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Patient perspectives and priorities in pleural infection : results of the MIST-3 feasibility trial qualitative sub-study
Get PDFThe question addressed by the study.
The optimal pleural infection treatment is yet to be determined and recruitment to trials can be challenging. Research into patient priorities in pleural infection is lacking. This qualitative study aimed to help us understand the patient perspective regarding priorities of care, to identify patient-centred study outcomes, and to explore the understanding of the risks and benefits of randomisation to different pleural interventions.
Methods.
A prospective, multi-centre, qualitative study using a semi-structured interview methodology explored key themes addressing the experiences of participation in a pleural infection randomised controlled trial (RCT) of combination intrapleural enzyme therapy versus surgery as well as priorities of care. Thematic analysis was conducted using the Framework method.
Results.
Thematic analysis identified five main themes: emotions, level of explanation and understanding, reaction to randomisation, influences on physical wellbeing, and overall experience. Pain was a significant feature due to both the infection and interventions. The overriding emotions described by patients were fear and anxiety. Participants demonstrated high levels of support for randomised allocation to intervention.
The answer to the question.
A pleural infection patient reported outcome measure (PROM) should be developed to assess pain, fatigue, anxiety, and breathlessness, so that valid health related quality of life data can be captured. Pain is an under-treated symptom of pleural infection and should be incorporated into treatment protocols. There was no clear patient preference between the interventions, and a surgical versus non-surgical pleural infection RCT is acceptable to participants
Do firms invest in energy adaptation? And, if so, why?
Get PDFThis study investigates the incorporation of climate change and energy price issues in UK firms' investment decision-making processes, using a comprehensive 2023 survey representative of the UK firm population. Our findings reveal a strikingly low rate of climate change mitigation consideration, with only 13 % to 16 % of investing firms factoring these issues into their decisions. We found that firms investing in process innovation exhibit a 14.09 % higher probability of supporting energy adaptation and a 10.89 % higher likelihood of mitigating energy price impacts. While the overall consideration of climate change in investment decisions remains low, firms that do respond tend to focus on process innovation market development and plant, machinery and vehicles investments. These targeted investments may yield tangible impacts on reducing environmental footprints and energy price exposure, particularly in high energy use sectors. However, the narrow focus suggests that UK firms' capacity to significantly reduce their environmental impact may be constrained in the short term
The effect of Collaborative Online International Learning (COIL) on higher education graduates’ employability
No full textMany countries have experienced a generational change in the skills required of potential new employees, with many employers reporting a gap between the skills they demand and the skills graduates possess. By investigating the effectiveness of Collaborative Online International Learning (COIL) in improving graduates’ employability, we tackle the key question of whether COIL courses sufficiently improve higher education students’ overall competence and employability. Drawing on the concepts of personal attributes and employability, this paper contributes to the literature by linking the personal attributes of individual self-efficacy and a proactive personality with the development of employability skills. The results are based on a pre- and post-survey of students participating in a COIL course organised by universities in Japan, collaborating with three overseas partners. This paper addresses several issues, such as whether students can improve their employability skills via COIL, which particular skills have been improved, and which areas need further improvement. It also discusses the implications for developing future programmes to reduce the gap between the skills developed and the skills needed
EDI and innovation through an intersectional lens : understanding the role of innovation policies in promoting inclusive ecosystems
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Malaria parasites undergo a rapid and extensive metamorphosis after invasion of the host erythrocyte
Get PDFWithin the human host, the symptoms of malaria are caused by the replication of malaria parasites within erythrocytes. Growth inside the erythrocyte exposes the parasites to the normal surveillance of erythrocytes by the host organism, in particular the clearance of erythrocytes in the spleen. Here we show that the malaria parasite Plasmodium falciparum undergoes a rapid, multi-step metamorphosis that transforms the invasive merozoite into an amoeboid-shaped cell within minutes after invading erythrocytes. This transformation involves an increase in the parasite surface area and is mediated by factors already present in the merozoite, including the parasite phospholipid transfer protein PV6. Parasites lacking PV6 do not assume an amoeboid form and instead are spherical and have a smaller surface area than amoeboid forms. Furthermore, erythrocytes infected with P. falciparum parasites lacking PV6 undergo a higher loss of surface area upon infection, which affects the traversal of infected erythrocytes through the spleen. This is the first evidence that after invasion, the parasite undergoes a rapid, complex metamorphosis within the host erythrocyte that promotes survival in the host
Midwives' experience of managing emergencies during labour and birth in a community setting : a mixed-methods systematic review
Get PDFBackground.
For women at low risk of complications during labour and birth, in the United Kingdom, planned birth in a ‘community’ setting (at home or a freestanding midwifery unit) is generally safe, and intrapartum emergencies are uncommon. Limited exposure may affect midwives’ experience of managing an emergency.
Aim.
Identify and synthesise available evidence about midwives’ experiences of managing intrapartum emergencies during labour in a community setting.
Methods.
A mixed-methods systematic review was undertaken, with searches conducted in April 2021 and February 2024. Studies were eligible for inclusion if they described midwives’ experience of managing intrapartum emergencies in high-income countries and if the setting(s) explicitly included community settings. Analytical themes were identified through integration of qualitative descriptive themes and a narrative summary of quantitative findings.
Findings.
Ten papers were included, reporting seven studies carried out in the United Kingdom, United States of America, Australia and the Netherlands. Four inter-related themes were identified: unexpected and unpredictable nature of events; confidence and preparedness in skills and the birthing process; immediate and enduring emotional impact; and mediating effects of relationships and support.
Discussion and conclusions.
Limited research exists about midwives’ experience of emergencies in community settings and much of the evidence included in this review was from studies about traumatic births, where emergencies were a subset of those studied. Further research about midwives’ experience would be valuable to inform optimal training and support
School nurse reflections on visibility, safety, and relevance in modern school nurse practice : a qualitative study
Get PDFBackground: School nurses globally face increasing professional pressures due to the growing complexity of children’s and adolescents’ health needs. This makes effective
working within the school health team critical.
Aim: To explore school nurses’ reflections on working within the school health team.
Methods: Thirty-three school nurses from four school health teams in England participated in restorative reflective supervision sessions. Observational data and field notes from four separate sessions were analysed using qualitative content analysis.
Results: Three themes were identified: (1) Collaboration and engagement with schools and multidisciplinary teams; (2) External perceptions of the school nurse role, professional identity, and boundaries; and (3) Workload, emotional demands, and support needs.
Conclusion: School nurses are facing sustained pressure, with growing caseload complexity, emotional strain, and limited recognition of their role. Restorative reflective sessions can act as a protective factor against burnout by giving school nurses the opportunity to share experiences, process emotional strain, and sustain their capacity for compassionate care. The findings underscore the need for systemic investment in school nursing, through clearer role definition, professional visibility, emotional support, and opportunities for career development
Multiscale characterization of solar radiation-induced structural degradation in Type I collagen
No full textCollagen, the most abundant structural protein in animals, plays a crucial role in maintaining skin integrity, elasticity, and strength. Type I collagen, which predominates in the skin, is particularly vulnerable to environmental stressors, such as solar radiation. Prolonged sun exposure accelerates collagen degradation, driving skin aging and impairing tissue functionality. However, the molecular mechanisms governing these intricate processes remain unclear. In this study, we employed bovine Type I collagen as a model system to investigate the molecular alterations induced by solar radiation, focusing on changes in structure, morphology, and fibrillogenesis potential. Collagen samples were irradiated using a solar simulator that mimics the full solar spectrum to ensure standardized conditions. Structural changes at different levels, were analyzed using a multi-technique approach combining classical spectroscopies, fluorescence lifetime imaging microscopy, and scattering-type scanning near-field optical microscopy (s-SNOM). This multimodal approach enabled both sensitive detection of molecular alterations and spatial mapping of local heterogeneities within collagen fibers. Results indicate partial destabilization of the triple-helical structure and a loss of cross-links and telopeptides, consistent with molecular misalignment. FLIM imaging on samples stained with Anilinonaphthalene-1-sulfonic acid (ANS), a gold standard fluorescent dye for the study of protein conformational transition highlighted increased sample heterogeneity and a reduction in hydrophobic regions, pointing to structural disruption which could be also related to the loss of self-assembly capabilities of collagen molecules