Impact of non-pharmacological interventions on prevention and treatment of delirium in critically ill patients: protocol for a systematic review of quantitative and qualitative research

Background: Critically ill patients have an increased risk of developing delirium during their intensive care stay.To date, pharmacological interventions have not been shown to be effective for delirium management but non-pharmacological interventions have shown some promise. The aim of this systematic review is to identify effective non-pharmacological interventions for reducing the incidence or the duration of delirium in critically ill patients.

Methods: We will search MEDLINE, EMBASE, CINAHL, Web of Science, AMED, psycINFO and the Cochrane Library.We will include studies of critically ill adults and children. We will include randomised trials and controlled trials which measure the effectiveness of one or more non-pharmacological interventions in reducing incidence or duration ofdelirium in critically ill patients. We will also include qualitative studies that provide an insight into patients and their families’ experiences of delirium and non-pharmacological interventions. Two independent reviewers will assess studies for eligibility, extract data and appraise quality. We will conduct meta-analyses if possible or present results narratively.Qualitative studies will also be reviewed by two independent reviewers, and a specially designed quality assessment tool incorporating the CASP framework and the POPAY framework will be used to assess quality.

Discussion: Although non-pharmacological interventions have been studied in populations outside of intensive care units and multicomponent interventions have successfully reduced incidence and duration of delirium, no systematic review of non-pharmacological interventions specifically targeting delirium in critically ill patients have been undertaken to date. This systematic review will provide evidence for the development of a multicomponent intervention for delirium management of critically ill patients that can be tested in a subsequent multicentre randomised trial.

Laughter Research: A Review of the ILHAIRE Project

Laughter is everywhere. So much so that we often do not even notice it. First, laughter has a strong connection with humour. Most of us seek out laughter and people who make us laugh, and it is what we do when we gather together as groups relaxing and having a good time. But laughter also plays an important role in making sure we interact with each other smoothly. It provides social bonding signals that allow our conversations to flow seamlessly between topics; to help us repair conversations that are breaking down; and to end our conversations on a positive note.

The pervasiveness and trajectory of methodological choices: A 20 year review of human resource management research

This paper examines the methodological choices of researchers studying the HR practices–outcome relationship via a content analysis of 281 studies published across the last twenty years. The prevalence and trajectory of change over time are reported for a wide range of methodological choices relevant to internal, external, construct, and statistical conclusion validity. While the results indicate a high incidence of potentially problematic cross-sectional, single informant, and single level designs, they also reveal significant improvements over time across many validity relevant methodological choices. This broad based improvement in the methodological underpinnings of HR research suggests that researchers and practitioners can view the findings reported in the HR literature with increasing confidence. Directions for future research are provided.

A systematic literature review of university technology transfer from a quadruple helix perspective: Towards a research agenda

Within recent years, there has been a rapid expansion of the University's role in economic development. This has resulted in University Technology Transfer (UTT) taking place within an increasingly complex network of regional stakeholders. This complexity has resulted in quadruple helix models where the triple helix model of academia, industry and regional government now includes societal based innovation users as a fourth helix. Despite this development, extant research is fragmented and lacks coherent frameworks and conceptualisations which fully depict the dynamic and evolving nature of UTT. Accordingly, this article reviews Mode 2 UTT from a quadruple helix perspective to identify key themes to develop a research agenda which reflects progression from a triple into a quadruple helix ecosystem.

Many ways to say 'no', different ways to say 'yes': Applying Q-Methodology to understand public acceptance of wind farm proposals

This paper explores the nature of public acceptance of wind farms by investigating the discourses of support and objection to a proposed offshore scheme. It reviews research into opposition to wind farms, noting previous criticisms that this has tended to provide descriptive rather than explanatory insights and as a result, has not effectively informed the policy debate. One explanation is that much of this research has been conceived within an unreflective positivist research frame, which is inadequate in dealing with the subjectivity and value-basis of public acceptance of wind farm development. The paper then takes a case study of an offshore wind farm proposal in Northern Ireland and applies Q-Methodology to identify the dominant discourse of support and objection. It is argued that this provides new insights into the nature of wind farm conflicts, points to a number or recommendations for policy functions of an example of how this methodology can act as a potential bridge between positivist and post-positivist approaches to policy analysis.

Grading gems: Appraising the quality of research about social work and social care.

The impetus towards basing practice and policy decisions more explicitly on sound research requires tools to facilitate the systematic appraisal of the quality of research encompassing a diverse range of methods and designs. Five exemplar tools were developed and assessed in terms of their usefulness in selecting studies for inclusion in a systematic review. The widely used ‘hierarchy of evidence’ was adapted and used to appraise internal validity. Four tools were then developed to appraise the external validity dimensions of generalizability (two scales) and methods of data collection (two scales). Methods of combining the scores generated by each tool were explored. Qualitative and quantitative studies were appraised, not separated into two spheres but by using complementary tools developed to appraise different aspects of rigour. There was a high level of agreement between researchers in applying the tools to twenty-two studies on decision making by professionals about the longterm care of older people. The scales for internal validity and generalizability discriminated between the qualities of studies appropriately. The two tools to appraise data collection gave diverse results. Excluding studies that scored in the lowest category on any scale appeared to be the scoring system that was most justifiable. This approach is presented to stimulate debate about the practical application of the evidence-based initiative to social work and social care. This study may assist in developing clearer definitions and common language about appraising rigour that should further the process of selecting robust research for synthesis to inform practice and policy decisions.

A review of the effect of the addition of hydrogen in the selective catalytic reduction of NOx with hydrocarbons on silver catalysts

Research is progressing fast in the field of the hydrogen assisted hydrocarbon selective catalytic reduction (HC-SCR) over Ag-based catalysts: this paper is a review of the work to date in this area. The addition of hydrogen to the HC-SCR reaction feed over Ag/Al2O3 results in a remarkable improvement in NO (x) conversion using a variety of different hydrocarbon feeds. There is some debate concerning the role that hydrogen has to play in the reaction mechanism and its effect on the form of Ag present during the reaction. Many of the studies use in situ UV-Vis spectroscopy to monitor the form of Ag in the catalyst and appear to indicate that the addition of hydrogen promotes the formation of small Ag clusters which are highly reactive for NO (x) conversion. However, some authors have expressed concern about the use of this technique for these materials and further work is required to address these issues before this technique can be used to give an accurate assessment of the state of Ag during the SCR reaction. A study using in situ EXAFS to probe the H-2 assisted octane-SCR reaction has shown that small Ag particles (containing on average 3 silver atoms) are formed during the SCR reaction but that the addition of H-2 to the feed does not result in any further change in the Ag particle size. This points to the direct involvement of H-2 in the reaction mechanism. Clearly the addition of hydrogen results in a large increase in the number and variety of adsorbed species on the surface of the catalyst during the reaction. Some authors have suggested that conversion of cyanide to isocyanate is the rate-determining step and that hydrogen promotes this conversion. Others have suggested that hydrogen reduces nitrates to more reactive nitrite species which can then activate the hydrocarbon; activation of the hydrocarbon to form acetates has been proposed as the key step. It is probable that all these promotional effects can take place and that it very much depends on the reaction temperature and feed conditions as to which one is most important.

A review of the selective reduction of NOx, with hydrocarbons under lean-burn conditions with non-zeolitic oxide and platinum group metal catalysts

Research on the selective reduction of NOx with hydrocarbons under lean-burn conditions using non-zeolitic oxides and platinum group metal (PGM) catalysts has been critically reviewed. Alumina and silver-promoted alumina catalysts have been described in detail with particular emphasis on an analysis of the various reaction mechanisms that have been put forward in the literature. The influence of the nature of the reducing agent, and the preparation and structure of the catalysts have also been discussed and rationalised for several other oxide systems. It is concluded for non-zeolitic oxides that species that are strongly adsorbed on the surface, such as nitrates/nitrites and acetates, could be key intermediates in the formation of various reduced and oxidised species of nitrogen, the further reaction of which leads eventually to the formation of molecular nitrogen. For the platinum group metal catalysts, the different mechanisms that have been proposed in the literature have been critically assessed. It is concluded that although there is indirect, mainly spectroscopic, evidence for various reaction intermediates on the catalyst surface, it is difficult to confirm that any of these are involved in a critical mechanistic step because of a lack of a direct quantitative correlation between infrared and kinetic measurements. A simple mechanism which involves the dissociation of NO on a reduced metal surface to give N(ads) and O(ads), with subsequent desorption of N-2 and N2O and removal of O(ads) by the reductant can explain many of the results with the platinum group metal catalysts, although an additional contribution from organo-nitro-type species may contribute to the overall NOx reduction activity with these catalysts.

Is there a role for n-3 long-chain polyunsaturated fatty acids in the regulation of mood and behaviour? A review of the evidence to date from epidemiological studies, clinical studies and intervention trials

Selected biochemical evidence suggests a potential role for n-3 long-chain PUFA (n-3PUFA) in the regulation of mood and behaviour. The present paper reviews the relevant evidence, to date, from epidemiological studies, clinical studies and intervention trials. Most evidence is available investigating a role for n-3PUFA in depression, depressive illness and suicidal behaviour, but work is also available on anxiety and anxiety-related disorders, fatigue and fatigue-related disorders, aggression, hostility and anti-social behaviour, inattention, impulsivity and attention deficit hyperactivity disorder and schizophrenic disorders. For all these aspects of mood and behaviour, the evidence available is currently limited and highly inconsistent, both in terms of study methodology and study findings. There is a clear need for further work in this area.

Adolescent men's attitudes in relation to pregnancy and pregnancy outcomes: A systematic review of the literature from 1980-2009

This review article reveals a long-standing gender bias in academic and policy research on adolescent pregnancy, which has led to the neglect of adolescent men's perspectives. The review summarizes the available literature on adolescent men's attitudes in relation to pregnancy occurrence and pregnancy outcomes in the context of addressing three questions: (1) What are adolescent men's attitudes to an adolescent pregnancy? (2) What are adolescent men's attitudes in relation to pregnancy outcomes? (3) What explanations are offered for the identified attitudes to adolescent pregnancy and resolution? The review establishes a foundation for future quantitative and qualitative research on adolescent men's perspectives. It emphasizes that a greater understanding of adolescent men's perspectives could lead to a re-framing of adolescent pregnancy away from being seen solely as a woman's issue. Furthermore, it is argued that the inclusion of adolescent men would lead to more effective adolescent pregnancy prevention and counseling programmes.