Evaluation (and related activities) of a NHS supported local delivery model for non-credit bearing Multi-professional Support for Learning and Assessment in Practice in Greater Manchester

Background: HEE North West (HEE NW) is currently piloting for 12 months a partnership of Trusts within Greater Manchester to deliver non-credit bearing Multi-Professional Support of Learning and Assessment in Practice (MSLAP) programme in NHS, private, voluntary and independent settings under an agreement with the University of Bolton (UoB). Health Education England North West (HEE NW) have commissioned an evaluation of the model by the University of Salford School of Nursing, Midwifery, Social Work & Social Sciences (NMSWSS) to compare this model to different national HEE mentorship training delivery models and policies

School Nurses' Role as Opinion Leaders Regarding the HPV Vaccine for Youth

The most common sexually transmitted infection for both males and females is the human papillomavirus (HPV). HPV is responsible for nearly all cervical cancers. Currently, an HPV vaccine is available; however, HPV vaccination rates for US adolescents are dismal. School nurses serve as the person connecting medical and school communities, and are a critical component in assisting families traverse the medical and educational systems. Thus, there is reason to assume school nurses can be key opinion leaders regarding the HPV vaccine. The purpose of this study was to: (1) explain how the Diffusion of Innovations (DOI) theory explains school nurses' roles as opinion leaders regarding the HPV vaccine; (2) document current literature regarding healthcare providers' perspectives and practice regarding the HPV vaccine; and (3) evaluate school nurses' knowledge, attitudes, perceptions of being an opinion leader and professional practice regarding the HPV vaccine for youth. DOI states opinion leaders influence the rate of an innovation (e.g., the HPV vaccine). We argue school nurses are opinion leaders for the HPV vaccine because of their unique leadership position through their cross-disciplinary understanding of the educational and health systems. The systematic literature review included 28 studies of healthcare providers. The main barrier, vaccine cost, was identified in 12 reports. Additionally, females and older adolescents were more frequently vaccinated than males and younger adolescents. To examine school nurses' knowledge, attitudes, perceptions and professional practice regarding the HPV vaccine, the study included a sample of 413 school nurses. Structural equation modeling revealed knowledge influenced attitudes, attitudes affected perceptions and professional practices, and perceptions predicted professional practice. Furthermore, the perceptions variable was found to be a partial mediator in the model. Practitioners designing programs to engage school nurses in disseminating HPV vaccine education may benefit from questioning whether their programs might be emphasizing non-crucial elements for influencing vaccine dissemination practice (e.g., knowledge) and de-emphasizing influential elements such as attitudes and perceptions

Reorganizing for Homeland Security: Does Centralization Improve Information-Sharing?

In the wake of the terror attacks of September 11, 2001, President George W. Bush signed into law the Homeland Security Act of 2002 (Public Law 107-296), which formally authorized the creation of the Department of Homeland Security (DHS). The Homeland Security Act of 2002 centralized twenty-two federal agencies with a diverse array of missions into a unified, integrated cabinet-level department. DHS was explicitly designed to rectify the conditions that enabled the September 11 terror attacks to take place. Thus, DHS’s centralized organizational structure was intended to facilitate information-sharing and coordination among the numerous government agencies with a stake in the homeland security mission. These structural reforms were based on the premise that a centralized bureaucratic model is more apt to foster inter-agency coordination than is a decentralized bureaucratic model. This paper examines the degree to which the creation of the Department of Homeland Security resolved the information-sharing challenges that ultimately resulted in the events of September 11. Chapter 1 evaluates the foremost theoretical perspectives on information-sharing to answer the following questions: What is information? What does information-sharing mean? How does information-sharing happen? How is information-sharing measured? Chapter 2 examines how bureaucracy contributes to, and at times exacerbates, the myriad factors that inhibit information-sharing efforts among Department of Homeland Security component agencies. Chapter 3 assesses DHS’s response to the terror attack in San Bernardino, California on December 2, 2015 as a case study to illustrate how the Department of Homeland Security’s centralized bureaucratic model enables and encourages its component agencies to pursue their parochial self-interests at the detriment of the Department’s overarching mission. All three chapters provide critical insight into the ways in which the Department of Homeland Security’s organizational structure institutionalizes interagency competition, thereby reinforcing factors that impede and discourage effective information-sharing. Self-interest ultimately, is what undercuts the unity of effort that the centralization of twenty-two disparate agencies was intended to foster. This paper concludes that structural reform alone is insufficient—the Department of Homeland Security must supplement its centralized organizational structure with an incentives system to promote effective, timely, and generous information-sharing among component agencies

Evaluation of a primary care triumvirate leadership development programme

This paper evaluates a primary care triumvirate leadership programme from the perspectives of key stakeholders (General Practitioners, General Practice Nurses, Practice Managers, programme and practice colleagues); and to provide evidencedinformed recommendations for future primary care triumvirate healthcare leadership development. Kirkpatrick's Four/Five Levels of Evaluation Model was used as the evaluation approach. Data was collected by the use of face to face and telephone focus group interviews. Thematic analysis was used to generate themes relating to the four levels of Kirkpatrick's model. Findings show how adopting a primary care triumvirate leadership approach offers a promising platform for operationalising the contemporary collective and distributed approaches to leadership development. Future programmes could benefit further by adopting a multi-dimensional leadership development model. This would expose the primary care triumvirate leader to the evidence based Six 'E's' approach to leadership development (evaluate, examine, exposure, education, environment, experience)

Reproductive outcomes following robotic myomectomy

Background: To assess pregnancy outcomes of patients following robotic myomectomy.Methods: Retrospective chart review was performed of 336 patients following robotic myomectomy at a university hospital from June 2006 to May 2013. Patients were called to obtain delivery outcomes.Results: Three hundred and thirty-six women had the following: mean age of 41.97 +/- 12.3 years (range 24-55), mean BMI of 24.6 +/- 4.96, mean of 3.37 +/- 3.1 fibroids removed (range 1-21), and mean weight of 352.28 +/- 339.56 grams of fibroids removed. Approximately 66.9% (N=250) provided pregnancy outcome data with 119 (47.6%) attempting pregnancy after surgery. Eighty-three (69.7%) achieved a total of 91 pregnancies. Less than half of these patients underwent cesarean section, and no cases of uterine rupture. Eighty-seven patients had known infertility pre-surgery; 22 underwent intrauterine insemination resulting in 12 pregnancies, and 34 underwent in vitro fertilization resulting in 25 pregnancies. A total of 53 (60.9%) of patients with infertility achieved 60 total pregnancies.Conclusions: The fertility rate after robotic myomectomy for patients attempting to conceive (69.7%) and for those with known infertility who continued to attempt pregnancy postoperatively (60.9%) were similar. There was a low incidence of complications associated with pregnancies conceived after robotic myomectomy

Associations Between Daily Wellness Behaviors and Outcomes among Medical Students

Objective: Explore which wellness behaviors have the greatest impact on wellbeing outcomes in medical students. Methods: A total of 213 medical students were enrolled in this study between June and September 2021. Participants completed a battery of online surveys, including demographic information, and 60-second nightly surveys on the WE-MD smartphone app, which assessed wellness-related indicators (exercise duration, sleep quality, nutrition quality, etc.) and wellbeing outcomes (mood, focus, stress, etc.). Results: 116 participants completed \u3e50% of nightly surveys between September 2021 and November 2021 and were included in the analysis. All wellness indicators were significantly associated with at least one wellness outcome. Quality of social interactions had the greatest relative positive association with wellbeing. Any amount of exercise, including 1-30 minutes, was significantly associated with improved wellbeing outcomes compared to no exercise. A lagged analysis separating indicators and outcomes by one day found wellbeing was only associated with limited sleep (\u3c 6 hours) and higher nutritional quality the day prior. Conclusion: This study provides substantial information on daily wellness behaviors and their relative impact on medical student wellbeing. Social interaction and exercise of any duration may be more important to wellbeing than previously recognized. Infrequently studied behaviors, including kindness, nutrition, and screen time, were also found to have significant associations with wellbeing. The numerous significant associations between behaviors and outcomes suggest a cumulative effect and point to the multifactorial nature of medical student wellbeing. This study may aid medical schools in developing high-impact initiatives and curricular changes that promote wellbeing for their students

Geometry of Schroedinger Space-Times II: Particle and Field Probes of the Causal Structure

We continue our study of the global properties of the z=2 Schroedinger space-time. In particular, we provide a codimension 2 isometric embedding which naturally gives rise to the previously introduced global coordinates. Furthermore, we study the causal structure by probing the space-time with point particles as well as with scalar fields. We show that, even though there is no global time function in the technical sense (Schroedinger space-time being non-distinguishing), the time coordinate of the global Schroedinger coordinate system is, in a precise way, the closest one can get to having such a time function. In spite of this and the corresponding strongly Galilean and almost pathological causal structure of this space-time, it is nevertheless possible to define a Hilbert space of normalisable scalar modes with a well-defined time-evolution. We also discuss how the Galilean causal structure is reflected and encoded in the scalar Wightman functions and the bulk-to-bulk propagator.Comment: 32 page

Phylogeography of Japanese encephalitis virus:genotype is associated with climate

The circulation of vector-borne zoonotic viruses is largely determined by the overlap in the geographical distributions of virus-competent vectors and reservoir hosts. What is less clear are the factors influencing the distribution of virus-specific lineages. Japanese encephalitis virus (JEV) is the most important etiologic agent of epidemic encephalitis worldwide, and is primarily maintained between vertebrate reservoir hosts (avian and swine) and culicine mosquitoes. There are five genotypes of JEV: GI-V. In recent years, GI has displaced GIII as the dominant JEV genotype and GV has re-emerged after almost 60 years of undetected virus circulation. JEV is found throughout most of Asia, extending from maritime Siberia in the north to Australia in the south, and as far as Pakistan to the west and Saipan to the east. Transmission of JEV in temperate zones is epidemic with the majority of cases occurring in summer months, while transmission in tropical zones is endemic and occurs year-round at lower rates. To test the hypothesis that viruses circulating in these two geographical zones are genetically distinct, we applied Bayesian phylogeographic, categorical data analysis and phylogeny-trait association test techniques to the largest JEV dataset compiled to date, representing the envelope (E) gene of 487 isolates collected from 12 countries over 75 years. We demonstrated that GIII and the recently emerged GI-b are temperate genotypes likely maintained year-round in northern latitudes, while GI-a and GII are tropical genotypes likely maintained primarily through mosquito-avian and mosquito-swine transmission cycles. This study represents a new paradigm directly linking viral molecular evolution and climate