Explore the vast range of titles available.

This study investigated the efficacy of medium-term Green Exercise (GE; being physically active within a natural environment) interventions for improving wellbeing, by pooling data collected at the start and end of participants’ engagement with a range of GE interventions. Hypotheses were that (i) interventions would show good efficacy for improving wellbeing in the overall sample; (ii) compared to participants reporting ‘average to high’ wellbeing at the start of their project, participants with ‘low’ starting wellbeing would report greater improvements post-intervention; and (iii) improvements would significantly differ between age groups. The pooled dataset was categorized in line with UK norms (n = 318) and analyzed using a standardized meta-analysis approach. Effect size was large: g = 0.812 (95% CI [0.599, 1.025]), and differences in wellbeing changes associated with project duration, age or sex were not statistically significant. Compared to those reporting ‘average-high’ starting wellbeing, participants reporting ‘low’ starting wellbeing exhibited greater improvements (BCa 95% CI [−31.8, −26.5]), with 60.8% moving into the ‘average-high’ wellbeing category. GE can play an important role in facilitating wellbeing and can provide alternative pathways for health and social care practice. Public health commissioners should consider integrating such interventions for patients experiencing low wellbeing or associated comorbidities.

Cancer-associated thrombosis, with the incidence rising over the years, is associated with significant morbidity and mortality in patients with cancer. Recent advances in the treatment of cancer-associated venous thromboembolism (VTE) include the introduction of direct oral anticoagulants (DOACs), which provide a more convenient and effective option than low-molecular-weight heparin (LMWH). Nonetheless, important unmet needs remain including an increased risk of bleeding in certain patient subgroups such as those with gastroesophageal cancer, concerns about drug-drug interactions, and management of patients with severe renal impairment. Although DOACs are more convenient than LMWH, persistence can decline over time. Factor XI inhibitors have potential safety advantages over DOACs because factor XI appears to be essential for thrombosis but not hemostasis. In phase II trials, some factor XI inhibitors were superior to enoxaparin for the prevention of VTE after knee replacement surgery without increasing the risk of bleeding. Ongoing trials are assessing the efficacy and safety of factor XI inhibitors for the treatment of cancer-associated VTE. This narrative review summarizes advances in the treatment of cancer-associated venous thromboembolism, outlines key unmet needs with the current treatment, and discusses how factor XI inhibitors may address the current knowledge gaps.

Background The use of non-drug, non-health-service interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve their health and well-being. Interventions typically involve accessing activities run by the third sector or community agencies and may also be described as non-medical referral, community referral or social prescribing. To be effective, patients need to be “transferred” from the primary care setting into the community and to maintain their participation in activities. However, it is not currently known how and why these approaches enable which people under what circumstances to reach community services that may benefit their health and well-being. Methods Database searches and extensive searching of grey sources will be carried out in an attempt to find evidence associated with referral and retention in social prescribing. After initial scoping searches, two main phases of searching will be conducted: (a) will focus on the identification of programme theories to illustrate how approaches to social prescribing work for different people and in different contexts and (b) will consist of targeted searches to locate evidence to refine these candidate theories into configurations of the contexts in which populations and the main mechanisms outcomes are achieved. Inclusion criteria will initially be broad in order to develop a clear picture of the ways in which social prescriptions might operate but may iteratively become more focused in response to initially identified evidence, for example, in terms of the population group. An expert advisory group consisting of professionals working in a range of organisations involved in social prescribing will be convened to check the approaches in the review and provide real-life experience of social prescribing. Findings from the review will be disseminated to commissioners, published in a peer-reviewed journal and used to help refine an intervention model for an outdoor nature-based group intervention. Discussion This realist review will explore why mechanisms of social prescribing work, for what groups of people and their impact on enrolment, attendance and adherence to programmes. The use of realist approaches to detail the social prescribing process is novel and will offer insights into effective transfer of patients. Systematic review registration PROSPERO CRD42016039491

The use of digital health products has gained considerable interest as a new way to improve therapeutic research and development. Although these products are being adopted by various industries and stakeholders, their incorporation in clinical trials has been slow due to a disconnect between the promises of digital products and potential risks in using these new technologies in the absence of regulatory support. The Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium hosted a public workshop to address challenges and opportunities in this field. Important characteristics of tool development were addressed in a series of presentations, case studies, and open panel sessions. The workshop participants endorsed the usefulness of an evidentiary criteria framework, highlighted the importance of early patient engagement, and emphasized the potential impact of digital monitoring tools and precompetitive collaborations. Concerns were expressed about the lack of real‐life validation examples and the limitations of legacy standards used as a benchmark for novel tool development and validation. Participants recognized the need for novel analytical and statistical approaches to accommodate analyses of these novel data types. Future directions are to harmonize definitions to build common methodologies and foster multidisciplinary collaborations; to develop approaches toward integrating digital monitoring data with the totality of the data in clinical trials, and to continue an open dialog in the community. There was a consensus that all these efforts combined may create a paradigm shift of how clinical trials are planned, conducted, and results brought to regulatory reviews.

Background The prevention of stroke in patients with atrial fibrillation (AF) involves the use of oral anticoagulation, commonly in the form of direct oral anticoagulants (DOACs). However, it comes with an increased risk of bleeding, and therefore, counselling patients on their individual risks is important. Although the majority of patients initiated on DOACs have been represented within the clinical trials, some cohorts are under-represented in whom clinicians cannot practice evidence-based medicine. Methods Utilising the pooled clinical trial (CT) data sourced from Medidata Enterprise Data Store, five recent open-label industry-sponsored AF trials were compared with real-world data (RWD) sourced from the HealthVerity™ Marketplace with the occurrence of bleeding events as the primary outcome of interest. Results A total of 64,421 patients were included in the analysis, with 3207 patients from the clinical DOAC trials and 61,214 patients from the RWD cohort. Overall, the patients from the RWD cohort had more co-morbidities, were older (72.2 ± 11.9 vs. 65.3 ± 10.7 years old, p < 0.001), had higher mean CHA2DS2VASc (3.98 ± 1.9 vs. 2.87 ± 1.73, p < 0.001), and HAD-BLED scores (2.13 ± 1.02 vs. 1/04 ± 0.93, p < 0.001) when compared to the trial data. When comparing the incidence of the first major bleed at 12 months post-treatment initiation, rates in the RWD cohort were significantly higher (10.69 vs. 18.97 per 100 person-years). The impact of co-morbidities such as age, CHA2DS2VASc, and HAD-BLED scores was similar in both cohorts; however, there was an under-representation of older females and more co-morbid patients within the clinical trial cohort. Conclusions DOAC-treated patients have a higher bleeding incidence rate in the RWD cohort than in clinical trials. This can be explained by the older patient age group with more complex medical h istories and higher HAS-BLED scores. The under-representation of higher-risk patients and lower proportion of females within clinical trials should be addressed to better translate clinical trial data into real-world clinical practice.

In social prescribing, people are referred by primary-care professionals to non-medical, community-based activities. The transfer between primary care and the community-based provider can be difficult, with low uptake and poor engagement with and adherence to interventions. There is an ambition to increase the use of social prescribing in the UK health service; however, to achieve this ambition the process of referral and retention needs improving. This study aimed to increase our understanding of what works and why in the social prescribing process and to apply this knowledge in primary-care settings where the use of the approach is being developed. In a realist review of literature considering the process of social prescribing, bibliographic and grey literature searches were used to locate evidence. The relevance of the evidence was assessed and then used to develop theory. Findings were contextualised through focus groups in the partner primary-care setting. Bibliographic and grey literature searches identified a total of 253 primary sources, and data were fully extracted from the most conceptually rich (n=109). Overarching programme theory integrating 40 active elements of the social prescribing process was developed through synthesis of the primary literature. This list was then refined through expert prioritisation leading to targeted searches conducted on key elements of the process relating to enrolment in, engagement with, and adherence to social prescribing. Key contexts and mechanisms contributing to successful uptake and enrolment included patient beliefs about suitable treatment options, presentation of the intervention and social prescribing process, accessibility of social prescribing (physically and psychologically), and supported uptake (eg, a link worker). Skilful and flexible intervention leadership and a change in the patient's condition were key contexts or mechanisms in maintaining adherence. Use of a realist approach, with findings iteratively refined and applied in a primary-care setting, has facilitated a better understanding of what works in the social prescribing process. However, despite increasing interest in the approach, there is a paucity of information in the current evidence base about how social prescribing interventions are developed, offered, and delivered. Therefore, future social prescribing interventions should integrate process evaluations. Part funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust.

The first strand of this thesis is methodological. The debate over the role and form of policy evaluation is taken forwards, in concert with a discussion about the way that language is used in policy-making. Emerging from these concerns is an attempt to develop a linguistic analytical framework for specific policy discussions, concentrating on the occurrences of different types of speech act, and placing them within a discursively-constructed context. The intention is to develop a tool that can be applied in a wide range of instances. The framework has a normative basis - it is aimed at measuring progress towards a more 'ethical' debate. The ideas of Jürgen Habermas are employed to understand the factors that foster those particular verbal contributions that are oriented towards providing a greater common understanding. The second strand is theoretical. A critical assessment is made of an emerging political construct - the 'new governance' - widely promulgated as a means for delivering the 'third way'. In particular, the roles that 'deliberation' and 'partnership' play in the governance relation between state and society are examined in detail. This provides a starting point to discuss a number of relevant issues: urban policy; planning; sustainable development; devolution; and the use of communication and information technologies. These are developed at a general level, and then in the specific context of urban brownfield policy in London. These two strands are brought together by the empirical research. A project concerning the provision of information on brownfield land in London was initiated. This included a series of seminars that ran in February 1999. These provide an initial test for the evaluative framework. The thesis then makes a series of conclusions concerning the applicability of the framework, the reality of a 'third way' of governance, and the future of brownfield policy in London.

Teams are always made up of a mixture of boys and girls, Arabs and Jews, wearing sporting kits donated by various English football clubs. Media coverage of the event was high profile and widespread; it was televised on CNN, Sky Sports and Aljazeera and also attracted coverage in the print media, putting an altogether different \"spin\" on news emanating from the region.

Understanding human fertility requires dynamic and three-dimensional (3D) analysis of sperm movement, which extends beyond the capabilities of traditional datasets focused primarily on two-dimensional sperm motility or static morphological characteristics. To address this limitation, we introduce the 3D+t Multifocal Imaging Dataset of Human Sperm (3D-SpermVid), a repository comprising 121 multifocal video-microscopy hyperstacks of freely swimming sperm cells, incubated under non-capacitating conditions (NCC) and capacitating conditions (CC). This collection enables detailed observation and analysis of 3D sperm flagellar motility patterns over time, offering novel insights into the capacitation process and its implications for fertility. Data were captured using a multifocal imaging (MFI) system based on an optical microscope equipped with a piezoelectric device that adjusts focus at various heights, recording sperm movement in a volumetric space. By making this data publicly available, we aim to enable applications in deep learning and pattern recognition to uncover hidden flagellar motility patterns, fostering significant advancements in understanding 3D sperm morphology and dynamics, and developing new diagnostic tools for assessing male fertility, as well as assisting in the self-organizaton mechanisms driving spontaneous motility and navigation in 3D.

\"Credit to the players because I'm proud of them and this has been a great season for us,\" said [Oldham]'s manager, John Sheridan. \"We had a real go at them but our defensive sloppiness left us with just too much to do.\" A capacity crowd watched them overcome a gallant Oldham side, who trailed 2-1 from the first leg of this play-off semi-final and were hoping to take inspiration from Yeovil's remarkable comeback against Nottingham Forest. However, in a game where three goals were disallowed for offside - two for Oldham and one for Blackpool - Keith Southern's first-half strike put the home side in control.