Practice Research Research Articles

Higher education of sustainable food systems: a literature review

PurposeThis study aims to fill data gaps concerning solutions and practices used in sustainable food systems (SFS) in higher education (HE). The development of SFS is a vital global challenge in which HE may play a significant role.Design/methodology/approachLiterature search and content analysis of found papers were performed. Additionally, the quantitative time trend of the emergence of research connected to SFS HE and the connectivity of content within the research papers about research questions were determined by regression analysis and data visualization, respectively.FindingsIt is evident that SFS education in universities (higher education institutes) is emerging, and the number of research papers is rapidly increasing. In the reviewed papers, universities recognized their significant role in managing wicked problems. The motivation for developing SFS education was high, with strong ambitions. SFS in HE includes developing education in-house through trans- and multidisciplinary solutions, developing education with stakeholders and supporting student growth to become responsible professionals and citizens.Practical implicationsWhen developing SFS education in HE both practical and theoretical research is needed. Ethical dimensions should be included in both research orientations because of the moral complexity that exists in SFS issues.Social implicationsThis study shows that competence in trans- and multidisciplinary working is needed. Concomitantly, the ability of cooperation between HE, business and society is vital when solving global food challenges. Also, the local tradition of food cultivation should be respected and maintained.Originality/valueTo the best of the authors’ knowledge, this is the first review on the development of SFS education in HEIs. A qualitative content analysis and data visualization were used to enrich the review.

Relationship of SOD-1 Activity in Metabolic Syndrome and/or Frailty in Elderly Individuals.

Although aging is a natural phenomenon, in recent years it has accelerated. One key factor implicated in the aging process is oxidative stress. Oxidative stress also plays a role in frailty (frail) and metabolic syndrome (MetS). A total of 66 elderly persons (65 years old and older) with no acute or severe chronic disorders were assessed for waist circumference (WC), arterial blood pressure, glycemia, glycated hemoglobin (HbA1c), plasma lipids, and activity of erythrocyte superoxide dismutase (SOD-1). Patients were classified as NonMetS-Nonfrail (n = 19), NonMetS-frail (n = 20), MetS-Nonfrail (n = 17), or MetS-frail (n = 10). There were no significant differences in superoxide dismutase activity among investigated elderly groups. However, the data suggest that MetS individuals, both frail and nonfrail, have higher risk factors for cardiovascular disease compared to NonMetS individuals. The correlations analyses of SOD-1 and other metabolic indices suggest that SOD-1 levels may be influenced by age, total cholesterol, HDL cholesterol, and fasting glucose levels in certain groups of seniors. Aging is associated with decreased antioxidant enzyme SOD-1 activity with glucose alteration in frailty syndrome as well as with lipids disturbances in metabolic syndrome. These factors provide a nuanced view of how frailty and metabolic syndrome interact with various health parameters, informing both clinical practice and future research directions.

How we approach steroid-induced affective disorder in pediatric oncology.

High-dose corticosteroids are an essential component of treatment for pediatric cancers. Yet, these agents often cause psychiatric disturbances including sleep disruption, steroid-induced psychosis, and steroid-induced affective disorder (SIAD). SIAD, identified as a specific form of substance/medication-induced mental disorder, can present with various psychiatric symptoms, including mania, depression, irritability, and inconsolability. SIAD's varied presentation can lead to underdiagnosis and complicates clinical care, research, and identification of best practices. Here we highlight three pediatric oncology cases involving SIAD and discuss recommendations for supporting patients with SIAD, while introducing a tiered intervention framework (modified from Kazak) that stratifies responses based on symptom severity.

Leveraging Greenspace to Manage Urban Flooding: An Investigation of Nature-Based Solutions Implementation in U.S. Public Parks

Many cities are looking to adopt nature-based solutions (NBS) in greenspace to manage urban flooding and provide diverse co-benefits. Yet little research exists to inform the planning and design of park NBS. This study investigated NBS adoption in 58 public parks across major U.S. cities, using a 2022 survey by the Trust for Public Lands and other secondary datasets. We developed a typology to conceptualize a wide range of park NBS into five high-level categories by size/capacity, location of the gray–green spectrum, and design objectives. We then employed this typology to explore how a park’s adopted NBS types may relate to its landscape and sociodemographic contexts. We found that the most used type of NBS in the studied parks was ECO (a typology we defined as conserving, restoring, or creating ecosystems to mitigate flooding through ecological processes and functions), while the least used NBS type was ENG (a typology we defined as imitating natural infiltration processes but having no living elements). Further, parks that adopted ECO had significantly higher percentages of greenspace in the surrounding, as well as higher flood risks. We also found notable—though not statistically significant—evidence of potential associations between the type of NBS implementation in a park and its nearby neighborhoods’ income level, poverty, and population racial and age compositions. Moreover, our findings indicated that park visitors were more privileged compared to residents living near a park. We concluded that park contextual factors deserve more explicit consideration in the planning and design of NBS and discussed key implications of this study for practice and future research around park NBS for urban flooding.

Contraceptive access and use among women with migratory experience living in high-income countries: a scoping review

BackgroundWomen who have migrated often encounter difficulties in accessing healthcare and experience inequitable sexual and reproductive health outcomes in destination countries. These health inequities include contraceptive access and use. To better understand what influences contraceptive access and use, this scoping review set out to synthesize the evidence on contraceptive access and use and on associated interventions among women with migratory experience in high-income countries (HICs) in Europe, North America and Australasia.MethodsThe scientific databases PubMed, Web of Science and CINAHL were searched for peer-reviewed quantitative, qualitative and mixed method articles published between January 2000 and June 2023. Articles were included if they reported on studies exploring contraceptive use to prevent pregnancies among women of reproductive age with migratory experience living in HICs. Two researchers independently screened and extracted data from the articles. Findings were categorized by patient and health system level factors according to Levesque et al.’s framework of access to health care.ResultsA total of 68 articles were included, about half (n = 32) from North America. The articles focused on the individual level rather than the health system level, including aspects such as women’s contraceptive knowledge, the influence of culture and religion on accessing and using contraception, partner involvement, and differing health insurance coverage. On the health system level, the articles highlighted lack of information on contraceptive services, cultural (in)adequacy of services and communication aspects, contraceptives’ side effects, as well as geographic availability and cost of services. The review further identified three articles reporting on interventions related to contraceptive counselling.ConclusionsThere is a lack of knowledge regarding how health systems impose obstacles to contraceptive services for women with migratory experience on an organizational level, as research has focused heavily on the individual level. This review’s findings may serve as a foundation for further research and advances in policy and practice, specifically recommending early provision of health system related information and contraceptive education, engagement of male partners in contraceptive discourses, cultural competency training for healthcare professionals, and strengthening of interpretation services for contraceptive counselling.

EFFICIENCY OF MONETARY POLICY IMPLEMENTATION AS A BASIS FOR CENTRAL BANK STABILISATION POLICY UNDER MARTIAL LAW (UKRAINIAN AND ISRAELI PRACTICES)

The purpose of the paper is to summarise and present the anti-crisis practices of a central bank during martial law in the country, based on the experience of the National Bank of Ukraine and the Bank of Israel. The research methodology is based on an analysis of reports, guidelines, statistical data, scientific articles, legislation bases, and other relevant materials. One of the methodological aspects of this study is a comparison of the knowledge acquired about the regulations implemented by the two central banks after the introduction of martial law in the countries. The objective is to identify potential lessons learned for the banking regulations of Ukraine and the State of Israel. The results of the study show that the practical implementation of stabilisation measures by central banks is crucial for achieving financial stability of the state both during and after wartime, as well as the ability to predict possible deepening of crises and minimise their consequences. The tools and methods used by these central banks differ. In particular, the NBU's main monetary policy instrument was foreign exchange interventions, while the BoI actively used the key policy rate. The proper formation of international currency reserves and the possibility of using them during a war-related crisis is critical for both countries. This fact confirms that crisis management has different types of scenarios. Each anti-crisis scenario is unique. This paper highlights the practical need for interaction between monetary and macroprudential policies of the central bank in wartime. It demonstrates various combinations of methods and instruments of the central bank's monetary policy. This study also shows the interdependence of the economies of these two countries. Practical implementation. This analysis provides insight into the anti-crisis activities of central banks during unpredictable periods in a country's life, namely, during martial law. At the present stage, banking systems do not often face the challenges of war. Therefore, studying each case is important for improving theoretical knowledge and deepening practical research. Value / Originality. The author of the study collected the experience and practices of stabilisation activities of the central banks of Ukraine and Israel during the war.

Excess health care use is significantly and persistently reduced following diagnosis of late‐onset epilepsy

AbstractObjectiveThe incidence of late‐onset epilepsy (LOE) is rising, and these patients may use an excess of health care resources. This study aimed to measure pre‐/post‐diagnostic health care use (HCU) for patients with LOE compared to controls.MethodsThis was an observational open cohort study covering years 1998–2019 using UK population‐based linked primary care (Clinical Practice Research Datalink [CPRD]) and hospital (HES) electronic health records. The participants included patients with incident LOE enrolled in CPRD and 1:10 age‐, sex‐, and general practice–matched controls. The exposure was incident LOE (diagnosed at age ≥65) using a 5‐year washout. The main outcome was all HCU (primary care [PC], accident and emergency [A&E], admitted patient and outpatient care) using inverse proportional weighting to PC use and HCU by setting. An interrupted time‐series analysis was used to examine pre‐/post‐diagnostic HCU between patients with LOE and controls over 4 years either side of diagnosis/matching date. An adjusted mixed‐effects negative binomial regression was used for post‐diagnosis HCU interactions.ResultsOf 2 569 874 people ≥65 years of age, 1048 (4%) developed incident LOE. Mean weighted total HCU increased by 32 visits per patient‐year (95% confidence interval [95% CI]: 13–50, p = .003) until LOE diagnosis, and then dropped by a mean of 60 visits per patient‐year (95% CI: −81 to −40). There was an acute rise and fall over the 1–2 years immediately pre‐/post‐diagnosis. Incident HCU remained higher for LOE compared to controls post‐diagnosis (adjusted incidence rate ratio: 1.72; 95% CI: 1.65–1.70; p < .001), including A&E, outpatient, and admitted care.SignificanceHealth care use demonstrates an acute on chronic rise over the 4 years before diagnosis of LOE. To what extent the partial reversal of the acute pre‐diagnosis rise, and the mediators of the accelerated increase compared to controls are attributed to epilepsy, comorbid and bidirectional disease states, or a combination of both warrants further exploration.

Design Practice Research: Conditions and Outcomes

There is no agreed framework for classifying what is, and is not, design practice research. This is a problem at a time when funders are interested in supporting practice research in the university context and look at design research as an example. This article addresses this challenge. Based on the key themes identified from a literature review—situated understanding, networked knowledge production, community of validation, and the knowledge status of objects produced through designing—we propose two frameworks. Collectively, the classificatory framework (specifying conditions) and the analytical framework (identifying outcomes) distinguish practice research in design from just practice on the one hand, and just research on the other. While allowing for historical and contextual variation, the approach offers a way of classifying practice research in design that is supported by practice researchers and that funders understand, without having to insist that there is something “ineffable” or ultimately inexpressible about practice research.

Incidence, Prevalence, and Survival of Prostate Cancer in the UK

ImportanceIncidence, prevalence, and survival are pertinent measures to inform the management and provision of prostate cancer care.ObjectiveTo calculate the incidence, prevalence, and survival rates for prostate cancer in the UK from 2000 to 2021.Design, Setting, and ParticipantsThis population-based cohort study uses routinely collected primary care data from the UK. Male patients aged 18 years or older with at least 1 year of history registered in Clinical Practice Research Datalink (CPRD) GOLD or Aurum were included. Data were analyzed from January 2023 to March 2024.Main Outcomes and MeasuresProstate cancer incidence rates (IR), period prevalence (PP), and 1-, 5-, and 10-year survival after diagnosis between 2000 and 2021, stratified by age and calendar years.ResultsThis study included 64 925 and 133 200 patients with prostate cancer in CPRD GOLD and Aurum, respectively, with a median age of 72 (65-78) years. The overall IR of prostate cancer was 151.7 (95% CI, 150.6 to 152.9) per 100 000 person-years in GOLD to 153.1 (95% CI, 152.3 to 153.9) per 100 000 person-years for Aurum and increased with age. The incidence of prostate cancer increased from 109 per 100 000 person-years in 2000 to 159 per 100 000 person-years in 2021. Peaks of incidence occurred in 2004 and 2018, before a decline in 2020. PP increased 3.5 times over the study period for both databases, from 0.4% in 2000 to 1.4% in 2021. IR and PP were highest in those aged 80 to 89 years. Median (95% CI) survival was similar in both databases (GOLD: 10.9 [95% CI, 10.7-11.1] years and Aurum: 11.1 [95% CI, 11.0-11.2] years). Survival at 1, 5, and 10 years after diagnosis were 93.4% (95% CI, 93.2%-93.6%), 71.8% (95% CI, 71.4%-72.2%), 53.2% (95% CI, 52.6%-53.7%) in GOLD and 93.9% (95% CI, 93.7%-94.0%), 72.7% (95% CI, 72.5%-73.0%), 53.7% (95% CI, 53.3%-54.1%) in AURUM, respectively. Survival increased over time: 1-year survival was 94.8% (95% CI, 94.5%-95.2%) in those diagnosed between 2015 to 2019 compared with 90.8% (95% CI, 90.2%-91.3%) from 2000 to 2004; 5-year survival improved from 65.3% (95% CI, 64.4%-66.3%) from 2000 to 2004 to 75.3% (95% CI, 74.4%-76.3%) in 2015 to 2019.Conclusions and RelevanceIn this population-based cohort study, incidence and prevalence increased with older age, with high survival rates reflecting a high burden of disease, particularly in the management of cancer survivorship in an aging population. Health care systems should consider this when managing the increasing numbers of people with prevalent prostate cancer.

Machine Learning for Actionable Warning Identification: A Comprehensive Survey

Actionable Warning Identification (AWI) plays a crucial role in improving the usability of static code analyzers. With recent advances in Machine Learning (ML), various approaches have been proposed to incorporate ML techniques into AWI. These ML-based AWI approaches, benefiting from ML’s strong ability to learn subtle and previously unseen patterns from historical data, have demonstrated superior performance. However, a comprehensive overview of these approaches is missing, which could hinder researchers and practitioners from understanding the current process and discovering potential for future improvement in the ML-based AWI community. In this paper, we systematically review the state-of-the-art ML-based AWI approaches. First, we employ a meticulous survey methodology and gather 51 primary studies from 2000/01/01 to 2023/09/01. Then, we outline a typical ML-based AWI workflow, including warning dataset preparation, preprocessing, AWI model construction, and evaluation stages. In such a workflow, we categorize ML-based AWI approaches based on the warning output format. Besides, we analyze the key techniques used in each stage, along with their strengths, weaknesses, and distribution. Finally, we provide practical research directions for future ML-based AWI approaches, focusing on aspects like data improvement (e.g., enhancing the warning labeling strategy) and model exploration (e.g., exploring large language models for AWI).

“Fue el Amor que nos Sostuvo”: The Relational Strengths of Latine Immigrant Couples

Family is an important protective factor for Latine immigrants. However, with most of the existing research focusing on overall family relationships, there is a knowledge gap about Latine couples and how their dyadic strengths may also be helpful in the face of immigration-related stressors. Using a Relational Cultural Theory framework, we conducted 16 semistructured interviews to qualitatively examine how eight Latine immigrant couples perceived their relationships positively impacted their immigration experiences. After analyzing over 20 hours of data, five themes emerged: (1) mutual support to overcome challenges and reach goals, (2) open communication based on respect, (3) working together as a team, (4) acceptance and admiration for each other, and (5) loving and being loved as a resource. Findings confirm the presence of significant relational strengths that can be leveraged in the management of immigration-related stressors. Implications for clinical practice and future research are discussed.

Syrian refugees in Canada: a qualitative report of the impact of the COVID-19 pandemic on psychosocial adaptation

Purpose Since March 2020, the global COVID-19 pandemic has disproportionately impacted refugees by compounding preexisting and systemic health, social and economic inequities. In Canada, approximately 50,000 Syrian refugees arrived between 2015 and 2020 and were in the process of rebuilding their lives when the pandemic started. This study aims to explore the impact of the COVID-19 pandemic for Syrian refugees in Canada and identify supports needed. Design/methodology/approach Drawing on frameworks for refugee psychosocial adaptation and social integration and a qualitative descriptive design, the study used thematic analysis to examine semi-structured interviews with 10 Syrians. Findings Findings indicated four themes that provide a snapshot of impacts relatively early in the pandemic: facing ongoing development, inequity and insecurity during integration; disruption of settlement, integration and adaptation due to the pandemic; ongoing adaptation and resilience during integration in Canada; and ongoing needs and solutions for integration and adaptation. Originality/value This study builds upon growing research concerning Syrian refugees and psychosocial adaptation, particularly during the pandemic. The findings highlight the impacts of the pandemic on a population already facing inequities in a resettlement country. While the findings emphasize the resilience of the Syrian refugee community, the study also demonstrates the need for ongoing supports and justice-oriented action to fulfill resettlement commitments, especially in the face of additional stressors like the COVID-19 pandemic. Implications for policy, practice and future research are discussed.

Trends in the prevalence and pharmacological management of migraine during pregnancy in the UK, 2000–2018

BackgroundMigraine is common in women of reproductive age. This study aimed to (1) describe the prevalence of migraine in pregnant women in the UK, (2) identify drugs commonly prescribed for...

Optimal risk-assessment scheduling for primary prevention of cardiovascular disease

Abstract In this work, we introduce a personalized and age-specific net benefit function, composed of benefits and costs, to recommend optimal timing of risk assessments for cardiovascular disease (CVD) prevention. We extend the 2-stage landmarking model to estimate patient-specific CVD risk profiles, adjusting for time-varying covariates. We apply our model to data from the Clinical Practice Research Datalink, comprising primary care electronic health records from the UK. We find that people at lower risk could be recommended an optimal risk-assessment interval of 5 years or more. Time-varying risk factors are required to discriminate between more frequent schedules for high-risk people.

THE DIFFERENTIATION OF SETTLEMENTS IN THE MUNICIPALITY OF SREBRENICA AS A CONSEQUENCE OF AGGRESSION

The municipality of Srebrenica is located in the northeast of Bosnia and Herzegovina. Due to the aggression, in April 1992, a large number of residents left the area. Thus, the exile crisis of the population of Srebrenica has begun and has not ended to this day. The paper presents theoretical and practical research on the settlements and population of Srebrenica and the changes that occurred after the aggression and genocide. The paper identified the causes and problems faced by the population living in this area today. Apart from literature and planning documents, indicators obtained from municipal departments for social activities, statistical indicators of the Agency for Statistics from the population and household census were used in the preparation of the work. The results show the demographic uncertainty, i.e. the municipality of Srebrenica is, from a demographic point of view, one of the most affected areas by the war in Bosnia and Herzegovina.

Improving digital storybook story comprehension in kindergartners with developmental delays using peer-assisted learning strategies

This study evaluated the effect of peer-assisted learning strategies (PALS) intervention on the language and story comprehension skills of two kindergartners with developmental delays from a special education class while reading a digital storybook. The study was conducted in Taiwan with participants who spoke Mandarin Chinese. This study was a single-subject A-B1-C1-B2-C2-M study. The study compared the effects of conventional teaching methods with those of the modified PALS intervention. A standardized instrument and visual analysis were used to assess changes in language and story comprehension skills. After the intervention, the teacher and parents of the study participants were interviewed to evaluate changes in language skills of the participants at home and at school. The qualitative and quantitative results showed that this strategy effectively improved story comprehension skills. The teacher and parents all had positive views on this teaching strategy. Based on the findings, practical and future research suggestions are proposed.

Effectiveness and risk of ARB and ACEi among different ethnic groups in England: A reference trial (ONTARGET) emulation analysis using UK Clinical Practice Research Datalink Aurum-linked data.

Guidelines by the National Institute for Health and Care Excellence recommend an angiotensin receptor blocker (ARB) rather than an angiotensin-converting enzyme inhibitor (ACEi) for the treatment of hypertension for people of African and Caribbean descent, due to an increased risk of angioedema associated with ACEi use observed in US trials. However, the effectiveness and risk of these drugs in Black populations in UK routine care is unknown. We applied a reference trial emulation approach to UK Clinical Practice Research Datalink Aurum data (linked with data from Hospital Episode Statistics and Office for National Statistics) to study the comparative effectiveness of ARB and ACEi in ethnic minority groups in England, after benchmarking results against the ONTARGET trial. Approximately 17,593 Black, 30,805 South Asian, and 524,623 White patients receiving a prescription for ARB/ACEi between 1 January 2001 and 31 July 2019 were included with a median follow-up of 5.2 years. The primary composite outcome was cardiovascular-related death, myocardial infarction, stroke, or hospitalisation for heart failure with individual components studied as secondary outcomes. Angioedema was a safety endpoint. We assessed outcomes using an inverse-probability-weighted Cox proportional hazards model for ARB versus ACEi with heterogeneity by ethnicity assessed on the relative and absolute scale. For the primary outcome, 27,327 (18.0%) events were recorded in the ARB group (event rate: 25% per 5.5 person-years) and 80,624 (19.1%) events (event rate: 26% per 5.5 person-years) in the ACEi group. We benchmarked results against ONTARGET and observed hazard ratio (HR) 0.96 (95% CI: 0.95, 0.98) for the primary outcome, with an absolute incidence rate difference (IRD)% of -1.01 (95% CI: -1.42, -0.60) per 5.5 person-years. We found no evidence of treatment effect heterogeneity by ethnicity for the primary outcome on the multiplicative (Pint = 0.422) or additive scale (Pint = 0.287). Results were consistent for most secondary outcomes. However, for cardiovascular-related death, which occurred in 37,554 (6.6%) people, there was strong evidence of heterogeneity on the multiplicative (Pint = 0.002) and additive scale (Pint < 0.001). Compared to ACEi, ARB were associated with more events in Black individuals (HR 1.20 (95% CI: 1.02, 1.40); IRD% 1.07 (95% CI: 0.10, 2.04); number-needed-to-harm (NNH): 93) and associated with fewer events in White individuals (HR 0.91 (95% CI: 0.88, 0.93); IRD% -0.87 (95% CI: -1.10, -0.63); number-needed-to-treat (NNT): 115), and no differences in South Asian individuals (HR 0.97 (95% CI: 0.86, 1.09); IRD% -0.17 (95% CI: -0.87, 0.53)). For angioedema, HR 0.56 (95% CI: 0.46, 0.67) with no heterogeneity for ARB versus ACEi on the multiplicative scale (Pint = 0.306). However, there was heterogeneity on the additive scale (Pint = 0.023). Absolute risks were higher in Black individuals (IRD% -0.49 (95% CI: -0.79, -0.18); NNT: 204) compared with White individuals (IRD% -0.06 (95% CI: -0.09, -0.03); NNT: 1667) and no difference among South Asian individuals (IRD% -0.05 (95% CI: -0.15, 0.05) for ARB versus ACEi. These results demonstrate variation in drug effects of ACEi and ARB for some outcomes by ethnicity and suggest the potential for adverse consequences from current UK guideline recommendations for ARB in preference to ACEi for Black individuals.

Foundational model aided automatic high-throughput drug screening using self-controlled cohort study.

Developing medicine from scratch to governmental authorization and detecting adverse drug reactions (ADR) have barely been economical, expeditious, and risk-averse investments. The availability of large-scale observational healthcare databases and the popularity of large language models offer an unparalleled opportunity to enable automatic high-throughput drug screening for both repurposing and pharmacovigilance. To demonstrate a general workflow for automatic high-throughput drug screening with the following advantages: (i) the association of various exposure on diseases can be estimated; (ii) both repurposing and pharmacovigilance are integrated; (iii) accurate exposure length for each prescription is parsed from clinical texts; (iv) intrinsic relationship between drugs and diseases are removed jointly by bioinformatic mapping and large language model - ChatGPT; (v) causal-wise interpretations for incidence rate contrasts are provided. Using a self-controlled cohort study design where subjects serve as their own control group, we tested the intention-to-treat association between medications on the incidence of diseases. Exposure length for each prescription is determined by parsing common dosages in English free text into a structured format. Exposure period starts from initial prescription to treatment discontinuation. A same exposure length preceding initial treatment is the control period. Clinical outcomes and categories are identified using existing phenotyping algorithms. Incident rate ratios (IRR) are tested using uniformly most powerful (UMP) unbiased tests. We assessed 3,444 medications on 276 diseases on 6,613,198 patients from the Clinical Practice Research Datalink (CPRD), an UK primary care electronic health records (EHR) spanning from 1987 to 2018. Due to the built-in selection bias of self-controlled cohort studies, ingredients-disease pairs confounded by deterministic medical relationships are removed by existing map from RxNorm and nonexistent maps by calling ChatGPT. A total of 16,901 drug-disease pairs reveals significant risk reduction, which can be considered as candidates for repurposing, while a total of 11,089 pairs showed significant risk increase, where drug safety might be of a concern instead. This work developed a data-driven, nonparametric, hypothesis generating, and automatic high-throughput workflow, which reveals the potential of natural language processing in pharmacoepidemiology. We demonstrate the paradigm to a large observational health dataset to help discover potential novel therapies and adverse drug effects. The framework of this study can be extended to other observational medical databases.

How might shared decision-making meetings reduce the need for children to be in care? A rapid realist review

Summary Meetings to enhance shared decision-making, such as family group conferences, potentially contribute to enhancing meaningful involvement of families. Such meetings are also claimed by some to reduce the need for children to be in care, either by increasing support from family for parents or by identifying care from within the family network. This rapid realist review aims to develop an understanding of how meetings that facilitate shared decision-making between professionals and families might work to safely reduce the need for children to be in care. It identifies mechanisms that are thought to make a difference and contextual factors that influence the impact of identified mechanisms. Findings A comprehensive search of academic and gray literature identified 64 documents spanning seven types of shared decision-making meetings. Data from these papers were collected using an iterative process of juxtaposition, comparison, contrast, and combination with a developing program theory. Data from the literature was supplemented with consultation to ensure relevance to the UK setting. The review identified three key mechanisms that made shared decision-making meetings more likely to be effective in safely reducing children's entry to care: enabling participation and engagement; building trust and reducing shame; enabling participation in decision-making processes. It describes how these work before, during, and after meetings. Applications The findings help us understand the complicated research findings about the relationship between meetings and care entry and provide a theory about what is needed to make such meetings work that is of practical use for practice and future research

Short-Term Risk of Cardiovascular Events in People Newly Diagnosed With Gout.

To investigate the temporal association between the first diagnosis of gout and cardiovascular events in the short term. We performed a self-controlled case series analysis and a cohort study using data from linked primary care, hospitalization, and mortality records from the United Kingdom's Clinical Practice Research Database-GOLD. We included individuals with a new diagnosis of gout either in the primary care or secondary care between January 1, 1997 and December 31, 2020. The first consultation at which gout was diagnosed was the exposure of interest. The main outcome consisted of cardiovascular events (ie, a composite of fatal and nonfatal myocardial infarction, ischemic or hemorrhagic stroke, and transient ischemic attack). The 4,398 patients (66.9% male, mean age 74.6 years) had a cardiovascular event within at least two years of their first recorded diagnosis of gout. The incidence of cardiovascular events was significantly higher in the 30 days after the first diagnosis of gout compared to baseline (adjusted incidence rate ratio 1.55, 95% confidence interval [CI] 1.33-1.83). Among 76,440 patients (72.9% male, mean age 63.2 years) included in the cohort study, the incidence of cardiovascular events in the 30 days after the first gout diagnosis (31.2 events per 1,000 person-years, 95% CI 27.1-35.9) was significantly higher than in days 31 to 730 after gout diagnosis (21.6 events per 1,000 person-years, 95% CI 20.8-22.4) with a rate difference of -9.6 events per 1,000 person-years (95% CI -14.0 to -5.1). Individuals had a short-term increased risk of cardiovascular events in the 30 days following the first consultation at which gout was diagnosed.