An interpretive phenomenological analysis of interprofessional education; An investigation of the experiences of pre-registration healthcare students

This research study explores the way in which pre-registration healthcare students experience interprofessional education (IPE) using Interpretative Phenomenological Analysis (IPA). The research involved four pre-registration healthcare students at CCCU from two year groups who experienced IPE delivered in different ways. Two participants were midwifery students, one participant was an occupational therapy student and one was an adult nursing student. Semi-structured interviews were held to facilitate a guided conversation. Each participant was interviewed on two separate occasions eight months apart. Interviews were recorded and transcribed. Transcripts were analysed and emerging themes were identified and examined, with the researcher considering and reflecting on his own interpretation. New knowledge has emerged from this research with regard to the impact of how facilitators communicate with students during IPE, the extent to which IPE activities can impact on student’s self-awareness and the impact that race and diversity may have on the student experience of IPE. Findings from this study have also reinforced the findings of previous studies including how having contact with students and professionals from different groups positively affects how members of other professional groups may be perceived, can improve working relationships and that hierarchy exists both between professional groups and within professional groups. The recommendations from this research are considered to be of interest to both academic and clinical staff. Due to the idiographic nature of IPA, this research offered an insight into the local context and specific programmes. However, it is suggested that findings might be used to positively inform the development of IPE programmes and activities more broadly, as they highlight some of the issues associated with IPE that result in students having a positive, or conversely negative experience of IPE

"We are Dumbledore's Army:" Forging the Foundation For Future Upstanders

The profusion of human rights atrocities and purported incidents of genocide across the globe in recent decades has increasingly forced multiple and complicated issues associated with combating these violations onto the political agendas of world leaders and institutions. Scholars are united in recognizing the growing importance and need for critical instruction on the complex issues related to human rights and genocide studies to inspire high school students toward a global, democratic citizenship for the 21st century. Therefore, how do educators and student programs prepare students to critically examine these complex questions in a way that encourages global citizenship? This study, conducted during a two-week intensive summer institute on human rights and genocide studies in western New York state, assessed the ability of a human rights and genocide educational institute to foster higher levels of self-efficacy among the participating students and their ability to be "upstanders," rather than bystanders in their daily lives. We argue that the students felt empowered to pursue their short- and long-term goals regarding becoming human rights upstanders through the role models in their lives who influenced them to come to the Institute and the various experiences they had during the Institute’s workshops and field trips.

Emergence and structure of decentralised trade networks around dark web marketplaces

Dark web marketplaces (DWMs) are online platforms that facilitate illicit trade among millions of users generating billions of dollars in annual revenue. Recently, two interview-based studies have suggested that DWMs may also promote the emergence of direct user-to-user (U2U) trading relationships. Here, we carefully investigate and quantify the scale of U2U trading around DWMs by analysing 31 million Bitcoin transactions among users of 40 DWMs between June 2011 and Jan 2021. We find that half of the DWM users trade through U2U pairs generating a total trading volume greater than DWMs themselves. We then show that hundreds of thousands of DWM users form stable trading pairs that are persistent over time. Users in such stable pairs turn out to be the ones with the largest trading volume on DWMs. Then, we show that new U2U pairs often form while both users are active on the same DWM, suggesting the marketplace may serve as a catalyst for new direct trading relationships. Finally, we reveal that stable U2U pairs tend to survive DWM closures and that they were not affected by COVID-19, indicating that their trading activity is resilient to external shocks. Our work unveils sophisticated patterns of trade emerging in the dark web and highlights the importance of investigating user behaviour beyond the immediate buyer-seller network on a single marketplace

Spinoparabrachial projection neurons form distinct classes in the mouse dorsal horn

Projection neurons in the spinal dorsal horn relay sensory information to higher brain centres. The activation of these populations is shaped by afferent input from the periphery, descending input from the brain, and input from local interneuron circuits. Much of our recent understanding of dorsal horn circuitry comes from studies in transgenic mice; however, information on projection neurons is still based largely on studies in monkey, cat, and rat. We used viral labelling to identify and record from mouse parabrachial nucleus (PBN) projecting neurons located in the dorsal horn of spinal cord slices. Overall, mouse lamina I spinoparabrachial projection neurons (SPBNs) exhibit many electrophysiological and morphological features that overlap with rat. Unbiased cluster analysis distinguished 4 distinct subpopulations of lamina I SPBNs, based on their electrophysiological properties that may underlie different sensory signalling features in each group. We also provide novel information on SPBNs in the deeper lamina (III-V), which have not been previously studied by patch clamp analysis. These neurons exhibited higher action potential discharge frequencies and received weaker excitatory synaptic input than lamina I SPBNs, suggesting this deeper population produces different sensory codes destined for the PBN. Mouse SPBNs from both regions (laminae I and III-V) were often seen to give off local axon collaterals, and we provide neuroanatomical evidence they contribute to excitatory input to dorsal horn circuits. These data provide novel information to implicate excitatory input from parabrachial projection neuron in dorsal horn circuit activity during processing of nociceptive information, as well as defining deep dorsal horn projection neurons that provide an alternative route by which sensory information can reach the PBN

Diversity of inhibitory and excitatory parvalbumin interneuron circuits in the dorsal horn

Parvalbumin-expressing interneurons (PVINs) in the spinal dorsal horn are found primarily in laminae II inner and III. Inhibitory PVINs (iPVINs) play an important role in segregating innocuous tactile input from pain-processing circuits through presynaptic inhibition of myelinated low-threshold mechanoreceptors and postsynaptic inhibition of distinct spinal circuits. By comparison, relatively little is known of the role of excitatory PVINs (ePVINs) in sensory processing. Here we use neuroanatomical and optogenetic approaches to show that ePVINs comprise a larger proportion of the PVIN population than previously reported, and that both ePVIN and iPVIN populations form synaptic connections amongst (and between) themselves. We find that these cells contribute to neuronal networks that influence activity within several functionally distinct circuits, and that aberrant activity of ePVINs under pathological conditions is well placed to contribute to the development of mechanical hypersensitivity

Outcome of Occupational Latex Allergy—Work Ability and Quality of Life

OBJECTIVE: The quality of life (QOL) and work ability of health care workers allergic to natural rubber latex (NRL) were assessed after implementation of regulations on powder-free NRL gloves in Germany. METHODS: 196 HCW with reported NRL allergy answered a questionnaire (response rate 58%) containing the Work Ability Index (WAI), Mini Asthma Quality of Life Questionnaire (MiniAQLQ), and Dermatology Life Quality Index (DLQI). RESULTS: 63.2% still had NRL-related symptoms during the last 6 month. However on a scale from 0 to 10, the intensity of NRL-related symptoms decreased from 8.5 before to 2.3 after implementation of regulations on powder-free NRL gloves. A higher number of subjects were able to avoid NRL in the private than in the work environment (85% vs. 61%). NRL-related symptoms decreased and WAI increased with successful avoidance of NRL at workplace (b = 0.23, p = 0.003). QOL was only little affected by NRL allergy (mean: MiniAQLQ = 6.0; DLQI = 4.1). CONCLUSIONS: Although there was improvement after implementation of powder-free NRL gloves, there is still a considerable number of HCW with NRL-related symptoms. Further investigations on latex avoidance and the cause of persisiting allergic symptoms in HCW with NRL allergy are therefore needed

Calretinin-expressing islet cells are a source of pre- and post-synaptic inhibition of non-peptidergic nociceptor input to the mouse spinal cord

Unmyelinated non-peptidergic nociceptors (NP afferents) arborise in lamina II of the spinal cord and receive GABAergic axoaxonic synapses, which mediate presynaptic inhibition. However, until now the source of this axoaxonic synaptic input was not known. Here we provide evidence that it originates from a population of inhibitory calretinin-expressing interneurons (iCRs), which correspond to lamina II islet cells. The NP afferents can be assigned to 3 functionally distinct classes (NP1–3). NP1 afferents have been implicated in pathological pain states, while NP2 and NP3 afferents also function as pruritoceptors. Our findings suggest that all 3 of these afferent types innervate iCRs and receive axoaxonic synapses from them, providing feedback inhibition of NP input. The iCRs also form axodendritic synapses, and their targets include cells that are themselves innervated by the NP afferents, thus allowing for feedforward inhibition. The iCRs are therefore ideally placed to control the input from non-peptidergic nociceptors and pruritoceptors to other dorsal horn neurons, and thus represent a potential therapeutic target for the treatment of chronic pain and itch

Brucellosis in Sub-Saharan Africa:Current challenges for management, diagnosis and control

Brucellosis is a highly contagious zoonosis caused by bacteria of the genus Brucella and affecting domestic and wild mammals. In this paper, the bacteriological and serological evidence of brucellosis in Sub-Saharan Africa (SSA) and its epidemiological characteristics are discussed. The tools available for the diagnosis and treatment of human brucellosis and for the diagnosis and control of animal brucellosis and their applicability in the context of SSA are presented and gaps identified. These gaps concern mostly the need for simpler and more affordable antimicrobial treatments against human brucellosis, the development of a B. melitensis vaccine that could circumvent the drawbacks of the currently available Rev 1 vaccine, and the investigation of serological diagnostic tests for camel brucellosis and wildlife. Strategies for the implementation of animal vaccination are also discussed.Publishe

From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment