'Discursive struggles' between criminal justice sanctions and health interventions for people who use drugs: a qualitative exploration of diversion policy and practice in Scotland

Amidst growing recognition that people who use drugs are often vulnerable and in need of health-focused support, international conventions and national priorities on personal drug use are changing with emphasis shifting from criminal justice to health narratives. In Scotland, there has been a move toward health-led drug policymaking, and yet little is known about how diversion operates in this context. An exploratory qualitative study was conducted utilizing semi-structured interviews with professionals holding lead, strategic-level roles in Scottish diversion policy and practice (n = 15). Interview transcripts were thematically analyzed using a structured framework technique. Findings show that the term ‘diversion’ is used to refer to criminal justice-initiated drug treatment routes, both pre- and post-conviction. Unlike many international examples, Scottish diversions tend to embed health-focused support within criminal sanctions, rather than acting as alternatives. Participants expressed the view that the term diversion implied a shift from criminal justice sanctions to health-led support that did not occur in reality. We, therefore, argue that the term diversion may function to mute a ‘discursive struggle’ between criminal justice sanctions and health interventions for people who use drugs, obscuring a growing gap between aspirational governance principles and institutional and lived realities

Lean towards learning: connecting Lean Thinking and human resource management in UK higher education

From its origins in the automotive industry, Lean Thinking is increasingly being seen as a solution to problems of efficiency and quality in other industries and sectors. In recent years attempts have been made to transfer Lean principles and practice to the higher education sector with indications of mixed consequences and debate over its suitability. This paper contributes to the debate by drawing evidence from thirty-four interviews conducted across two UK universities that have implemented Lean in some of their activities and we pay particular attention to the role of the HR function in facilitating its introduction. The findings suggest there are problems in understanding, communicating and transferring Lean Thinking in the higher education context; that, despite HR systems being vital facets of Lean, HR professionals are excluded from participation; and that as a consequence the depth and breadth of Lean application in the two institutions is very limited

Dickkopf-3 is upregulated in osteoarthritis and has a chondroprotective role

Objective Dickkopf-3 (Dkk3) is a non-canonical member of the Dkk family of Wnt antagonists and its upregulation has been reported in microarray analysis of cartilage from mouse models of osteoarthritis (OA). In this study we assessed Dkk3 expression in human OA cartilage to ascertain its potential role in chondrocyte signaling and cartilage maintenance. Methods Dkk3 expression was analysed in human adult OA cartilage and synovial tissues and during chondrogenesis of ATDC5 and human mesenchymal stem cells. The role of Dkk3 in cartilage maintenance was analysed by incubation of bovine and human cartilage explants with interleukin-1 (IL1) and oncostatin-M (OSM). Dkk3 expression was measured in cartilage following murine hip avulsion. Whether Dkk3 influenced Wnt, TGF and activin cell signaling was assessed in primary human chondrocytes and SW1353 chondrosarcoma cells using RT-qPCR and luminescence assays. Results Increased gene and protein levels of Dkk3 were detected in human OA cartilage, synovial tissue and synovial fluid. DKK3 expression was decreased during chondrogenesis of both ATDC5 cells and humans MSCs. Dkk3 inhibited IL1 and OSM-mediated proteoglycan loss from human and bovine cartilage explants and collagen loss from bovine cartilage explans. Cartilage DKK3 expression was decreased following hip avulsion injury. TGF signaling was enhanced by Dkk3 and Wnt3a and activin signaling were inhibited. Conclusions We provide evidence that Dkk3 is upregulated in OA and may have a protective effect on cartilage integrity by preventing proteoglycan loss and helping to restore OA-relevant signaling pathway activity. Targeting Dkk3 may be a novel approach in the treatment of OA

Interventions to improve healthcare workers’ hand hygiene compliance: a systematic review of systematic reviews

Objective: To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). Methods: PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. Results: Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. Conclusions: This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes

Factors Influencing Patient Satisfaction with Healthcare: The Patient\u27s Perception

The purpose of this descriptive study was to identify factors that perspective patients perceive as ones that influence their satisfaction with healthcare. A distinctive feature of the study was that it addressed factors that influence satisfaction with healthcare from the patient\u27s perception (emic perspective) rather than the provider\u27s (etic) assumptions

How the nursing associate role is viewed by different stakeholders: a qualitative research study

Background: The nursing associate role was created following a review by Health Education England in 2015 that examined nurse education and training so that capacity and improvements could be made to the provision of care in England. Objective: To explore different stakeholder perspectives of how the nursing associate role has been embedded within local healthcare practice. Design: The study was designed to explore and evaluate the role of the nursing associate in practice from the perspectives of those stakeholders who have experience of working with the nursing associate. Setting(s): Online semi-structured interviews. Participants: 9 stakeholder participants who had direct contact with the nursing associate or trainee nursing associate in the practice setting. Methods: A mixed-methods qualitative approach was used, which included a creative methodological approach in the form of photo-elicitation and semi-structured interviews to explore the lived experience of participants. Results: Analysis revealed 2 superordinate themes: (1) the contribution of the nursing associate; (2) real-work perspectives of the role. Conclusions: The findings demonstrated that the role was important to the provision of care, but that there were challenges related to communication, support and education provision throughout the organisations

Stress and Wellbeing during the COVID-19 Pandemic: A Mixed-Methods Exploration of Frontline Homelessness Services Staff Experiences in Scotland

Staff working in homelessness services often find the work rewarding yet challenging, and the sector experiences high levels of staff burnout and staff turnover. During the COVID-19 pandemic, staff working in these services faced particularly stressful working conditions. This study explored the experiences of stress and wellbeing among those working in frontline homelessness service roles during the early stages of the pandemic in Scotland. Semi-structured interviews were conducted with 18 participants, 11 of whom completed the Maslach Burnout Inventory (MBI). Qualitative data were analysed using Framework Analysis in NVivo, informed by the Revised Transactional Model of occupational stress and coping. MBI data were analysed using descriptive statistics. The COVID-19 pandemic positively and negatively impacted participants’ lives and roles. Organisational culture acted as a magnifying glass for pre-pandemic practices: for some, the pandemic brought teams and staff closer together, creating a better working environment. For others, it led to fragmentation and frustration. Participants discussed coping strategies and recommendations for the future to protect staff wellbeing. Quantitative data suggested that participants were not experiencing burnout, although some were at heightened risk. Future research should explore the longer-term impact of the pandemic on homelessness service staff outcomes

Metformin Improves Insulin Signaling in Obese Rats via Reduced IKK Action in a Fiber-Type Specific Manner

Metformin is a widely used insulin-sensitizing drug, though its mechanisms are not fully understood. Metformin has been shown to activate AMPK in skeletal muscle; however, its effects on the inhibitor of κB kinaseβ (IKKβ) in this same tissue are unknown. The aim of this study was to (1) determine the ability of metformin to attenuate IKKβ action, (2) determine whether changes in AMPK activity are associated with changes in IKKβ action in skeletal muscle, and (3) examine whether changes in AMPK and IKKβ function are consistent with improved insulin signaling. Lean and obese male Zuckers received either vehicle or metformin by oral gavage daily for four weeks (four groups of eight). Proteins were measured in white gastrocnemius (WG), red gastrocnemius (RG), and soleus. AMPK phosphorylation increased (P < .05) in WG in both lean (57%) and obese (106%), and this was supported by an increase in phospho-ACC in WG. Further, metformin increased IκBα levels in both WG (150%) and RG (67%) of obese rats, indicative of reduced IKKβ activity (P < .05), and was associated with reduced IRS1-pSer307 (30%) in the WG of obese rats (P < .02). From these data we conclude that metformin treatment appears to exert an inhibitory influence on skeletal muscle IKKβ activity, as evidenced by elevated IκBα levels and reduced IRS1-Ser307 phosphorylation in a fiber-type specific manner