: Lessons in Social Learning

Rural India, the problem of Open Defecation and India’s Public Health Programs: Lessons in Social Learning

Acknowledgment of collective victimization: Findings from four contexts of historical victimization

AbstractAcknowledgment of collective victimization is often understood as a crucial precursor to promoting victimized groups’ well‐being and breaking the cycle of violence. Yet, research on acknowledgment has focused on a few forms of acknowledgment from the perpetrator group, thus limiting our understanding on what acknowledgment entails and who should engage in it. Furthermore, what is considered to be appropriate acknowledgment may be shaped by the historical and sociopolitical context. To address these issues, we conducted a qualitative online survey that explored how four historical victim groups (Armenian Americans, Black Americans, Jewish Americans, and the Palestinian diaspora, total N = 273) perceive how acknowledgment of their group's collective trauma should look like. Qualitative content analysis revealed four broad theoretical categories of what acknowledgment entails: symbolic gestures, knowledge and education, structural redress, and learning lessons and preventing violence. We also found four categories concerning who should acknowledge the ingroup's trauma: everyone, adversaries, the ingroup, and third parties. Responses varied across groups, suggesting the importance of the sociopolitical context in acknowledgment. The findings extend theoretical and empirical work on acknowledgment and have important program and policy implications.

Ergonomic Transgression of the Corridor: A Sojourn of Microscopic to Endoscopic Middle Ear Surgery, the Learning Curve, Lessons Learned, and Reflections

Objective: For the last 20 years, transcanal endoscopic ear surgery has emerged as a viable, ergonomic, and powerful alternative surgical modality of choice replacing the conventional microscopic approach in many ways. This study compares the functional and anatomical outcomes of endoscopic tympanoplasty with microscopic tympanoplasty using full-thickness tragal cartilage as a graft of choice. Methodology: This observational, analytical, retrospective study was conducted in the department of Otolaryngology in a tertiary care hospital over two years. It included an analysis of medical records of 38 patients (above 10 years of age), who underwent conventional microscopic and transcanal endoscopic tympanoplasty (type I) for dry and small/medium size tympanic perforations. Morphological and functional outcomes were compared in both groups by noting the condition of graft and air-bone gap on follow-up. Result: There were 19 patients each in both groups. The mean pre-and post-operative ABG in each group was comparable and the difference was statistically significant in each group ( P< 0.05). Comparing the mean ABG change between both groups, there was a statistically significant difference noted (P<0.05). The success rate was found to be 89.5% (17 /19) in the endoscopic surgery group and 94.7% (18/19) in the microscopic surgery group. The difference in the anatomical success of both groups was not statistically significant. Conclusion: There was no statistically significant difference between both groups regarding graft take-up rates but functionally hearing outcomes were better in the MES group which was statistically significant. Bangladesh J Otorhinolaryngol 2024; 30(1): 5-14

Qualitative study of the feasibility and acceptability of implementation, and potential mechanisms of Learning Together for Mental Health, a whole-school intervention aiming to promote mental health and wellbeing in secondary schools

BackgroundDespite high rates of adolescent mental-health problems, there are few effective whole-school interventions to address this. Whole-school interventions offer a feasible and sustainable means of promoting mental health. We previously evaluated the Learning Together (LT) intervention which was effective in preventing bullying (primary outcome), promoting mental well-being, psychological functioning, and reducing substance use (secondary outcomes). We adapted LT to develop Learning Together for Mental Health (LTMH) with a new menu of evidence-based actions to address mental health and an enhanced SEL curriculum.MethodsWe undertook a feasibility study of LTMH, a whole-school intervention featuring needs assessment, student and staff participation in decision-making via action groups selecting actions from an evidence-based menu, restorative practice, and a SEL and resilience skills curriculum between 2022 and 2023. This article examines the feasibility, acceptability, and potential mechanisms of LTMH, qualitatively, drawing on interviews and focus groups with 49 students in years 8 and 10, and 20 staff across four state secondary schools in southern England.ResultsThe intervention was feasible and acceptable to implement. In terms of feasibility, the SEL curriculum was the most challenging to implement and was not prioritised by schools that had existing social and emotional learning lessons. Training and external facilitation were well-rated. Some schools struggled with the resourcing and workload implications of implementing actions from the evidence-based menu. Some aspects were not clear. Some staff were not aware that the various components worked together. Needs reports were not easy to understand for all. Students were generally supportive of restorative practice and SEL lessons. Data supported a potential mechanism involving increased school belonging and developing practical knowledge and skills to manage emotions and relationships. The intervention has little potential for harm.ConclusionsThe intervention is ready for phase III trial with minor adaptations. A phase III trial of effectiveness is justified.Trial registrationISRCTN15301591 https://doi.org/10.1186/ISRCTN15301591

Integrating Generative Artificial Intelligence and Problem-Based Learning into the Digitization in Construction Curriculum

This study proposes incorporating generative artificial intelligence large language models (LLMs) into the Master of Science (M.Sc.) curriculum on digitization in construction. The aim was to help students generate computer code to solve, automate, and streamline practical challenges in advanced construction engineering and management (CEM). To this end, a host of problem-based learning (PBL) individual assignments and collaborative team projects were developed, alongside a combination of flipped classroom models and blended learning lessons, in order to teach effective interactions with LLMs and mitigate concerns, such as bias and hallucination. The effective interaction with LLMs not only facilitated code generation, which would otherwise be complex without additional formal training, but also provided a platform for strengthening basic project management skills, such as departmentalization, work breakdown structuring, modularization, activity delegation, and defining key performance indicators. The effectiveness of this approach was quantitatively and qualitatively evaluated within two new modules, Digital Engineering and Construction and Digital Technologies in Field Information Modeling. These modules were offered over three semesters each as part of a new M.Sc. program in Technology and Management in Construction at the Karlsruhe Institute of Technology. It was observed that 86.4% of students fully completed the PBL projects, while the remaining 13.6% achieved over 50% completion across all six semesters. Furthermore, anonymous student surveys indicated a teaching quality index of 100% in five semesters and 96.4% in one semester. These preliminary results suggest that the proposed strategy can be used to effectively integrate LLMs to support students in code generation for open-ended projects in CEM. Further research was, however, found to be necessary to ensure the sustainable revision and redesign of the problems as LLM capabilities evolve.

Teaching and Practicing Congenital Hand Surgery in Cambodia - Lessons Learnt.

The global burden of surgical conditions is becoming increasingly prevalent in the developing world. Hand surgery, in particular congenital hand surgery, presents with its own challenges, particularly the unique skill sets needed, multidisciplinary nature and heterogeneity of cases. The aim of this review article is to present our experience of practising congenital hand surgery in Cambodia, and to explore the feasibility of teaching this specialty in developing countries within a meaningful and sustainable framework. Since 2013, a group of hand surgeons and therapists have visited the Children Surgical Centre in Cambodia. A community-oriented curriculum was developed following the initial visits, with analysis of data and local surgeon's skill sets. These were further refined using the Pareto analysis and selected competency procedures to develop entrustable professional activities (EPAs). Common paediatric hand cases were identified and taught to the local surgeons. Essential elements of this model include the need for measurable outcomes, clear curriculum goals, long-term partnerships and information technology support.

Perioperative practitioners' experiences of critical incident debriefing: A qualitative explorative study.

A critical incident is described as any unplanned event which causes, or has the potential to cause, injury to a patient. Critical incident debriefing is a team discussion to gather facts and analyse the experience, evaluate lessons learned and provide staff with support. However, this phase is often neglected. This UK-based explorative qualitative study aims to explore perioperative practitioners' experiences of critical incident debriefing. Data were collected from six participants through audio-recorded, semi-structured interviews. Data were analysed using a thematic analysis framework. Five themes emerged detailing the advantages of critical incident debriefing, including addressing staff's personal needs and learning lessons from incidents, and the disadvantages such as time constraints and unsupportive/uninformative debriefs leading to poor-quality debriefs. Implementation of a short debrief immediately post-incident to address immediate concerns, a later in-depth debrief and additional training for facilitators were recommended to improve debrief quality.

Better Medicines for Children: Lessons Learnt and Share Learnings at the EFGCP Annual Paediatric Conferences.

For many years, the European Forum for Good Clinical Practice (EFGCP) Children Medicines Working Party has organised a Paediatric conference annually. In the past, this event was organised jointly with the European Medicines Agency who was used to host it, along with the Drug Information Association (DIA). This conference is the opportunity for all involved in paediatric drug development, i.e., regulators, HTA bodies, patients' representatives, academia and industry, to share learnings and raise awareness about new regulatory requirements of interest to optimise paediatric drug development. The theme of the 2021 conference was "Challenges and Solutions - the path forward" while in 2022 it focused on "Progress made and Continuing Challenges". Because of the COVID-19 pandemic these two conferences were organised virtually. However, this has not impacted the attendance and value of the conference, since because of a broad and attractive agenda there was a wide stakeholder participation, which provided a compendious overview of the leading issues to improve children's access to innovative medicines.

Connected Communities | Learning lessons from person-centred community-based support services’ implementation: a mixed-methods study protocol.

Background Person-centred community-based support services (PCCBSS) are an array of non-clinical services provided by organisations such as NHS Trusts, voluntary sector organisations, or local authorities. All PCCBSS involve an individual (variously known as a 'social prescriber’, ‘link worker’, ‘signposter’, ‘navigator’, ‘connector’ or ‘neighbourhood coach’) who talks with a service user before directing them to a range of relevant community sources of social, emotional, and practical support. Despite much recent investment in social prescribing, and its increased prominence within the policy context across England, little is understood about how PCCBSS are implemented. Research is required across different contexts to describe PCCBSS implementation; in particular, how social care providers successfully interact to support the implementation of PCCBSS, and how services responded to circumstances imposed by the COVID-19 pandemic. Purpose The aim of this post-implementation mixed-methods study is to explore how PCCBSS are implemented and become part of usual working practice. Using three services in North West England as case studies, we will examine factors influencing PCCBSS implementation and establish where there is learning for the wider adult social care system. Focus The study comprises two work packages (WPs): WP1: collecting data by reviewing service documents from three PCCBSS case studies; WP2: interviewing staff and service users (≤20 participants per PCCBSS); Key implementation data will be systematically abstracted (from WPs1&2) into a coding frame; combining contextual determinants from the Consolidated Framework for Implementation Research (CFIR) with process-related domains from Normalization Process Theory (NPT). Key outputs The findings from WP1 and WP2 will be presented in the form of an illustrated ‘pen portrait’, developed collaboratively with Applied Research Collaboration North West Coast (ARC NWC) public advisers, to illustrate how implementation evolved for each of the PCCBSS across key time-points in the process (initiation; operation; maintenance). The findings will also inform an online implementation toolkit providing recommendations for setting up future PCCBSS.

Lessons Learnt from HIV and Noncommunicable Disease Healthcare Integration in Sub-Saharan Africa.

In sub-Saharan Africa (SSA), a rising burden of noncommunicable diseases (NCDs) coexists with a persistent high burden of human immunodeficiency virus (HIV). Integrating care for chronic conditions is potentially beneficial, but the optimal approach remains unclear. By use of a narrative review of 14 recent case studies from different SSA countries, examples of NCD and HIV healthcare integration were described. Case studies were categorized into three models: integrating NCD care into existing HIV care (n = 8), integrating HIV care into existing NCD care (n = 2), and simultaneous implementation of HIV and NCD services (n = 4). Facilitators include staff and patient education, while barriers encompass the lack of guidelines and inadequate infrastructure. Providers, patients, and policymakers support integrated care but note several challenges. Available health economics data suggest cost-effectiveness in the long run. Concluding, NCD and HIV healthcare integration in SSA was deemed feasible with models of service integration related to the implementation context.

Bispecific Antibodies for Multiple Myeloma in the Real World: Lessons Learnt from a Nation-Wide Dutch Observational Registry

Bispecific Antibodies for Multiple Myeloma in the Real World: Lessons Learnt from a Nation-Wide Dutch Observational Registry

Stoichiometry understanding of upper secondary students through active science learning

The goals of the study were as follows: i) to design an active science learning activity on stoichiometry for grade 10 students, ii) to evaluate the academic achievement of grade 10 students after receiving an active science learning activity on stoichiometry, and iii) to investigate the perspectives of grade 10 students regarding an active science learning activity on stoichiometry. The research utilized a sample group consisting of 41 students who were enrolled in the tenth grade during the second semester of the academic year 2022. The research tools provided participants with active science learning lessons. A test of the kids’ academic prowess as well as their thoughts on the use of hands-on scientific learning activities will be administered. The mean, the standard deviation, and a one-sample t-test were the types of statistics that were utilized in the investigation. The following is an outline of what the research found: i) the appropriateness of the active science learning activities was judged to be the highest level, ii) the academic achievement of grade 10 students after receiving the active science learning activities on stoichiometry had an average score that was higher than the criteria of 70% with a statistical significance at the .05 level; and iii) the opinions of students on the implementation of active science learning activities on stoichiometry were in the agree level.

Analysis of Chemistry Interest Level in Merdeka Curriculum Implementation at SMA Negeri 8 Pontianak

Elective subject is the flagship program of Merdeka Curriculum..The elective subject program is based on students’ interest, talents, and aspirations. Therefore, students’ interest level in chemistry, as one of the options for elective subject program is a necessary to determined. This study aims to determine the level of student interest in choosing chemistry as an elective subject, so that teachers could find the best alternatives to increase students’ interest. The research was conducted with quantitative analysis methods and descriptive statistical approaches, using 139 students of grade 11th who have chosen chemistry as the elective subject. The level of students’ interest in chemistry is measured by students’ interest questionnaire. The questionnaire was adopted and developed by aspects of students’ interest: teachers’ role, students’ perception, students’ intrinsic motivation in learning, and meaningful learning of lesson. Content validation test using Aiken formula showed the questionnaire validity is very high, as value 1. Based on the analysis, the result stated that the level of students’ interest was included as high category with 76,11%. All aspects are categorized as high, aspects of the teacher's role in learning with 77.44%, students’ perceptions with 73.63%, students’ intrinsic motivation 78.99% and the meaningfulness of learning lesson with 74.37%.

Transparency in action or political fiction? The pre-inquiry phase of the UK COVID-19 Inquiry

AbstractThis article examines how public inquiries come into being through a detailed analysis of the pre-inquiry phase of the UK COVID-19 Inquiry. We focus on two key points of contestation—around the timing of the inquiry and its terms of reference—and suggest that what is at stake during the pre-stage of an inquiry is its ontological and epistemological orientation. Our analysis traces the emergence of two distinct positions during this phase: a grassroots position (conceiving of the inquiry as a response to the experience of collective grief) and an official position (conceiving of the inquiry as a means of learning lessons). Particular attention is given to the latter position and what it reveals about the rhetorical function of transparency in confirming a political commitment to institutional accountability, at the same time as working towards a particular conception of the inquiry as a practical task, expansive in remit, and future oriented.

Life course prevention - challenges for public health lying ahead

Abstract Issue/problem Demographic and epidemiological transitions have now shifted the focus from vulnerable population groups onto the active population, in particular young adults. At the same time lessons from the covid-19 pandemic taught us about missing actions on the elderly. While the latter have shown compliance and have followed most preventative activities, we observe scepticism and reluctance in the young adults. Description of the problem The covid-19 pandemic showed that young to middle-aged adults were the most reluctant group to adhere to preventative measures but in complying to the recommendations concerning vaccination. Since European activities are now focusing on addressing determinants of NCDs and are hoping to mobilise all population strata, including young and middle-aged adults, it would be important to explore how this mindset might affect the overall attitude to prevention. Results Health policy should explore specifically the needs of young to middle-aged adults (e.g. ages 30 to 44) to list their specific needs, expectations from preventative activities. On the other hand, it would be necessary to find out about the concerns, reluctance, and objections. The interplay of these will play a significant role in acceptance of present and future preventative activities. Exploration on these topics presents the following challenges: 1. Multiple sources of information on given health problems; 2. Lack of structured accessible and well-understandable explanations of advantages and benefits; 3. Inappropriate communication by health professionals or agencies on their behalf; 4. Complexity of the problem, which is then translated into complex and not easily understood messages. Lessons Learning about the specific needs of young adults, their expectations from the health systems in terms of prevention and health care as these will shape their overall attitude to prevention and have an impact on their families, particularly children. Key messages • Knowledge about expectations, needs, concerns, and reserves with respect to prevention is essential for the future activities on prevention. • Involving young and middle-aged adults in the preparation of the future preventative activities for their population groups is essential.

Enhancing Aromaticity of Alkenylbenzenes May Decrease Their Metabolic Activation and Reduce Their Potential Cytotoxicity: Lessons Learnt from the Investigation of Myristicin and Elemicin.

Metabolic activation studies of lead compounds are a crucial step in drug development and offer a key consideration during rational drug design. Myristicin (MRS) and elemicin (ELM), natural products belonging to alkenylbenzenes, share the backbone of 1-allyl-3-methoxybenzene. The backbone fuses with a methylenedioxy five-membered ring in MRS, while ELM is connected with two adjacent methoxy groups. ELM displayed powerful ability to induce cytotoxicity in cultured primary hepatocytes relative to MRS. Additionally, ELM exhibited superior efficiency in metabolic activation by CYP3A4, resulting in the formation of reactive metabolites carbonium ion, epoxides, and α,β-unsaturated ketone. Quantum chemical calculation and molecular dynamic studies revealed that the fused methylenedioxy 5-membered ring enhances the aromaticity of MRS, which affects the interaction between the allyl side chain and the heme for metabolic activation by the π-π stacking interaction with the aromatic amino acid residues of the host enzyme.

The Design of Teaching and Learning Platform to Support Exchange Learning for Elementary and Middle Schools in Korea

The education sector needs to improve education quality after the post-pandemic and subsequent decline in educational attainment. Additionally, there has been a heightened reliance on private education, coupled with the projected inflection point of 2070, when the global population will decline. Various solutions have been developed and implemented to support changing educational environments and teaching methods. However, despite these efforts, the problem of a widening educational gap between urban and rural students persists. This is due to difficulties accessing educational resources caused by long distances between schools, and there is an increasing demand for practical measures to make education more inclusive. In this case study, we analyzed the building and operation of a teaching-learning platform. We interviewed stakeholders to prepare a preemptive response to social issues that education will face in the future. Through this, we derived considerations for an exchange learning-based teaching-learning platform (that supports teachers' exchange learning lesson designs) and proposed a design plan platform. The results of this study are expected to minimize the learning gap between urban and rural areas, support the development of educational programs that consider students' interests, and adjust the educational difficulty to a suitable level for each student. It is also believed to help develop and utilize an AI-based, learner-customized learning platform.