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Contextual influences on adaptation in four types of hospital teams: An ethnographic study
No full textHealthcare quality and safety efforts increasingly focus on understanding how complex systems adapt to maintain operations during disruptions. This paper explores team adaptation within hospitals, examining how different types of teams respond to misalignments between demand and capacity. To explore whether different types of teams experience different types of demand capacity misalignments, and whether and how teams differ in how they adapt. The overall goal was to identify whether and how different types of teams might have different requirements to support their adaptive capacity and system resilience. This study used ethnographic observations to collect data from five wards in a large London hospital: two surgical wards, an older adult ward, a critical care unit, and the Acute Assessment Unit (AAU) specifically designed to expedite patient flow from the Emergency Department. A typology of hospital teams and the CARE Model 2.0 framework were used to analyse misalignments and adaptations. All team types experienced misalignments, but their adaptations in response to misalignments varied. Team design, structure, and membership influenced adaptation strategies. Structural and satellite teams, with stable membership, had fewer misalignments and coordinated adaptations effectively. Hybrid teams, with both stable and unstable members, were more vulnerable due to their fragmented interactions. Coordinating teams, integrating representatives from multiple areas, faced challenges due to conflicting priorities and information changes. Different hospital teams adapt in different ways to misalignments. Team features influence adaptation strategies. Designing and supporting adaptive teams is crucial for improving healthcare quality and safety. Future research should focus on adaptive teamwork and explore interventions to enhance team adaptive capacity
Thyroid hormone receptor beta signaling is a targetable driver of prostate cancer growth
No full textThyroid hormone (TH) signaling plays a major role in the development, energy homeostasis, and metabolism of most tissues. Recent studies have identified THs as drivers of prostate cancer (PCa) development and progression. We reported that the T3-scavenger protein µ-crystallin (CRYM) regulates the development and progression of PCa and that this involved crosstalk with androgen receptor (AR) signaling. However, the mechanisms remain incompletely understood. Here, we explored the role of thyroid hormone receptor β (TRβ), which is the main effector of TH signaling, in the context of PCa. The use of the TRβ-selective antagonist NH-3 inhibited PCa cell proliferation in vitro and reduced tumor size in PCa xenograft models in vivo. Notably, NH-3 was highly effective in the engrafted 22Rv1 cell line, a model for castration-resistant PCa (CRPC). Mechanistic studies revealed that NH-3 downregulates AR and the AR target genes Nkx3.1 and KLK3 (PSA). NH-3 was a more effective anticancer agent than enzalutamide, and their combined use was synergistic. Evidence from human datasets corroborates our findings, whereby elevated TRβ expression and mutations in the TH signaling pathway are associated with the onset of PCa. Collectively, these results establish TRβ as a mediator of tumorigenesis in PCa and identify NH-3 as a promising therapeutic agent for targeting AR signaling, particularly in CRPC
Learning processes in the judge–advisor system: a neglected advantage of advice taking
No full textPrevious research in the judge–advisor paradigm has focused on how judges utilize the wisdom of others by taking their advice and on the beneficial effect of receiving advice on judges' postadvice final judgments about the exact same problem. However, a completely different possibility of how judges might benefit from advice has been overlooked so far: Learning processes could improve the accuracy of judges' subsequent initial judgments from one problem to another problem on the same type of task as well. Hence, we test the assumption that advice can induce individual performance enhancements that differ as a function of the advisor's judgment accuracy. The results of three experiments support our hypothesis and indicate positive learning, particularly when participants receive high‐quality advice. Furthermore, we show that external information about the advisor's accuracy is not crucial for the occurrence of these individual performance enhancements. In general, our results suggest that advice can have a positive effect on judges' subsequent initial judgments
Free school meals, diet quality and food insecurity in secondary school students: protocol for a multiple-methods study - the CANTEEN study
No full textINTRODUCTION: Food insecurity is increasing in the UK, impacting choice and diet quality. The current means-tested free school meals (FSM) policy was put in place to address dietary inequalities and food insecurity in school children. In secondary schools, approximately 20% of students who are eligible and registered do not take their FSM. Working across a range of schools that have variable levels of FSM uptake, this study aims to evaluate the effectiveness and cost-effectiveness of the current means-tested FSM policy in UK secondary schools on diet and food insecurity outcomes, understand what factors are associated with uptake and test the potential impact of any proposed policy change.Secondary schools (n=32) in both Northern Ireland and the Midlands region of the UK are being recruited into the study. Data will be collected from school staff, governors, students and parents via questionnaires, as well as observational data of school eating environments. Qualitative data will be collected in selected case study schools (n=6-8). Multilevel modelling will be undertaken to evaluate the association between FSM uptake and fruit and vegetable intake, overall diet quality and food insecurity in all students. Economic evaluation will be conducted using a cost-utility approach. The effect of policy change will be modelled and school factors associated with FSM uptake explored using multiple methods.ETHICS AND DISSEMINATION: Ethical approval has been obtained from Queen's University Belfast Faculty of Medicine, Health and Life Sciences Research Ethical Committee (MHLS 23_55). Findings will be disseminated to key national and local agencies, to schools through reports and presentations, and to the public through media and open access publications.</p
Adherence to usability and accessibility principles in digital health applications for patients with diabetes: systematic review
No full textBACKGROUND: Health apps have the potential to enable people with diabetes to access care more easily, monitor their condition, and reduce the number of times they need to attend health care appointments. However, the development pipeline for apps may differ widely before the apps are released for use, due to limited funding, difficulty in obtaining iterative feedback from patients/users, and varying levels of developer expertise. In response to concerns about the quality and consistency of apps being released, two guidelines were created: the Digital Technology Assessment Criteria (DTAC) and the National Institute for Health and Care Excellence (NICE) Evidence Standards Framework. These two frameworks aim to standardize the development and evaluation of digital health technologies (DHTs). They outline core requirements, such as accessibility, clinical safety, data protection, interoperability, usability, and safeguarding, which help ensure that digital health apps are accessible, safe, effective, and suitable for real-world use.OBJECTIVE: This systematic review evaluated the performance of diabetes digital health apps, as presented in published studies, in terms of adherence to DTAC 2021 and NICE 2022 guidelines during development. METHODS: We systematically searched Embase and MEDLINE and identified 43 studies that met the inclusion criteria. Each study was assessed against 13 binary scoring criteria derived from the two frameworks. RESULTS: Our findings highlighted that 93% (n=40) of the studies met fewer than 40% of the recommended criteria. Specifically, 88.4% (n=38) studies did not report accurate and reliable measurements, 86% (n=37) omitted app accuracy validation, and 83.7% (n=36) failed to address inequalities considerations. Only 3 (7%) studies achieved scores between 7 and 9 out of a possible 13, and none fully adhered to the guideline criteria.CONCLUSIONS: These results suggest a significant gap between digital health guidelines and real-world app development practices. We recommend the adoption of DTAC and NICE guidelines more widely and consistently during design and development. Additionally, we suggest that journals request that authors submit an adherence checklist alongside their manuscript to improve standardization and transparency across digital health publications. TRIAL REGISTRATION: PROSPERO CRD42022322040; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022322040.</p
The critical role of LRG1 in pathological fibrosis
No full textPathological fibrosis is a chronic process characterized by excessive deposition of extracellular matrix (ECM), which disrupts tissue architecture and function and accelerates disease progression in organs such as the lungs, liver, heart, kidneys, skin, and eyes. Recent studies have identified leucine-rich α-2 glycoprotein-1 (LRG1), a secreted glycoprotein known for modulating angiogenesis and immune responses, as a key player in the pathogenesis of fibrotic disorders. LRG1 expression is up-regulated by multiple pro-fibrotic mediators, including transforming growth factor-beta (TGF-β), and has been shown to regulate fibroblast differentiation, myofibroblast activation, and ECM production. Through interactions with the TGF-β signaling pathway and other cascades, LRG1 plays a crucial role in pathological fibrosis. Elucidating the molecular mechanisms by which LRG1 drives fibrogenic responses will pave the way for novel therapeutic strategies targeting pathological fibrosis. This review explores the emerging functions of LRG1 in fibrosis of different organs and discusses therapeutic approaches aimed at mitigating fibrosis through LRG1 inhibition.</p
Endangered white-clawed crayfish (Austropotamobius pallipes) eDNA detection suggests agriculture may exert significant pressure on the species
No full textThe white-clawed crayfish (Austropotamobius pallipes) is IUCN Red-Listed as globally endangered being in unfavorable (bad) status in both the UK and Ireland. Crayfish, and crayfish plague (Aphanomyces astaci) eDNA were sampled at 110 sites throughout Northern Ireland during 2024. Crayfish eDNA was detected at 45% of sites comparable to sightings and field signs at 44% of sites during the last survey in 2017. All samples were crayfish plague eDNA negative. Crayfish eDNA detection was unrelated to water levels preceding sampling, or the volume of water filtered, but declined throughout September and October reflecting the end of the survey season as crayfish are less active in cooler conditions. Future surveys should be restricted to late spring to mid-summer when crayfish are more active. Crayfish were detected more frequently at sites with past records, and those with more recent than old records, suggesting vulnerability to local extirpation. Crayfish distribution was restricted by calcareous bedrock, where calcium is necessary for shell growth, and occurrence was higher at rivers than lakes, in lowland grassland sites with boulder and cobble substrates. At rivers, occurrence was higher in wider channels and at lakes with rocky shores. Eighteen perceived pressures were recorded, notably, risk of siltation from adjacent plowing (49% of sites), pollution (47% of sites) mostly agricultural in origin (32% of sites) where livestock (mostly cattle) access to water (44% of sites) demonstrably lowered crayfish eDNA detection by −33%. This study suggested there has been no change in white-clawed crayfish conservation status in Northern Ireland which remains vulnerable to stochastic extirpation potentially driven by water quality deterioration principally associated with agriculture. Concerns are raised about the condition of white-clawed crayfish in Areas of Special Scientific Interest (ASSIs) especially four key sites with the species as their designated feature. Eighteen candidate conservation measures are identified.<br/
Characterizing the field of fluidic effect around vitrectomy probes using particle image velocimetry
No full textPurpose: The shape and characteristics of the velocity fields around vitrectomy probes are unknown, resulting in an incomplete understanding of their surgical effects and behavior. The primary aim of this study was to define and measure with high spatial and temporal resolution the field of fluidic effect induced by vitrectomy probes, with assessment of both convective and temporal acceleration in a range of surgically relevant settings with an optimized particle image velocimetry (PIV) methodology.Methods: This was a laboratory-based investigation using in vitro testing carried out at Newcastle University. Testing was conducted using a DORC EVA Nexus vitrectomy system with dual cutting action vitrectomy probes in three gauge sizes (23G, 25G and 27G). With the use of balanced salt solution (BSS), PIV measurements were conducted for various flow, vacuum, and cut rates. Experiments were conducted in a range of different probe orientations to reconstruct a three-dimensional representation of the flow fields.Results: Using a variety of improvements in the PIV setup, including choosing an optimal time delay (dt) between the image pairs, the field of fluidic effect was measured with high spatial resolution up to the probe port. Fluid acceleration in the vicinity of the cutter was accurately resolved with values significantly higher than previously reported values. Two clinically relevant zones, high-flow and low-flow, were identified and defined. The high-flow zone (HFZ) had an acceleration of up to 400 m/s2 and reached velocities of up to 1 m/s close to the port for the maximum aspiration setting. The low-flow zone (LFZ) extended approximately 2 to 2.5 mm from the port, or 3.5 to 4 times the diameter of the cutter (during maximum aspiration), with the mean velocity at the edge of the zone reaching 0.01 m/s. The extent of the HFZ was relatively constant with respect to gauge size and increased only marginally with both increased flow and vacuum settings. The LFZ increased in extent with both flow and vacuum. It varied in extent by gauge size with vacuum but was relatively unaltered by gauge size with fixed flow. Cut rate had no clinically relevant effect on the HFZ and LFZ extents and velocity fields.Conclusions: Using optimized PIV measurements on an experimental in vitro vitrectomy setup, two clearly defined flow zones could be identified around the vitrectomy port. The study defined the shape of the two flow zones in BSS, outlined influencing factors, and correlated fluctuations with gauge, flow, and cut rates. These parameters enhance surgical understanding and provide a benchmark for future design evaluations. Further study using non-Newtonian fluids would be of interest to outline the differences in flow fields
Driving enhanced exciton transfer by automatic differentiation
No full textWe model and study the processes of excitation, absorption, and transfer in various networks. The model consists of a harmonic oscillator representing a single-mode radiation field, a two-level system acting as an antenna, a network through which the excitation propagates, and another two-level system at the end serving as a sink. We investigate how off-resonant excitations can be optimally absorbed and transmitted through the network. Three strategies are considered: optimising network energies, adjusting the couplings between the radiation field, the antenna, and the network, or introducing and optimising driving fields at the start and end of the network. These strategies are tested on three different types of network with increasing complexity: nearest-neighbour and star configurations, and one associated with the Fenna–Matthews–Olson complex. The results show that, among the various strategies, the introduction of driving fields is the most effective, leading to a significant increase in the probability of reaching the sink in a given time. This result remains stable across networks of varying dimensionalities and types, and the driving process requires only a few parameters to be effective
