Supporting strategic cultural change: The Strathclyde learning technology initiative as a model

This paper describes the strategies being developed at the University of Strathclyde in response to the vision in the Dearing Report of a learning society in which Communication and Information Technology (C&IT) is central to students' learning experiences. The Strathclyde Learning Technology Initiative aims to support strategic change in the development and use of new learning technologies to improve the quality and efficiency of teaching and learning within the University. In order for a major cultural shift in teaching and learning to take effect there are three main areas that need to be addressed: (i) many academics still work within a traditional teaching framework and believe that these methods can simply be transferred to the Web, (ii) students who have been taught in a traditional teaching environment need support in acquiring new learning skills for an electronic learning environment, and (iii) new methods of learning and teaching can only be successfully integrated within the environment of a supporting infrastructure and institutional climate. These key elements are further explored, drawing on the lessons learned from the implementation of the Initiative, and suggestions are made for ways of surmounting the barriers to the uptake of C&IT perceived by academics

First-time mothers and their health visitors: perceptions of a home visit

This study explores the relationship between mother and health visitor through their perceptions of a home visit. The aims are to describe the interaction on a routine home visit, compare the perceptions of the participants, and explore their contrasting views. Through this exploration the worth of home visits is demonstrated.The theoretical framework was based in thnomethodology, and multiple methods of data collection provided complementary data.Fifteen volunteer health visitors carried out a routine home visit to three primiparous mothers, with babies aged 2 to 6 months. This visit was tape recorded. Both client and health visitor were interviewed by the researcher, and were asked to complete a short questionnaire after the visit.There was a similarity of views about the visit and their relationship. Both participants judged a successful visit in terms of the client's response and satisfaction. To the health visitors, a good relationship was not necessary to carry out their work. To the clients, however, a good relationship was of prime importance. A non-authoritarian approach was much preferred.The interaction revealed a number of verbal strategies whereby the participants guided the interaction. Satisfaction does not depend on having similar aims and priorities for the visit. The health visitors, while possessing more power than they think they halve, use many strategies to ensure acceptability.The home visit is demonstrated as an interaction of some complexity, providing boundless possibilities for the exchange of information, with the client very much an equal participant.The research ends with recommendations for management, education, and practice, one of which is the use of a health visitor / client contract, which might effectively explain the service offered, and assist in forming good relationships

Promoting Hospital Patients’ Health in Jordan: Rhetoric and Reality of Nurses’ Roles

Background: Hospital nurses are urged to promote patients’ health, but little is known about their role inhealth promotion in general and, specifically, no Jordanian study was found that examines such a role. Objective:this paper is a report of a study to understand and explore hospital nurses’ roles in heath promotion.Population: Surgical and medical nurses in a large Jordanian teaching hospital.Methods: A case study design using a multiple method triangulation strategy was used. Hospital nurses’ roles inhealth promotion were examined using focus group discussions, non-participant observations, interviews, semistructuredquestionnaires and documentary analysis.Results: Generally, hospital nurses’ views towards their role in health promotion were positive. However, theirperceived role and actual practice of health promotion were largely restricted to individualised informationgiving and behavioural change approaches. Diverse factors contributed to this situation. These included lack oftime, shortage of nursing staff, lack of knowledge in heath promotion, a power imbalance between doctors andnurses, low public image of nursing and gender issues related to nursing. The way hospital nurses’ role in healthpromotion is currently perceived and operationalised in practice in Jordan is inconsistent with recent healthpromotion ideas operating at the level of empowerment and political actions.Conclusion: Addressing the identified barriers therefore, together with a radical reform from curative servicestowards a health promoting health agenda, is crucial

HIV - health promotion and prevention

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A Randomized Greedy Algorithm for Near-Optimal Sensor Scheduling in Large-Scale Sensor Networks

We study the problem of scheduling sensors in a resource-constrained linear dynamical system, where the objective is to select a small subset of sensors from a large network to perform the state estimation task. We formulate this problem as the maximization of a monotone set function under a matroid constraint. We propose a randomized greedy algorithm that is significantly faster than state-of-the-art methods. By introducing the notion of curvature which quantifies how close a function is to being submodular, we analyze the performance of the proposed algorithm and find a bound on the expected mean square error (MSE) of the estimator that uses the selected sensors in terms of the optimal MSE. Moreover, we derive a probabilistic bound on the curvature for the scenario where{\color{black}{ the measurements are i.i.d. random vectors with bounded $\ell_2$ norm.}} Simulation results demonstrate efficacy of the randomized greedy algorithm in a comparison with greedy and semidefinite programming relaxation methods

Leadership in Community Nursing - Report of a study carried out by Queen Margaret University Edinburgh, NHS Lanarkshire and NHS Forth Valley

Study funded by Queens Nursing Institute ScotlandIn response to national and local agendas, both NHS Lanarkshire and NHS Forth Valley maintain a strong commitment to the development of those in clinical leadership positions. Queen Margaret University programmes in Nursing incorporate leadership as a core element in preparation for practice, and QMU have accredited NHS Lanarkshire's leadership educational programme for several years. This project emerged from that collaboration, from ideas about the nature of leadership and the recognition that few empirical studies exist in nursing in general, and fewer specifically in community nursing. The two data collection sites were not involved in pilot work of the Review of Nursing in the Community (SEHD 2006) although all staff were working in this context of policy drivers encouraging change (SE 2005a, SE 2005b, Pollock 2007, Kennedy et al 2009, RCN 2009a 2009b).sch_nurAntrobus S, Kitson A (1999) Nursing leadership: influencing and shaping health policy and nursing practice. Journal of Advanced Nursing 29 (3) 746 - 753 Boumans, N.P. & Landeweerd, J.A. (1993) Leadership in the Nursing Unit: Relationships with Nurses' Well-being. Journal of Advanced Nursing 18 pp.767-775. Bowles A, Bowles N B (2000) A comparative study of transformational leadership in nursing development units and conventional clinical settings. Journal of Nursing Management 8 69 - 76 Cain M (2005) Essential qualities of an effective clinical leader. Dimensions of Critical Care Nursing 24 (1) 32-4 Cook M J, Leathard H L (2004) Learning for clinical leadership. Journal of Nursing Management 12 436 - 444 Kennedy C., Christie J., Harbison J., Maxton F., Rutherford I. & Moss D. (2008), Establishing the contribution of nursing in the community to the health of the people of Scotland: integrative literature review. Journal of Advanced Nursing 64(5), 416-439 Kennedy C, Elliott L, Rush R, Hogg R, Cameron S, Currie M, Hall S, Miller M, Plunkett, S Lauder W (2009) Review of Community Nursing: baseline study. Available at: http://www.scotland.gov.uk/socialresearch McKenna H, Keeney S, Bradley M (2004) Nurse leadership within primary care: the perceptions of community nurse, GPs, policy makers and members of the public. Journal of Nursing Management 12 69 - 76 Morton J (1999) A model of leadership for community nurses. Journal of Community Nursing 13 (5) 8 - 11 Pollock L (2007) Responses to Visible, Accessible and Integrated Care - the Practitioners' Voice.- Edinburgh: QNIS. Ritchie, J and Spencer, L (1994), 'Qualitative data analysis for applied policy research', in Bryman and Burgess, eds., Analysing Qualitative Data, London: Routledge, p173-194. Royal College of Nursing (2009a) A Sustainable Future: the RCN Vision for Community Nursing in Scotland http://www.rcn.org.uk/__data/assets/pdf_file/0006/238092/RCN_vision_for_Community_Nursing_in_Scotland.pdf Royal College of Nursing (2009b) A Sustainable Future: Voices on a Vision http://www.rcn.org.uk/__data/assets/pdf_file/0015/238101/A_Sustainable_Future_Voices_on_a_Vision.pdf Scottish Executive (2005a) Building a health service fit for the future: a national framework for service change in the NHS in Scotland (The Kerr Report-) Edinburgh, Scottish Executive http://www.scotland.gov.uk/Resource/Doc/924/0012112.pdf Scottish Executive (2005b) Delivering for Health Edinburgh, Scottish Executive http://www.scotland.gov.uk/Publications/2005/11/02102635/26356 Scottish Executive Health Department (SEHD) (2006) Visible, accessible and integrated care. Report of the review of nursing in the community in Scotland. Edinburgh: HMSO Smith, M. A. (2004). Health visiting: the public health role. Journal of Advanced Nursing, 45 (1), pp.17-25. Stanley D (2006) Recognising and defining clinical nurse leaders. British Journal of Nursing 15 (2) 108 - 111 Thurtle, V., Saunders, M. and Clarridge, A. (2006). Advancing practice by developing a primary care nursing programme. British Journal of Community Nursing, 11 (4), pp.167-173. Tweddell L (2007) Health visiting faces fundamental change to cope with future need. Nursing Times 103 (26) 9 Wong CA, Cummings G G (2007) Relationship between nurse leadership and patient outcomes - a systematic review. Journal of Nursing Management. 15 (5) 508 - 521pub4561pu

Inflammatory profiles across the spectrum of disease reveal a distinct role for GM-CSF in severe COVID-19

While it is now widely accepted that host inflammatory responses contribute to lung injury, the pathways that drive severity and distinguish coronavirus disease 2019 (COVID-19) from other viral lung diseases remain poorly characterized. We analyzed plasma samples from 471 hospitalized patients recruited through the prospective multicenter ISARIC4C study and 39 outpatients with mild disease, enabling extensive characterization of responses across a full spectrum of COVID-19 severity. Progressive elevation of levels of numerous inflammatory cytokines and chemokines (including IL-6, CXCL10, and GM-CSF) were associated with severity and accompanied by elevated markers of endothelial injury and thrombosis. Principal component and network analyses demonstrated central roles for IL-6 and GM-CSF in COVID-19 pathogenesis. Comparing these profiles to archived samples from patients with fatal influenza, IL-6 was equally elevated in both conditions whereas GM-CSF was prominent only in COVID-19. These findings further identify the key inflammatory, thrombotic, and vascular factors that characterize and distinguish severe and fatal COVID-19

Genomic and molecular analyses identify molecular subtypes of pancreatic cancer recurrence

Pancreatic cancer (PC) remains a highly lethal malignancy, and most patients with localized disease that undergo surgical resection still succumb to recurrent disease. Pattern of recurrence after pancreatectomy is heterogenous, with some studies illustrating that site of recurrence can be associated with prognosis.1 Another study suggested that tumors that develop local and distant recurrence can be regarded as a homogenous disease with similar outcomes.2 Here we investigate novel molecular determinants of recurrence pattern after pancreatectomy for PC

Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial

Summary: Background: Functional motor disorder—the motor variant of functional neurological disorder—is a disabling condition that is commonly associated with poor health outcomes. Pathophysiological models have inspired new treatment approaches such as specialist physiotherapy, although evidence from large randomised controlled trials is absent. We aimed to assess the clinical effectiveness of a specialist physiotherapy intervention for functional motor disorder compared with treatment as usual. Methods: In this pragmatic, multicentre, phase 3 randomised controlled trial at 11 hospitals in England and Scotland, adults with a clinically definite diagnosis of functional motor disorder, diagnosed by a neurologist, were included. Participants were randomly assigned (1:1, stratified by site) using a remote web-based application to either specialist physiotherapy (a protocolised intervention of nine sessions plus follow-up) or treatment as usual (referral to local community neurological physiotherapy). Individuals working on data collection and analysis were masked to treatment allocation. The primary outcome was the physical functioning domain of the 36-item short form health questionnaire (SF36) at 12 months after randomisation. The primary analysis followed a modified intention-to-treat principle, using a complete case approach; participants who were unable to receive their randomised treatment due to the suspension of health-care services during the COVID-19 pandemic were excluded from the primary analysis. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN56136713, and is completed. Findings: Recruitment occurred between Oct 19, 2018, and March 11, 2020, pausing during the COVID-19 lockdown, and resuming from Aug 3, 2021, to Jan 31, 2022. Of 355 participants who were enrolled, 179 were randomly assigned to specialist physiotherapy and 176 to treatment as usual. 89 participants were excluded from the primary analysis due to COVID-19 interruption to treatment (27 were assigned to specialist physiotherapy and 62 to treatment as usual). After accounting for withdrawals (n=11) and loss to follow-up (n=14), the primary analysis included data from 241 participants (138 [91%] assigned specialist physiotherapy and 103 [90%] assigned treatment as usual). Physical functioning, as assessed by SF36, did not differ significantly between groups (adjusted mean difference 3·5, 95% CI –2·3 to 9·3; p=0·23). There were no serious adverse events related to the trial interventions. 35 serious adverse events were recorded in the specialist physiotherapy group by 24 participants (17·0%), and 24 serious adverse events were recorded in the treatment as usual group by 18 participants (17·0%); one death occurred in the specialist physiotherapy group (cause of death was recorded as suicide). All were considered unrelated to specialist physiotherapy. Interpretation: Although more participants who were assigned specialist physiotherapy self-rated their motor symptoms as improved and had better scores on subjective measures of mental health, the intervention did not result in better self-reported physical functioning at 12 months. Both the specialist and community neurological physiotherapy appeared to be a safe and a valued treatment for selected patients with functional motor disorder. Future research should continue to refine interventions for people with functional motor disorder and develop evidence-based methods to guide treatment triage decisions. Funding: National Institute for Health and Care Research and Health Technology Assessment Programme