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Acute measurement of flow-mediated dilation following passive heating in adults: The confounding role of altered shear stress and baseline vasodilation
No full textChanges in flow-mediated dilation (FMD) following acute heating are not well understood, appear protocol-specific, and may be better understood by additional measures of acute vasoactivity. This study investigated FMD responses before and after three different 30-min hot-water immersion conditions (40°C-Shoulder, 42°C-Waist, and 40°C-Waist) in 22 adults. Brachial artery diameter was recorded at baseline (Dbase), during the final 30 s of occlusion (Docc), and at peak post-occlusion (Dpeak). Allometrically scaled FMD%, and changes in diameter during occlusion (OIV), and from end-occlusion to peak diameter (FMDDocc) were calculated. Pre-occlusion shear rate was greater post-immersion in 40-Shoulder (p base increased (Δ0.4 ± 0.2 mm, p base (rrm = −0.47, p = 0.001). OIV% was the only vasoactivity metric to statistically differentiate between all conditions post-immersion (40°C-Shoulder: −8.1 ± 4.9%. 42°C-Waist: −3.0 ± 5.3%. 40°C-Waist: 1.1 ± 4.1%. p < 0.001). Post-heating FMD is confounded by heat-induced increases in baseline diameter, even after allometric scaling, while OIV% may provide complementary insight into acute vasoactivity following passive heating
The INTERDEM Silver Jubilee: 25 years of building bridges for psychosocial dementia research across Europe
No full textA special five-page article celebrating the 25th anniversary of INTERDEM. INTERDEM is a network of researchers interested in psychosocial interventions, made up of more than 600 researchers and academics with different professional disciplines, spread across 20 countries
Everyday work organising: a sociomaterial examination of coworkers using different work settings
Full text linkPurpose: This research examines the dynamics in work organizing practices of coworkers as they shift between work settings over time. Experiences of organizing are examined using a sociomaterial lens that allows an in-depth understanding of the sociocultural and material entanglement of tools used to organize.Methodology: Semi-structured interviews were undertaken with three coworkers at three points between 2019-2022 when work settings changed. Using a narrative inquiry approach and reflexive thematic analysis, the findings are reported through three case studies developed to depict different experiences of organizing. They are themed the agile worker, the over-worker and the sociable worker.Findings: Recurring organizing practices were the start and end of the workday, choice of work location, work tasks and taking breaks, however there was variation within these practices that were influenced by the spatial and temporal contexts.Originality: The study extends research on organizing through examining the dynamic practices of organizing, the tools used to organize and the contextual influence on these choices. It also contributes to the sociomateriality perspective through the longitudinal design which demonstrates the shifting sociomateriality of organizing practices, that others have only explored in a single setting/ time.Practical implications: This research provides recommendations for organizing practices in different work settings, which will support an increasingly flexible workforce
Organisational Interventions for Compassionate Care: The Perspectives of Healthcare Professionals. A Qualitative Evidence Synthesis
No full textBackground: In response to global outcries of poor healthcare, organisational interventions have been implemented with the aim of promoting compassionate care. An overall synthesis of qualitative data, including the perspectives of healthcare staff who have attended interventions, can establish ‘what works’ and inform future interventions. Aims: To synthesise existing research exploring how healthcare staff experience organisational interventions for compassionate care. Design: Qualitative evidence synthesis. Methods and Data Sources: A qualitative evidence synthesis was conducted in August 2023. Five databases were searched: MEDLINE, Academic Search Premier, CINAHL, APA PsycInfo and APA PsycArticles. Articles met the following criteria: (a) reported on the experiences of healthcare staff who had participated in organisational interventions for compassionate care, (b) taken place in a healthcare setting, (c) use of a qualitative or mixed-methods methodology, (d) published in English and (e) published since 2010. A thematic synthesis was conducted using NVivo software to synthesise findings. Data from the complete ‘findings/results’ sections were included in the synthesis. The final search protocol and search strategy were registered on PROSPERO (ID: CRD42023472404) and are reported using the PRISMA guidelines. Results: Eighteen qualitative or mixed-methods studies were included in the review, encapsulating the experiences of healthcare staff across eight countries. Four themes were identified: (1) holding back, (2) humanising healthcare, (3) values are instilled and (4) sustainability is important. Conclusion: Organisational interventions for compassionate health care are valued and appreciated by healthcare staff and foster reflection and connection. Interventions facilitate clinical creativity, improve staff well-being and strengthen communication between staff. Implications: The implementation of organisational interventions for compassionate care should be encouraged in healthcare settings. Interventions that consider organisational cultures are driven by organisational values and are embedded with sustainability in mind can improve staff well-being and positively impact the provision of patient care. Reporting Method: PRISMA guidelines were followed in the reporting of this review
The influence of reward qualifying conditions on participation in online referral programs
Full text linkOnline referral reward programs (RRPs) incentivize customers to promote products within their digital social networks by offering rewards, yet these programs often face persistently low participation. This research examines how online RRP qualifying conditions—specifically, whether rewards depend solely on the referrer's own actions or require assistance from others—shape customers' willingness to engage. Drawing on psychological reactance theory, the study investigates both the direct impact of assistance-based conditions and the mediating role of psychological reactance, as well as whether the timing of the reward offer (pre-vs. post-consumption) moderates these effects. Three scenario-based online RRP experiments conducted in gym, meal-kit, and coffee-shop contexts show that assistance-based conditions heighten reactance and reduce engagement, while post-consumption timing attenuates this reactance-driven decline. The findings advance understanding of consumer responses to online RRPs and provide actionable guidance for designing more effective digital referral strategies
Loss and gain of motor protein function can cause 1 ROS-dependent or -independent 2 microtubule bundle damage in axons
Full text linkNeurodegeneration often starts by atrophy of the cable-like nerve fibres (axons) that wire nervous systems. Maintaining axons requires supply via motor protein-driven transport along uninterrupted bundles of microtubules. Functional loss of motor proteins, but surprisingly also their hyperactivation, link to conditions of axonal atrophy; in both cases the underlying mechanisms are little understood. To bridge this important knowledge gap, we carried out systematic studies using 40 different genetic tools to manipulate 19 context-related genes in one standardised Drosophila primary neuron system. Starting with transport motors, we found that downregulation in at least three of them, Dynein heavy chain, the KIF5 orthologue Kinesin heavy chain (Khc) and KIF1A orthologue Unc-104, caused disintegration of axonal microtubule bundles which we refer to as ‘microtubule-curling’; this damages the essential highways for life-sustaining axonal transport. To understand this phenomenon, we focussed on Khc’s various subfunctions. We found that abolishing Khc-mediated mitochondrial and lysosomal transport affects the homeostasis of reactive oxygen species (ROS) which, in turn, triggers microtubule-curling in fly and mouse neurons alike. Taking the opposite approach by using conditions where Khc is hyperactive, comparable microtubule-curling is observed, triggered by a ROS-independent mechanism likely involving excessive mechanical force generation. To assess wider relevance of our findings, we studied Unc-104, its binding partner KIFBP and human KIF5A. These studies suggest that functional loss and hyperactivation also of other transport motors cause ROS-dependent and -independent microtubule-curling, which could therefore represent two fundamental pathways that link transport motors to microtubule bundle decay and neurodegeneration
Investigating prevention, diagnosis and impact of surgical site infection
No full textSurgical site infection (SSI) is the most common healthcare-associated infection, affecting up to 40% of surgical procedures depending on patient, operation, and specialty. Prevention and early recognition are essential to reducing morbidity and improving quality of life. Remote assessment offers opportunities to detect infections earlier, minimize patient travel and costs, and lessen environmental impact.This thesis addresses the problem through a series of seven studies. Surveys of UK vascular surgeons and international practice reveal wide variation in SSI prevention across multiple domains, highlighting the absence of consensus. A systematic review of diagnostic test accuracy studies demonstrates that while remote assessment shows good screening potential for SSI (sensitivity 87.9%, specificity 96.8%), no research has assessed combined use of wound images and patient-reported data.Building on these findings, a novel remote diagnostic tool—the ASSIST measure—was developed and validated. This 11-item instrument achieved excellent diagnostic accuracy (sensitivity 97.9%, specificity 92.5%, AUC 0.997). Subsequent studies quantified the impact of SSI on healthcare resources, showing a 62.5-fold increase in carbon emissions for patients with SSI compared to those without (643.8±1,276.4 vs 10.3±24.3 kgCO2e, p<0.001). Financial costs were similarly disproportionate (£8,355.08±18,144.84 vs £61.10±133.67 per patient, p<0.001). Implementing remote assessment in place of inperson review reduced emissions by 30.8±26.2 kgCO2e per patient (71.0% relative reduction, p<0.001) and lowered per-patient costs by £77.58 (87.0% relative reduction, p<0.001).In conclusion, this thesis demonstrates significant variability in SSI prevention practices and the urgent need for evidence-based recommendations. The ASSIST measure shows high diagnostic accuracy and the potential to markedly reduce both financial and environmental burdens, supporting broader healthcare goals such as Net Zero 2045 and Darzi recommendations. Future work should assess this approach across other specialties and optimize remote delivery technologies
Coming to terms with dying: Advance care planning as a conduit between clinicians, patients, and conversations about death and dying – a qualitative interview study
Full text linkBackground: Advance care planning discussions exploring future care and support needs can be beneficial to people with advanced illness. While research has focussed on barriers, outcomes, and completion, little is known about how discussions influence thoughts, feelings, and behaviours. Aim: To explore experiences of advance care planning for people with incurable life-limiting illnesses, to understand the impact of discussions on individuals, and factors influencing psychological responses. Design: Semi-structured qualitative interviews were conducted. Data were analysed using framework analysis. Reflexive journalling and discussion of coding framework and themes supported rigour. Setting/participants: Twenty purposively sampled adults receiving hospice care, aged 30–93 with cancer (n = 15) and non-cancer (n = 5) diagnoses were interviewed. Results: Advance care planning elicits multiple complex thoughts, emotions, and behaviours, with responses ranging from the procedural to the profound. Discussions empowered and instilled confidence, promoted openness with relatives, encouraged people to make the most of their time remaining, and sometimes contributed to coming to terms with their mortality. Factors influencing experiences of discussions reflected the complexity and diversity in participants’ lives, personalities, and life experiences, with discussions exposing the realities of living with terminal illness. Conclusion: Individuals’ unique lives and experiences shape their responses to, and the impact of advance care planning on how they think, feel and behave. Advance care planning is not simply a means to document end-of-life care preferences, but can empower and instil confidence in patients, and may form part of the process of coming to terms with mortality, allowing clinicians to shift focus from process-related outcomes
Decontextualising the UK summer 2024 riots via the courtroom
Full text linkThis article examines 126 cases where people were charged with criminal offences in relation to the summer 2024 riots in England. Among other dynamics, it looks at examples where people were charged for their involvement in the riots, and also in reaction to them, including those who chose to protect asylum seekers, racialised communities and their institutions. It reveals how dominant, politically established anti-asylum-seeker and anti-migrant narratives were echoed in the violence and how, in some cases, criminal justice agencies followed politicians’ lead by downplaying the racist context of the riots and framing them as ‘thuggery’, thereby decontextualising what took place. It asks whether what happened in the courts echoed a dominant thesis of cumulative extremism, and shows how the crackdown on the riots swept up many vulnerable people from across different backgrounds
Incremental hemodialysis practices and impact on survival: systematic review and meta-analysis
Full text linkBackground: Starting hemodialysis (HD) incrementally may help reduce the burden of treatment in patients with established kidney failure. A systematic review has been conducted to describe variations in the practice of incremental HD world-wide and to study its impact on mortality.Study Design: Systematic reviewSetting & Population: Patients with established kidney failure starting HDSelection Criteria for Studies: Medline and Academic Search Premier were searched from inception to 20 July 2020 for observational and interventional studies comparing incremental or twice-weekly treatments with conventional treatment, with mortality as one of the outcome measures.Predictor: Incremental (or twice-weekly) HD therapy vs three-times weekly treatmentsOutcomes: MortalityResults: 14 studies were included (combined 91,928 participants; 5,075 [5.5%] in the intervention, 86,853 [94.5%] in standard treatment groups). Large variations in the practice of incremental HD were noted with treatments differing in HD frequency, treatment goals, monitoring schedules, duration of the incremental programme and co-interventions. Larger studies with lowest risk of bias demonstrated equivalent survival between incremental and conventional treatment groups. Meta-analysis of mortality hazards showed an overall HR of 0.97 (95% CI 0.76-1.19). Centres which screened patients for adequacy of residual kidney function at baseline and pursued pre-specified treatment goals have demonstrated better outcomes in incremental HD recipients compared to conventional treatment. There is evidence of publication bias in the literature.Limitations: Studies from diverse settings, searches limited to English languageConclusions: There is wide variation in the interpretation of incremental HD treatments and therefore primary studies of incremental HD must be examined in the context of their settings, population, and available resources. Optimal method of implementing incremental HD remains controversial; available data indicate that incremental HD is at least non-inferior to conventional HD