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Deconstructing the 6-Step handrubbing technique for healthcare staff: a mixed-methods investigation of efficacy, acceptability and feasibility
No full textBackground: A 6-step technique is recommended for applying alcohol-based handrubs (ABHR) in healthcare. However, evidence supporting the effectiveness of individual steps is limited, and healthcare workers’ compliance is low, potentially due to low acceptability or feasibility, or inadequate training. This study evaluated the effectiveness of the 6-step handrubbing technique for healthcare staff with consideration of microbiological efficacy, acceptability and feasibility.Methods: A mixed-method design was used. Data were collected in two stages between 2017-2020. Stage 1 employed a Latin square design with a modified EN 1500 procedure to compare the 6-step technique to six variations omitting one step each, for bacterial load reduction and hand surface coverage (n=35). Stage 2 was a cross-sectional online survey of the acceptability and feasibility of using the 6-step handrubbing technique in clinical practice (n=78). Results: Omitting step 4 (backs of fingers) resulted in significantly lower bacterial load reduction compared to the full 6-step technique (p=0.001). Omitting step 1 (palms) or step 2 (dorsa) resulted in significantly lower hand coverage compared to all other technique variations (p≤0.001). Stage 2 participants perceived the 6-step technique as acceptable and feasible, with step 1 as the most acceptable and feasible step.Conclusion: Step 4 contributed most to bacterial load reduction, and steps 1 and 2 were key for hand coverage. Healthcare workers should continue using the 6-step technique, with efforts to improve compliance with individual steps. Future research should investigate the effects of altering step sequence and the contribution of individual steps during handwashing with soap and water.<br/
Economic evaluation of participation in community led organisations for individuals living in disadvantaged areas in the UK
Full text linkThis paper presents an economic evaluation of community-led and -owned organisations that deliver activities to support health and wellbeing. Because community-led organisations (CLOs) are a vital part of the social and solidarity economy, they increasingly feature in public health policies targeting disadvantaged populations. However, little is known about the value CLOs generate as few economic evaluations of them exist and those available focus on isolated activities (such as exercise classes) and/or specific populations (e.g., men-only collectives). The novelty of our work lies in the inclusion of multiple CLOs, comprehensive coverage of their activities, breadth of participants studied, and control group methodology applied in creating new knowledge of the health and wellbeing outcomes of CLOs and resources consumed to achieve them.We conducted cost-effectiveness and cost-consequence analyses of data collected via a 12-month longitudinal study. We compared 331 CLO participants in 14 UK-based CLOs to a ‘do nothing’ synthetic control group (n=100). Health and wellbeing were measured using the ICECAP-A capability measure for adults, EuroQol EQ-5D-5L, Short-form Warwick Edinburgh Mental Wellbeing Scale and the Revised Social Connectedness Scale. Resource use data included health, social care, and other community sector resources. Data collection occurred at four-points over the study period supported by publicly available accounts and data provided by each CLO.We found an incremental cost per year in full capability of £35,813 and an incremental cost per quality adjusted life year of £29,827. Statistically significant improvement in both social connectedness, and mental wellbeing were observed over the 12 month follow up. This work supports CLOs as an intervention to improve health and wellbeing in disadvantaged communities and identifies challenges for traditional evaluation methodology with regards to costing and comparator groups. <br/
Seeking support: the voice of young men who have experienced sexual harm during their life course
Full text linkThe sexual abuse and assault of boys and men is not uncommon, and seeking support is useful in reducing negative outcomes. However, male survivors are less likely than women to seek support. Gendered norms and myths persist with several gender-specific barriers to seeking support existing for men. The present study is guided by three research questions: (1) What are men’s support needs in relation to their experience of sexual harm? (2) What are men’s experiences of seeking support in relation to their experience of sexual harm? (3) What are the barriers that hinder men from seeking support? Interviews were conducted with 14 men (19–37 years old) attending one of two universities in New Zealand, who had experienced sexual harm. The interviews included a discussion of the men’s experiences of seeking support and were conducted as part of two broader projects. The young men experienced a complex and multifaceted journey in seeking support and described a range of informal and formal avenues that they had reached out to. Three prominent needs were highlighted: (1) increased awareness of male survivors, (2) a need for clarity around formal support services, and (3) a need for a diverse range of support modalities. The men described a variety of barriers encountered, including individual-level barriers such as difficulties in recognizing their experiences as sexual harm, a reluctance to acknowledge a need for support, preconceived notions about what seeking help might be like, as well as several overarching social and contextual influences such as living situations, cultural norms, religious beliefs, and family dynamics. These findings underscore the need for a holistic approach to supporting male survivors that addresses gender norms and myths about male survivors, acknowledges the diversity among male survivors, and addresses both individual-level and broader systemic barriers to support seeking by young men who have experienced sexual harm.</p
Structured exercise program for hip arthroplasty: an expert consensus using the delphi technique
No full textBackground: A structured exercise program following hip arthroplasty for hip fractures is crucial for improving patients’ physical function and quality of life. Despite the increasing incidence of hip fractures, there is a dearth of literature on exercise programs for hip arthroplasty performed for fractures. This study aimed to obtain an expert consensus on a structured exercise program for hip arthroplasty patients. Methods: A literature search was performed in electronic databases such as PubMed, Web of Science, PEDro, and Scopus, and evidence was pooled and formulated into items for the protocol. A three-round, online modified Delphi survey was conducted to validate the results of the framed exercise protocol which included national and international physiotherapy experts as panelists. Results: In round 1, 59 items about rehabilitation were mailed to the panelists, and 50 items reached a consensus. Round 2 had 19 items, and 13 items reached a consensus. Consensus was sought on items for which the authors disagreed by sending them for review before the next round. In round three, a model exercise program was framed based on the results of previous rounds and was mailed to the panelists for their feedback. Based on their comments and suggestions, the framework of the structured exercise program was finalized. Conclusions: Based on the results of the Delphi survey, the exercise protocol for hip arthroplasty was framed and validated. The validated exercise program can serve as guidance for physiotherapists in enhancing optimal recovery following hip arthroplasty.</p
<i>Candidozyma auris</i>: implications for infection prevention and control in the management of this resilient biofilm former
No full textCandida auris is now recognized by the World Health Organization (WHO) as a critical priority pathogen. Not only does it exhibit multidrug resistant properties, but also has the intrinsic capacity to form adherent biofilm communities in the hospital setting that impact and negatively influence clinical management. Its biological properties are primed to maintain its population within harsh environmental niches, which has supported its successful emergence on the global stage. Clinically, these behaviors and its antifungal tolerant phenotype have created an infection prevention and control problem. This chapter review will explain its clinical importance, its importance as a transmissible pathogen, and its key biological features that support biofilm growth. We will also consider why antifungal agents fail, and offer insights into how to optimally prevent and/or control these biofilms within healthcare facilities
Vulvovaginal candidiasis: pathophysiology, the role of biofilms, and emerging therapeutics
No full textVulvovaginal candidiasis (VVC) is a prevalent fungal infection of the female genital tract that impacts millions of women worldwide, representing a considerable burden on health and quality of life. Despite comprehensive knowledge of the causative species (Candida albicans and non-albicans Candida), approximately 8% of women experience recurrent VVC (RVVC), characterised by more frequent, persistent infections. Fungal biofilm formation has been proposed as one possible mechanism underlying this response; however, this remains a topic of debate. In this chapter, we review the current understanding of R/VVC pathophysiology, clinical presentation and diagnostic approaches. We further discuss the evidence linking biofilms to RVVC and highlight emerging therapeutic strategies aimed at better managing this challenging condition
Applying ambivalent sexism theory to explain the intersection of gender, power, and sexism within intimate partner violence
No full textTwo theoretical perspectives on intimate partner violence (IPV) emphasize the need for understanding its foundations in sexism, gendered power dynamics, and gender inequalities.The gendered perspective emphasizes that patriarchal attitudes lead to men's IPV as an expression of dominance and, by contrast, that women's IPV occurs in self-defense. We draw from ambivalent sexism theory to present a gender-inclusive framework for explaining IPV. Two forms of sexism — hostile sexism and benevolent sexism — are critical for understanding distinct occurrences of men's and women's IPV that are nonetheless consistent with representative community-based evidence that victimization occurs across genders. For instance, men's endorsement of hostile sexism predicts IPV via insecure concerns about lacking power, whereas women's endorsement of benevolent sexism predicts IPV via heightened pressures on women to maintain their relationships. We conclude by describing the need for gender-inclusive research, practice, and policy acknowledging IPV toward women, men, and non-binary genders
Using time delayed disturbance compensation for sliding mode control
No full textUnder the framework of using Time Delay Control (TDC) for disturbance compensation in Sliding Mode Control (SMC), we address two practical problems. The first problem involves mitigating chattering in SMC caused by input delay, while the second problem focuses on designing TDC under conditions of limited measurements. Our research demonstrates that incorporating TDC as a phase lead compensator in the first problem can effectively accommodate larger input delays. To reduce the chattering, we propose a switching gain design, consisting of reference signals rather than measured states, resulting in an ultimately bounded solution. In the second problem, when acceleration measurements are unavailable, we provide stability conditions under which TDC can be designed with acceleration construction using delayed velocity signals. By constructing a modified sliding surface that incorporates the integral error remainder associated with the acceleration construction, our approach ensures switching gain are kept at minimal, with robust disturbance compensation at higher frequencies. We perform a simulation investigation of an autonomous underwater vehicle under input delay and disturbance to demonstrate the efficiency of the approach
CEO turnover and financial policy transfer
No full textWe explore how Chief Executive Officer (CEO) turnovers influence firms’ capital structures. Our findings indicate that adjustments in capital structure are markedly more significant when the incoming CEO is sourced from outside the firm, compared to internal promotions. Moreover, firms undergoing CEO turnovers tend to realign their actual leverage to target levels more swiftly than those without such changes, with this process being particularly accelerated when the CEO is externally appointed. A notable insight from our analysis is that external CEOs frequently adopt and apply leverage strategies from their previous positions, transferring financial strategies that reflect their past experiences. These patterns remain robust when we specifically examine forced turnovers, suggesting that the external versus internal nature of succession, rather than the reason for turnover, drives the transfer of financial policies.</p
Dismantling the master's house? Abolition, deradicalisation and social work
No full textThis chapter applies an abolitionist lens to the UK government’s PREVENT policy response to the threat of violent extremism. It examines critiques and justifications, exploring the consequences for social work of engaging in this statutory duty. Using key texts, the authors illustrate how abolitionist perspectives can offer a framework for understanding the ways in which social work is used as a form of policing. It is argued that in the current neoliberal context both professions coalesce around notions of creating and sustaining order. PREVENT is aligned with a violent and coercive carceral logic and connected to the racialised threat of disorder, in contrast to accepted images of social work as inherently liberal and accepting of diversity. The potential for abolitionist thought to inform new forms of social work praxis that disrupt and displace what we now know and do is illustrated – offering renewed hope for a more equitable world
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