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When Digital Tools Break: A Practical Guide for Nurse Managers on Why Health Systems Keep Failing
Full text linkDigital transformation initiatives in health systems repeatedly falter despite significant capital allocation, technical refinement, and sustained managerial commitment. This paper contends that these breakdowns are structural, not operational. Health systems are treated as epistemic infrastructures whose central product is stabilised institutional knowledge. Digital platforms, performance indicators, and algorithmic architectures do not simply document clinical reality; they reorganise the classificatory framework through which that reality attains institutional visibility. Reform therefore recalibrates the geometry of inference prior to any alteration in care delivery.The analysis advances a formal schema integrating four constructs: regime dependence, semantic drift, institutional fragility, and entropy accumulation. Drawing on NHS waiting time and autism assessment datasets from 2022 to 2023, regime transitions are specified as formally documented definitional modifications within national technical guidance. Variance decomposition through principal component analysis separates regime induced variance at 78.3% from measurement noise at 7.1%, meeting the fragility criterion where š_regime / š_measurement > 10. Robustness evaluation under s20% perturbation sustains the classification. A counterfactual continuity specification indicates that a 21.4% shift in median waiting time after the ASD17 denominator contraction arises from definitional deformation rather than throughput variation.The paper further formalises entropy growth under digital acceleration, demonstrating that when informational flux surpasses institutional regularisation capacity, inferential coherence deteriorates, generating instability independent of clinical performance. Observed digital programme failure rates within the NHS are interpreted as effects of epistemic overload rather than deficiencies of execution.For nurse managers, the implications are operationally concrete: detect regime transitions, quantify information attrition, situate performance indicators within their regime conditions, and defend deliberative intervals against temporal compression. Durable governance depends on bounding entropy growth and constraining fragility, not solely on throughput optimisation
Examining the latent structure of ICD-11 depression symptoms
No full textBackground: ICD-11 presents updated descriptions for single episode and recurrent depressive disorder. A depressive episode (DE) is integral to these disorders and contrasting descriptions of the structure of DE symptoms are presented in ICD-11 and the Clinical Descriptions and Diagnostic Requirements for ICD-11 (CDDR). The former presents symptoms as unidimensional while the latter suggests symptoms are multidimensional reflecting affective, cognitive-behavioural, and vegetative clusters. This study examined if the latent structure of the DE symptoms is better represented by a one- or three-factor model. Methods: Data were collected from general population samples from the United Kingdom (UK: N = 975) and Ukraine (N = 2050). DE symptoms were measured using the International Depression Questionnaire, and the latent structure of the DE symptoms was assessed using confirmatory factor analysis.Results: The three-factor model of DE symptoms outlined in the CDDR performed substantially better than the one-factor model and was a close fit to the UK and Ukrainian data. This model was invariant for sex in each nation. Prevalence estimates based on a three-factor model were similar to those based on the ICD-11 requirements, and similarly sized sex differences were observed.Conclusions: The multidimensional description of the DE symptoms outlined in the CDDR better represented data from two culturally distinct samples. Discrepancies in how DE symptoms are described in ICD-11 and the CDDR should be resolved to facilitate future research efforts
Effect of a previous high pathogenicity avian influenza ( HPAIV ) infection on the breeding success of Northern Gannets ( Morus bassanus)
Full text linkHighly pathogenic avian influenza (HPAIV) caused widespread mortality and breeding failure among many wild, avian populations in Europe and North America in 2021–2023, but most populations exhibited a marked reduction in mortality in the year following an outbreak, suggesting that surviving individuals may have developed immunity. A critical mechanism for population resilience is whether individuals that have survived the disease show reduced breeding success because of the potential costs associated with recovery, notably elevated immune defence. We found that, at two UK colonies, the breeding success of Northern Gannets Morus bassanus with black eyes (an indicator of past exposure to HPAIV) was similar to those with normal blue eyes in the year following a severe disease outbreak, suggesting that population recovery may not be hampered by lower reproductive performance of recovered individuals compared to those that were unexposed. However, breeding success, irrespective of past exposure, was lower than the long‐term average, suggesting potential carry‐over effects on all individuals from the extensive disruption caused by the epidemic the previous year
Declaring Worldviews in SSM for Sustainability & Community Learning
No full textFor over fifty years, Soft Systems ideas and the Soft Systems Methodology (SSM) have played a pivotal role in understanding various problem situations and initiating action. Often tackling the grandest challenges of our time, SSM will retain continued relevance in helping decision-makers address sustainability challenges within organisations and their communities. In this paper, we are concerned with the meaningful co-creation of sustainable value through community-based learning using SSM. More specifically, recognising that a sustainability paradigm, characterised by the need to create a just and safe space for humanity to thrive within the means of a living planet (as called for by Raworth, 2017), is often marginalised or overlooked. This paradigm presents us with an ethical imperative, complex and messy challenges/issues, and a set of ideals (articulated in the United Nations Sustainable Development Goals) that are significantly off track. This paper employs a variation of the Delphi method, drawing on the authors’ collective interest and experience in applying SSM in communities, to propose a double-loop learning cycle to explore the underlying assumptions of our worldviews and mental models within communities. We suggest that an SSM learning cycle can be enhanced by initiating conversations on relevant models for sustainability (such as Doughnut Economics, UN SDGs, and the principles for a Circular Economy), to find common ground for triggering new learning. This idea is contextualised and proposed as the value(s)-action gap phenomenon, which can help explain the difference between an individual, an organisation, and/or a community's intention(s) and their actual action(s).In doing so, find common ground, shift to higher levels of systems consciousness from an ego-centric to an ecosystem level of awareness, engage communities, and take an intergenerational perspective. We suggest that incorporating a double-loop learning cycle into SSM can support organisations and their communities in putting shared values into meaningful action
There Is No Rose Without a Thorn: Examining the Contribution of Collaborative Platforms to Sustaining Collaborative Governance
No full textThis study investigates the extent to which collaborative platforms contribute to strengthening the collaborative governance capacity of municipal governments, focusing on smart city development as an empirical context. Drawing on survey data from 289 municipal government officials and using a multinomial logit model, we test eight hypotheses linking collaborative platforms to key dimensions of collaborative governance: knowledge sharing, innovation culture, competences, strategic orientation, monitoring, vertical and internal coordination, and decision‐making power. Our findings challenge the prevailing assumption that such platforms are uniformly beneficial. While their presence might support some collaborative governance dimensions, their contribution is less certain in others. Moreover, in some cases, our data shows that municipalities managing collaborative governance initiatives by means of a collaborative platform might perform just as well or even worse than those without one. These results suggest that expectations about collaborative platforms should be more carefully calibrated. By critically examining the contribution of collaborative platforms across key dimensions of collaborative governance, this study advances theoretical understanding and offers actionable insights for municipal platform managers and policymakers
Climate change and the built environment - a systematic review
Full text linkRecent intergovernmental panel on climate change reports have once again emphasised the effective measures to reduce greenhouse gas emissions and the importance of the built environment. Historically, passive and active solutions are known for their potential to make the built environment more environmentally friendly. Recently, a significant number of studies covered the effectiveness of such solutions under distinct current and different future climate and emission predictions. Through the PRISMA framework, this paper presents a comprehensive state-of-the-art review of such studies within the last 10 years (2013–2023) to understand their impact, their tangible applications, and their empirical evidence. Local ecosystems, weather patterns, geographical and cultural challenges dictate the solutions for a warmer future. Among the solutions, as expected, passive solutions remain most effective even though a combination with active ones is necessary regardless of the context. The review in this paper is expandable beyond the effective reported solutions and it highlights the most effective solutions under different climate zones
Unveiling the energy transfer paradox in electric arc furnace long arcs: a thermal-flow field synergy perspective
Full text linkIn this study, a validated coupled mathematical model integrating electromagnetics, thermodynamics, and fluid mechanics is developed, innovatively employing the thermal-flow field synergy principle to diagnose the LA’s performance. According to the conclusion, the LA is an intrinsically inefficient system is firstly revealed; despite a high-energy core concentrated near the cathode, the thermal-flow synergy angle (β) of LA in the furnace is remarkably high, indicating poor convective heat transfer and substantial energy loss. Consequently, the baseline energy efficiency (η) is only 29.2 % under typical condition of electrode current (I) = 12.5 kA and arc length (L) = 200 mm. The conventional control strategies, adjusting I or L, are then demonstrated, which leads to a fundamental power-efficiency paradox. Increasing I or L boosts arc power (QArc) but invariably decreases η. The peak QArc of 3.8 MW (at 15.0 kA, 250 mm) and the peak η of 33.4 % (at 10.0 kA, 150 mm) occur at opposite ends of the operational spectrum, defining a clear performance trade-off. To transcend this impasse, the “Ordered Heat Transfer” concept is proposed in this paper for LA in EAF as a new paradigm, aimed at simultaneously enhancing QArc and η by strategically managing convective energy pathways. Finally, multiple regression equations are established to accurately predict anode energy fluxes, providing a valuable tool for industrial process optimization
Trauma-Informed Forensic Interventions
No full textTrauma- Informed Forensic Interventions explores the innovative wave of trauma- informed practices in forensic settings, addressing the unique challenges of implementation in environments that are often ill- suited to such approaches. Written collaboratively by forensic practitioners and service users across prison, forensic mental health, youth justice, and social care settings, this book provides practical guidance for professionals working with justice- involved individuals who commonly have extensive trauma histories.The text establishes core principles for best practice by examining diverse settings, including male and female prisons, high security hospitals, and secure children’s homes, while addressing complex needs related to personality disorders, self- injury, sexual violence, and neonaticide. It offers practical approaches to overcome institutional barriers and reconcile Substance Abuse and Mental Health Services Administration’s trauma-informed care guidelines with established forensic structures and culture.This essential reference for forensic practitioners and students builds upon Trauma-Informed Forensic Practice, inspiring further development of trauma- informed approaches as a crucial focus in contemporary forensic work across prisons, community services, youth justice, and forensic mental health settings
‘Peeling back the layers’: Power dynamics and saviour complex in South-South volunteer tourism
No full textSouth–South volunteer tourism is expanding rapidly yet remains empirically and theoretically underexplored. This paper examines how privilege, cultural hierarchy and saviourism manifest among non-Western volunteers, challenging the assumption that cultural proximity produces more equitable volunteer–host relationships. Drawing on 20 semi-structured interviews with volunteers from 16 countries, inductive thematic analysis identifies six interconnected dynamics: benevolent intentions and unintended consequences, the saviour complex, cultural superiority, power imbalances, commodification of poverty, and ethical awareness. The findings show that volunteers often reproduce paternalistic behaviour and romanticise poverty, framing their engagement as personally transformative rather than community-driven. By introducing relational privilege alongside mobility privilege and volunteer elitism, the paper illuminates context-specific hierarchies within the Global South. Spiritual motivations also emerge as a distinctive driver of participation. These insights extend postcolonial critiques of volunteer tourism and highlight the need for ethical, community-led programme design that strengthens local agency and long-term capacity building
Patients’ perspectives on medication adherence feedback interventions for managing long-term medications: a systematic review of qualitative evidence
Full text linkIntroduction: Optimising medication usage is a worldwide challenge. While numerous feedback interventions have been developed to address this issue, understanding patients' perspectives on the use of such interventions to optimise adherence provides opportunities for successful development and implementation. Aim: To synthesise qualitative evidence on patients' views on medication adherence feedback interventions to support adherence behaviour. Method: CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed were systematically searched from database inception to February 2023 with searches updated to February 2025. Additionally, Google Scholar was used to identify any potentially relevant grey literature or supplementary sources. Eligible studies included qualitative or mixed-methods research that explored adult patients’ perspectives on medication adherence feedback interventions for long-term conditions, specifically those aimed at self-management within community settings. The review was conducted according to ENTREQ and reported following PRISMA guidelines. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and analysed using thematic synthesis, with findings presented narratively. Results: Of the 1270 studies screened, 11 met the inclusion criteria and evaluated participants’ views on therapeutic drug monitoring and digital adherence interventions across conditions including asthma, human immunodeficiency virus (HIV), coronary heart disease, hypertension, type 2 diabetes, and opioid use disorder. Three themes were identified; balancing support and autonomy in feedback interventions, maintaining patient-provider relationship and enhancing engagement through tailored design. Interventions were considered acceptable when they were easy to use, offered users control over personal data, incorporated audio-visual cues, and provided emotional or motivational support. Trust and shared decision-making between patients and providers facilitated uptake, while tailored interventions were considered essential for supporting engagement. Conclusion: Medication adherence feedback interventions are acceptable, however further improvements will enhance user engagement and optimise adherence. Future research should prioritise co-designed interventions that address user needs, improve patient-provider communication, deliver accurate adherence feedback, and support cost-effective scalability
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