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Does moral distress in emergency department nurses contribute to intentions to leave their post, specialisation, or profession: A systematic review
Get PDFThere is a global shortfall of nurses. Despite national targets to increase nurse training and retention, the numbers leaving the profession continue to rise. Emergency departments (EDs) consistently record above average staff-turnover. Meanwhile descriptions of moral distress amongst emergency nurses are increasing. It is vital to consider the long-term emotional and psychological impact of moral distress on the emergency nursing workforce. However, the events which trigger moral distress in the emergency department may differ from those described in other clinical areas. A clearer understanding of the effects of moral distress on intention to leave could help identify those at risk and inform decisions on interventions designed to mitigate moral distress, aiding nurse retention and the organisational stability of health services. Aim This systematic review aims to synthesise the available evidence on the association between moral distress and intention to leave in emergency nurses. Methods A systematic search of studies was performed on MEDLINE, CINAHL, PsychINFO, Web of Science and Cochrane databases (8th -10th June 2022). Results were screened and quality-assessed with cross-checks. The heterogeneity of samples and insufficient data precluded statistical pooling and meta-analysis. Consequently, narrative synthesis was performed. Results Five studies reported quantitative results eligible for synthesis. Low to moderate levels of moral distress were reported in emergency nurses; contrasting starkly with the significant proportion who reported having left or considered leaving due to moral distress (up to 51%). Sparse, mostly low-quality evidence was identified, highlighting a need for more robust research. Current tools for measuring moral distress appear not to capture the unique pressures which contribute to moral distress in emergency nurses. Conclusions Emergency nurses cite moral distress as a reason for leaving. Further study is required to determine the levels of moral distress associated with intentions to leave and the strength of that association. This is fundamental to the design of effective retention policies. Future research should also explore the applicability of current moral distress measures to the emergency department, with consideration given to developing emergency department specific tools
Guideline summary: assessment, diagnosis, care and support for people with dementia and their carers [Scottish Intercollegiate Guidelines Network SIGN Guideline 168]
Get PDFThe Scottish Intercollegiate Guidelines Network (SIGN) have recently published their guideline SIGN168 on ‘Assessment, Diagnosis, Care, and Support for People with Dementia and their Carers’. The guideline makes evidence-based recommendations for best practice in the assessment, care and support of adults living with dementia. Topics featured in this guideline are limited to those prioritised by stakeholders, especially people with lived and living experience, and those not well covered under pre-existing guidance. We summarise the guideline recommendations related to identification and diagnosis of dementia, investigative procedures, postdiagnostic support living with dementia, including non-pharmacological approaches for distressed behaviours, using technology to support people with dementia, grief and dementia and changing needs of people with dementia. The guideline content is summarised as officially published, with additional commentary in the final section
iVOMS: Instrumented Vestibular / Ocular motor screen in healthy controls and mild traumatic brain injury
Get PDFObjective Vestibular/ocular deficits occur with mild traumatic brain injury (mTBI). The vestibular/ocular motor screening (VOMS) tool is used to assess individuals post-mTBI, which primarily relies upon subjective self-reported symptoms. Instrumenting the VOMS (iVOMS) with technology may allow for more objective assessment post-mTBI, which reflects actual task performance. This study aimed to validate the iVOMS analytically and clinically in mTBI and controls. Methods Seventy-nine people with sub-acute mTBI (<12 weeks post-injury) and forty-four healthy control participants performed the VOMS whilst wearing a mobile eye-tracking on a one-off visit. People with mTBI were included if they were within 12 weeks of a physician diagnosis. Participants were excluded if they had any musculoskeletal, neurological or sensory deficits which could explain dysfunction. A series of custom-made eye tracking algorithms were used to assess recorded eye-movements. Results The iVOMS was analytically valid compared to the reference (ICC2,1 0.85–0.99) in mTBI and controls. The iVOMS outcomes were clinically valid as there were significant differences between groups for convergence, vertical saccades, smooth pursuit, vestibular ocular reflex and visual motion sensitivity outcomes. However, there was no significant relationship between iVOMS outcomes and self-reported symptoms. Conclusion The iVOMS is analytically and clinically valid in mTBI and controls, but further work is required to examine the sensitivity of iVOMS outcomes across the mTBI spectrum. Findings also highlighted that symptom and physiological issue resolution post-mTBI may not coincide and relationships need further examination
Self-control failures, as judged by themselves
Get PDFThe existence of self-control failures is often used to legitimize public policy interventions. The argument is that reducing self-control failures can make people better off, as judged by themselves. However, there is only scarce evidence on the frequency and welfare costs of self-control failures. This paper presents a survey method that allows us to measure self-control failures in everyday life and to identify their welfare costs in terms of associations with experienced subjective well-being. We present novel survey evidence using this method and discuss its implications for behavioural welfare economics and behavioural public policy
Digit Classification using Biologically Plausible Neuromorphic Vision
Get PDFDespite tremendous advancement in computer vision, especially with deep learning, understanding scenes in the wild remains challenging. Even modern image classification models often misclassify when presented with out-of-distribution inputs despite having been trained on tens of millions of images or more. Moreover, training modern deep-learning classifiers requires a lot of energy due to the need to iterate many times over the training set, constantly updating billions of model parameters. Owing to problems with generalisability and robustness as well as efficiency, there is growing interest in computer vision to mimic biological vision (e.g., human vision) in the hope that doing so will require fewer resources for training both in terms of energy and in terms of data sets while increasing robustness and generalisability. This paper proposes a biologically plausible neuromorphic vision system that is based on a spiking neural network and is evaluated on the classification of hand-written digits from the MNIST dataset. The experimental outcome indicates improved robustness of the proposed approach over state-of-the-art considering non-digit detection
Pilot and Feasibility Studies In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression
Get PDFBackground Depression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial. Methods We recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could 'enrol' a family member/ 'other' to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement. Results Study 1 Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention. Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome. Study 2 Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention. Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward
Evidence of interspecific plasmid uptake by pathogenic strains of Klebsiella isolated from microplastic pollution on public beaches
Get PDFMicroplastic beads are becoming a common feature on beaches, and there is increasing evidence that such microplastics can become colonised by potential human pathogens. However, whether the concentrations and pathogenicity of these pathogens pose a public health risk are still unclear. Therefore, the aim of this study was to determine realistic environmental concentrations of potential pathogens colonising microplastic beads, and quantify the expression of virulence and antimicrobial resistance genes (ARGs). Microplastic beads were collected from beaches and a culture-dependent approach was used to determine the concentrations of seven target bacteria (Campylobacter spp.; E. coli; intestinal enterococci; Klebsiella spp.; Pseudomonas aeruginosa; Salmonella spp.; Vibrio spp.). All seven target bacteria were detected without the need for a pre-enrichment step; urban sites had higher bacterial concentrations, whilst polymer type had no influence on bacterial concentrations. Klebsiella was the most abundant target bacteria and possessed virulence and ARGs, some of which were present on plasmids from other species, and showed pathogenicity in a Galleria melonella infection model. Our findings demonstrate how pathogen colonised microplastic beads can pose a heightened public health risk at the beach, and highlights the urgency for improved monitoring and enforcement of regulations on the release of microplastics into the environment
Neighbouring Scots pine populations from contrasting climatic regions show substantial variability but consistent response to warming
Get PDFNatural tree populations consist of individuals that exhibit intraspecific adaptive variation at a range of geographic scales, as a result of the balance between gene flow and selection. The spatial distribution and magnitude of such variation will influence the capacity of populations to adapt to forthcoming changing environmental conditions. The native Scots pine populations in Scotland represent what remains of the iconic Caledonian forest. Despite being distributed within a relatively narrow geographic area these populations occur across a steep East-West environmental gradient of increasing rainfall and temperature. We hypothesised that western populations compared to those from the east may be better adapted to warmer conditions and as a consequence, may respond differently to the increased temperature predicted during climate change. We conducted an experiment lasting 22 weeks in controlled environment chambers using a nested hierarchical design based on material from different regions (west or east), populations and families (half sibs). We examined the effects of two temperature scenarios, current temperature and warmer predicted temperature on percentage germination as well as growth and morphology of above and below-ground traits. Most of the variation occurred at the family level. Nevertheless, significant regional and population differences were detected, where eastern populations invested more in roots, exhibited fewer stomatal rows per needle and produced thinner roots. In addition, warmer temperatures had strong effects on early growth that were consistent in material from both regions and resulted in earlier germination, greater growth and biomass, but these effects were not accompanied by shifts in biomass partitioning. Although the strong effect of warming suggested temperature limitation for early growth in the study areas under current conditions our results did not support the idea that low seedling recruitment resulting from poor emergence and early growth would lead to a decline in Scottish populations of Scots pine under a warmer climate. Our results are informative regarding the adaptive potential in the populations and will contribute to the development of appropriate forest conservation strategies
Walk, talk, think, see and feel: harnessing the power of digital biomarkers in healthcare
Get PDFFirst paragraph: A key pillar of healthcare’s journey towards precision medicine has been the proliferation and development of biomarkers to detect, monitor and manage disease. Over the last fifty years, healthcare has seen a rapid acceleration in the discovery of traditional biomarkers for a variety of conditions, including cancer, namely Carcinoembryonic antigen (CEA), and in the 1980s, CA15-3 for breast cance
Gratuitous risk: danger and recklessness perception of adventure sports participants
Get PDFSince the 1970’s there has been a major increase in adventure sports participation but it seems that engagement in such sports comes with a stigma: adventure sports participants are often regarded as reckless ‘daredevils’. We approach the questions about people’s perception of risk and recklessness in adventure sports by combining empirical research with philosophical analysis. First, we provide empirical evidence that suggests that laypeople tend to assess the danger of adventure sports as greater than more mundane sports and judge adventure sports participants as more reckless than participants in non-adventure sports. We contextualise these findings within existing psychological risk perception paradigms and outline new philosophical explanations of the identified pattern in laypeople’s risk perception
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