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Prison leavers encounter significant barriers to successfully re-integrating into the community, which can lead to re-offending. Complex interventions which are multi-faceted and involve successful partnerships are needed to meet the distinct health and social needs of this population group. For this study, we conducted a process evaluation of a pilot project, which aimed to offer holistic support to prison leavers through a combination of peer mentoring, sport and physical activity, and signposting, delivered in a community setting. Semi-structured interviews and focus groups were conducted with individuals (n = 14) involved in the delivery and the management of the project to understand how it had been implemented and what factors had influenced the delivery and partnerships involved. Factors that influenced project delivery included safeguarding and risk assessment concerns, lived experience of peer mentors, accessibility of the intervention, and the role of sport and physical activity as a vehicle for community re-integration. Partnership working was influenced by effective information sharing, organizational commitment, building relationships and professional networks, and regular communication between organizations. An intervention involving peer mentoring, sport and physical activity, and signposting, supported by close partnership working, was viewed as a promising approach to support the community re-integration of prison leavers.

Prison leavers encounter significant barriers to successfully re-integrating into the community, which can lead to re-offending. Complex interventions which are multi-faceted and involve successful partnerships are needed to meet the distinct health and social needs of this population group. For this study, we conducted a process evaluation of a pilot project, which aimed to offer holistic support to prison leavers through a combination of peer mentoring, sport and physical activity, and signposting, delivered in a community setting. Semi-structured interviews and focus groups were conducted with individuals (n = 14) involved in the delivery and the management of the project to understand how it had been implemented and what factors had influenced the delivery and partnerships involved. Factors that influenced project delivery included safeguarding and risk assessment concerns, lived experience of peer mentors, accessibility of the intervention, and the role of sport and physical activity as a vehicle for community re-integration. Partnership working was influenced by effective information sharing, organizational commitment, building relationships and professional networks, and regular communication between organizations. An intervention involving peer mentoring, sport and physical activity, and signposting, supported by close partnership working, was viewed as a promising approach to support the community re-integration of prison leavers.

Prison leavers encounter significant barriers to successfully re-integrating into the community, which can lead to re-offending. Complex interventions which are multi-faceted and involve successful partnerships are needed to meet the distinct health and social needs of this population group. For this study, we conducted a process evaluation of a pilot project, which aimed to offer holistic support to prison leavers through a combination of peer mentoring, sport and physical activity, and signposting, delivered in a community setting. Semi-structured interviews and focus groups were conducted with individuals (n = 14) involved in the delivery and the management of the project to understand how it had been implemented and what factors had influenced the delivery and partnerships involved. Factors that influenced project delivery included safeguarding and risk assessment concerns, lived experience of peer mentors, accessibility of the intervention, and the role of sport and physical activity as a vehicle for community re-integration. Partnership working was influenced by effective information sharing, organizational commitment, building relationships and professional networks, and regular communication between organizations. An intervention involving peer mentoring, sport and physical activity, and signposting, supported by close partnership working, was viewed as a promising approach to support the community re-integration of prison leavers.

Prison leavers encounter significant barriers to successfully re-integrating into the community, which can lead to re-offending. Complex interventions which are multi-faceted and involve successful partnerships are needed to meet the distinct health and social needs of this population group. For this study, we conducted a process evaluation of a pilot project, which aimed to offer holistic support to prison leavers through a combination of peer mentoring, sport and physical activity, and signposting, delivered in a community setting. Semi-structured interviews and focus groups were conducted with individuals (n = 14) involved in the delivery and the management of the project to understand how it had been implemented and what factors had influenced the delivery and partnerships involved. Factors that influenced project delivery included safeguarding and risk assessment concerns, lived experience of peer mentors, accessibility of the intervention, and the role of sport and physical activity as a vehicle for community re-integration. Partnership working was influenced by effective information sharing, organizational commitment, building relationships and professional networks, and regular communication between organizations. An intervention involving peer mentoring, sport and physical activity, and signposting, supported by close partnership working, was viewed as a promising approach to support the community re-integration of prison leavers.

Mental workload, defined as the recruitment and allocation of cortical resources in response to task demands, is an integral underlying mechanism of cognitive-motor learning and performance. Although widely examined in individuals without motor impairment, the study of mental workload in a clinical context of motor rehabilitation is limited. In particular, it is not well understood how the cortical processes underlying mental workload adapt over time as individuals learn to operate upper-limb prosthetic devices. In this work, mental workload assessment using electroencephalography (EEG) along with other ancillary measurement tools were employed to examine the recruitment of cognitive-motor processes as individuals learned to operate either a body-powered (BP) or myoelectric (MYO) bypass prosthesis during a ten session upper limb prosthetic training program. The first two studies examined changes in mental workload and cognitive-motor performance as prosthesis users executed tasks requiring transport of objects with the same or different shape/size during a prosthetic training program. Then, these newly trained prosthesis users engaged in activities which manipulated contextual demands to examine how real-world scenarios affect mental workload and cognitive-motor performance. Finally, a preliminary validation of a novel mental workload self-report measure aimed to address the paucity of mental workload measurement tools in upper-limb rehabilitation was implemented. Although these four studies offer a rich and complex pattern of results, the main findings suggested that i) while both prosthetic groups experienced similar levels of cognitive-motor performance by the end of training, the BP group exhibited more refined cortical dynamics and better cognitive-motor efficiency when compared to the MYO group, thus indicating a more advanced progression of learning; ii) contextual demands degrade mental workload and cognitive-motor performance similarly in both prosthetic gr

Identifying genetic determinants of reproductive success may highlight mechanisms underlying fertility and identify alleles under present-day selection. Using data in 785,604 individuals of European ancestry, we identified 43 genomic loci associated with either number of children ever born (NEB) or childlessness. These loci span diverse aspects of reproductive biology, including puberty timing, age at first birth, sex hormone regulation, endometriosis and age at menopause. Missense variants in ARHGAP27 were associated with higher NEB but shorter reproductive lifespan, suggesting a trade-off at this locus between reproductive ageing and intensity. Other genes implicated by coding variants include PIK3IP1, ZFP82 and LRP4, and our results suggest a new role for the melanocortin 1 receptor (MC1R) in reproductive biology. As NEB is one component of evolutionary fitness, our identified associations indicate loci under present-day natural selection. Integration with data from historical selection scans highlighted an allele in the FADS1/2 gene locus that has been under selection for thousands of years and remains so today. Collectively, our findings demonstrate that a broad range of biological mechanisms contribute to reproductive success.

Identifying genetic determinants of reproductive success may highlight mechanisms underlying fertility and identify alleles under present-day selection. Using data in 785,604 individuals of European ancestry, we identified 43 genomic loci associated with either number of children ever born (NEB) or childlessness. These loci span diverse aspects of reproductive biology, including puberty timing, age at first birth, sex hormone regulation, endometriosis and age at menopause. Missense variants in ARHGAP27 were associated with higher NEB but shorter reproductive lifespan, suggesting a trade-off at this locus between reproductive ageing and intensity. Other genes implicated by coding variants include PIK3IP1, ZFP82 and LRP4, and our results suggest a new role for the melanocortin 1 receptor (MC1R) in reproductive biology. As NEB is one component of evolutionary fitness, our identified associations indicate loci under present-day natural selection. Integration with data from historical selection scans highlighted an allele in the FADS1/2 gene locus that has been under selection for thousands of years and remains so today. Collectively, our findings demonstrate that a broad range of biological mechanisms contribute to reproductive success.

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell–driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. © 2021 GA²LEN. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

This thesis is an investigation into the makings of a successful youth baseball facility. Youth sports is a multi-billion dollar industry in the United States, and much of the competition follows a tournament, or "travel league" format. This is especially true in youth baseball. Despite this growing trend towards travel play, facilities that host these tournaments were designed and constructed in an age where the primary format was not tournament play, but rather a recreational structure where single games were played individually. These facilities do not meet the needs of the typical park user: players and their families. The parts of the following investigation are the Author's research, including a literature review and four case studies of facilities that are representational of a larger sample. This is followed by the identification of a list of universial challenges faced by many facilities which led to a development of a list of design criteria to correct the issue of under-performing parks, identification of a fundamental design question, and specific goals and objectives. Finally, identification of a site to be studied is introduced and analyzed, and the development of the Author's concept for a new design is reported and then analyzed. The Master Plan is then presented and discussed in detail. The master plan for the new Rockville School Park has been developed based on the list of design criteria developed by the Author, based largely on field research. A large effort was made to identify literature directly regarding the questions presented in this thesis. The literature used has been included within the references section at the end of this document.

Fusarium head blight (FHB) is one of the most economically destructive diseases of wheat (Triticum aestivum L.), causing substantial yield and quality loss worldwide. Fusarium graminearum is the predominant causal pathogen of FHB in the U.S., and produces deoxynivalenol (DON), a mycotoxin that accumulates in the grain throughout infection. FHB results in kernel damage, a visual symptom that is quantified by a human observer enumerating or estimating the percentage of Fusarium-damaged kernels (FDK) in a sample of grain. To date, FDK estimation is the most efficient and accurate method of predicting DON content without measuring presence in a laboratory. For this experiment, 1266 entries collectively representing elite varieties and SunGrains advanced breeding lines encompassing four inoculated FHB nurseries were represented in the analysis. All plots were subjected to a manual FDK count, both exact and estimated, near-infrared spectroscopy (NIR) analysis, DON laboratory analysis, and digital imaging seed phenotyping using the Vibe QM3 instrument developed by Vibe imaging analytics. Among the FDK analytical platforms used to establish percentage FDK within grain samples, Vibe QM3 showed the strongest prediction capabilities of DON content in experimental samples, R2 = 0.63, and higher yet when deployed as FDK GEBVs, R2 = 0.76. Additionally, Vibe QM3 was shown to detect a significant SNP association at locus S3B_9439629 within major FHB resistance quantitative trait locus (QTL) Fhb1. Visual estimates of FDK showed higher prediction capabilities of DON content in grain subsamples than previously expected when deployed as genomic estimated breeding values (GEBVs) (R2 = 0.71), and the highest accuracy in genomic prediction, followed by Vibe QM3 digital imaging, with average Pearson’s correlations of r = 0.594 and r = 0.588 between observed and predicted values, res

Aims: This study provides a multimodal conversation analytic account of directive sequences used in the presence of a child aged 1;8–2;4 growing up in an English-dominant environment and acquiring Polish as a heritage language. Design: The video recorded data are drawn from naturally occurring interactions, in which the child is present when one caregiver produces a directive turn (request, proposal, or suggestion) and another one carries it out in an embodied fashion. Analysis: The analysis focuses on the sequential unfolding of the triadic interactions, the two adults’ and child’s verbal turns, gaze direction, manual actions, and handling of objects. Findings: Although the child is not always verbally active in the directive sequences, she observes them and sometimes takes part, either through bodily actions or verbal utterances. The multimodal analysis also shows that even if the child’s verbal activity might indicate understanding a prior turn and responding to it, the child may not actually be orienting to the conversation. Observing adults carrying out heritage language directive sequences is only possible when the child is interacting with two speakers of her heritage language, or a speaker of that language and a person who has some passive knowledge of it. Seeing adults’ mutual social actions offers the child a social environment, in which she can get a rich linguistic model and also observe the benefits of using the heritage language in everyday interactional situations. Originality: This is the first study to offer a multimodal conversation analysis of directive sequences in which one adult produces the directive and another adult responds to it in the presence of a child acquiring a heritage language.

This thesis is an investigation into the makings of a successful youth baseball facility. Youth sports is a multi-billion dollar industry in the United States, and much of the competition follows a tournament, or "travel league" format. This is especially true in youth baseball. Despite this growing trend towards travel play, facilities that host these tournaments were designed and constructed in an age where the primary format was not tournament play, but rather a recreational structure where single games were played individually. These facilities do not meet the needs of the typical park user: players and their families. The parts of the following investigation are the Author's research, including a literature review and four case studies of facilities that are representational of a larger sample. This is followed by the identification of a list of universial challenges faced by many facilities which led to a development of a list of design criteria to correct the issue of under-performing parks, identification of a fundamental design question, and specific goals and objectives. Finally, identification of a site to be studied is introduced and analyzed, and the development of the Author's concept for a new design is reported and then analyzed. The Master Plan is then presented and discussed in detail. The master plan for the new Rockville School Park has been developed based on the list of design criteria developed by the Author, based largely on field research. A large effort was made to identify literature directly regarding the questions presented in this thesis. The literature used has been included within the references section at the end of this document.

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell–driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

Fusarium head blight (FHB) is one of the most economically destructive diseases of wheat (Triticum aestivum L.), causing substantial yield and quality loss worldwide. Fusarium graminearum is the predominant causal pathogen of FHB in the U.S., and produces deoxynivalenol (DON), a mycotoxin that accumulates in the grain throughout infection. FHB results in kernel damage, a visual symptom that is quantified by a human observer enumerating or estimating the percentage of Fusarium-damaged kernels (FDK) in a sample of grain. To date, FDK estimation is the most efficient and accurate method of predicting DON content without measuring presence in a laboratory. For this experiment, 1266 entries collectively representing elite varieties and SunGrains advanced breeding lines encompassing four inoculated FHB nurseries were represented in the analysis. All plots were subjected to a manual FDK count, both exact and estimated, near-infrared spectroscopy (NIR) analysis, DON laboratory analysis, and digital imaging seed phenotyping using the Vibe QM3 instrument developed by Vibe imaging analytics. Among the FDK analytical platforms used to establish percentage FDK within grain samples, Vibe QM3 showed the strongest prediction capabilities of DON content in experimental samples, R2 = 0.63, and higher yet when deployed as FDK GEBVs, R2 = 0.76. Additionally, Vibe QM3 was shown to detect a significant SNP association at locus S3B_9439629 within major FHB resistance quantitative trait locus (QTL) Fhb1. Visual estimates of FDK showed higher prediction capabilities of DON content in grain subsamples than previously expected when deployed as genomic estimated breeding values (GEBVs) (R2 = 0.71), and the highest accuracy in genomic prediction, followed by Vibe QM3 digital imaging, with average Pearson’s correlations of r = 0.594 and r = 0.588 between observed and predicted values, res

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA²LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell–driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.

As various property studies continue to emerge on high entropy and entropy-stabilized ceramics, we seek a further understanding of the property changes across the phase boundary between "high-entropy"and "entropy-stabilized"phases. The thermal and mechanical properties of bulk ceramic entropy stabilized oxide composition Mg0.2Co0.2Ni0.2Cu0.2Zn0.2O are investigated across this critical transition temperature via the transient plane-source method, temperature-dependent x-ray diffraction, and nano-indentation. The thermal conductivity remains constant within uncertainty across the multi-to-single phase transition at a value of ≈2.5 W/mK, while the linear coefficient of thermal expansion increases nearly 24% from 10.8 to 14.1 × 10-6 K-1. Mechanical softening is also observed across the transition.

Though the title of my thesis infers a unifying theme via the application of machine learning, the two projects that form the bulk of my graduate degree are frankly more disparate than they are similar. Both endeavors provide novel methods to a field where ground truth is obscure and/or limited, and both apply machine learning techniques in their methodologies. Those similarities notwithstanding, the scientific domains, technical applications, experimental designs, and overall goals remain independent. While having a thesis comprised from two independent parts may not be conventional, this is, as they say, not a bug but a feature. Working within (and occasionally across) two research domains has helped me to acquire a diverse skillset and has provided me with a better and broader understanding of machine learning practices for scientific research.As this thesis is composed of two linked, but distinct projects, the abstract (and chapters) is divided in two. The first section details work related to large-scale predictions of purchasable chemical space, and the second summarizes a novel method for automating diagnosis of melanocytic atypia in human histopathological samples.I. Large-Scale Predictions for Purchasable Chemical SpaceThere are now over 400 million compounds one can easily purchase from the ZINC database (zinc.docking.org). About 350 million (85%) of these compounds are affordable enough for the average academic lab to conduct a ligand discovery project. However, the molecular targets (proteins) that these purchasable compounds bind and modulate—if any—are rarely known. Fewer than 1 million compounds (<0.25%) have been reported active in a target-specific assay according to public databases such as ChEMBL. In the absence of target activity information, the process of selecting compounds for general purpose screening will often be target-naïve.To facilitate access to new chemistry for biology, my collaborator John Irwin and I generated predictions for al

Though the title of my thesis infers a unifying theme via the application of machine learning, the two projects that form the bulk of my graduate degree are frankly more disparate than they are similar. Both endeavors provide novel methods to a field where ground truth is obscure and/or limited, and both apply machine learning techniques in their methodologies. Those similarities notwithstanding, the scientific domains, technical applications, experimental designs, and overall goals remain independent. While having a thesis comprised from two independent parts may not be conventional, this is, as they say, not a bug but a feature. Working within (and occasionally across) two research domains has helped me to acquire a diverse skillset and has provided me with a better and broader understanding of machine learning practices for scientific research.As this thesis is composed of two linked, but distinct projects, the abstract (and chapters) is divided in two. The first section details work related to large-scale predictions of purchasable chemical space, and the second summarizes a novel method for automating diagnosis of melanocytic atypia in human histopathological samples.I. Large-Scale Predictions for Purchasable Chemical SpaceThere are now over 400 million compounds one can easily purchase from the ZINC database (zinc.docking.org). About 350 million (85%) of these compounds are affordable enough for the average academic lab to conduct a ligand discovery project. However, the molecular targets (proteins) that these purchasable compounds bind and modulate—if any—are rarely known. Fewer than 1 million compounds (<0.25%) have been reported active in a target-specific assay according to public databases such as ChEMBL. In the absence of target activity information, the process of selecting compounds for general purpose screening will often be target-naïve.To facilitate access to new chemistry for biology, my collaborator John Irwin and I generated predictions for al

Background: To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions: QICs are associated with improving clinical processes in stroke care

Background: To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions: QICs are associated with improving clinical processes in stroke care

Background: To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions: QICs are associated with improving clinical processes in stroke care

Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline Vaccination recommendations for the prevention of HPV-associated lesions, which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.

Anal cancer is a relatively rare tumor but has shown a continuous increase of new diseases with a doubling of the incidence in the last 20 years. Nearly all anal cancers are induced by a persisting infection with human papillomavirus (HPV). In the guidelines program for oncology for the first time German language S3 guidelines for optimization of the diagnostics, treatment and aftercare of anal cancer have been compiled under the patronage of the German Society of Coloproctology. Suggestions for recommendations were compiled in interdisciplinary working groups based on the formulated key questions, which were modified and graded within a nominal consensus procedure. After the systematic literature search the endpoint-related assessment and classification of the evidence was carried out within the framework of the GRADE procedure. A total of 93 recommendations and statements were formulated with respect to the topics prevention and screening, diagnostics and staging, supportive measures before and after targeted tumor treatment, treatment of anal cancer in stages I-III, response evaluation following primary chemoradiotherapy, aftercare, treatment of residual and recurrent anal cancer, treatment of metastatic anal cancer (stage IV), palliative care and rehabilitation. The new guidelines provide a foundation for the optimization of interdisciplinary and cross-sectoral care of anal cancer patients. Based on quality indicators future health services research should investigate whether the guideline recommendations are taken into consideration and whether these contribute to an improvement in care.

Objectives: This systematic review aimed to explore the perspectives of healthcare, exercise, and fitness professionals working with people post-stroke regarding the factors affecting the implementation of aerobic exercise after stroke. Data Sources: OVID SP MEDLINE, OVID SP EMBASE, and CINAHL were searched from inception to December 2018 using a combination of search terms with synonyms of stroke, aerobic exercise and barriers/facilitators. Review methods: Studies focusing on the factors affecting implementation of aerobic exercise after stroke from staff perspectives were included with no restriction on the types of study design. For inclusivity, a broad definition of aerobic exercise was used. Review authors independently extracted data from included studies using domains from the Consolidated Framework for Implementation Research, then synthesised using a framework synthesis approach. Retrospective automated screening was conducted using Rayyan software. Results: Twenty studies were included. Four reported on implementation of aerobic exercise, sixteen on general exercise interventions, all post-stroke. Factors identified as influencing implementation of aerobic exercise after stroke included professionals’ self-efficacy and knowledge about stroke, patients’ needs, communication and collaboration within and between organisations and resources such as equipment, staff and training. Conclusions: Key factors influencing the implementation of aerobic exercise after stroke included characteristics of the staff and intervention and system-level issues, some of which are modifiable. Further research should evaluate strategies which specifically target these modifiable factors to facilitate implementation in practice.

Objectives: This systematic review aimed to explore the perspectives of healthcare, exercise, and fitness professionals working with people post-stroke regarding the factors affecting the implementation of aerobic exercise after stroke. Data Sources: OVID SP MEDLINE, OVID SP EMBASE, and CINAHL were searched from inception to December 2018 using a combination of search terms with synonyms of stroke, aerobic exercise and barriers/facilitators. Review methods: Studies focusing on the factors affecting implementation of aerobic exercise after stroke from staff perspectives were included with no restriction on the types of study design. For inclusivity, a broad definition of aerobic exercise was used. Review authors independently extracted data from included studies using domains from the Consolidated Framework for Implementation Research, then synthesised using a framework synthesis approach. Retrospective automated screening was conducted using Rayyan software. Results: Twenty studies were included. Four reported on implementation of aerobic exercise, sixteen on general exercise interventions, all post-stroke. Factors identified as influencing implementation of aerobic exercise after stroke included professionals’ self-efficacy and knowledge about stroke, patients’ needs, communication and collaboration within and between organisations and resources such as equipment, staff and training. Conclusions: Key factors influencing the implementation of aerobic exercise after stroke included characteristics of the staff and intervention and system-level issues, some of which are modifiable. Further research should evaluate strategies which specifically target these modifiable factors to facilitate implementation in practice.

Objectives: This systematic review aimed to explore the perspectives of healthcare, exercise, and fitness professionals working with people post-stroke regarding the factors affecting the implementation of aerobic exercise after stroke. Data Sources: OVID SP MEDLINE, OVID SP EMBASE, and CINAHL were searched from inception to December 2018 using a combination of search terms with synonyms of stroke, aerobic exercise and barriers/facilitators. Review methods: Studies focusing on the factors affecting implementation of aerobic exercise after stroke from staff perspectives were included with no restriction on the types of study design. For inclusivity, a broad definition of aerobic exercise was used. Review authors independently extracted data from included studies using domains from the Consolidated Framework for Implementation Research, then synthesised using a framework synthesis approach. Retrospective automated screening was conducted using Rayyan software. Results: Twenty studies were included. Four reported on implementation of aerobic exercise, sixteen on general exercise interventions, all post-stroke. Factors identified as influencing implementation of aerobic exercise after stroke included professionals’ self-efficacy and knowledge about stroke, patients’ needs, communication and collaboration within and between organisations and resources such as equipment, staff and training. Conclusions: Key factors influencing the implementation of aerobic exercise after stroke included characteristics of the staff and intervention and system-level issues, some of which are modifiable. Further research should evaluate strategies which specifically target these modifiable factors to facilitate implementation in practice.

BACKGROUND: To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and 'take home' best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. METHODS: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote-counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). RESULTS: Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC's active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. CONCLUSIONS: QICs are associated with improving clinical processes in stroke care

This article investigates the role of direct input in the code-mixing of three bilingual children aged 2–4 years acquiring English as one language, and either German, Polish, or Finnish as the other. From a usage-based perspective, it is assumed that early children’s utterances are item-based and that they contain many lexically fixed patterns. To account for such patterns, the traceback method has been developed to test the hypothesis that children’s utterances are constructed on the basis of a limited inventory of chunks and frame-and-slot patterns. We apply this method to the code-mixed utterances, suggesting that much of the code-mixing occurs within frame-and-slot patterns, such as Was ist X? as in Was ist breakfast muesli? “What is breakfast muesli?” We further analyzed each code-mixed utterance in terms of priming. Our findings suggest that much of the early code-mixing is based on concrete lexically fixed patterns which are subject to input occurring in immediately prior speech, either the child’s own or that of her caregivers.

Objectives: This study investigates monolingual and code-mixed utterances in four bilingual children with different language combinations (German–English, English–Polish, Finnish–English, and French–Russian) in terms of utterance lengths (MLUs) and complexities offering a usagebased (UB) explanation based on cognitive mechanisms. Methodology: Utterances from four different child bilingual corpora were extracted and coded for individual monolingual languages and bilingual utterances. Data and analysis: 35.441 utterances between the age of 2–4 were analyzed in terms of MLU and syntactic complexity. Findings/conclusions: Results showed that for all children monolingual MLUs and complexities reflect their input situations: the more input in one language, the longer and more complex those utterances were. However, in all four children code-mixed utterances were longer and more complex from the beginning of the recordings. Implications: This is the first study that systematically compares MLU scores and complexities of monolingual and bilingual utterances taking diverse language combinations into account and offering a UB explanation based on chunking and entrenchment processes as a new alternative for further research in bilingualism.

This article investigates the role of direct input in the code-mixing of three bilingual children aged 2–4 years acquiring English as one language, and either German, Polish, or Finnish as the other. From a usage-based perspective, it is assumed that early children’s utterances are item-based and that they contain many lexically fixed patterns. To account for such patterns, the traceback method has been developed to test the hypothesis that children’s utterances are constructed on the basis of a limited inventory of chunks and frame-and-slot patterns. We apply this method to the code-mixed utterances, suggesting that much of the code-mixing occurs within frame-and-slot patterns, such as Was ist X? as in Was ist breakfast muesli? “What is breakfast muesli?” We further analyzed each code-mixed utterance in terms of priming. Our findings suggest that much of the early code-mixing is based on concrete lexically fixed patterns which are subject to input occurring in immediately prior speech, either the child’s own or that of her caregivers.

This paper aims to investigate whether language use can account for the differences in code-switching within the article-noun phrase in children exposed to English and German, French and Russian, and English and Polish. It investigates two aspects of language use: equivalence and segmentation. Four children’s speech is derived from corpora of naturalistic interactions recorded between the ages of two and three and used as a source of the children’s article-noun phrases. We demonstrate that children’s CS cannot be fully explained by structural equivalence in each two languages: there is CS in French-Russian although French does, and Russian does not, use articles. We also demonstrate that language pairs which use higher numbers of articles types, and therefore have more segmented article-noun phrases, are also more open to switching. Lastly, we show that longitudinal use of monolingual articles-noun phrases corresponds with the trends in the use of bilingual article-noun phrases. The German-English child only starts to mix English articles once they become more established in monolingual combinations while the French-Russian child ceases to mix French proto-articles with Russian nouns once target articles enter frequent use. These findings are discussed in the context of other studies which report code-switching across different language pairs.

BACKGROUND: To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and 'take home' best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. METHODS: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote-counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). RESULTS: Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC's active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. CONCLUSIONS: QICs are associated with improving clinical processes in stroke care

This paper aims to investigate whether language use can account for the differences in code-switching within the article-noun phrase in children exposed to English and German, French and Russian, and English and Polish. It investigates two aspects of language use: equivalence and segmentation. Four children’s speech is derived from corpora of naturalistic interactions recorded between the ages of two and three and used as a source of the children’s article-noun phrases. We demonstrate that children’s CS cannot be fully explained by structural equivalence in each two languages: there is CS in French-Russian although French does, and Russian does not, use articles. We also demonstrate that language pairs which use higher numbers of articles types, and therefore have more segmented article-noun phrases, are also more open to switching. Lastly, we show that longitudinal use of monolingual articles-noun phrases corresponds with the trends in the use of bilingual article-noun phrases. The German-English child only starts to mix English articles once they become more established in monolingual combinations while the French-Russian child ceases to mix French proto-articles with Russian nouns once target articles enter frequent use. These findings are discussed in the context of other studies which report code-switching across different language pairs.

This article investigates the role of direct input in the code-mixing of three bilingual children aged 2–4 years acquiring English as one language, and either German, Polish, or Finnish as the other. From a usage-based perspective, it is assumed that early children’s utterances are item-based and that they contain many lexically fixed patterns. To account for such patterns, the traceback method has been developed to test the hypothesis that children’s utterances are constructed on the basis of a limited inventory of chunks and frame-and-slot patterns. We apply this method to the code-mixed utterances, suggesting that much of the code-mixing occurs within frame-and-slot patterns, such as Was ist X? as in Was ist breakfast muesli? “What is breakfast muesli?” We further analyzed each code-mixed utterance in terms of priming. Our findings suggest that much of the early code-mixing is based on concrete lexically fixed patterns which are subject to input occurring in immediately prior speech, either the child’s own or that of her caregivers.

Objectives: This study investigates monolingual and code-mixed utterances in four bilingual children with different language combinations (German–English, English–Polish, Finnish–English, and French–Russian) in terms of utterance lengths (MLUs) and complexities offering a usagebased (UB) explanation based on cognitive mechanisms. Methodology: Utterances from four different child bilingual corpora were extracted and coded for individual monolingual languages and bilingual utterances. Data and analysis: 35.441 utterances between the age of 2–4 were analyzed in terms of MLU and syntactic complexity. Findings/conclusions: Results showed that for all children monolingual MLUs and complexities reflect their input situations: the more input in one language, the longer and more complex those utterances were. However, in all four children code-mixed utterances were longer and more complex from the beginning of the recordings. Implications: This is the first study that systematically compares MLU scores and complexities of monolingual and bilingual utterances taking diverse language combinations into account and offering a UB explanation based on chunking and entrenchment processes as a new alternative for further research in bilingualism.

Background: To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions: QICs are associated with improving clinical processes in stroke care

Objectives: This systematic review aimed to explore the perspectives of healthcare, exercise, and fitness professionals working with people post-stroke regarding the factors affecting the implementation of aerobic exercise after stroke. Data Sources: OVID SP MEDLINE, OVID SP EMBASE, and CINAHL were searched from inception to December 2018 using a combination of search terms with synonyms of stroke, aerobic exercise and barriers/facilitators. Review methods: Studies focusing on the factors affecting implementation of aerobic exercise after stroke from staff perspectives were included with no restriction on the types of study design. For inclusivity, a broad definition of aerobic exercise was used. Review authors independently extracted data from included studies using domains from the Consolidated Framework for Implementation Research, then synthesised using a framework synthesis approach. Retrospective automated screening was conducted using Rayyan software. Results: Twenty studies were included. Four reported on implementation of aerobic exercise, sixteen on general exercise interventions, all post-stroke. Factors identified as influencing implementation of aerobic exercise after stroke included professionals’ self-efficacy and knowledge about stroke, patients’ needs, communication and collaboration within and between organisations and resources such as equipment, staff and training. Conclusions: Key factors influencing the implementation of aerobic exercise after stroke included characteristics of the staff and intervention and system-level issues, some of which are modifiable. Further research should evaluate strategies which specifically target these modifiable factors to facilitate implementation in practice.

Objectives: This systematic review aimed to explore the perspectives of healthcare, exercise, and fitness professionals working with people post-stroke regarding the factors affecting the implementation of aerobic exercise after stroke. Data Sources: OVID SP MEDLINE, OVID SP EMBASE, and CINAHL were searched from inception to December 2018 using a combination of search terms with synonyms of stroke, aerobic exercise and barriers/facilitators. Review methods: Studies focusing on the factors affecting implementation of aerobic exercise after stroke from staff perspectives were included with no restriction on the types of study design. For inclusivity, a broad definition of aerobic exercise was used. Review authors independently extracted data from included studies using domains from the Consolidated Framework for Implementation Research, then synthesised using a framework synthesis approach. Retrospective automated screening was conducted using Rayyan software. Results: Twenty studies were included. Four reported on implementation of aerobic exercise, sixteen on general exercise interventions, all post-stroke. Factors identified as influencing implementation of aerobic exercise after stroke included professionals’ self-efficacy and knowledge about stroke, patients’ needs, communication and collaboration within and between organisations and resources such as equipment, staff and training. Conclusions: Key factors influencing the implementation of aerobic exercise after stroke included characteristics of the staff and intervention and system-level issues, some of which are modifiable. Further research should evaluate strategies which specifically target these modifiable factors to facilitate implementation in practice.

Background: The effects of spinal anesthesia as compared with general anesthesia on the ability to walk in older adults undergoing surgery for hip fracture have not been well studied. Methods: We conducted a pragmatic, randomized superiority trial to evaluate spinal anesthesia as compared with general anesthesia in previously ambulatory patients 50 years of age or older who were undergoing surgery for hip fracture at 46 U.S. and Canadian hospitals. Patients were randomly assigned in a 1:1 ratio to receive spinal or general anesthesia. The primary outcome was a composite of death or an inability to walk approximately 10 ft (3 m) independently or with a walker or cane at 60 days after randomization. Secondary outcomes included death within 60 days, delirium, time to discharge, and ambulation at 60 days. Results: A total of 1600 patients were enrolled; 795 were assigned to receive spinal anesthesia and 805 to receive general anesthesia. The mean age was 78 years, and 67.0% of the patients were women. A total of 666 patients (83.8%) assigned to spinal anesthesia and 769 patients (95.5%) assigned to general anesthesia received their assigned anesthesia. Among patients in the modified intention-to-treat population for whom data were available, the composite primary outcome occurred in 132 of 712 patients (18.5%) in the spinal anesthesia group and 132 of 733 (18.0%) in the general anesthesia group (relative risk, 1.03; 95% confidence interval [CI], 0.84 to 1.27; P = 0.83). An inability to walk independently at 60 days was reported in 104 of 684 patients (15.2%) and 101 of 702 patients (14.4%), respectively (relative risk, 1.06; 95% CI, 0.82 to 1.36), and death within 60 days occurred in 30 of 768 (3.9%) and 32 of 784 (4.1%), respectively (relative risk, 0.97; 95% CI, 0.59 to 1.57). Delirium occurred in 130 of 633 patients (20.5%) in the spinal anesthesia group and in 124 of 629 (19.7%) in the general anesthesia group (relative risk, 1.04; 95% CI, 0.84 to 1.30). Conclusions

Anal cancer is a relatively rare tumor but has shown a continuous increase of new diseases with a doubling of the incidence in the last 20 years. Nearly all anal cancers are induced by a persisting infection with human papillomavirus (HPV). In the guidelines program for oncology for the first time German language S3 guidelines for optimization of the diagnostics, treatment and aftercare of anal cancer have been compiled under the patronage of the German Society of Coloproctology. Suggestions for recommendations were compiled in interdisciplinary working groups based on the formulated key questions, which were modified and graded within a nominal consensus procedure. After the systematic literature search the endpoint-related assessment and classification of the evidence was carried out within the framework of the GRADE procedure. A total of 93 recommendations and statements were formulated with respect to the topics prevention and screening, diagnostics and staging, supportive measures before and after targeted tumor treatment, treatment of anal cancer in stages I-III, response evaluation following primary chemoradiotherapy, aftercare, treatment of residual and recurrent anal cancer, treatment of metastatic anal cancer (stage IV), palliative care and rehabilitation. The new guidelines provide a foundation for the optimization of interdisciplinary and cross-sectoral care of anal cancer patients. Based on quality indicators future health services research should investigate whether the guideline recommendations are taken into consideration and whether these contribute to an improvement in care.

Anogenital and oropharyngeal infections with human papilloma viruses (HPV) are common. Clinically manifest disease may significantly impact quality of life; the treatment of HPV-associated lesions is associated with a high rate of recurrence and invasive neoplasms, such as cervical, anal, vulvar, penile, and oropharyngeal cancers, which are characterized by significant morbidity and mortality. Vaccination against HPV is an effective and safe measure for the primary prevention of HPV-associated lesions, but immunization rates are still low in Germany. The present publication is an abridged version of the German evidence and consensus-based guideline Vaccination recommendations for the prevention of HPV-associated lesions, which is available on the website of the German Association of the Scientific Medical Societies (AWMF). On the basis of a systematic review with meta-analyses, a representative panel developed and agreed upon recommendations for the vaccination of different populations against HPV. In addition, consensus-based recommendations were developed for specific issues relevant to everyday practice. Based on current evidence and a representative expert consensus, these recommendations are intended to provide guidance in a field in which there is often uncertainty and in which both patients and health care providers are sometimes confronted with controversial and emotionally charged points of view.

Background: To successfully reduce the negative impacts of stroke, high-quality health and care practices are needed across the entire stroke care pathway. These practices are not always shared across organisations. Quality improvement collaboratives (QICs) offer a unique opportunity for key stakeholders from different organisations to share, learn and ‘take home’ best practice examples, to support local improvement efforts. This systematic review assessed the effectiveness of QICs in improving stroke care and explored the facilitators and barriers to implementing this approach. Methods: Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, and Cochrane Library) were searched up to June 2020, and reference lists of included studies and relevant reviews were screened. Studies conducted in an adult stroke care setting, which involved multi-professional stroke teams participating in a QIC, were included. Data was extracted by one reviewer and checked by a second. For overall effectiveness, a vote counting method was used. Data regarding facilitators and barriers was extracted and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Twenty papers describing twelve QICs used in stroke care were included. QICs varied in their setting, part of the stroke care pathway, and their improvement focus. QIC participation was associated with improvements in clinical processes, but improvements in patient and other outcomes were limited. Key facilitators were inter- and intra-organisational networking, feedback mechanisms, leadership engagement, and access to best practice examples. Key barriers were structural changes during the QIC’s active period, lack of organisational support or prioritisation of QIC activities, and insufficient time and resources to participate in QIC activities. Patient and carer involvement, and health inequalities, were rarely considered. Conclusions: QICs are associated with improving clinical processes in stroke care

Objectives: This systematic review aimed to explore the perspectives of healthcare, exercise, and fitness professionals working with people post-stroke regarding the factors affecting the implementation of aerobic exercise after stroke. Data Sources: OVID SP MEDLINE, OVID SP EMBASE, and CINAHL were searched from inception to December 2018 using a combination of search terms with synonyms of stroke, aerobic exercise and barriers/facilitators. Review methods: Studies focusing on the factors affecting implementation of aerobic exercise after stroke from staff perspectives were included with no restriction on the types of study design. For inclusivity, a broad definition of aerobic exercise was used. Review authors independently extracted data from included studies using domains from the Consolidated Framework for Implementation Research, then synthesised using a framework synthesis approach. Retrospective automated screening was conducted using Rayyan software. Results: Twenty studies were included. Four reported on implementation of aerobic exercise, sixteen on general exercise interventions, all post-stroke. Factors identified as influencing implementation of aerobic exercise after stroke included professionals’ self-efficacy and knowledge about stroke, patients’ needs, communication and collaboration within and between organisations and resources such as equipment, staff and training. Conclusions: Key factors influencing the implementation of aerobic exercise after stroke included characteristics of the staff and intervention and system-level issues, some of which are modifiable. Further research should evaluate strategies which specifically target these modifiable factors to facilitate implementation in practice.

This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria., Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs); European Union (EU); 6th Framework Programme; Global Allergy and Asthma European Network (GA2LEN); European Academy of Allergology and Clinical Immunology (EAACI); Asia Pacific Association of Allergy, Asthma and Clinical Immunology (APAAACI); European Dermatology Forum (EDF)

Objectives: This systematic review aimed to explore the perspectives of healthcare, exercise, and fitness professionals working with people post-stroke regarding the factors affecting the implementation of aerobic exercise after stroke. Data Sources: OVID SP MEDLINE, OVID SP EMBASE, and CINAHL were searched from inception to December 2018 using a combination of search terms with synonyms of stroke, aerobic exercise and barriers/facilitators. Review methods: Studies focusing on the factors affecting implementation of aerobic exercise after stroke from staff perspectives were included with no restriction on the types of study design. For inclusivity, a broad definition of aerobic exercise was used. Review authors independently extracted data from included studies using domains from the Consolidated Framework for Implementation Research, then synthesised using a framework synthesis approach. Retrospective automated screening was conducted using Rayyan software. Results: Twenty studies were included. Four reported on implementation of aerobic exercise, sixteen on general exercise interventions, all post-stroke. Factors identified as influencing implementation of aerobic exercise after stroke included professionals’ self-efficacy and knowledge about stroke, patients’ needs, communication and collaboration within and between organisations and resources such as equipment, staff and training. Conclusions: Key factors influencing the implementation of aerobic exercise after stroke included characteristics of the staff and intervention and system-level issues, some of which are modifiable. Further research should evaluate strategies which specifically target these modifiable factors to facilitate implementation in practice.IMPLICATIONS FOR REHABILITATION Aerobic exercise after stroke is an effective intervention but there are challenges to implementation from a staff and system perspective. Any changes to the identified factors should be tailored to suit the staff group and s

This is a collection of senior theses written by honors students at Columbus State University in Spring 2020., https://csuepress.columbusstate.edu/honors_theses/1001/thumbnail.jpg