Background In the UK, over 100,000 people have a stroke annually. Over 1.3 million live with the effects of stroke, including problems with mobility, communication, cognition, anxiety, depression and fatigue. Previous research has tested single interventions to improve stroke outcomes in separate, fixed design, parallel-group trials. Evidence generation has been slow and inefficient. Adaptive trial designs are required, to better understand multiple treatments, targeting multiple questions simultaneously. We undertook to develop the first efficient adaptive platform trial protocol, aligned with national research priorities for ‘Life After Stroke’. Methods We embedded PPI activities throughout the platform development and co-developed resources to maximise equality, diversity, and inclusion. We established an inclusive multidisciplinary collaboration to inform design choices and future UK-wide platform delivery. We scrutinised existing research to identify candidate interventions and relevant outcomes; agreeing these with collaborators and PPI. We undertook detailed simulations to inform choice of platform design (adaptive elements, allocation, numbers of interventions, decision criteria for dropping/adding arms, interim analyses timing/frequency; intermediate outcomes choice). We explored barriers to trial and intervention participation through in-person and virtual meetings. To facilitate rapid trial set-up, we engaged with stroke research leaders and data providers; reviewed platform randomisation requirements; and widely disseminated our learning. Results We developed an efficient, adaptive trial protocol, which is feasible, inclusive and acceptable to stroke survivors and services and submitted a funding application for a platform trial testing at least five pre-determined non-pharmacological interventions for post-stroke emotional difficulties, the top research priority for ‘Life After Stroke’. Conclusions The complex and inclusive platform trial design has only been possible through UK-wide multidisciplinary collaboration with stroke researchers, trialists, clinicians, methodologists, third sector, and patient and public contributors. Such a trial would be a step-change in trial design, reducing research waste and accelerating evidence generation to inform improved stroke service provision world-wide.
A visible‐light‐driven E‐selective semihydrogenation scheme of alkyne compounds was developed for designing and synthesizing glioblastoma multiforme (GBM) inhibitors. In the present study, room‐temperature semihydrogenation reactions of various alkyne compounds were successfully achieved under the irradiation of white light. The representative reaction mechanism was decoded through theoretical calculations and deuteration experiments, revealing the critical roles played by [Ir(Cp‐Me5)Cl2]2, PdCl2, DPPE and TEOA as photosensitizer, catalyst, ligand, and electron donor, respectively. Our method exhibits excellent E‐selectivity and broad functional group compatibility, and demonstrates its practical value by producing pinosylvin and its derivatives with strong inhibitory effects on U87 cells.
Biogenic crystals and, in particular, guanine crystals are crucial for certain organisms in manipulating light. A systematic study of the properties of their different crystalline forms and the effect of the computational method considered is, however, currently lacking. In this study, we present a density functional theory (DFT)-based computational investigation using local basis set formalisms of the key properties of three crystalline forms of anhydrous guanine (AG). Their structural, electronic, vibrational Infrared, Raman, and refractive properties have been investigated. In addition, based on the computed data, we present for the first time a fourth AG form. In most cases, we find the computed data to be in very good to excellent agreement with the available experimental data. In particular, all AG forms are found to be thermodynamically accessible with differences in their computed lattice energies lower than similar to 1 kcal/mol. However, the previously proposed orthorhombic gamma form is found to systematically correspond to a second-order saddle point on the potential energy surface with all DFT models considered. On the other hand, the proposed gamma ' form is a true minimum and displays a characteristic Raman signature already obtained experimentally for the beta form and optical properties close to those provided by the other stable polymorphs. This indicates that gamma ' might also contribute to AG polymorphism and offer an additional possibility for certain organisms to generate specific optical effects.
Challenges of longitudinal qualitative research (LQR) include participant motivation and researcher continuity. Following a six-year study of two medical students (Arjun and Charlotte) from Year 1 to their first year as interns, this submission explores our motivations and experiences of "being" participants and a researcher in LQR. To explore our experiences in different roles in the professional identity study, we used what we have called a textual conversational approach. We posed questions to each other and responded individually. I (the researcher) collated and recirculated the responses for further comment. This final working document (a written conversation) became the "data." Our "conversation" as participants and researcher highlighted a range of LQR considerations. From participants' perspectives, initial participation in a study may depend on intrinsic motivation (i.e., a sense of responsibility) and continued participation may depend on perceived personal benefit (i.e., therapeutic in this case). Who the interviewer is matters, with Charlotte and Arjun initially preferring an independent person with no "power." As the interview location needs to be safe and familiar, it should be the participant's choice. From a researcher perspective, our conversation identified the pros and cons of a researcher's status, i.e., being an "insider" (interviewer) or an "outsider" (listening to recordings and reading transcripts). Since being a qualitative researcher can be emotional, emotional intelligence is important. In LQR, cognizance thus needs to be taken of a range of considerations both in terms of participants and the researcher.
The healthcare industry has already been burdened by longstanding trends like aging populations, provider burnout, and patient dissatisfaction. Healthcare burnout has increased significantly during the pandemic. Many factors are putting strain on the industry: expanding healthcare roles, squeeze in reimbursements, competition for patient volume, shifts in the delivery of care, and a shortage of providers and staff. These factors have contributed to the unprecedented challenge forcing healthcare organizations to rethink established norms and operational best practices. While new technologies have promised significant clinical and operational benefits for healthcare organizations, COVID-19 has turned them from nice-to-haves to imperatives. This session will discuss how today’s workforce crisis can be addressed through new models of care such as telehealth. Objectives: Discuss the business process and business applications revolution Explain the experience revolution Describe the impact of new models of care on the clinical workforce
