Godfreybynum0293
ole of the vlincRNA class of lncRNAs and a potentially important role played by these transcripts in the hidden layer of RNA-based regulation in complex biological systems.
Global health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July andgies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints.
Several epidemiological and cohort studies suggest that regular low-dose aspirin use independently reduces the long-term incidence and risk of colorectal cancer deaths by approximately 20%. However, there are also risks to aspirin use, mainly gastrointestinal bleeding and haemorrhagic stroke. Making informed decisions depends on the ability to understand and weigh up benefits and risks of available options. A decision aid to support people to consider aspirin therapy alongside participation in the NHS bowel cancer screening programme may have an additional impact on colorectal cancer prevention. This study aims to develop and user-test a brief decision aid about aspirin to enable informed decision-making for colorectal screening-eligible members of the public.
We undertook a qualitative study to develop an aspirin decision aid leaflet to support bowel screening responders in deciding whether to take aspirin to reduce their risk of colorectal cancer. The iterative development process involved two focus groups with public members aged 60-74years (n = 14) and interviews with clinicians (n = 10). Interviews (n = 11) were used to evaluate its utility for decision-making. Analysis was conducted using a framework approach.
Overall, participants found the decision aid acceptable and useful to facilitate decision-making. They expressed a need for individualised risk information, more detail about the potential risks of aspirin, and preferred risk information presented in pictograms when offered different options. Implementation pathways were discussed, including the possibility of involving different clinicians in the process such as GPs and/or community pharmacists. A range of potentially effective timepoints for sending out the decision aid were identified.
An acceptable and usable decision aid was developed to support decisions about aspirin use to prevent colorectal cancer.
An acceptable and usable decision aid was developed to support decisions about aspirin use to prevent colorectal cancer.
Sepsis is a severe illness that affects millions of people worldwide, and its early detection is critical for effective treatment outcomes. In recent years, researchers have used models to classify positive patients or identify the probability for sepsis using vital signs and other time-series variables as input.
In our study, we analyzed patients' conditions by their kinematics position, velocity, and acceleration, in a six-dimensional space defined by six vital signs. The patient is affected by the disease after a period if the position gets "near" to a calculated sepsis position in space. We imputed these kinematics features as explanatory variables of long short-term memory (LSTM), convolutional neural network (CNN) and linear neural network (LNN) and compared the prediction accuracies with only the vital signs as input. The dataset used contained information of approximately 4800 patients, each with 48 hourly registers.
We demonstrated that the kinematics features models had an improved performance compared with vital signs models. The kinematics features model of LSTM achieved the best accuracy, 0.803, which was nine points higher than the vital signs model. Although with lesser accuracies, the kinematics features models of the CNN and LNN showed better performances than vital signs models.
Applying our novel approach for early detection of sepsis using neural networks will prove to be an invaluable, more accurate method than considering only simple vital signs as input variables. We expect that other researchers with similar objectives can use the model presented in this innovative approach to improve their results.
Applying our novel approach for early detection of sepsis using neural networks will prove to be an invaluable, more accurate method than considering only simple vital signs as input variables. We expect that other researchers with similar objectives can use the model presented in this innovative approach to improve their results.
There seems to be a consensus that a vision for an organization is a valuable thing for organizations to have. However, research on organizational vision has predominantly been studied from a leadership perspective. In contrast to previous research, organizational vision in this paper takes an employee perspective. Specifically, the purpose is to examine factors associated with the integration of organizational vision among employees in hospital organizations. Consequently, it focuses on a relatively neglected domain within health services research.
A conceptual model, centred on the concept of organizational vision integration, was developed and tested on a sample (N = 1008) consisting of hospital employees. Partial least-squares structural equation modelling (PLS-SEM) was used to test the hypotheses, using SmartPLS 3 software. Furthermore, a bootstrapping test was used to inspect potential mediating effects. Specifically, the test assessed whether the proposed direct and indirect effects were statisticaizational vision matters and its impact on hospital employees' work performance. To achieve organizational vision integration among hospital employees successfully, this study shows that it is important for hospital leaders to be aware of the pattern of impact of both personal as well as environmental-related factors.
Taking an employee perspective, this study contributes to revealing whether and how organizational vision matters and its impact on hospital employees' work performance. To achieve organizational vision integration among hospital employees successfully, this study shows that it is important for hospital leaders to be aware of the pattern of impact of both personal as well as environmental-related factors.
The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers' perspectives on current practices in delivering transitional care services.
We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidengnificantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71).
We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.
We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.
Heterogeneity among patients' responses to treatment is prevalent in psychiatric disorders. Personalized medicine approaches-which involve parsing patients into subgroups better indicated for a particular treatment-could therefore improve patient outcomes and serve as a powerful tool in patient selection within clinical trials. click here Machine learning approaches can identify patient subgroups but are often not "explainable" due to the use of complex algorithms that do not mirror clinicians' natural decision-making processes.
Here we combine two analytical approaches-Personalized Advantage Index and Bayesian Rule Lists-to identify paliperidone-indicated schizophrenia patients in a way that emphasizes model explainability. We apply these approaches retrospectively to randomized, placebo-controlled clinical trial data to identify a paliperidone-indicated subgroup of schizophrenia patients who demonstrate a larger treatment effect (outcome on treatment superior than on placebo) than that of the full randomized samplveness, to predict membership in the paliperidone-indicated subgroup.
These results help to technically validate our explainable AI approach to patient selection for a clinical trial by identifying a subgroup with an improved treatment effect. With these data, the explainable rule lists also suggest that paliperidone may provide an improved therapeutic benefit for the treatment of schizophrenia patients with either of the symptoms of high disturbance of volition or high uncooperativeness.
clincialtrials.gov identifier NCT 00,083,668; prospectively registered May 28, 2004.
clincialtrials.gov identifier NCT 00,083,668; prospectively registered May 28, 2004.
To study the effectiveness of an aromatase inhibitor (Anastrozole) associated with levonorgestrel-releasing intrauterine device (LNG-IUD, Mirena®) in the treatment of endometriosis.
Prospective, randomized clinical trial.
University Hospital (single center). Elegibility criteria Endometriomas > 3 × 4cm, CA-125 > 35 U/mL and endometriosis symptoms.
Thirty-one women randomized to anastrozole + Mirena® + Conservative Surgery(CS) (n = 8), anastrozole + Mirena® + transvaginal ultrasound-guided puncture-aspiration (TUGPA) (n = 7), Mirena® + CS (n = 9), or Mirena® + TUGPA (n = 7).
Anastrozole 1mg/day and/or only Mirena® for 6months; CS (ovarian and fertility-sparing) or TUGPA of endometriomas one month after starting medical treatment.
Visual analogic scale for symptoms, CA-125 levels, ultrasound findings of endometriomas and recurrences.
A significant improvement in symptoms during the treatment (difference of 43%, 95% CI 29.9-56.2) occurred, which was maintained at 1 and 2years. It was more significant in patients including anastrozole in their treatment (51%, 95% CI 33.
