Understanding the impact of professional motivation on the workforce crisis in medicine: a rapid review

Background: The NHS is facing a workforce crisis. Responses to date have focused on improving recruitment of staff, but less attention has been paid to retention. Aim: To conduct a rapid review using Rosabeth Moss Kanter's three Ms model of workforce motivation as a sensitising framework to examine the current medical workforce crisis. The work considers how insights from research in other professions offers new thinking for understanding what motivates doctors to continue working. Design & setting: Rapid literature review with secondary analysis of existing research examining reasons for leaving medicine. Method: A systematic search strategy was developed with the aid of an information specialist. The search terms used were: medical professionals, retention, and NHS. The exclusions were: commentaries, non-medical professionals, non-English language, and it was limited to post-1990. The search was applied to three electronic databases, MEDLINE, Embase, and Healthcare Management Information Consortium (HMIC). This produced a dataset describing study design, and factors related to motivation for leaving the medical profession. Comparative thematic analysis distilled core themes explaining the reasons for leaving and their relation to the three Ms model. Results: Of 3389 abstracts identified, screening and assessment produced 82 articles included in the final analysis. Thematic analysis identified four key themes: low morale, disconnect, unmanageable change, and lack of personal and professional support. The themes of mastery, membership, and meaning were substantially present within the dataset. Conclusion: Kanter's three Ms model of motivation can be applied to the medical workforce to understand retention issues. This work supports the development of targeted solutions to tackle the worsening workforce crisis

Nonapeptide influences on social behaviour: effects of vasotocin and isotocin on shoaling and interaction in zebrafish

Nonapeptides are important regulators of social behaviour across vertebrate taxa. While their role in simple grouping behaviour has been explored in estrildid finches, other taxa are understudied, prompting us to investigate nonapeptide influences on shoaling behaviour in zebrafish. Subjects received injections of isotocin, an isotocin antagonist, vasotocin, a vasotocin antagonist, or saline, followed by a test of grouping behaviour. Vasotocin decreased social interaction with the shoal. Unexpectedly, the vasotocin antagonist also reduced social interaction with the shoal, as well as general shoaling behaviour. Isotocin and its antagonist had minimal effects on grouping behaviours. These results suggest social interaction and shoaling are discrete aspects of sociality differentially influenced by vasotocin, although we cannot discount possible anxiogenic effects of vasotocin. Contrasting these results with studies in other systems demonstrates that each nonapeptide’s role in social behaviour varies across taxa, and cautions against a simplistic characterisation of nonapeptides as prosocial regulators of behaviour

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

A College Semester Abroad Study Program in Tanzania: Evaluation and Grading of Intercultural Competencies

This Capstone Paper attempted to answer the following question: how are the intercultural competencies as they are proposed in the WorldLearning, Inc./SIT Intercultural Competency Checklist at the present time evaluated in the College Semester Abroad (CSA), Tanzania Wildlife Ecology and Conservation program (Tze). The study includes a review of institutional documents and program guidelines as well as an overview of existing literature concerning Intercultural Competence and evaluation and assessment. Assessment instruments and interviews were used to gain insight into students’ learning outcome and processes of both academic and culture learning. For example, interviews with local program staff about students intercultural competence learning were conducted to provide input by host nationals. The study suggests that most of the proposed competencies on the Intercultural Competency Checklist are evaluated in the Tze program. However, the competencies are not stated as learning objectives and there are no evaluation criteria for them. Furthermore, the study raises the issue of what kind of qualification is needed to be able to evaluate the intercultural competencies. For example, are all Academic Directors equally well-qualified to evaluate cultural learning? Are the students able to evaluate themselves? Evaluation of the competencies is not recorded and made public, e.g. by being included into the final grade report each student receive. It was revealed that some discrepancies between evaluation guidelines as they stated in the Academic Director (AD) Handbook and practice exist, and that there is a lack of clear course evaluation criteria in the students’ syllabus and the AD Handbook. The study concludes that the CSA, Tze Program is presently, though not officially, evaluating the much-debated personal learning that is just one outcome of study abroad participation. However, it is questionable whether the evaluation is reliable and consistent. Finally, the Capstone Paper suggests several practical recommendations directed toward the CSA department, the Intercultural Communicative Competencies Task Force, and the Tanzania program itself

Vad menas med normkritik då? : En kvalitativ studie om pedagogers arbete med normkritisk pedagogik i förskolan.

Sammanfattning Barn vistas stora delar av sin vardag i förskolan, vilket gör att de pedagoger som arbetar i förskolan har stora möjligheter till att påverka barns framtida syn på samhällets normer. Denna studie syftar till att undersöka hur förskollärare och barnskötare arbetar med normkritisk pedagogik i förskolan samt om det finns skillnader i yrkeskategoriernas beskrivningar i deras arbetssätt utifrån ämnet. Vi anser att studien är av relevans, då vi ser en brist på kunskap om hur normkritisk pedagogik kan inkorporeras i förskolans utbildning. Studiens data samlades in genom kvalitativa intervjuer, där förskollärare och barnskötare som är verksamma i förskolan intervjuades. Empirin analyserades med hjälp av hermeneutisk metod med inslag av tematisk analys och bearbetades sedan med utgångspunkt från queerteorin samt tidigare forskning. Studiens resultat visar att både förskollärare och barnskötare arbetar med normkritisk pedagogik i förskolan, men att förskollärarna har en större medvetenhet om hur normkritik kan integreras i utbildningens undervisning, och visar därför på skillnader i förskollärarnas och barnskötarnas kunskaper om ämnet. Resultatet visar på att samtliga förskollärare och barnskötare menar att barn gör motstånd mot utbildningens och pedagogernas normer i förskolan. Dock finns, enligt vår tolkning, en skillnad i förskollärarnas och barnskötarnas beskrivningar om när det ses som acceptabelt att barn gör motstånd i förskolan. Vi tycker oss ändå, trots skillnader i förskollärarnas och barnskötarnas beskrivningar, se en viss kontinuitet i respondenternas förhållningssätt i deras bemötande gentemot barn och hur arbetet med normkritisk pedagogik kan utföras

Vad menas med normkritik då? : En kvalitativ studie om pedagogers arbete med normkritisk pedagogik i förskolan.

Sammanfattning Barn vistas stora delar av sin vardag i förskolan, vilket gör att de pedagoger som arbetar i förskolan har stora möjligheter till att påverka barns framtida syn på samhällets normer. Denna studie syftar till att undersöka hur förskollärare och barnskötare arbetar med normkritisk pedagogik i förskolan samt om det finns skillnader i yrkeskategoriernas beskrivningar i deras arbetssätt utifrån ämnet. Vi anser att studien är av relevans, då vi ser en brist på kunskap om hur normkritisk pedagogik kan inkorporeras i förskolans utbildning. Studiens data samlades in genom kvalitativa intervjuer, där förskollärare och barnskötare som är verksamma i förskolan intervjuades. Empirin analyserades med hjälp av hermeneutisk metod med inslag av tematisk analys och bearbetades sedan med utgångspunkt från queerteorin samt tidigare forskning. Studiens resultat visar att både förskollärare och barnskötare arbetar med normkritisk pedagogik i förskolan, men att förskollärarna har en större medvetenhet om hur normkritik kan integreras i utbildningens undervisning, och visar därför på skillnader i förskollärarnas och barnskötarnas kunskaper om ämnet. Resultatet visar på att samtliga förskollärare och barnskötare menar att barn gör motstånd mot utbildningens och pedagogernas normer i förskolan. Dock finns, enligt vår tolkning, en skillnad i förskollärarnas och barnskötarnas beskrivningar om när det ses som acceptabelt att barn gör motstånd i förskolan. Vi tycker oss ändå, trots skillnader i förskollärarnas och barnskötarnas beskrivningar, se en viss kontinuitet i respondenternas förhållningssätt i deras bemötande gentemot barn och hur arbetet med normkritisk pedagogik kan utföras

XPC–PARP complexes engage the chromatin remodeler ALC1 to catalyze global genome DNA damage repair

Cells employ global genome nucleotide excision repair (GGR) to eliminate a broad spectrum of DNA lesions, including those induced by UV light. The lesion-recognition factor XPC initiates repair of helix-destabilizing DNA lesions, but binds poorly to lesions such as CPDs that do not destabilize DNA. How difficult-to-repair lesions are detected in chromatin is unknown. Here, we identify the poly-(ADP-ribose) polymerases PARP1 and PARP2 as constitutive interactors of XPC. Their interaction results in the XPC-stimulated synthesis of poly-(ADP-ribose) (PAR) by PARP1 at UV lesions, which in turn enables the recruitment and activation of the PAR-regulated chromatin remodeler ALC1. PARP2, on the other hand, modulates the retention of ALC1 at DNA damage sites. Notably, ALC1 mediates chromatin expansion at UV-induced DNA lesions, leading to the timely clearing of CPD lesions. Thus, we reveal how chromatin containing difficult-to-repair DNA lesions is primed for repair, providing insight into mechanisms of chromatin plasticity during GGR.German Research Foundation 213249687 - SFB 1064, 325871075 - SFB 1309Dutch Cancer Society KWF-YIG 11367European Research Council 310913Netherlands Organization for Scientific Research 711.018.007Institute of Basic Science IBS-R022-A1Natural Sciences and Engineering Research Council of Canada RGPIN-2016-05868, RGPAS-492875-2016Israel Cancer Research Fund Research Career Development Award 3013004741Dutch Research Council ENW-M (OCENW.KLEIN.090), ALW.016.161.320, VI.C.182.052National Cancer Insitute P01- CA092584Israel Cancer Association 20210078Israel Science Foundation 1710/1

NSUN3 and ABH1 modify the wobble position of mt‐tRNA Met to expand codon recognition in mitochondrial translation

Mitochondrial gene expression uses a non-universal genetic code in mammals. Besides reading the conventional AUG codon, mitochondrial (mt-)tRNAMet mediates incorporation of methionine on AUA and AUU codons during translation initiation and on AUA codons during elongation. We show that the RNA methyltransferase NSUN3 localises to mitochondria and interacts with mttRNAMet to methylate cytosine 34 (C34) at the wobble position. NSUN3 specifically recognises the anticodon stem loop (ASL) of the tRNA, explaining why a mutation that compromises ASL basepairing leads to disease. We further identify ALKBH1/ABH1 as the dioxygenase responsible for oxidising m5C34 of mt-tRNAMet to generate an f5C34 modification. In vitro codon recognition studies with mitochondrial translation factors reveal preferential utilisation of m5C34 mt-tRNAMet in initiation. Depletion of either NSUN3 or ABH1 strongly affects mitochondrial translation in human cells, implying that modifications generated by both enzymes are necessary for mt-tRNAMet function. Together, our data reveal how modifications in mt-tRNAMet are generated by the sequential action of NSUN3 and ABH1, allowing the single mitochondrial tRNAMet to recognise the different codons encoding methionine.peerReviewe