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The challenges of mothers living with adolescents who have experienced suicide attempts:a qualitative analysis
Get PDFAbstract Background Adolescence is a key time of increased suicide risk. Parents, particularly those who identify as mothers, often face distress when their adolescent(s) attempt suicide. This study aimed to explore mothers' understandings of the challenges of living with an adolescent with a history of suicide attempts in the context of Iran.Methods A descriptive qualitative study was conducted. Our sampling strategy was purposive. Conventional content analysis of semi-structured interviews with 22 mothers of adolescents with experience of suicide attempts was employed.Results The challenges encountered were categorized into two main themes and six subcategories. Participants predominantly experienced two significant difficulties: residing within a psychologically traumatic environment and confronting both cultural and social impasses. Factors such as uncertainty about the future, apprehensions regarding childbearing, and persistent concerns about suicidal ideation contributed to the psychologically distressing context. Additionally, the convergence of deteriorating familial dynamics, heightened social isolation, and exposure to stigmatizing societal beliefs collectively operated to entrench these mothers within adverse socio-cultural vulnerabilities. Conclusions Caring for adolescents with a history of suicide attempt(s) presents significant psychological, cultural, and social challenges for mothers. The findings of this study may inform policymakers, health administrators, and healthcare professionals, including psychiatrists and psychologists, in developing strategies to enhance psychological well-beingthrough the provision of targeted psychological services such as family therapy and counselling
Patient and Physician Narratives on Collaborative Care Between Emergency and Family Medicine Services: A Narrative Review
Get PDFInterprofessional collaboration between emergency medicine (EM) and family medicine (FM) is essential to ensure continuity, quality, and safety of patient care. While much has been written about system-level integration, fewer studies have focused on the lived experiences and narratives of patients and physicians navigating care transitions between these services. This narrative review synthesizes qualitative and mixed-method studies that explore the perspectives of both physicians and patients on collaborative care between EM and FM. A thematic analysis of selected literature reveals recurring themes of communication challenges, role ambiguity, care fragmentation, and emotional burden. While some narratives highlight positive, coordinated experiences, others describe systemic barriers that compromise patient outcomes and satisfaction. Gaps in the literature include limited patient voices and a lack of longitudinal perspectives. This review underscores the need for more inclusive, story-driven research to inform collaborative practice models that are both clinically effective and experientially meaningful
Microplastic polymer type impacts water infiltration and its own transport in soil
Get PDFMicroplastics (MPs) pose a substantial threat to humans and ecosystems. How MPs move in soils is controlled by a large number of coupled parameters, including MPs and soil properties as well as hydrological and geochemical conditions. We conduct laboratory experiments where two commonly MPs types found in soils—polyethylene terephthalate (PET) and polypropylene (PP)—are leached into an idealized soil analog (glass beads). We use time-lapse imaging to analyze the water flow pathways and spectroscopy to measure the MPs transport. We find that MPs impede water infiltration into preferential pathways, with a stronger effect for the more hydrophobic PP, and that PET is more mobile than PP. We explain this by the stronger impedance of PP on water flow that carries the MPs (the driving force), as well as PP surface charge enhancing its adsorption onto soil particles, and its lower density that limits downward transport. These findings advance our understanding the mechanisms underlying MP transport in soils.</p
In-situ measurements of oxygen concentration at the PEMFC cathode catalyst layer/membrane interface
Get PDFThe current trend in the development of Proton Exchange Membrane Fuel Cells (PEMFCs) towards high-power (>300 kW) applications is driving manufacturers to adopt ever-larger electrodes in pursuit of improvements in power density and durability required for heavy-duty use cases. One of the most significant challenges in large-format cells is maintaining a uniform oxygen concentration at the cathode. There are currently no direct techniques for measurement of the oxygen concentration at the interface between the cathode catalyst layer (CL) and membrane, where starvation is most likely to occur. In this work, a novel ‘instrumented membrane’ approach has been developed to address this gap in diagnostic capability. An in-situ, chronoamperometric oxygen sensor is fabricated directly on the PEMFC membrane. A data-driven model taking sensor DC current and impedance as inputs is able to predict local oxygen concentration at the PEM/catalyst layer interface with an accuracy of ±5 %. This in-situ diagnostic approach is demonstrated as a powerful tool for measuring and evaluating the distribution of oxygen in large-format PEMFCs, offering deep insights enabling improvements in system longevity and performance.</p
Stability of acoustic streaming jets confined in cylindrical cavities
Get PDFWe study the stability of a steady Eckart streaming jet flowing in a closed cylindrical cavity. This configuration is a generic representation of industrial processes where driving flows in a cavity by means of acoustic forcing offers a contactless way of stirring or controlling flows. Successfully doing so, however, requires sufficient insight into the topology induced by the acoustic beam. This, in turn, raises the more fundamental question of whether the basic jet topology is stable and, when it is not, of the alternative states that end up being acoustically forced. To answer these questions, we consider a flow forced by an axisymmetric diffracting beam of attenuated sound waves emitted by a plane circular transducer at one cavity end. At the opposite end, the jet impingement drives recirculating structures spanning nearly the entire cavity radius. We rely on linear stability analysis (LSA) together with three-dimensional nonlinear simulations to identify the flow destabilisation mechanisms and to determine the bifurcation criticalities. We show that flow destabilisation is closely related to the impingement-driven recirculating structures, and that the ratio between the cavity and the maximum beam radii plays a key role on the flow stability. In total, we identified four mode types destabilising the flow. For, a non-oscillatory perturbation rooted in the jet impingement triggers a supercritical bifurcation. For, the flow destabilises through a subcritical non-oscillatory bifurcation and we explain the topological change of the unstable perturbation by analysing its critical points. Further reducing increases the shear within the flow and gradually moves the instability origin to the shear layer between impingement-induced vortices: for, an unstable travelling wave grows out of a subcritical bifurcation, which becomes supercritical for. For each geometry, the nonlinear three-dimensional (3-D) simulations confirm both the topology and the growth rate of the unstable perturbation returned by LSA. This study offers fundamental insight into the stability of acoustically driven flows in general, but also opens possible pathways to either induce turbulence acoustically or to avoid it in realistic configurations.</p
The mixed-meal tolerance test as an appetite assay:methodological and practical considerations
Get PDFAppetite control is a topic which attracts widespread interest given its importance to energy balance and obesity. In this research area, the mixed-meal tolerance test (MM-TT) has emerged as an ‘appetite regulation assay’, facilitating the dynamic assessment of appetite parameters (e.g. subjective appetite perceptions, appetite-related hormones, food reward) in response to an individual meal. The MM-TT is commonly employed in observational and experimental studies to examine population differences and intervention effects. Problematically, no practice standard exists for the MM-TT and protocols vary widely. This presents a challenge for researchers designing new MM-TTs and hampers the comparability of findings. Therefore, within this narrative review we sought to identify and discuss key methodological considerations inherent within a MM-TT. The scope of our review extends to evaluating participant familiarisation and methodological standardisation practices, test meal characteristics, appetite perception assessment, blood sampling techniques, measurement of appetite-related hormones and data handling/analysis. A checklist has been devised to summarise relevant methodological issues identified within this review. This checklist can be used as a tool by researchers to facilitate MM-TT design and promote greater standardisation/comparability between studies. This review highlights the need for broader standardisation of MM-TT procedures to support consistency across future research. Additional research is needed to strengthen the evidence base on which various recommendations are made, particularly relating to participant familiarisation and methodological standardisation practices. Additional scrutiny of less common outcomes employed in MM-TTs (not addressed here), such as diet-induced thermogenesis, gastric emptying and ad libitum energy intake, is also needed
A scoping literature review of rehabilitation policy recommendations during the COVID-19 pandemic in the WHO European Region
Get PDFAs with other frontline healthcare services, the delivery of rehabilitation services has been greatly affected by the COVID-19 pandemic with many services suspended, despite WHO's mandate that rehabilitation is an essential service. This review aimed to provide an overview of policy responses that were taken across the WHO European Region to identify systems and processes that helped to inform and shape decisions pertaining to rehabilitation during the COVID-19 pandemic. A scoping literature search was conducted according to PRISMA-ScR guidelines and prospectively registered on Prospero (ID: CRD42024550641). Cinahl, Cochrane, PubMed and Scopus databases were searched from inception to February 2024. Eligibility criteria for selecting publications: Published work that includes any policy documents that informed rehabilitation during the COVID-19 pandemic in any of the 53 World Health Organisation European member states. Search results were extracted using the PESTLE heading framework in Microsoft Excel. Seven publications comprising seven policy documents from Italy (N=2), England (N=2) and the United Kingdom (N=3) were included in this review. Five key areas were identified in response to COVID-19 and rehabilitation: 1) government direction, 2) funding, 3) education, 4) telerehabilitation, and 5) social distancing and isolation. Our study's findings demonstrate a dearth of published government policy documentation referring to rehabilitation in response to the COVID-19 pandemic. This lack of published documents indicates that rehabilitation is not considered an essential health service during emergency response. Research should investigate the systems and processes of key decision-makers to inform future rehabilitation pandemic preparations. [Abstract copyright: Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.
Examining Transnational Education in British Universities for Enhancing Internationalisation:The Impact of Constructivism on Alignment
Get PDFTransnational education (TNE) and the accelerating internationalisation of higher education demand pedagogical approaches that support deep learning across diverse contexts. Constructive alignment (CA) is widely adopted to align learning outcomes, teaching and assessment; however, its underlying constructivist rationale has weakened, creating a gap in effective curriculum design. Without its constructivist foundations, alignment risks being applied superficially, undermining deep learning potential. This study examines how emphasis on alignment affects the incorporation of constructivist theory in higher education institutions (HEIs) curricula. Adopting a qualitative cross‐institutional approach, we conducted 47 interviews across multiple UK and international HEIs and disciplines. Findings reveal diminished integration of constructivist principles, with CA often implemented as a linear process. Crucially, we identify a symbiotic relationship between learning outcomes and learning objectives, both essential for authentic CA design. We conceptualise CA as a dynamic, cyclical model for sense‐making, challenging purely linear interpretations. Theoretically, our study extends CA theory by proposing a novel cyclical constructivist model (with five interrelated elements) and articulating the mutual interplay of CA components. Practically, these results carry implications for policy and curriculum design in HEIs globally, urging institutions to reintegrate constructivist pedagogy to realise CA's full potential and enhance deep learning, thereby emphasising the importance of continuous knowledge sharing and iterative evaluation in effective CA design
Enhancing Evidence-Based Practice Implementation in Acute Care:A Qualitative Case Study of Nurses’ Roles, Interprofessional Collaboration, and Professional Development
No full textBackground and Purpose Evidence-based practice (EBP) is essential for improving patient outcomes and healthcare quality. However, its implementation in acute care remains inconsistent due to organisational hierarchies, professional silos, and limited access to continuous professional development (CPD). Nurses play a key role in translating research into practice but often encounter barriers that limit their ability to lead EBP initiatives. Interprofessional collaboration and CPD are recognised enablers of EBP, yet their impact in acute care requires further investigation. This study explores how interprofessional collaboration, nurse-led initiatives, and CPD influence EBP adoption. Methods and Procedures A collective qualitative case study was conducted across two acute care hospitals in the East Midlands, England. Data collection included 25 semi-structured interviews, nonparticipant observations, and document analysis over six years, with an intensive fieldwork phase in 2022. Thematic analysis was used to identify key patterns related to EBP adoption, interprofessional collaboration, and nurse-led knowledge implementation. Results Nurses actively advocated for EBP integration but often worked independently due to the absence of formal collaboration structures. Interprofessional collaboration facilitated knowledge-sharing and decision-making, yet hierarchical constraints limited nurses’ influence in clinical governance. CPD enhanced nurses’ confidence and ability to challenge outdated practices, but disparities in access led to inconsistent EBP engagement across nursing teams. Conclusion Structured CPD, interdisciplinary collaboration, and inclusive decision-making are essential for EBP adoption. Addressing hierarchical constraints and resource limitations is crucial for sustaining evidence-driven care. Future research should explore the long-term sustainability of EBP implementation