Ethics, narratives and legitimacy in Defence acquisition

Purpose: This research examines the proposition that ethics in business functions as part of legitimising narratives, rather than as a normative framework to guide or assess behaviour. Methodology: The applied ethics context of the acquisition of UK military capabilities is employed as a case study to test the proposition. Adopting a critical realist paradigm, Bourdieu’s theory of practice is applied in two stages. Quantitative (survey) and qualitative (narrative interview) data are collected, from which a Weberian ideal type is developed via narrative analysis. Findings: The results reveal that the public/private sector interface should be understood as a Bourdieusian practice, in which people use narratives involving normative ethical claims as a means of delegitimising options that threaten their field positions and capital accumulations. It is argued that akrasia – acting against one’s best interests – can be explained in these terms, and that even if a normative ethics of Defence acquisition is one day possible, any theory of ethics should – for completion – attempt to take account of how ethics serves to support or delegitimise specific narratives in the business of acquisition. Research limitations/implications: The research builds on the literature on akrasia, suggesting that the options available to people in business are behaviourally as well as cognitively limited. Moreover, potential codes of ethics are overruled by symbolic power within a practice and hence have no effect. The research is not longitudinal and is limited to a case study that necessarily involved unrepresentative populations, although the methodology facilitates generalisation. Further work on public/private sector interfaces is needed to explore how other populations narrate challenges to convention. Originality/value: The research represents a novel application of Bourdieu’s theory of practice to the context of public/private sector integration and uniquely to Defence acquisition, disputing the viability and utility of codes of ethics as part of professionalising the acquisition function. It also offers a sociological explanation of akrasia

Evolution hesitancy: challenges and a way forward for teachers and teacher educators

BACKGROUND: It has long been acknowledged that evolution is a difficult topic for many students, partly because of the conceptual demands it makes, and partly because for some students an acceptance of evolution conflicts with their religious beliefs. The study we report on here was designed to see if there were additional reasons why evolution might be a difficult topic for certain students. RESULTS: Using in-depth, semi-structured interviews with seventeen adults studying for education qualifications, we show that evolution is a difficult topic for certain people because it can give rise to existential concerns. Thematic content analysis of interview transcripts revealed six themes associated with existential concerns: time, identity, death, responsibility/freedom, meaninglessness, and isolation. Analysis revealed that the topic of evolution frequently gave rise to feelings of disquiet. CONCLUSIONS: Because it concerns issues to do with death, extinction and change, evolution can be deeply unsettling for many people, even if they may have difficulty articulating why this is so. Teachers when they teach evolution therefore need to consider at least three overlapping constituencies who may find evolution difficult: those for whom it is cognitively challenging; those who reject aspects of evolution on religious grounds; and those who are uncomfortable with evolution for existential reasons. Teacher educators need to decide how best to prepare new teachers for these challenges. We argue that a pedagogy based on two approaches—treating evolution as a conceptually demanding topic and treating it as a sensitive issue—may provide a way forward

A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors

Background: To evaluate the effectiveness of interventions used in primary care to improve health literacy for change in smoking, nutrition, alcohol, physical activity and weight (SNAPW). Methods: A systematic review of intervention studies that included outcomes for health literacy and SNAPW behavioral risk behaviors implemented in primary care settings. We searched the Cochrane Library, Johanna Briggs Institute, Medline, Embase, CINAHL, Psychinfo, Web of Science, Scopus, APAIS, Australasian Medical Index, Google Scholar, Community of Science and four targeted journals (Patient Education and Counseling, Health Education and Behaviour, American Journal of Preventive Medicine and Preventive Medicine). Study inclusion criteria: Adults over 18 years; undertaken in a primary care setting within an Organisation for Economic Co-operation and Development (OECD) country; interventions with at least one measure of health literacy and promoting positive change in smoking, nutrition, alcohol, physical activity and/or weight; measure at least one outcome associated with health literacy and report a SNAPW outcome; and experimental and quasi-experimental studies, cohort, observational and controlled and non-controlled before and after studies. Papers were assessed and screened by two researchers (JT, AW) and uncertain or excluded studies were reviewed by a third researcher (MH). Data were extracted from the included studies by two researchers (JT, AW). Effectiveness studies were quality assessed. A typology of interventions was thematically derived from the studies by grouping the SNAPW interventions into six broad categories: individual motivational interviewing and counseling; group education; multiple interventions (combination of interventions); written materials; telephone coaching or counseling; and computer or web based interventions. Interventions were classified by intensity of contact with the subjects (High ≥ 8 points of contact/hours; Moderate \u3e3 and \u3c8; Low ≤ 3 points of contact hours) and setting (primary health, community or other). Studies were analyzed by intervention category and whether significant positive changes in SNAPW and health literacy outcomes were reported. Results: 52 studies were included. Many different intervention types and settings were associated with change in health literacy (73% of all studies) and change in SNAPW (75% of studies). More low intensity interventions reported significant positive outcomes for SNAPW (43% of studies) compared with high intensity interventions (33% of studies). More interventions in primary health care than the community were effective in supporting smoking cessation whereas the reverse was true for diet and physical activity interventions. Conclusion: Group and individual interventions of varying intensity in primary health care and community settings are useful in supporting sustained change in health literacy for change in behavioral risk factors. Certain aspects of risk behavior may be better handled in clinical settings while others more effectively in the community. Our findings have implications for the design of programs

Development and early Evaluation of a novel tool for assessment of individualised risk tolerance during surgical consent

PURPOSE: The legal interpretation of consent has transitioned over the last decade. Surgeons must identify what patients value to individualise surgical consent. This presents a considerable challenge during busy ward rounds or outpatient clinics. We aimed to develop and evaluate a novel risk tolerance tool to aid surgical consent. METHODS: This prospective, longitudinal cohort study evaluated the views of adult, elective surgical patients from a single centre. Attitudes to the existing surgical consent process were assessed (n = 48) and responses underwent thematic analysis. From these responses and a stakeholder focus group, a novel risk tolerance tool was developed. The risk tool was evaluated using questionnaires in 25 pre-operative patients. Post-operatively, the same cohort were followed-up with a telephone clinic 6–8 weeks after discharge. RESULTS: Overall patients were satisfied with the current consent process, but negative themes emerged including that it is generalised, impersonal, and time pressured. The developed risk tool contained six domains: death, pain, loss of physical function, loss of cognitive function, need for repeat medical interventions, and social disability. Loss of physical function (mean = 34.0, SD = 12.8) and loss of cognitive function (mean = 34.0, SD = 6.1) had lowest risk tolerance, and need for repeat medical interventions (mean = 18.8, SD = 10.9) had the highest risk tolerance. Thirteen (93%) patients had a positive experience of the consent process vs 85% of patients in pre-consent tool cohort. CONCLUSIONS: The tool demonstrated good patient acceptability and patient reported experience. The tool gathered data that may enhance understanding of patient risk tolerance and personalise the surgical consent process

Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England.

BACKGROUND: Vaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5-10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers. METHODS: We performed a multivariate regression analysis to estimate the burden of RSV in children younger than 5 years in England (UK), a representative high-income temperate country, and used these results to assess the potential effect of different RSV immunisation strategies (targeting vaccination for infants, or pregnant women, or prophylactic antibodies for neonates). We did a cost-effectiveness analysis for these strategies, implemented either separately or concurrently, and assessed the effect of restricting vaccination to certain months of the year. FINDINGS: We estimated that RSV is responsible for 12 primary care consultations (95% CI 11·9-12·1) and 0·9 admissions to hospital annually per 100 children younger than 5 years (95% CI 0·89-0·90), with the major burden occurring in infants younger than 6 months. The most cost-effective strategy was to selectively immunise all children born before the start of the RSV season (maximum price of £220 [95% uncertainty interval (UI) 208-232] per vaccine, for an incremental cost-effectiveness ratio of £20 000 per quality-adjusted life-year). The maximum price per fully protected person that should be paid for the infant, newborn, and maternal strategies without seasonal restrictions was £192 (95% UI 168-219), £81 (76-86), and £54 (51-57), respectively. INTERPRETATION: Nearly double the number of primary care consultations, and nearly five times the number of admissions to hospital occurred with RSV compared with influenza. RSV vaccine and antibody strategies are likely to be cost-effective if they can be priced below around £200 per fully protected person. A seasonal vaccination strategy is likely to provide the most direct benefits. Herd effects might render a year-round infant vaccination strategy more appealing, although it is currently unclear whether such a programme would induce herd effects. FUNDING: UK National Institute for Health Research

Improving pressure ulcer management in Australian nursing homes: results of the PRIME Trial organisational study

Pressure ulcers are a significant cause of morbidity and mortality in the aged care population with prevalence rates reported to be as high as 43% in some aged care facilities. The PRIME Trial was designed to investigate the effectiveness of an integrated pressure ulcer management system in reducing pressure ulcer prevalence and incidence in nursing homes. A total of 1956 residents from 23 nursing homes in NSW, Vic, SA and WA were enrolled in this Commonwealth funded study.This paper presents the results from phase 1 of the trial and indicates that the prevalence of pressure ulcers in the cohort of 1956 residents was 25.9%. Significant associations between the development of a pressure ulcer and comorbidity level (Charlson Index) (p=0.01), risk assessment level (Braden Scale) (p=0.00) and the lack of appropriate equipment (p=0.00) were detected. Residents who developed a pressure ulcer whilst in an acute hospital showed a trend to develop more than one ulcer and ulcers that were of higher severity than those developed in a nursing home.The results from phase 1 of the PRIME Trial suggest that emphasis needs to be given to appropriate risk assessment of the elderly nursing home resident that should include comorbitity status and the provision of suitable pressure relieving equipment

The glacial geomorphology of western Dronning Maud Land, Antarctica

Reconstructing the response of present-day ice sheets to past global climate change is important for constraining and refining the numerical models which forecast future contributions of these ice sheets to sea-level change. Mapping landforms is an essential step in reconstructing glacial histories. Here we present a new map of glacial landforms and deposits on nunataks in western Dronning Maud Land, Antarctica. Nunataks are mountains or ridges that currently protrude through the ice sheet and may provide evidence that they have been wholly or partly covered by ice, thus indicating a formerly more extensive (thicker) ice sheet. The map was produced through a combination of mapping from Worldview satellite imagery and ground validation. The sub-metre spatial resolution of the satellite imagery enabled mapping with unprecedented detail. Ten landform categories have been mapped, and the landform distributions provide evidence constraining spatial patterns of a previously thicker ice sheet

Improving Neurosurgery Education Using Social Media Case-Based Discussions: A Pilot Study.

BACKGROUND: The increasing shift toward a more generalized medical undergraduate curriculum has led to limited exposure to subspecialties, including neurosurgery. The lack of standardized teaching may result in insufficient coverage of core learning outcomes. Social media (SoMe) in medical education are becoming an increasingly accepted and popular way for students to meet learning objectives outside formal medical school teaching. We delivered a series of case-based discussions (CbDs) over SoMe to attempt to meet core learning needs in neurosurgery and determine whether SoMe-based CbDs were an acceptable method of education. METHODS: Twitter was used as a medium to host 9 CbDs pertaining to common neurosurgical conditions in practice. A sequence of informative and interactive tweets were formulated before live CbDs and tweeted in progressive order. Demographic data and participant feedback were collected. RESULTS: A total of 277 participants were recorded across 9 CbDs, with 654,584 impressions generated. Feedback responses were received from 135 participants (48.7%). Participants indicated an increase of 77% in their level of knowledge after participating. Of participants, 57% (n = 77) had previous CbD experience as part of traditional medical education, with 62% (n = 84) receiving a form of medical education previously through SoMe. All participants believed that the CbDs objectives were met and would attend future sessions. Of participants, 99% (n = 134) indicated that their expectations were met. CONCLUSIONS: SoMe has been shown to be a favorable and feasible medium to host live, text-based interactive CbDs. SoMe is a useful tool for teaching undergraduate neurosurgery and is easily translatable to all domains of medicine and surgery

High fidelity simulation of the endoscopic transsphenoidal approach: Validation of the UpSurgeOn TNS Box

Objective: Endoscopic endonasal transsphenoidal surgery is an established technique for the resection of sellar and suprasellar lesions. The approach is technically challenging and has a steep learning curve. Simulation is a growing training tool, allowing the acquisition of technical skills pre-clinically and potentially resulting in a shorter clinical learning curve. We sought validation of the UpSurgeOn Transsphenoidal (TNS) Box for the endoscopic endonasal transsphenoidal approach to the pituitary fossa./ Methods: Novice, intermediate and expert neurosurgeons were recruited from multiple centres. Participants were asked to perform a sphenoidotomy using the TNS model. Face and content validity were evaluated using a post-task questionnaire. Construct validity was assessed through post-hoc blinded scoring of operative videos using a Modified Objective Structured Assessment of Technical Skills (mOSAT) and a Task-Specific Technical Skill scoring system./ Results: Fifteen participants were recruited of which n = 10 (66.6%) were novices and n = 5 (33.3%) were intermediate and expert neurosurgeons. Three intermediate and experts (60%) agreed that the model was realistic. All intermediate and experts (n = 5) strongly agreed or agreed that the TNS model was useful for teaching the endonasal transsphenoidal approach to the pituitary fossa. The consensus-derived mOSAT score was 16/30 (IQR 14–16.75) for novices and 29/30 (IQR 27–29) for intermediate and experts (p < 0.001, Mann–Whitney U). The median Task-Specific Technical Skill score was 10/20 (IQR 8.25–13) for novices and 18/20 (IQR 17.75–19) for intermediate and experts (p < 0.001, Mann-Whitney U). Interrater reliability was 0.949 (CI 0.983–0.853) for OSATS and 0.945 (CI 0.981–0.842) for Task-Specific Technical Skills. Suggested improvements for the model included the addition of neuro-vascular anatomy and arachnoid mater to simulate bleeding vessels and CSF leak, respectively, as well as improvement in materials to reproduce the consistency closer to that of human tissue and bone./ Conclusion: The TNS Box simulation model has demonstrated face, content, and construct validity as a simulator for the endoscopic endonasal transsphenoidal approach. With the steep learning curve associated with endoscopic approaches, this simulation model has the potential as a valuable training tool in neurosurgery with further improvements including advancing simulation materials, dynamic models (e.g., with blood flow) and synergy with complementary technologies (e.g., artificial intelligence and augmented reality)