Rethinking early warning scores

Dr Stephanie Heys, Susan Rhind, Camella Main and Daisy Pegler discuss misplaced metrics when caring for pregnant and recently pregnant women in pre-hospital care. Despite escalating global concern around the high rates of morbidity and mortality in pregnant patients, the early signs of clinical deterioration in pregnant patients often go unrecognised, particularly in the pre-hospital environment (Ebert et al, 2020; McCullough et al, 2024). A critical, yet underappreciated, contributing factor is the application of generic early warning scores, such as the National Early Warning Score 2 (NEWS2). The NEWS2 has been applied with a blanket approach in the pre‑hospital setting without considering groups of patients where they are not validated, such as pregnancy and immediately following pregnancy

Always make it current

No. 6 (June 2025) in the 'Mastery in Writing' series of articles: https://www.paramedicpractice.com/content/mastery-in-writing. Georgia Howat and David Hepworth joining you this month on the Mastery in Writing series. We were having a conversation about what constitutes an ‘up-to-date’ source/citation. It's a question students often ask, and the answer varies, context dependent on who, what and why you are referencing. You'll be familiar with 5–10 years as the suggestion for current evidence, which sounds reasonable in terms of currency – but isn't always when it comes to your academic writing. Let's think context

Embedding anti racism in education with Professor Sally Elton-Chalcraft [podcast]

In this podcast series the University of Cumbria profiles its researchers, hearing in detail about their work and the impact this has on wider society. Professor Sally Elton-Chalcraft, Director of the Learning Education and Development Research Centre at the University of Cumbria, discusses addressing racism in education, with a focus on riots following the Southport stabbings (podcast duration: 30 minutes)

Rewilding's social-ecological aims: integrating coexistence into a rewilding continuum

This paper presents results from a grounded theory study of rewilding aims, addressing calls for broad scale studies of rewilding to contribute to the development of guidelines. The grounded theory draws from a broad set of data sourced from rewilding organizations, case studies, and research. Expressions from the data relating to rewilding aims and outcomes were coded. The results demonstrate the intentions for rewilding to affect systemic, ecological, and socio-cultural change. Outcomes to support rewilding aims are also identified. The aims and outcomes are presented under these headings in a social-ecological framework which offers a shared vision for rewilding. The significance of this research is that it demonstrates rewilding's multi-disciplinarity and engagement with systemic or transformative change. It addresses a perceived paradox between rewilding intervention and non-human autonomy, demonstrating that rewilding is not necessarily about removing human influence but affecting coexistence through more-than-human collaboration. A revised rewilding continuum integrating coexistence is proposed

Balance training Parkinson

Introduction: The disease Parkinson give all in the beginning problems with walking and especially with the balance. The treatment ideas improve, this is great and is a great achievement, because now have people the feeling be active to “stopped” this disease and indeed, it will slow down the great number of symptoms that makes the quality of life very difficult. Design of this article: The purpose of the design was to search for the reason, why this aspect- balance- was so fragile and so fast affected. Then is the search for the functioning of the damaged brain the first” stop”, because there will be the answer, why people with this disease are using “cues” to get the influence of that damaged brain under control. Cues are capable to transform a freezing moment in movements- possibilities. That difference must be done in the brain and that means that are different ways to create a movement. Result: This fact that there are more possibilities to get a movement done, means that there is through this disease a problem to choose immediately the optimal way. This -not capable- to choose the optimal way, must have a reason and one of them is that the brain must choose for an pathological tone (rigidity) to master the gravity. Conclusion: Looking at the way people with the disease of Parkinson move and search for cues to get an better control and get the force of gravity under control, let us believe that this gravity force, forces people to use lower systems with an pathological tone and muscle pattern. This conclusion, direct us, that this gravity force asked for too much tone. That asked for measurement and treatments in which that tone increase isn’t necessary. So that the selectivity can be trained on his highest level

‘Sometimes I’m feeling baffled and they’re probably feeling baffled’: On the experiences of psychological therapists working with autistic people in a structured primary care service for anxiety disorders and depression

Abstract: Autistic people are more likely to experience mental health problems such as anxiety disorder and depression than are the general population. This study reports a qualitative analysis of interview data provided by 12 psychological therapists regarding their experiences of working with autistic people with anxiety disorders and/or depression within a structured primary care mental health service in the north of England. Interviews were analysed using thematic analysis. Four main themes were identified: (1) Experience and Trepidation, (2) Wrong Service, Only Service, (3) Therapeutic Environment and (4) Training and Adaptations. Participating therapists identified challenges in the structure of the services they worked in, the applicability of conventional therapies and the need for autism-specific therapy training ideally led by autistic people. Centrally, participants did not routinely feel fully equipped to separate endemic aspects of autism itself from features of a mental health disorder in an autistic person, which had left some feeling powerless to help in certain cases, or as if they may have done more harm than good. All participants were, however, able to identify positive adaptations made from practical experience, and most reported a growing confidence in working with autistic people. Lay Abstract: The experiences of psychological therapists working with autistic people in a primary care service for anxiety disorders and depression. We are a group of autistic people, academic researchers and psychological therapists, with some of us being more than one of those things. We started from the knowledge that autistic people are particularly prone to have anxiety disorders and depression. We were, therefore, interested in how current ‘talking therapy’ services in England might, or might not, be helping autistic people with those problems. To address this issue, we interviewed 12 psychological therapists in the north of England who had experience of working with autistic people with an anxiety disorder, depression or both. We found that the therapists often felt that they were not prepared or trained to give autistic people their best service. The therapists were also concerned that some of the therapies they usually applied did not always work with autistic people, or sometimes even made things worse. They felt it was important, however, that autistic people should keep using the service, as there was no other service available to them if they had an anxiety disorder or depression. There was evidence, however, that talking therapies still had positive effects for autistic people, and that therapists had therefore probably underestimated their positive impact in a lot of cases. Consequently, training was recommended such that psychological therapists might better understand mental health and specific therapy adaptations that help autistic people

Contemplating or confronting? How the Inner Development Goals can activate reflexivity through Q methodology

This chapter explores how the Inner Development Goals (IDGs) can trigger processes of reflexivity. Challenge-based learning (CBL) connects theory with practice. However, methods that allow CBL participants to reflect on their development within a normative framework are still rare. Through the IDGs we develop a method to evaluate CBL courses aimed at increasing self-efficacy (‘Selbstwirksamkeit’), validating the method through a workshop with experts. Self-efficacy is the capacity of people to pursue goals, and the IDGs provide normative concepts that bridge inner reflection to outer, goal-oriented action. We used the IDGs as a pathway to triggering individual and group reflection on self-efficacy. We eschewed traditional measurement scales and opted to engender reflexivity in the CBL participants through Q methodology. To co-create these conditions, the IDGs were “confronted” in two ways. First, we describe confronting the IDGs through first-person narratives, describing the encounter with each other through the planning and delivery of the workshop. This process raised our various shared and distinct identities, and shaped our responses to the IDGs. In this sense, we place the intersubjective into both a performative and an instructional context. Second, we describe how Q methodology enables a confrontation with the IDGs that creates the conditions for collective leadership through learning. We identify two specific viewpoints on the IDGs, the perceptive translator and the relational disruptor, and describe how awareness of the subtle but salient differences among these viewpoints enables a broader, more systemic, and critical perspective on our practice as researchers and facilitators

“We’re not the right people to deal with it”: How policing the pandemic revealed significant inadequacies in UK mental health provision

The COVID-19 pandemic triggered a variety of responses. While many UK public agencies were encouraged to close their doors, police officers continued to work enforcing the rapidly changing government restrictions and first responding to emergency incidents. One pre-existing responsibility was responding to people in mental health crisis; an area both fraught with complexity and where the police are often thought ill-equipped to handle (Trebilcock & Weston, 2019). Drawing on interviews with frontline police officers and other related personnel, this chapter exposes the inadequacy of mental health provision in the UK. While documenting how the police became the service of first and last resort for mental health by both agencies and service users long before the pandemic, we also illustrate how the Covid restrictions placed on officers exposed the extent of work they do with people presenting with mental ill health. To conclude, the chapter considers how the policing pandemic response to mental health offers contemporary and new challenges to the level of police involvement in this contested and complex area

The effect of business coaching on the performance of small medium enterprises in Malaysia: moderating role of competitive advantage

The attainment and maintenance of high-impact growth are often seen as essential factors for small and medium-sized enterprises’ survival and long-term viability (SMEs). Business coaching has the potential to facilitate and guarantee such progress. Nevertheless, numerous leaders in small and medium-sized enterprises fail to allocate sufficient time and resources toward cultivating staff capacities and facilitating substantial growth inside their organizations. Further investigations are warranted in Malaysia to examine the influence of business coaching on the higher performance of SMEs. This study aims to examine the impact of the outcomes of business coaching on the performance of SMEs in Malaysia. Additionally, the study sought to examine the potential moderating influence of competitive advantage on these relationships. Data was collected from the respondents through a survey questionnaire, while the data analysis process was carried out employing structural equation modeling. The study’s findings indicate a notable and favorable influence of cultural intelligence, coaching culture, and innovation on the growth and performance of small and SMEs in Malaysia. The study suggests it would benefit leaders of small and medium-sized enterprises in Malaysia to actively promote a coaching culture and foster innovation to achieve enhanced growth and performance outcomes

Winner-loser plant trait replacements in human-modified tropical forests

Anthropogenic landscape modification may lead to the proliferation of a few species and the loss of many. Here we investigate mechanisms and functional consequences of this winner–loser replacement in six human-modified Amazonian and Atlantic Forest regions in Brazil using a causal inference framework. Combining floristic and functional trait data for 1,207 tree species across 271 forest plots, we find that forest loss consistently caused an increased dominance of low-density woods and small seeds dispersed by endozoochory (winner traits) and the loss of distinctive traits, such as extremely dense woods and large seeds dispersed by synzoochory (loser traits). Effects on leaf traits and maximum tree height were rare or inconsistent. The independent causal effects of landscape configuration were rare, but local degradation remained important in multivariate trait-disturbance relationships and exceeded the effects of forest loss in one Amazonian region. Our findings highlight that tropical forest loss and local degradation drive predictable functional changes to remaining tree assemblages and that certain traits are consistently associated with winners and losers across different regional contexts