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Pritchard MW, Robinson A, Lewis SR, et al. Perioperative exercise programmes to promote physical activity in the medium to long term: systematic review and qualitative research. Southampton (UK): National Institute for Health and Care Research; 2022 Jul. (Health and Social Care Delivery Research, No. 10.21.)

Perioperative exercise programmes to promote physical activity in the medium to long term: systematic review and qualitative research.

Chapter 5 recommendations and conclusions.

• Recommendations for future research

The following recommendations are not presented in priority order; therefore, we give them equal merit.

Patient voice

To hear from patients (in different contexts, such as different communities and people with different surgical indications) about their experiences of PA promotion in the perioperative pathway, in particular patients who have engaged in specific perioperative PA programmes.

Practitioner and service manager voice

• To further explore (using our expanded thematic analysis) identified tentative values and principles and present these. To study the utility and adoption of these further in the context of shaping new service development or quality improvement in relevant perioperative settings.
• To further explore the role of the ‘prehabilitation or perioperative practitioner’ as part of a structured evaluation project.

Interventional studies

• To develop a core outcome set for studies promoting PA (including in pre-surgical prehabilitation), to facilitate a structured approach to evaluation and to allow proper comparison and, if necessary, quantitative synthesis, of studies. We propose outcomes that reflect the wider benefits of PA programmes, for instance greater feelings of control and autonomy for patients, and reduction in symptoms (such as pain). We also recognise the need for adherence to be included.
• To consider long-term follow-up of study participants beyond 12 months.
• To provide more contextual information in study reports about how interventions were delivered, or at least make wider use of descriptive frameworks such as the Template for Intervention Description and Replication (TIDieR) checklist. Providing greater detail of the interventions proposed is likely to lead to making such features more explicit.
• To explore the interplay of ethnicity and PA in the perioperative setting, especially given that black and ethnic minority patients have been disproportionately represented in the numbers of COVID-19 deaths and hospital admissions. It will be important to explore cultural narratives, contextual factors and structural assumptions.
• To map inequities in digital access, which appear to intersect with existing inequities including socioeconomic conditions, pre-existing illness and age. To document and explain corrective strategies from the research literature and exemplar services of relevance to perioperative service delivery. More broadly, to explore the physical, social and economic conditions driving health inequality and inequitable provision for the purpose of equitable ‘lifestyle’ health gains experienced across the population. This may include exploration of radical effective approaches.

Organisation

• To consider, within service evaluations, the long-term benefits of provision, including social impact as an important measure to quantify the value of broader changes people (and communities) may experience. This could include measuring and acknowledging factors such as social relationships, self-confidence, the creation of ‘safe spaces’, accounting for people being more engaged in positive behaviours, raising awareness of green space depletion and equitable access to public space, and reduced demands on the public purse.
• To develop and test a relevant service evaluation measures toolkit, to enable a standardised approach to data collection and service evaluation as programmes evolve.
• To explore how best to flexibly support patients through the now evolving (post-COVID-19) blended (digital/home-based/face-to-face) approaches services are adopting. It would be helpful to understand the optimum blended approach and how patients can still receive the important peer support, compassionate relationships with practitioners, and individualised care and encouragement we identified as important.
• To design and evaluate simple programmes for enhancing the educational skills of health professionals in the promotion of PA. Although clinical staff are knowledgeable about their own area of work, they are not always trained as ‘educators’, especially of patients and the public.
• To explore broader implementation issues such as the challenging logistics of embedding such support in perioperative and cancer care pathways.
• To explore the potential benefits of establishing a national PA ‘observatory’, extending beyond the perioperative setting to encompass PA more generally, initially by a scoping study examining similar initiatives either in other areas of health care in the UK, or relevant centres abroad.
• Implications for decision-makers

We would encourage decision-makers to engage in our application of Bate et al. ’s 39 challenge framework. However, in summary, the findings of this evidence synthesis support a focus by decision-makers on the following:

• The repercussions of intersecting inequalities and inequitable access to both services and appropriate public spaces and resources appear to be key to effective engagement of patients/participants and the promising impact of interventions. This warrants, but is not limited to, a focus on good and appropriate facilities (non-clinical, hyperlocal, warm, well-equipped and easy to access), green space and good pedestrian/cycleways, appropriate support and/or alternatives relating to digital exclusion (technologies and access to data), good public transport links and close parking, and culturally accessible services (that consider the norms of all faiths, traditions and backgrounds).
• Strong links, collaboration, co-working and multipurpose sites between primary and secondary care, local authority services and staff, grassroots/community organisations and commercial exercise facilities can be beneficial in terms of resources, patient care and patient engagement.
• Seed funding is helpful for getting things going but, once established, a degree of funding security is necessary to ensure investment in staff (who are knowledgeable, excellent communicators and compassionate, and well-supported).
• Design of services that takes seriously the inclusion of patients ‘at the table’ is essential because different patients, in different places, require different things.
• Implications for policy and practice

We would encourage policy decision-makers and practitioners to engage in our application of Bate et al. ’s 39 ‘challenge framework’. However, in summary, the findings of this evidence synthesis present the following implications for policy and practice:

• Active collaboration with colleagues in primary and secondary care, local authorities, grassroots/community organisations and commercial exercise facilities makes programmes possible and supports participant engagement. This includes shared messaging that places conversations about PA into routine clinical care and engenders the value of PA as treatment in all perioperative narratives from receptionist to senior clinical practitioners (and particularly senior clinical practitioners). The sharing and linking of data, the acknowledging of and supporting of the shift from ‘usual practice’, and engaging health-care professionals in evidence may support adoption of this messaging.
• A core compassionate team with knowledge and capacity for empathy, kindness and excellent communication supports the delivery of PA programmes. This, however, requires staff to be well supported and actively valued. Staff should be able to access training and have available specialist support that acknowledges the impact of often working closely with people with terminal illness. In addition, an active workforce can support solidarity with patients.
• Policy and delivery of services must focus on reducing the inequalities in the determinants of health. These are interconnecting and far-reaching, but should specifically consider factors influencing engagement in, and maintenance of, good health behaviours, including digital literacy and access to appropriate spaces and facilities.
• A holistic approach that sees patients as social rather than physiological beings, which places them at the centre of their own care, with autonomy to choose what they enjoy and are motivated to make a habit and with support to understand the benefits they might experience and changes they will need to make, appears to trump any focus on generalised PA goals of dose and intensity.
• Services benefit from a learning culture that includes ongoing patient feedback and involvement and the capacity to evolve in changing contexts. Data and measurement appear to be key to a learning culture, as well as to buy-in from commissioners and senior management.

The research evidence base for interventions delivered in the perioperative setting, aimed at enhancing PA among patients in the longer term, suggests some overall benefit in terms of engagement, levels of activity, physical fitness and quality of life. Our detailed contextual enquiry complements the research literature by identifying many features that contribute to establishing and delivering successful programmes.

• Cite this Page Pritchard MW, Robinson A, Lewis SR, et al. Perioperative exercise programmes to promote physical activity in the medium to long term: systematic review and qualitative research. Southampton (UK): National Institute for Health and Care Research; 2022 Jul. (Health and Social Care Delivery Research, No. 10.21.) Chapter 5, Recommendations and conclusions.
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Chapter 5 SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

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Strategies to Improve State Traffic Citation and Adjudication Outcomes (2023)

Chapter: chapter 5 - recommendations for future research.

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

22 This project provided a survey of the challenges facing effective citation and adjudication tracking within states as of 2021–2022. While comprehensive, the scope was necessarily limited, and these suggestions are offered for the development of meaningful follow-on research that will provide further benefit, context, and detail to support the deployment of improved citation tracking across the United States. Longitudinal Analyses As the results of the current project represent data collected at a snapshot in time, future research should consider following a subset of evolving legal, institutional, and technological systems to determine how these changes play out over time. For example, during interviews for this project several states reported ongoing system transitions, including major database system overhauls supporting judicial and law enforcement agencies. It would be valuable to follow these transitions as they occur and identify ongoing examples of strategies and techniques that are most successful given changing conditions and technology. Implications of Technological Advances Technology changes quickly, particularly when advancements in mobile computing and net- work access are considered. The contradiction between this rapid shift and the gradual pace of institutional change is likely to result in substantial new challenges and opportunities over the coming years. Research should continue to investigate advancements in and novel methods of citation and adjudication tracking, system design, and technological implementation, and identify ways to take advantage of innovation while working within the bounds of regulatory and institutional processes. Interstate Benefits of Standardization The present project focused on the benefits and challenges of improved citation tracking within states. However, several state representatives suggested that cross-state data standardization efforts such as the National Information Exchange Model (NIEM; https://www.niem.gov/) can pave the way for more effective tracking of violations across state lines. This would be particu- larly beneficial for tracking of violations involving commercial vehicle drivers who regularly travel among states and for cities near or straddling state lines (e.g., Kansas City). C H A P T E R   5 Recommendations for Future Research

Recommendations for Future Research 23   Further Collaborative Opportunities As discussed in project outputs, a number of state-level stakeholders identified strong benefits of collaboration with individuals and agencies within other states and with federal partners such as NHTSA Go Teams. Specific research building upon these collaborations, including identify- ing further opportunities for collaboration, tools to support collaboration, and mechanisms that prepare the groundwork for technical collaboration, would be of substantial benefit at all levels. In particular, these efforts may dovetail with those aimed at improving cross-state standardization. Standardized Methods to Align Data One challenge that many stakeholders reported when shifting to centralized datasets was the need to align data types and formats across many jurisdictions. This often occurred when jurisdictions independently shifted to digital systems, often resulting in a patchwork of contrac- tor systems that were difficult to align due to incompatible and sometimes proprietary data standards. Currently, states are responsible for working with vendors to align these standards independently; if a flexible set of tools was developed to facilitate this process, this would provide substantial savings in time and resource investments at state and local levels. Ways to Engage the Public Many of the systems and technologies discussed in this project are relatively unknown to the public, which may limit taxpayer support for the resources necessary to implement technical and regulatory system overhauls. By improving transparency and public engagement and dem- onstrating the benefits to society of improved citation tracking, both in terms of the tracking of repeat offenders and improvements of safety and efficiency to law enforcement and court personnel, it may be possible to engage public enthusiasm and improve prioritization and avail- able funding.

The ability of state agencies to track citation, adjudication, and disposition data accurately and effectively is essential for the identification and appropriate adjudication of problem drivers and habitual offenders. Efficient data tracking can provide benefits at all steps of the citation-adjudication process, from providing real-time information and safer roadside stops for law enforcement officers to reducing errors and improving transmission speed during the adjudication stage to facilitating data storage and effective analyses following disposition.

The TRB Behavorial Transportation Safety Cooperative Research Program's BTSCRP Research Report 5: Strategies to Improve State Traffic Citation and Adjudication Outcomes identifies challenges and barriers to effective citation data tracking along with proven strategies and solutions to address these challenges, with the goal of developing a series of practical and meaningful steps that state highway safety officials could use to implement these strategies.

Supplemental to the report is Toolkit for Improving Citation and Adjudication Tracking , which is a PowerPoint presentation with voiceover components. Slides from the toolkit are presented in Appendix D and the script for the voiceover is included in Appendix E.

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Writing a Research Paper Conclusion | Step-by-Step Guide

Published on October 30, 2022 by Jack Caulfield . Revised on April 13, 2023.

• Restate the problem statement addressed in the paper
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Step 1: restate the problem, step 2: sum up the paper, step 3: discuss the implications, research paper conclusion examples, frequently asked questions about research paper conclusions.

The first task of your conclusion is to remind the reader of your research problem . You will have discussed this problem in depth throughout the body, but now the point is to zoom back out from the details to the bigger picture.

While you are restating a problem you’ve already introduced, you should avoid phrasing it identically to how it appeared in the introduction . Ideally, you’ll find a novel way to circle back to the problem from the more detailed ideas discussed in the body.

For example, an argumentative paper advocating new measures to reduce the environmental impact of agriculture might restate its problem as follows:

Meanwhile, an empirical paper studying the relationship of Instagram use with body image issues might present its problem like this:

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Argumentative paper: Restate your thesis and arguments

In an argumentative paper, you will have presented a thesis statement in your introduction, expressing the overall claim your paper argues for. In the conclusion, you should restate the thesis and show how it has been developed through the body of the paper.

Briefly summarize the key arguments made in the body, showing how each of them contributes to proving your thesis. You may also mention any counterarguments you addressed, emphasizing why your thesis holds up against them, particularly if your argument is a controversial one.

Don’t go into the details of your evidence or present new ideas; focus on outlining in broad strokes the argument you have made.

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In an empirical paper, this is the time to summarize your key findings. Don’t go into great detail here (you will have presented your in-depth results and discussion already), but do clearly express the answers to the research questions you investigated.

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Argumentative paper: Strong closing statement

An argumentative paper generally ends with a strong closing statement. In the case of a practical argument, make a call for action: What actions do you think should be taken by the people or organizations concerned in response to your argument?

If your topic is more theoretical and unsuitable for a call for action, your closing statement should express the significance of your argument—for example, in proposing a new understanding of a topic or laying the groundwork for future research.

Empirical paper: Future research directions

In a more empirical paper, you can close by either making recommendations for practice (for example, in clinical or policy papers), or suggesting directions for future research.

Whatever the scope of your own research, there will always be room for further investigation of related topics, and you’ll often discover new questions and problems during the research process .

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Full examples of research paper conclusions are shown in the tabs below: one for an argumentative paper, the other for an empirical paper.

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While the role of cattle in climate change is by now common knowledge, countries like the Netherlands continually fail to confront this issue with the urgency it deserves. The evidence is clear: To create a truly futureproof agricultural sector, Dutch farmers must be incentivized to transition from livestock farming to sustainable vegetable farming. As well as dramatically lowering emissions, plant-based agriculture, if approached in the right way, can produce more food with less land, providing opportunities for nature regeneration areas that will themselves contribute to climate targets. Although this approach would have economic ramifications, from a long-term perspective, it would represent a significant step towards a more sustainable and resilient national economy. Transitioning to sustainable vegetable farming will make the Netherlands greener and healthier, setting an example for other European governments. Farmers, policymakers, and consumers must focus on the future, not just on their own short-term interests, and work to implement this transition now.

As social media becomes increasingly central to young people’s everyday lives, it is important to understand how different platforms affect their developing self-conception. By testing the effect of daily Instagram use among teenage girls, this study established that highly visual social media does indeed have a significant effect on body image concerns, with a strong correlation between the amount of time spent on the platform and participants’ self-reported dissatisfaction with their appearance. However, the strength of this effect was moderated by pre-test self-esteem ratings: Participants with higher self-esteem were less likely to experience an increase in body image concerns after using Instagram. This suggests that, while Instagram does impact body image, it is also important to consider the wider social and psychological context in which this usage occurs: Teenagers who are already predisposed to self-esteem issues may be at greater risk of experiencing negative effects. Future research into Instagram and other highly visual social media should focus on establishing a clearer picture of how self-esteem and related constructs influence young people’s experiences of these platforms. Furthermore, while this experiment measured Instagram usage in terms of time spent on the platform, observational studies are required to gain more insight into different patterns of usage—to investigate, for instance, whether active posting is associated with different effects than passive consumption of social media content.

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The conclusion of a research paper has several key elements you should make sure to include:

• A restatement of the research problem
• A summary of your key arguments and/or findings
• A short discussion of the implications of your research

No, it’s not appropriate to present new arguments or evidence in the conclusion . While you might be tempted to save a striking argument for last, research papers follow a more formal structure than this.

All your findings and arguments should be presented in the body of the text (more specifically in the results and discussion sections if you are following a scientific structure). The conclusion is meant to summarize and reflect on the evidence and arguments you have already presented, not introduce new ones.

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Conclusions and Recommendations for Future Research

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Chapter 5: “Transforming Global Governance”

By   richard ponzio, international & regional organizations.

• September 9, 2024

From continued volatility and inequality in the global financial and economic system and fears of renewed health risks to the present triple planetary crisis (climate change, biodiversity loss, and pollution) and need to overcome growing divisions between the BRICS+ and G7 countries, divergent views animate current debates on reform of the United Nations, international financial institutions, World Trade Organization, and G20 toward forging a more coherent and effective way for managing global financial, economic, social, and environmental governance. At the same time, Great Power tensions, especially over Ukraine, Taiwan, and reform of the Security Council, as well as Global North-South mistrust (think Gaza, as well as the failure to meet climate finance and wider development-aid targets) have risked, since the start of intergovernmental negotiations in 2023, paralyzing preparations toward this month’s (September 22-23, 2024) Summit of the Future.

Against this politically fraught backdrop, the Summit of the Future—and equally important, its sustained, multi-year follow-through —provides unique opportunities for modernizing global multilateral institutions to meet current and over-the-horizon challenges and opportunities. Simultaneously, the implementation of the summit’s chief outcome document, the Pact for the Future, and two associated instruments (a Global Digital Compact and Declaration on Future Generations), can help to begin to build greater trust and improve conditions for global cooperation between the G7 and BRICS+ countries and, more broadly speaking, between advanced industrialized countries in the Global North and both emerging economies and least developed countries in the Global South.

Nowhere in the near-finalized Summit of the Future agenda are the opportunities greater for reinvigorating and creating new multilateral institutions than in Chapter 5 of the Pact for the Future on “Transforming global governance.” Encompassing twenty distinct actions (#’s 41-60) and many more associated commitments, five stand-out initiatives that wield promise as high-impact global governance innovations and are likely to constitute a chief part of the legacy of this month’s summit are:

Reform of the Security Council

The present (Revision 3) draft of the Pact for the Future calls for (in Action 42) reforming the UN Security Council, including by: “recognizing the urgent need to make it more representative, inclusive, transparent, efficient, effective, democratic and accountable.”With the new momentum generated by the Summit of the Future, the Intergovernmental Negotiations on Security Council Reform should work, over the next two-years, toward a long overdue agreement on a more representative Security Council in line with changing geo-political realities. Consistent with recommendations of the 2015 Albright-Gambari Commission on Global Security, Justice & Governance (co-led by the Stimson Center and The Hague Institute for Global Justice), reform of the Council should aim to create more opportunities for countries, regional organizations, local authorities, and non-state actors to contribute to peacemaking, peacekeeping, and peacebuilding, while increasing the Council’s representative legitimacy and restraint in the use of the veto.

Develop the New Biennial Summit on the Global Economy

Albeit with limited guidance, the Pact for the Future further welcomes (in Action 51): “the initiative to convene a Biennial Summit at the level of Heads of State and Government to strengthen existing and establish more systematic links and coordination between the United Nations and the international financial institutions, and we stress the importance of inclusive participation.” As elaborated in the new Global Governance Innovation Network Policy Brief on a Biennial UN-G20+ Summit: Bridging the Global Economy Governance Gap , UN Member States now must flesh out and fully maximize this new, potentially dynamic global platform toward, for instance, the intertwined goals of better fostering socioeconomic recovery from the pandemic, mitigating and managing cross-border shocks, and addressing rising global inequality. Moreover, establishing a small “networked secretariat” led by the UN Deputy Secretary-General and engaging senior technical staff from the IFIs, WTO, and rotating G20 presidency could ensure the accountability of Biennial Summit decisions.

Support the UN in Rolling-Out Emergency Platforms

Thirdly, the Pact for the Future also recommends (in Action 57): “Present for the consideration of Member States protocols for convening and operationalizing emergency platforms based on flexible approaches to respond to a range of different complex global shocks, including criteria for triggering and phasing out emergency platforms, ensuring that emergency platforms are convened for a finite period and will not be a standing institution or entity.” In response to shocks to the global system caused by, for example, a sudden financial downturn, food and energy insecurity, environmental disasters, and future pandemics, emergency platforms manifest the potential to better harness capabilities and cement commitments across the international system (harnessing the resources of myriad, diverse state-based and non-state actors) to achieve greater proficiency and positive, life-saving results—rather than a “power grab”,  emergency platforms are much more a “force multiplier.”

Strengthen and Innovate the Annual Climate COPS

While the Pact for the Future speaks to “strengthening international cooperation for the environment” in Action 58, it does not offer ideas on rethinking and enhancing the global apex intergovernmental negotiating forum for climate action: the annual Conference of the Parties of the UN Framework Convention on Climate Change. As recommended by the Robinson-Espinosa-Rockström Climate Governance Commission (supported by the Stimson Center), UN Member States should work to streamline and rationalize the annual Climate COPs as a more catalytic and results-oriented global decision-making and policy action forum , with more effective inclusion of diverse stakeholders through the formation of dynamic yet focused multistakeholder coalitions. Additionally, professional mediation and facilitation tools should be employed, and new Paris Agreement accountability mechanisms introduced.

Upgrade the UN Peacebuilding Commission Into An Empowered Peacebuilding Council

Fifth and finally, under Action 47 (“We will strengthen the Peacebuilding Commission”), the Pact for the Future does not offer any imaginative or consequential ideas. With an eye to the 2025 Peacebuilding Architecture Review and learning from the 2005/6 (UN60) upgrade of the UN Human Rights Commission into a more authoritative and effective Human Rights Council, the Global Governance Innovation Report 2023: Redefining Approaches to Peace, Security & Humanitarian Action recommends upgrading the Peacebuilding Commission into an empowered Peacebuilding Council for both preventing and building just and durable peace after a protracted violent conflict. Crucially, this would involve an expanded mandate to lead on peacebuilding policy development, coordination, resource mobilization, and conflict prevention efforts in countries and regions not directly addressed by the UN Security Council. The upgraded body should be further entrusted with a new Peacebuilding Audit tool, modeled on the Human Rights Council’s Universal Periodic Review (UPR), for tracking early-warning indicators to better facilitate early action by the Peacebuilding Council toward preventing the outbreak or recurrence of violent conflict. As with the UPR, all countries would participate periodically in such audits, supported in some cases by the rigorous work of UN special rapporteurs.

While all sixty of the Pact for the Future’s actions and associated commitments hold out hope—if their ambition is fully realized through a concerted, multi-year implementation and monitoring effort that allows for rapid course corrections, where necessary—the twenty presented in its Chapter Five on “Transforming global governance” demonstrate the highest potential for achieving a more networked, inclusive, and effective multilateral system . Fortunately, several are also the focus of the twenty new multistakeholder ImPact Coalitions (comprised of like-minded civil society organizations, private sector partners, and champion governments) initiated at the 2024 UN Civil Society Conference in Support of the Summit of the Future. Civil society, the business community, and committed governments are essential to leveraging the Pact for the Future’s generational opportunity to renew and innovate our system of global governance for the benefit of all nations and peoples.

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