Pressure Off Research Articles

Contract as Vow or Oath

Abstract Many scholars and judges attempt to harmonize legal practices of contracting with the social practice of promising in ordinary life. This article explores an alternative genealogy of contract in traditional social practices that track many of contract's core norms: taking vows and oaths. Without denying that promissory morality infiltrates modern contract, contract-as-vow-or-oath can expose by way of a supplementary account why some contract rules work as they do and can take some pressure off of a more unitary promissory theory in justifying, explicating, and reforming contract law.

Fold in the Cheese? An Approach to Teaching Qualitative Data Analysis to Students

There are many elements of qualitative data analysis that may appear intangible to novice researchers. In this article, I present an approach to a data analysis workshop with students, where I do my best to avoid the instruction to “fold in the cheese,” as per the television series Schitt’s Creek. Students attend 90-minute workshops where they use an assortment of buttons to practice different strategies of qualitative analysis. The tactile mechanism of sorting objects has proven invaluable in workshops, as it helps students to physically organize their thoughts and takes pressure off to find the “right” answer. The nature of the items could also be adapted to meet students’ accessibility needs. The workshop has improved the quality of student writing in methods chapters and built students’ confidence as they approach their own data analysis processes, especially for master’s students and research assistants, where a full-length course may not be feasible.

The role of aquaculture in the international trade of giant clams (Tridacninae) for the aquarium industry (2001–2019)

An overview over the international trade in live giant clams (Bivalvia: Tridacninae) from 2001 to 2019 was made based on worldwide import data from the CITES Trade Database. A distinction was made between trade records of wild-caught clams and maricultured ones. A general decline in the trade of wild giant clams was observed. Since these bivalves naturally live attached to rocky substrate in coral reefs and their forceful removal is harmful to surrounding corals, this trend helped to prevent damage to their natural environment. Possible reasons behind this decline are lower population numbers, trade restrictions, and a decrease in demand. Trade in wild-caught Tridacna crocea decreased, whereas that of T. maxima increased, taking over the former's position as most popular species. From 2015 onwards, over 50% of the source was made up by aquaculture, up to 2019. Aquaculture of live giant clams can be profitable, but there are still obstacles to overcome in order to ensure stable production numbers and long-term profit. With more research and support from governments, aquaculture can help to take pressure off wild populations of giant clams that are already suffering from exploitation for the sea-food market and souvenir industry, and also from habitat degradation due to climate change and other anthropogenic disturbances.

COVID-19 vaccine refusal as unfair free-riding

Contributions to COVID-19 vaccination programmes promise valuable collective goods. They can support public and individual health by creating herd immunity and taking the pressure off overwhelmed public health services; support freedom of movement by enabling governments to remove restrictive lockdown policies; and improve economic and social well-being by allowing businesses, schools, and other essential public services to re-open. The vaccinated can contribute to the production of these goods. The unvaccinated, who benefit from, but who do not contribute to these goods can be morally criticised as free-riders. In this paper defends the claim that in the case of COVID-19, the unvaccinated are unfair free-riders. I defend the claim against two objections. First, that they are not unfair free-riders because they lack the subjective attitudes and intentions of free-riders; second, that although the unvaccinated may be free-riders, their free-riding is not unfair.

Storing veterinary medical products correctly and safely

The correct storage of veterinary medical products and accurate recording of temperatures has been highlighted as an area of concern by the RCVS and the Veterinary Medicines Directorate. This article explains the refrigeration technology that can ensure compliance with the Veterinary Medicines Regulations and help to take the pressure off busy practices and teams.

Human-Computer Collaborative Visual Design Creation Assisted by Artificial Intelligence

With the support and promotion of big data and cloud computing, AI has penetrated into every field of people's lives more and more deeply, with its characteristics of sustainable work, extremely fast computing speed, and a certain intelligence. This is an effective way to solve the general lack of demand and productivity of visual design, and relieve the pressure off designers to deal with relatively low-quality and high-demand designs. Therefore, the combination of design and artificial intelligence technology is a necessity. Research on the application of artificial intelligence technology for visual design is also in full swing at home and abroad However, at present, teams at home and abroad are in the exploratory stage. This paper considers whether it is possible to build an intelligent visual design and creation system by using artificial intelligence technology to help graphic communication designers achieve high-quality, high-efficiency, and high-quantity design output. Additionally, this paperexplores how to combine artificial intelligence technology with designers' design workflow so as to form a complementary human-computer cooperation mode. We will explore how to integrate AI technology with designers' design workflow and then create a human-machine collaboration model with complementary advantages to achieve the high quality, high efficiency, and high quantity of design output required by the intelligent visual design creation system being built. Finally, a basic framework of a generative smart human-computer collaborative visual design creation system based on a subset of neural network expert systems in multiple domains and an aggregate of different modules supported by the system is formed, and the working principle and usage process of the system are further elaborated with the example of packaging design.

90 Breast Abscess Management: What Is Best for Breast?

Abstract Aim To assess the speed of resolution of breast abscesses presenting to the unit. There is significant variation in the management of breast abscesses between units at a national level. Whilst the MAMMA study results are awaited, we wished to understand our unit’s outcomes in order to improve the patient journey. Method A single centre retrospective service evaluation of acute breast abscesses. The project was approved on the hospitals online QSIS system. The data was collected by interrogating the health records database using the following criteria: female, minimum age 16, presenting between 01/01/2017 - 31/12/2021. ICD codes for; breast abscess and/or breast infection were analysed with Excel (v16.40). Results 298 notes were reviewed as a representative sample of outcomes (n = 700). 73 patients (24.5%) were correctly coded to have a breast abscess. The median age was 41 years (IQR 50-29.5). All received an USS scan within 24 hours. The cohort was stratified along smokers (32%) and lactational (23%) risk factors. Smokers were most likely to require I&D (39%) and had the longest duration of antibiotics (24 days). The median time for resolution was similar between those treated with serial aspirations (40 days) and those who needed I&D (42 days). Conclusions The study demonstrated prompt access to USS and aspirations. Each abscess presentation took approximately 1 month to resolve and needed 4 visits to the unit. This aspect of care is an area for improvement so that we can streamline the process and take pressure off valuable clinic slots.

Predicting Heart Attack

Heart diseases are increasing day by day, and predicting these diseases is very important and worrying. This diagnosis is a difficult task because it must be done accurately and efficiently. Most studies focus on patients at risk for heart disease based on a variety of medical conditions. We proposed a heart disease predictor that uses the patient's medical history to predict whether a patient will be diagnosed with heart disease. We use various machine learning algorithms, such as logistic regression and KNN, to predict and classify heart patients. A useful way to formalize how the model can be used to improve the accuracy of heart attack prediction for each individual The power of the model is very good and can predict the evidence of heart disease in an individual using KNN and logistic regression, comparing performance with other methods and previously used classifiers such as Naive Bayes. By using the given model to find the probability of the distributor being correct and to determine the heart disease, we have taken most of the pressure off ourselves. Predicting heart disease improves health and reduces costs. This project has given us important information that can help us predict patients with heart disease

Taking the pressure off: glaucoma and what can be done to help

Prompt recognition and treatment to reduce the intraoccular pressures is key in canine patients with glaucoma. If treatment is delayed, glaucoma can cause permanent damage or result in enucleation of the affected eye. Acute glaucoma develops quickly, increasing intraocular pressure and causing high levels of pain, disorientation, stress and discomfort. Nurses play a vital role in the management of these patients, by monitoring and recording pressures, recognising and managing pain, correct and timely application of medications and reducing patient stress.

The use of simulation in medical ultrasound: Current perspectives on applications and practical implementation (WFUMB state-of-the-art paper).

Simulation has been shown to improve clinical learning outcomes, speed up the learning process, and improve trainee confidence, while taking the pressure off initial face-to-face patient clinical areas. The second part of The World Federation for Ultrasound in Medicine and Biology state-of-the-art paper on the use of simulators provides a general approach on the practical implementation. The importance of needs assessment before developing a simulation-based training program is outlined. We describe the current practical implementation and critically analyze how simulators can be integrated into complex task scenarios to train small or large groups. A wide range of simulation equipment is available especially for those seeking interventional ultrasound training, ranging from animal tissue models, simple synthetic phantoms, to sophisticated high-fidelity simulation platforms using virtual reality. Virtual reality simulators provide feedback and thereby allow trainees to not only to practice their motor skills and hand eye coordination but also to interact with the simulator. Future developments will integrate more elements of automated assessment and artificial intelligence, thereby enabling enhanced realistic training experience and improving skill transfer into clinical practice.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

The ultrasound use of simulators, current view, and perspectives: Requirements and technical aspects (WFUMB state of the art paper).

Simulation has been shown to improve clinical learning outcomes, speed up the learning process and improve learner confidence, whilst initially taking pressure off busy clinical lists. The World Federation for Ultrasound in Medicine and Biology (WFUMB) state of the art paper on the use of simulators in ultrasound education introduces ultrasound simulation, its advantages and challenges. It describes different simulator types, including low and high-fidelity simulators, the requirements and technical aspects of simulators, followed by the clinical applications of ultrasound simulation. The paper discusses the role of ultrasound simulation in ultrasound clinical training, referencing established literature. Requirements for successful ultrasound simulation acceptance into educational structures are explored. Despite being in its infancy, ultrasound simulation already offers a wide range of training opportunities and likely holds the key to a broader point of care ultrasound education for medical students, practicing doctors, and other health care professionals. Despite the drawbacks of simulation, there are also many advantages, which are expanding rapidly as the technology evolves.

The Compassionate Communities Connectors programme: experiences of supported families and referring healthcare providers.

Comprehensive evaluations that include the experience of patients and service providers are vital if interventions are to be translated into the standard practice of health services and allow formal networks to work as partners with informal community networks. However, published evaluations are limited in the palliative care volunteering literature. The objective of the study is to explore the experiences and views of both patients and their family carers who received support and their referring healthcare providers concerning their participation in the Compassionate Communities Connectors programme, in the south-west region of Western Australia. Connectors identified and addressed gaps in community and healthcare provision by accessing resources and mobilising social networks of people with life-limiting illnesses. The perspectives of patients, carers and service providers concerning the feasibility and acceptability of the intervention were sought. Semistructured interviews were undertaken with 28 patients/families and 12 healthcare providers, resulting in 47 interviews in total (March 2021-April 2022). An inductive content analysis was used in analysing interview transcripts to identify key themes. Families greatly appreciated the support and enablement received from the Connectors. Healthcare providers were impressed with the high level of resourcefulness exhibited by the Connectors and perceived a great need for the programme, particularly for those socially isolated. Three themes captured the patients'/families' perspectives: connector as an advocate, increasing social connectedness and taking the pressure off families. Healthcare providers' perspectives were captured in three themes: reducing social isolation, filling a gap in service provision and building the capacity of the service. Perspectives of patients/families and healthcare providers demonstrated the mediating role of Connectors. Each group saw the Connectors' contribution through the lens of their particular interests or needs. However, there were indications that the connection was shifting the way each group understood and practised care, encouraging or restoring agency to families and reminding healthcare providers that collaborating beyond the boundaries of their roles actually enhances the whole ecology of care. Using a Compassionate Communities approach to mobilise health and community sectors has the potential to develop a more holistic approach that addresses the social, practical and emotional domains of care.

Perspectives from parents of autistic children on participating in early intervention and associated research.

Support for autistic children early in life should help them to lead flourishing lives. However, many of the early intervention programmes for young autistic children are time-consuming and costly for families. These programmes are also often conducted in settings that are not closely matched to real life. We spoke to 23 parents (of 22 autistic children) to understand their experiences of their children's involvement in early intervention. Parents told us they were grateful for the opportunity, that they had 'hit the jackpot', and their children had 'gained so much' from the programme. They seemed to value the service because it made them feel safe and secure during an uncertain time in their children's lives. Parents told us they trusted staff, felt that they weren't 'doing it alone', and this 'took that pressure off' and helped them feel empowered. They also spoke of feelings of safety from being linked to the university research programme which offered 'accountability' and 'integrity'. Parents' comments showed a strong commitment to the early intervention model and staff - but also common feelings of abandonment and disempowerment as their child's time with the programme came to an end and they went 'back to the real world' and needed to find new supports for their children. These parents' insights should help to inform the design and delivery of community supports for preschool-aged autistic children and their families, which match the reality of their lived experiences.

An evaluation of remote algorithm-assisted consultations for the safe prescribing of progesterone-only pills in a digital setting

Abstract Introduction This study aimed assessed the prescribing quality of progesterone-only pills (POP) to determine whether online asynchronous algorithmic assisted consultations alone could help women or whether enhanced remote consultations still need to be performed. Our digital service follows Faculty of Sexual and Reproductive Healthcare FSRH clinical guidance, patients who have conditions that fall in category of UKMEC 3 and 4 would be signposted to other methods.1,2 The service works by patients completing an online consultation which is supported by algorithm-assisted consultations. The algorithm is written by doctors and pulls out the relevant information for the clinician to suggest whether it safe to prescribe. Asynchronized consultations using algorithms can identify patients for whom POP is not suitable to prescribe. As this is safe and scalable, it has the potential to improve access to contraception for women. For those women where technology identifies that POP is not suitable, there is still an important place for remote interaction to ensure that women are able to make an informed and safe contraceptive choice. Aim To review patients who met a Faculty of Sexual and Reproductive Healthcare (FSRH) exclusion for POP to determine adherence to FSRH clinical guidance on signposting these patients to in-person services where appropriate,1.2 and to review patients’ medical records, who were initially declined POP after completing an online consultation to identify the outcome and potential pathway improvement. Methods A retrospective case-note review of 362 patients, who met a FSRH exclusion criteria for POP, using a large digital sexual health service for POP (Cerelle, Cerazette, Norgeston, Noriday) between 1.3.21-25.5.22. Those patients who were not prescribed POP were then identified, to see how they were managed; how many were signposted to the clinic and how many were managed remotely and subsequently prescribed POP. The data underwent descriptive statistical analysis. Ethical approval was not required as this was a service evaluation. Results Of the 362 patients who met the FSRH exclusion criteria (100% female, aged 18-51), 288 (80%) patients were declined from POP treatment and signposted to in-persons services, 74 (20%) were prescribed POP after clinician review. Of the 288 who were initially declined POP, 110 (38%) patients sought further advice with a clinician remotely, resulting in 83 being prescribed POP and 27 being declined. Overall clinicians correctly followed guidance for 99% (284/288) of POP consultations who met the FSRH exclusion criteria.2 Of these 4 patients reported potential exclusion criteria for POP and were prescribed. Upon reflection, clinicians felt the potential exclusion criteria could have been explored further before prescribing. Discussion/Conclusion Asynchronous consultations bring lots of efficiencies, assists clinicians in triaging and managing the majority of patients. We’ve developed a pathway where patients can undertake a further discussion with a clinician remotely, which resulted in provision of remote contraception. This is convenient for patients and has the potential or may ease pressure off in-person services.

Pressure-dependent electronic properties in the rocksalt structure of lithium fluoride: A DFT Study

Density functional theory (DFT) calculation are carried out for the cubic structure of lithium fluoride (LiF). Variation of applied pressure is considered, ranging from 0 to 120 GPa with an increment of 30 GPa based on PBE and SCAN functional scheme. In zero pressure and energy-cut off 100 Ry, best result on lattice parameter is obtained by using PBE functional with the value of 4.06 Å, while SCAN functional overestimates the lattice parameter at 4.15 Å. The insulating gap of both results is significantly underestimated with 8.82 eV and 9.26 eV for PBE and SCAN functionals respectively. With the applied hydrostatic pressure, the lattice parameter are reduced exponentially, while still retaining the insulating behaviour with an increased value of gap energy.

RF32 | PSUN65 Effect of Oral Contraceptive Medication on Blood Pressure, Plasma Renin, and Aldosterone Levels

Abstract Background Combination oral contraceptive medications may cause elevations of plasma renin activity and aldosterone levels. Clinical Case A 20-year-old female with a past medical history of chronic migraines and allergic rhinitis was referred to endocrinology for evaluation of secondary hypertension after she was found to have elevated renin levels by her primary care physician. The patient was noted to be hypertensive during a tonsillectomy 4 months prior and had also experienced an increased frequency of headaches prompting an evaluation for secondary hypertension and the initiation of lisinopril 10 mg daily. Her other medications included levocetirizine, biotin, and the combined oral contraceptive pill (OCP) norgestimate-ethinyl estradiol (0.25 mg/0.035 mg). Physical examination was remarkable for blood pressure 130/85mmHg, Pulse rate 77, BMI 30 kg/m2, pale striae on upper arms, lower back and abdomen, and a slight fat pad on the posterior nape of her neck. Initial lab results revealed normal plasma sodium, potassium, metanephrines and normetanephrines, plasma renin activity (PRA) 70.657 ng/mL/h (0.167-5.380 ng/mL/h), aldosterone 18.9 ng/dL (0.0-30.0 ng/dL), and 8: 00 amcortisol 30.3 mcg/dL (6.2-19.4mcg/dL). Doppler ultrasound and magnetic resonance angiography excluded renal artery stenosis and abdominal renin-secreting tumors. Owing to concern about OCP interference with the measurements of PRA and aldosterone levels, these tests were repeated at the end of a seven-day OCP placebo pills and biotin withdrawal. Lab results revealed: PRA >178 ng/mL/h, aldosterone 15.3 ng/dL, 1 mg overnight dexamethasone suppression test cortisol 1.1 mcg/dL, and 24-hour urinary cortisol 22.4 mcg/L (normal value <24mcg/L). Subsequently, the patient agreed to discontinue OCP and biotin and have labs redrawn 6 weeks later, which revealed PRA of 0.9 ng/mL/h and aldosterone of 5.9 ng/dL. Her blood pressure also normalized off the oral contraceptive and lisinopril was successfully discontinued. Conclusion This case report demonstrates the clinically significant impact of oral contraceptive medication on blood pressure, plasma renin activity and aldosterone levels. It's well known that oral contraceptives may cause elevations in PRA and aldosterone1 likely due to an upregulation of angiotensin mediated by the effect of ethinyl estradiol on the hepatocytes1, albeit not previously reported of the magnitude found in our patient. The extreme elevations of PRA and aldosterone in our patient suggested a diagnosis of either renovascular hypertension, renin secreting neoplasm or coarctation of aorta all of which were excluded. The subsequent normalization of blood pressure, PRA and Aldosterone off oral contraception×6 weeks confirmed that the OCP was the source of her hypertension and lab abnormalities. This case highlights the importance of identifying and omitting interfering medications when evaluating patients for secondary causes of hypertension. References Oelkers WK. Effects of estrogens and progestogens on the renin- aldosterone system and blood pressure. Steroids 1996;61: 166–71. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 12:36 p.m. - 12:41 p.m.

Inter-imperiality: Vying Empires, Gendered Labor, and the Literary Arts of Alliance

Inter-imperiality: Vying Empires, Gendered Labor, and the Literary Arts of Alliance

New study suggests taking pressure off inpatient hypertension management

Researchers of a recently published retrospective cohort analysis published in the February 2022 issue of The Journal of Clinical Hypertension looked at hypertensive urgency patients at several teaching hospitals within their health system. Perhaps surprisingly, their results suggest that treatment of end organ damage (i.e., hypertensive urgency)—when developed during an admission—in addition to intravenous antihypertensive medication may be more deleterious than oral antihypertensive medication or no treatment at all.

Wetland importance and dependence among households around the Ogun River Basin, Nigeria

Wetland is particularly important in developing countries for economic purposes. This study examines livelihood activities, wetland dependence and its determinants among wetland households. Primary data were collected from households in a two stage random sampling procedure. Both descriptive and quantitative methods were employed for data analysis. Results show that support for dry season production, all year round water supply, and fishing were the first, second and third most important benefits of wetland to households. Socio-economic factors have influences on wetland dependence. This study concludes that wetland support dry season farming and is heavily depended upon for income by households in wetland communities. It is therefore recommended that skills acquisition centres should be established in wetland communities to engage youths particularly male in other employment apart from wetland related ones so as to reduce dependence on wetlands and thus take pressure off them.