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Strategies for implementing Sustainability in Quality Improvement (SusQI) education: educator perspectives
No full textThe climate and ecological emergencies represent a significant threat to health, and yet healthcare is a major contributor to environmental degradation. Sustainability in Quality Improvement (SusQI) is a framework that enables healthcare professionals to improve how good health is achieved and healthcare delivered in line with social, economic and environmental sustainability goals. SusQI education provides healthcare learners with the knowledge and practical skills for sustainable clinical transformation.
We interviewed eleven SusQI course leads at ten educational sites in the UK and Republic of Ireland, exploring educator perspectives on how SusQI can be successfully implemented in diverse health educational contexts. Our aim was to identify what works, in which contexts, and why. We thematically analysed the interviews and tabulated case study details.
We identified four interlinked themes: choosing SusQI, getting it into the curriculum, making it work, and embedding it. Each of these stages was influenced by factors related to the educators themselves, their students, and their institution, as well as specific educational or curricular factors. The most successful implementations demonstrated synergistic benefits for both learners and institutions, engendering self-sustaining communities of practice.
Strong institutional commitment, distributed expertise, and opportunities for supported project work emerge as key success factors. Together these fostered self-sustaining virtuous cycles of stakeholder engagement, transformative educational impacts, and progress towards sustainable clinical practice.
What is already known:
Prior research established SusQI's potential to engage and motivate learners to contribute to the creation of a sustainable healthcare system, but this lacked detailed insights into SusQI’s practical implementation in diverse educational settings.
What this study adds:
Course leads from ten clinical education settings reveal why they chose to teach SusQI, how they integrated it into their curricula, how they made it work for learners and host organisations alike, and how they addressed any contextual challenges. The findings offer practical guidance for educators seeking to embed SusQI effectively, improving the ability of learners to contribute to more sustainable healthcare delivery.
Implications and applications:
Making the wider co-benefits of learner-led SusQI project work visible to all stakeholders, thereby creating self-sustaining communities of practice, emerges as a key success factor. This research reveals the potential for agile educational innovation through distributed expertise and shared learning to address the urgency of the ecological crisis within the healthcare sector
Cardiac Output Measurement in Malawian children aged 2 months to 12 years hospitalised with severe anaemia (COM-TRACT)
No full textBackground:
Little is known about myocardial perturbations in African children hospitalised with severe anaemia.
Methods:
An observational study nested within a clinical trial of blood transfusion conducted on the paediatric ward, Blantyre, Malawi. Children were aged 2 months to 12 years hospitalized with severe anaemia (haemoglobin 4-6g/dl). By randomisation 13 children received 30 mls/kg whole blood; 13 received 20 mls/kg whole blood and 26 had no immediate transfusion (usual care). We measured standard
parameters of cardiac function using Ultrasonic Cardiac Output Monitoring at enrolment, 8, 24 hours and discharge.
Results:
Fifty-two children, median age 39 months (IQR 25-58) and median haemoglobin 5.1 g/dl (4.8-5.6) were studied. Severe tachycardia and tachypnoea overtime corrected faster in the transfused arms than control. At enrolment Stroke volume index was within the normal range; 26/52 (50%) had
cardiac output index (COI) > 97.5% standard centile. COI reduced in all arms by discharge but was greatest in the transfusion arms (p=0.05 for 20mls/kg and p=0.009 for 30mls/kg). A higher volume or receipt of whole blood did not worsen cardiac function. No child required diuretics.
Conclusions:
The data generated by this small but granular study of haemodynamic and cardiac function provide reassuring physiological evidence to show the safety of higher doses of blood transfusion than currently recommended. It also supports the findings of a secondary analysis of the TRACT trial indicating that whole blood transfusions are safe. These data support the new evidence-based paediatric transfusion algorithm for anaemic African children, and its recommendation for safe use
Sensing multi-directional forces at superresolution using taxel value isoline theory
No full textRobots can benefit from touch perception for enhanced interaction. Interaction involves tactile sensing devices, contact objects, and complex directional force motions (normal and shear) in between. We introduce a comprehensive theory unifying them to advance sensor design, explain shear-induced performance drops, and suggest application scenarios. Our theory, based on sensor isolines, achieves superresolution sensing with sparse units, avoiding dense layouts. Through structural analysis of the sensor perception field, force sensitivity, and contact object effects, we also explore the force direction influences: normal, tangential shear, and radial shear forces. The model predicts an inherent accuracy reduction under shear forces compared to pure normal forces. Validation used Barodome, a 3D sensor predicting contact locations and decoupling shear/normal forces. Its performance confirmed the significant impact of shear forces, with observed drops (0.5 mm) closely matching theoretical predictions (0.33 mm). This theory provides valuable guidance for future tactile sensor design and advanced robotic touch systems
Serine palmitoyltransferase-mediated de novo sphingolipid biosynthesis is required for normal insulin production and glucose tolerance
No full textThe impact of three distinct probiotic supplements on the gut microbiota and its metabolites in healthy adults
No full textThe effects of probiotics on the gut microbiota and microbial metabolites in healthy individuals are not well understood. Faecal and serum samples were collected at the start and end of a 3-month, double-blind, placebo-controlled, randomised study with three different probiotic
formulations in free-living healthy adults. The composition of the faecal microbiota and levels of faecal and/or serum short-chain fatty acids (SCFA) and bile acids (BA) were measured and the probiotic formulations were found to impart differing effects including shifts in the composition and structure of the faecal microbiota, enhanced levels of circulating short chain fatty acids such as butyrate and propionate and elevated levels of sulphated bile acids in
faeces. This was in contrast to the outcomes with the placebo population where very little change occurred over the study. These findings demonstrate that probiotic supplementation elicits formulation specific effects and that there are potential benefits for healthy individuals
Prevalence and risk factors of cerebral microhemorrhages and superficial siderosis in cognitively unimpaired older adults: analysis from the CHARIOT-PRO SubStudy
No full textINTRODUCTION
Cerebral microhemorrhages (CMHs) and superficial siderosis (SS) are relatively common side effects of anti-amyloid immunotherapies, termed amyloid-related imaging abnormalities (ARIA-H). They are also observed in treatment-naïve older adults. This study explored relationships with modifiable and non-modifiable risk factors.
METHODS
This cross-sectional study included 1414 cognitively unimpaired, treatment-naïve individuals aged 60 to 85 years from the Cognitive Health in Ageing Register: Investigational, Observational and Trial Studies in Dementia Research (CHARIOT): Prospective Readiness cOhort (PRO) SubStudy. Relationships between CMHs/SS and cardiovascular risk factors, amyloid beta (Aβ) load, apolipoprotein E (APOE) ε4 status, educational attainment, and white matter hyperintensities were investigated using regression analyses and structural equation modeling.
RESULTS
CMHs were observed in 8.3% of participants and SS in 1.3%. Significant risk factors for CMHs included age and hypertension. Higher education attainment appeared to have a protective effect. Elevated amyloid is a risk factor, particularly when adjusting for APOE ε4 status in individuals aged 70 or younger.
DISCUSSION
Increasing age and hypertension are significant risk factors of CMHs. Higher educational attainment may offer a protective effect.
Highlights
Of the 1414 participants from the CHARIOT-PRO SubStudy (CPSS), CMHs were present in 118 (8.3%), and SS was present in 18 (1.3%).
Age and hypertension were identified as significant risk factors for CMHs, and the latter had a stronger association with the presence of CMHs among female participants. Having a bachelor's degree or higher was found to be protective.
Elevated brain amyloid burden, particularly when adjusted for APOE ε4 carrier status, was identified as a risk factor in individuals aged 70 years and below
Nanoscale re-structuring of the immune synapse with an engager enhances NK cell function
No full textNano-org, a functional resource for single-molecule localisation microscopy data
No full textThe nanoscale organisation of proteins plays a key role in diverse cellular processes, including signalling, adhesion, and structural integrity. Single-molecule localisation microscopy (SMLM) is a super-resolution imaging technique that captures the spatial distributions of proteins in cells with nanometre precision, enabling detailed studies of protein clustering and architecture. However, comparing such data across experiments remains challenging due to a lack of curated, functional resources. Here we present a publicly accessible, curated, and functional resource, termed “nano-org”, containing SMLM data representing the nanoscale distributions of proteins in cells. Nano-org is searchable by comparing the statistical similarity of the datasets it contains. This unique functionality allows the resource to be used to understand the relationships of nanoscale architectures between proteins, cell types or conditions, supporting the development of the field of spatial nano-omics
How can we ensure accessible and high-quality specialist care for patients with pulmonary hypertension?
No full textBetween-hospital variability in the management and outcomes of postoperative periprosthetic femoral fractures
No full textAIMS: Postoperative periprosthetic femoral fractures (POPFFs) following hip arthroplasty pose complex challenges, with differences in management and outcomes across healthcare facilities. However, there is limited published literature on such variability to inform improvement initiatives. This study aims to quantify the between-hospital variations in surgical management and short-term outcomes. METHODS: Administrative hospitalizations data from all 177 NHS hospital Trusts in England were analyzed for patients aged 18 years and above with a primary diagnosis of POPFF between April 2016 and December 2022. Patient demographic characteristics, comorbidities, procedures, length of stay, in-hospital mortality, 30-day total mortality (in or out of hospital), and emergency 30-day all-cause readmissions were extracted. Multilevel models with random intercepts for hospitals and funnel plots assessed the non-random variations between hospitals in procedures and outcomes. RESULTS: Among 39,035 hospitalized patients, 66% were female (n = 25,720), with a median age of 82 years (IQR 73 to 88). Hospital variation existed in treatment outcomes, with adjusted intraclass correlation coefficients for fixation without revision, revision, and no surgical procedure of 4.0%, 3.8%, and 2.4%, respectively. Funnel plots revealed hospital outliers for procedure choice after adjusting for age, sex, and number of comorbidities - among 177 hospitals, nine (5.1%) exceeded the upper 95% control limit for fixation and 17 (9.6%) did so for revision; outlier proportions were 14.1% for length of stay, 3.9% for emergency 30-day readmission, and 1.1% for mortality. CONCLUSION: Inter-hospital variation exists for the management and short-term outcomes following POPFFs in England. This warrants further explanation to better understand the reasons for this