The progress and outcomes of black and minority ethnic (BME) nurses through the Nursing and Midwifery Council's "Fitness to Practise" process: Final report

BACKGROUND This is the first investigation of the relationship between ethnicity and regulation of the nursing profession conducted internationally. The study was commissioned by the Nursing and Midwifery Council which is the regulator of the professions in the UK. AIMS OF THE STUDY “To establish whether the progress and outcomes of Black and minority ethnic (BME) nurses in relation to fitness to practice, from the point of referral to the point of case closure, is different from that of White nurses and midwives (N&M); and whether we can from the data account for any differences identified” (Call for research, NMC 2015). The study was designed to investigate whether BME N&M nurses are more likely to be referred and whether they were more likely to progress through the stages of the Fitness to Practise (FtP) process (screening, investigation or adjudication) and whether they were more likely to receive a severe penalty at the end of the process. DATA The NMC made available a copy of the register which had socio-demographic information on 681,258 nurses and midwives between April 2012 and December 2014 as well as data on referrals from April 2012 to December 2014 which totalled 5,851. Over that period the total number of cases that went to adjudication was 946. VARIABLES The main independent variable is ethnicity which we divided into Black, Asian, White, Other and Unknown. The latter category accounted for 40% of all referrals. The outcomes studied were rates of referral, the imposition of interim orders (where the referred individual is not allowed to work, progression through screening, investigation, adjudication and final outcome, which was dichotomised into “can work” or “cannot work”. The regression models also controlled for: age, gender, source of referral (9 categories), region of qualification (Africa, Asia, Europe, Other, UK), country of referral (4 counties of the UK) and whether or not the individual referred had a representative, such as a Union. METHODS OF ANALYSIS Descriptive statistics, cross-tabulation analysis, logistic regression and ordinal logistic regression FINDINGS Descriptive statistics showed that BME nurses are more likely to be referred than white nurses and to progress through the FtP process. Having trained in Africa is also a risk factor for referral. Older N&M and males are more likely to be referred. Most referrals come from employers but members of the public are also an important source of referral. Inferential statistics show that relative to Whites, being Asian, Black or of Unknown ethnicity is associated with progressing through FtP process. However, when “source of referral” is entered into the regression model only the “Unknown ethnicity” category remains significantly more likely to progress than White N&M. Males are more likely to progress through the FtP process but age, though positive, is not significant. There were few significant differences among the countries of the UK. The imposition of interim orders did not vary by ethnicity. The presence of a representative seems to reflect the stage of the FtP process rather than being a factor that contributes to the outcome. Finally, at adjudication, being Asian or Black is associated with a less severe penalty than White. Only those of Unknown ethnicity are more likely than Whites to get a severe penalty. These results are not altered by controlling for the source of referral. STRENGTHS AND WEAKNESSES OF THE STUDY The strengths include: the fact that this is the first study of its kind, the datasets analysed are large and the statistics are appropriate. Weakness include the fact that in 40% cases the ethnicity of the referred individual is not known. Some of the registered N&M may not be working which means that their risk of being referred to the NMC is low which could be a threat to the comparison of different ethnic groups. The administrative data which we analysed did not provide information about the specialty (e.g. mental health, maternity), job setting (care home, acute hospital) or level of seniority (staff nurse or Director of Nursing of the individuals referred were not amenable to analysis. RECOMMENDATIONS The analysis reported here could be enhanced in the future if the information on ethnicity, the setting in which the referred individual is working and their grade is made available. Some jobs may simply carry a higher risk of referral to the NMC and BME nurses may disproportionately occupy those positions. The main finding, which is that the relationship between ethnicity and FtP is mediated by referral by the employer, directs our attention to the need for further research to understand how the working environment leads to an over-representation of BME nurses in the FtP process. Within the NMC, further research needs to be conducted to understand why White nurses are more likely to be given a severe penalty at adjudication even though they are underrepresented in referrals and less likely to progress through the process. With the introduction of the NMC code and revalidation, the collection of data by the NMC and the FtP process will undoubtedly change. At the same time, the NHS has introduced policies to directly affect the working environment of BME nurses and midwives. This means that this study should be repeated to take account of these changes in the wider environment

Understanding edge-connectivity in the Internet through core-decomposition

Internet is a complex network composed by several networks: the Autonomous Systems, each one designed to transport information efficiently. Routing protocols aim to find paths between nodes whenever it is possible (i.e., the network is not partitioned), or to find paths verifying specific constraints (e.g., a certain QoS is required). As connectivity is a measure related to both of them (partitions and selected paths) this work provides a formal lower bound to it based on core-decomposition, under certain conditions, and low complexity algorithms to find it. We apply them to analyze maps obtained from the prominent Internet mapping projects, using the LaNet-vi open-source software for its visualization

A Survey of Top-Level Ontologies - to inform the ontological choices for a Foundation Data Model

The Centre for Digital Built Britain has been tasked through the Digital Framework Task Group to develop an Information Management Framework (IMF) to support the development of a National Digital Twin (NDT) as set out in “The Pathway to an Information Management Framework” (Hetherington, 2020). A key component of the IMF is a Foundation Data Model (FDM), built upon a top-level ontology (TLO), as a basis for ensuring consistent data across the NDT. This document captures the results collected from a broad survey of top-level ontologies, conducted by the IMF technical team. It focuses on the core ontological choices made in their foundations and the pragmatic engineering consequences these have on how the ontologies can be applied and further scaled. This document will provide the basis for discussions on a suitable TLO for the FDM. It is also expected that these top-level ontologies will provide a resource whose components can be harvested and adapted for inclusion in the FDM

Is a combination of varenicline and nicotine patch more effective in helping smokers quit than varenicline alone? A randomised controlled trial

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Germline MBD4 deficiency causes a multi-tumor predisposition syndrome

We report an autosomal recessive, multi-organ tumor predisposition syndrome, caused by bi-allelic loss-of-function germline variants in the base excision repair (BER) gene MBD4. We identified five individuals with bi-allelic MBD4 variants within four families and these individuals had a personal and/or family history of adenomatous colorectal polyposis, acute myeloid leukemia, and uveal melanoma. MBD4 encodes a glycosylase involved in repair of G:T mismatches resulting from deamination of 5'-methylcytosine. The colorectal adenomas from MBD4-deficient individuals showed a mutator phenotype attributable to mutational signature SBS1, consistent with the function of MBD4. MBD4-deficient polyps harbored somatic mutations in similar driver genes to sporadic colorectal tumors, although AMER1 mutations were more common and KRAS mutations less frequent. Our findings expand the role of BER deficiencies in tumor predisposition. Inclusion of MBD4 in genetic testing for polyposis and multi-tumor phenotypes is warranted to improve disease management. Keywords: 5′-methylcytosine deamination; colorectal cancer; mutational signature; mutator phenotype; polyposi

Contribution of Sex-linked Biology and Gender Roles to Disparities with Trachoma1

Gender roles, rather than biology, dictate why trachoma is more common in women

A COMPARISION BETWEEN STATIC AND DYNAMIC FOOT MOBILITY MAGNITUDE MEASURES

Traditional methods used to assess foot posture during dynamic activities rely on static measures of foot dimensions during partial weight bearing. In recent years, evidence was found which links musculoskeletal and overuse injury patterns in athletes to foot posture. To be able to accurately assess the relationship between injury patterns and foot posture, it might be necessary to study changes in the foot posture during the dynamic activities that the athlete normally undertakes. The purpose of this research is to introduce a method which can be used to measure changes in the foot posture during dynamic activities, hence providing a better prediction of the changes in the foot posture and its relationship to lower limb injuries. The results from static and dynamic Foot posture measures were compared for two subjects and the results showed significant differences

A comparison between static and dynamic foot mobility magnitude measures

Traditional methods used to assess foot posture during dynamic activities rely on static measures of foot dimensions during partial weight bearing. In recent years, evidence was found which links musculoskeletal and overuse injury patterns in athletes to foot posture. To be able to accurately assess the relationship between injury patterns and foot posture, it might be necessary to study changes in the foot posture during the dynamic activities that the athlete normally undertakes. The purpose of this research is to introduce a method which can be used to measure changes in the foot posture during dynamic activities, hence providing a better prediction of the changes in the foot posture and its relationship to lower limb injuries. The results from static and dynamic foot posture measures were compared for two subjects and the results showed significant differences

A business model perspective for ICTs in public engagement

This is the post-print version of the Article. The official published article can be accessed from the link below - Copyright @ 2012 ElsevierPublic institutions, in their efforts to promote meaningful citizen engagement, are increasingly looking at the democratic potential of Information and Communication Technologies (ICTs). Previous studies suggest that such initiatives seem to be impeded by socio-technical integration barriers such as low sustainability, poor citizen acceptance, coordination difficulties, lack of understanding and failure to assess their impact. Motivated by these shortcomings, the paper develops and applies a business model perspective as an interceding framework for analysis and evaluation. The underlying principle behind this approach is that it is not technology per se which determines success, but rather the way in which the businessmodel of the technological artifact is configured and employed to achieve the strategic goals. The business model perspective is empirically demonstrated with the case of an online petitioning system implemented by a UK local authority. The case illustrates the importance of considering ICTs in public engagement from a holistic view to make them more manageable and assessable