324139 research outputs found
Sort by
Understanding the retention and support needs of UK first contact practitioner physiotherapists in primary care; a realist review
Get PDFBackground: First Contact Practitioner Physiotherapists (FCPPs) have been widely implemented in UK general practice through the Additional Roles Reimbursement Scheme to improve access to musculoskeletal (MSK) care and reduce GP workload. While evidence suggests clinical and economic benefits, concerns are emerging regarding practitioner burnout and turnover. Understanding how contextual factors contribute to these outcomes is essential for sustainable workforce planning. Aim: To explore how the UK based FCPP role interacts with workplace contexts to influence practitioner wellbeing, burnout, and turnover intentions, and to identify implications for support and service design. Methods: A realist review of UK-based literature examining the implementation and experiences of FCPPs and comparable primary care roles was conducted in line with RAMESES standards. Initial programme theories were developed through stakeholder consultation and iteratively refined using published evidence. Data were synthesised into context–mechanism–outcome configurations (CMOCs), organised across four domains: role characteristics, personal characteristics, caseload complexity, and working environment. Results: Thirty-three CMOCs were synthesised. Role ambiguity and poorly defined boundaries contributed to inappropriate referrals and role overload, intensifying an already complex caseload. These pressures were exacerbated by limited supervision and organisational support, leading to emotional strain, professional isolation, and increased burnout risk. Although practitioner experience and resilience could mitigate some effects, reliance on individual coping without adequate structural support undermined sustainability and contributed to turnover intentions. Conclusion: Burnout and turnover intentions among FCPPs arise primarily from systemic and organisational factors rather than individual shortcomings. Addressing role clarity, supervision, interprofessional integration, and workload alignment is essential to support practitioner wellbeing and ensure the long-term sustainability of FCPP roles. Trial registration: This review was registered with Prospero (CRD42024551933)
Perinatal management of extreme preterm birth before 27 weeks of gestation (2026): a BAPM framework for practice
Get PDFThe purpose of this Framework for Practice is to assist decision-making prior to and/or at the time of birth relating to perinatal care and preterm birth at 26 weeks and 6 days of gestation or less in the United Kingdom.
Whilst this update retains the core elements of the 2019 Framework, we have made revisions to provide clearer language, support and guidance around appropriate decisions for babies assessed to be at extremely high risk of dying. It emphasises that for such babies, comfort care should be provided.
This framework also includes updated survival and neurodevelopmental outcome figures and the proportion of babies liveborn. This revision emphasises the importance of joint maternity and neonatal counselling with families, which includes communication between centres when transfers antenatally or postnatally are considered.
Diurnal Variability Modulates Episodic Convection in Hothouse Climates Over Ocean and Swamp‐Like Surface Conditions
Get PDFPlain Language Summary: In hot and wet “hothouse” climate conditions, rainfall transitions from a pattern that fluctuates from about a mean of 3 mm day − 1 to more intense outbursts that are separated by multi‐day dry spells. Previous studies on hothouse climates did not consider the role of the diurnal cycle even though it strongly controls precipitation in Earth's current climate. This study uses radiative‐convective equilibrium simulations to investigate the impact of rising temperatures on the transition to hothouse conditions, incorporating the diurnal cycle with both swamp‐like and open ocean surface conditions. We find that episodic precipitation occurs at surface temperatures above 322 K even when accounting for the diurnal cycle. However, the diurnal cycle significantly influences the timing of convection and rainfall at high temperatures with precipitation primarily starting late at night or in the early morning
Evaluating the impact of financial navigation on financial catastrophe and distress for cancer care: a randomized control trial—COST-FIN
Get PDFBackground: As with most Sub-Saharan African countries, Nigeria has a rising incidence of cancer, with disproportionate mortality rates. The financial burden of cancer care often results in catastrophic healthcare spending, leading to treatment refusal, disruption, and discontinuation. This is particularly significant in Nigeria, where nearly all patients are uninsured, and out-of-pocket costs often exceed households’ ability to pay. Financial navigation programs (FNPs) have been shown to mitigate treatment-related financial toxicity in cancer care and reduce treatment abandonment, but there is a paucity of high-quality data on this intervention in resource-constrained settings. Here, we present a randomized controlled trial to evaluate the impact of a novel FNP in Nigeria. Methods: We designed the COST-FIN trial, a multi-site pragmatic single-blinded randomized controlled trial of newly diagnosed (<6 weeks from diagnosis) adults (≥18 years) with breast, colorectal, or prostate cancer at two tertiary cancer centers in Nigeria. Participants (n = 200) will be randomized (1:1) to either the intervention (FNP) or the control arm and followed for 12 months. Data on key individual, treatment, and financial parameters will be collected via structured interviews and chart abstraction at baseline, 3-, 6-, and 12-month follow-up. In addition, participants randomized to the FNP will receive a tailored financial literacy assessment, financial planning support, and enhanced access to resources by trained financial navigators. Primary and secondary outcomes are financial catastrophe (FC) and financial distress (FD), respectively. Exploratory outcomes will include cost-related non-adherence and cost-effectiveness of the program. An interim analysis will be conducted when 50% of the estimated accruals reach 6 months of follow-up, with crossover if compelling evidence of benefit is demonstrated at that time point. All participants will be followed for 12 months from recruitment. Discussion: This first-of-its-kind study will provide evidence on the role of FNP in potentially eliminating financial barriers to cancer care in Nigeria. Given the country’s renewed interest in cancer control through the passage of the National Cancer Control Plan, findings from this study have the potential to influence policy reform and set the stage for further studies to evaluate the scalability and implementation of similar interventions in resource-limited settings. Trial registration: ClinicalTrials.gov NCT06630962. Registered on Oct 8, 2024
Drivers of evapotranspiration in Central Africa: investigating seasonality and change in interactions with soil moisture, and solar radiation
Get PDFThe present study uses 41 years of ERA5 and MERRA2 reanalysis data to assess Soil moisture-Evapotranspiration Interactions (SEIs) and the contribution of surface solar radiation (SSR) to evapotranspiration (ET) variability in Central Africa (CA). The study area is clustered using the k-means method, and the nature and strength of changes in ET induced by soil moisture (SM) and SSR are assessed. A comparative evaluation of the performance of MERRA2 and ERA5 in representing SEIs is also made. The results indicate that transitional areas (wet and dry areas) show a strong significant control of SM on ET, while very wet areas show a weak but almost significant sensitivity of ET to changes in both SM and SSR. MERRA2 shows an extreme sensitivity of ET to changes in SM, resulting in a failure to capture the competitive controls on ET exerted by surface versus root zone SM during wet and dry seasons, particularly in dry and very dry soil regimes. The two reanalysis datasets reveal a possible interaction between SM and SSR in very wet area, which could impact SEIs. A rapid drying process, accompanied by a hydrometeorological regime transition, may be currently underway in the CA region. The most significant and strongest transition seems to be occurring in very wet area. The seasonal meridional migration of the strong response of ET to changes in SM is associated with a switch in the control of ET between SM and SSR. The switch in control depends on soil water content, cloud cover and land cover. When considering the surface versus the root zone soil layer, a shared control of ET can be observed
Genetic associations of circulating plasma proteins with cardiometabolic diseases
Get PDFBackground: Cardiovascular disease is the leading cause of death worldwide, and its risk is closely linked to metabolic abnormalities. Through summary-data-based mendelian randomization and colocalization analysis, we investigate the causal relationships between plasma proteins, six cardiovascular diseases (atrial fibrillation, coronary artery disease, heart failure, venous thromboembolism, peripheral artery disease and stroke), and 19 metabolic traits (including anthropometric phenotypes, blood pressure, glycemic phenotypes, inflammatory phenotypes, kidney-related phenotypes, lipidemic phenotypes, and liver-related phenotypes). Results: We identify 49 proteins genetically associated with cardiovascular diseases, validated across two proteomic platforms. Among them, 35 are also associated with one or more metabolic phenotypes, with six showing evidence of colocalization. These six candidate proteins are classified into three categories based on drug development status, with PCSK9 already successful in therapies for cardiovascular diseases and hypercholesterolemia. DUSP13B, LRIG1, APOH, INHBC, and GUSB also demonstrate high therapeutic potential. Further phenome-wide MR analysis indicates that INHBC, APOH and DUSP13B represent promising therapeutic targets for cardiovascular diseases characterized by metabolic disorders. Conclusions: Overall, this study revealed causal plasma proteins underlying the onset of cardiovascular diseases and metabolic abnormalities, advancing the understanding of disease mechanisms and facilitating drug discovery
Mobility freedoms: conceptions of freedom in contestations over urban transport
Get PDFThe link between urban transport and freedom has long been recognised in academic literature and is drawing renewed attention in controversies over initiatives to reduce car use within urban areas and flying between cities. This paper analyses how multiple conceptualisations of freedom from across the humanities and social sciences are, and can be, implicated in public contestations over urban transport. It suggests that individualised notions of freedom are commonly invoked by adversaries of car- and flight-curbing initiatives, a dominance that reflects prevailing histories of systems of automobility and aeromobility across the global North. It also proposes that those initiatives can be understood as applications of Mill’s harm principle by the (local) state seeking to reconfigure the co-evolution of mobility freedoms and unfreedoms. Yet, the harm principle is ultimately inadequate as legitimation for interventions in urban transport on a climate-constrained planet given its grounding in individualised freedoms. The paper therefore elaborates a collective, dynamic and non-sovereign conceptualisation of mobility freedoms as a framework for changes to urban mobility systems from above and below. The paper concludes that harnessing freedom’s descriptive and performative capabilities can enrich analysis of urban mobility contestations and facilitate practical action to transform urban mobilities at times of climate emergency
The urgent need for African research collaboration on medicine quality
No full textSubstandard and falsified medicines threaten African health systems, yet research on this crisis is fragmented and concentrated in few countries, predominantly led by Global North institutions. Building African-led research capacity is essential for evidence-based policy
Building careers in project-based organizations: breadth, fit, and the path to advancement
No full textProject-based organizations allow employees in ostensibly similar roles to acquire very different experiences by working on different kinds of projects. We study how people build careers in these contexts, examining when employees choose to diversify their experience—both in terms of project content and collaborators—and how the resulting diversification affects their career advancement. Using longitudinal project data from a services organization, our results suggest that employees initially explore different kinds of work by moving across project types, but then go on to find their fit in a particular area. This process is quicker for high-performing employees and for those with longer tenure and more diverse collaborator networks. We also find that promotion rates and compensation are lower for employees who worked on a broader portfolio of content types and collaborators in the most recent year, but higher for employees who had worked on broader project portfolios in prior years
Mountain pass for the Ginzburg-Landau energy in a strip: solitons and solitonic vortices
No full textMotivated by recent experiments, we study critical points of the GinzburgLandau energy in an infinite strip where phase imprinting is applied to half of the domain. We prove that there is a critical width of the cross section below which the soliton solution is a mountain pass solution and the minimizer within the subspace of odd functions. Above the critical width, we find that the mountain pass solution is a vortex with a solitonic behaviour in the infinite direction, called a solitonic vortex. Moreover, depending on the width, we prove that the minimizer in a space with some symmetries can display one or several solitonic vortices. While the problem shares some similarities with the analysis of stability and minimality of the Ginzburg-Landau vortex of degree one in a disk or the whole plane, the change in geometry introduces subtle analytical differences. Extensions to the case of an infinite cylinder in 3D are also given