Evaluation of the first 5 years of the Next Generation GP leadership programme:balancing autonomy and accountability

Background: In 2017, a group of trainee general practitioners (GPs) came together to design and deliver a six-session leadership development programme for their peer trainee and early career GPs: the Next Generation GP programme. Over 2500 GPs took part in Next Generation GP between 2017 and 2022.Aim: To evaluate the origins and development of the Next Generation GP programme, its early impact on individuals and general practice, and what it reveals about GPs’ needs for career and leadership development at a time of major workforce and demand pressures.Methods: A rapid review of evidence on general practice workforce and career trends informed the design of qualitative research interviews (n=28) with a purposive sample of programme participants, primary care leaders and educational experts. This was supplemented by analysis of secondary data from participant evaluations of programme workshops.Results: Many programme participants reported: improved competence in leadership skills, increased understanding of the health system, having new support networks and more energy for their GP role. Respondents pointed out the strengths of the programme, also highlighting ways in which it could be adapted to enable a transition to a more sustainable position within broader clinical and leadership career development.Conclusions: Next Generation GP has to date largely fulfilled its programme objectives. It now needs more tangible, longer-term objectives against which to assess outcomes. This evaluation has contributed to evidence about primary care leadership needing more policy attention, for the balance of autonomy and accountability within GP leadership needs careful and sustained support

Nineteenth-century Ship-based Catches of Gray Whales, Eschrichtius robustus, in the Eastern North Pacific

The 19th century commercial ship-based fishery for gray whales, Eschrichtius robustus, in the eastern North Pacific began in 1846 and continued until the mid 1870’s in southern areas and the 1880’s in the north. Henderson identified three periods in the southern part of the fishery: Initial, 1846–1854; Bonanza, 1855–1865; and Declining, 1866–1874. The largest catches were made by “lagoon whaling” in or immediately outside the whale population’s main wintering areas in Mexico—Magdalena Bay, Scammon’s Lagoon, and San Ignacio Lagoon. Large catches were also made by “coastal” or “alongshore” whaling where the whalers attacked animals as they migrated along the coast. Gray whales were also hunted to a limited extent on their feeding grounds in the Bering and Chukchi Seas in summer. Using all available sources, we identified 657 visits by whaling vessels to the Mexican whaling grounds during the gray whale breeding and calving seasons between 1846 and 1874. We then estimated the total number of such visits in which the whalers engaged in gray whaling. We also read logbooks from a sample of known visits to estimate catch per visit and the rate at which struck animals were lost. This resulted in an overall estimate of 5,269 gray whales (SE = 223.4) landed by the ship-based fleet (including both American and foreign vessels) in the Mexican whaling grounds from 1846 to 1874. Our “best” estimate of the number of gray whales removed from the eastern North Pacific (i.e. catch plus hunting loss) lies somewhere between 6,124 and 8,021, depending on assumptions about survival of struck-but-lost whales. Our estimates can be compared to those by Henderson (1984), who estimated that 5,542–5,507 gray whales were secured and processed by ship-based whalers between 1846 and 1874; Scammon (1874), who believed the total kill over the same period (of eastern gray whales by all whalers in all areas) did not exceed 10,800; and Best (1987), who estimated the total landed catch of gray whales (eastern and western) by American ship-based whalers at 2,665 or 3,013 (method-dependent) from 1850 to 1879. Our new estimates are not high enough to resolve apparent inconsistencies between the catch history and estimates of historical abundance based on genetic variability. We suggest several lines of further research that may help resolve these inconsistencies

Local cytokine transcription in naïve and previously infected sheep and lambs following challenge with Teladorsagia circumcincta

<b>Background</b><p></p> The abomasal helminth Teladorsagia circumcincta is one of the most economically important parasites affecting sheep in temperate regions. Infection is particularly detrimental to lambs, in which it can cause pronounced morbidity and severe production losses. Due to the spreading resistance of this parasite to all classes of anthelmintic drugs, teladorsagiosis is having an increasingly severe impact on the sheep industry with significant implications for sheep welfare. Protective immunity develops slowly, wanes rapidly and does not appear to be as effective in young lambs. To investigate the development of immunity to T. circumcincta in sheep and lambs, we used cytokine transcript profiling to examine differences in the abomasal mucosa and gastric lymph node of naïve and previously infected sheep and lambs following challenge.<p></p> <b>Results</b><p></p> The results of these experiments demonstrated that the abomasal mucosa is a major source of cytokines during abomasal helminth infection. A local Th2-type cytokine response was observed in the abomasal mucosa and gastric lymph node of the previously infected sheep and lambs when compared with those of the naïve during the early stages of infection. In contrast, a pro-inflammatory component more was evident in the abomasal mucosa and gastric lymph node of the naïve sheep when compared with those of the previously infected, which was not observed in the lambs.<p></p> <b>Conclusions</b><p></p> The greater levels of Th2-type cytokine transcripts in both the abomasum and gastric lymph node of the previously infected compared with naïve sheep and lambs emphasises the importance of these mechanisms in the immune response to T. circumcincta infection. Younger lambs appear to be able to generate similar Th2-type responses in the abomasum suggesting that the increased morbidity and apparent lack of resistance in younger lambs following continuous or repeated exposure to T. circumcincta is unlikely to be due to a lack of appropriate Th2-type cytokine production

DNA and pacific commensal models : applications, construction, limitations, and future prospects

Components of the Pacific transported landscape have been used as proxies to trace the prehistoric movement of humans across the Pacific for almost two decades. Analyses of archaeological remains and DNA sequences of plants, animals, and microorganisms moved by or with humans have contributed to understanding prehistoric migration, trade, exchange, and sometimes revealed the geographic origins of particular plants and animals. This paper presents the basic elements of a DNA-based commensal model and discusses the phylogenetic and population genetic approaches these models employ. A clear delineation of the underlying assumptions of these models and the background information required to construct them have yet to appear in the literature. This not only provides a framework with which to construct a commensal model but also highlights gaps in current knowledge. The ways in which commensal models have enriched archaeological reconstructions will be highlighted, as will their current limitations. With these limitations in mind, options will be outlined for augmenting commensal models through the application of established techniques and new technologies in order to provide the best tools for reconstructing ancient human mobility and behavior in the Pacific and beyond

Effect of adenosine on insulin activation of rat adipocyte pyruvate dehydrogenase

AbstractAdenosine and its analogue N6-phenylisopropyladenosine stimulated pyruvate dehydrogenase activity of isolated rat adipocytes. Maximal stimulation was obtained with concentrations between 50 and 100 μM, with the effect decreasing at higher concentrations. The effects of insulin on this enzyme was modified by adenosine. The concentration of insulin (10 μunitsml) that produced almost half-maximal stimulation, had little or no effect, when adenosine deaminase was present. Adenosine also enhanced the effect of suboptimal but not optimal concentrations of insulin. Thus, the mechanism of adenosine action on adipocyte pyruvate dehydrogenase could in some way be similar or related to that of insulin

Adenosine and oxytocin reverse antagonism of cyclic AMP elevating agents to insulin activation of adipocyte pyruvate dehydrogenase

AbstractACTH, isoprenaline, forskolin, and dibutyryl cyclic AMP prevented insulin from stimulating adipocyte pyruvate dehydrogenase in the presence of adenosine deaminase. Antagonism was reversed by N6-phenyliso-propyladenosine as well as oxytocin. The stimulatory effects of insulin, adenosine and oxytocin on adipocyte pyruvate dehydrogenase appear to be through (a) mechanism(s) which is (are) similar or related

Analysis of Nurse and Patient Preferences for Pre-Filled Pen Devices for Self-Injection of Highly Purified Human Menopausal Gonadotropin (HP-hMG, MENOPUR®)

PURPOSE: This study aimed to identify the most important attributes for a gonadotropin pen as perceived by assisted reproductive technology (ART) patients and fertility nurses, and to examine how well a prototype HP-hMG (MENOPUR PATIENTS AND METHODS: This market research study incorporated a two-part survey with respondents (N=221) from Poland, Spain and the UK. Respondents included patients (n=141) who consulted a fertility specialist in the previous 2 years, and fertility nurses (n=80) who assisted in at least 75 ART cycles/year. Patients were divided into two subgroups depending on their experience with ART (experienced and naïve). Key attributes for an injection pen, as perceived by patients and nurses, were assessed via an online survey and ranked by their relative importance using Anchored Maximum Difference Scaling. After performing a dummy injection, respondents compared the attributes of an unbranded prototype pen against the key attributes identified. RESULTS: Across all survey respondents, the ability to correct the dialed dose was considered to be the most important product attribute of a gonadotropin pen. Confidence in the patient\u27s ability to inject correctly at home was also identified as a key attribute, considered by both nurses and naïve patients as extremely high. When considering the prototype pen device, almost all study respondents reported a positive experience (99%) with 72% rating it as very good . The prototype pen was perceived to possess the key attributes considered important for a gonadotropin pen by patients and nurses, including correcting the dose, the ability to self-inject safely and correctly, ease of preparation and use, and an injection which appeared to be as painless as possible. CONCLUSION: The prototype pen was found to perform well across all key attributes, especially those considered most important in gonadotropin pens, suggesting that it is a user-friendly option for patients undergoing ART

The development and evaluation of an emotional support algorithm for carers

Peer reviewedPostprin

Battered Non-Wives and Unequal Protection Order Coverage: A Call for Reform

Civil protection orders are effective, yet under-used weapons in the battle against domestic violence. In New York and in other states as well, civil orders of protection provide unique benefits and remedies to domestic violence victims that are in addition to, or that are in place of, the benefits the criminal system offers. They are under used in part because they are not available to all victims. In every state, the availability of civil protection orders is limited to those victims who are in certain defined relationships. While many states have expanded their definitions of the types of relationships that qualify for protection, too many states still deny protection to victims in dating relationships, cohabitation relationships, same-sex relationships, and other domestic relationships. New York limits access to its civil orders of protection to fewer types of victims than any other state. It finds the need for civil protection only where the definitions of “family offense,” a restricted list of crimes, and “family or household member,” a restricted list of persons, intersect. A historical explanation exists for this state of the law. The system was created in the 1960s by a legislature that was attempting to provide “practical help” to traditional families by taking cases out of criminal court and placing them in the exclusive jurisdiction of the family court. Its goal, above all, was to keep traditional families together. Civil orders of protection were invoked to serve that goal. Over time, though, a social shift in the perception of domestic violence occurred. As the focus moved from the goal of family cohesion to the goal of ending violence, the courts and the legislature attempted to strike a balance between the two competing interests. Ultimately, the legislature and the courts created, in what could perhaps be characterized as a historical accident, the dual inquiry, or “bifurcated” system that exists today. The role of protection orders also shifted from serving the goal of family cohesion to serving the goal of violence cessation. This shift in role, coupled with the parallel shift in the state’s interests, renders the historical rationales for maintaining this system meaningless. New York, as all other states, must reform its civil protection order statutes to capture all victims of domestic violence, and to include all crimes as bases for protection. To the extent the legislature can provide current rationales to maintain its differential treatment of domestic violence victims, it must at least provide rational reasons that bear some relation to the goals the civil order of protection statutes serve. It is not at all clear that the legislature can satisfy that burden here

Platelet microvesicles (microparticles) in cardiac surgery

SIGNIFICANT POSTOPERATIVE BLEEDING is a common risk of cardiac surgery, with approximately 3.5% of patients requiring surgical re-exploration.1 Re-exploration is associated with adverse outcomes, including infections, ischemia, and increased 30-day mortality.2 Similar adverse outcomes are related to erythrocyte transfusions associated with cardiac surgery,3 in addition to the immunologic and administrative hazards of transfusion.4 These risks are important because the majority of patients undergoing cardiac surgery receive a blood transfusion despite the lack of evidence to support liberal transfusion strategies.5 The frequency and significance of bleeding after cardiac surgery warrant investigation of the hematologic changes throughout the procedure. This review focuses on the (patho)physiology of platelet-derived microvesicles in the setting of cardiovascular surgery, a developing area in the understanding of the control of coagulation