A qualitative study exploring senior nurses’ understanding of compassionate leadership in community healthcare

Background:Developing compassionate leadership is a priority since high profile failings in older people care have come to light. Little is known regarding how compassionate leadership is perceived in community healthcare organisations. Aim:The aim was to understand how leaders and senior staff within a Community NHS Trust perceive compassionate leadership and its importance. Method:This qualitative study employed semi-structured, audio-recorded interviews analysed using interpretative phenomenological analysis. Sample:Purposive sampling was used to recruit nursing leaders (n=11) within one Community NHS Trust. Findings:Leading and caring with compassion are particularly important in the community. Compassionate leadership involves role modelling, person-centred care and compassion towards staff not just patients. A concept of 'gritty compassion' was identified which could lead to a loss of compassion. Conclusion:Community organisations need compassionate leaders who lead with their heads and their hearts and ensure that patients, clients and families feel cared for not merely treated

Women, decision making and sustainability: Exploring the experience of the Badi Foundation in rural China

Beginning in 1994, international conventions such as the Convention on Biological Diversity have increasingly encouraged the use of collaborative processes at the local level to manage and protect community resources. Participation on the part of women in particular, in such decision making processes has been advanced and supported by the International Conference on Population and Development (1994), the Beijing Declaration and Platform for Action (1995), the World Summit on Sustainable Development (2002), and the 2005 World Summit. While such international conventions do not have binding legal effect, such instruments provide a moral force acknowledging the pivotal role women play in sustainable development and decision making at the grass roots. Such processes involve stakeholders from the public and private sectors who consult together in order to arrive at shared goals regarding resource use and planning. While much scholarship has focused on the requirements and parameters of such participatory decision making processes, little systematic attention has been given to the question of how capacities for genuine participation in local decision making, consultation and collaboration are developed, and the important role of scientific understanding and empowerment in this process. This paper will explore this question through a participatory research approach

Early biofilm and streamer formation is mediated by wall shear stress and surface wettability: A multifactorial microfluidic study

Biofilms are intricate communities of microorganisms encapsulated within a self-produced matrix of extra-polymeric substances (EPS), creating complex three-dimensional structures allowing for liquid and nutrient transport through them. These aggregations offer constituent microorganisms enhanced protection from environmental stimuli—like fluid flow—and are also associated with higher resistance to antimicrobial compounds, providing a persistent cause of concern in numerous sectors like the marine (biofouling and aquaculture), medical (infections and antimicrobial resistance), dentistry (plaque on teeth), food safety, as well as causing energy loss and corrosion. Recent studies have demonstrated that biofilms interact with microplastics, often influencing their pathway to higher trophic levels. Previous research has shown that initial bacterial attachment is affected by surface properties. Using a microfluidic flow cell, we have investigated the relationship between both wall shear stress (τw) and surface properties (surface wettability) upon biofilm formation of two species (Cobetia marina and Pseudomonas aeruginosa). We investigated biofilm development on low-density polyethylene (LDPE) membranes, Permanox® slides, and glass slides, using nucleic acid staining and end-point confocal laser scanning microscopy. The results show that flow conditions affect biomass, maximum thickness, and surface area of biofilms, with higher τw (5.6 Pa) resulting in thinner biofilms than lower τw (0.2 Pa). In addition, we observed differences in biofilm development across the surfaces tested, with LDPE typically demonstrating more overall biofilm in comparison to Permanox® and glass. Moreover, we demonstrate the formation of biofilm streamers under laminar flow conditions within straight micro-channels

Investigation of SLA4A3 as a candidate gene for human retinal disease.

SLC4A3 has been shown to cause retinal degeneration in a genetically engineered knockout mouse, and in a naturally occurring form of canine progressive retinal atrophy considered to be the equivalent of retinitis pigmentosa in humans (RP). This study was undertaken to investigate if SLC4A3 coding variants were implicated in human retinal degeneration. SLC4A3 exons were amplified and sequenced in 200 patients with autosomal recessive retinal degeneration who had no known molecular diagnosis for their condition, which included 197 unrelated individuals with suspected RP and three individuals with other forms of retinal disease. Three rare variants were identified that were predicted to be potentially pathogenic, however each variant was heterozygous in a single patient and therefore not considered disease-causing in isolation. Of these three variants, SNP-3 was the rarest, with an allele frequency of 7.06 x 10(-5) (>46,000 exomes from the ExAC database). In conclusion, no compound heterozygous or homozygous potentially pathogenic variants were identified that would account for recessive RP or retinal degeneration in this cohort, however the possibility remains that the rare variants identified could be acting with as yet undiscovered mutations in introns or regulatory regions. SLC4A3 remains an excellent candidate gene for human retinal degeneration, and with the advent of whole exome and whole genome sequencing of cohorts of molecularly unsolved patients with syndromic and non-syndromic forms of retinal degeneration, SLC4A3 may yet be implicated in human disease

CFD modelling of a pilot-scale counter-current spray drying tower for the manufacture of detergent powder

A steady-state, three-dimensional, multiphase CFD modelling of a pilot-plant counter-current spray drying tower is carried out to study the drying behavior of detergent slurry droplets. The software package ANSYS Fluent is employed to solve the heat, mass and momentum transfer between the hot gas and the polydispersed droplets/particles using the Eulerian-Lagrangian approach. The continuous phase turbulence is modelled using the differential Reynolds stress model. The drying kinetics is modelled using a single droplet drying model[1] which is incorporated into the CFD code using user-defined functions. Heat loss from the insulated tower wall to the surrounding is modelled by considering thermal resistances due to deposits on the inside surface, wall, insulation and outside convective film. For the particle-wall interaction, the restitution coefficient is specified as a constant value as well as a function of particle moisture content. It is found that the variation in the value of restitution coefficient with moisture causes significant changes in the velocity, temperature and moisture profiles of the gas as well as the particles. Overall, a reasonably good agreement is obtained between the measured and predicted powder temperature, moisture content and gas temperature at the bottom and top outlets of the tower; considering the complexity of the spray drying process, simplifying assumptions made in both the CFD and droplet drying models and the errors associated with the measurements

Early-Onset Progressive Degeneration of the Area Centralis in RPE65-Deficient Dogs.

PURPOSE: Retinal epithelium-specific protein 65 kDa (RPE65)-deficient dogs are a valuable large animal model species that have been used to refine gene augmentation therapy for Leber congenital amaurosis type-2 (LCA2). Previous studies have suggested that retinal degeneration in the dog model is slower than that observed in humans. However, the area centralis of the dog retina is a cone and rod photoreceptor rich region comparable to the human macula, and the effect of RPE65 deficiency specifically on this retinal region, important for high acuity vision, has not previously been reported. METHODS: Spectral-domain optical coherence tomography, fundus photography, and immunohistochemistry of retinal wholemounts and sagittal frozen sections were used to define the time-course and cell-types affected in degeneration of the area centralis in affected dogs. RESULTS: Area centralis photoreceptor degeneration was evident from 6 weeks of age, and progressed to involve the inner retina. Immunohistochemistry showed that RPE65-deficient dogs developed early loss of S-cone outer segments, with slower loss of L/M-cone outer segments and rods. CONCLUSIONS: Early-onset severe photoreceptor degeneration in the area centralis of dogs with RPE65-deficiency offers a model of the early foveal/perifoveal degeneration in some patients with LCA2. This model could be used to refine interventions aiming to improve function and halt the progression of foveal/perifoveal photoreceptor degeneration

Who Meets the Contraceptive Needs of Young Women in Sub-Saharan Africa?

PURPOSE: Despite efforts to expand contraceptive access for young people, few studies have considered where young women (age 15-24) in low- and middle-income countries obtain modern contraceptives and how the capacity and content of care of sources used compares with older users. METHODS: We examined the first source of respondents' current modern contraceptive method using the most recent Demographic and Health Survey since 2000 for 33 sub-Saharan African countries. We classified providers according to sector (public/private) and capacity to provide a range of short- and long-term methods (limited/comprehensive). We also compared the content of care obtained from different providers. RESULTS: Although the public and private sectors were both important sources of family planning (FP), young women (15-24) used more short-term methods obtained from limited-capacity, private providers, compared with older women. The use of long-term methods among young women was low, but among those users, more than 85% reported a public sector source. Older women (25+) were significantly more likely to utilize a comprehensive provider in either sector compared with younger women. Although FP users of all ages reported poor content of care across all providers, young women had even lower content of care. CONCLUSIONS: The results suggest that method and provider choice are strongly linked, and recent efforts to increase access to long-term methods among young women may be restricted by where they seek care. Interventions to increase adolescents' access to a range of FP methods and quality counseling should target providers frequently used by young people, including limited-capacity providers in the private sector

The Bregman chord divergence

Distances are fundamental primitives whose choice significantly impacts the performances of algorithms in machine learning and signal processing. However selecting the most appropriate distance for a given task is an endeavor. Instead of testing one by one the entries of an ever-expanding dictionary of {\em ad hoc} distances, one rather prefers to consider parametric classes of distances that are exhaustively characterized by axioms derived from first principles. Bregman divergences are such a class. However fine-tuning a Bregman divergence is delicate since it requires to smoothly adjust a functional generator. In this work, we propose an extension of Bregman divergences called the Bregman chord divergences. This new class of distances does not require gradient calculations, uses two scalar parameters that can be easily tailored in applications, and generalizes asymptotically Bregman divergences.Comment: 10 page

Monochorionic triamniotic triplet pregnancy with a co-triplet fetus discordant for congenital cystic adenomatoid malformation of the lung

BACKGROUND: Spontaneous monochorionic triamniotic pregnancy is rare and is at increased risk for pregnancy complications. The presence of an anomalous fetus further complicates the management. CASE PRESENTATION: We present a case of monochorionic triamniotic triplet pregnancy diagnosed at 15 weeks of gestation with one fetus having developed a multicystic lung lesion, suggestive of congenital cystic adenomatoid malformation (CCAM). At 24 weeks, the largest cyst measured 10 mm in diameter. We managed the pregnancy conservatively and delivered three live male fetuses with birth weights 1560 g, 1580 g and 1590 g at 35 weeks of gestation. Two newborns were admitted to the neonatal intensive care unit with respiratory distress, the third one died due to sepsis 7 days postpartum. One of the newborns was discharged healthy at 24 days postpartum. The newborn with CCAM developed a pneumothorax on the right side, recovered after treatment, and was discharged after one month. Computerized tomography (CT) of the infant at 3 months demonstrated two cystic lesions in the middle lobe of the right lung measuring 25 mm and 15 mm. A repeat CT of the infant at 6 months showed a 30 mm solitary cystic mass. CONCLUSION: Monochorionic triamniotic triplet pregnancy with a co-triplet fetus discordant for CCAM, present rarely and can be managed conservatively. These findings may help in decision making and counselling of parents