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Developing a novel typology of unprofessional behaviours between healthcare staff: a best fit framework synthesis
No full textBackground
Unprofessional behaviours such as bullying, harassment, and microaggressions negatively affect patient safety and staff psychological wellbeing in healthcare systems globally. These behaviours do so by: (i) inhibiting health care professionals’ abilities to speak up to raise safety concerns; (ii) impairing team communication and individuals’ concentration; and (iii) promoting tolerance of bad practice. Unfortunately, there is little consensus in practice or academia about how these behaviours are defined. This can lead to an underestimation of the prevalence of these behaviours, inhibition of speaking up by victims and bystanders, and reduced accountability by those who enact these behaviours. We aimed to map definitions of unprofessional behaviours between staff to understand their similarities and differences and to develop a useful typology for theory-informed interventions.
Methods
We used a six-step modified best-fit framework synthesis methodology to formulate our new typology, as a part of a wider realist review project. We employed a systematic approach to develop a framework for understanding UB. First, we identified relevant literature through a systematic search of Embase, CINAHL and MEDLINE databases (and more) (n = 146 sources). An initial framework outlining the dimensions of unprofessional behaviours was then constructed based on extracted definitions. Terms from included studies were then coded against this framework, with new dimensions introduced as needed to accommodate terms that did not align with existing categories. The resulting framework was refined iteratively and validated through stakeholder engagement, enhancing its relevance and validity.
Results
We identified 37 behaviours drawing on 146 literature sources and found little consensus in how unprofessional behaviours between staff are defined in the academic literature. By collating definitions, we identified five dimensions inherent to unprofessional behaviours between staff namely: visibility; inherent frequency; whether they are highly targeted; if behaviours target protected characteristics (personal attributes that are legally safeguarded against discrimination in the UK and many other countries, such as race, sex or religion); if behaviours are physical; and if hierarchy is required. These dimensions enabled formulation of the typology with increased understanding of the differences between unprofessional behaviour types.
Conclusions
We found that poor and inconsistent understanding of unprofessional behaviour could undermine interventions by inhibiting speaking up, enabling instigators to avoid accountability, and inhibiting ability to measure unprofessional behaviour and address it. Our typology provides a useful resource for academics, healthcare organisations, intervention architects, and individuals who are seeking to understand and clarify the range of unprofessional behaviours that may be encountered in healthcare settings
Using artificial intelligence (CognoSpeakTM) in memory assessments: a GP interview study
No full textBackground: The memory assessment pathway for people with subjective memory deficits (dementia, mild cognitive impairment, and other diagnoses) is under huge strain and new diagnostic technologies have been identified as a high priority for research.
Aim: To investigate the views of GPs on the memory assessment pathway, and on how an artificial intelligence tool (CognoSpeakTM) could be implemented.
Design & setting: Qualitative interview study in a large region of the NHS (South Yorkshire).
Method Recruitment of 18 GPs using convenience sampling to undertake semi-structured interviews, analysed using reflexive thematic analysis (demographic data was monitored to ensure diversity).
Results: GPs think that the memory assessment pathway has system-wide problems, and that GPs are overworked yet underutilised. They highlighted assessment/referral dilemmas, and the perspectives of patients and families. When asked about implementation of CognoSpeakTM they gave their thoughts on the optimal sites of implementation, they highlighted barriers/ difficulties, as well as the opportunities/benefits, and they made proposals for the future development of CognoSpeakTM.
Conclusion: GPs thought effective implementation of CognoSpeakTM could save time, expedite diagnosis, free-up much needed capacity, and improve the longitudinal assessment of people with mild cognitive impairment. A major concern amongst GPs was the potential for unintended consequences such as creating additional unfunded work, and exacerbating difficulties at the intersections between subjective memory deficits and other factors such as low mood, alcohol excess, learning difficulties, language and culture. They were concerned about poor access to technology amongst old and economically deprived people
Risk of sarcopenia in community dwelling older adults in Kuwait
Get PDFIntroduction: Sarcopenia is characterized by a loss of skeletal muscle mass, strength, and/or physical performance, and is associated with numerous adverse health outcomes. Data on the risk of sarcopenia in Arabic speaking countries is lacking, in particular in Kuwait, and this study aimed to provide initial estimates of sarcopenia risk. Given that sarcopenia predicts frailty, we also examined how population characteristics interact with sarcopenia risk and key frailty determinants, including mobility, strength, independence, and falls risk.
Methods: This cross-sectional study included community-dwelling older adults in Kuwait City. In a single session, data collected included socio-demographics; sarcopenia risk using the SARC-F screening tool; independence in daily living using the Physical Self-Maintenance Scale (PSMS); fear of falling using the Short Falls Efficacy Scale-International (Short FES-I); frailty using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale; strength using handgrip strength and the Five Times Sit-to-Stand Test (FTSTS); and mobility using the 4-meter gait speed test and Timed Up and Go (TUG) test. Participants were classified as at risk (SARC-F ≥ 4) or not at risk (< 4). Associations were analyzed using Chi-square and ANOVA. Logistic regression identified factors linked to sarcopenia and frailty, treating the persons without frailty as the reference group. Model fit was assessed by McFadden’s R2.
Results: A total of 92 older adults participated in the study. Of these, 29 (31.5%) were at risk of sarcopenia (SARC-F ≥ 4). Females were significantly more likely to exhibit sarcopenia risk (47.4%) than males (20.4%) (p = 0.006). Sarcopenia risk was significantly associated with lower independence, slower gait speed, and higher age, FRAIL scores, TUG, and 5xSTS values. Logistic regression showed that female gender and advanced age (70–79 years) were significant predictors of sarcopenia risk. Frailty was present in 18.5% of participants and was strongly associated with multimorbidity (>3 chronic conditions). Concern about falling was common, with 73.9% reporting moderate to high concern.
Conclusion: The risk of sarcopenia among older adults in Kuwait may be high. Accurate risk estimates are needed, involving muscle mass assessments and exploration of risk factors in order to implement effective screening and intervention services
Cost-effectiveness of paramedic administered ketamine compared to morphine for the management of acute severe pain from traumatic injury
No full textBackground
Pain after traumatic injury is common, yet few patients receive adequate pain relief. NHS paramedics have a limited formulary to treat severe pain.
Objectives
To estimate the cost-effectiveness of ketamine versus morphine for severe pain in acute traumatic injury.
Methods
A cost-utility analysis was conducted based on data from a pragmatic, multicentre, randomised controlled trial (PACKMAN). The base-case analysis took the form of an intention-to-treat analysis conducted from a UK National Health Service (NHS) and personal social services (PSS) perspective and separately from a societal perspective. Costs (£ 2021–2022 prices) were collected prospectively over a 6-month follow-up period. A bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained and the incremental net monetary benefit (INMB) of ketamine in comparison to morphine. Sensitivity and pre-specified subgroup analyses explored uncertainty and heterogeneity in cost-effectiveness estimates.
Results
Participants (n = 416) were randomised to ketamine (n = 206) or morphine (n = 210) amongst whom complete data for the economic evaluation was available for 189 (45.4%) participants. Mean (standard deviation [SD]) observed NHS and PSS costs over 6 months were £5,191 (£3,155) in the ketamine arm versus £5,143 (£3,897) in the morphine arm (mean difference [MD]: £47). Mean (SD) observed QALY estimates were 0.309 (0.10) versus 0.293 (0.010), respectively (MD: 0.016). The base case (imputed) analysis generated an incremental cost of -£117 (95%CI: -£849 to £597) and incremental QALYs of 0.025 (95%CI: 0.010 to 0.041), indicating a 92%-96% probability of cost-effectiveness at cost-effectiveness thresholds of £20,000 and £30,000 per QALY. A sensitivity analysis, using observed data only (without imputation) generated an incremental cost of £233 (95%CI: -£783 to £1216) and incremental QALYs of 0.016 (95%CI: -0.013 to 0.044), indicating a lower 54%-62% probability of cost-effectiveness. The base-case cost-effectiveness results remained robust to other sensitivity analyses.
Conclusions
This economic evaluation found that ketamine administered by paramedics to adults with severe pain following traumatic injuries is cost-effective compared to morphine. However, our results are subject to high levels of missing data, which were handled through recommended multiple imputation techniques.
Trial registration
The trial was registered with the International Standard Randomised Controlled Trial Number (ISRCTN) registry (ISRCTN14124474) on 22 October 2020
Black hole spectroscopy and tests of general relativity with GW250114
Get PDFThe binary black hole signal GW250114, the loudest gravitational wave detected to date, offers a unique
opportunity to test Einstein’s general relativity (GR) in the high-velocity, strong-gravity regime and probe
whether the remnant conforms to the Kerr metric. Upon perturbation, black holes emit a spectrum of
damped sinusoids with specific, complex frequencies. Our analysis of the postmerger signal shows that at
least two quasinormal modes are required to explain the data, with the most damped remaining statistically
significant for about one cycle. We probe the remnant’s Kerr nature by constraining the spectroscopic
pattern of the dominant quadrupolar (l ¼ m ¼ 2) mode and its first overtone to match the Kerr prediction
to tens of percent at multiple postpeak times. The measured mode amplitudes and phases agree with a
numerical-relativity simulation having parameters close to GW250114. By fitting a parametrized
waveform that incorporates the full inspiral-merger-ringdown sequence, we constrain the fundamental
ðl ¼ m ¼ 4Þ mode to tens of percent and bound the quadrupolar frequency to within a few percent of the
GR prediction. We perform a suite of tests—spanning inspiral, merger, and ringdown—finding constraints
that are comparable to, and in some cases 2–3 times more stringent than those obtained by combining
dozens of events in the fourth Gravitational-Wave Transient Catalog. These results constitute the most
stringent single-event verification of GR and the Kerr nature of black holes to date, and outline the power of
black-hole spectroscopy for future gravitational-wave observations
Weak Physics‐Guided Multi‐Agent Learning for Surface to Subsurface Moisture Estimation Across Diverse Climate and Soil Conditions
Get PDFEstimating subsurface soil moisture remains challenging due to limited in situ observations and the complexity of soil water dynamics. Although surface soil moisture can be retrieved from satellites with high accuracy, deeper layers are not directly observable. Traditional physics‐based models that predict subsurface soil moisture require site‐specific hydraulic properties of the soils. This limits their large‐scale applicability. Alternative data‐driven machine learning models for subsurface soil moisture estimation generally lack physical interpretability. To address the limitation of physical and machine learning models, we propose a weakly physics‐constrained, multi‐agent diffusion model for subsurface soil moisture estimation. The model employs lightweight physical regularization (flux smoothness and feasible‐range constraints) that guide predictions without enforcing strict parameterization, while a multi‐agent structure allows specialization across dry, intermediate, and wet soil regimes. This framework balances predictive flexibility with hydrological consistency and provides uncertainty quantification through stochastic diffusion sampling. The model is evaluated using globally distributed in situ data sets from 20 different sites within the International Soil Moisture Network (ISMN) and from three sites in Zambia, Africa. Soil moisture observations from ISMN are available at hourly intervals, while measurements from the Zambian stations are recorded every 10‐min. The results show a strong agreement between the modeled and observed soil moisture at multiple depths (10, 20, and 40 cm), with median values of exceeding 0.91 and nRMSE of 0.37 at 10 cm and remaining robust at deeper layers, although performance decreases with depth as expected. The model outperforms several benchmark machine learning algorithms, particularly at greater depths, and exhibits stability under stochastic initialization and input perturbations
A factor integrating transcription and repression of surface antigen genes in African trypanosomes
Get PDFAntigenic variation in Trypanosoma brucei ( T. brucei) requires monoallelic expression of one variant surface glycoprotein (VSG) from one of the subtelomeric bloodstream form (BSF) expression sites (BESs). This transcription is unusually mediated by RNA polymerase I (RNA Pol I) and occurs in a specialized nuclear body, the expression site body (ESB). While factors promoting active BES transcription and silencing inactive BESs are known, how these opposing activities are integrated remains unknown. Here, we identify ESBX (Tb927.3.1660) as a BSF-specific ESB protein necessary for this coordination. We show that ESBX RNAi knockdown prevents RNA Pol I localizing to the ESB and reduces active BES transcription, while also derepressing inactive BESs with low processivity transcription. Conversely, ESBX overexpression weakly activates inactive BESs in a distinct manner from ESBX knockdown, leading to processive transcription, without disrupting the active BES or forming supernumerary ESBs. ESBX knockdown causes a similar transcriptomic defect to ESB1 and VEX2 knockdown combined, establishing ESBX as a key factor linking transcriptional activation of the active BES with inactive BES silencing through the VSG exclusion (VEX) phenomenon. This allows us to suggest models for understanding the establishment and maintenance of monoallelic expression critical for parasite immune evasion
Deeper Sociological Insight Needed for Behaviour Change:A Systematic Review of Chinese Ivory Consumption
Get PDFChinese consumer demand for ivory threatens vulnerable African elephant populations, despite long-standing efforts to combat the illegal wildlife trade. Behavioural science approaches have been proposed to address these systemic behaviours. However, their robust use remains uncommon in demand management interventions. A culturally nuanced, psychological and sociological understanding of the behaviours driving ivory consumption is essential for effective behaviour change. We conducted a qualitative systematic literature review in English and Chinese to understand the drivers and barriers of Chinese ivory consumption. We sought to understand ivory acquisition, possession and disposal behaviours through purchase, gifting and inheritance practices. Our final review included 13 articles from the academic and grey literature. After inductive thematic analysis, we deductively applied UNICEF's Behavioural Drivers Model to support practitioner applications. Building on the limitations highlighted, we additionally deductively explored ivory consumption through a Consumer Culture Theory lens to assess ivory subcultures and market identities. Ivory consumption is driven by a mix of social, cultural and economic factors, and the degree to which each influences consumption behaviour is not well understood. Better understanding of Chinese social norms that affect individual and collective gifting behaviours could lead to more effective strategies to change behaviour. Most research focuses on purchase and does not address the underlying motivations for gifting and personal collecting to an extent that establishes actionable insight for behavioural interventions. Moreover, inheritance and bequeathing of ivory are not explored in the literature. This limits our understanding of the importance of familial and sentimental values and evolving generational values of ivory for consumers. Effecting demand for wildlife products requires diverse interventions aimed at different consumer groups to target different underlying motivations that shape consumer behaviour. If behaviour change interventions do not integrate evidence-based behavioural insights into their design, it is unlikely they will successfully achieve their aims. Understanding social and cultural determinants of different consumer groups' behaviour is a critical component of designing effective behaviour change interventions for conservation outcomes
Lower Bounds for the Support of Cubature Measures on Wiener Space and Optimal Degree-five Constructions
No full textA qualitative evidence synthesis to explore relationship‐centred dental care for older people living in care homes
Get PDFBackground
Patient groups and policymakers are calling for the implementation of relationship-centred, co-ordinated care for vulnerable older people. Relationship-centred care highlights the significance of strong, quality relationships among residents, their families and the broader healthcare team. The present work performed a qualitative evidence synthesis to explore issues relating to the provision of relationship-centred dental care for older people living in care homes, as perceived by care home staff, dental professionals, family and residents. This builds on the existing evidence base and outlines areas for improvement of dental care provision within residential care homes.
Methods
A ‘best fit’ framework synthesis of primary research was used to understand how and why current dental care might or might not be relationship-centred. A palliative healthcare-focused conceptual framework for relationship-centred care was used as the basis for the synthesis. The review focuses on qualitative primary research studies exploring dental care for care-home residents.
Results
Of 235 unique citations, fifteen qualitative primary research papers were included. The synthesis identified supporting evidence for all five of the broad a priori themes from the relationship-centred care coding framework: Relationship-centred care, Integration within the wider health and social care systems, Digital inclusion, Workforce support and Parity of esteem. Relationships between themes were articulated.
Conclusions
This ‘best-fit’ framework synthesis found that care home staff identified numerous barriers to providing relationship-centred dental care for older residents. Dentists, families and residents were underrepresented, highlighting the need for further research into their perspectives. By acknowledging the complexity of dental care and addressing issues such as integration, workforce support, digital services and parity of esteem, the synthesis suggests that applying organisational change research may help improve oral health outcomes in care homes
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