Lost Opportunities Research Articles

Is Our Limited Understanding of the Effects of Nerve Stimulation Resulting in Poor Outcomes and the Need for Better "Rescue Programming" in SNM and PTNS, and Lost Opportunities for New Sites of Stimulation? ICI-RS 2024.

Sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) are strongly recommended by international guidelines bodies for complex lower urinary tract dysfunctions. However, treatment failure and the need for rescue programming still represent a significant need for long-term follow-up. This review aimed to describe current strategies and future directions in patients undergoing such therapies. This is a consensus report of a Think Tank discussed at the Annual Meeting of the International Consultation on Incontinence - Research Society (ICI-RS), June 6-8, 2024 (Bristol, UK): "Is our limited understanding of the effects of nerve stimulation resulting in poor outcomes and the need for better 'rescue programming' in SNM and PTNS, and lost opportunities for new sites of stimulation?" Rescue programming is important from two different perspectives: to improve patient outcomes and to enhance device longevity (for implantable devices). Standard SNM parameters have remained unchanged since its inception for the treatment of OAB, nonobstructive urinary retention, and voiding dysfunction. SNM rescue programming includes intermittent stimulation (cycling on), increased frequency and changes in pulse width (PW). The effect of PW setting on SNM outcomes remains unclear. Monopolar configurations stimulate more motor nerve fibers at lower stimulation voltage; hence, this could be an option in patients who failed bipolar stimulation in the long term. Unfortunately, there is little evidence for rescue programming for PTNS. However, the development of implantable devices for intermittent stimulation of the tibial nerve may increase long-term adherence to therapy and increase interest in alternative programming. There has been recent promising neurostimulation targeting the pudendal nerve (PNS), especially in BPS/IC. More recently, preliminary data addressed the benefits of high-frequency bilateral pudendal nerve block for DESD and adaptive PNS on both urgency and stress UI in women. The exploration of rescue programming and new stimulation sites remains underutilized, and there are opportunities that could potentially expand the therapeutic applications of nerve stimulation. By broadening the range of target sites, clinicians may be able to tailor treatments according to individual patient needs and underlying conditions, thereby improving overall outcomes. However, further studies are still needed to increase the level of evidence, potentially allowing for an individualized treatment both in patients who are candidates for electrostimulation and in those who have already received surgical implants but seek a better outcome.

451 Lost Opportunities in the Management of Critically Ill Patients Boarding in the Emergency Department

451 Lost Opportunities in the Management of Critically Ill Patients Boarding in the Emergency Department

Exploring Twitter as a social learning space for education scholars: An analysis of value‐added contributions to the #TPACK network

AbstractSocial media has been shown to be an efficient way to engage in networked participatory scholarship (NPS), which is defined as the use of online social networks to share and further develop scholarship. As leaders in the field, educational technology scholars should be at the forefront of this practice. We used social network analysis (SNA) to examine the structure and characteristics of the #TPACK Twitter network and to determine whether and how the users were engaging in value‐added NPS. Our findings revealed that the #TPACK Twitter network was loosely organized, and users were not very well connected outside of their clusters. Our findings also revealed that #TPACK tweets largely did not represent value‐added NPS. The majority of posts lacked useful context, were limited to merely sharing links to resources and did not establish meaningful interactions among users. The implications of this study provide a new direction for educational technology researchers and PK‐12 practitioners to approach social media from a value‐added standpoint and to apply value‐added NPS to improve their use of social media to advance research, enhance professional learning and forge closer ties between researchers and practitioners. Practitioner notesWhat is already known about this topic Publication in high‐impact academic journals and measuring research impact through citations and journal indexing is still the dominant practice in research dissemination; however, there is growth in the use of alternative methods and the use of altmetrics to measure the impact of these methods. Scholars struggle with using social media in ways that align with networked participatory scholarship (NPS). Social network analysis (SNA) is the study of the structure and characteristics of the relationships that form in social networks, and can be used to fanalyze an online social network. What this paper adds Value‐added social learning theory and NPS can be used in SNA to both evaluate and inform scholars' social media practices. Educational technology scholars and practitioners struggle with using social media for value‐added NPS. Lost opportunities for value‐added NPS that were documented in this study include lack of engagement with the wider network, not sharing the role of spreading ideas and not making value‐added contributions. Implications for practice and policy Education scholars should use SNA as a tool to evaluate the level of value‐added NPS in the social media networks around areas of study they care about so that they can develop both personal and systemic plans for implementing value‐added NPS to create more dynamic learning spaces on these platforms. Institutions should investigate ways they can remove barriers and incentivize value‐added NPS. Innovations in the dissemination of scholarship should involve helping scholars to develop the skills needed for successful value‐added NPS.

Lost opportunities: the underutilization of castrate-resistant prostate cancer treatment in real-world settings.

Various treatment regimens are now available for metastatic castrate-resistant prostate cancer (CRPC). This work evaluates the real-world prescription patterns of CRPC in a large tertiary care center and the factors influencing them. Health records of 330 patients with de novo metastatic hormone-sensitive prostate cancer (HSPC), treated and progressed to CRPC between 2016 and 2020, were reviewed from a prospective uro-oncological database. We studied their demographics, medical co-morbidities, treatment utilization patterns before and after progression to CRPC, and survival outcomes. The median age was 74 years [interquartile range (IQR), 67-80 years] at diagnosis of CRPC. At CRPC, beyond androgen deprivation therapy (ADT) monotherapy, 70.3% (n=232) of patients received at least one additional line, 21.5% (n=71) received two lines, and 5.5% (n=18) received three lines of systemic treatments. As first-line treatment, novel hormonal agents (NHAs) were the most prescribed at 57.6% (n=190). The likelihood of receiving treatment was associated with age <65 years [odds ratio (OR) 2.08, P=0.01, 95% confidence interval (CI): 1.22-3.57] and lower Charlson Comorbidity Index (CCI) score (OR: 2.62, P=0.04, 95% CI: 1.07-6.45), treatment intensification for HSPC (OR 2.45, P=0.04, 95% CI: 1.07-5.62) and primary physician being an oncologist (OR 1.59, P=0.04, 95% CI: 1.04-2.48). Patients who received additional treatment lines at CRPC had longer survival (median: 23 vs. 17 months, OR 1.72, P<0.01, 95% CI: 1.23-2.38). More than one in four patients do not receive any additional treatment line beyond ADT monotherapy and have worse survival outcomes. Health status, prescribing physician, and treatment at HSPC appear to affect prescription patterns at the CRPC stage.

Current Economic Crisis Effect on the Rural Community (By Ritigaha Arawa Village in Rideemaliyadda Divisional Secretariat in Badulla District Sri Lanka)

Today, Sri Lanka has faced to an economic crisis, and even everyone is suffering from it. COVID pandemic was a reason to expand the crisis, but the economic policy fallowed by Sri Lanka was the main reason for the crisis. The Sri Lankan government announced Sri Lanka as an economically bankrupt country, and Sri Lanka has also stopped the resettlement of foreign loans. Exports, import restrictions, organic policy, taxation, inflation, and a lack of investors are the main reasons for spreading the crisis. The rural community is the most suffering unit of society and the objective of this paper is to examine the effect of the current economic crisis on this community. Mix methodology was used, and questionnaires, discussion, direct observations, and field visits were used to collect the data. Day to day life has been lost to the rural community with the economic crisis, and their income is not enough to fulfill their basic needs. As a result of it, some students have stopped their education, and many young people are suffering their lives with the crisis. Lost job opportunities, and the increasing price of goods are reasons to spreading malnutrition in the rural community,and the crisis has spread all over the rural community in Sri Lanka.

Lost opportunities for globalisation, digitalisation, and socially sustainable education? Advocating for digital and global Bildung in Swedish upper secondary schools

In this article, we point to how the making visible of diverse linguistic, digital, and cultural competences can contribute to more sustainable and inclusive classroom contexts and future societies. Western notions of universal knowledge reproduces a western way of viewing the world and, as a result, this usually discounts alternative knowledge systems, which perpetuates inequality and may cause tensions in today’s diverse classrooms. Our 2022 pilot study, drawing on an online survey with more than 700 respondents and focus group interviews with 27 participants, indicates that for some multiethnic, multi-abled, and otherwise diverse upper secondary students underlying, often ethnocentric, norms of Swedish education create hurdles in educational contexts. Firstly, in the Swedish context, non-normative and often global experiences are not recognised at school. Secondly, topics addressed in the courses they take are primarily focused on aspects originating in a Swedish, Nordic, or Western tradition. Curricular policies and classroom practices must take lost opportunities, which we argue are not socially sustainable, into account as a more global and holistic approach when articulating what educational learning is supposed to be about, for, and for whom, and thus integrating learning, digitalisation, and social sustainability.

Perceptions of Obesity in Old Age: A Qualitative Study

IntroductionThe relationship between obesity and mental health in old age is complex and widely impacted by different biological, psychological, and social factors.ObjectivesThe primary objectives of this qualitative research study are: a) To understand the influence of obesity on older adults’ well-being; b) to assess emotional experiences related to obesity in old age and; c) to explore how obesity influences the mental health of older adults.MethodsThis study included 346 participants aged 65 to 84 years (M=73.9; SD=5.61) from three different nationalities (English, Spanish, and Portuguese). All interviews went through content analysis.Results This study identified four main themes regarding the influence of obesity on older adults’ well-being: (1) Insatisfaction with Body Image (66%); (2) Feeling embarrassed (65%); (3) Feeling Social Isolated (57%); and (4) Lost Opportunities (46%)Three main themes for emotional experiences were frequently verbalized by the participants: (1) Shame (81%); (2) Guilt (78%); and (2) Incompetence (76%). Finally, three main influences in mental health due to obesity were reported: (1) Self-concept (88%); (2) Stress (78%); and (3) Melancholia (63%).ConclusionsThese results highlighted that obesity negatively influences older adults’ well-being and emotional experiences and has serious mental health-related negative outcomes for older adults. Interventions like community-based weight loss programs can be effective in controlling weight and improving the social interaction of obese older adults.Keywords: Emotional experiences; mental health; obesity; older adults; well-being.Disclosure of InterestNone Declared

Caregiver Perspectives on Barriers and Facilitators to Timely Well-Child Visits for Black Infants.

Missed infant well-child visits (WCV) result in lost opportunities for critical preventive care. Black infants consistently receive less WCV care than other racial groups. We sought to understand barriers and facilitators to timely infant WCV for Black families in the context of COVID-19. We conducted 21 semi-structured interviews with caregivers of Medicaid-insured Black children aged 15- to 24-months who attended six or fewer of eight recommended well-child visits within the first 15months of life. Interviews focused on WCV value, barriers, and facilitators. After developing our initial coding structure through rapid qualitative analysis, we inductively derived the final codebook and themes through line-by-line content analysis. Caregivers attended a mean of 3.53 of eight infant visits. Structural (e.g., transportation) and psychological (e.g., maternal depression) barriers delayed Black infant WCV. Families most frequently valued monitoring development and addressing concerns. Caregivers perceived visits as less urgent when infants seemed healthy or more recently avoided visits due to fears around COVID-19. Long waits and feeling rushed/dismissed were linked to WCV delays; positive provider relationships encouraged WCV attendance. Most caregivers reported reluctance to vaccinate. Vaccine hesitancy contributed to delayed infant WCV. Caregivers described several factors that impacted WCV attendance for Black infants. Persistent structural and psychological barriers are compounded by perceptions that caregiver time is not respected and by notable vaccine hesitancy. To address these barriers, well-care can meet Black families in their communities, better address caregiver wellbeing, more efficiently use caregiver and provider time, and cultivate partnerships with Black caregivers.

Epistemological Deviant, Epistemic Abjection and Lost Opportunities: A Case Study of a Muslim Trans Intersex Student’s Othering and Dehumanisation in an Indian Science Classroom

This article sheds light on the registers of violence through which people from marginalised groups—especially non-normative or minoritised collectivities of gender, sex and religion—are constructed as outsiders in science higher education in India. Further, this article delineates the production and construction of a ‘normal’ sex/gender in a science classroom as distinct from a ‘biological’ sex/gender. Towards these goals, this article uses autobiographical narratives of a Muslim intersex transgender (trans) individual pursuing their masters in a science institution in Bengaluru, India, which it analyses using sociology of science and psychoanalytic lenses to articulate these mechanisms as the construction of the ‘epistemological deviant’ and the employment of ‘epistemic abjection’.

Pengembangan Agro-Sociopreunership Berbasis Potensi Lokal Sebagai Rintisan Usaha Bersama Pedagang Buah di Wilayah Tanggul Jember

Agriculture-based agro-sociopreneyrship is social service entherpreneurship in agriculture. Darungan Village,Tanggul Disctrict,Jember Regencyis an area that produces good local fruit potential and is always available in season, example of fruit that are often found in the area are mangosteen,rambutan and even durian.This lack of understanding and knowledge has caused many lost business opportunities for fruit traders in Darungan Village,Tanggul District,Jember Refency. The Purpose of this service is to develop startups together with the development of agro-sociopreneyrship so that they are sble to market properly so that partners can produce competitive products and improve the walfare of each member. Community service activities in the form of training are carried out using the socialization method discussions with the Unej community service implementation team. Service activities are carried out by outreach by explaining 2 materias,namely the formation of business Groups and Procedures for Making SKU. The result of this service is the formation of a business group with the name “Barokah Tanggul Fruit Business Group” and the management of SKU in the village. The results of the service are expected to be properly implemented to invrease the income of each member and reduce the problem of damage to fruit.

Does financial repression inhibit or facilitate private investment? The case of Ethiopia

This study examines the impact of financial repression (FR) on private investment in Ethiopia over the period 1980 to 2020. Investigating the consequences of FR policies makes use of the cointegration technique. The dynamic ordinary least square (DOLS) estimation result demonstrated that FR has a detrimental and statistically significant impact on private investment, resulting in considerable lost opportunities for private investors by driving away banks' productive investment. In addition, the structural reforms implemented since 2011 have a beneficial and significant influence on private investment. The effects of financial development, per capita GDP, and domestic lending to the private sector all produce similar consequences. Additionally, Ethiopia's private investment is negatively impacted by trade liberalization and inflation. The primary findings are used to infer potential policy implications.

P103 - Lost Opportunities: The Underutilization of Castrate-Resistant Prostate Cancer Treatment in Real-World Settings

P103 - Lost Opportunities: The Underutilization of Castrate-Resistant Prostate Cancer Treatment in Real-World Settings

A29Simulation Integration: A Multispecialty Programme Embedding Simulation within Departmental Teaching Programmes in two Cardiothoracic Centres

UK-based doctors in training have faced major disruption, loss of training opportunities and increased risk of burnout due to covid-19 [1,2]. Furthermore, the intensified post-covid strain on services continues to hamper efforts to restore training. A bottom-up review across departments at both of our sites revealed demand across specialties and grades for increased simulated training opportunities. Further highlighting the need for additional simulation programmes, simulated training has recently been demonstrated to reduce risk of burnout [3]. To restore lost learning opportunities, improve morale and promote team cohesion, we began a project to embed simulated training at a departmental level. A key aim of this project was to give departments ownership of their simulation programmes, to promote autonomy, tutor upskilling and sustainability. We systematically reviewed the curricula for all specialties with doctors-in-training across our two sites in order to establish how training needs could be met with simulation. Consultant ‘simulation lead’ positions were offered to consultants in each department. Following this, we met with each assigned simulation lead to perform a scoping exercise - thus establishing specific training needs and opportunities within each department. The medical education team used this information to support each department to develop its own simulated training programme and support its delivery. Crucially, unlike many simulated training opportunities, our programme is not tied to a particular training scheme nor does it incur any fees. This allows equal access to the programme for both locally employed doctors and Health Education England trainees. We worked with 13 departments in developing simulation-based training programmes. Eight departments had a single lead identified, three shared lead positions and in two departments no consultants assumed the position of lead. Experience and enthusiasm varied by department. In departments where a simulation lead was not identified, the education department has supported other team members such as Clinical Nurse Specialists and specialty registrars to devise and deliver sim-based training. Anonymized Microsoft Forms based post-course questionnaire responses completed by 42 participants to date have been overwhelmingly positive (outlined in Percentage of attendees rating the following areas as ‘agree’ or ‘strongly agree’ Our scheme has led to embedding of effective simulated training programmes across specialties at our sites, leading to sustainably improved training opportunities for post graduate doctors in the post covid era. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Promoting the Well-Being of Older People in Ethiopia: Lost Opportunities Due to the Poverty of Policy.

The world's population is aging with the fastest growth in the older population projected to take place in Africa. In this article, we present the challenges of the growing older population in Ethiopia, outline some key changes that are needed to address those challenges, and consider the opportunities that can come about when older adults' basic needs are met and they are supported in contributing to their communities. Older adults in Ethiopia are faced with multidimensional challenges that call for collaborative efforts from different stakeholders at local, regional, and national levels. However, some measures should be given the utmost priority: combating negative attitudes toward older people, strengthening geriatric/gerontology and social work education and research, and developing aging-specific policies and services. Although the challenges faced by older adults in Ethiopia seem like a problem of aging compounded by poverty, the root source of the problem is a poverty of policy fueled by ageism. If income support and appropriate health care was provided to older adults throughout Ethiopia, health and well-being in late life would improve, food and housing insecurity among older adults would lessen, and all Ethiopians could anticipate a dignified late life.

Coming of Age in 2023: Transitional-Age Youth With Anxiety and Depression Facing Lost Opportunities

Coming of Age in 2023: Transitional-Age Youth With Anxiety and Depression Facing Lost Opportunities

Male reproductive success is not strongly affected by phenological changes in mate availability in monoecious Sagittaria latifolia.

Many plants express their female and male sex roles at different times (dichogamy), with important consequences for mating. Dichogamy can yield mate limitation via biased floral sex ratios, particularly at the beginning and end of the flowering season when many plants simultaneously function as the same sex. This form of mate limitation should be reduced if plants adjust their allocations to female versus male sex functions in a manner that tracks seasonal variability in mating opportunities. For example, under protogyny (i.e. dichogamy with female function expressed first) plants with male-biased sex expression should have enhanced mating opportunities early in the flowering season as other plants begin to flower (in female sex phase). We quantified seasonal changes in sex allocation, patterns of mate availability and realized siring success in a population of protogynous Sagittaria latifolia. Our results were consistent with previous findings that seasonal changes in sex allocation should compensate for lost mating opportunities under the temporally variable mating environments caused by dichogamy. However, patterns of siring success in the population were inconsistent with this interpretation. We suggest that realized siring success might depend more strongly on spatial than on temporal aspects of mate availability.

SP9.16 An international consensus for mitigation of the detrimental effects of the COVID-19 pandemic on laparoscopic training

Abstract Aim Achieve an international consensus on how to recover lost training opportunities. Background A global survey conducted by our team revealed the factors perceived by trainees as barriers to training and gave birth to four-point framework of recovery. Their implementation, however, relies heavily on the active participation and leadership by trainers. Based on the results of the global trainee survey, the authors would like to conducted a survey, addressed to trainers on this occasion, to establish a pragmatic step-by-step approach to improve training during and after the pandemic. Methods A questionnaire was proposed; this was based on the results of expert semi-structured interviews. After validation, the questionnaire was disseminated to trainers across the globe. Results 208 international surgeons replied (M:80.29%). Most were 35-44y.o. (71/208) and worked in teaching hospitals (75.96%). The topics of the questionnaire were: (1)causes of impact, with lack of theatre time (108/164) and management pressures to finish cases quickly (102/164) being identified, (2)availability of guidelines, highlighting lack thereof (93/164) and highlighting the importance of training recovery specific guidelines (112/155) (3)impact of COVID-19 on trainer’s morale, with 87/164 feeling demoralised (4)mentorship; mentorship should be provided (139/155) (5)curriculum changes; opportunities for training in each list (138/155), dedicated training lists (120/155), pairing junior to senior trainees (130/155), training should be individualised to address different levels of needs (134/155) (6)simulation training; should be integrated in the curriculum (127/155), with individualised targets (129/155) and supervised. Conclusion This international survey provides a straightforward guide for the recovery of training after the COVID-19 pandemic.

Interpersonally-Based Fears and Feelings During the Covid-19 Pandemic Revisited: Research Findings and Further Reflections on Fear of Missing out and Feelings of not Mattering.

Much has transpired since severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began spreading throughout the world in 2020. In our previous commentary, we focused on the significance of two specific fears with an interpersonal basis (i.e. the fear of missing out, FoMO, and the fear of not mattering) during a period in which daily routines were disrupted and physical distancing or "social distancing" was implemented as a crucial important public health intervention in response to the coronavirus. In the current article, we examine the current context and review what has been learned about the similarities and differences among people during the pandemic with a particular emphasis on research during the pandemic on the fear of missing and feelings and fears of not mattering to other people. The nature of these constructs as revealed during the pandemic is discussed with a focus on how these attributes reflect insecurity and doubts about the self that heighten susceptibility to external feedback. Key themes include the need to consider FoMO from a broad perspective that includes actual lost opportunities during the pandemic and how individual differences in mattering have been reflected in coping and adaptability and related outcomes. It is clear from our analysis that FoMO and mattering are highly salient and relevant constructs with clear ecological validity in terms of accounting for individual differences in the costs and consequences of the pandemic.

Commentary on the Right to Education

The right to education is identified as a crucial and classical right. This classification is premised on the fact that it provides the basis on which an individual has the potential to transform their status and build their desired personality. Additionally, it is the basis on which society is projected to be transformed and set on a better pedestal, with individuals playing positive roles. The recognition of the right, though emanating from the Universal Declaration of Human Rights (UDHR) received only tacit recognition through other treaties. The Maputo Protocol recognises the right to education, as it flows from the African Charter on Human and Peoples’ Rights. This commentary, therefore, examines the right to education as enshrined in the Maputo Protocol with the aim of restating the grounds covered in the protection of female children and women and exposing lost opportunities. Finally, it makes recommendations on how the lost ground can be covered and give better content and scope to the right to education.

Lost lives and opportunities for the legacy of harm reduction in Scotland, UK

Lost lives and opportunities for the legacy of harm reduction in Scotland, UK