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Closing investigations: The role of national policy in shaping structural, organisational and relational constraints on learning from patient safety incidents
Get PDFThis study aimed to understand the role of a national patient safety policy, the Serious Incident Framework, on local organisational practices of responding to, investigating, and learning from patient safety incidents in the National Health Service (NHS) in England. Qualitative interviews were conducted with healthcare professionals in six NHS organisations and analysed using inductive thematic analysis and taking a constant comparison approach. Systemic challenges linked to the policy's prescriptive requirements were identified, including its emphasis on metrics such as incident closure and harm levels, which often obscured meaningful learning and systemic improvement. The findings highlight the misalignment between the policy's key aims and principles and its practical implementation, revealing an ‘industry of investigations’ that risked turning the investigative process into a compliance-oriented ‘tick box exercise’. Furthermore, the overspecification of performance requirements coupled with the underspecification of substantive guidance led to variability in investigative processes, organisational capacity and resources, and investigator training and expertise. The involvement of patients and families affected by safety incidents was found to be inconsistent and often limited, with perceptions of senior managers and frontline staff underlining some tensions in operationalising large patient safety policies. The analysis considers how the development and implementation of national safety incident policies needs to carefully and intelligently balance the need for adaptive flexibility, clarity of guidance, and specification of organisational resourcing and infrastructure to ensure future national policy can effectively support local practices of learning from safety incidents
Votes at 16 in the UK: Opportunities and Ethical Challenges for the Hard-to-Reach and Seldom-Heard Youth Segment
Get PDFIn July 2025, the UK Government extended voting rights to 16 and 17-year-olds, enfranchising approximately 1.5 million young citizens. While widely seen as a milestone for democratic renewal, this reform raises pressing questions about how to engage newly enfranchised voters, often characterized as hard-to-reach or seldom-heard. Traditional methods such as surveys and adult-led focus groups frequently underperform with this group, risking misrepresentation and low participation. This paper advances methodological innovations for researching young people in ways that are authentic, ethical, and transferable to broader market research contexts. A case study of Jersey, which lowered its voting age in 2008 yet continues to face low turnout among youth, illustrates both persistent barriers and emerging opportunities. Findings show that young people are interested in issues, crave impartial information, value genuine interaction with decision-makers, and appreciate opportunities to be heard. Creative methods including projective storytelling, gamified polling, participatory digital ethnography, and peer-led groups proved effective in eliciting richer insights and building trust. The paper positions young people as co-creators of engagement rather than passive subjects and outlines practical strategies for researchers, policymakers, and practitioners. Beyond politics, these lessons highlight how methodological innovation can help market researchers reach elusive consumer groups across commercial and social contexts
A Re-Exploration of our Unconscious: What We Have Come To Unmask; What Still Lies Beneath
Get PDFIn this manuscript, concepts, issues and resolutions that call for conscious awareness in research into the unconscious are revisited and reviewed. Historical episodes and episodes of controversial experimentation that are formative rallying points for understanding contemporary attitudes to the unconscious in psychological science, and the impact of historical controversy to contemporary polarisation, are meticulously discussed. The theoretical debates, methodological inquiries and contributing resolutions that have stemmed from these controversies are cited and discoursed. Replicated empirical illustrations, that show how purportedly established and well-known biases persist, and previously unaddressed methodological biases occur, and how we may resolve them, are experimentally demonstrated. We show that resolutions are still pending further advances within the – frequently overlooked – limitations of our current scientific paradigm. As a seminal communication, stemming from engaging with these themes, concepts, issues and resolutions, the contextual importance and research value of a reminding, and combined scholarly-theoretical and applied-empirical conscious understanding of unconscious research is carefully emphasised and accentuated
Single-colony resolution of CRISPR–Cas adaptation in E. coli reveals altered spacer-source bias during solid-phase growth
Get PDFCRISPR–Cas systems provide adaptive immunity by integrating short DNA fragments from mobile genetic elements into host arrays. While the core biochemical mechanism of adaptation is well defined, its modulation by physiological contexts is less well understood. Here, we present a visual papillation assay that enables single-colony detection of CRISPR–Cas adaptation in Escherichia coli. Spacer acquisition restores the reading frame of a disrupted lacZ gene, forming blue papillae on lactose X-gal plates. The assay is semi-quantitative, highly sensitive, capable of detecting single events among 109 cells, and responds predictably to Cas1–Cas2 expression levels. Spacer mapping revealed a major shift in source bias: in liquid culture, 64% of spacers were plasmid-derived, but on solid medium this dropped to ∼9%. Adjusting inducer concentration to match liquid conditions did not restore plasmid bias, indicating a physiological basis linked to colony growth. Accounting for the molar excess of chromosomal DNA, the 9% plasmid share reflects near-neutral DNA source sampling rather than plasmid overrepresentation. These findings suggest that the spatial and metabolic structure of colonies strongly shapes the adaptation landscape. The assay provides a scalable platform for dissecting condition-specific features of CRISPR–Cas adaptation, including spacer origin, sequence features, and growth context
ForSys: Non-invasive stress inference from time-lapse microscopy
Get PDFDuring tissue development and regeneration, cells interpret and exert mechanical forces that are challenging to measure in vivo. Stress inference algorithms have thus emerged as powerful tools to estimate tissue stresses. Yet, effectively incorporating tissue dynamics into these algorithms remains elusive. Here, we introduce ForSys, a Python-based software that infers intercellular stresses and intracellular pressures from time-lapse microscopy. After validation, we applied ForSys to the migrating zebrafish lateral-line primordium, revealing increased stress during the cell rounding that precedes mitosis and accurately predicting the onset of epithelial rosettogenesis. We further used ForSys to study neuromast development and uncovered mechanical asymmetries linked to cell type-specific adhesion. The software performs both static and dynamic stress inference, supports command-line use, scripting, and a user-friendly graphical interface within Fiji, and accepts segmentation inputs from EPySeg and Cellpose. This versatility of ForSys enables the analysis of spatiotemporal patterns of mechanical forces during tissue morphogenesis in vivo
Additive Manufacturing for Advanced Quantum Technologies
Get PDFThe development of quantum technology has opened up exciting opportunities to revolutionize computing and communication, timing and navigation systems, enable noninvasive imaging of the human body, and probe fundamental physics with unprecedented precision. Alongside these advancements has come an increase in experimental complexity and a correspondingly greater dependence on compact, efficient and reliable hardware. The drive to move quantum technologies from laboratory prototypes to portable, real-world instruments has incentivized miniaturization of experimental systems relating to a strong demand for smaller, more robust, and less power-hungry quantum hardware and for increasingly specialized and intricate components. Additive manufacturing, already heralded as game-changing for many manufacturing sectors, is especially well-suited to this task owing to the comparatively large amount of design freedom it enables and its ability to produce intricate 3D forms and specialized components. Herein we review work conducted to date on the application of additive manufacturing to quantum technologies, discuss the current state of the art in additive manufacturing in optics, optomechanics, magnetic components and vacuum equipment, and consider pathways for future advancement. We also give an overview of the research and application areas most likely to be impacted by the deployment of additive manufacturing techniques within the quantum technology sector
A systematic review of the barriers to diagnosis of vulval lichen sclerosus in primary care
Get PDFBackgroundVulval lichen sclerosus (VLS) is a chronic, inflammatory genital skin condition causing itch, pain, anatomical changes and increased risk of vulval cancer. Diagnostic delay and misdiagnosis are common. Once diagnosed, VLS can be effectively treated using potent topical corticosteroids. Most women with symptoms of VLS first present to primary care in the UK.ObjectivesTo identify patient and professional perspectives on barriers to diagnosis of VLS in primary care through systematic review and thematic synthesis of the literature.Materials & MethodsSeparate literature searches of 7 databases, relevant to patient and professional perspectives were conducted. Two reviewers screened titles and abstracts with one performing full text review. Data extracted were coded ‘line by line’, codes were organised into descriptive themes and subsequently developed into analytical themes.ResultsWe identified 2468 references; a total of 56 studies met inclusion criteria. Six analytical themes were developed:1. A medically challenging diagnosis2. Cultural and social taboos3. Education and knowledge gaps4. Feelings and attitudes5. Inadequate health systems6. Challenges in female genital examinationConclusionsThis review highlights obstacles for women in achieving a diagnosis of VLS.Education and knowledge gaps were reported in both clinicians and women on their own normal anatomy. Targeted, comprehensive education for clinicians could expedite diagnosis.Dismissive clinician attitudes compound patient feelings of anxiety and embarrassment, reinforcing taboos and stigma. Acknowledgement of embarrassment and stigma validates feelings, improving patient interactions.Future research priorities include the development of a diagnostic tool and implementation of a complex intervention to expedite diagnosis
Trustworthy, responsible and ethical artificial intelligence in manufacturing and supply chains: synthesis and emerging research questions
No full textIn recent years, the manufacturing sector has seen an influx of artificial intelligence applications, seeking to harness its capabilities to improve productivity. However, manufacturing organizations have limited understanding of risks that are posed by the usage of artificial intelligence, especially those related to trust, responsibility, and ethics. While significant effort has been put into developing various general frameworks and definitions to capture these risks, manufacturing and supply chain practitioners face difficulties in implementing these and understanding their impact. These issues can have a significant effect on manufacturing companies, not only at an organization level but also on their employees, clients, and suppliers. This paper aims to increase understanding of trustworthy, responsible, and ethical Artificial Intelligence challenges as they apply to manufacturing and supply chains. We first conduct a systematic mapping study on concepts relevant to trust, responsibility and ethics and their interrelationships. We then use a broadened view of a machine learning lifecycle as a basis to understand how risks and challenges related to these concepts emanate from each phase in the lifecycle. We follow a case study driven approach, providing several illustrative examples that focus on how these challenges manifest themselves in actual manufacturing practice. Finally, we propose a series of research questions as a roadmap for future research in trustworthy, responsible and ethical artificial intelligence applications in manufacturing, to ensure that the envisioned economic and societal benefits are delivered safely and responsibly
Trial protocol: DOLFIN trial: Developmental Outcomes of Long-term Feed Supplementation in Neonates—A UK multicentre, blinded, stratified, randomised controlled trial
No full textBackground: Infants born extremely preterm (EP; < 28weeks of gestation) or term born infants with hypoxic-ischemic encephalopathy (HIE) have increased risk of long-term cognitive and learning deficits. Early supplementation with long chain polyunsaturated fatty acids (LCPUFAs) docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (ARA), choline, uridine-5′-monophosphate (UMP), and cytidine-5′-monophosphate (CMP), zinc, iodine, and vitamin B12 may improve cognitive and language outcomes in these populations. Methods: This multicentre, blinded, stratified, randomised controlled trial, including an economic evaluation, will investigate the impact of nutritional supplementation on cognitive development in infants born EP or term born infants with HIE. The planned sample size is 1010 (538 EP, and 472 HIE) infants from up to 40 National Health Service neonatal units in the UK. The trial patient populations are infants born EP (preterm stratum) and term infants (born at or more than 35weeks of gestation) with HIE who received therapeutic hypothermia (HIE stratum). Patient strata were chosen to include infants at high risk of adverse neurodevelopmental outcomes by virtue of EP birth, or HIE requiring therapeutic hypothermia. Infants are randomly assigned, in a 1:1 allocation ratio, to receive either the active supplement or a matched control, in addition to standard care. Families, clinical teams, investigators, and Clinical Trials Unit staff are blinded to allocation. Only the Senior Trials Programmer and Trial Statisticians have access to allocation information. The active supplement is a nutrient powder formulated to be mixed with breast milk, infant formula, or food, containing LCPUFAs (including DHA, EPA, and ARA), choline, UMP, CMP, zinc, iodine, and vitamin B12. Supplementation commences once infants achieve full milk feeds and continues until 12months post-estimated date of delivery (EDD), with a daily dosage of 1g per kilogram of body weight. The primary outcome is the Parent Report of Children’s Abilities-Revised non-verbal cognitive scale at 24months post-EDD. EP and HIE patient population comparisons have been appropriately powered and will be analysed separately. Discussion: Findings from the DOLFIN trial will inform international neonatal and infant nutritional and feeding policy and practice. Learnings from the trial will inform the design and delivery of future neonatal nutritional intervention trials. Trial registration: ISRCTN62323236. Registered 16 May 2022, https://www.isrctn.com/ISRCTN62323236
Clinical Characteristics and Outcomes of Rome IV Diarrhea-Predominant Irritable Bowel Syndrome and Functional Diarrhea Prescribed With Ondansetron: A Real-World Study
Get PDFBackground: 5-HT3 receptor antagonists, such as ondansetron, are effective in the management of irritable bowel syndrome-diarrhea predominant (IBS-D). However, real-world data and evidence exploring the response to ondansetron in patients with functional diarrhea (FDr) are lacking. The aim of this study was to assess the clinical characteristics and response to ondansetron among patients with bowel disorders associated with chronic diarrhea in a real-world setting. Methodology: We conducted a retrospective study of consecutive patients (October 2016–February 2024) diagnosed with IBS-D or FDr in a tertiary care neurogastroenterology outpatient clinic. Demographic, clinical data, previous surgery, relevant investigations and current medications were collected. Clinical response to ondansetron was defined as (i) a reduction of at least one bowel movement/day versus baseline and (ii) firmer stool consistency (an improvement of ≥ 1 on the Bristol Stool Form Scale [BSFS] vs. baseline). Results: Ninety-two patients were included, among whom 75 (81%) and 17 (18%) had IBS-D and FDr, respectively. Urgency to defecate was significantly more frequent in patients with FDr versus IBS-D (p = 0.003). Sixty-eight of the 92 patients (73.9%) reported a clinical response to ondansetron, which was maintained at a median dosage of 8 mg/day for a median duration of 19 months with few minor side effects. Conclusion: When used in clinical practice, 8 mg/day of ondansetron is associated with a reduction in bowel frequency and an improvement in fecal consistency in approximately two-thirds of patients with IBS-D and FDr
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