Research Team Research Articles

Oral glucose tolerance test-The imperfect gold standard for gestational diabetes screening: A qualitative study involving clinicians in regional, rural and remote areas of Western Australia.

The oral glucose tolerance test is the 'gold standard' for detecting gestational diabetes in Australian and International guidelines. Test completion in regional, rural and remote regions may be as low as 50%. We explored challenges and enablers for regional, rural and remote antenatal clinicians providing gestational diabetes screening to better understand low oral glucose tolerance test completion. We conducted a qualitative descriptive study using semi-structured interviews. Participants eligible for the study were doctors or midwives providing antenatal care in regional, rural and remote Western Australia, between August 2019 and November 2020. Interviews were recorded digitally and transcribed into a Word document. We conducted a thematic analysis after initial categorisation and deduction of themes through workshops involving the research team. We found a diversity of viewpoints on oral glucose tolerance test reliability for detecting gestational diabetes. Themes that emerged were; good collaboration between antenatal clinicians is required for successful screening; screening occurs throughout pregnancy using various tests; clinicians make significant efforts to address barriers; clinicians prioritise therapeutic relationships. Effective universal screening for gestational diabetes in regional, rural and remote Western Australia is difficult and more complex in practice than guidelines imply. Detecting gestational diabetes requires creative solutions, early identification of at risk women and trust and collaboration between clinicians and women. SO WHAT?: Detection of gestational diabetes in regional, rural and remote Western Australia remains poorly completed. New strategies are required to adequately identify women at risk of adverse birth outcomes relating to hyperglycaemia in pregnancy.

Effectiveness of Online Programmes for Family Carers of People with Intellectual Disabilities: Systematic Review of the International Evidence Base.

This systematic literature review examines the evidence base on the effectiveness of online programmes on the mental health and well-being of family carers of people with intellectual disabilities. Databases (ERIC, Medline, PsycINFO and CINAHL) were searched for intervention studies that considered online interventions for family carers of people with intellectual disabilities. Data were extracted using standardised data extraction tools. Bias was assessed using the Cochrane risk of bias tool for randomised trials (RoB 2). Screening, extraction and assessment of bias were completed independently by two members of the research team. Given the low number of included studies and different outcomes assessed within them, it was not possible to conduct a meta-analysis; therefore, data are presented narratively. Two studies met the criteria to be included in the review. Both studies utilised a feasibility randomised controlled trial methodology. One study found a significant decrease in parental stress, while the other found a significant increase in psychological well-being. Caution must be taken in drawing firm conclusions, given the small sample sizes and low retention rates in both studies. Online programmes seem to offer potential benefits to family carers of people with intellectual disabilities. However, further investigation is needed to examine these programmes, adopting a collaborative approach with family carers.

Agreement between patient-reported and clinically documented symptoms of acute myeloid leukemia: Study protocol.

To describe our methods to compare patient-reported symptoms of acute myeloid leukemia and the corresponding documentation by healthcare providers in the electronic health record. Patients with acute myeloid leukemia experience many distressing symptoms, particularly related to chemotherapy. The timely recognition and provision of evidence-based interventions to manage these symptoms can improve outcomes. However, lack of standardized formatting for symptom documentation within electronic health records leads to challenges for clinicians when accessing and comprehending patients' symptom information, as it primarily exists in narrative forms in various parts of the electronic health record. This variability raises concerns about over- or under-reporting of symptoms. Consistency between patient-reported symptoms and clinician's symptom documentation is important for patient-centered symptom management, but little is known about the degree of agreement between patient reports and their documentation. This is a detailed description of the study's methodology, procedures and design to determine how patient-reported symptoms are similar or different from symptoms documented in electronic health records by clinicians. Exploratory, descriptive study. Forty symptoms will be assessed as patient-reported outcomes using the modified version of the Memorial Symptom Assessment Scale. The research team will annotate symptoms from the electronic health record (clinical notes and flowsheets) corresponding to the 40 symptoms. The degree of agreement between patient reports and electronic health record documentation will be analyzed using positive and negative agreement, kappa statistics and McNemar's test. We present innovative methods to comprehensively compare the symptoms reported by acute myeloid leukemia patients with all available electronic health record documentation, including clinical notes and flowsheets, providing insights into symptom reporting in clinical practice. Findings from this study will provide foundational understanding and compelling evidence, suggesting the need for more thorough efforts to assess patients' symptoms. Methods presented in this paper are applicable to other symptom-intensive diseases.

Sense of Purpose, Reduced Stress, and Connection as Protective Factors for Longevity: An Exploration of Barriers

ABSTRACT Background Utilizing the Blue ZonesⓇ framework and the nine lifestyle factors that promote well-being with longevity, an interdisciplinary team of researchers examined protective factors and barriers to engaging in each of the nine lifestyle factors. Purpose To report on protective factors and barriers to improving three of the nine lifestyle factors – sense of purpose, stress, and connection. Methods Using a mixed-method approach, 185 residents living in a rural community in the mid-southern part of the USA participated in this study via e-mail and social media. Results Notable demographic factors including age were significantly associated with fewer obstacles to achieving purpose, reduced stress, and leaving the home regularly. Qualitative responses link disruptions from the COVID-19 pandemic and isolation to feelings of disconnect. Discussion Work, hobbies, and resilience were protective factors to achieving purpose, low stress, and connections. Translation to Health Education Practice Barriers (isolation and disruption) were salient during the pandemic. However, direct human interactions mattered in promoting belonging, having a sense of purpose, and reducing stress. Technologies should also be promoted as a necessary alternative in periods like COVID-19, to help communities and senior residents feel engaged and less lonely. Likewise, hobbies, and the resilience of local residents should be highlighted as sources of inspiration to promote healthy lifestyle practices that achieve low stress levels, good relationships, and a sense of purpose.

Analysis of the distribution of authorship by gender in scientific output: A global perspective

This study presents a thorough examination of gendered scholarly contributions and impact from 2003 to 2023, encompassing details on 212,631,585 authorships indexed in Scopus. The analysis unveils promising advancements towards gender equity, demonstrating an increase in contributions from both genders, which indicates the trend towards a progressive and inclusive environment. These findings challenge an initial perception of male prolificacy. The positive trends extend to female-led research teams, highlighting a correlation between gender balance and leadership. This evolving landscape is reflected in the convergence of male and female authorship participation over time. A decline in citable papers suggests a narrowing of the productivity gap, which challenges gender disparities in impact metrics and emphasizes the multifaceted nature of scholarly excellence across genders. Our data and gender classification method also enables us to look into the country level in order to characterize gender distribution locally. Contrary to conventional assumptions, developing countries are exhibiting a pronounced evolution in female authorship rates. In summary, the study underscores the positive trends towards gender equity, advocating for sustained efforts to promote diversity and foster nuanced understanding in academia.

Rangatahi Maori climate action: A dialogue with nature-based solutions

This article explores the broad area of rangatahi Māori climate activism. As a research team made up of academics, rangatahi and rangatahi Māori activists, this perspective piece discusses the importance of whakapapa, belonging and connections to the environment as a foreground to climate activism. While we highlight the lack of academic research focussed on rangatahi Māori climate activism, we show that there is a plethora of activity happening through digital and social media which provides a rich space for sharing innovative ideas for a just future in which nature is centered. We suggest that there are many commonalities between the current articulations of Nature-Based Solutions and rangatahi Māori activism and that greater dialogue between these spaces is vital for any solutions being offered for an environmentally just future for Aotearoa.

Successes and challenges of partnership working to tackle health inequalities using collaborative approaches to community-based research: mixed methods analysis of focus group evidence

BackgroundThe concept of collaborative approaches involves community residents in joint decision-making processes to maintain or enhance their material and social conditions. During COVID-19, public services saw the benefits of actively collaborating with communities and involving residents in decision-making processes. As communities have resources and assets, they are well-placed to contribute to developing local health and wellbeing initiatives. An interdisciplinary and nationally funded three-phase research programme, “Mobilising community assets to tackle health inequalities”, was established with the objective of utilising local, cultural, and natural assets to support health and wellbeing. The current study aimed to synthesise evidence collected by research teams awarded funding in phase one of the programme, comprising academic and non-academic, health and social care, voluntary and community partners.MethodsTen online focus groups were conducted with research teams from across the UK exploring the successes and challenges of partnership working to tackle health inequalities using collaborative approaches to community-based research. Eight focus group questions were split between partnership working and health inequalities.ResultsThematic and content analysis produced 185 subthemes from which 12 themes were identified. Major themes representing an above average number of coded responses were research evidence; funding; relationships with partners; health inequalities and deprivation; community involvement; and health service and integrated care systems. Minor themes were link workers and social prescribing; training and support; place-based factors; longevity of programmes; setting up and scaling up programmes; and mental health.ConclusionsSuccesses included employing practice-based and arts-based methods, being part of a research project for those not normally involved in research, sharing funding democratically, building on established relationships, and the vital role that local assets play in involving communities. Challenges involved a lack of sustainable financial support, the short-term nature of funding, inconsistencies in reaching the poorest people, obtaining the right sort of research evidence, making sufficient research progress, building relationships with already over-burdened health care staff, and redressing the balance of power in favour of communities. Despite the challenges, participants were mainly optimistic that collective approaches and meaningful co-production would create opportunities for future research partnerships with communities.

Tropical vibes with peoples from Ciénaga Grande de Santa Marta: dialogic reflection in joint inquiries as feelthinking-doing in design practice and research

ABSTRACT Reflection as a resource and capacity in Social Transformation Design leads to understanding the nature of designing as a communal act. This article explores the polysemic use of reflection and the role that design practitioners and researchers could play in the Global South, and how their work may become a decolonial practice, transitioning from a design-led intervention approach to a collaborative process of joint inquiry. We explore how to decolonise ourselves, by reviewing work done in the past in the Colombian Caribbean shores. In collaboration with People from Ciénaga Grande de Santa Marta and a team of designers, researchers and several organisations, we built a palaphitic building for cultural tourism practices.We look at what the process entailed in retrospect, to understand how to move from dialectics to dialogics. In an effort to rebuild ourselves as decolonial researchers and practitioners. In the work that we’re reviewing, we tracked four different categories of reflection. We identified two sets of intertwined results. The first set is related to transitional forms of reflection that fluctuate from design interventions to joint inquiries, and; the second set is related to the process of how people flow from a dialectical position to a participatory dialogical feeling-thinking-doing.

Suicidal behaviours and associated factors among medical students in Bangladesh: a protocol for systematic review and meta-analysis (2000–2024)

IntroductionSuicidal behaviour is common among medical students, and the prevalence rates might vary across various regions. Even though various systematic reviews have been conducted to assess suicidal behaviours among medical...

O-225 A study investigating whether egg share donors treatment outcome impacted on their overall psychological well-being and treatment experience

Abstract Study question Does unsuccessful egg sharing treatment impact on the egg share donor’s psychological well-being or make her regret her decision to participate? Summary answer Egg share (ES) donors whose treatment was unsuccessful did not regret egg sharing, and were unanimously happy for their recipient if her treatment was successful. What is known already ES programmes are a unique form of egg donation for two main reasons. First, both the donor and her anonymously matched recipient are engaged in the simultaneous pursuit of having a baby. Second, egg sharing schemes offer a benefit for the donor other than altruism. However, a major concern is for the psychological well-being of ES donors whose own treatment is not successful. This concern raised was based on opinion, rather than empirical research. It is therefore vital that the psychological well-being of ES donors through egg sharing is better studied. Study design, size, duration Data for this study were gathered using a questionnaire. Selection criteria for the study were those who had participated in egg donation treatment between 2014-2022 at Lister Fertility Clinic (LFC), Chelsea, London. Only patients who had agreed to participate in research during the consenting process of their treatment were sent an email invitation asking them to participate in the study. 394 ES donors were sent an email invite. Participants/materials, setting, methods After receiving the email link, respondents filled out the questionnaire online using the Qualtrics survey tool. The paper copies received were manually inputted by the research team onto Qualtrics. The questionnaire took on average 15-20 minutes for participants to complete. 197 egg share donors were included in analysis Statistical analysis was conducted using the χ², analysis of variance (ANOVA), Mann Whitney U test, and Fisher’s exact test. Main results and the role of chance This is the largest study to investigate the psychological issue surrounding ES donation. Overall, ES donors rated their treatment ‘very positively’ (85.7%). The vast majority of egg sharers (91.8%) were glad they took part in the programme. Significantly, patients were stratified into whether IVF treatment was successful or not, with successful treatment being defined as a resulting live birth. For egg sharers, there was no difference between positive or negative treatment outcome, and their responses to whether they: would participate in egg sharing again in the future; would recommend egg sharing to a friend or family member who needs fertility treatment; felt well informed of egg sharing; and felt they had sufficient support from the fertility clinic during and after treatment. The only answer that was statistically significant based on treatment outcome was when asked if they were ‘glad they took part’, with 99.4% of successful egg sharers answering yes, compared to 72.7% of unsuccessful egg sharers (Fishers exact, p < 0.05). Of the unsuccessful ES donors who found out their recipient’s treatment was successful, 100% reported they were ‘happy for their recipients’, with the vast majority of this category stating they were glad they took part (85.7%). Limitations, reasons for caution As with all questionnaire generated data, there is a potential for sampling bias. Second, this is a single centre study. LFC is one of the largest ES centres in the UK and has success rates above the national average. Therefore, this data may not represent the ES programme nationally. Wider implications of the findings As with all questionnaire generated data, there is a potential for sampling bias. Second, this is a single centre study. LFC is one of the largest ES centres in the UK and has success rates above the national average. Therefore, this data may not represent the ES programme nationally. Trial registration number n/a

P-482 Construct validity of the donor conception identity questionnaire and its association with searching for and finding donor connections

Abstract Study question Is there an association between donor conception identity, psychological and social wellbeing, and searching for and finding donor connections? Summary answer Donor conceived individuals differ on key domains that tap into aspects of their donor conception identity. These relate to searching for and finding donor connections. What is known already There is variation in the ways that donor conceived individuals feel about their conception. Factors such as the age of disclosure are associated with how donor conceived individuals feel about being donor conceived. Associations have been found between donor conception identity and parent-child relationship quality among adolescents, suggesting that curiosity and negativity about donor conception are influenced by the valence of the parent-child relationship. The Donor Conception Identity Questionnaire (DCIQ) has not been previously validated. Study design, size, duration 88 donor conceived adults in the UK participated in a cross-sectional study using an online multi-method survey. Data were collected between January and August 2022. The survey was advertised by the Donor Conception Network and Donor Conceived Register Registrants’ Panel via mailing lists and social media and circulated by the research team and others on social media and university mailing lists. The present findings draw from a subsection of the data collected from this survey. Participants/materials, setting, methods Most participants identified as female (n = 65,74%) and were conceived using donor sperm (n = 79,90%). Participants completed the 25-item DCIQ (adapted from studies of donor conception and adoption identity), and the Mental Health Continuum, the Satisfaction with Life Scale, and adapted versions of the community connectedness and pride subscales of the Gender Minority Stress and Resilience Measure and the HIV Stigma Scale. Participants reported on whether they had searched for and/or found donor connections. Main results and the role of chance Factor analysis of items on the DCIQ identified four domains: 1. Concern and centrality, 2. Internalised stigma, 3. Pride and acceptance, and 4. Openness and understanding. ‘Concern and centrality’ correlated positively with community connectedness (r(86)= 283, p=.008), and stigma (r(86)= 280, p= .008), and negatively with pride (r(86) =-.398, p<.001). ‘Internalised stigma’ was positively correlated with stigma (r(86)=.858, p<.001) and negatively correlated with psychological wellbeing (r(85)=-.378, p <.001), satisfaction with life (r(86)= -.263, p=.013) and pride (r(86)=-716, p<.001). ‘Pride and acceptance’ was positively correlated with psychological wellbeing (r(85) = .276, p = .010), satisfaction with life (r(86)=.329, p =.002) and pride (r(86)=.800, p<.001), and negatively correlated with stigma (r(86)=-.396, p <.001). ‘Openness and understanding’ was positively correlated with psychological wellbeing (r(85)=.304, p=.004), satisfaction with life (r(86)=.316, p=.003), and pride (r(86)=.584, p<.001) and negatively correlated with stigma (r(86)=-.614, p<.001). Searchers scored higher than non-searchers on ‘concern and centrality’ F(1, 79) = 7.543, p= .007 and ‘internalised stigma’ (F(1, 79)=4.355, p=.040). Donor conceived individuals who had found donor connections scored lower on ‘internalised stigma’ F(1, 79) = 7.071, p=.009 and higher on ‘openness and understanding’ (F(1, 79)=6.083, p=0.016) compared to those who had not found their donor connections. Limitations, reasons for caution Lack of diversity within the sample with regards to participant gender, age, and donation type means that findings may not apply across donor conceived populations. The sample were self-selected. Causal relationships between variables cannot be established. Wider implications of the findings The DCIQ may be useful to understand variation in donor conceived people’s psychological health and interest in their donor. The value of the measure in a practical context (e.g., in counselling) should now be evaluated. Further work to validate the scale across different contexts and with different populations is recommended. Trial registration number the UK Economic and Social Research Council [New Investigator Award ES/S015426/1

Designing a core data set for benign hysterectomy registration system and its implementation in a referral teaching hospital in Northwest Iran

Background and aimsAlthough minimally invasive hysterectomy offers advantages, abdominal hysterectomy remains the predominant surgical method. Creating a standardized dataset and establishing a hysterectomy registry system present opportunities for early interventions in reducing volume and selecting benign hysterectomy methods. This research aims to develop a dataset for designing benign hysterectomy registration system.MethodsBetween April and September 2020, a qualitative study was carried out to create a data set for enrolling patients who were candidate for hysterectomy. At this stage, the research team conducted an information needs assessment, relevant data element identification, registry software development, and field testing; Subsequently, a web-based application was designed. In June 2023the registry software was evaluated using data extracted from medical records of patients admitted at Al-Zahra Hospital in Tabriz, Iran.ResultsDuring two months, 40 patients with benign hysterectomy were successfully registered. The final dataset for the hysterectomy patient registry comprise 11 main groups, 27 subclasses, and a total of 91 Data elements. Mandatory data and essential reports were defined. Furthermore, a web-based registry system designed and evaluated based on data set and various scenarios.ConclusionCreating a hysterectomy registration system is the initial stride toward identifying and registering hysterectomy candidate patients. this system capture information about the procedure techniques, and associated complications. In Iran, this registry can serve as a valuable resource for assessing the quality of care delivered and the distribution of clinical measures.

Garden of forking paths in ERP research - Effects of varying pre-processing and analysis steps in an N400 experiment.

This study tackles the Garden of Forking Paths, as a challenge for replicability and reproducibility of ERP studies. Here, we applied a multiverse analysis to a sample ERP N400 dataset, donated by an independent research team. We analyzed this dataset using 14 pipelines selected to showcase the full range of methodological variability found in the N400 literature using systematic review approach. The selected pipelines were compared in depth by looking into statistical test outcomes, descriptive statistics, effect size, data quality, and statistical power. In this way we provide a worked example of how analytic flexibility can impact results in research fields with high dimensionality such as ERP, when analyzed using standard null-hypothesis significance testing. Out of the methodological decisions that were varied, high-pass filter cut-off, artifact removal method, baseline duration, reference, measurement latency and locations, and amplitude measure (peak vs. mean) were all shown to affect at least some of the study outcome measures. Low-pass filtering was the only step which did not notably influence any of these measures. This study shows that even some of the seemingly minor procedural deviations can influence the conclusions of an ERP study. We demonstrate the power of multiverse analysis in both identifying the most reliable effects in a given study, and for providing insights into consequences of methodological decisions.

Universal artificial intelligence workflow for factory energy saving: Ten case studies

Numerous studies have affirmed that artificial intelligence (AI) can effectively enable energy savings in factories. However, there is currently a lack of explicit research that identifies the energy-saving effects of AI methods as compared to the conventional practices employed in factories, which involve the replacement of equipment with high energy efficiency (non-AI method), with respect to variance in the effectiveness. Thus, this ignited the motivation for this study, wherein the research team developed a “Universal AI workflow for energy saving” which adopted a standard workflow of “learning, Modeling, and Prediction.” Additionally, a three-year research project was launched to conduct empirical tests in ten factories, comparing the efficacy differences between AI and Non-AI methods. In 2021, research team established the energy consumption baselines for each factory through data collection; the entirety of 2022 was dedicated to AI integrations; and energy-saving benefits were evaluated in 2023. During the research period, each factory also implemented other non-AI energy-saving methods which were juxtaposed with AI approaches for comparison. Our study results showed that average AI-enabled energy savings across the ten factories amounted to 106,124 kWh/yr, while average energy savings from non-AI methods amounted to 1,231,625 kWh/yr. Despite the inferior energy-saving results, the AI methods had an average return on investment (ROI) of 0.46 years while non-AI methods had an average ROI of 6.22 years, indicating that AI methods could recover the investment costs through energy savings in less than one year. It is also worth noting that the ten factories produced a diverse range of products encompassing wafers, steel, and foods, but the AI methods used for energy saving employed the same workflow. By contrast, the non-AI methods necessitated distinct workflows and detailed engineering adjustments. It can be inferred from these empirical findings that AI techniques for achieving energy-saving control in factories can be integrated using standardized processes. In summary, AI methods can facilitate standardized workflows in factories and offer substantial energy-saving benefits that can typically cover investments within a year. AI represents a highly viable energy conservation option for factories seeking to maintain uniformity in product processes and realize efficient ROIs.

Bibliometric analysis of model-based systems engineering in advanced manufacturing

PurposeModel-based systems engineering (MBSE) is an important approach for the transforming process from “document-centered” to “model centered” systems engineering mode in equipment development, which can effectively shorten the equipment development cycle and improve product design quality. This paper aims to understand if MBSE enables to support manufacturing and equipment development.Design/methodology/approachThe paper opted a bibliometric analysis of MBSE in domain of advanced manufacturing from different perspectives such as publication volume, research team, sources and keyword co-occurrence.FindingsFirstly, the application of MBSE in advanced manufacturing can be roughly divided into three stages. And MBSE has been widely implemented globally and has gradually formed several noteworthy teams. Secondly, this article has identified some high-quality sources, with a large number of publications and citations, the most influential publications focus on the practice or guidance of digital twins and intelligent manufacturing. Thirdly, research can be divided into six categories, including systems engineering, digitalization, intelligent manufacturing, product design, model and architecture and MBSE applications.Research limitations/implicationsBecause of the chosen research approach, the visualized network tends to lose certain information such as a few keywords may be inaccurately categorized.Practical implicationsThis paper comprehensively study the research status of MBSE in advanced manufacturing and forecasts future research trends, emphasizing the combination of intelligent manufacturing and digitization.Originality/valueThis paper fulfills an identified need to understand the current application status and future development trends of MBSE.

Engaging adolescents in research: Home self-collection of biological samples and health questionnaires.

Adolescent health research with biomarker data collection is limited due to difficulties in recruiting and engaging this age group. Thus, successful recruitment, engagement, and retention of adolescents in translational research are necessary to elucidate factors influencing mental and physical health conditions, uncover novel biomarkers, and expand prevention and treatment options. This paper describes strategies for effective recruitment and retention of adolescents in a research study, using a project examining depressive symptoms and the microbiome to illustrate these approaches. This cross-sectional study collected electronic self-reported survey data and self-collected biospecimens (stool and salivary samples) from adolescents 13-19 years old. All but two participants completed the questionnaires, with few missing responses. 94% provided at least one salivary sample and 89% supplied a stool sample. Participants were able to adhere to the study instructions. Using a participant-centered approach, our study successfully recruited and engaged the targeted 90 participants in self-collection of electronic survey data and biospecimens. Successful strategies of recruitment and retention included: 1) on-site clinic recruitment by research team, 2) active involvement of parents as appropriate, 3) use of electronic surveys and self-collection of biospecimens to foster control and ease of participation while addressing privacy concerns, 4) noninvasive collection of data on biospecimen, 5) frequent texting to communicate with participants, 6) flexibility in the pickup and transferring of biospecimens to accommodate adolescent schedules, 7) developmentally appropriate research, 8) participant reimbursement, and 9) sensitivity toward discussing stool sample materials. As a result of these strategies, adolescent participation in the research proved feasible.

Perceptions of C-reactive Protein Measurement Among General Physicians: A Qualitative Study on Diagnostic Value, Clinical Dilemmas, and Professional Growth.

Introduction C-reactive protein (CRP) is a widely used laboratory test for assessing infections, inflammatory diseases, and malignancies, playing a critical role in clinical diagnosis and management. Despite its utility, CRP measurement practices vary among physicians, often influenced by training and clinical experience. This study explores general physicians' perceptions of CRP measurement in clinical practice, focusing on its diagnostic value, associated dilemmas, and impact on clinical growth and decision-making. Methods This qualitative study employed thematic analysis to examine the perceptions of general physicians at Unnan City Hospital, Unnan, Japan regarding CRP measurement. Sixteen general physicians were selected through purposive sampling and participated in one-on-one semi-structured interviews. The interviews were conducted in Japanese, recorded, transcribed verbatim, and analyzed inductively to identify themes. The analysis involved iterative coding and extensive discussion among the research team to ensure the reliability and validity of the findings. Results Three main themes emerged from the analysis: the usefulness of CRP for diagnosis and collaboration, dilemmas associated with CRP usage, and clinical growth through reconsideration of CRP's importance. Physicians highlighted CRP's value in distinguishing inflammatory from non-inflammatory diseases, predicting clinical courses, and facilitating communication with specialists. However, dilemmas arose from discrepancies between CRP levels and clinical symptoms, the influence of various non-specific factors, and habitual testing driven by training, leading to unnecessary tests and diminished clinical skills. Participants recognized the need to view CRP as one of many diagnostic tools, cultivate a habit of questioning its necessity, and reflect on its use to enhance clinical reasoning and professional growth. Conclusions CRP measurement is a valuable diagnostic tool, but effective use requires a balanced and critical approach. Discrepancies between CRP levels and clinical symptoms can lead to over-reliance on laboratory results and unnecessary testing. General physicians should integrate CRP within a broader diagnostic framework, combining it with patient history, physical examination, and other tests. Reflecting on the necessity and implications of CRP measurements can improve clinical reasoning and decision-making, ultimately enhancing patient care and resource management. Future research should explore similar perceptions in diverse healthcare settings and develop strategies to optimize CRP use in clinical practice.

Implementing the multiple capitals model in integrated reporting: insight from a case study

Purpose This study aims to explore the process of identifying and defining multiple capitals in the integrated report (IR) of a government-owned tourism company. Design/methodology/approach Interventionist research was conducted using a case study design. The researcher was directly involved in developing the first IR of Zètema, a heritage and tourism company owned by the Municipality of Rome. The research team analyzed internal reports, business model (BM), strategic plan and marketing plan, and collected data through semistructured interviews and participation in company meetings. Findings A template based on a step-by-step deductive process to select and define relevant capitals was derived. Following this process, an appropriate form of capital emerged: “cultural capital”. Furthermore, this study emphasizes a novel awareness of the different meanings that capitals can assume as inputs and outcomes of a BM. Originality/value This study meets the demand for empirical research that investigates real information in integrated reports intended for those for whom value is created. Thus, the paper contributes to the existing knowledge on integrated reporting by examining the partially explored concept of capital, particularly its identification process. Furthermore, this study provides support to preparers of integrated reports by defining a conceptual reference model for the disclosure of significant capitals and underlining the importance of distinguishing capitals as input or outcome.

A qualitative study of Samoan cancer patients' experiences.

This qualitative interview study was part of a larger study that interviewed19 participants recruited among patients with cancer registered with Samoa Cancer Society, or patients recently discharged from the main tertiary hospital in Samoa. Interview transcripts were reviewed, and the research team identified the key palliative-care-related themes. Analysis led to the generation of the following key themes: living with pain; resource constraints; support from family and faith; and interactions with healthcare professionals. Most participants were experiencing unresolved pain as a result of poor health knowledge, lack of access to medications and practical issues, such as financial limitations and lack of transport. Participants also reported a lack of resources, including financial constraints, as a significant barrier to effective healthcare. Sources of support for patients with cancer were most commonly strong family relationships and religious faith. Although it was difficult for the participants to access care from healthcare professionals, they found that honest communication about their condition was comforting. However, they were frustrated if they felt communication was unsatisfactory. This study provides much needed evidence on the issues that affect the quality of life patients with cancer receiving palliative care and their families in Samoa. It also highlights the intersectionality of these issues and how this compounds the patient experience. Practical recommendations for improving palliative care lie in a few key areas, including a need for improved access to opioids and support for family caregivers. However, from a systemic perspective, the way forward should lie in harnessing the strengths of Samoan culture, including the strong sense of family and the role of religion, to provide support and care for palliative patients.

Advancement of data-driven SHM: A research paradigm on AE-based switch rail condition monitoring

The past ten years have witnessed the tremendous progress of structural health monitoring applications in civil infrastructures. This is particularly embodied in railway engineering. The increasing train speed brings greater challenges to safety and ride comfort, and the primary theme of maintenance has been gradually altered from offline inspection to online monitoring. Rail operators must get an in-time warning of potential structural defects before critical failure takes place. It is more favourable that the rail operators can take hold of the real-time status of the key components and infrastructures in railway systems. This paper summarizes a long-term research series by the authors’ research team on online monitoring of rail tracks at turnout areas utilizing acoustic emission-based sensing technique, and more importantly, successively advancing signal processing methods and data-driven analysing frameworks, covering Bayesian inference, convolutional neural networks, transfer learning and task similarity analysis. The proposed algorithms tackle noise interference brought by wheel-rail impacts, great uncertainties in an open environment, and insufficiency of monitoring data, and realize comprehensive monitoring of rail tracks in turnout areas from basic crack detection to regressive condition assessment step-by-step.