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Abstract Foresight plays an important role in public policy development. The foresight learning process brings together various actors in the policy community and incentivizes them to think about the future. It encourages new ways of thinking and approaches to strategy and is a practical approach to using the future to inform decisions and actions in the present. Foresight faces challenges in becoming embedded in the policy process. One of these challenges is in establishing its epistemic authority when compared to natural science and social science disciplines. This paper argues foresight can benefit from developments in political theory and philosophy of science. Democratic deliberation is an approach to public discourse which emphasizes pluralism in debate and provides a detailed account of how reason-giving can add epistemic depth to foresight’s contribution to policy. Perspectival realism is a theory in philosophy of science which identifies the interplay between separate epistemic communities as the key mechanism in scientific development. The modal models that these epistemic communities create present a new way of understanding foresight’s study of the future and its part in the weave of scientific evidence, opinion and analysis that constitute policy development in a democratic society.

Abstract Background Limited studies have explored the use of the hybrid approach combining team-based learning (TBL) and case-based learning (CBL) in dental education. This study evaluates how students perceive the hybrid TBL-CBL approach to learning endodontics and determines whether gender and ethnicity impact students’ perceptions. Methods The final-year undergraduate Bachelor of Dental Surgery (BDS) students were invited to participate in a hybrid TBL-CBL session. They were randomly divided into six groups of six to seven students, and the session was conducted by one facilitator, supported by two lecturers. At the end of the session, a 23-item questionnaire consisting of four domains (perception of effectiveness, teacher, team interaction and learning environment) and open-ended questions was distributed. Descriptive statistics were used to analyse quantitative data using IBM SPSS software version 27.0 for Mac (SPSS Inc.). Thematic analysis was used to code qualitative data. ANCOVA (Analysis of covariance) was used to evaluate the relationship between gender and ethnicity towards the students’ perception of this hybrid TBL-CBL session, with a significant difference set at P

Susan Williams,1 Aoife Whiston,2 Ann-Marie Morrissey,1 Clíona O’Riordan,1 Margaret O’Connor,3 Deirdre Hartigan,1 Collette Devlin,1 Rose Galvin1 1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 2Department of Psychology, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; 3Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, IrelandCorrespondence: Susan Williams, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland, Email Susan.Williams@ul.ieBackground: Early supported discharge (ESD) facilitates early discharge from acute hospitals with continued rehabilitation in the home environment from a multi-disciplinary team at the same intensity as would be received in the inpatient setting. Emerging evidence suggests it can have a positive impact on the care of older adults on discharge from the acute hospital setting to home. This study aims to characterize an inreach model of ESD for older adults discharged from four hospitals in the Mid-West of Ireland and describe its impact on clinical and process outcomes at 30 and 180 days.Methods: Consecutive older adults referred for ESD from four hospitals were recruited over six-months. Baseline assessments were carried out on initial review, and patients were followed up at 30 and 180 days by an independent outcome assessor. Outcomes measured include functional status, frailty, health related quality of life, mortality, and healthcare utilization.Results: One hundred and thirty older adults (mean age 76.62 years, SD 9.81 years) were recruited, 44 for surgical complaints and 86 for medical complaints. The ESD service was provided over a median of 31 (medical) - 44 (surgical) days, primarily by physiotherapy and occupational therapy. The incidence of functional decline was 16.41% at 30 days and 27.5% at 180 days. There was a significant improvement in the self-reported function from index visit 72.94 (19.50) mean standard deviation (SD) to 30 days 84.05 (21.08) mean (SD) which was maintained at 180 days 80.53 (30.93) mean (SD). Frailty was independently associated with incidence of functional decline at 30 days (OR 2.06, 95% CI 1.39 to 3.06) and 180 days (OR 1.7, 95% CI 1.29 to 2.24).Conclusion: An ESD model of care can have significant effects on patient outcomes for older adults admitted to hospital at 30 and 180 days, without increasing the risk of unscheduled Emergency Department re-presentation. Future research should explore the impact of an ESD model of care on specific older adult cohorts.Keywords: early supported discharge, older adult, hospitalization, patient discharge, cohort studies

Prostate cancer (PCa) is a major public health concern for men globally and the most commonly diagnosed cancer among men in the European Union (EU). Despite large trials suggesting benefits from early detection of PCa, risks of overdiagnosis and overtreatment are evident. In 2022, the EU Commission proposed introducing prostate-specific antigen (PSA) testing for men in an organised setting, in combination with magnetic resonance imaging (MRI) scanning as a follow-up test to minimise these risks. PRostate cancer Awareness and Initiative for Screening Europe (PRAISE-U) is a pilot study evaluating the implementation of a risk-stratified population-based approach to PCa screening in Ireland, Lithuania, Poland, and two areas in Spain (Galicia and Manresa) for feasibility, efficacy, and cost effectiveness. As per the protocol designed for the pilots, men aged 50–69 yr residing within the catchment area of the study sites will be invited to participate. Those consenting to participate will undergo PSA testing, and men with PSA >3 ng/ml will undergo risk stratification before MRI and, if necessary, after MRI before undergoing biopsy. A collaborative user board comprising health care professionals, patients, and decision-makers will be formed to provide stakeholder input throughout the study. PRAISE-U will be evaluated on three major pillars: analysis of clinical and programme outcomes, psychosocial impact, and cost effectiveness. A set of key performance indicators (KPIs) has been developed to be piloted in the PRAISE-U pilot sites. The KPIs will serve to assess the performance and outcomes of risk-stratified PCa screening at each site. A REDCap database will be used to collect and manage pseudoanonymised data from the pilot sites. Ethics approval was obtained from each pilot site. The PRAISE-U pilot implementation is expected to commence in the 3rd quarter of 2024 for 12 mo and provide valuable data on the implementation outcomes of a risk-stratified screening approach across Europe. The findings is expected to inform the development of an optimised screening strategy with an acceptable benefit to harm ratio.

Background: The partial pectoralis major transfer for the treatment of serratus anterior deficiency and modified Eden-Lange/Triple Tendon Transfer for trapezius deficiency result in improvement in pain and shoulder function. However, athletic function following these procedures is unknown. The purpose of this study is to determine the outcomes and return to military duty and athletic tasks following partial pectoralis major transfer and Tripler Tendon Transfer. Methods: A retrospective review of prospectively gathered data was performed for all patients surgically treated for medial and lateral scapular winging at two military medical centers. Preoperative patient-reported outcomes collected included the Single Assessment Numeric Evaluation (SANE), Visual Analog Scale (VAS), and American Shoulder and Elbow Surgeons (ASES). Patients were excluded if they had less than 1 year follow-up, no postoperative patient-reported outcomes or return to military duty data. Results: Eleven patients were surgically treated for scapular winging, 7 patients for serratus anterior deficiency and 4 patients for trapezius deficiency and were available for follow-up at a mean of 28 months. The mean preoperative outcome scores were SANE 40.9%, VAS 4.4 and ASES 54.4. Significant improvement in SANE 77.4% (P = .001), VAS 1.8 (P = .017) and ASES 75.7 (P = .008) was identified. Five of the 9 (55.6%) active-duty service members were able to meet their fitness requirements and remain on active-duty status. Conclusion: The split pectoralis major transfer for serratus anterior deficiency and the Triple Tendon Transfer for trapezius deficiency are excellent treatment options in patients who have high physical demands.

Background: Limitations to using the knee as donor cartilage include cartilage thickness mismatch and donor site morbidity. Using the radial head as donor autograft for capitellar lesions may allow for local graft harvest without distant donor site morbidity. The purpose of this study is to demonstrate the feasibility of performing local osteochondral autograft transfer from the nonarticular cartilaginous rim of the radial head to the capitellum. Additionally, we sought to determine the load to failure of the radial head after harvest. Methods: Sixteen matched cadaveric elbows were used. A Kaplan approach was performed in half of the specimens and an extensor digitorum communis split in the other half. 6-mm and 8-mm capitellar cartilage defects were created. A donor plug was harvested from the rim of the radial head and transferred to the capitellum. In half of the specimens, the donor site was backfilled with autograft from the recipient plug. The other half was backfilled with calcium phosphate cement. The radial head was removed from the specimen and biomechanical analysis performed. Results: Both surgical approaches had adequate exposure to access the lateral two-third capitellar lesions in all specimens. The medial third of the capitellum was less accessible in extensor digitorum communis split approaches (1/8) compared to the Kaplan approach (6/8; P = .01). The average cartilage thickness of the peripheral rim of the radial head and capitellum was 2.5 mm (range 1.8-3.2, standard deviation 0.4) and 2.2 mm (range 1.8-3, standard deviation 0.3), respectively. During the procedure, 2 of 8 radial heads fractured in the 8-mm plug group. No radial heads fractured in the 6-mm group (P = .47). Biomechanical testing demonstrated a mean load to failure of 1993N with no difference between groups when stratified by donor plug size or type of backfill. Conclusion: This study demonstrates that the nonarticulating peripheral cartilaginous rim of the radial head could be a local harvest site for osteochondral autograft transfer for capitellar lesions up to 8 mm in diameter. The cartilage thickness of the radial head closely approximates the capitellum. Biomechanical analysis did not demonstrate a significant difference in load to fracture when backfilling the radial head harvest site with autograft bone or calcium phosphate cement. After harvest, the radial head could withstand forces much greater than those seen across the elbow when nonweight-bearing. Further investigation is needed to determine how to mitigate the risk of iatrogenic fracture with this operation.

This article presents the findings of a qualitative study of foster carers' and multidisciplinary practitioners' perceptions of foster carers' needs and existing practices in foster care in Ireland. This study explored participants' perceptions of the development of a trauma-informed care (TIC) psychoeducational intervention for foster carers. From a purposive sample of foster carers and multidisciplinary practitioners, four focus groups were carried out. Thematic analysis revealed three themes: The Need for Trauma-informed Care, Development of Trauma-informed Care and Implementation of Trauma-informed Care. The findings have informed the development of a culturally sensitive TIC intervention for foster carers that reflect the needs and practices of the Irish foster care context.

Typically, departments and universities evaluate and/or provide feedback to college mathematics instructors on their teaching by conducting classroom observations. When these observations are guided by an observation protocol, the protocol provides a particular lens that focuses the observer's attention on certain aspects of instruction. To understand the way in which mathematics departments are currently evaluating teaching and investigate whether they align with inquiry-based mathematics education practices, we evaluated 24 observation protocols from universities around the United States. Through our analysis we found that protocols mainly include closed-response items that are evaluative, focus more on the instructor than the students or the content, and rarely attend to inquiry-based mathematics education practices. These results suggest that where we aspire the field to go and where it is currently at requires significant and targeted work to achieve. Moreover, our findings provide suggestions and have implications for both those who develop observation protocols and those who use observation protocols as a measure of teaching practices. Our study highlights the need for careful explicit and clear purposes when observations are used for performance measures.

Based on decades of single-spacecraft measurements near 1 au as well as data from heliospheric and planetary missions, multi-spacecraft simultaneous measurements in the inner heliosphere on separations of 0.05-0.2 au are required to close existing gaps in our knowledge of solar wind structures, transients, and energetic particles, especially coronal mass ejections (CMEs), stream interaction regions (SIRs), high speed solar wind streams (HSS), and energetic storm particle (ESP) events. The Mission to Investigate Interplanetary Structures and Transients (MIIST) is a concept for a small multi-spacecraft mission to explore the near-Earth heliosphere on these critical scales. It is designed to advance two goals: (a) to determine the spatiotemporal variations and the variability of solar wind structures, transients, and energetic particle fluxes in near-Earth interplanetary (IP) space, and (b) to advance our fundamental knowledge necessary to improve space weather forecasting from in situ data. We present the scientific rationale for this proposed mission, the science requirements, payload, implementation, and concept of mission operation that address a key gap in our knowledge of IP structures and transients within the cost, launch, and schedule limitations of the NASA Heliophysics Small Explorers program.

Study advisory committees (SACs) provide critical value to clinical trials by providing unique perspectives that pull from personal and professional experiences related to the trials healthcare topic. The Emergency Medicine Palliative Care Access (EMPallA) study had the privilege of convening a 16-person SAC from the projects inception to completion. The study team wanted to understand the impact this project had on the SAC members. In this narrative, we use reflective dialogue to share SAC members lived experiences and the impact the EMPallA study has had on members both personally and professionally. We detail the (1) benefits SAC members, specifically patients, and caregivers, have had through working on this project. (2) The importance of recruiting diverse SAC members with different lived experiences and leveraging their feedback in clinical research. (3) Value of community capacity building to ensure the common vision of the clinical trial is promoted.

ABSTRACT: Early lactation is a critical period for dairy cows, as energy requirements rapidly increase with the onset of lactation; however, early-lactation DMI in pasture-based systems are under measured. The objectives of this study were (1) to measure and profile total DMI (TDMI) and animal performance of dairy cows during early lactation in a pasture-based system, (2) to investigate early-lactation energy balance in pasture-based systems, and (3) to examine production efficiencies, including TDMI and milk solids production per 100 kg of BW. Eighty spring-calving dairy cows were allocated to a grazing group as they calved over a 2-yr period (2021 and 2022). Cows were offered a daily herbage allowance to achieve a postgrazing sward height of 4 cm, with silage supplementation when necessary due to inclement weather. Total DMI was measured using the n-alkane technique over a 12-wk period from February 1, 2021, to April 23, 2022. Total DMI and daily milk yield were significantly affected by parity with both variables being greatest for third-parity animals (17.7 kg of DM and 26.3 kg/cow per day, respectively), lowest for first parity (13.2 kg of DM and 19.6 kg/cow per day, respectively) and intermediate for second-parity animals (16.8 kg of DM and 24.1 kg/cow per day, respectively). Peak TDMI was reached on wk 10 for first-parity animals (14.6 kg of DM), wk 11 for second parity animals (19.3 kg of DM) and wk 12 for third-parity animals (19.9 kg of DM). Parity also had a significant effect on unité fouragère lait (UFL; feed units for milk) feed balance as first-parity animals experienced a greater degree of negative energy balance (−3.2 UFL) compared with second- and third-parity animals (−2.3 UFL). Breed and parity had an effect on production efficiencies during the first 12 wk of lactation as Jersey × Holstein Friesian cows had greater TDMI/100 kg of BW and milk solids/100 kg of BW compared with Holstein Friesian cows.

Aims/method This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance. Results Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016–2017 and 2019–2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18–25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS. Clinical implications This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.