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A mixed methods evaluation of a facilitated research career pathway for nurses, midwives, allied health professionals and healthcare scientists working in the NHS
Get PDFBackground: Opportunities for nurses, midwives, allied health professionals and healthcare scientists (NMAHP+s) to engage in research are increasing but still lag behind opportunities for medical staff.Iinitiatives to identify, support and develop NMAHP+s considering and pursuing clinical academic roles are key to growing an NMAHP+ clinical academic workforce. We describe and evaluate the impact of the Interdisciplinary Clinical Academic health Research Excellence facilitated research career pathway (iCAhRE™ programme) on NMAHP+ participants in one National Health Service Trust in England. Methods: The study used a mixed methods approach informed by the Kirkpatrick Model of Training/Evaluation. Quantitative data related to uptake, progression through programme stages and key demographics of participants in the programme. Twenty-nine participants participated in a survey which assessed experiences of the programme, learning and impact from the programme, career trajectories, and barriers and enablers to pursuing a clinical academic career. Experiences of the programme were captured in greater depth in 12 interviews. Results: Since 2016, participants were able to engage with the programme appropriate to their needs and research careers. Responses to the programme were highly positive and participants had increased their research knowledge and skills, initiated new research-related activities, improved their practice and increased their confidence. A high number had progressed to a role with a higher banding compared to when they started the programme (37.9%) and had research as part of their current role (55.2%). However, significant challenges to pursuing a clinical academic career for NMAHP+s included: unsupportive managers, lack of dedicated time for research engagement in a context of clinical pressures, a lack of clinical academic posts and limited progression opportunities. Conclusions: This NHS Trust-supported high-quality facilitated research career pathway has lasting effects, increasing research knowledge and skills, informing and changing participants’ clinical practice, building confidence, increasing research-related activities undertaken and career progression. The programme’s range of opportunities across the whole pathway, the strong collaborative partnership between the NHS Trust and partner Higher Education Institute (HEI) and visible support for research are important contributors to the programme’s impact. However, challenges to pursuing a clinical academic career for NMAHP+s persist and require further attention
Adolescents' and youths' perceived barriers and facilitators to engaging with digital mental health interventions for depression and anxiety: A scoping review
Get PDFDigital mental health interventions (DMHIs) can be effective for adolescents and young people experiencing depression and anxiety. However, maintaining engagement remains a persistent challenge. While internal factors such as interface design, interactivity and personalisation have been widely examined, less is known about how young people themselves perceive barriers and facilitators to engaging with these tools. This scoping review explores adolescents' and young people's perceived experiences of engagement with DMHIs. A systematic search in PubMed, Scopus and PsycInfo identified 37 studies that met the inclusion criteria. Analysis revealed a broad range of perceived facilitators, including accessibility, perceived usefulness, opportunities for social connection and supportive human involvement. Commonly reported barriers included stigma, privacy concerns, low motivation, lack of personalisation, technical difficulties and limited trust in the interventions. Notably, most studies reported these perceptions qualitatively, with limited systematic assessment of their impact on engagement. This highlights a gap in the evidence base and underscores the need for future research to quantify how perceived barriers and facilitators shape engagement and adherence. Addressing barriers while building on facilitators may enhance sustained engagement and improve the real-world effectiveness of DMHIs for adolescent mental health
A Cost-Effective and Flexible Decision-Making Method for Multi-Objective Finite Control Set Model Predictive Control
Get PDFMulti-objective finite control set-model predictive control (FCS-MPC) plays a prominent role in controlling modern power converters and electric drives. However, selecting weighting factors (WFs) remains challenging, particularly when considering additional control objectives (ACOs). To address this challenge, this paper proposes a straightforward, cost-effective, and flexible decision-making (DM) method for multi-objective FCS-MPC strategies. The proposed hierarchical structure DM method utilises the Euclidean norm to individually evaluate the main and additional control performances. Because it allows for the expansion of the number of hierarchical stages and does not require a sorting algorithm, it stands out as a flexible and technically effective solution among existing DM techniques for the given problem. To demonstrate its effectiveness, it is applied to the model predictive torque control (MPTC) strategy to drive a permanent magnet synchronous motor. The MPTC with the proposed DM method is tested under various operating conditions and compared with the conventional MPTC. The experimental results confirm the ability of the proposed DM technique to handle ACOs in conjunction with the main control objectives and system constraints, while also demonstrating increased flexibility, enhanced control performance, and reduced computational demand
Development of a Multikilogram-Scale One-Pot Albright–Goldman Oxidation/Dienol Acetate Formation Sequence for the Synthesis of Noroxymorphone from Morphine
Get PDFThe syntheses of therapeutically important μ-opioid receptor antagonists such as naloxone and naltrexone use noroxymorphone as a key late-stage intermediate, which is manufactured from the poppy-derived alkaloids oripavine or thebaine. However, it would be advantageous to instead use morphine as the starting material, which is cheaper and more abundant. In this paper, we describe the conversion of morphine into a dienol acetate required for installation of the C14 hydroxyl group of noroxymorphone. Our approach is more efficient than previously described approaches and uses a one-pot Albright–Goldman oxidation/dienol acetate formation sequence of an allylic alcohol as the key feature. This synthesis has been successfully applied on multikilogram scales. A brief investigation of the scope of the one-pot Albright–Goldman oxidation/dienol ester formation on other substrates is also described
Life cycle greenhouse gas implications of low-carbon gaseous fuel supply chains from technological, geospatial, and temporal perspectives
Get PDFThere is consensus that achieving net-zero emissions will require the use of low-carbon hydrogen (H2) and its derivatives, particularly in the hard-to-abate sectors. This necessitates the development of a global H2 supply chain, which can be complex given that there are limited experiences worldwide. While H2 production emissions at the plant gate might be low, the emissions throughout their supply chains are not yet well understood. Here, we summarise key insights drawn from over 10,000 cases, analysing the supply of H2 from six renewables-rich regions and transporting it via different modes to two European markets, using six different chemical forms, including compressed-H2 (CH2), liquefied-H2 (LH2), synthetic natural gas (SNG), methylcyclohexane (MCH), ammonia (NH3), and methanol (MeOH). We discussed the implications on the overall energy efficiency, product losses throughout the supply chains, and life cycle greenhouse gas (GHG) emissions from temporal, geospatial, and technological perspectives. The total loss and energy efficiencies of H2 and SNG throughout the supply chains were estimated to range from 0.8–11.0 %/kg and 1.8–3.6 MJ/MJ of gaseous fuel delivered, respectively. The lifecycle GHG emissions (without embodied emissions) ranged from 5–86 gCO2e/MJ in 2025, and this could reduce to 2–40 gCO2e/MJ in 2050, due to changes in technological, design and operational factors. Minimising the impact of fuel/carrier production, H2/CH4 losses, fuel and electricity emissions factors by combining centralised and decentralised supply chain approaches could result in a lower GHG estimate. The use of chemical carriers could increase GHG emissions due to the H2 liberation step at the destination. Even when starting with a low carbon intensity H2 at the plant gate, the emissions associated with the supply chain can drive the emissions above the EU and UK regulatory limits. This paper further adds to the body of evidence pointing to the need for life cycle assessment-based certification that is asset-specific and supply chain-specific for demonstrating compliance against regulatory limits or H2 standards globally
Full exclusively enteral fluids from day 1 versus gradual feeding in preterm infants (FEED1): a open-label, parallel-group, multicentre, randomised, superiority trial
Get PDFBackgroundPreterm infants typically receive intravenous fluids or parenteral nutrition while milk feeds are gradually increased. Feeding with milk sooner could reduce length of hospital stay and risk of invasive infections but might increase the risk of necrotising enterocolitis. We aimed to investigate if exclusively enteral fluids (ie, full milk feeds) from day 1 compared with gradual feeding supplemented with intravenous fluids or parenteral nutrition reduces the length of hospital stay in infants born at 30 weeks and 0 days (30+0weeks) to 32+6 weeks of gestation.MethodsThis open-label, parallel-group, multicentre, randomised, superiority trial recruited mothers of infants born at 30+0 weeks to 32+6 weeks of gestation, in 46 neonatal units in UK hospitals. Infants younger than 3 h were included if they were clinically stable; those with congenital anomalies that make enteral feeding unsafe and who were small for gestational age with reversed end-diastolic flow on umbilical doppler were excluded. Parents and the clinical team could not be masked, but investigators and data analysts were masked until after database lock. The mother was randomly assigned to either full milk feeds (60–80 mL/kg per day) or gradual milk feeding (maximum of 30 mL/kg per day on day 1) with intravenous fluids or parenteral nutrition for their infant within 3 h of birth using a web-based minimisation algorithm with a random element to ensure balance on important prognostic factors. The primary outcome was length of hospital stay; events of hypoglycaemia and necrotising enterocolitis were safety outcomes and analysis was performed by intention-to-treat. This trial was prospectively registered (ISRCTN89654042) and follow-up to 24 months is ongoing.FindingsBetween Oct 15, 2019, and July 14, 2024, we recruited and randomly assigned 1761 mothers, enrolling 2088 infants (1047 full milk feeds, 1041 gradual feeding). Mean gestational age was 31·7 weeks (SD 0·8), which was the same in both groups, and mean birthweight was 1626·0 g (301·8) in the full milk feeds group and 1617·1 (295·2) in the gradual feeding group. Of 1047 infants in the full milk group, 494 (47·2%) were female and 552 (52·7%) were male and in 1041 infants in the gradual feeding group, 500 (48·0%) were female and 540 (51·9%) were male. Primary outcome data were missing for 18 infants in each group. We found no difference in the length of hospital stay (32·4 days [SD 13·3] in the full milk group vs 32·1 days [13·5] in the gradual feeding group; adjusted difference between means –0·02 days [95% CI –1·07 to 1·03]; p=0·97). Survival to discharge (1030 [99·6%] of 1034 vs 1027 [99·6%] of 1031; –0·004 [95% CI –0·54 to 0·53]), presence of necrotising enterocolitis (4 [0·4%] of 1030 vs 6 [0·6%] of 1027; –0·19 [–0·80 to 0·41]), and mean number of blood glucose tests <2·2 mmol/L (0·6 [SD 1·0] vs 0·5 [0·7]) were similar. Serious adverse events were similar in both groups (eight [0·8%] of 1047 infants in the full milk group vs ten [1·0%] of 1041 infants in the gradual feeding group), all were unrelated to trial intervention.InterpretationIn infants born at 30+0 weeks to 32+6 weeks of gestation, full milk feeds from day 1 does not alter length of hospital stay. It does not increase the risk of necrotising enterocolitis or hypoglycaemia
Executive compensation and the credibility of share buyback announcements
Get PDFThe extant literature views open market share repurchase announcements as a signal of undervaluation, but these lack characteristics of a credible signal and hence can be misleading. In this paper we assess the credibility of the repurchase announcement signal by observing the underlying managerial wealth and repurchase incentives as measured by their compensation arrangements. We find that both short-and longer-term returns (actual repurchases) are positively (negatively) related to manager wealth sensitivity to changes in stock price (Delta and equity holdings) and negatively (positively) related to managerial incentives to increase firm risk (high Vega). These findings are particularly strong for firms with higher information asymmetry, or undervaluation. Our results add to the existing literature by showing that the market appears to be using executive remuneration arrangements to assess the credibility of a repurchase announcement signal and responds accordingly
Smart product platforming in the industry 4.0 era and beyond
Get PDFSince 1990s, product platforming has been extensively pursued in many industries to design and offer personalized products and services tailored for specific needs. The recent emergence of advanced technologies extends platforming to both integrate different units within a firm and connect different firms in the entire chain of value creation. The resulting process and activity expansion creates new opportunities and challenges in fulfilling personalized requirements based on smart platforms. We launched the special issue: Smart product platforming in the Industry 4.0 era to collect promising research and developments in this topic. The aim of this extended editorial is threefold: 1) introducing the context of the special issue, 2) presenting collected papers, and 3) offering our reflections and future research perspectives on the topic. In presenting the collected papers, we transversally classify them from different lenses, including product lifecycle stages, methodologies, and performance indicators. Based on these papers, we highlight our reflections and point out future perspectives, in hope of inspiring more research in the domain
Sublethal concentrations of antibiotics enhance transmission of antibiotic resistance genes in environmental Escherichia coli
Get PDFThird-generation cephalosporin-resistant Enterobacterales are ranked second on the World Health Organisation (WHO)’s Bacterial Priority Pathogens List. Amongst them, extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) are used by the WHO as sentinel organisms to monitor the spread of antibiotic resistance worldwide and are often associated with mobilisable multidrug resistance (MDR). However, we know less about how ESBL-producing genes spread in environmental E. coli. This study investigates how the blaCTX-M-15 gene from ESBL-Ec isolated on a UK dairy farm could transfer between strains. For this study, 39 E. coli were isolated from a single dairy farm over 4 months, using cefotaxime-supplemented selective media. All had similar antibiotic susceptibility test phenotypes, and PCR, whole genome sequencing (WGS), and resistance gene transmission experiments demonstrated they were all closely related. In silico multi-locus sequence typing and single-nucleotide polymorphism analysis showed that all 39 strains were Sequence Type 2325, but plasmid carriage differed. In total, 35 of the 39 ESBL-Ec strains were multidrug resistant, displaying blaCTX-M type cephalosporin resistance and resistance to fluoroquinolones and tetracyclines. WGS confirmed all 39 isolates carried the ISEcp1 mobile genetic element carrying the blaCTX-M-15 ESBL-producing gene, and the qnrS1 partial quinolone resistance gene in the chromosome. A total of 35 strains also carried tetAR within this ISEcp1 element. We found that sub-lethal levels of ampicillin, cloxacillin, and ceftazidime could enhance the transfer of ISEcp1 blaCTX-M-15 from the chromosome of these dairy farm strains into endogenous self-transmissible plasmids, which can themselves then transfer into and confer phenotypic antibiotic resistance in a recipient E. coli K-12 strain. In conclusion, we observed not only clonal dissemination of these environmentally occurring ESBL-producing strains within the farm environment but also showed experimentally that these strains had the ability to mobilise their ESBL producing genes, and that these and other resistance genes can be acquired or lost on transfer. This shows the importance of longitudinal monitoring of antibiotic resistance, especially in places with high prevalence or selective pressure for resistant bacteria
Clinical and Functional Effects of Resistance Exercise Prehabilitation in Colorectal Cancer: Systematic Review and Meta‐Analysis
Get PDFBackgroundColorectal cancer (CRC) is the fourth most common cancer in the United Kingdom, accounting for ~11% of new cancer diagnoses. CRC is predominantly a disease of ageing, and its occurrence often coincides with an age-associated decline in physiological performance. The stress of surgery can also leave cancer survivors functionally limited. Exercise-based prehabilitation may ameliorate some of the functional decline seen after surgery for CRC, with resistance exercise training (RET) increasingly recognised as an important driver of physiological adaptation in this context. Although prehabilitation with a RET component in operable CRC has been studied, no systematic review exists. This systematic review and meta-analysis aims to delineate the effects of prehabilitation with a RET component in patients with CRC treated with surgery with curative intent, on clinical and functional outcomes.MethodsThis systematic review and meta-analysis (PROSPERO: CRD42023421372) was performed in accordance with the PRISMA 2020 statement and PERSiST guidelines. Studies on adults with histologically confirmed or clinically suspected colorectal neoplasia scheduled for surgery with curative intent, undergoing short-course (< 12-week) pre-operative RET were sought via searches on CINAHL, CENTRAL, Embase, Medline, PubMed, Clinicaltrials.gov and ICTRP.After eligibility review, risk of bias assessment was undertaken and data extracted. Meta-analysis was undertaken on clinical and functional outcomes.ResultsDatabase searches revealed 5808 reports including 1910 duplicates. Citation searching detected nine reports, and a final 18 were discovered after searching clinical trial databases. After exclusions, eight reports representing 324 (n = 136 female; 42.0%) individuals with CRC were included for systematic review and considered for meta-analysis. All studies were found to carry ‘high’ or ‘critical’ risk of bias. Criteria for meta-analysis was reached for four outcomes: postoperative complications, length-of-stay, 6-min walk test (6MWT) and handgrip strength (HGS). Prehabilitation with a RET component demonstrated statistical and clinically significant increases in 6MWT distance (mean difference [MD]: 34.14 m, 95% confidence intervals [CI]: 16 to 52.27 m). There was no significant difference in postoperative complications (odds ratio: 0.77, 95% CI: 0.47 to 1.29), length-of-stay (MD: 3.02 days, 95% CI: −6.26 days to 0.21 days) or HGS (MD: 0.22 kg, 95% CI: −0.83 kg to 1.27 kg).ConclusionsThese findings support the use of prehabilitation with a RET component for increasing functional capacity, as demonstrated by a significant increase in 6MWT, in individuals with CRC scheduled for surgery with curative intent. Confidence is limited due to inherent bias in included studies
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