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The rise in the use of AI in most key areas of business, from sales to compliance to financial analysis, means that even the highest levels of corporate governance will be impacted, and that corporate leaders are duty-bound to manage both the responsible development and the legal and ethical use of AI. This transformation will directly impact the legal and ethical duties and best practices of those tasked with setting the ‘tone at the top’ and who are accountable for the firm’s success. Directors and officers will have to ask themselves to what extent should, or must, AI tools be used in both strategic business decision-making, as well as monitoring processes. Here we look at a number of issues that we believe are going to arise due to the greater use of generative AI. We consider what top management should be doing to ensure that all such AI tools used by the firm are safe and fit for purpose, especially considering avoidance of potential negative externalities. In the end, due to the challenges of AI use, the human component of top corporate decision-making will be put to the test, to prudentially thread the needle of AI use and to ensure the technology serves corporations and their human stakeholders instead of the other way around.
To investigate the impact of the widespread availability and use of the semi-synthetic cannabinoid hexahydrocannabinol (HHC) on hospital admissions owing to psychosis. Medical records of patients admitted for psychotic illness to University Hospital Galway were examined to assess HHC or other illicit drug use before admission.
Results
Of the 214 total admissions for psychotic illness, 28 admissions (13.1%) were preceded by use of HHC, nine of whom used only HHC. Sixteen (34%) admissions of first-episode psychosis were preceded by HHC use, with seven of these using only HHC.
Clinical implications
Clinicians should explicitly enquire about the use of HHC in patients presenting with first-episode and relapse of psychotic illness. Sufficient evidence has now accumulated from research of a link between HHC and psychosis. Such psychoses appear to be more prominent in young people with early-phase psychosis, and highlights the need for authorities to change legislation to avoid further harm.
Much Persian sufi literature is explicitly didactic, aiming to instruct its readers and motivate pious reform. Moving beyond a recapitulation of religious content, The Poetics of Spiritual Instruction investigates the performative function of didactic poetry for mystical audiences, focusing in particular on the verse of Farid al-Din ʿAttar, a central figure of the tradition best known for long narrative poems imbued with edifying sufi themes. Through a series of sensitive and creative readings, O'Malley shows how ʿAttar uses frame-tales, metapoetic commentary and allegories to think through his relationship with his readers, imagine and guide their reactions to his work and perform his instructive authority. By teasing out this implicit, recipient-centred poetics, O'Malley recovers sufi didacticism's participatory, interactive character and shows how the act of reading was invested with ritual significance as a spiritual exercise aimed at the purification of the soul.
Over the past century there have been numerous Irish translations of literature from central and eastern European countries that are reworkings of existing English versions. This chapter focuses on examples of this phenomenon produced by three notable writers: Seamus Heaney’s work on Leoš Janáček’s song cycle, Diary of One Who Vanished (1999), Flann O’Brien’s Rhapsody in Stephen’s Green (a 1943 rendering of Karel and Josif Čapek’s Ze života hmyzu/The Insect Play), and Brian Friel’s versions of Anton Chekhov’s Three Sisters (1981/2008). The original texts have very little in common with each other, thematically or stylistically, and these translations reflect this diversity. However, they are all characterized by acts of domestication as, in a variety of ways, the three translators infused their renderings with Irish notes in order to distinguish them from the standard and British English versions that informed their creation. In this light, these translations operate almost entirely in English language and cultural terms, and speak more to the position of Irish literature in the Anglosphere than to its relationship with central and eastern European cultural worlds.
Complexity stratification for CHD is an integral part of clinical research due to its heterogenous clinical presentation and outcomes. To support our ongoing research efforts into CHD requiring disease severity stratifications, a simplified CHD severity classification system was developed and verified, with potential utility for clinical researchers without specialist CHD knowledge or access to clinical/medical records.
Method:
A two-tiered analysis approach was undertaken. First-tier analysis included the audit of a comprehensive system based on: i) timing of intervention, ii) cardiac morphology, and iii) cardiovascular physiology using real patient data (n = 30), across 10 common CHD lesions. Second-tier analysis allowed for a simplified version of the classification system using morphology as a stand-alone predictor. Twelve clinicians of varying specialities involved in CHD care ranked 10 common lesions from least to most severe based on typical presentation and clinical course.
Results:
First-tier analysis identified that cardiac morphology was the principal driver of complexity. Second-tier analysis largely confirmed the ranking and classification of the lesions into the broad CHD severity groups, although some variation was noted, specifically among non-cardiac specialists. This simplified version of the classicisation system, with morphology as a stand-alone predictor of severity, allowed for effective stratification for the purposes of analysis.
Conclusion:
The findings presented here support this comprehensive and simple CHD severity classification system with broad utility in CHD research, particularly among clinicians and researchers with limited knowledge of CHD. The model may be applied to produce locally relevant research tools.
The cause of most CHD is unknown and considered complex, implicating genetic and environmental factors in disease causation. The Kids Heart BioBank was established in 2003 to accelerate genetic investigations into CHD.
Methods:
Recruitment includes patients undergoing interventions for CHD at The Children’s Hospital at Westmead. Informed consent is obtained from parents/guardians, and blood is collected at the time of cardiac intervention from which DNA is extracted and stored. Associated detailed clinical information and a family history are stored in the purpose-designed database.
Results:
To date, the Kids Heart BioBank contains biospecimens and associated clinical information from over 4,900 patients with CHD and their families. Two-thirds (64.1%) of probands have been included in research studies with 28.9% of participants who underwent genomic sequencing receiving a molecular diagnosis with direct clinical utility. The value of this resource to patients and families is highlighted by the high consent rate (94.6%) and the low withdrawal of consent rate (0.4%). The Kids Heart BioBank has supported many large national and international collaborations and contributed significantly to CHD research.
Conclusions:
The Kids Heart BioBank is an invaluable resource and, together with other similar resources, the resulting research has paved the way for clinical genetic testing options for CHD patients, previously not possible. With research in the field moving away from diagnosing monogenic disease, the Kids Heart BioBank is ideally placed to support the next chapter of research efforts into complex disease mechanisms, requiring large patient cohorts with detailed phenotypic information.
Background: Infections lead to high mortality among patients on chronic dialysis; knowledge of multi-drug resistant infections is limited. The Centers for Disease Control and Prevention’s Emerging Infections Program (EIP) conducts laboratory- and population-based surveillance for carbapenem-resistant Enterobacterales (CRE) in 10 U.S. sites and carbapenem-resistant Acinetobacter baumannii (CRAB) in 9 U.S. sites. We investigated clinical characteristics, healthcare exposures, and outcomes of CRE and CRAB cases in persons on chronic dialysis from 2016-2021. Methods: Among EIP catchment-area residents on chronic dialysis, we defined a CRE case as the first isolation of Escherichia coli, Enterobacter cloacae complex, Klebsiella aerogenes (formerly Enterobacter aerogenes), Klebsiella oxytoca, Klebsiella pneumoniae, or Klebsiella variicola resistant to any carbapenem, from a normally sterile site or urine in a 30-day period. A CRAB case was defined as the first isolation of Acinetobacter baumannii complex resistant to any carbapenem (excluding ertapenem), from a normally sterile site or urine (or lower respiratory tract or wound since 2021) in a 30-day period. Medical records were reviewed. A case was considered colonized if the case culture had no associated infection type or colonization was documented in the medical record. Descriptive analyses, including analyses stratified by pathogen, were conducted. Results: Among 426 cases, 314 were CRE, and 112 were CRAB; most cases were male (235, 55.2%), Black (229, 53.8%), and 51-80 years old (320, 75.1%) (Table). An infection was associated with 363 (85.2%) case cultures; bloodstream infections (148; 40.8%), urinary tract infections (134; 36.9%), and pneumonia (17; 4.7%) were the most frequent. Overall, most cases had documented healthcare exposures (excluding outpatient dialysis) in the year before incident specimen collection, including: 366 (85.9%) hospitalizations, 235 (55.2%) surgeries, 209 (49.1%) long-term care facility stays, 54 (12.7%) long-term acute care facility stays. Additionally, 125 (29.3%) had an intensive care unit admission within the 7 days before incident specimen collection. Compared to CRE cases, a higher proportion of CRAB cases (a) had a long-term care facility stay (82/112 [73.2%] versus 127/314 [40.5%], P<.0001) or hospitalization (103/112 [92%] versus 263/314 [83.8%], P = .03) within the preceding year and (b) died within 30 days of incident specimen collection (40/112 [35.7%] versus 64/314 [20.4%], P = .001). Discussion: Among CRE and CRAB cases in persons on chronic dialysis, healthcare exposures were common, and mortality was high. Additional efforts to better describe the burden of these organisms and associated risk factors in the dialysis population are needed for tailoring infection prevention strategies to this vulnerable.
To examine whether the rate of clinical and non-clinical complaints towards a mental health service (MHS) in the west of Ireland has changed over the preceding seven years. We aim to clarify the pathways for managing clinical and non-clinical complaints locally and compare with other MHS nationally. We aim to capture the nature of complaints, potential factors in any change in rate and quantify associated workloads via survey of senior clinicians involved in managing complaints.
Methods
We obtained anonymous data from a local database maintained by administrative staff regarding annual complaint numbers for the previous seven years (2016–2022). Data separating clinical and non-clinical complaints were available for the previous four years only due to previous recording practices. Current complaint pathways were captured via administrative staff. A survey via telephone or email of Executive Clinical Directors (ECDs) typically involved in complaint management was conducted.
Results
Annual rates of complaints have increased in the past four years, with these representing higher totals than any of the three previous years (2019–2022, n = 27,23,23,46 v. 2016–2018, n = 21,12,14). A significant increase in rate is noted in 2022 (n = 46) representing at least double the rate of five of the preceding six years. Clinical complaints are more predominant than non-clinical across a four year period (mean = 59% annual total) but no significant change in rate was noted. Rates of complaints are perceived to have increased in the previous five years by ECDs (n = 4). Repeat complainants are perceived to be common (n = 4). Workload regarding complaints is reported to be variable between services (n = 2, 0–4 hrs/week v. n = 2, 4–8 hrs/week). A clear appeals pathway is unavailable regarding clinical complaints across MHS (n = 4). A disparity between MHS around clinical complaints structures and recording practices between services is noted.
Conclusion
Overall rates of complaints towards MHS have broadly increased in the last four years, with a significant increase in 2022. There appears to be a significant disparity in structures between both clinical and non-clinical complaints pathways and between individual MHS. Further research in this area and a standardised national framework for management of clinical complaints is needed.
Medical-legal partnerships (MLPs) support patients and clinicians by streamlining legal and medical care and helping identify and address a subset of social drivers of health (SDOH). Less is known on the effect of MLPs on the competency of residents regarding SDOH. The aim of this study was to identify how integration of an MLP into a pediatric residency training program affected residents’ experience understanding and addressing SDOH.
Plant growth requires the integration of internal and external cues, perceived and transduced into a developmental programme of cell division, elongation and wall thickening. Mechanical forces contribute to this regulation, and thigmomorphogenesis typically includes reducing stem height, increasing stem diameter, and a canonical transcriptomic response. We present data on a bZIP transcription factor involved in this process in grasses. Brachypodium distachyon SECONDARY WALL INTERACTING bZIP (SWIZ) protein translocated into the nucleus following mechanostimulation. Classical touch-responsive genes were upregulated in B. distachyon roots following touch, including significant induction of the glycoside hydrolase 17 family, which may be unique to grass thigmomorphogenesis. SWIZ protein binding to an E-box variant in exons and introns was associated with immediate activation followed by repression of gene expression. SWIZ overexpression resulted in plants with reduced stem and root elongation. These data further define plant touch-responsive transcriptomics and physiology, offering insights into grass mechanotranduction dynamics.
The clinic visit is a critical point of contact for family caregivers. However, only 37% of family caregivers are able to accompany patients to visits. When they cannot attend, caregivers receive visit information to assist with their caregiving. However, little is known about how method of receiving information from clinic visits is associated with important caregiver outcomes. This study sought to determine whether mode of receiving clinic visit information (speaking with the patient, attending the visit, or using an after-visit summary [AVS]) was associated with changes in caregiver burden, caregiver preparedness, and the positive aspects of caregiving.
Methods
Cross-sectional web-based survey of a national sample of adult family caregivers. Multiple linear regression models determined associations between communication modes and caregivers’ burden, preparedness, and positive aspects of caregiving, adjusting for sociodemographic covariates.
Results
Respondents (N = 340) were mostly male (58%), White (59%), ranged from 18 to 85 years old, and supported patients with conditions including diabetes, dementia, and cancer. Speaking with patients was associated with increases in positive aspects of caregiving (95% CI = 2.01, 5.42) and an AVS was associated with increases in positive aspects of caregiving (95% CI = 0.4, 3.56) and preparedness for caregiving (95% CI = 0.61, 3.15). Using any method of receiving information from visits was associated with the greatest increase in preparedness, compared to not receiving visit information. We did not observe an association between method of communication and caregiver burden.
Significance of results
Method of communicating visit information is associated with improvements in caregiver preparedness and the positive aspects of caregiving, though caregiver burden may be unaffected by information exchange. Given the limitations of current communication methods, future work should explore directionality of the associations we found and identify visit communication strategies with caregivers that optimize caregiver and patient outcomes.
Use of both cannabis and synthetic cannabinoids has been regularly linked to the development of psychotic illness. Thus, semisynthetic cannabinoids such as hexahydrocannabinol (HHC), which have a similar neurobiological profile to delta-9-THC, may also be expected to lead to psychotic illness. However, no such relationship has yet been reported in scientific literature. HHC is readily available online and in many vape shops in Ireland. Here, we present two cases of psychotic illness which appear to have been precipitated by use of legally purchased HHC and discuss its psychotogenic role and factors linked to its current widespread availability.
In September 2020, a University of Northampton (UK) team, led by Professor Parkes and Dr Mary O’Malley (now at the University of Worcester) were successful in securing funding from the Wellcome Trust Public Engagement Fund. The central aims of the DEfIN-YD project were to share knowledge about young onset dementia (YOD) research; create a younger onset dementia public and patient involvement (PPI) network; develop ideas for future YOD research; and provide a reference group to support researchers developing YOD projects. Currently, 21 people have been recruited into one of three regional groups. Prof Parkes leads the Midlands group, Dr Cole from University of West London hosts the Southern group, and Bradford University supports the Northern group. The members were recruited via the Young Dementia Network (YDN), Dementia UK, Alzheimer’s Society, the DEEP network, and local NHS Services. They come from urban and rural settings across the UK. Some attend the meetings alone and others are supported by advocates (usually carers). They have a variety of diagnoses and are at different stages of their dementia journey. The groups include members from different cultural backgrounds. They are able to share their personal experiences and are keen to do so in order to improve the care experiences of others. Due to COVID, members effectively completed all 5 regional workshop sessions from August 2021-March 2022 via Microsoft Teams. They are now fully prepared to engage in designing and developing YOD research projects. The top priority they identified for future research was for professionals to be more specifically trained in YOD. Once the workshops were designed and delivered, the first phase of the project was complete. Phase 2 (from April-October 2022) has sort to capture the experiences of participating in the workshops from the group members, facilitators, and project team; as well as developing a sustainable model for the future of the regional groups. The project comes to an end on the 31st March 2023.
In this presentation we would like to explore the following objectives:
Primates are important species for biomedical research and ensuring their good welfare is critical for research translatability and ethical responsibility. Systematic animal welfare assessments can support continuous programme improvements and build institutional awareness of areas requiring more attention. A multi-facility, collaborative project aimed to develop and implement a novel primate welfare assessment tool (PWAT) for use with research macaques. PWAT development involved: establishing an internal focus group of primate subject matter experts, identifying animal welfare categories and descriptors based on literature review, developing a preliminary tool, beta-testing the tool to ensure practicality and final consensus on descriptors, finalising the tool in a database with semi-automated data analysis, and delivering the tool to 13 sites across four countries. The tool uses input- and outcome-based measures from six categories: physical, behavioural, training, environmental, procedural, and culture of care. The final tool has 133 descriptors weighted based upon welfare impact, and is split into three forms for ease of use (room level, site level, and personnel interviews). The PWAT was trialled across facilities in March and September 2022 for benchmarking current macaque behavioural management programmes. The tool successfully distinguished strengths and challenges at the facility level and across sites. Following this benchmarking, the tool is being applied semi-annually to assess and monitor progress in behavioural management programmes. The development process of the PWAT demonstrates that evidence-based assessment tools can be developed through collaboration and consensus building, which are important for uptake and applicability, and ultimately for promoting global improvements in research macaque welfare.
Understanding contemporary African American literature, this chapter argues, requires accounting for the rich, multifaceted dialogue between Black literary production and the visual arts. This chapter traces what Toni Morrison called the “alliances and alignments” between literature and the other arts by analyzing the aesthetics and themes of contemporary African American writing and examining the cross-arts influences that shaped it. The dialogue between African American literature and visual culture is part of a much longer tradition, and contemporary writers have built on many earlier precedents. But this chapter also unpacks how important historical changes, including developments in media technology and the rise of Black art institutions, have generated new and more numerous intersections between Black literary and artistic cultures since the 1970s. Focusing on three key spaces that provided material support and thematic inspiration for Black writers’ experiments with visual art – the home, museum, and university – this chapter examines how authors working in a range of literary genres, including novels, poetry, plays, screenplays, memoirs, and essays, engaged with a variety of visual arts, including painting, film, sculpture, and photography. The influences and aesthetics of visual culture, the chapter shows, powerfully infuse the work of many writers today.