The politics of health services research: health professionals as hired hands in a commissioned research project in England

Previous health services research has failed to account for the role played by clinical staff in the collection of data. In this paper we use the work of Roth on hired hand research to examine the politics of evidence production within health services research. Sociologies of work predict lack of engagement in the research tasks by subordinated groups of workers. We examine the role of midwives in researching ante-natal screening for sickle cell and thalassaemia in England, and construct three ideal types: repairers, refractors, and resisters to account for the variable engagement of health staff with research. We find some features of the hired hand phenomenon predicted by Roth to be in evidence, and suggest that the context of our project is similar to much health services research. We conclude that without concerted attempts (1) to change the social relations of research production; (2) to mitigate hired hand effects; (3) to assess the impact of the hired hand effect on the validity and reliability of findings, and (4) to report on these limitations, that health services research involving large teams of subordinated clinical staff as data collectors will be prone to produce evidence that is of limited trustworthiness. Keywords: evidence-based research; health services research; hired hands; politics of evidence; screening; midwives; research methodology; work and employment

Alterations in thoracolumbosacral movement when pain causing lameness has been improved by diagnostic analgesia

Lameness, thoracolumbosacral pain and reduced range of motion (ROM) often coexist; better understanding of their relationship is needed. The objectives were to determine if thoracolumbosacral movement of horses changes when pain causing lameness is improved by diagnostic analgesia. We hypothesised that reduction of lameness will increase ROM of the thoracolumbosacral region. Thirteen horses with different types of hind limb lameness were trotted in straight lines and lunged on a 10 m diameter circle on left and right reins before and after lameness was subjectively substantially improved by diagnostic analgesia. Inertial sensor data were collected from the withers, thirteenth (T13) and eighteenth thoracic (T18) vertebrae, third lumbar (13) vertebra, tubera sacrale (TS), left and right tubera coxae. ROM of flexion-extension, axial rotation, lateral bending, dorsoventral, lateral-lateral motion and vertical movement symmetry were quantified at each thoracolumbar site. Hiphike difference (HHD), maximum difference (MaxDiff) and minimum difference (MinDiff) for the pelvic sensors were measured. Percentage changes for before and after diagnostic analgesia were calculated; mean standard deviation (SD) or median [interquartile range] were determined. Associations between the change in pelvic versus thoracolumbar movement symmetry after each local analgesic technique were tested. After resolution of lameness, HHD decreased by 7% [68%] (P = 0.006). The MinDiff decreased significantly by 33%[61%] (P = 0.01), 45 +/- 13% (P = 0.005) and 52 +/- 23% (P = 0.04), for TS, L3 and T18, respectively. There was significantly increased ROM in flexion-extension at T13, in axial rotation at T13, T18, 13 and in lateral-lateral ROM at 13. Thoracolumbosacral asymmetry and reduced ROM associated with lameness were both altered immediately by improvement in lameness using diagnostic analgesia. (C) 2017 Elsevier Ltd. All rights reserved

Critical realism, agency and sickle cell: case studies of young people with sickle cell disorder at school

Critical realism suggests that historical structures may operate as underlying generative mechanisms but not always be activated. This explains the near-absence of references to racism by black students with sickle cell disorder (SCD). Through case studies we show how latent mechanisms are not activated, and how social actors come to develop corporate agency. Themes discussed include: wider/historical racisms (carers' own experiences of overt racism at school); conscious actions (moving away from a school where racism was experienced); naming racism as an emergent strategy (when communal discussions enable multiple negative experiences to be framed and named as racism); and `passing` (not ostensibly experiencing racism if one is sufficiently light-skinned). Critical realism suggests how racism may be structuring the experiences of students with SCD at school even in the absence of specific accounts by young people

Asymptotic Level Spacing of the Laguerre Ensemble: A Coulomb Fluid Approach

We determine the asymptotic level spacing distribution for the Laguerre Ensemble in a single scaled interval, $(0,s)$, containing no levels, E_{\bt}(0,s), via Dyson's Coulomb Fluid approach. For the $\alpha=0$ Unitary-Laguerre Ensemble, we recover the exact spacing distribution found by both Edelman and Forrester, while for $\alpha\neq 0$, the leading terms of $E_{2}(0,s)$, found by Tracy and Widom, are reproduced without the use of the Bessel kernel and the associated Painlev\'e transcendent. In the same approximation, the next leading term, due to a ``finite temperature'' perturbation (\bt\neq 2), is found.Comment: 10pp, LaTe

Student midwives' perspectives on the efficacy of feedback after objective structured clinical examination

Students’ experience of feedback is considered an indicator of the efficacy of the assessment process. Negative experiences of feedback are unproductive in terms of the likelihood that students will act upon and learn from assessment. To understand the impact of feedback on learning this study explored the experiences of student midwives after receiving feedback following Objective Structured Clinical Examination (OSCE). Data were collected from second year undergraduate student midwives who had recently completed OSCE, via a focus group. Students reported raised stress levels, concerns around legitimacy of feedback, and inconsistencies in the manner in which feedback was articulated. Assessment feedback in higher education should be used to empower students to become self-regulated learners. This is important for student midwives for whom a considerable amount of leaning is spent in practice. The study has implications for midwifery academics concerned with modes of assessment and quality of assessment feedback in midwifery education

Anthropic tuning of the weak scale and of m_u/m_d in two-Higgs-doublet models

It is shown that in a model in which up-type and down-type fermions acquire mass from different Higgs doublets, the anthropic tuning of the Higgs mass parameters can explain the fact that the observed masses of the $d$ and $u$ quarks are nearly the same with $d$ slightly heavier. If Yukawa couplings are assumed not to "scan" (vary among domains), this would also help explain why the t quark is much heavier than the b quark. It is also pointed out that the existence of dark matter invalidates some earlier anthropic arguments against the viability of domains where the Standard Model Higgs has positive $\mu^2$, but makes other even stronger arguments possible.Comment: 31 pages, 7 figure

Action research in physical education: focusing beyond myself through cooperative learning

This paper reports on the pedagogical changes that I experienced as a teacher engaged in an action research project in which I designed and implemented an indirect, developmentally appropriate and child‐centred approach to my teaching. There have been repeated calls to expunge – or at least rationalise – the use of traditional, teacher‐led practice in physical education. Yet despite the advocacy of many leading academics there is little evidence that such a change of approach is occurring. In my role as teacher‐as‐researcher I sought to implement a new pedagogical approach, in the form of cooperative learning, and bring about a positive change in the form of enhanced pupil learning. Data collection included a reflective journal, post‐teaching reflective analysis, pupil questionnaires, student interviews, document analysis, and non‐participant observations. The research team analysed the data using inductive analysis and constant comparison. Six themes emerged from the data: teaching and learning, reflections on cooperation, performance, time, teacher change, and social interaction. The paper argues that cooperative learning allowed me to place social and academic learning goals on an even footing, which in turn placed a focus on pupils’ understanding and improvement of skills in athletics alongside their interpersonal development

Conformational control of anticancer activity: the application of arene-linked dinuclear ruthenium(II) organometallics

Dinuclear metal complexes have emerged as a promising class of biologically active compounds which possess unique anticancer activity. Here, we describe a novel series of arene-linked dinuclear organometallic Ru(II) complexes, where the relative conformation of the ruthenium centres is controlled by the stereochemical configuration of 1,2-diphenylethylenediamine linker moieties, as confirmed by X-ray crystallography. The reactivity and cytotoxicity of these compounds is compared to flexible dinuclear and mononuclear analogues, demonstrating in all cases the complexes can undergo aquation, coordinate to typical biological donor ligands and importantly, in the case of dinuclear analogues, crosslink oligonucleotide and peptide sequences. Differences in the conformation of the isomeric dinuclear compounds lead to significantly different levels of cytotoxicity against A2780, A2780cisR and HEK-293 cell lines; isomers with a closed conformation are significantly more cytotoxic than isomers with a more open conformation and they are also significantly less susceptible to acquired resistance mechanisms operating in the A2780cisR cell line. These rigid dinuclear compounds possess markedly increased cytotoxicity relative to the non-cytotoxic mononuclear analogues that does not appear to be related to differences in complex lipophilicity or cellular uptake, which, in general, remain similar in magnitude across the series. Thus, the molecular conformation of such dinuclear species may be crucial in determining the nature of the adducts formed on coordination to biological targets in a cellular environment, and opens up a novel route toward the development of more active metal-based anticancer agents

Potential of cycloaddition reactions to generate cytotoxic metal drugs in vitro

Severe general toxicity issues blight many chemotherapeutics utilized in the treatment of cancers, resulting in the need for more selective drugs able to exert their biological activity at only the required location(s). Toward this aim, we report the development of an organometallic ruthenium compound, functionalized through a η6-bound arene ligand with a bicyclononyne derivative, able to participate in strain-promoted cycloaddition reactions with tetrazines. We show that combination of the ruthenium compound with a ditetrazine in biological media results in the in situ formation of a dinuclear molecule that is more cytotoxic toward cancer cells than the starting mononuclear ruthenium compound and tetrazine components. Such an approach may be extended to in vivo applications to construct a cytotoxic metallodrug at a tumor site, providing a novel approach toward the turn-on cytotoxicity of metallodrugs in the treatment of cancer